HomeMy WebLinkAboutBuilding Permit #76-12 - 844 SALEM STREET 7/28/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: y
Date Issued:���//
IMPORTANT: E
T.00:ATTON �T+ SC t enn
To
Date Received
must complete all items on this
Print
11111 L
MAP NOA, 60 PARCEL: DU�gONING DISTRICT
it
Historic District yes no
Machine Shop Village yes no
100 year-old structurees no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
RRepair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
'®Septic1Well
(]Floodplain Wetlands$
)
40' s7h__ istrict
— 10`Water/Sewer
r
_
DESCRIPTION OF WORK TO BE PERFORMED:
r
OIL., 1E,_ S14,N)IIJ9 ONC, �SAAC, cs-� �iou,3e-
(Identification Please Type or Print Clearly)
OWNER: N
Address: ? I L S cA o-� ST
CONTRACTOR Name: hy bZ W Phone:
Address: � 4' e rv1 O,�J � � 6,erry #f/// "/ 0 3 055
Supervisor's Construction License: 1p�J �� Exp. Date:
Home Improvement License: 11 1�3 g-9 Exp. Date
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
2.-12-12
FEE SCHEDULE: BULDING ERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Project Cost: ® 0 FEE: q6 �Teta � �Row,S
r)
Check No.: C7 Q �' �I Receipt No.: `{q
NOTE: Persons contracting i4th unNg:ktered Vontractors do not have access to the guaranty fund
03
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 Perry
Addition or Decks
NOTE:
❑ 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 Woi
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Appllca
❑ Engineering Affidavits for Engineered products
All dumpster permits require sign off from Fire Departme,
New Construction (Single and Two Family)
NOTE:
With Sprinkler Plan And
prior to issuance of Bldg Permii
❑ 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
All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Perm!
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: Doc.Building Permit Revised 2008mi
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
HEALTH
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:
FIRE DEPARTMENT' -'Temp Dumpster on site
Located at 124 Main Street
Fire Department signature/date
COMMENTS
Located 384 Osgood Street
yes no
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
Doc:.Building Permit Revised 2011 June/mi
Location � L/
No. s�3 / Date 3&Z
a
NORTH TOWN OR NORTH ANDOVER
o? � ' •• 0
� a
' Certificate of Occupancy $
C►IusE� Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $—
Check #
13745 / _v..
Building Inspect
Location U # �:"��
No. _L_ Date
NORTH TOWN OF NORTH ANDOVER
.. c� 7
Certificate of Occupancy $
c►+us t�' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # ioIhd`
24413
Building Inspector
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The Commonwealth of Massachusetts
Department of industrial. Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www mass.gov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/.1E+ lectricians/JPlumbers
Name (Business/Organization/Individual): /yj
Address:
r
7
(�
CO3, (� 6 l ,�_3 C
City/State/Zip: kJ E%rr� , Phone #:
Are you an employer? Check the appropriate box:
1. [Pam a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. I
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
5. ❑ We are a corporation and its
[No workers' comp. insurance
required.]
officers have exercised their
3. ❑ I am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling .
8. ❑ Demolition
9. ❑ Building addition
10. F1 Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12.❑ Roof repairs
13. E Other . 411 j
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
7 Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew 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.
lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: C4 � Z5 7 J 31 . W C�5 43 "a Expiration Date: ,2 6 ^ 12—
Job Site Address: 0 `1 �f sc,-�,e_ rA 5T City/State/Zip: /U A oJoi%C, d l 2+5
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 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 e, ! der the aims crnd en �erjury that the information provided above is true and cor�r�ect.
�+.,.-...,+.,..,.. . /'1/l) J.IJ�
Phone #: '
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License 9 -
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
J ,
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. 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 or on our website.
TT___ -
uvuicvvvuvi lulul-Wallun Contractor Information
NameCompany
Name n
Street A�Icjre s (dootuse aPost ffi'e ox address)
•�Qj4'/fil " S
Contrac r/Salesperson/ Owner Fame
City/Town,S'a'e
A)
Zip Coe
Business Address�cmust include a str t�address)
n
CV e.(ZZ o06
nooj 5
Daytime Phone
-97F
Evening Phone
A27 203
City own State Zip Code-
ci0 y ty3 �
Mailing Address (It different om above)
Business Phone Federal Employer ID or S.S. Number
Law requires that most home
Home Improvement Contractor Reg. Number
Expiration date
improvement contractors have
n valid registration number
J
I`J H
I ///��� ^ ^ /
I {.. —�R S
ric a.vutractur agrees to ao the lollowmg 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 if necessary.)
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 of —7—Z 7" J(Date when contractor will begin contracted work
MGL chapter 142A.)
5�^ ate when contracted work will be substantially completed.
