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HomeMy WebLinkAboutBuilding Permit #46-12 - 92 MOODY STREET 7/19/2011Permit NO: i/1; Date Issued: oiF' TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this nate — I LOCATION -57- Print Print PROPERTY OWNER ,D A V) O U U 1$ Unit # Print MAP NO: �PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Exp. Date: 7 /Z eJ le,017 Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other OSeptic Well ❑ Floodplain oodplain p Wetlands 'Watershed District - ❑Water/Sewer - DESCRIPTION OF WORK TO BE PERFORMED: \/t^ 4 41 r� f co v -e r a (Identification Please Type or Print Clearly) OWNER: Name: prV 117 U U 1 5 Phone: �t 7 8- y7s'a yd�l Address: 41Z- tj U () D� -S CONTRACTOR Name: Sv &Li v ,-, /fid 6,e r Phone: 9 %� (o 9',2- G y 7Y Address: ,2 -7 117 /'W/o n a"" SS! • Z -a n 1.e r Supervisor's Construction License: 0 U g SS Exp. Date: Ll Home Improvement License: / DS" s % y Exp. Date: 7 /Z eJ le,017 ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ '7, aD D , a C2 FEE: zftl,--� Check No.: y f—&3 Receipt No.: A5 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofFAgent/Qwner 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 (;OMMENTS HEALTH Reviewed on Signature COMMENTS - 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 2011 June/mi 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: Doc.Building Permit Revised 2008mi Location GI Ul d Z2 a /S No. Date -15- �oR,M TOWN OF NORTH ANDOVER 0 s + + Certificate of Occupancy $ sACMUSEBuilding/Frame Permit Fee $ Foundation Permit Fee $ , Other Permit Fee $ TOTAL $ Check # 24 Building Inspector CA m m X U) m v, C � CA Cl) Cl CD a Z CO) CLO = . r c CL = y O O o CD CD CL Q CD Sr CD CD CD C O Vag — CD CL O CO) CO !OD S v y O 1CD Z O CD O oc CD cn cn n O cn C cn 2 o� 0 cn C_ 0 0 0 CD O m 0 W ca CD m V! C 0 CL CO) N m c�$o to ? x m ® 0 m n m m d n y 7 a1 d�y � �l cloa 0 m CD CO) O, Dl ZS.ca O y ED-COO COD a� CL ..... CD O N a CL go y ' cr CL C O. �W cc ® o T'. y CA a O 1 O m O C C oma: irp �oCD. C o � CO) o m ' o ^' C C o CD a3 � .� y CD o co m d nom• C7 n C. p :• .-r O C O � O O CD O . Cn 5 . CA rB b7 p V ?I O 'Jd O '�7 p (�J 7d O ^ GO ',{f p 7d O. ?1 n O 'rf rO Cn to al O 7d v z O 0 A. H 0 9 O C (D The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston, MA 02I11 UF www.mass.gov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): SU %�/ ✓�+^ /irn fYiry k1 f �C� /w! Address: a2 % M; d /d 11 ce S/_ City/State/Zip: (-i�Wr.P n <'-l. /-I/)- Phone #: Are you an employer? Check the appropriate box: 1. [11 am a employer with / 4. ❑ I am a general contractor and I employees (full. and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. t 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.] 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.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12. ❑ Roof repairs 13.©"Other V.I vy /17 *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. T Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit 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. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: j/ !< 4 Policy # or Self -ins. Lic. #: w& O©d 7 V 33 75-.- Expiration Date: Job Site Address: 9Z /10ed', ST N- /t�v DD VF, /7 %1 City/State/Zip: O/,P 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 DTA for insurance coverage verification. .I do hereby certify under the pains andpenaldes ofperjury that the information provided above is true and correct Signature: ,LFrp .6) Date: 7- 119' 19 - // Phone #: g 7<?_ w/ 4Z -- 6 Y_// 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 4. e Of t!29jvi�. or'suur r a A rr 041E I&Ip e A JI irs Re6jsj, .. ROVE/ , WEIV a - Slaess ratioqt T. — TOR "101ration, -M4 10 — CONT C 40z 7 , v,4 U'2012 YPLA.ytt N 6 ANT, -42�::t, BA D Robrt Sullivan V -- L aWr6 n ce -4- 0--- 4 3< Ivn CC ret qry no ill*(] oI- Ijtats _ t P., .:qonst fruiation, ructi6 ct� , r) Su S 'In(I St License: CS 11 S1. erviso! pe -c Restricted to: 100955"�ItY Licen WS Se :ROBERT SULLIVAN 27 A41L)N. STREET LAWRELAN6E, A4A01•841 6)(Pirati on: 41y2012 100955 ACORD W. CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 07/19/2011 PRODUCER Phone: (978) 475-0400 Fax: (978) 475-2171 THE HOWE INSURANCE AGENCY THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 4 PUNCHARD AVE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ANDOVER MA 