HomeMy WebLinkAboutBuilding Permit #746 - 80 PINE RIDGE ROAD 4/18/2012�ylln ry
BUILDING PERMIT
TOWN OF NORTH ANDOVER to t
APPLICATION FOR PLAN EXAMINATION
Permit NO: F Date Received yA°gArlo
• SSai-u,15��
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
❑ One family
❑ Addition
❑ Two or more family.
❑ Industrial
❑ Alteration
No. of units:
0 Commercial
'Repair, replacement
❑ Assessory Bldg
❑ Others:
emolition
❑ Other
❑epttc r 1�`Welf 3
❑�FloDdplam INettat�ds F
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DESCRIPTION OF WORK TO BE PREF ORmED:
l %a `% ac -,-t A -S Po -r' 4o%Gf
Please Type or Print Clearly)
OWNER: Name: L,4a4j, 112914-Aizle-
C--I-, rr�, �fJr .,,
e: 7uu
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: $ ° C161 FEE: $
Check No.: `o 12C Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have acce the guarantypnd
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 2.2007
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
PLANNING & DIfLOPMENT ❑
DATE APPROVED
COMM TS
DATE REJECTED DATE APPROVED
CONSERVATION �. ❑ ❑ g 13 1
COMMENTS
DATE REJECTED DATE APPROVED
/HEALTH- ❑
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comme
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
Located at 384 Osgood Street
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
NV i t5 and UA I A — (tor department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2007
Location () n =- r�,
-^-� �-
No./
yL
Date
e TOWN OF NORTH ANDOVER
� O
Certificate of Occupancy $
Building/Frame Permit Fee $1�5�
Foundation Permit Fee , $
Other Permit Fee $
TOTAL $
Check # to
25199 Building Inspector
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Massachusetts Home Improvement 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. Seek 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.
Homeowner Information Contractor Information
Name Doug Adamic Companyl[lame Professional Building Services
Street Address (do not use a Post Office Box address)contractor/ Salesperson/ Owner Name Peter M. Ciaraldi
Vf6 Pine Ridge Rd
North Andover MA 01845
Daytime Phone Evening Phone
978-688-2738
Address (must include a street address)
Olde Woode Rd
State Zip Code
SALEM MA01844
Mailing Address (It different from above)
Business Phone
Federal Employer 1D or S.S. Number
45-3129617
Law requires that most home home lmprovemem Corrector
Expiration Data
taprovemera cpm ar o. have a valid reg. —b— 170870
1/10,114
Registration —bar
I
The Contractor agrees to do the following work for the Homeowner:
(Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets ifnecessarv.)
Construct new deck
Required Permits - The following building permits are required Proposed Start and Completion Schedule - The following
and will be secured by the contractor as the homeowners agent schedule will be adhered to unless circumstances beyond
Owners who secure their own permits will be the contractors control arise
excluded from the Guaranty Fund provisions of —V23/2012 Date when contractor will begin contracted work.
MGL chapter 142A.) 5/8/2012 Date when contracted work will be substantially
completed.
Total Contract Price and Pavment Schedule
The Contractor agrees to perform the work, famish the material and labor specified above for the total sum of. 512,942.50
Payments will be made according to the following schedule:
$_4000 upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater)
$_4000 by _/ / or upon completion of frame
$ 4942.50 upon completion of the contract. (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 orderIF 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 Warranty -Is an express warranty beine provided by the contractor? No Yes (all terms of the warranty 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.
The Commonwealth of Massachusetts
Department o, f Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A licant Information Q t Please Print legibly
Name (Business/Organizationandi%idual): Ro fesnotri 1 B U TL.() T jc) se-ey[p-r
Address: C,.r Gro oc- 'C Go r�A �. � /v1 t>�{i � t'� 3 �
City 5Ae f /
State u`ifZip; aQ/c' Phone
Are you an employer? Check the, Appropriate boa:
1. [a I .am a etlrpioyer With 4. ❑ T am a general contractor and T
Type of project (required):
employees (full and/or part tmm).*
have hired the sub -contractors
6. 0 New construction
2. ❑ I am a sole;pmpriemr or partner-
listed on the attached sheet t
7. 'C] Remodeling
ship and have no employees
These sub -contractors have
8. Q DunDliriou
working for me in any capacity.
(No workers'' comp. insttranoe
workers' comp_ insurance.
