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HomeMy WebLinkAboutBuilding Permit #44 - 93 MAIN STREET 7/8/2010 BUILDING PERMITof "°RT"qti TOWN OF NORTH ANDOVER3� s` F r APPLICATION FOR PLAN EXAMINATION Permit NO: 1112 /p Date ReceivedPeArso � °4 � -'�• ° � Date Issued: CHU`��t�� IMPORTANT:Applicant must complete all items on this page .LOCATION �3r �-� /� f PROPERTY OWNER;J�XCA!�- / c L 7ii7Us-t n r- Pnnt � � MAP 210 G� PARCEL:ZONING DISTRICT& Historic District yes o j Machine Shop Village yes , no TYPE OF IMPROVEMENT PROPOSED USE j Residential Non- Residential New Building One family Addition Two or more famil Industrial Alteration No. of units: - t Commercials-���f Repair, replacement Assessory Bldg Others: Demolition Other -- -Flo lain WetlLs Water District titer/Sewe DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearl ) OWNER: Name: ,TyTY Phone: 5z��� Address: CONTRACTOR Name: C Phone: 47Z?- 4 1 Address:. �(> Supervisor Construction License:. , �L'�' �Q Exp. Date.: Home Improvement License: /0-3 --5.5'S" Exp. Date: _ 7 7 / ARCHITECT/ENG INEER _ Phone: Address: Reg. No. FEE SCHEDULE:BULDING PER IT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 10z) _ FEE: $ Check No.: 1q 113Jre-- Receipt No.:_ � �(�.� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner n� Signature of contractor T �� Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Taming/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 COMMENTS a HEALTH Reviewed on Signature COMMENTS Abf Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes l/� Planning board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: ocated 384 Osgood Stre FIRE'DEP.ARTMENT -Temp Dumpster on site yes no Located.at 124 Main Street ' Fire Department signature/date COMMENTS Dimension j Number of Stories: Z 0 Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: i ELECTRICAL: Movement of Meter location, mast or serum p 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 s ❑ Notified for pickup - Date i 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 I ❑ -Workers Comp Affidavit + 14indw z- 0 Photo Copy Of H.I.C. And/Or C.S.L. Licenses kl'Copy of Contract . ❑ -Fleer%n-®r Proposed Interior Work A10,0 9 _F_4eeeritigAffidavits for Engineered products Z.)©,ry i 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 1 Location !2 2r 9&el No. L Date v 110RT1y TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ ' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ �— TOTAL $ Check # 2350L Building Inspector ORTH TO" Of Andover . o .�; A No. oA K E o dover, Mass., ACOCHICHEWICK 7�ADRATED PPa,t�C� SS BOARD OF HEALTH Food/Kitchen -PERMI..T D Septic System 00, BUILDING INSPECTOR THISCERTIFIES THAT......... .. . . ...� 0U.0w..... .......................... ................................................................................ Found ation .... .......... Rough permission to erect................:..................... buildings on .... .t . ..... . ........ to be occupied.as........ �> Chimney provided that the person ac pting this permit shall in eve sped conform to the terms of the app i ation on file in Final this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final D ,r, PERMIT EXPIRES IN 6 MONTHS CONSTRU O TS ELECTRICAL INSPECTOR UNLESS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 4 SEE REVERSE SIDE h r The Commonwealth of Massachusetts Department o f Industrial Accidents Office of l_nvestie amens 600 Washington Street Boston, AL4 02111 Workers' CompensationInsurance Aff da gSS-6 ov1&a ;4oplicant Information �ft: Builders/Contractors/Electricians/Plumbers Name A��� G . .Please Print Legibly (Business/Organization/Individual): �' �L' SA `VIS0 Address: �� jam(, d �' City/State/Zip: ( J o �-I�4 (� a U f 1� 1 one#: X75" 7 7 Are you an employer?Check the appropriate boa: �- 1•❑ I am a employer with f 4. 0 I am a a Type of project(required): =eneral contractor and I 2.❑ employees(full and/or part-time).