01810 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY EXPIRATION DATE MM/DD LIMITS INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Penn America Insurance Company EACH OCCURRENCE ROBERT SULLIVAN INSURER B: Granite State Insurance Company COMMERCIAL GENERAL LIABILITY CLAIMS MADE I X OCCUR DBA SULLIVAN ANTENNA & ALARM 27 MIDLAND STREET INSURER C: - INSURER D: g 100,000 LAWRENCE MA 01840 INSURER E: A CUVEKAGE5 THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSRLTR INSRADD' LTR �INSRf) TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE DATE MM/DD/YY POLICY EXPIRATION DATE MM/DD LIMITS GENERAL LIABILITY PAC6906451 05/19/11 05/19/12 EACH OCCURRENCE $ 1,000,000 COMMERCIAL GENERAL LIABILITY CLAIMS MADE I X OCCUR DAMAGE TO RENTED PREMISES (Ea occurence) g 100,000 MED. EXP (Any one person) $ 5,000 A PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG. $ ` 2,000,000 - --- — POLICY JECPROT LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS BODILY INJURY I SCHEDULED AUTOS (Per person) $ HIRED AUTOS NON -OWNED AUTOS _ BODILY INJURY (Per accident) $ F-1PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT_ $ _ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESS / UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC002502894 05/10/11 05/10/12 WC 1 TORYTLIMITS I OTHER -- E.L. EACH ACCIDENT $ 100,000 $ 100,000 B ANY PROPRIETORIPARTNER/EXECUTNE OFFICER/MEMBER EXCLUDED] E.L. DISEASE -EA EMPLOYEE If yes, describe under E.L. DISEASE -POLICY LIMIT $ 500,000 SPECIAL PROVISIONS below OTHER: i DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS l+tK I Wlt A I It: NULUtK CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE 1600 Osgood g North Andover, MA 01845 EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. Attention: AUTHORIZED REPRESENTATIVE r/ vlq ouiS AGUKU 25 (ZUU1/US) certificate # 7876 © ACORD CORPORATION 1988 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. 1lviucuwuGr MiLurlilatlun Contractor Information Name 4 Company Name v / 0 Ge v / �J /�i %t n /�7�Pf7/j Gtr 7- Street Address (do not use a Post Office Box address) Contractor/ Salesperson/ Owner Name 72- I'l?a Y S 1- City/Town State Zip Code Business Address (must include a street address) /v . /9•viI0u,-'.? /YA a 7 �; O� �•vd SyL. Daytime Phone Evening Phone City/Town State Zip Code Gi'3G✓re r ,- 1:�p / -e V / Mailing Address (It different from above) Business Phone Federal Employer D or S. S. Number Law requires that most home Home Improvement Contractor Reg. Number Expiration date improvement contractors have a valid registration number 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 sheet5 if necessarx.) V"' vl"'► rD v P rA --e Required Permits - The following building permits are required and will be secured by the contractor as the homeowner's agent: (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of MGL chapter 142A.) Proposed Start and Completion Schedule - The following schedule will be adhered to unless circumstances beyond the contractor's control arise % / q ^ / 1 Date when contractor will begin contracted work. f /':7I ' i t Date when contracted work will be substantially completed. 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: $ 0?430-000upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater) $ Z/ 300, D�by _/ / or upon completion of SD 11/0 $ �%U�(JUby _/_/ or upon completion of 7 `T.f/ �7"d $ 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 to meet the completion schedule.(**) $ to be paid for $ 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 bein provided by the contractor? YJ No ❑ Yes tall terms of the warranty must be attached to the contra 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 Irri rovement 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 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. eof;DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! o 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. Homeowner's Signatu Contractors Signature Date -7-19-11 7 Date 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 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 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 http://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 hnp://www.inass.pov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: hM:Hdb.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