HomeMy WebLinkAboutBuilding Permit #650 - 796 WINTER STREET 4/27/201041
BUILDING PERMIT
OWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0:
Date Issued: {A
Date Received
IMPORTANT: Applicant must complete all items on this Daae
LOCATION3 U), T-cA S / /Q /1
42 E
Print
PROPERTY OWWER /vt A 4 � A 0 (? 0 o CN
Print
MAP 210 V PARCEL: ''ZONING DISTRICT: Historic District yes
Q510 2-0f) !Machine Shop Village yes
no
no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Others:
Repair, replacement
Assessory Bldg
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
Identification Please Type or Print Clearly)
OWNER: Name:_ My R oo c" Phone:
Address:37
CONTRACTOR Name: �= Phone: `l'�%.S ''%'w3/
Address: �3b Tc� 121-c 0/� l - -zh en rrm 143S O4 4C
Supervisor's Construction License: Exp. Date:
Home Improvement License: f C
Date:
ARCHITECT/ENGINEER Phone:
Address:
Reg. No.
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
O , O �.
Total Project Cost: $ • /� Ja FEE: $ ��
Check No.:':� Receipt No.:
NOTE: Persons contracting with un °egis red contractors do not have access to the guar my fund
Signature of Agent/Owner � ..._ Signature of contractor
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
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
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
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
Doc.Building Permit Revised 2010
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
Addition Or Decks
❑ 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
❑ Certified Proposed Plot Plan
❑ 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
NOTE: 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 Clerks 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: Building Permit Revised 2008
Location kK 4
No. 4�n Date
&ORTol TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
CH
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #C -3)(a
2 2 If 6 '71
LIr Building Inspector
Massachusetts Home Improvement Sample Contract
This form satisfies all basic requirements of the state's Home Improvement Contractor Law (MOL chapter 142A), but does not Include standard
language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of "a ,
Massachusetts consumer guide to (tome 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 617-973-8767 or 1=888-283-3757.
Homeowner Information Contractor Information
MA94 M O ( DOC44
suer
34S t..J 1'fJT-e—/( S J
ompany Name
l f cI /1
Street Address (do not use a Post Office Box address)
Contractor/ Salesperson/ Owner Name
�} l� 1441 A .S .S
J a t ,\
City/fovea State Zip Code
usmess Address (must include a street address)
3a TI�1J{t 109
Daytime Phone Evening Phone
.ityfrown State Zip Code
fpF*
a
Mailing Address (It different from above)
lusiness Phone 9 q2? Q1 S 9)-31 ederal Employer ID or S.S. Number
Law requires that most home hn- Nome improvement Contractor Reg. Number
prowmeot contractors have a
sad registration ourober
Expiration date
The Contractor agrees to do the following work for the Homeo
per:
mme worx to comilletMe me NUE-MMMMe
1
S71,�
Required Permits - The following building 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 own permits will be
excluded from the Guaranty Fund provisions of2 CID/ ` Date when contractor will begin contracted work.
MGL chapter 142A.)
Jj C- 2`1* Date when contracted wo will be substantially completed.
(2 Age a f
t otal r..:ontract race ano rayment scneowe 7 4 �O O C> (*)
The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of:
Payments will be made according to the following schedule:
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 /_/� or upon completion of
$ D J, o ® upon completion of the contract. (Law forbids demanding full payment until contract is completed to both patty's satisfaction)
The following material/equipment must be special S to be paid for
ordered before the contracted work - begins in order S 0 to be paid for
to meet the completion schedule.(**)
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 (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 Warrantv - Is an express warranty being Provided by the contractor? No Yes tall terms of the warrnnfv 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 third
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 agreement
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 lien or other security interest has been placed on the residence. Review the following cautions and notices
carefully before signing this contract.
• Don't be pressured into signing the contract Take time to read and fully understand it. Ask questions if something is unclear.
• Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor
registration by:writing to the Director at One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or
1-800-223-0933.
• Does the contractor have insurance? Check to see that your contractor is properly insured.
• Know your rights and responsibilities. Stead the important Information on the reverse side of this form and get a copy of the Consumer
Guide to the. Home Improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the
contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the
third business day following. the signing of this agreement. See the attached notice of cancellation form for an explanation of this right.
r1/1 11l _ nr—>,
LIFW 111W oivtt MO U A I KAIL114 I riEKE ARE ANY BLANK SPACESM
Two identical copies of the contract must be completed and signed One copy should go to the homeowner. The other '.y should be kept by the contractor.
Homeowner's
1Signature
Co ctor's Signature
Date Date �i
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.
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 firm 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.
Homeowner's Signature Contractor's Signature
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 varties.
