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HomeMy WebLinkAboutBuilding Permit #521-13 - 8 EVERGREEN DRIVE 1/18/2013BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION*( Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition wo or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Welly `9LFlootlplain}x °UVetlantls� Watersh'edDistrct�° Wate.Sewers._,. z )ESCRIPTION OF WORK TO BE PREFORMED: e /-I o L /`Fo ci /:-- Please Type or Print Clearly) OWNER: Name: e,P o2.z7 OVR— 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. Total Project Cost: $ FEE: $ Check No.: :3 9k6F-*1 Receipt No.: 29 05�% NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner :Signature of,corntractorer ,f Location No. ��� "` / Date l Check # 26099 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Bui ing Inspector 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 Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments A Conservation Decision: Comments Wafter & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: 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 2008 . 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies all basic ragnirements of the state's Home improvement Contractor Law (MGL chapter 142A), but does not include sfaodnrd language to protecthomeownem Seek legal advice if necessary." Any person planning home "pnovements should first obtain a copy of"a Massachuseav eorummerguide to home:impmventent" before agreeing to any work on yourresidence. You may obtaia>a free copy by calling the m Office of Consuer:Affairs and Business.Regulation's Consumer information Hotline at61777s3'4787 or 1*88&2834757. Homeowner Information Conffactor Information L;Dmp-y ams ... Street Address (do not use.a Post Office Box address): I Untractor/Salespetann/ownerName, City/town State Zip Code lusiness Address (must include a street address) . Daytime Phone . Evening Phone, 'ty/iown State Zip Code Mailing Address (It different from above) 3usiness Phone llederal Employer M or S.S. Numbs tamrep im Watmon homeim.l Aome iCmmdor aey Thmher 'aelisatioaWele>.. ad a6iMtfon attmhe The Contractor agrees to do the following work for the Homeo net:. i.JV Roo P ]"required Pererits - The -following building pcirnits are required Proposed Start and' CompletionSchedule - The fdllowffig schedule will and will be secure0y the contractor as the'homeownel's agent; be adhered to inileSS circumstances beyond the eontmctoes' conmol arise. (Owners who',secure their own permits will be ezcluded<fromshe,GparanityFnndprovisionsof Date when contractor will begin contracted work MGL' chapter 142A.) Date when contractid .work will.besubstantially completed. . Total Contract Price and Pavment c.r..a..r. The Contractor.agrees to perform the wont, firraish'the material and labor specified above for the totalsum of: �% uz 0 (s) Pgyments will be made according to the followmg schedule: .>f6 gel $ upon.signing. contracC (noAto exceed 1/3 of the totel`corltract price. gr the cost;of special order items, whichever is -greeter) $ by or upon completion of by or upon completion of U (� $p 4/010 on completion of the contract (Law forbids dcmanding full Payment yment until.contract is completed to .both party's satisfaction) Tie following materiaVequipment must be special S� �e be paid for ordered before the contracted work'begina in order S / to be paid for . to meet the completion schedule.(**) NOTES: (s) Including all fiance charges (•s) Law requires that any depositor down -payment required by the contractor before work not,exceed the greater of (a) one-third of the total contract price or (b) the actual con of im beams may which must be Y special.zquipment or custom made material special ordered in advance to meet the completion schedule. a m es ofa eWill .. Subcontractors - The contractor agnxs to be solely responsible for completion of the work deacnbed iegardless of the actions ofany thiid party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors foi materials and labor under this pore• tot Contract Acceptance -Upon sign this document becomes a binding. contract -der Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest)as 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 