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Home My WebLink AboutBuilding Permit #540-11 - 97 WINDKIST FARM ROAD 1/19/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: U �� Date Received Date Issued: 14 —1-1 IMPORTANT: Applicant must complete all items on flus page 1 I C�/ LOCATION - Print ��NN � C � PROPERTY OWNER Print MAP NO: LD PARCEL: 3 ZONING DISTRICT: Historic District yeCUO Machine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Assessory Bldg ❑ Others: ❑ Repair, replacement ❑ Demolition ❑ Other K yFlood lam. Wetlands ';®1°Watersheci�District - ¢ r. I_.ANNater/Sewer,_--- -:_ -__ :_�._�� ::.�-�.�:=-• ,--- .._. ._._--- . _ :.--------<- �, __ z.��-i�ys.�. ��_'___.�,� �._.r_4.�:._.:.�. OF WORK TO BE PERFORMED: DESCRIPTION E OWNER: N Address: Identif�ca 'on Plea Type or Print Clearly) t—L. c t'q dJ I'1 GL e2 CONTRACTOR Name: Address: 3 Y ,�, 7 � -( 9F= 3gai - Phone: � 7 ?_' F5 7 -Ai Supervisor's Construction License: QS ?7 q1_3 Exp. Date: / / 2-Z Ll _-2- �I Home Improvement License: 1 � / � 3 Exp. Date: 17 t r ARCHITECT/ENGINEER LJ//4 Phone: Address: Reg. N FEE SCHEDULE. BULDING PERMIT, $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Tota( Project Cost: $ b, �b0 Zed FEE: $ Check No.: 5-q Receipt N NOTE: Pers contracting with unregistered contra rs nyt ,�a# access to the guaranty fund Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED iX DATE APPROVED 711 Reviewed on Signature Reviewed on Signature D Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Com 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 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. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 DOTE: 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 iat 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.Buillding Permit Revised 2008mi Location No. d Date _ TOWN OF NORTH ANDOVER /t` v I• 7O L Y ;o Certificate of Occupancy $ s�CMus <n Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # `� uilding Inspector I ? t - a 0 N U) m X m m N mm _ y d C d CO) CO) CD a Z y G.r O n� C c CL y O n C CD - d� O cc � Q G CD Co CD C CD y CL v y O O co CD � v CO) O 'vCD Z O CD CDC 0 I 6 d C c?�o m S O -•NOQ v+ C � m y = a ®'a n H CD d t7 T Z ?� cm O O1 .drt O N T1 C=L p CLm O m CD 0 > > CD n o ZS.�� W � O C = CA a a p Cc �a am c " m m c C3 o•- c a9 •: m CA O. Q CL gyC.. : ? O H m m cF co o m. O n C o �a: c� H m CD •a „« o a� .�C m ^« . o W md' a� o (A _sc o 0 0 0 = O aGc p O , d tz G �. b giO p- o Ili y 0 c The Commonwealth of Hassachusetts Department of Industrial.Accirlents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: BuildersIContractors/JElectri.ciaus/JPlulmbers Naive (Business/Organization/Individual): P Address: City/State/Zip: Nl Phone #: Are you an employer? Check the appropriate box: 1. ❑ I 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. s 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. F1 Electrical repairs or additions 11. E] Plumbing repairs or additions 12. FJ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also fill. out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hue 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 isproviding workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company N, Policy # or Self -ins. Lic. Expiration Date: Job Site Address: City/State/Zip: 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 certify under the pains andpenalties ofperjury that the information provided above is true and correct. Signature: Date: Official use only. Do not write in this area, to he 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 Contact Person: Phone usetts Hoy rovement S Ile Contrict This Form satisfies all basic requirements of the state's Home ilnprlivement'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 na ; lvi:assachusetts consumer guide to home imprpvemenf' 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 Infarmntion Hotline at 617-973-8767 or ]=888-283-3757. ,' .Homeowner Information Contractor Information . ••.�� ` v I • r �� I Pi'n I tQ��./ . g9C��T-lob tpbation ddue ��r �•• �/ ,t//'JJ x/J r f/ /��tJ,,auuMLuual �Sn MrG 1rnr+rne i J (d `� ` :J " S P z t/"' Vx-•-j (ter _ /.