S. 0 We are a corporation and its
9. El Budding addition
required]
affcers have exercised �ttr
10 '
[] Electrical repairs or additions
3. [l I am a homeowner doin all work
g
right of exemption per MGL
1 I:Q Phutibing repairs Or additions
myself. [No workers' comp.
c. 152, § 1(4), .and we .have no12
[) hoof repairs
insurance required_'] r
employees. [No workers'
11n poor
comp. insurance reouired.l
;Any spplicmt that cbedca box # 1 mu& also fill out the section below showing their workers' coi npestsatioa policy mfbnmdm
Homoowum wbo submit this affidavit indicating they arc doing all work and then bac outside contractors must submit a new affidavit inm5cating stxic
tContraeenra that cheek this box moat attached am additional shat aboWing the same of the sub contractors and their woTkcre comp. policy information.
/ am an entplober that is providing tvorRers' compensation insurance for rn enViovees. Below is the policy and job site
information [- --
insurance Company Name:
Policy # or Self -ins. i_ic:# U �
� � T� /'P/'19
Expiration Date:
Job Site Address: e
/fir i� i�� City
AV - ''Yb 0 L—_<
State Zip:. 01 PIT
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 b4OL e. 152 can lead to the impasition of criminal penalties of a fine up to $1.500.00 andlor one-
year imprisonment as avlt 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 statemenRrNI"e
be forwarded to the Office of Investigations of .the DIA for insurance coverage verification.
1.do hereby certifi pains and penalties of perjury that the information protdded above is rule and c orree't.
Signature: Dare!/�L%
Phone d 60-'3 C %)
Officid use only. Do not writ in this area, to be completed b3' cily or town offtcW
City or Town:
Permitil icense
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CkyfTown Clerk
6. Other
4. Electrical Inspector 5. Plumbing inspector
Contact Person- Phone #:
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 contrail.
• Don't be pressured into signing the contract. Take time to read and Polly 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. 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.
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 ofthis agreement. See the attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM
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.
Homeo s Signature
Date
Contractor's Signature
Date
5/11/2012
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 1.42A.
HomeowtKs Si ature 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
: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 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 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 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 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
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
LEGEND:
ECP EDGE OF PAVEMENT
80---- EX. CONTOUR
96X7 EX SPOT GRADE
BIT. BITUMINOUS
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GRAPHIC SCALE
FEET SCALE: Y=30'
30 0 15 30 60
ZONING INFORMA770N:
ZONING DISTRICT : R1
OWNERIAPPLICANT.-
DOUGLAS & MICHELLE ADAMIC
80 PINE RIDGE ROAD
NORTH ANDOVER, MA 01845
DEED REFERENCE:
BOOK: 7918 PAGE: 231
ASSESSOR REFERENCE.•
ASSESSOR MAP 65 PARCEL 79
1. THE TOPOGRAPHY, SITE DETAIL & SURFACE IMPROVEMENTS DEPICTED
HEREON KERE OBTAINED FROM A PARBAL FIELD SURVEY CONDUCTED ON
MARCH 26, 2011 BY SULLIVAN ENGINEERING GROUP, LLC
2. THE LOCATION OF ALL UNDERGROUND URDDES SINOKN ARE APPROXIMATE
AND ARE BASED UPON A PARTIAL FIELD SURVEY AND COMPILATION OF
PUNS OF RECORD. THE DESIGN ENGINEER DOES NOT WARRANTY NOR
GUARANTEE THE LOCATION OF ALL UTILITIES DEPICTED OR NOT DEPICTED.
THE CONTRACTOR, PRIOR TO COMMENOEWDVT OF CONSTRUCTION, SHALL
VERIFY THE LOCATION OF ALL UTILITIES AND CONTACT DIG SAFE AT
1-888-344-7233.
3. THIS PLAN DOES NOT SHOW ANY UNRECORDED OR UNMRIflEN EASEMENTS
NH/CH MAY EXIST. A REASONABLE AND DILIGENT ATTEMPT HAS BEEN MADE
TO OBSERVE ANY APPARENT, l45/BLE USES OF THE LAND: HOWEVER, INNS
DOES NOT CONSTITUTE A GUARANTEE THAT NO SUCH EASEMENTS EXIST.
4. THE ELEVATIONS DEPICTED HEREON WERE BASED UPON AN ASSUMED DATUM
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