HomeMy WebLinkAboutMiscellaneous - 103 PEMBROOK ROAD 4/30/2018Location 103 C;-, A2
No. V/ / Date O -V
"GRT" TOWN OF NORTH ANDOVER
Certificate of Occupancy $
CH 9
c�' Buildin /Frame Permit Fee $
s�ust
z
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ v�
Check #17028
_ � Building Inspector ��
TOWN OF NORTH ANDOVER
` BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR, RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
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BUILDING PERMIT NUMBER:f j DATE ISSUED:
7 �o
SIGNATURE:
Building Commissioner/I for of Buildings Date
SECTION 1- SITE INFORMATION
1.1M1 Property Address:
1.2 Assessors Map and Parcel Number:
Map Number Parcel Number
da /�
1.3 Zoning Infgorm�ation:
1.4 Property Dimensions:
Zoning District Proposed Use
Lot Area Frontage ft
1.6 BUILDING SETBACKS ft
Front Yaid Side Yard
Rear Yard
Required Provide Leq±ed Provided
R red
Provided
1.7 Water Supply M.G.L.C.40. 54) 1.5. Flood Zone Information:
Public ❑ Private ❑ Zone Outside Flood Zone 0
1.8 Sewerage Disposal System:
Municipal ❑ On Site Disposal System ❑
SECTION 2 - PROPERTY OWNERSHIP/AUTHORIZED AGENT
2.1 Owner of Record
U p'1 V"i Gl"� �-.-�5 163
Name Aiddress for Service
j(I,'nt)
% v �i6g FS
Signature ff Telephone
2.2 Owner of Record:
Name Print Address for Service:
Signature « Telephone
SECTION 3 - CONSTRUCTION SERVICES
3.1 Licensed Construction Supervisor:
Not Applicable ❑
Licensed Construction Supervisor:
License Number
& /1 /7
(/
Addr s
Q % 2,
Expiration Date
Signature Telephone
3.2 Registered Home Improvement Contractor
Not Applicable 0
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/�3 3
Company me
s/
Registration Number
AddMs [ -67,37
Expiration Date
Signature Telephone
SECTION 4 - WORKERS COMPENSATION (M.G.L C 152 § 2506)
Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result
in the denial of the issuance of the building permit.
Signed affidavit Attached Yes .......❑ No ....... ❑
SECTION 5 Description of Proposed Work check au applicable)
New Construction 0
Existing Building ❑
Repair(s)
❑
Alterations(s) ❑
Addition ❑
Accessory Bldg. 0
Demolition ❑
Other ❑ Specify
Brief Description of Proposed Work:
G �
SECTION 6 - ESTIMATED CONSTRUCTION COSTS
Item
1. Building
Estimated Cost(Dollar) to be
Completed b permit alicant
�3FFICIA)(.
(a) Building Permit Fee
I Multi Tier
USE ONLY
M
2 Electrical
(b) I Estimated Total Cost of
Construction
p a U @ 0
0
3 Plumbing
Building Permit fee (a) x (b)
P( 2
4 Mechanical HVAC
5 Fire Protection
6 Total 1+2+3+4+5
Check Number
SECTION 7a OWNER AUTHORIZATION TO BE COMPLETED WHEN
OWNERS AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT
I, as Owner/Authorized Agent of subject property
Hereby authorize to act on
My behalf, in all matters relative to work authorized by this building permit application.
Signature of Owner Date
SECTION 7b OWNER(AUTHORIZED AGENT DECLARATION
I, ,as Owner/Authorized Agent of subject
property
Hereby declare that the statements and information on the foregoing application are true and accurate, to the best of my knowledge '
and belief
PAL g
Prilam
>i%����t
Si ature of Owner/ ent
Date
NO. OF STORIES
SIZE
BASEMENT OR SLAB
SIZE OF FLOOR TINMERS 1 ST2ND
3RD
SPAN
DM4ENSIONS OF SILLS
DEV ENSIONS OF POSTS
DIlvIENSIONS OF GIRDERS
HEIGHT OF FOUNDATION
THICKNESS
SIZE OF FOOTING
X
MATERIAL OF CHIMNEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
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BOARD OF BUILDYNG`REGULATIONS
r t fr c License CONSTRUCTION, SUPERVISOR.
