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HomeMy WebLinkAboutBuilding Permit #267-12 - 79 OLD VILLAGE LANE 9/28/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �� Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION { tae.. iiP^,_rint PROPERTY OWNER t �P Loyl b;n Unit# Print MAP NO:�gO PARCEL:0060 ZONING DISTRICT: Historic Districtyes o Machine Shop Village yes 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑ teration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other P_:...,...- • "'�-c � aw- =_r :'_G ��rSeptict (�Welk ° I f0 Floodplairii D�Wetlands, { t�1 WatersheclDistnct; '_` _: 3 . DESCRIP–TJO14 OF WORK TO BE PERFORMED: 5 luGf, J2� 3o *d F,,Z� s a XCa4 � � � � ���s' �yv4on t2xa,4� , _nSkIIAew ele-41 kewave,a"�rt�� Ident'ficatipn Please Type or Print Cleary) OWNER: Name: i 1KJ 01'''1 r gaL Phone: 4P 17��1� o�G Address: Q n ��� � � 10- +`2, CONTRACTOR Name: Phone: Address: 9 lei Supervisor's Construction License: 25—,719" Exp. Date: Home Improvement License: 170 OW Exp. Date: j ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ $ q 1FEE: _ Check No.: t I Receipt No.: (03 NOTE: Persons contracting with unregistered contractors do not have accts t the g ara fund .Signature-of`A`.gentlQwner 4`Signature of coritracto _ r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 1 HEALTH Reviewed on Siqnature COMMENTS I Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS i Dimension Number of Stories: ^Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA-- For department use Notified for pickup - Date DomBuilding Permit Revised 2011 June/mi I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i Addition or Decks i i ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (if Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application a Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products V®TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Permit In all cases if a variance or special permit was required the Town CIerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Doe.Building Permit Revised 2008mi ACC?R1:> CERTIFICATE OF LIABILITYINSURANCE DA'E` "`°°m"' 8/30/11 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO-RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAMCONT Eric Jansen Hasbany Insurance Agency PHONE (978) 685-3188 FAIC�AX No): (978) 685-9460 236 Pleasant Street AE DAREss: eric@hasbany.com Methuen, MA 01844 PRODUX 2520 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:CT — Western World Julien Dupont INSURERB:MA - W C - Travelers DBA Julien Dupont Construction INSURER C: 20 May Lane Drive INSURER D: Salem, NH 03079 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPEOFINSURANCE ADDLSUBR POLICY NUMBER PM�NEFF (MP UMTS GENERALLIABILITY EACH OCCURRENCE $ 1,000,000 A COMMERCIAL GENERAL LIABILITY NPP1167773 7/13/11 7/13/12 DAMAGE TO RENTED ce $ 50,000 CLAIMS4%ADE Fx—]OCCUR MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIESPER PRODUCTS-COMP/OPAGG $ 2,000.000 X POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (E a accident) ANYAUTO BODILY INJURY(Per person) $ ALL O WNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIREDAUTOS (Peraccident) NON-OWNED AUTOS $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESSLIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ B WORKERS COMPENSATION 9889M298 UB 8/20/11 8/20/12 %sTATU- X FIR 0TH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y� NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICERMIEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICYLIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Refferks Schedule,if more space is requi red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Eric Jansen ©1988 0 CORD CORPORATION. All rights reserved.. ACORD 25(2009/09) The AC ORD name and logo are registered marks ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Indivi dual): Lc�t�,, ��(k aAs -U Cj,[ Address: an � VP City/State/Zip: Phone#: a60 ff Arwtam an employer?Check the appropriate box: Type of project(required): 1. a employer with 5 4. ❑ I am a general contractor and I 6. New construction employees(full and/or part-time).* have hired the sub-contractors ❑ 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. t 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g. ❑Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.E]Electrical repairs or additions 3.E] I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: c// -V1hu0h6,e 415�4 Policy#or Self-ins.Lic.#: ,�/� � Expiration Date: T Z_ Job Site Address: 4v City/State/Zip (j/C LIV,� J Attach a copy of the workers' compens ion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify u er thtep, n n enalties of perjury that the information provided abOe is t ue and correct. Si nature: Date: Phone#: 6Y Offlcial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Massucbuxetts-Department of Public Web- : Bftrd of Building Regulations unit Standards •Donstruwtbn Supervisor License License: CS 78718 3t STEPHt�I�t•lA1�lE>R� _�... 9 DENI41►Q iR CIR BRADFORD;"6"U E:pbramm W24=2 Tires 1675 � gn.� o&e � � HOME IMPROVEMENT CONTRACTOR Registration: 170080 Type: Expiration: \ io a , andiv S EN LAN R � . | . t, . S E N LANDk /» !, e 9NE NWORTH BELUN — ! BRADFORD,MA 018 Undersecretary AORTH ® of : Andover . lit No. a &7 o , dover, Mass., • D - LAKE COCHICHEWICK AORATE D p`P5 SNook BOARD OF HEALTH P�ERMIT T U Food/Kitchen Septic System BUILDING INSPECTOR t THIS CERTIFIES THAT.................�.... ............... .. ..#.