•" Y ` ;/ LC/1/�¢�J� � y 91 �`:Pi>tita-l�-2' -1- /�-e�'.C-�'.ee--- �--2•,t- �L�Q l._i; � /ti.4-5 ' � G-a.Gc��r••r't, ; Reg6ired.'Eernilts - The followinj building permits are required and Nyill be secured by the contractor as the homeowner's agent, (Owners who secure their own permits wiH be excluded from the Guaranty% Fund provisions- of MGL chapter 142A.) ' Praposed Start and Completion' Schedule - The following schedule will be adhered to unless circumstances beyond the contractor's control arise % Date when contractor will begin contracted work. jM� 1/ Date when contracted work will be substantially completed. Total Contract Pi•]ce and Payment Schedule , The Contractor agreer to perform the work, furnish the material and labor specified above for the total sum of d 606 , 6 i7 Payr gents will be made according to the following schedule: S___L upon signing'contract (not to exceed 1/3 of the•total contract price or the cast of'special order items, whichever is greater) by or upon completion -of S by -or upon completion of LDpob b upon completion of the contract (Law forbids demanding full payment until contract is completed to both party's satisfaction i • ) The following material/equipment must be special $ to be paid for ordered before the contracted wort begins in order 5 to boaid for to meet the completion scbedule.(**) p 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 cast of any special equipment or custom made material which must be special ardered.in advance to meet the completion schedule. - -- - r..4 terms or me warren must be aliac ed o the contract u c. ntractocS - ii orittactor agrees to be solely responsible for coinpletion of the work described regardless of the actions of any third party{subcontractor utilized by the contractor. The contractor further agrreeg to be solely responsible for all payments to all subcontractors for r materials and labor under tbisagrcement 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 limo to read and fully understand it Ask questions if something is unclear. • ' Make sure the contractor has a valid Home Improvement Contractor_R.enistration 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 One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or 1-800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Inforn' Mian on the reverse side of this form and get a copy of file Consumer Guide to the Home. Improvement Contractor Law. v You may cancel this agreement if it has been signed at a place o}fier than file 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 foliowing.the signing of this agreement Seethe attached notice of cancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical co ' o e•contractmust be completed and signed. One copy should go to fhb ho' �^ The other cop should be kgtt by the contractor. Romeo ear's Signa re f�t�� )'� Contractor's Signature Date / �v Date _Om paay� a�me,�, Coutrrbtorl Salesperson/ Street Address (do not use a Post Office Box address) OwnerNime a-IYL4e. , usm"s Address (must include a street address) City/Town Statee Nd . A.�- /44Zip cCod,If 3 c)- P Ds�- Daytitbe Phone r , Eveoing Phone ylTo State Zip Code Mailing Address (It different from above) ' Mines$ Phone I.220iegoiresthalmorthamtSim- edcral Employer ID or S.S. Nm Home provemenicamnctorReg.Ntaober b The Contractor agrees to da the'following work for the Hameo provemeat contractors have a slid registration nuroha en c in e w r - o comp e e soca e e P- Mn ner: g9C��T-lob tpbation ddue ��r �•• �/ ,t//'JJ x/J r f/ /��tJ,,auuMLuual �Sn MrG 1rnr+rne i J (d `� ` :J " S P z t/"' Vx-•-j (ter _ /.•" Y ` ;/ LC/1/�¢�J� � y 91 �`:Pi>tita-l�-2' -1- /�-e�'.C-�'.ee--- �--2•,t- �L�Q l._i; � /ti.4-5 ' � G-a.Gc��r••r't, ; Reg6ired.'Eernilts - The followinj building permits are required and Nyill be secured by the contractor as the homeowner's agent, (Owners who secure their own permits wiH be excluded from the Guaranty% Fund provisions- of MGL chapter 142A.) ' Praposed Start and Completion' Schedule - The following schedule will be adhered to unless circumstances beyond the contractor's control arise % Date when contractor will begin contracted work. jM� 1/ Date when contracted work will be substantially completed. Total Contract Pi•]ce and Payment Schedule , The Contractor agreer to perform the work, furnish the material and labor specified above for the total sum of d 606 , 6 i7 Payr gents will be made according to the following schedule: S___L upon signing'contract (not to exceed 1/3 of the•total contract price or the cast of'special order items, whichever is greater) by or upon completion -of S by -or upon completion of LDpob b upon completion of the contract (Law forbids demanding full payment until contract is completed to both party's satisfaction i • ) The following material/equipment must be special $ to be paid for ordered before the contracted wort begins in order 5 to boaid for to meet the completion scbedule.