HomeMy WebLinkAboutMiscellaneous - 460 MAIN STREET 4/30/2018 W6 0 MAIN STR
0
210/057.0-0007-000000.0
Location ! B Al /1 /
No. Date
NORTh TOWN OF NORTH ANDOVER
O:4„9° ,• O
OL
0 y
Certificate of Occupancy $
�' b'•°•'<�
Building/Frame/Frame Permit Fee $
cHusa 9
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ /
Check # A
15888
Building Inspector
TOWN OF NORTH ANDOVER
BUILDING DEPARTMENT
APPLICATION TO CONSTRUCT REPAIR,RENOVATE, OR DEMOLISH A ONE OR TWO FAMILY DWELLING
BUILDING PERMIT NUMBER: DATE ISSUED: X
c C�SIGNATURE:
Building Commissioner/In for of Buildings Date z
SECTION 1-SITE INFORMATION O
1.1 Property Address: 1.2 Assessors Map and Parcel Number:
Map Number Parcel umber
r
1.3 Zoning Information: 1.4 Property Dimensions:
Zoning District Proposed Use Lot Areas Frontage ft
1.6 BUILDING SETBACKS ft
Front Yard Side Yard Rear Yard
Required Provide R 'red Provided Required Provided
1.7 Water Supply M.G.L.C.40, 54) 1.5. Flood Zone Information: 1.8 Sewerage Disposal System:
Public ❑ Private 0 Zone Outside Flood Zone 0 Municipal 0 On Site Disposal System 0
SECTION 2-PROPERTY OWNERSIIIP/AUTHORIZED AGENT M
2.1 Owner of Record
ame(Print) Address for Service
Ml S MICA /4� Pe /Z�S�C
Signature Telephone
gS87
2.2 Owner of Record:
Name Print Address for Service:
z
M
Signature Telephone
SECTION 3-CONSTRUCTION SERVICES 90
3.1 Licensed Construction Supervisor: Not Applicable ❑
r
Licensed 99nStgrPtion Supervisor:
J, License Number
mn
Address
pirati6n Date
(� U
Signature Telephone r
3.2 Registered Home Improvement Contractor Not Applicable 0 0
om Name m
Registration Number r
Address r-� f%, Glqle,�lr
Z
Expirat on Date
Y/
Si natur Telephone
SECTION 4-WORKERS COMPENSATION(NLG.L C 152 § 25c(6)
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 all applicable)
New Construction ❑ Existing Building ❑ Repair(s) ❑ [Aherations(s) ❑ Addition ❑
Accessory Bldg. ❑ Demolition ❑ Other ❑ Specify
Brief Description of Proposed Work:
/ t
rL
SECTION 6-ESTIMATED CONSTRUCTION COSTS
Item Estimated Cost(Dollar)to be OFFICIAL US19 ONLY
Completed by permit applicant
1. Building (a) Building Permit Fee
(rte
Multiplier
2 Electrical (b) Estimated Total Cost of
Construction
3 PlumbinE Building Permit fee(a)X (@)
4 Mechanical HVAC
5 Fire Protection r
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, Gt ,as Owner Authorized Agent f subject property
ereby 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
1, 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
Print Name
Signature of Owner/Agent Date
NO. OF STORIES SIZE "
BASEMENT OR SLAB
SIZE OF FLOOR TINMERS 1 ST 2ND 3
SPAN
DIMENSIONS OF SILLS
DIMENSIONS OF POSTS
DIMENSIONS OF GIRDERS
HE-IGHT OF FOUNDATION THICKNESS
SIZE OF FOOTING X
MATERIAL OF CH VINEY
IS BUILDING ON SOLID OR FILLED LAND
IS BUILDING CONNECTED TO NATURAL GAS LINE
w -_-_ The Commonwealth of Massachusetts
_ Department of Industrial Accidents
_ Office offnyestfyatlons
600 Washington Street
Boston, Mass. 02111
Workers' Compensation Insurance Affidavit
4
n I aa homeowner performing all Work myself.