Number *GS 022680 '
Birthdate U6I09/1939 �
{ pees 06!09/2004 Tr nb 26824 k
Restnctec� b0 iE
ARTHUR J WALSti
55 PLEASANT
N_ANDOM R, MA'.01845 °
—Administrator
�' �
�' � ✓iie V� a7z�no�rr,�uea�ii � `'�ivat� �l
Board of Building Regulations and Standards
F4 ' HOME IMPROVEMENT CONTRACTOR
e 43 r
Registrations 103358 r '
E_- Type: PnvateCorporation '
t A. J.. WALSH &SONS INC 1
Arthur. Walsh Jr.
55 Pleasant St��;
N AAndover, MA -,0184,5,-,,
,Administrator
North Andover Building Department.
Tel: 978-688-9545
r
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
Number is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by MGL
c11,S150A.
The debris will be disposed of in:
(Location of Facility)
Signature o Permit Applicant
..1
_ Date
NOTE: Demolition permit from the Town of North Andover must be obtained for
this project through the Office of the Building Inspector
F
/JN."
The Commonwealth of Massachuseas
Department of Industrial Accidents
office Offnuestigatiolls
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
location: G3 LI '
❑ I am a homeowner performing all work myself.
❑ I am a sole proprietor and have no one working in any capacity
❑ I am an employer providing workers' compensation for my employees working on this job.
I am a sole proprietor,
the following worker.,
one years' imprisonintut.as well as civil penalties in the form of a STOP WORK ORDER and a fine of 5100.00 a day against me. I understand that a
copy of this stateiaeut may be forwarded to the Office of investigations of the DIA for coverage verification.
I do hereby certi xmder the pains and penalties ofperjury that the information provided above is truce and correct
Signature — Date
Print name 2 ��'i/ �.�% % %� /2 Phone# % �o kk —6-73 7
(official use only do not write in this area to be completed by city or town official
city or town: permit/license # OBuilding Department
[]Licensing Board
0 check if irnwAAiate response is required oSelectmen's Office
oHealth Department
contact person: phone #; —Other
(`evised 3/95 PJA)
A.J. Walsh & Sons Inc.
55 11Icasunl S(rccl
North A ndovcr, MA 01845
,\Liss. LICENSE d 0226811
Mass. RlicilSTltATION n 10.3.359
RESIDENTIAL CONTRACTING AGREEMENT
Read this agreement and make sure you understand it before signing it.
This agreement has legal force and effect and binds those who sign it.
Notice: All home Improvement contractors and subcontractors engaged In home Improvement contracting, unlessspecifically
exempt from registration by provisions of Chapter 142aofthe general laws, must be registered with the Commonwealth
of Massachusetts. inquiries about registration and status should be made to the Director, Home Improvement
Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108.
Designated Registrant's Name:
Registration Number:
Salesperson's Name.
This agreement is made on 1 '�
of 5YY1�I/��YLA
hereinafter called "Contractor" and
-e- Vm, ,/ �7�k l 0
(ADDRESS)
hereinafter called "Owner".
DETAILED DESCRIPTION OF WORK TO BE PERFORMED
(COWMACi�`O77R)f�
—,o Cil %, �� /�7j —7
,2
�.S9`(o/' •G..���E2�:ics�zy "6�" /�/ 010 11 aFJt)
(DWNFJt)
(PRONE NUMBER)
DETAILED DESCRIPTION OF MATERIALS TO BE USED
Materials to be used in perfo tng thea j` e d$ 'bed w�o9k consist o the following: / //
,tom (Z cf% %GL(P,�'1 z f�f c1� DiZ ! ) -411.i 4( x2e"hil%
I.I. PRICE 00
Contractor agrees to do all work described in Section I for the total price of S OC�P64,1.
111. PAYMENT
Payment will be made as follows:
[33 1l1-1 % (S 0 f -upon signing Contract;
r `jo (S pon completion of
upon completion of
' / _�
and the remaining e �'a ($ y��i ) upon verification of the work by Owner
and Contractor as having been satisfactorily completed, which verification shall take
place promptly after completion.
Notice: No agreement for home Improvement contracting work shall require a down payment (advance deposit) of more than
one-third of the total contract price or the total amount of all deposits or payments which the contractor must make,
in advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is
treater
1V. COMMENCEMENT AND COMPLETION OF WORK
Contractor will not begin the work or order the terials 04ore Oe third day following the signing of this Agreement, unless specified herein writing.
Contractor will begin the work on or about (date). Barring delay caused by circumstances bevond Contractor's control. the work
will be completed by a�o� (I`t< (date). The w•ner hereby aclmowicdges and aerecs that the scheduling dates are approximate and that such
delays that are not avoidable by the Contractor shall not be considered as violations of this Ageement.