(**) p 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 cast of any special equipment or custom made material which must be special ardered.in advance to meet the completion schedule. - -- - r..4 terms or me warren must be aliac ed o the contract u c. ntractocS - ii orittactor agrees to be solely responsible for coinpletion of the work described regardless of the actions of any third party{subcontractor utilized by the contractor. The contractor further agrreeg to be solely responsible for all payments to all subcontractors for r materials and labor under tbisagrcement 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 limo to read and fully understand it Ask questions if something is unclear. • ' Make sure the contractor has a valid Home Improvement Contractor_R.enistration 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 One Ashburton Place, Room 1301, Boston, MA 02108 or by calling 617-727-3200 or 1-800-223-0933. • Does the contractor have insurance? Check to see that your contractor is properly insured. • Know your rights and responsibilities. Read the Important Inforn' Mian on the reverse side of this form and get a copy of file Consumer Guide to the Home. Improvement Contractor Law. v You may cancel this agreement if it has been signed at a place o}fier than file 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 foliowing.the signing of this agreement Seethe attached notice of cancellation form for an explanation of this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM Two identical co ' o e•contractmust be completed and signed. One copy should go to fhb ho' �^ The other cop should be kgtt by the contractor. Romeo ear's Signa re f�t�� )'� Contractor's Signature Date / �v Date Contractor Arbitration The Home Improvement Contractor Law provides homeowners with•the right to initiate an . alternative to -court action) if they have a dispute with acontractas a or. The same right arbitration action is not automatically afforde contractor, however. The contractor would have to resolve any dispute he/she to a' has with a homeowner in court unless both parties agree to the optional clauseprovided below. This clause would give the contractor the §8me right to arbitration anis afforded to the homeowper 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 apprpved.by the Secretary. of the- Executive Office -of Consumer Affairs and Business Re ation and the sumer shall. be required to submit to such a itration as provided In Massachusetts General Laws, ap r 142A H'omeowner's Signature Contractor's Signature NOTICE: The signatures of the parties above apply only to the agreement of the parties. to alte, tive dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where is 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 is 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 area automatically excluded from all Gua*mnty.Pund provisions of 'the Home Improvement Contractor Law. The contractor is responsible for completing the work as described, in a timely and workmanlike manner. Homeowners maybe entitled'to other specific ipgal rights if the contractor guarantees or provides an express warranty for workmanship or in In addition to guarantees it warranties racprovtor outsd,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 term's of the contract as long as they do not restrict a homeowner's basic consumer nights. If you have questions ab6ut Your consumer/homeowner rights, contact the Consumer Infoiznation Hotline (listed below). Execution of Contract ,. The contract must be executed in dulicate and should not; be signed u documentsntil•a copy of all exhibits and referenced have been•attached. Parties are.also advised nut to sign the document until all'blank sections have been fitled.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 co of the contract,. and the three day recission period has expired. py Accelerated Payments A contractor may not demand'payments in advance of the dates specified on the payment schedule in cas homeowner deems him/herself to be financially insecure. -However,. in instances es where the where a contractor deems 'to be financially insecure, the contractor mtiy require that the balance of funds not yet due be placed tri a joint a/crow np liim/lierself account as a prerequisite to continuing the contracted worl� Withdrawal of funds froW said account would require the signatures ofbothparties. Additional ,Information If you have general 'questions or need additional information about the Home Improvement Contractor Law o consumer rights, orif you wish to obtain a free co r other Law," contact; Py. of °•F� Consumes Guide to the Home Improvement Contractor 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 4 If You want to verify the registration bf a contractor or if you Have queStloilS Or need aadlCi0n81 l about the contractor registration component of the Home' Improvement Contractor L ' nformation specifically Law contact: Director of Home Improvernenf Contractor Registration Bureau of Building Regulations and Standards One•Ashburtoin 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, usiness, call: Consumer Complaint Section Office of the Attorney General ' (617) 727-8400 AND/OR Better Business Bureau (508) 652-4800 .(508) 755-2548 (413) 734-3114