Loading...
HomeMy WebLinkAboutMiscellaneous - 30 Water Street TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received I Date Issued: `A IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER RIC/719-Xc,- PriAt- 100 Year Old Structure yesno MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid laI 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 PERFORMED,: Identification Please Type or Print Clearly) OWNER: Name: l2 Phone: 7d' Address: 70 �t) 6 L ('ta l CONTRACTOR Name: �� Address: GGf L 1 Rc f G�/7��U1(1 Cry Supervisor's Construction License: 0z-Z- _Exp. Date: Home Improvement License: 16513 3 TiP- -Exp. Date: 171� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING P IT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON4125.00 PER S.F. Total Project Cost: $ � FEE: $ C�-7 0o Check No.: � Receipt No.: 2'7���° NOTE: Persons contracting with unregistered contractors do not have access the,g; fund ;Signature of Agent/Owner Signature of contracto c Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 DATE REJECTED. DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION ATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature I COMMENTS I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ♦ II "A Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Toiw : Engineer: Signature: Locat 84 bhood Street FIRE Temp Dumpster on site yes no Located-at 124 Mair Street- -Fire treet-Fire Departinerifsiignature/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.$10041000 fine NOTES and DATA— (For department use D Notified for pickup - Date Doe.Building Permit Revised 2010 I i I Building Department I The foi:wing is list of the required forms to be filled out for the appropriate permit to be obtained. Roofh1g, Siding, Interior Rehabilitation Permits ❑` Building pp Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract Li Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ' o Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application ❑ Certified Proposed Plot Plan o 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 o Mass check Energy Compliance Report o 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 apvaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application .1 , Doc: Doc.Bui.dm Permit Revised 2012 g Location No. � —( Date 3 • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ `� 'e 'Al."." e .. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# �" Building Inspector tNORTly Town of Andover O - No. Zo �.K. h ver, Mass, . ZS26 Iff . 4 CCCHICMlwIC1c 1' �•9 A°R�re o �P�`,��(5 S U BOARD OF HEALTH Food/Kitchen PERMT T LD Septic System THIS CERTIFIES THAT ........ .....% to ...OrqrA nvelsoel BUILDING INSPECTOR ...... .... .... ....... ....... .......... . ........... has permission to erect buildings on Foundation ..............................1:W .................. Rough e to be occupied as ... .�. ..................... ... ...........1.��......... ..................... Chimney provided that the person accepting this permit I in every res ect conform to the terms of the application Final on file in 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 lei PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR N S Rough Service ........ ........................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. F . 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 Subm' o: An Job Name Job# Address Job 2d�' Date Date of Plans I Phone# Fai# Architect We hereby submit sp ations and estimates for: I �ia2J We propose hereby to furnish material and labor—complete in accordance with the above specifications-€or the sum of: $ Dollars with payments to be made as follows: �► ��J2,4,, _ 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.Ah agreements contingent upon strikes,accidents,or delays beyond our cdhtroi. Note—this proposal may be withdrawn by us if not accepted within days. The above prices,specifications and conditions are satisfactory and are signature hereby accepted.You are authorized to do the work as specified. Payments will be made as outlined above. Date of Acceptance Signature i \ i MASSACHUSETTS HOME IMPROVEMENT CONTRACT This form satisfies-all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),hot doei not lnciude standard language to protect>homeowners. Seek legal advice it necessary. Any peison•planninghome rpmvements should.fust obtain a copy of"a Massachusetwconsumer:guide to homeimprovement"before agrecing.to any work on yourresidence.You may obtain>a free copy by'calliing the Office of Consumer..Affairs and Business.Ragulation's Consumer Information Hotline at617-9714787'or 1#888;2834757. Homeowner Information Contitactor Information Name. �.. Strtx A (do-nof use.a PoirOffice Box address)L2 77Satesperson/.owncr ame 12,1 LIN . U� City/rown State CbdeUsinessAddreis(must include a street addresg) Daytime Ph Evening Phone 'tyrrown State Zip Code 0(. Mailing Address(It different from above) lusiness Phone edtsal Employer M or S.S.Number lav«quirnlWtmon home im•I Home tCMMcWaea�He W Esphadmk pmvemamceoomm hive e . enact eegimsam o®he The Contractor agrees to do the following work for the Homeo ner: Required Termits-The-following building peil» =rcqWmd1 Proposed Start and't timpletlon Schedule-The following schedule will and will beseeured:by the contractor as the'homeowner's agent; be adhered to`utiless circumstances hiyoad:the contractot's'control arise (Owners who;secure their own permits will be exclnded:from;the.