HomeMy WebLinkAboutBuilding Permit #612 - 996 SALEM STREET 5/12/2009Permit NO:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
3? �':::��•_ �_ "• a o�
°;
Date Issued: 2 "
IMPORTANT: Applicant must complete all items on this page
LOCATION 15110105 S7
Print
PROPERTY OWNEmoi'
Print
MAP NO: /y PARCEL: f �`f ,ZONING DISTRICT Historic District yes no
'Machine Shop Village ves no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
4,61160%9(-- Re-, Roo /--
Identification Please Type or Print Clearly)
OWNER: Name: %rU �0/'� uJ �f// ,/ a101/ �� Phone:
Address:
CONTRACTOR Name: v- av A(,S)q , <=v 3&Avs Phone
Address: I�G+cS/ S /l'�I,,dl%r
Supervisor's Construction License: 62- Exp. Date.: 6ZL
9
Home Improvement -License: c Exp. Date;. %
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDINGSERMIT. $12.00 PER v000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ y�� FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have. access to the guaranty fund
■
I
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work.
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to' issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o 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 Application
Revised 2.2008
Location
No. —1:5
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
CH Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check # 211
2 2 Al
Buildin'glinspector
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Massachusetts - Department of Public Safety
Board of Building Reputations and Standards
� Cons#niCt bnn,Supervisor License
�&e-n'se; CS 22680 '��'
Restricted.to•_00
,'ARTHUR J WALSH JR
1
%55 PLEASANTtST + ,
1N,ANDOVER, MA 01845 ' '=
Expiration; 6/9/2010
C omnii",�ioncr t Tr#` 27002
f
71, �omvmo�uuea�i o�✓�aaaac�ivaelld
Board of Building Regulatiobs and Standards
HOME IMPROVEMENT CONTRACTOR
Registration c: 103358
Expiration:=7/7/2010 Tr# 271352
jType='Private Corporation
A. J. WALSH & SONS,INC.A="�j
Arthur Walsh,Jr. Aff,€'
55 Pleasant St _ r
N Andover, MA 018454 � �
Administrator
The Commonwealth of Massachusetts
--; Department of Industrial Accidents
Of
fioe of Investigations
600 TfWshington Street
4 %r Boston, MA 02111
.. .. wwwanass.g ovldia f .
Workers' Compensation Insuranee Affidavit: Builders/Contractors/Electricians/Plumbers
pylicant Information Please Print Ledbiv
ame (Business/Organ= izationfindividual); -Y
ty/State/Zip: M &Y gymnk ,f Phone W: 9 %ir —40 - 67-V
rqd an employer? Check the Appropriate box:
I am a employer with
4. 1 am a general contractor and I
employees (full and/or part-time).'*
have hired the sub -contractors
I am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
:"hese sub -contractors have
working for me in any capacity,
employees and have workers'
[No workers' comp, insurance
comp. insurance.=
required.]
5. % are a corporation and its
j I am a homeowner doing all work
officers have exercised their .
myself [No workers' comp,
right of exemption per MGL
insurance required.]t
C. 152, §1(4), and we have no
employees. [No work-ers'
comp. insurance required,l
Type of project (required):
6. ❑ New construction
.7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building -addition
10. F-1 Electrical repairs or additions
11.❑ Pl g repairs or additions
12. oof repairs
13.❑ Other
pplicam that checks box n i must also fill out the section below shoving their workers' compensation policy information.
;o -ers who submit this affidavit indicaning they are doing all work: and then hire outside contra-mrs must submit anew affidavit indicating such.
iwtor; that theel. this box must attached an additional sheet showing the name of the sub•contraetdr5 and "state wheth,,T oT not those entities have
ees. if the subcontractors have employees, they must provide their workers' comp. policy number.
in employer that is. providing ivoricers' compensation insurance for my einplovees. Below is the poligy and job site.
'ration._ �� p
lice Company Name: H of Opys
rr or Self -ins. Lic. #; %0/eW i�6 `2-00 Expiration Date:
to Address_ City/state/Zip: ")Yee4 ( 9Pe1,E
I a cope of the workers' compensation policy declaration page (showing the policy number and expiration date).
to secure coverace as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
o 5250.00 a day against the violator. Be. advised that a copy of this statement may be forwarded to the Office of
nations of the DLk for insurance coveratre verincation.
:relih certify ut der the pains -and penalties ofperjure that the information provided above is true and correct
---;,�---� )ate
tial use onli!. Do not write in this area, to he completed by city or town official.
or Town:
Permit/License ;r
ng Authority (circle one):
lard of Health 2. Building Departmeut 3. City/Town Clerk; 4. Electrical Inspector 5. Plumbing Inspector
Hier
ak Person:. Phone 9:
Massachusetts Home Improvement Sample Contract
This form satisfies all basic requirements of the state's Home Improvement Contractor law (MGL chapter 142A), but does not include standard
language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"a
Massachusetts consumer guide to home improvement" before agreeing to any work on your residence. You may obtain a free copy by calling the
Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888.283-3757.