* have hired the sub-contractors ti• ❑Neur construction I am a sole proprietor or partner_ listed on the attached sheet 7. ❑Remodeling ship and have no employees These sub- contractors have ❑ working for me in any capacity. workers com . ' g' Demolition [No workers'com . ' � P insurance. p insurance 5. ❑ We are a corporation and its 9. ❑Building addition 3•(� required] officers have exercised their 10.0 Electrical r .I am a homeownepairs doing all work right of ex or additions myself. [No workers'comp, c. 152 1 Vtion per MGL .11.0 Plumbing repairs or additions insurance required.] t ('4),and we have no employees. [No workers' 1 Roof repairs comp,insurance required-] 13.0 Other arp?icaut that h bo,. i mus!aso ilii c¢!the secii ceiot+•aheY W.. 'I�omeowners who submit this affidavit indicating th- are doing ci en ire oms'corn^��_ cc +Contractors that checl;this bo..•�is a..-.he;an addinonai sheet the ��hire outside conuactoi �•;;� �yy� '• submit a new affidavit indicating such. name of the sub contractors and their worlds'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the pofi �and information. cJ fob site Insurance Company Name: ,/ Ml NS o Policy#or Self-ins.Lic. #: ExpirationDate: t� Sob Site Address:�_�� ✓^ City/State/Zip: Attach a copy of the workers'compensation policy declaration pa �Z Failure to secure coverage as required under Section 2 p g (shower the policy number and expiration date). fine up to$1,500.00 and/or one-year imprisonmco assWell NIG c. 152 can lead to the imposition Of Of up to $250.00 a da aor. t' Penalties in the form of a STOP WORKpRj and analties te Investigations of the DIA for insurance coverage verifiised cation.t a copy°f this it may be forwarded to th,Office of I do hereby c;; I under the pains and penalties o er �atm-e: J'J f P ! az the information provided ab Siove is true and correct. Phone#: r- Official use only. Do not write in this area, to be completed b citj,or town official City or Town: permitucense# FssU*v,'Authority(circle one): I. Board of Health 2.Building" rt Department 3. Cif<'/TOw 6. Other n Clerk 4. Electrical Inspector 5.PIumbRin e Inspector Contact Iverson: Phone'-. Information an_ d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is deed as"...every peon in the service of another under any contract of hire, express or implied.,oral or written." An employer is defined as"an individual,partnership,associ;3tion, corporation or otherlegal entity,or any two or more of the foregoing engaged in a joint enterprise;and including the legal representatives of a deceased employer, or the j receiver or trustee of an individual,partnership, association o:ir other legal entity,employing employees. However the owner of a dwelling house having not more than three apartmL cuts and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintcmance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such,employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the.perfoimance of public work uav:u acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contr a,_cting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors) name(s), address(es) and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers' comp ensafion insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of ins anc coverage.v o e:ra. e. Also be s g tare to sign and zd date the affidavit. The affidavit should be ret.'i urri d to the city or town that the applicauQn for the perriaIt'QZ license L4 being requested,not f.'.^.e DepETT.^;e rt.0{ Industrial Accidents.. Should you have any questions rcgardir•z e1.the l-- m ilr you aiv:�^i::.ed to obtain a workers' compensation policy,please call the Department at the numbe=r listed below. Self-insured companies should enter their self-insurance license member on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant, Please be sure to fill in the permit/license number which will be used as a reference number. In addition;an applicant that must submit multiple permitllicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under`.`Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future per-nits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or pert not relaxed to any business or commercial venture (i.e. a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would Bite to than you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and:fax_number:. The Cdammonwealtbt cif Massachusetts Depaiment of Industrial Accidents Office of Inv-estigrations 600 Win Street Boston,MA 02111 Tel. # 617-72.7-4900 eart4).6 or 1-i5—/7-MASSAA.Fp. Revised 5-26-05 Fax IT 617-72.7-7/7749 ���uJ.mass..