fullyunderstand it.' As questions if something is unclear. • 'Make ante the Contra .tnr has p vpli.t con.... r..,......._ent Confractor R ¢j=figk The h1w requires most home improvement contractors and . subcontractors to be registered with .the Director ofHonte Improvement Contracnfr Regisiratioa You may inquire eboueo 1-800-223-0933. t.nnactor registration by writing to the Director at:One Ashburton Place, Room 1301, Boston, MA 02108 or-bycalling 617-727-3200 Or . • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read tine important information on the ieveraeside Of" tonin and get a copy of the Constimer Guide to the Home Ithprovement Contractor Law: You may cancel this agreement if it has been signed at a place other. than the contraEA-RE ormal place:ofbusineas, ed=notifythecontractor in writing at his/her main office or branch office by ordinary mail posted,third business day followinthi ofthisa !in sent t� greement.. See the -attached notice oellation forn o DO NOT SIGN THIS CONTRACT IF THERE ANY or SPACES!!! Two ideatiral Dopies ofthe ecaeact must be Compicted and siaoed, onecopyahould aototheThe othe Dopy aheuld be lupi hY Ne cannagor. - 4CJ Homeow�rtzr's tore Contractor's Signature -;Dau Y Contractor Arbitrdilii The Home. Improvement'ContractorLawvmvides.-homeowners with4he.-nghvth4nitiate•an arbitration action (as an alterative to,court action) tf they,have a dtspute:with a contractor. The same.hhtis nbt automatically afforded to'a. contractor, how..ever.<:.. contractor; would have: tp resolve any,dispute helshe.has with a homeowner in court unless both parties agree to. the optional Clause provided below:. Tlris clause would give the contractor the.same.rght 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 an'dihe consumer shall be required to sub it ch arbitration as provided In.Massachusetts General Laws, chapter 142A. Homeowners Signilture Contractor's Signa 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:dtspute resolution even where this section: is not CPnArntely siamd-bVIhe tftes -- Homeowner's Rights A homeowners rights mid' -thetHoing-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. Homeownerrs 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:;wotioaanlike,manner. Homeownersmay be entitled to .other specific legal. rights if the contractor guarantees. or provides .an. express warranty for. workmanship of materials. In addition to .guarantee's •or warranties provided by the contractor, all goods sold in Massachusetts carry an implied warranty of merchantability ;and iitness.fora particular purpose. An enumeration of other matters on which •the homeowner and contractor lawfully agrmmay 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 : nsumer/homeowner rights; contact the Consumer Information Hotline (listed Below). Execution of Contract The contract must be executed in du Lica a 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 griginal'coniract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have 06 received a fully executed copy of the contract, and the three day recission period has expired Accelerated Payments A contractor may not demand payments inadvance.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 in, 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 rights consumer , or if.you wish to obtain a free. -copy of "A Consumer. Guide to the.Home Improvement Contractor Law,"- contact: . Cgnsumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 (617) 973-8787 or 1-(888) 281.3757 . If you want to verify the registration of a contractor or if you have questions orneed .additional information speclfidally 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 s (617) 727-3200 or 1-800-223-0933 For assistance with informal mediation: of'dirtputes or to registerformal complaints against a htitsiness, call Constit[ner`C6mplaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 CS # 022680 HIC# 103358 Propiowd = A. J. Walsh & Sons 55 Pleasant Street .North Andover, MA 01845 # of pag 978-688-6737 or 1-866-AJWALSH Proposal Submitted To: f , Job NameJob # Address f) U Job Location JZW �Q 1d �S Date / 3% 1e Date of Plans Phone #Fax # Architect We hereby