V. NO ACCELERATION ION OF PAYMENT S Ito;"1 ALLOWED
T he Contractor may not require payments to be ntalle to ail Val of Lite limes specified to Sri hull Ill (Payment) above for the reastm that he docros himself
or the payments to be insecure. If, however, he deems himself oto tw insecure, he may require, as a prerequisite to continuing the work described herein,
that thn halance of the payment► under this contract that air tit till- rt,ntrol of the Owner, shall Ix- placed in a joint r.scrosv accouni that requires the signature
of both the Contractor and the Owner for withdrawal
VI. INSURANCE
Contractor will he responsible to Owner or any third party for any property damage or bodily injury caused by himself, his employees or his subcontractors
in the performance of, or as a result of, the work under this Agreement. Contractor agrees to carry insurance to cover such damage or injury.
VU. SUBCONTRACTING
Contractor agrees that, notwithstandurg any agreement for materials and/or labor between Contractor and a third party, Contractor is responsible to Owner
for completion of all work described in a timely and workmanlike manner.
Vlll. CONSTRUCTION -RELATED PERMITS
The following construction -related permits will M•. necessary in order eco complete the scope of work included in this Agreement:
The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and obtain all construction -related permits. The Contractor
shall not be deemed responsible for delays in the work described in this Agreement caused by regulatory, permit granting or inspectional agencies,
authorities or individuals.
Notice: If the homeowner obtains his own construction -related permit% for the work described under this agreement, the
homeowner is hereby advised that In the event of a dispute, Judgment and nonpayment of the contractor, the
homeowner will not be entitled to make a claim to or collect from the guaranty fund established by Chapter 142A,
M.G.L.
IX. MODIFICATION
This Agreement, including the provisions relating to price (Section 11) and payment schedule (Section III) cannot be changed except by a written statement
signed by both Contractor and Owner. However, cancellation by Owner is allowed in accordance with the Notice of Cancellation (annexed).
X. WARRANTIES ,
The Contractor warrants that tltc work I urnishcd hereunder shall be It cc (tum defects tit ntatct ials and workntartship for a period of_� following
completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the
Contractor, his subcontractors, employees or agents, is dtsutvered within one year after completion of any job, including cleanup, the Contractor shall,
at his own expense, forthwith remedy, repair, correct, replace, or cause to be remeditel, repaired, or replaced, such damage or such defect in materials or
workmanship. •lite forecoinr warranties shall survive. anv insp•ction v-rforrned in cor-nec•tinn with th- ttgrerd-urw-r work.
All warranties for equipment supplied by the Contractor under this Agreement shall he those given by the manufacturers of such equipment, which shall
be azul roc hr►rby l asscul through directly to the I ►wort.
U it,lrr sit, It ntanut,trtill crs' will t;uttir.:, the Owner may be required to register or mail tit a wananty
card or other evidence of ownership and use of such equipment in order to activate such warranties. The Owner's failure to mail in or register such
documentation, w9tich failure voids the manufacturer's wan anty, shall riot Create any responsibility for the Contractor to warranty such equipment.
This warranty gives the owner specific legal rights, and owner may also have other rights which vary from state to state. Under Massachusetts law, sales
of goods carry an implied warranty of merchantability anti fitness for a Inarticular purpose.
X1. COMPLETENESS OF AGREEMENT FOR EXECUTION
The Owner is hereby advised that he should not sign this Agreement carless and until all blank sections have been filled in or marked as void, deleted or
not applicable, &ad until all exhibits and related or referenced documents that arc incorporated herein arc attached hereto.
XII. COPY OF AGREEMENT TO BE GIVEN TO OWNER
'Ibis Agreement is governed by the Laws of Massachusetts. It roust be executed in duplicate, and an original signed copy hereof given to the Owner at
thr" time of execution. No work under the Agreenu•nt shall bt-gin prior to the signing of the Agreement and transmittal to the owner of a copy thereof.
RIGIITS TO CANCEL
The om-ner may cancel this agreement if it has been signed by( I ieowner at a place other
than an address of the contractor which may be his -main office or branch thereof,
provided that the owner notifies the contractor in writing at his main office or branch
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. See attached Notice of
Cancellation.
HOMEOWNER:
DO NOT SIGN TI [IS CONTRACT IF TIIERE ARE ANY BLANK SPACES.
Owner's Siguauur Date Signed
Contractor's Si'n:cure Date Signed
ti gn
II -(IG 2�M"2