•Guar.-anty Fund`provisions of Date when contractor will begin 6'mracud work. MGL chapter 142A.) Date when contracted .work will be substantially completed. Total Contract Price and Payment Schedule , The Contractor.agrees to perform the work,furnish the material and labor specified above for thetotal sum of $iyments will be according to thafollowing schedule: S �'""`� upon.signing contract'(not•to exceed 1/3 of the total:contract price.qt the cost of special order items,whichever is greater) $_��by`7=Y= or upon completion of — � $ by7 T—or upon completion of 0 upon completion of the contract (Law forbids demanding full payment until.contract is completed to both P party's.satisfaction) The following mate ial/equipmeatmust be special $ e paid for ordered before theeantractod work'begios in order S to be paid for to meet thacompietion schedule.(**) NOTES:(*)including all finance charges(*•)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the grester of(a)one-third of the total contract price ar(b)the actual con of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. a,. Express Warranty-Is an expresswarranty beta¢provided by th•r•.t.b w.r No Yes /allterms of the!MixentK cached to the cooMctl Subcontractors The contractor agrees to be solely responsible for completion of the work described regardless of the actions ofmauy fluid party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors foi materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding.contract underlaw. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest�tmas been pieced on the residence. Review the following cautions and notices carefully before signing this contract • Doa't be pressured into signing the contract Take time to read'and fully understand it Ask'ques ions ifsoim thing is unclear. • Make sure the contra two m nc•valid Home]in ...__e nt Contractor Registration The hlw requires most home improvement contractors and. subcontractors to be registered with the Director ofHome 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 ImportantInformation on the reverse side of this foim'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 contracides'normal place of business,provided you notify the contractor in writing at his/her main of fi"ce or branch office by ordinary mail posted,by telegram sent or delivery, third business day following the signingof this a by �,not later than midnight of the. grcement.Sen theattache.d notice of cancellation form for an explanation of.this right DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACESM coofdemiralcopiesofthewntmctmust becompleted and sipted,one copy.ahouldaotorhe other copy should be� � l kept tryae contractor. .. Homeowner's Smgnatnre Coauactbr's Signature ct Date •:Dam l— Contractor Arbiteli on The Home ImprovementContractor Lawprovides;homeowners with:tknght4o4nitiate an arbitration action(as an alternative to court actrgn)if they;have a:dispute*ith.e contractor. The.same t ghtis not'automatically afforded to"a contractor,how.ever.=.•The.contractor would have tp resolve any,dispute he/she.has.with a homeowner in court unless both parties agree to the optionat clause provided below:.This clause would,give the contractor the same.right to arbitration as is afforded to the homeownerby 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,. theS 'tary of the Executive Office of Consumer Affairs and Business Regulation and°the consumer shall be required brut to such arbitration as provided In-Massachusetts General Laws,ch a 142A. Homeowner's Signdture Cokficirs Signature NOTICE:'The signatures of the parties above apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor, The<homeowner.may initiate alternative4.5pute resolution even where this section is not separately signJeddry':the paities,. Homeowner's Rights A homeowner's rights under tlLkAbole'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,homeowner; 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.manne.r. 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$tness.for:a particular purpose. An enumeration of other.matters on whichthe 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 c ftinal 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 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 onneed additional information about the Home Improvement Contractor Law or other m consuer nghts,or'if you wish to obtain.a free:copy of,"A Consumer Guide to the Homelraprovement Contractor Law,"contact: . Cgnsumer Information Hotline Office-of Consumer Affairs and Businessass Regulationl- ation 10 Park Plaza,Room 5170,Boston,MA 02116 (617)973-8787 or 1-(888)283.3757 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 ofthe 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 s (617)727-3200 ort-800-223-0933 For assistance with informal madiation of disputes or to register formal complaints against a business,call