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Home My WebLink AboutBuilding Permit #717 - 8 WALKER ROAD 5/17/2010BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: �� %� ' (0 IMPORTANT: Applicant must complete all items on this naize LOCATION S9 QJ4TJ 4P, AD Print PROPERTY OWNER e%kfluj ti.iC-0• t 2 Print MAP MAP 210 �4 PARCEL: Z ZONING DISTRICT: Historic District yes Machine Shoo Villaae ves 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: f _ Repair, replacement Assessory Bldg Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: 1 5 rel 1 cc nur J &E L, 1, 0 n-{ i F I -R E R gZz5!o po o rz A "J o F -M vv, -e-5. Identification Please Type or Print Clearly) OWNER: Name: M&1&oov0 \1&J ai 0a AID MA - 05 ca 8 e -3 ki MA vcaUe3k CONTRACTOR Name: /J A $ C- Phone: Address: Po A50x t Z . 4,v>hiq O�— Supervisor's Construction License: &a b 16 Exp. Date: & /1(,o /10 Home Improvement License: 13 7 SS a• Exp. Date: l t -Z(, //Z) 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: $°1�1Z� FEE: $ �-- Check No.:`� 6-3 1j Receipt No.: NOTE: Persons contracting wit .,unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Si nature 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS i]EALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature 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 LI 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 A l 1 No. 2/+ Date TOWN OF NORTH ANDOVER h 9 • ; ; Certificate of Occupancy $ ..�.- �'�S Building/Frame Permit Fee $ s�cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Jf ✓ 236� - Building Inspector m m m m Y+ m v C CD yCD az y CD O �� r = o CL y nI CD fl. � O �F m CD CD O CD O CD y. —� CD CZ O y CO CD v y O 'o z CD O CD O CCD ij J 40 O -• y O Q y r—L m y -•1 O m In C9 m m t7 a T z y O•'s H• ..�a^'a m m �o m H G C/2 o m m m a > > m 0 o zcnm p y n CD W = O -�. c �� a aye: C a Occ y CL s O Sol C� D1 y iA 0. d Q c p O y rC O �i �O m CO3 y �� O mm�� w y CD,C,� , O CY O CD O Co Wim: CD CD cu o m a � CA o '1 � m o m J W 0 Cf) 0 Crn Z b7 rD H ?1 7� G ro �, �r1 w Cyn `�. GO i7 y 07d GO ��" ° Z m 0°� w 0 W C z O r) O p\ 7C rD ° ►� � y 0 9 0 c 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 he 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 MA. Homeowner's Signature Contractor's Signature NOTICE: The signatures of the parties above apply only to the agreement of the partes to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this stiction 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 work as described, in a timely and workmanlike manner. Homeowners may be entitled to other specific liegal 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 ownerand 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 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 worlL. 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'lf 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 If you want to verify the registration of a contractor or if you have questions or need additional information specificall about the contractor registration component of the Home Improvement Contractor Law, contact: y 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 OfLnvesiigations 600 Kashington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers iplicant Information Name (Business/Organization/Individual): Address: P 8 60k l 3 Z City/State/Zip: /V , 4ALor.�, mqphone #: q7'7S Are you an employer? Check the appropriate box: 1. F& am a employer with (1' 'part-time).* 4. ❑ I am a general contra7sheetl employees (full and/or 2.[] I am a sole have hired the sub-co proprietor or partner_ ship and have no employees listed on the attached These subcontractors have working for me in any capacity. [No workers' comp. insurance workers' comp. insurance. 5. ❑ We are a corporation ;. ❑required.] I am a homeowner doing all and its officers have exercised their work myself. [No workers' comp, right of exemption per MGL c. 152, § I (4), and we have insurance required.] t no employees. [No workers' comp. insurance 82 � Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.7 Electrical repairs or additions I1.