submit -specifications and estimates for: r/i?i 0 We propose hereby to furnish material and labor — complete in accordance`wltl the above specifications for the sum of: $ Dollars withpayment , to be made as follows: 111003 Any alteration or deviation from above specifications involving extra costs will be Respectfully executed only upon written order, and will became an extra charge over and submitted above the estimate. All agreements contingent upon strikes, accidents, or delays U r beyond our cdhtrol. Note — this proposal may be withdrawn by us if not accepted within days. acceptance of propozar The above prices, specifications and conditions are satisfactory and are Signature hereby accepted You are authorized to do the work as specified. V Payments will be made as outlined above. Date of Acceptance Signature t Massachusetts - Department of public Safety Board of Building Regulations and Standards Construction SuperNisnr License: CS -022680 ARTHUR J WALSft 159A WAVERLY."' N ANDOVER MR 018 k ��.�..` Explratton Commissioner 06/09/2014 r�/r.e C!oarr�rrnuruerrlfl c//^ h1,jjrrrlrrreffi Office of Consumer Affairs & Busihess Regulation ! ` COME IMPROVEMENT CONTRACTOR � Registration: 103358 Type; xpiration: 7/7/2014 Private Corporatic• AW LSH & SONS NC: Arthur Walsh,Jr. 55 Pleasant St N Andover, MA 01845 Undersecretary . + WORKERS COMPENSATION AND EMPLOYERS LIABILITY INSURANCE POLICY INFORMATION PAGE Associated Industries of Massachusetts Mutual Insurance Company 54 Third Avenue, Burlington, Massachusetts 01803 N (800)876-2765 CCI NO 26158 POLICY NO. I AWC 7014648012012 PRIOR N0, I-AWC 7014648012011 ITEM 1. The insured Arthur Walsh dba A J Walsh & Sons , Mail Address: 55 Pleasant Street North Andover MA 01845 Street No. Town or City County state Zip Code FEIN xxxxx6792 ®Individual []Partnership ❑Corporation []Joint Venture ❑Association ❑Other Other workplaces not shown above: 2. The policy period is from 11/1412012 to X11412013 12:01 a.m. standard time at the Insured's mailing address. 3. A. Workers Compensation Insurance: Part One of the policy applies to the Workers Compensation Law of the states listed here; MA. B. Employers Liability Insurance: Part Two of the policy applies to work in each state listed in item 3A. The limits of our liability under Part Two are: Bodily Injury by Accident $ 100.000 each accident Bodily Injury by Disease $ policy limit Bodily Injury by Disease $ 100.000 each employee C. Other States Insurance: Coverage Replaced By Endorsement WC 20 03 06A 0. This policy includes these endorsements and schedules: SEE SCHEDULE 4. The premium for this policy will be determined by our Manuals of Rules, Classifications, Rates and Rating plans. All information required below is subject to Verification and change by audit Classifications GOV CLASS Premium Basis Rates CLAIM I OFFICE NAME I CHECK Code Estimated Persloo Estimated 705 No. Total Annual Of Anne Remuneration Remuneration Premium INTRA 040579 SEE E(TENSION OF INFORMAT N PAGE Minimum premium $ 500.00 Total Estimated Annual Premium $ 500.00 As indicated interim adjustments of premium shall be made: Deposit Premium $ 500,00 ® Annually ❑ Semi Annually 11 Quarterly ❑ Monthly MA Assessment Chg. $291.00 x 4.2000% $0.00 This policy, including all endorsements, is hereby countersigned by 11/0212012 Authorized Signsture tate GOV STATE GOV CLASS i KIND I AUDIT I PIACING I OFFICE CLAIM I OFFICE NAME I CHECK 1 SAFETY . GROUP -MA. 5403 2 705 WC 00 00 01 A (7-11) includes copyrighted material or the National Council on Compeneation insurance. used with its permission. Durso & Jankowski Insurance Agency Inc 198 Mass Ave Suite 1018 North over, MA 01845 The Commonwealth ofHassachusetts Department of lndustriq[Accidents Office oflnvestigations 600 Washington Street Boston, .NIA. 02111 www.massgov/ilia Worker' Compensation Insurance Affidavit: Builders/Contractors/Electxlcians/Plumbers Applicant Information Please Print Lealbly Name (Business/Organization/lndividual): Address:_ 'g, e",7 Si City/State/Zip: M *A1 J o - //W"hone #: 97t----(4-� ' 73 % Are yo employer? Check the appropriate box: 1. I am a employer with, % 4. El I' am. a general contractor and 1 employees (fall and/or nut -time) * have Hired the sub -contractors 2. ❑ I am a sole proprietor or partner- ship and'haveno employees working for me in any capacity. [No workers' comp. insurance required.] 