Con'siririer'CComplaint'SeCtion Office of the Attorney General (617)727-8400 AND/OR Better Business Bureau (508)652-4800 (508)755-2548 (413)734-3114 i- 6 V I J 1 c • 1 i m „V V V V 1 n I L V III VV n n,v V L II V• L V 7 U I-- I c CERTIFICATE OF LIABILITY INSURANCE DATE(MVUDDMW) 92/04/2013 THIS CERTIFICATE 16 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER, THIS XRTIFICAT91:LOW. THIS DOES RTIFICATEFOF AFFIRMATIVELY RDOESANNOT CONSSTITEH AECOAITORRACTTBERTWEECOVERAGE THE ISSUING INSURER(S),AUTHOLRIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. MPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the poficy(ies)must be endorsed. If SUBROGATIONI 18 WAIVED,subject to :he terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the w0ficate holder In Ileu of such endorsement(s). IDUCER 00775.001 O CT use&Jankowski Insurance Agency Inc % (g78 882.5176 .Ns.t (978)7940319 8 Mass Ave Suite Iola frth Andover,MA 01845 61688: )RED A.I.M.Mutual Insurance Company 33758 thur Watsh J Walsh 8,Sons Pleasant Street Irth Andover,MA 01845 )VERAGES CERTIFICATE NUMBER: REVISION NUMBLR: IHIS ATED NOTWITHSTTIFY AN IDNQ ANYCIES OF REQUIREMENT, TERM OR CONDITION OF ANY CONISSUED TRACTOR OTHER DOCUMENT WITE INSURED NAMED H FOR THE RESP CT TO LWHICH PERIOD ERT)FICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT T XCLUSIONS AND CONDITION C 0 ALL THE TERMS, S OF SUCH POLICIES. I C ES,L MITE SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 7YPEOPINSURANCE 1 P40LICYNUMBER MAtlOD LIMITS GENERAL LlAe1LITY �+� EACH OCCURRENCE d COMMERCIAL GENERAL LIABILITY DAMAGE YoAMED d PREMISES Ira osasmafitl— CLAIMS MADE OCCUR MED GXP(Any one peraon) 5 PERSONAL d ADV INJURY 3 GENERAL AGGREGATE S EML AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPlOQAGG $ OLICY RO. OC AUTOMOBILELtABILIT+/ COMBINEV SINGLECOMBINE LIMIT f ANY AUTO ALL OWNED SCHEDULED DODILYINJURY(per pemn) S AUTOS AUTOS AUTOS BODILY INJURY(Per awWnt) S HIRED NON-OWNED R PERTY DAMAGE AUTOS f 8 UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS MADE AGGREGATE S OED RETENTION S S ggppppRq��EETTpoqq�pR7�ER�xECUTNE OFFICERIMEM9ER EXCLUOEQ 1 N N 1A AWC.Q E.L.EACH ACCIDENT $ 100,000.00 00 7014648-2013A 11/14120 (Mandatory In NN) � 13 11/14/2014 ( �s�a F-L DISEASE•EA EMPLOYEE S 900,000.00 Da vF OPERATIONS below EL DISEASE•POLICY LIMIT d 500,000.00 +`RIPTION OF OPERATIONS f LOCATIONS/VEHICLES(AItseh ACORD 101,Additional Remarks Schedule,If more space to required) (TIFICATE HOLDER CANCELLATION ,n Of North Andover )Osgood Street SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE :h Andover,MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPAESENTATiVE 0 1988-2010 ORD 25(2010105) The ACORD name and logo are registered marks of ACORD RD CORPORATION.All rights reserved. Office of Consumer Affai /e rs&Busi ss Regulation h '^ WOME IMPROVEMENT CONTRACTOR ;: .Registration: 103358 Type: Expiration: -717/2014 Private Corporati( A.J. WA LSH&SONS,INC. Arthur Walsh,Jr. 55 Pleasant St N Andover, MA 01845 Undersecretary i 'vlassacl)usetts --0tapariment of Public Safely Board of Building Regulations and Standards Construction SulurN icor License: CS-022680 ARTHUR J WALSH JR 159A WAVERLYRD N ANDOVER MA 01845 06/09/2014 �t Office of Investigations I t 600 Washington Street l Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contras$ors/Llectricians/Pluinbers plicant Information Please Print Legibly 11e (Business/Organization/Individual): /Y S cress: � /� j //State/Zip: M 1�-A//d C? U Pi/C Zo,,* 3 /ou employer?Check the appropriate box: Type of project(required): am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).` have hired the sub-contractors 6. ❑New construction I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' coin insurance.! 9• ❑ Building addition [No workers' comp. insurance P• required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions I am a homeowner doing all work officers have exercised their 11.❑ Plu ' g repairs or additions myself. [No workers' comp. right of exemption per MGL 12 oof repairs insurance required.] t c. 152, §1(4), and we have no employees. [No workers' 1.3.0 Other comp. insurance required.] )licant that checks box#1 must also fill out the section below showing their workers'compensation policy information. wners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such, tors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have :s. If the sub-contractors have employees,they must provide their workers'comp.policy number. i employer that is providing workers'compensation insurance for fny employees. Below is the policy and job site .ration. ce Company Name: or Self-ins.Lic.4: �0/ zlefe912- Expiration Date: :Address: l?Q /y'/gr �' City/State/Zip: 141 4 ,0A1-f�,e � a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of rations of the DIA for insurance coverage verification. veby certify der the ains and penalties of perjury that the information provided above is true and correct. re: - Dater lal use only. Do not write in this area,to be completed by city or town official or Town: Permit/License# ng Authority(circle one): card of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector `her sort PPc-aoc1- Phone#.