%o..6 .................. .................................. Foundation r has permission to erect....... iftbuildings on .....I: .......6.4......4.4, ....... Rough to be occupied as 1111Vmod Chimney provided that the person accept! this permit shall in every respect c*thenspection, o the terms of the application on file in Final' this office, and to the provisions of the Codes and By-Laws relating tAlteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS cow ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOC S TS Rough ................................................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. i I � I I Massachusetts Home Improvement Sample Contract This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners!ISeek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to,Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. . Homeowner Information Contractor Information Name Company Name I r 34,eA Street Address( o not use a Post 0 e x a res 04 Contractor/Salesperson Owner Name �? OC a km City/Town State ! Zip Code Bus' ess Addr s (must include a street address) Daytime Phone : arN �1a Yt Evening Phone City/Town �State Zip Coac Mailing Address(It different from above �3r Business Phone Federal Employer ID or S.S.Number ! Home Improvement Contractor Reg.Number Expiration date Lmv squires tont most home improvement contractors have I-100 ` a valid registration number i''1 O 0 I r7 The Contractor agrees to do the following work for the Homeowner: �}� ld 1' (Describe in detail the work to completed,1�oLk_% cifying the type,brand,and grade of materials o be used use ad tiona shee if ne essa V 511:,p 0A 3h' 6A* � ga.(cc.Gj e l g��e-&e W Rets d�� M K i tv a��`f�► i` Roi Loq*'S V�s I :i c���P �n �( vw- dyes 3 �-t�- Required Permits-The followinglb 'ding permits are required Proposed Start and Completion/Schedule-The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their 6Wn permits will be excluded from the Guaranty fund provisions of Z Date when contractor will begin contracted work MGL chapter 142A.) 0 Date when contracted work will be substantially completed. I Total Contract Price and Payment!Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum of: 00 (*) _7 Payments will be made according to the following schedule: 0 (� upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by / or upon completion of $ by / / i or upon completion of $. o upon completion of the contract. Q�i Q I (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule i(**) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of I(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty-Is an express warranty beiRg.Rrovided by the contractor? ❑No Yes all terms of thewarranty must be attached to the contract Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any thud party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this apreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lienor other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract! • Don't beressured into signing going the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has alvalid Home Im rovement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registeredl Mth the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,Boston,MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage,or ask to see a copy of a"proof of insurance"document. • Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contractor Law. ; i � You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business,provided you no the contractor in writing at his/her maim office or branch office by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the thud business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. DO NOT S16X, THIS CONTRACT]F THERE ARi+ y BLANK SPACES!!! Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be kept by the contractor. i ' I Homeowner's Signator j actor's ' e Date Date it Contractor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner by the Home Improvement Contractor Law. i The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firmk which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided In Massachusetts General Laws,chapter 142A. meownefs Signature 'tractor's Si e NOTICE:The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeowner's rights under the Home Improvement Contractor Law(MGL chapter 142A)and other consumer protection laws(i.e.MGL chapter 93A)may not be waived in any way, even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty Fund provisions of the Home Improvement Contractor.Law. The contractor is responsible for completing the iwork as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights, contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exlAits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void,deleted, or not applicable. One original signed copy of the con6a.ct with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of fiords not yet duel be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home Improvement)Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: � i Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza.,Room 5170,Boston,MA 02116 j 617-973-8787, 888-283-3757 or visit the OCABR website at http://www.mass.t ov/ocabr/ If you want to verify the registration of a contractor or if you have questions or need additi�nal information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 I 617-973-8787, 888-283-3757 or visit the HIC website at http://www.mass.zov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: I b=://db.state.ma.-Lis/hol-neimprovementilicenseelist.asp For assistance with informal mediation of disputes or to register formal complaints against a business,call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 j Version 2.1-11/22/2010 I ii Location's No. D®te CJI 1 NORTh TOWN OF NORTH ANDOVER F w 9 } ° ;+ Certificate of Occupancy $ Building /Frame ( t " /Frame Permit Fee $ saMusa Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check # 24666 Building Inspector