HomeMy WebLinkAboutBuilding Permit #523-14 - 93 MAIN STREET 1/7/2014Permit N0. Tl --
Date Issued: f—
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
I 1 IMPORTANT: Applicant must complete all items oil this pane I
LOCATION r/ ��/��/ S� �'�D%Y�%d (J1�lZ, 1�) I`►'`-
-�^ Pr'
PROPERTY OWNER D —�J /y r% Z Z /'—
Print 100 Year Old Structure yesno
MAP NO: &M PARCEL6045'ZONING DISTRICT: Historic District yes no
A10 Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ O"mily
❑ Addition2-Two
or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
0 Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
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tificatio Please Type or Print Clearly)
OWNER: Name: d IV7 Z. Z 14 Phone:
Address: -7 /: /IXS 7-' ' 7- d 1V/Y'oa VC
CONTRACTOR Name: /#� Phone: 97d- —<� �-cF --t� 7,32
Address:
Supervisor's Construction License: C-�D Exp. Date: (- g t
11 Home Improvement License: /Cc�� Exp. Date: 7/7/11-ARCHITECT/ENGINEER Phone: 11
Address:
Reg. No
FEE SCHEDULE: BULDING PT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
O Z�
Total Project Cost: $ FEE: $
Check No.: Receipt No.: d L
NOTE: Persons contracting with unregistered contractors do not have access to a guaranty fund
Signature_of Agent/Owner Signature of contractor
Plans Submitted 11 Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans 11
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
a
a
DATE REJECTED
x
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 & Seaver Connection/Signature & Date Driveway Permit
DPW 'Thyro Engineer: Signa
F, RE DEPARTMENT - Temp Dumpster on site
Located at -124 Main Street
Fire Departhier signature/date
COMMENTS -
ood 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 crop 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
L] Notified for pickup - Date
Doe.Building Permit Revised 2010
Building Department
The foliawing is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
u Building Permit Application
u Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
Li Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
a Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o 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 app, al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm;tted with the building application
Doc: Doc.Bui?ding permit Revised 2012
Location
Date
No. r'
Check # ��
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee sx4 l---
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
492,��
Building Inspector
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CS # 022680
HIC# 103358
Proposal Submitted To:
Address ti�
Phone # Fax #
We hereby submit specifications and estimates for:
ikopomd =
A. J. Walsh & Sons
55 Pleasant Street
,.North Andover, MA 01845
# of
978-688-6737
or
1-866-AJWALS H
Job Nam Job #
Job Location
Date Date of Plans
Architect
r /
III
We propose hereby to furnish material and labor — complete in accordance with file above specifications for the sum of:
,
J
00 Dollars
with payments to be made as follows: &4V �Q,00
/V v
Any alteration or deviation from above specifications involving extra costs will be Respectfully
executed only upon written order, and will become an extra charge over and Submitted
above the estimate. All agreements contingent upon strikes, accidents, or delays
beyond our cohlrol. Note — this proposal may be withdrawn by us if not accepted within days.
�cce�tartce o€�o�o�a� .
The above prices, specifications and conditions are satisfactory and are Signature
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
Date of Acceptance Sign Vre—
h The Commonwealth ofMassachusetts
: r Department of Industrial Accidents
= Office of Investigations
... 600 Washington ,Street
Boston, MA 02111
www. nmss.govldia
Workers' Compensation Insurance Affidavit: Build ers/Contractors/Electricians/Plurnbers
Apt21icant Information Please Print Legibly
Name (Business/Organization/IndividuaI):
Address: GyffUe/e L �' led—
/State/Zip:_A0 P)I1 0060 / g- Phone 73 %
Are y n employer? Check the appropriate box:
1. ffrl am 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.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
[No workers' comp. insurance
comp. insurance.t
required.]
5. ❑ We are a corporation and its
3. ❑ I am a homeowner doing all work
officers have exercised their
myself. [No workers' comp.
insurance required.] t
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ Ne construction
7. :modeling
8. ❑ Demolition
9. ❑ Building addition
10. F1 Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
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 state whether or not those entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am 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. #:%�/�i�, t/�Q J�.�0. /4/ Expiration Date:__�� T_ L
Job Site Address: 77��/2R cs) 7— S r� City/State/Zip: Of/142. pc?et, 1114v -
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 c unadhr the pains andpenalties erjury that the information provided above
/is true and correct.
OkIll I
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 5. Plumbing Inspector
6. Other
Cnntnet Peron- Phone #•
CS -022680
ARTHUR JWALSHJR
159A WAVERLY RJD
N ANDOVER MA 01845
06/09/2014
Office of Consumer Affairs &I us, ess Regulation
HOME IMPROVEMENT CONTRACTOR
Registration: 103358
�-�".;Expiration: 7/7/2014 Type:
Private Corporati(,
A. J. WALSH & SONS,INC.
Arthur Walsh,Jr.