�ov6dia MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form.satisfies-'all basic rr+quitemenis of the state's Home lmprovemera Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice If necessary.-Any peison'platmmg home improvtiments should 5tst'obtain a copy of"a Massachnsetta:cotraumerguide to home improvement"bt fore agret ing to any work on yourrestdence.You may obtain a free copy IV cal*the' . Office of Consumer:Affairs and Business Regulation's Consumer Information Hotline at617-97318787 or 1:8884283-3757. Homeowner Information contractor Information Name patty Name Rip 14- `ti c C /-9;�!:. CIC jo a Street Address(do not use a Post Office Box address) haUor/Salespnaon/Owner Name :. NS C&O t5ty/fown State Zip Cede ess Address(must include a street address) . 0j) Sr Daytime Phone Evening Phone itylfown State Zip Code---, Pyr�N OCR Mailing Address(it different from above) udnesa Phone odors!Employer ID or S.S.Numbs lav rpp6et autmpl home mr AcmehRprovamw coatrtew aeuta®be :8.Pauc•4ta- .. aoonamat havoc . msden com bar I /033s�'l. '7 . The Contractor agrees to do the following work for the Homeoner: 0- S. Required Permits-The following building peimitc 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 Data when contractor will begin cum racted work. MGL chapter 142A.) Date when contracuid .work will be subatantiaily.completed. Total Contract Price and Payment Schedule , The Contractor.agrees to perform the work,furnish the matmiai and labor specified above for thetotal sura of (') Payments will beide according to the following schedule: ' D S� upon sighing contract(not_to exceed 1/3 of the total.contmet price.Ili the cost:of speci 11 order items,whichever is.greater) S by_/ --7�"�up&completion of y $ by�or—upon completion of $ upon completion of the contract (Law forbids demanding full payment until.contract is completed to both party's satisfaction) 71e following materml/equipment must be special S � � m b�e t'd for to ma t before completion ricteds&ed weds begins is order S he oeid for to meet ftie.compietion echedule.(•*) ���— �� -i NOTES:(•)Including all faience 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 arty special equipment or custom trade material which must be special ordered in advance to meet the completion schedule. :. . Ecoids Warranty-Is fn r=pr..s-warranty bora¢provided by theontntxor+ agreesWarranty Subcontractors The contractor ags to be solely responsible for completion of the work described re gardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsrbie for all payments to all subcontractors.16r. materials and labor under this aereement Contract Acceptance-Upon signing,this document becomes a bindingcontract 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 res;dente Review the following cautions and notices this contract carefully before signing • Don't be pressured into sighing the contract Take time to read and fully understand it Ask' '" is • Make sure the contractor has a valid Hom Imnrovem r nor- questions tfsomethmg I�' The I&requites most home improvement contractors and. subcontractors to be registered with the Director of Home Improvement Contractor Regisiraiim You may requite aboutconnactor. 1-80 registration writipg to the Director atone Ashburton Place,Room 13Q1,.Boston,-MA 02108 or by Calling 617-727-3200 or _ 0.223-09393 3. . ,.. • 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 Idlprovement Contractor law. You may cancel this agreement if it has been signed at a place other than the contmetot's'normal lace of bits contractor in writing at his/her train office or branch office o p mom,provided late you notify the thrid business day following the signing of this a ordinary mail posted by telegram sent or by delivery,not laser than midnight of the. Sri g agreement..Seethe attached notice of cancellation form for an explanation of.this right O NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES!!! ?Mo' be completed andsWmd one copy should W to the .. error copy absoW be lupi by the eontranm. .. Homeowner's sl Contractor"s Si lure Date .Date Contractor Arbitrafion - 7be Home.Improvement Contractor I:aw.provides homeowners with the rightlo4nitiatean arbitration action(as an alternative to court.actroa)if they,have a dispute with a,contractor. The same fightis not automatically afforded to a. contractor,how.ever...The contractor.would have rp resolve any.dispute helsbe.