❑ Plumbing repairs or additions 12.❑ Roof repairs recpured] 13.❑ Other .-.n "y applicant that checlas box #i muni also ED ...t the sermon �eop ho�.�^.. f� Homeowner who submit this affidavit indicating they are doing aL' work and mr woti ers' comP--,4= 44 a poo: c, a tc. W tion +Contractors that check this box must attached as additional sheet showing the -name of the sub coaide otrac a and �tk2new Affidavit indicating such. �R employer rnat isproviding workers' compensation i information. nsurance for my employees. Below is the policy,and, job site Insurance Company Name: A i Policy # or Self -ins. Lie. #: `7boA. 3 G _7UJ ZpCf_ Expiration Date: cj Sob Site Address: Y�) Wa�kzr 90 Attach a copy of the workers' compensation policy declaration page rho Cify/State/Zip: /V �-,�I�U �?(' (+�(.ct the policy Failure to secure coverage as required under Section 25A of MCL c. 152canlead to the impositionnumber bof and expiration matron datea fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WOR{ ORDER penalties of a of up to $250.00 a day against the violator. Be advised that a copy of fine Investigations of the DIA for insurance coverage verification statement maybe forwarded to the Office of I do hereby under the pains and penalties of perjury thQt the information provided above is true and correct -- sone Official use only. Do not write in this area, to be completed IT city or town official City or Town: PermitUcense # Issuing Authority (circle ane): L Board of Health 2. BuiMing Department 3. City/Town Clerk 6. Other c 4. Electrical Insnertnr Contact Person: Phone #: :ter �las.�achusctts - Department of Puhlic ti:ifct.� Bir rd of Building Rc'u Construction Su lations and Standards t pervisor License License: CS 82816 Restricted to: 00 JOHN R LEEMAN JR 70 PILLON ROAD MILTON, MA 02186 ' c-- - Expiration: 6/16/2010 ( umii..i nrr Tr 26067 z -v z >boO zCDz 0)<m D m-►mz X"'DO z< D m o � c A C Ol f 0 z O m i �'� '• �� .. �,, s t " Y�.v a -'i; `23:'rt .i'.+s t+ tft •z Y , {f ISSUE DATE 02/23/2010 S�L�' : t'; �W . • .F« ti . r ., •., ` f Kir s . PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND MTM Insurance Associates LLC CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE 575 Chickering Road DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. North Andover, MA 01845 COMPANIES AFFORDING COVERAGE INSURED North Andover Building Corp 70 Pillon Road COMPANY A A.I.M. Mutual Insurance Co Milton, MA 02186 LETTER GGA 4. .A l� i i'.:. 1•) t•# "Fe i "i Z 1 .en;1. kft' a%5' 4 i Ys 1 F1�3 e'FyrCS.. .N'i' YI !m Six .A _..,. +.• >a'.. ,,FFd g /. •:a. .,tt 4-S F,. si.-,`n 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 REQUIRFMFNT, 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. CO LTR TYPE OF INSURANCE POLICY NUdIBER POLICY EFFECTIVE DATEN"DIYY) POLICY EXPIRATION DATE(16tMU) lYY) LIMITS GENERAL LIABILITY GENERAL AGGREGATE QCOdIMERCfAL GENERAL LIABILITY PRODUCTS-COMWOP AGS I PERSONAL& ADV. ILItY QQ CLApCS MADE QOCCLR EACH OCCURRENCE Q OWNERS A CONTRACTORS PROT. FIRE DAMAGE (AIIyow fire) %IM EXPENSE(A"aw pwsm) AUTOMOBILELIABILTTY COMBINED SINGLE LIMIT ANY AUTO ALL OWNED AUTOS SCHEDULED AUTOS BODB.Y IdJURY (Par Vow) HIRED AUTOS MOH -OWNED ALTOS BODILY INJURY GARAGE LIABILITY (Per aciderel PROPERTY DAMAGE EXCESS LIABILITY EACH OCCURRF)XE UMBRELLA FORM AGGREGATE OTHERTHAN[AIBRELLA FORM _Yi ogi'kRFa 4OTHER %VORKERS COMP&NSATION AND AT LIMITS STATE ENIPL•OYERS LIABILITY I MA HE PROPRIETOR/ A ARNERS'ExECUTRE ELEACHACCIDENT S 100,000 FFICTERS ARE: DE.cT. 7023267012009 11 m on09 11 11 /2010 EL DrsEAs>;-.PoucY u.nT S 500,000 EL DISEASE -EACH 100,000 EMPLOYEE IS COMMENTS/ DESCRIPTION OF OPERATIONS OR LOCATIONS: .. Ir.: N - ,: c z:• JIOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE EREOF. THE ISSUING COMPANY WILL ENDEAVOR TO MAIL JkWRITTEN NOTICE TO THE CERTIFICATLDER NAMED TO THE LEFT. BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION LIABILITY OF A.14Y KIND UPON THE COMPANY. ITS AGENTS OR REPRESENTATIVES. 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