3111 I am a homeowner doing all work myself. [No workers' comp. insurance required.] i listed on the attached sheet. x These sub -contractors have workers' comp. insurance. 5. ❑ We area corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and wehave no employees. [No workers' comp, insurance required.] Type ofproject (required): 6. [] New oonstruciion 7. ❑ Remodeling 8. [] Demolition 9. ❑ Building addition 1011 Electrical repairs or additions 11.❑ Plumbi PIM s or additions 12. oofrepairs 13.❑ Other Any applicant that checks box #I must also fill out the section below showing their workers' compensationpolioy information. I Homeowners who submit this affidavit indicating they ere doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sbeet showing the name of the sub -contractors and their workers' comp, policy information. X am an employer that is providing workers' compensation insurance foryny employees: Below is thepolicy antZjob site information. f Insurance Company Name% ALAi 9wre(o/. //a e -J Policy #. or S elf -ins. LID. #: Expiration Date: Job Site Address: d �� (a, eflCC-, y a /i? City/StateMix Attach a copy of the workers' compensation -policy ileclaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL o. 152 can lead to the imposition of criminal penalties of a fine up to $1,500.00 and/or oneyearimprisonment, as well as civilpenalties 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. I do Hereby cert*Fader the pains andpenalties ofper, jury that the information provided above Is true and correct. - [one #: 7 Official 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 S. PlumbingInspector 6. Other - - Contact Person: _ phone Information and Instruction's 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 ofhire,- 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 ofpublic 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-contractor(s) name(s), address(es) and phonenumber(s) along with their certificate(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. Han LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confi oration of insurance coverage. Also be sure to sign and date the affidavit. Ti he affidavit should be returned to the city or town that the application for the permit or license is being requested, not the Department of . Industrial Accidents. Should you have any questions regarding the law or ifyou are required to obtain a workers' compensationpolicy, 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 permithicense number which will be used as a reference number. In addition, an applicant that must submit multiple permMicense 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. Anew affidavit must be filled out each year. 'Where a home owner or citizen is obtaining a license o pdrmit not related to any business or commercial venture (i.e. a dog license orpermit to burn leaves etc) said person is NOT required to complete this affidavit. The Office oflnvestigations would like to thank you in advance for your cooperation and shquld you have any questions, please do not hesitate to give us a call. The Department's address, telephone and fax number: Tho Com*ORWORAo assachv.:sPits T3. eparime-at of kdustdal .A,ccideats Qf'fke OURVOdtigatio.w 600 Wa$ gtoa Street Boston, .02111 Tel, # 617.727_4900 W406 Qr 1-877�MA.SS.AFF Revised 5-26-05 Fay, # 617-727-7749 a 9 A CA m m m y m y m C � N n 0 0 n Z .N 0 U) > -v �0�, vCD CD CL Cr CD CD 0 CD CL v CD O y CO CD v 0 0z CD 0 o PMIPCD CD C � o, N O O O� (O O W O. U2 CDto 0 U) 0 Q N U) CD O O 'a r -I— O 6 CD O. CD n 9Q m m O O •+ CLCD m h��� o _SCD C O N C O O O rt cC CL O N � O C.) S rt CD CD S (D 'a . 0 O O^ O <co asp h U) o f Cr C, nCD .) CL CL CL O N 0) CD < `° pQn �oCLo ` D .� �,► ch y D� C I ca ;n CD CD 9 U) CD �U) (D 0 CL �s . . • Lr :n 3 0 rD K N 1 rD r0* aZ Co c m o M. z T 7• .Z7 O G7 y N O 7D. T O N rD 0 N 70 O c S r m � A m A O X T S. a 17 O c 3 C W M A p X T >' p) n S 7 � Zo O c S T O c Q 'OY. p = W C v z Li m O M N rD 'a n K v N 3 T O O \ r�r' S N ' o0 o am r x *ft c