Homeowner Information
Contractor Information
Name
`
Company Name
/� &i& -l'.�
Street Address (do not use a Post Office Box address)Contractor/
sperson/ Owner lame
Ciwlrmvo State Zip Cade
siness Address (must m 1 a sveei address
Daviume Phone Evening Phone,
ity/Tow/d State Zip Code ry'yJ
Mailing Address (it different from above)
Busiiess Phone ederal Employer ID or S.S. Number
law regmms roar matt Lameim
Home ^tr:nw!mwt Ce•:� cterae�. TiLT.lher fizpuxtiou dalc
twzvnwt covaacien Fazex
•aad rcpisvaticn n�cnFv
/
� � a L��
The Contractor agrees to do the following work for the Homeo
ner:
gLje%mneiTtUEEMIUlEWOrKtOCOtDOICLCLLSI]eClIVIOLUICIVDt!.nraria.anu2raueoImatenaisio
MUM.use
nauflionalh s h a •. t i
i�1���W�
Required Permits - The following building permits are required
and will be secured by the contractor as the homeowners agent.
(Owners who secure their own permits -Mll be
excluded from the Guaranty Fund provisions of
MGL chapter 142A.)
Proposed Start and Completion Schedule - The following schedule will
be adhered to unless circumstances beyond the contractors control arise
when contractor will begin contracted work.
when contracted work will be substantially completed.
i otm contract rnee one raymenr ncneeme
The Contractor agrees to perform the work, furnish the material and labor specified above for die total sum of:
ments will be made according to the following schedule:
0�
S�% upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater)
S 77 ---by _ _ _ ^r upon completion of
S by -7 --- _/o�upon completion of
S (J V n upon completion'of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction)
The following material/equipment must be special S to be paid for %r
ordered before the contracted work begins in order S to be paid for
to meet the completion schedule.(•*)
NOTES: (*) Including all finance charges(**) Law requires that any depositor down -payment required by the contractor before work begins may
not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material
which must be special ordered in advance to meet the completion schedule.
Express warrant - Is an express warranty being Provided by the contractor? No Yes tall terms of the warranty must be attached to the contract)
Subcontractors -The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third
panyisubcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for
materials and labor under this agreement
Contract Acceptance - Upon signing. this document becomes a binding contract under Imo. unless otherwise noted within this document. the
contract shall not imply that any lien or other security interest has been placed on die residence. Review the following cautions and notices
carefully before signing this contract.
• Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if somedhing is unclear.
• Make sure the contractor has a valid Home IranmvcmentContractor Registration. The law requires most home improvement contractors and
subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor
registration by writing to the Director at 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 Information on the reverse side of this form and get a copy of the Consumer
Guide to the Home improvement Contractor Law.
You may cancel this agreement if it has been signed at a place other than the contractors normal place of business, provided you notify die
contractor in writing at his/her main office or branch office by ordinary mail posted. by telegram sent or by delivery, not later than midnight of the
third business day following the signing of this agreement. Seethe attached notice of cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES'.'.'.
Two identical copra ortht wnpact must M completed and signed.
t
tHomeown s gnature
Date
Me copy should go to the homeownv. The other copy should he kept by the contractor.
}
Contractor's Si alure
j/ b
Date
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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 1 Job #
Address /� f� � Job Location
Date // Date of Plans
Phone # ` Fax # Architect
rWe hereby submit specifications and estimates for: ............. .. ................... . ....... ...... _...__._..._._..._.__......_..___..__._.._..._____..................__....._.._....__....._._._......._._._..__...-....._..___......._......................._..
...................._........-...r� .._.. C�-1��._ 1� �, trzfi
_
....-_-_ __ _ __ _ u ___ _ - --_ _ ......_ _ _ _
- �'_.r�._. r .:.? �% ° �• ...-......._ '.....�.......... _....._... .... ... ....... ....
_ _ _ . __ _ ____ _ .......................
.ter _ -0-- ® - ♦ / _
F -�t•�- .
v
We propose hereby to furnish material and labor — complete in accordance with the above specifications for the sum of:
$ Dollars
�iC f
with payments to be made as follows:
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 f r
beyond our control. Note — this proposal may be withdrawn by us if not accepted within days.
Occeptance �Of �oogai '
The above rices, specifications and conditions are satisfactory and are
p p ry Signature
hereby accepted. You are authorized to do the work as specified.
Payments will be made as outlined above.
Date of Acceptance Signature