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HomeMy WebLinkAboutBuilding Permit #454-11 - 940 JOHNSON STREET 11/30/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: q—J( Date Received Date Issued: v IMPORTANT:Applicant must complete all items on this page LOCATION q�t0 -rp �.I N f plo j r12e L`� /�61L1 J j�rv�� Print PROPERTY OWNER C � L ` Print MAP NO:1U =/ ARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Vone family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial "epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other C Floodglairi ®hWetlands `0.�WatershedlDistnct Water/Sewer - DESCRIPTION OF WORK TO BE PERFORMED. Identification Please T e or Print Clearly) } OWNER: Name: T � Lo � Phone: IV17f�"��j - I/77f Address: y wf�w SJ7�l`t-`7� M/yll CONTRACTOR Name: � n � / Phone:t/a,0-3 ,.—1 ry 3 J Address: • 5 kv1/V1e - It viv P)- 9j9ki) „/ A/)� d 3 9--/ Supervisor's Construction License: C,S '9-3'7'7 3 Exp. Date: i Home Improvement License: ��Ct. �h 2713 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Y - Check No.: �( -1 Receipt No.: ,� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owne..: __gnature of contract r< Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools • ., �' Tanning/MassageBody Art ❑ 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 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 2008 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. II 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 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit n all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals hat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording lust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi Location No. Date MaRT� TOWN OF NORTH ANDOVER a a y e Certificate of Occupancy $ ��s•�n°'�tA Building/Frame/Frame Permit Fee $ s,KMuse 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1-124 Check # T-` 23749 Building Inspector ORTH TO" of oAndover . over, Mass. O COC K ICK.WICKG �d ORATE D PPa,C�J 7 S BOARD OF HEALTH Food/Kitchen .PERM I T T D Septic System a BUILDING INSPECTOR THIS CERTIFIES THAT .................... /+6. .. �......... Foundation ........... /l has permission to erect........................................ buildings on ......�.'. �d /7�4/7 Rough to be occupied.as....5....... .................�'....................../e .1�2�f I -1 Chimney .. ..provided that the persona opting this permit shall in every conform to the terms of the application on file 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 PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUC ST TS ELECTRICAL INSPECTOR 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 Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. IF SEE REVERSE SIDE Smoke Det. Ti ORREY PAINTMIG C C0XTRA ''.6LG .t, Tc7my JOB ESTIMATE 5 Squirrel Run Rd. PLAISTOW, NH 03865 (D4�ce: (603) 3€32-8431 PN� E cJ ' '' ���• t �/1 Wl: (303) 234-8090 JOB NAME/LOCATION TO c r JOB DESCRIPTION: ......................................................................................................................................................................................................... ................................................................................................................................................. .'.�..n...............�.�..........._......._ .............................._ ...... ........................................_................___.._-........... ____-_ ..- ....... f `........... ............ .. .. 4C'• ......_...... ....r,�/.......-..lel. 6s� .................................... t .............. ............ ............. .......... �r� .......... ......... .. _c � __ . .......................................................................................................................................................................................... rA ' '_ ................... .............. --------------------------------------------------- .................................................................................. ... .. .......................................................................................................................................................................................................................................... ............... ................ ................. ... ... .................................................................................. ..... ....................... ....................................... ..... . .................................. .............. --:. ................................................................................................................... ................... ............................................................................................... ............................... ------------------- -- ............................................ . ...... ............................................................... - ......................................................................................... ............... ............................................................................................................. ... .... ... ............... ............................................................................................................................................................................................... ---- ----- - ------------------------------------------------------------ .................................................................................................................... ............ ........ ................................................................................................. ............................... THIS ESTIMATE IS FOR COMPLETING THE JOB AS DESCRIBED ABOVE. ESTIMATED IT IS BASED ON OUR EVALUATION AND DOES NOT INCLUDE MATERIAL JOB COST PRICE INCREASES OR ADDITIONAL LABOR AND MATERIALS WHICH MAY BE REQUIRED SHOULD UNFORESEEN PROBLEMS OR ADVERSE ESTIMATED WEATHER CONDITIONS ARISE AFTER THE WORK HAS STARTED. BY / The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information /1Please Print Legibly Name(Business/Organization/Individual): Address: S l�ly lJ City/State/Zip: 5)V w 4V Phone Are ou an employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.? 