55 Pleasant St
N Andover, MA 01845
Undersecretar,,
1. 1- &V 1 J 14- 1,0- m n V V V V a f, 1 LV ! 11 WV 1%n 11 V L
CERTIFICATE OF LIABILITY INSURANCE
IIV. LU7U f, 1.)
DATE (MINDDIr"
92104/2013
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
BELOW, ERTIFICATEFOF INSURANCE DOESAi 0 CONSTITUTE EXTEND, OR
1300E COVERAGE TISING INSURER(S), AUTPHORZIED
REPRESENTATIVE OR PRODUCER, AND TME CERTIFICATE HOLDER.
IMPORTANT: If the oerttflcate holder Is an ADDITIONAL INSURED, the P011Cy(Ies) must be endorsed, if SUBROGATIONIIS WAIVED, subject to
Ae terms and conditions of the policy, Certain policies may require an endorsement. A statement on this Certificate does not confer rights to the
:er lficate holder in lieu of such endorsement(s).
mue" 00775.001 ?CT
Imo
Iso & Jankowski Insurance Agency Inc W.1te, , (978 882 -SITS Na; (978)794.0313
8 Mass Ave Suite 1018
)rth Andover, MA 01845 Whaa!
)RED
thur Welsh
J Walsh 81 Sons
Pleasant Street
Irth Andover, MA 01a45
.M.
33758
)VERAGES CERTIFICATE NUMBER: REVISION NUMBER:
HIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
IDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
ERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 18 SUBJECT TO ALL THE TERMS,
XCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
TYPE OF INSURANCE
GENERAL UAGILITY
COMMERCIAL GENERAL LIABILITY
CLAIM644ADE ❑ OCCUR
EML AGGREGATE LIMIT APPLIES PER
AUTOMOBILE LIABILITY
ANY AUTO
AUTOWNED
S ED
SCHEDULED
HIRED AUTOSNON-OANEO
AUTOS
UMBRELLA LIAR OCCUR
EXCESS LIAR 17 CLAIMt3 MADE
OED I I RETENTION $
AqAryryNyyD EgMpipLOCiE9Tgpgq' ugARBILiT�Y�E� �I / �,
OFFICERIM�MBER�P&nSEII'IECUTIVE�'-'-t
(Mandatory In NH) u NIA
POLICY NUMBER
LIMITS
EACH OCCURRENCE i
'=',2r;,
AMAGE O ED =
P P IeF S IRA dei
MED EXP (Arty one person) s
PERSONAL & ADV INJURY S
GENERAL AGGREGATE s
PRODUCTS-COMP)ORAGG Is
BODILYI_ NJU_ RY (POP Person) a
BODILY INJURY (Per ecL9dent) s
et P ERTY DAMAGE s
B
EACH OCCURRENCE s
AGGREGATE $
s
AWC-400-7014848-2013A 11/1412013 111IQ2014 E.L. EACH ACCIDENT— Is 1
E.L. DISEASE • EA EMPLOYEE s 1
E.L. DISEASE • POLICY LIMIT 19 5
3RIPTION OF OPERATIONS ) LOCATIONS) VEHICLE81Anaen ACORD 101, AdOUoeai Remarks Schedule, If more apace to requtrod)
,n Of North Andover
) Osgood Street
:h Andover. MA 01845
ORD 25 (2010105)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
RP RATION. All rights
The ACORD name and logo are registered Menai of CORD rest
MASSACHUSETTS HOME IMPROVEMENT CONTRACT
this form satisfies-.ali basic rGquuements of the state's Home Improvement Contractor Law (M(JI: chapter 142A), butdoes not include standard
anguage to protecthomeowners. Seek legal advice if necessary. Any pown'planuing home irinprovements should fusf obtain acopy of"a
etts:
Massachusconsmner guide to home improvement" before agreeing to any work on yourresrdence, You may obtaina free copy by'cauing'the
)ffice of Cons°mer:Af airs:and. Business Regulation's Consumer Information Hotline at -617-9734787 or 11.:888493.3757.
itmm�nvunu.infn...weYi..... '
--- -- -- - ------ uont:racwr intormation-
ame -
PmY
Street Address (do not use a Pont Office Box addressltnutor/7espersolk/. 0VVAq Name
City/roan State Zip CbdeW.ess
Address (must include a street address) .