The Contractor agrees to perform work, fillmish the material and labor specified above for the total sum of. R, dim
the (*)
Payments will be made according to the following schedule:
$tet l?8 upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater)
$ ,3,e0 by �/- /�or upon completion of V eLL. 1 03
ao
$% 066° 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
ordered before the contracted work begins in order 1�//'��
to meet the completion schedule.(**) $_a�7 _ 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 (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 being 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
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 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.
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 writin er, in office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the
4blusinessZaturd—
oing of this agreement. See the attached notice of cancellation form for an explanation of this right.
N THIS CONTRACT IF THERE ARE BLANK SPACES!!!
ontract must he completed and signed. One copy should go tot eo r. The other cop s opt by the contractor.
Contractor's Signature
bate
Date
-7-2--7-11
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 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 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 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 funds not yet due be placed in a joint escrow
account as a prerequisite to continuing the contracted work. Withdrawal of fiends 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:
Consumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the OCABR website at ft://www.mass.gov/ocabr/
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
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
617-973-8787, 888-283-3757 or visit the HIC website at http://www.mass.gov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration:
hqp://db.state.ma.us/homeimprovement/licenseelist.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
Version 2.1 - 11/22/2010
A. F. Watson General Contracting
3 Edgemont Street
Derry, NH 03038
Tel. 603-437-6134
Cell # 603-661-5360
NAME/ADDRESS
Joyce Cooper
844 Salem Street
North Andover, MA 01845
Estimate
DATE
ESTIMATE #
7/26/2011
1450
SIGNATURE
OWNERS SIGNATURE
TERMS
PROJECT
Due on receipt
Siding & Misc Repairs
ITEM
DESCRIPTION
QTY
COST
TOTAL
labor
Carpenter's labor
96
42.00
4,032.00
1. Strip and replace cedar siding Right side of house
Gable end
clapbd
Primed cedar clap boards
3,500
1.04
3,640.00
Tyvek
Tyvek Air Infiltration Barrier
104.00
104.00
Miscellaneous
Miscellaneous
250.00
250.00
07/26/2011
Town of North Andover
844 Salem Street
THANK -YOU A. F. WATSON
TOTAL $8,026.00
SIGNATURE
OWNERS SIGNATURE
312, 2011 12:30 PH FROid: Fat: TO: +1 (603) 437-£6133 PF -GE: 002 OF 003
07/26/2011
AC,ORDI= CERTIFICATE OF LIABILITY INSURANCE
PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
Obrey Insurance Agency, Inc. HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
1ECommons Drive Unit 27 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
Londonderry NH 03053
INSURED Af Watson General Contracting
3 Edgemont St
Derry NH 03038
INSURERS AFFORDING COVERAGE I NAIC 4
1M 5ZPPA- PEERLESS INSURANCE COMPANY
COVEfiAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE INSURED NAMEDABOVE FOR THE POLICYPERIOD INDICATED_ NOTWITHSTANDING
ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR
MAY PERTAIN, THE INSURANCEAFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
D
P011CYNUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
03/06/2012
LIMITS
I TR
A
MAW
TYPE OF INSURANCE
GENERAL UABILRYEACHOCCLFS€NCE
X CCNNERCIAL C�ERAL UABILITY
CtAINSWDEE a OCCLR
G L 8257537
03/0612011
S 1,000,000
pie41= s (Fd OtturarFN S 100,00
$ K
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Pc-HsonAL&ADVRQURY s1,000,000
GEE{7AL AGGREGATE s 2,000,000
(EIL AGG FECATE U&ITAPPLIES PER
PRODUCTS- CCNPIi P AG 3 6 2,000,000
POLICY PRO- LOC
JFCT
AUTOMOBILE
LIABILITY
CDVBIN D 9133E UNIT S
(Ea accideM
ANY AUTO
ALL OWNED AUTOS
SCHMLlED AUTOS
BODILY INILRY S
(Per person)
HI;EDAUTOS
NON.ONNEDAUIOS
BODILYIMLR! S
(Pe: accident)
PROPFRTYMIAG:E S
(Per acciderg
GARAGE LIABILITY
AUTO ONY-EAAMDENT S
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ANYAUIO
AUTO CALY_ A(, S
EXCESS IUMBRELLA LASILIiY
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AG(;€GATE S
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AND EMPLOYERS' LIABILITY
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WC 9364376
03/0612011
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F -L CASEASE - EA ENPLOYEE, 5100,000
OFFICH7INfiRVBEREXCLL[?-YI
(MandatoryIn NH)
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SPECIAL PRONSIOJhS below
DISEASE _ POLICY UMT S 500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Town Of North Andover
844 Salem Street
- North Andover, MA
ACORD 25 (2009101) -
SHOULD ANY Or THE ABOVE DESCRBEO POLICIES SE CANCELLED 13EFORETHE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TOirk LERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 $O SHALL
IMPOSE NO OBLATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR
REPRESENrATIV3
AU, HORIZED REP.Z'e5-�vTA7iVE
81988-2009 ACORD 0DRPORA7ION. All rights reserved.
The ACORD name and logo are registered marks of ACORD