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 contrac ontractor may submit the dispute to a.private arbitration firm which has been.approved by the Secretary of ec a Offic et Affairs and Business Regulation a idthe consumer shall be required to submit arbi p vM achusetts General Laws,c pter 142A. Ho s 911wit, Contractor's Sign NOTICE:'T•he signatures o parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contras . The homeownermay initiate alternative-dispute resolution even where this section:is not s aratel signedi)ythe amiss:: Homeowner's Rights A homeowner's rights under the.Home'#mprovement 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.orwarranties provided by the contractor,all goods sold in Massachusetts cant'an implied warranty of merchantability and fitness.:for.a particular purpose. An enumeration of other matters on whicithe 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 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 Tiginal cntract 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 meed 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)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 ort-800-223-0933 For assistance with informal mediation:of disputes or to register£oral complaints against a business;call: ConsiimerComplaint Section Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 Page# of pages CS # 022680 978-688-6737 HIC# 103358 A. J. Walsh & Sons or 55 Pleasant Street 1-866-AJWALSH .North Andover, MA 01845 Proposal Submitted To:, Job Name Job If lz)w Addressi!1 C � �-t/►�J /Q� lZ� Job Location4 I, /��.'J' V. a3��/ Date / 1,.,2 � 110 ��ef Plans Phone# Gj� Fax# (p Architect Wehereby submit specifications and estimates for:__..._._._._....................................._......_._.....__....._....................._..........._........--........_........._._..__.___.__.._..__..__..........._...-.----.-.-.--..........._-................_..........._..................._.._......-__.._..................................... _.........._... fir ' _ __... 1� � ...._. f'D ?o ..-..._._. � ` i__-- '...._._....... -- - ---- ..__._....._...*...... _. -%- ......_...... ......_................------- _____ _____ ------ ._..._..... __. .................� - --_ _-..... .......----. _ ._ _ __ r��_ _% -....._._�_�...h.... ._.__��-� ........ .._ l�v_�_.`...... ...- ._._....__.`. .... � ..--- _................................................__._-_ .._..._... .......__.._......_,........_.._...._._..._ . ....___._. ......_....._.__....._.. -_ --=- -_- ...._._..--- --- _._......... _...---- _ .._._.__._._.._.. . _ _ _......_ _..........._ ........ ._____-_........... _._.._ ............. ___-_-_________......- _............. -.r >' .- ._�..° ..._.. _...__..._._..._......... ..__...._... ...---.._._..._....__.._..._.__._.__....._... ..........-........._........... .............................................._............. _ ......_................_.............___ . _ .......................---.... __ __..._........................................---_._......_.................................-......._._..---.................................._... __ --_ _ -......._.................. ji- f� a a _. Oe We propose hereby to furnish material and labor—complete in accordance with the above specifications dor the sum of: $ `�`� �" '� •��`���y CO Dollars with payments to be made as follows: r 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 v beyond our control. Note—this proposal may be withdrawn by us if not accepted within days. acceptance of propood The above prices,specifications and conditions are satisfactory and areGA�yZ .►---�-� -Signatur hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. fes/ Date of Acceptance Signature �I:r..acfill NcttDq)itrtnrcnt fit' I'll hlic �, t'ct� Ruartl r,l Ruiltiin:; 1tr,!ulafiun, ;rrrt) �t:ur+l:u't!� License: CS 22680 Restricted to: 00 ARTHUR J WALSH JR 55 PLEASANT ST N ANDOVER, MA 01845 E x h i ra I ro n; 6/91 0, / t nnni i .n r r~: 27002I -\ Board of Building Regulatiohs anct Standards HOME IMPROVEMENT CONTRACTOR Registration: 103358 Expiration: 7/7/20101 Tr# 271352 Type: Private Corporation A.J.WALSH&SONS,INC. Arthur Walsh,Jr. 55 Pleasant St ` N Andover,MA 01845 Administrator