C1 I am a sole proprietor and have no one working in any capacity
M" 11[am an employer providing workers' compensation for my employees working on this job.
ali1v �'i : 17 License# t t
.r'`� zraticxt ate �r` d
ne
NUNN
I am a sole proprietor, general contractor,or homeowner(circle one) and have hired the contractors listed below who have
the following workers' compensation polices:
company name•
address•
insurance co' p hcy#
catnpanw:name
EM
t;s131ress.
in�nrance co: policy#
Failure to secure coverage as required under Section 25A of NIGL 152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 and/or
one years'imprisomment 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 statement may be forwarded to the Office of Investigations of the DIA for coverage verification.
I do hereby cern•y under
the pains and penalties of perjury that the information provided above is true and correct
Signature GL ��L� t Date 7/,7)//o
Print name Phone# / (cam 'crd r� 7
r
official use only do not write in this area to be completed by city or town official
city or town: permit/license# nBuilding Department
C]Licensing Board
check if immediate response is required C]Selectmen's OMce
❑Health Department
contact person• phone q; nOther
(r tmd 3ro5 PJA)
Information and Instructions
Massachusetts General Laws chapter 152 section 25 requires all employers to provide workers' compensation for their
employees. As quoted from the"law", an employee is defined as every person in the service of another under any
contract of hire, express or implied, oral or written.
An employer is defined as an individual, partnership, association, corporation or other legal entity, or any two or more of
the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual , partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance , construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer.
MGL chapter 152 section 25 also states that every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of compliance with the insurance coverage required.
Additionally, neither the commonwealth nor any of its political subdivisions shall enter into any contract for the
performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have
been presented to the contracting authority.
Applicants
Please fill in the workers' compensation affidavit completely, by checking the box that applies to your situation and
supplying company names, address and phone numbers as all affidavits may be submitted to the Department of
Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The
affidavit should be returned to the city or town that the application for the permit or license is being requested,
not the Department of Industrial Accidents. Should you have any questions regarding the"law"or if you are required
to obtain a workers' compensation policy, please call the Department at the number listed below.
City or Towns
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of
the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please
be sure to fill in the permit/license number which will be used as a reference number. The affidavits may be returned to
the Department by mail or FAX unless other arrangements have been made.
The Office of Investigations would like to thank you in advance for you cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address,telephone and fax number:
The Commonwealth Of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,Ma. 02111
fax#: (617)727-7749
phone #: (617) 727-4900 ext. 406, 409 or 375
AJ. Walsh & Sons Inc.
55 11Icasani SIrcct
North Andover, MA 01845
mass. LICENSE n 022680 Mass. 10',GlSTRA'110N 10.3.358
RESIDENTIAL CONTRACTING AGREEMENT
Read this agreement and make sure you understand it before signing it.
This agreement has le al force and effect and binds those who sign it.
Notice: All home Improvement contractors and subcontractors engaged In home Improvement contracting,unless specifically
exempt from registration by provisions of C apter 142aof the 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 "' '� j ' ®� _between -V-s
y�(DATE) Cn��tivGli�°G fCOKTitACiOR)
of �v ?k— C f-t�z?
(ADDRESS) (MIONP,NUMBER) --
hereinafter called"Contractor"and
of f ® lq rowNEJt) `
(ADDRESS) (PHONE NUMBER)
hereinafter called"Owner",
DETAILED DESCRIPTION OF WORK TO BE PERFC RMED
Contra fora refs to perform in a go I and workma dike n nrr II work(let,'Icditx:low. Such work consists f e foil wing:
^ ,Fssaad J
DETAILED DESCRIPTION OF MATERIALS TO BE L SED
Materials to be used in performing the above described work consist of the following:
ll. PRICE Q
Contractor agrees to do all work described in Section I for thetotal price of S l 6� 1
Ill. PAYMENT
Payment will be made as follows:
[33 111-1%(S (J06� �)upon signing Contract;
3066 --)upon completion of ,
upon completion of
A.A. --- —and the remaining Y, (s 3 4 56 upon verification of the work by Owner
and Contractor as having be n satisfactorily completed,which verification shall take
place promptly after compl tion.