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 work as described, in a
timely and workmanlike manner. Homeowners may be entitled to other spec
ii'ic 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 exhibits 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 contract 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 riot begin until both parties have received a fully executed copy of
the contract, and the three day recission 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 funds not yet due 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, orff you wish to obtain a free copy of "A Consumer Guide to the Home Improvement Contractor
Law," contact:
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
(617) 973-8787 or 1-(888) 2833757 a
If you want to verify the registration of a contractor or if you have questions or need additional information specifically
about the contractor registration component of the Home Improvement Contractor Law, contact:
Director of Home Improvement'Contractor Registration
Bureau of Building Regulations and Standards
One Ashburton Place, Room 1301, Boston, MA 02108
(617) 727-3200 or 1-800-223-0933
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
(413)734-3114
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of investigations
600 Kashington Street
Boston, MA 02111
www mass.gorldia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
imlicant Infarmnii--
Name (Business/Organization/Individual):
Address: 6 b T -C, a ( t
4-c /;� 6 -dam
City/State/Zip: /•� -c. J e >1 v Phone #:
Are you an employer? Check the appropriate box:
I...L
I am a employer with - ly--
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
2. ❑ I am a sole
have hired the sub -contractors
proprietor or partner-
listed on the attached sheet
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
3. ❑ I am a homeowner doing
officers have exercised their
all work
myself. [No workers' comp.
right of exemption per MGL
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
Pomp. insurance required.]
`=-n1' applicant that checks box 4t rLL&o fill also L` St theSerR� be-401VEhnR^^z their tx. -
Type of project (required):
6. El New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
11M Roof repairs
1310ther d
Homeowners who submit thrs affidavit indicating they are doing all worts and t} en hire outside contractors mustsubmit 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
information. insurance for my employees Below is the policy and job site
Insurance Company Name: ,/4,
Policy # or Self -ins. Lie. #:
Expiration Date: (g ! c,
Job Site Address: ��S^ W ! l T --'e-/1 S f
City/State/Zip: /�/�- /y►�lI3�
Attach a copy of the workers' compensation 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 Wa
of up to $250.00 a day against the violator. Be advised that a copy of this statement mayWORK ORDEnd a fine
be forwarded to the OfficeR a
Investigations of the DIA for insurance coverage verification of
I do hereby certify under the p ins and penalties of perjury that the information provided above is true and correct
Signature: O C /Z.j
Date.: / /
Phone #: 91
Official use only. Do not write in this area, to be completed by city or town offrciaL
City or Town: Permit/License #
Issuing Authority (circle one):
I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their cerdficate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners,. are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. .Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permait or License is being maues+.ed, not the .Department. of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or Licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111.
Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05
Fax # 617-72.7-7749
mrVnAl-mms..gov/dia.
10f13/2009 3:27:00 PM
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10j �s
Chimneys
Siding
Mass Toll Free
1 -800 -WAIT -4 -US
(924-8487)
5j���,;
ap m. MSP
Residential & Commercial Roofing All Types Of
POINTED -REBUILT -CAPPED
- e
ExPrt MasonryWork
" Roof L°"�; s �: x atts , Licensed & Insed
Locally Owned do Operated Since 1976 'W� License #034200
CWI-V wvzw or ohn -
tai We Work Year Round
1. Strip all shingles from entire roof
2. Inspect and re– nail any loose or lifted plywood.
3. Proposal includes removal and replacement of
(15) sheets of 1/2" cdx fir plywood on main house
Any additional compromised plywood will be re-
placed at an additional cost of $50.00 per sheet.
4. Install heavy gauge 8" aluminum drip edge to all
eaves and rakes.
5. Install 6' of IKO Armourguard ice and water
shield along all eaves, wall connections and top to
bottom in the valleys. 6' MA state code.
6. Install all new pipe boots.
7. Above the ice and water; install heavy 301b felt
base sheet to remaining boards. (not thin 151b)
8. Counter -flash chimney with ice and water shield
and re -seal with clear sealants.
9. Install IKO 30year Cambridge architectural shin-
gles to entire roof.
10. Install new GAF Cobra ridge vents.
11. Building permit included.
12. Removal of all work related debris.
13. Shingles are covered by the manufacturer up to
30yrs.(Pro-rated after 5 years.)
14. Contractor workmanship warranty =10 years un-
der normal wind and rain conditions.
ptance of Proposal—The above prices, specifica
d. You are authorized to do the work as specified
of Acceptance: 12-"1.
14. To our referred customers: IKO Shield Pro
Plus extended mfg. warranty. Fully transferable,
100% full coverage for stock and labor for ten
years. Offered to our repeat customers at no addi-
tional cost.
Total cost: $ 9,800.00
Shingle upgrade option:lKO Cambridge Lifetime
shingles increase wind ratings and extended mfg.
warranty to 15 years of Shield Pro Plus coverage.
Additional cost: $1,400.00
Balance due upon completion
Referrals available upon request
Highly rated member of the BBB and Angies' List
Thank you!
and conditions are satisfactory and are herby ac-
nent will be made a utlme above.
Signature: —
J � t
r