Daytime Phone Evening Phone ity/Towa State Zip Code
W -e 4A
Mailing Address (]t different from above)/� "4O
usiness Phone 116110111 Employer W or S.S. Number
UW mgwn W.1 heve
ahomeim•I �i/Rome tcaomddraea MamhQ :Eatmnimd�r
p?i�meeam a•s z y�� y
mrhaedw mmhrr
The Contractor agrees to do the following work for the Homeo ner:
Required Permits- The -following building pcimits are required Proposed Start add' CompletionSchedule -The fdllowiiig schedule will
and will bcsecured .by the contractor'as the'homeownees agent; be adhered W'unless Circumstances beyond the contmetot's control arise
(Owners whti;secure, their own perwitits will be
exclndedifrom the Gaaranty Flirnd`provisions of �'Tjaro when 'contractor will begin contracted work
MGL chapter 142A.) /
ate when contracted .work will be substantially completed
Total Contract Price and Payment Schedule
'1110 Contractor.agrees to perform the work, fmaish -the material and labor specified above for the total sum of (.)
Payments
/will
)bWde according to thefollowing schedule:
S V w upon.signing contract (notdb exceed 1/3 of the total.contract price, 2r the cost;of special order items, whichever is, greater)
s
Paolo, 1 by �-/=r or upon completion of
$—b or upon completion of
s 6 upon Completion of the contract (Law forbids demanding full payment until .contract is completed to both
mP P»Y's.satisfaction) . .
74e following material/equipment must be special S be paid for
ordered before the contracted workbegins is order s;!to
to be paid for
to meet the:completion schedule.(••) ✓
NOTES:(*) Including all noir exceed finance (**)Law requires that any deposit or down -payment required by the contractor before work begins may
greater of (a) one-third of the total contrset price or (b) the actual con of any special, equipment or custom made material
which must be special ordered in advance to mat the completion schedule.
Subcontractors - The contractor a o •` ° tb o e
grees to be solely responsible for completion of the work described regardless of the actions'of any thud
PAY/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 sere Ment
Contract Acceptance Upon signing, Chia document becomes a binding. contractunder.lsw. Unless otherwise noted within this document, the
contract shall not imply that any lien or other security interesI 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 reed and full understand it -Ask'
. Y questions ifsoufethiiiiig is unclear.
Make stare the contractor has a valid Hom Imorovement ontra ' R The haw
requires -03t subcontractors to be registered with the Director ofHome Improvement Contractor Re 'straticuL You mayor a improvement contractors and .
mgistratioa by writing to the Director at One Ashburton Place, Room 1301 Y qui x7-320 ontractor
1-800.223-0933.,BostoqMA 02108 orby.tmlliiig 617-727-3200 or
• 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 foim'and get a copy of the Consumer
Guide to the Home bhprovement Contractor Law:
You may cancel this agreement if it has been signed at a place other tban tine contractors 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.
thud business day following the si of this agreement . See the. attached notice of cancellation form for an explanation of.this right
D NO GN THI CONTRACT IF THERE ARE ANy BLANK SPACES!!!
o i 1 cops ofthe contract lemd and siymd, Ooe copy should o to toe
a homwwne. TheodwcopysbWWbekcptbytheeantraetor.
o wner's i
n Coatttretor's Signat'tre
r eW/ 45
Dau
•,Date
Contractor Arbitrsfion .:
The Home Improvement Contractor Law pmvides.homeowners with the right -to -initiate an arbitration action (as an
alteniative to court action) if they have a.dispute witha contractor. The.same. right is not'automatically afforded to'a.
contractor, how.ever.• ..The. contractor would have _p resolve any.dispute helshe-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,57ffi�3
tractor may submit the dispute to a.private arbitration firm which has,.been. approved by, .
the Secretary of Fac sand Business Regulation an.dthe consumer shallbe requiredpig`it s i arbi prs General Laws, cha�tcr ]42A
1
�TICMe
reContractors Signature tgn ZZs of the parties above apply to the agreement of the parties to alternative dispute resolution
initiated by the contractor::Thetomeowner.may ' tiate altanative:dispute resolution even where this section: is not
ernAfat61v Sianediw the nartiesr- .. .
Homeowner's Rights
A homeowners rights undec-ft 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 responsrble-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 ;maybe 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 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 coniractznust 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 mpy 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 deems him/herself
to be fmancially 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 ormeed: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: .
Cgnsumer Information Hotline
Office of Consumer Affairs and Business Regulation
10 Park Plaza, Room 5170, Boston, MA 02116
(617) 973-8787 or 1-(888) 283.3757
If you want to verify theregistration 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 or1-800-223-0933
For assistance with informal mediation ofdisputes or to register formal complaints against: a business; call:
Con umerComplamt-Sei-tion
Office of the Attorney General
(617)727-8400
AND/OR
Better Business Bureau
(508)652-4800
(508)755-2548
(413)734-3114