7• ❑Remodeling . ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its ' officers have exercised their 10.❑Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12. Roof repairs insurance required.] employees.[No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box 41 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. lContractors 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: / + b� �— �_ l LS'�G ( �' �v Policy#or Self-ins.Lic.#: kA L� J �7 7Z 9S Expiration Date: 0 6 n I �^ V/31 Job Site Address: ► ht/V 3 b YV 5)YCC -City/State/Zip: /y !'v V '1 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 verificatiom f do hereby certify hepains andpenaldes ofperjury that the informadon'providedabove is true and correct. Date: Signature: p Phone y D G/ 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): Y.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectricaI Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MM/DD/YYYY) �Rv® CERTIFICATE OF LIABILITY INSURANCE OP ID ST 11/26/10 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: if the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER WN I AU I NAME: PHOE FAX THE JOSEPH S. HILLS AGENCY INC A/CNNo,Ext): (A/C,No): 129 MAIN STREET, PO BOX 300 ADDRESS: PLAI STOW NH 03865-0300 CUSTOMER ID#: TORDBAl Phone:603-382-9211 Fax:603-382-3387 INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: NGM Insurance Company 14788 Jeffrey Torrey dba INSURER B: Torrey Painting & Decorating 5 Squirrel Run INSURERC: Plaistow NH 03865 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 10-003 REVISION NUMBER: 001 THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY MPJ37725 06/01/10 06/01/11 PREMISES(Ea occurrence) $ 500,000 CLAIMS-MADE ❑X OCCUR MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 POLICY[XI PROJECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIRED AUTOS (Per accident) NON-OWNED AUTOS $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKERS COMPENSATION WCJ37725 06/01/10 06/01/11 WC—ST—ATT-7— H- AND T U- AND EMPLOYERS'LIABILITY Y/N TORY LIMITS I ER ANY PROPRIETOR/PARTNER/EXECUTIV� /A E.L.EACH ACCIDENT $ 100000 OFFICER/MEMBER EXCLUDED? Y (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500000 T-1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) PAINTING Sole Proprietor exclusion applies on the workers compensation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TAYLORC THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN Carroll Taylor ACCORDANCE WITH THE POLICY PROVISIONS. 940 Johnson Street North Andover MA 01845 AUTHORIZED REPRESENTATIVE � °7J ©1988-2009 ACORD CORPORA ION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD Atmomme Massachusetts- Department of Public Safety: Board of Buildin« Construction Sup ul�itions a°d Standard,~ License: CS Pervisor'License Restricted to: 00 93873 JEFFREY TORREY 5 SQUIRREL RUN RD 's PLAISTOW, NH 03865 ('ununis�iuner Expiration: 9/29/2011. --— Tr#: 7205 Board or Building Regulation and Standards i HOME IMPROVEMENT CONTRACTOR I = Registration: 162713 Expiration: 4/6/2011 Tr# 282577 I Type: Individual JEFFREY TORREY JEFFREY TORREY 5 SQUIRREL RUN RD PLAISTOW, NH 03865 ""` Administrator • s • 4�. Y •.•'yeb�A��1� � ��� 1 ��,�ry���IJ�Y O, ly. .y �\ Y-�j� •� ILI if _ r w � � ... _w � � �:� +,.a r ...°• �4` lj' + .V, Gia s + E N ,/ h � • ' 4a5'W w�y1 .fi I :,tayypi � 4• V t 4 - two-WOWawsom"m r ;} t .44.1!In ,.� ,'�:'. rJ1Hr"�r.rj�r `J9v"� vl��rl i�J�J •���,�, `•, y's - «�„ / i -Y, �'"y �O'7���/j���'Ncf,�/u�.•.�y � 'R�?A.•w���iVi4 L "' ! �. 4 � f. c /�4j a a` l• `� �; y F .. - �. ���•i tt'�``,i ty'., �, 'r�"y���-�f 'i ;,INV >r't ••N�������V� Af -fai ' . Y � fw•- - 4 0,; r, jy t F v "•�NJ �3 4' fi .fir•`' � { :� v i Ty�r- , a 'A - - + >r :..���1=AS`s - , G r"fi �.. �;a,;�*... C •�..�:. Contract Torrey Painting and Contracting 603-382-8431 office 5 Squirrel Run Road 603-234-8898 cell Plaistow, NH 03865 MA CSL # CS 93973 MA HIC # 162713 Fed Tax Id # 04-2908762 Name: Address: D -<bHAISO 57&4 G Town/State/Zip Code: Ah of�- DA vor2 , v V 6 Daytime Phone: l f 1 y.3 % ` 37'7 Evening Phone:'` I agree to do the following work for the homeowner: See Estimate. I agree to secure all required building permits and act as the homeowner's agent. Proposed Start and Completion Schedule: 45date when work will begin. f� date when work will be substantially completed. Total Contract Price Payment Schedule: 1/3 due at start of work.Balance due upon completion. Special order items must be paid in advance: $M`MY-for Notes: MA Law states that any down payment required by the contractor can not exceed 1/3 of the total cost of the job, or the total cost of special ordered items. I agree to be responsible for completion of the work described in the estimate. I agree to be responsible for all payments to subcontractors and suppliers. Warranty: No Yes Terms: Contract Acceptance: Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract does not imply that any lien has been placed on the residence. • Please read and understand all terms of this contract before signing. • Please verify that the contractor has a valid Home Improvement Contractors Registration. • Please verify that the contractor has the proper insurance to perform the work. 9 Know your rights and responsibilities. Read the information on the following pages. You may cancel this agreement provided that you contact me in writing,no later than midnight of the third business day following the signing of this contract. DO NOT SIGNTHIS ONTRACT IF THERE ARE ANY BLANK SPACES. Homeowner's si a e Date Contractor's si a Date �l i 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 p 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 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: P , 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 the Better Business Bureau(508)652-4800(508)755-2548.