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 other wise obtain d elivery of special order materials and equipment,whichever amount is
greater.
IV, COMMENCEMENT AND COMPLETION OF WORK
Contractor will not begin the work or order thematerials bc.foro the third day following the signing of this Agreement,unless specified here in writing.
Contractor will begin the work on or about 4? '-Q (date). Barring delay caused by circumstances beyond Contractor's control,the work
will be completed by c? 0 >- (date). The Ownerhereby acltrtowiedbes and agrees that the scheduling dates are approximate and that such
delays that are not avoidable by the Contractor shall not be co sideas violations of this Agreement.
V. NO ACCELERATION OF PAYMENT S 11(1 LSCRc►WI G ALLOW -D
The Contractor may not require payments to bent a,It!tie ail viii it.e of lite times slxxified in See it(If,iiI(Payment)ahove for the reason that he deems himself
or the payments W be insecure. If,however,he dorms htmsclf to ht,insecure,he may require,as a prerequisite to continuing the work described herein.
Uul ilia hslance of the payments under Utis contra(t that aur til thr 1 onuol of the Owner.ahal l be plat rd to it joint rs(.-ro%.account I)m requires ilio signattue
of both the Contractor and the Owner for withdrawal.
VI. INSURANCE
Contractor will be.responsible to Owneror any third party for:env property damage or IHwlily injury canted 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.
VII. SUBCONTRACTING
Contractor agrees that,notwithstanding any agreement for materials and/or labor between Contractor and a third party.Contractor is resportsiblc to Owner
for completion of all work described in a timely and workmanlike manner.
VIII. CONSTRUCTION-RI:LATER Pi:RMITS
The following c s ucon-tela rmits w ll M,necessary in order to complete the scope of work included in this Agreement:
C.0
The Contractor funder 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 granung or inspectional agencies,
authorities or individuals.
Notice: If the homeowner obtains his own construction-related permlts for the work described under this agreement, the
homeowner is hereby advised that in the event of 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 Agreemen4 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 U)c work f urrlished hr tcunder shall be lice flurn defects tit nlaict tats and workmatuhip 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
Contactor,his subcontractors,employees or agents, is duurvered wtdtin one year after completion of any job,including cleanup,die Contractor shall,
at his own expense, forthwith remedy,repair,correct replace,or cause to he remedied,rcnaired,or replaced,such damage or such defect in materials or
workmanship. 'lhe foreeoinr warranties shall survive any irtsprrli n T—formed in cm—ii on with the Jnr rtoo-1C, -
All warranties for equipment supplied by the Contractor under this Agreement shall be.those given by the manufacturers of such equipment,which shall
be mud arc hetrby passed throughdirrctly to the•I)wart, (tnctrl su(It nlanulactu)clN, Will l;,,,fir;,the Owner may iw required torcgistcror mail in a warranty
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, which failure voids the manufacturer's warranty,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 whnch vary from start:to state. Under Massachusetts law,sales
of goods carry an implied warranty of merchantability and fitness for a particulw purpose.
X1. COMPLETENESS OF AGREEMENT FOR EXECUTION
The Owner is hereby advised that he should not sign this Agreement unless and until all bl:utk sections have been filled in or marked as void,deleted or
not applicable,Aid until all exhibits and related or referenced documents that are incorlmrauoi herein arc attached hereto.
Xft. COPY OF AGRI:EAIENT TO BE GIVEN TO OWNER
']his Agreement is governed by the Laws of Massachusetts. It must be executed in duplicate,and an original signed copy hereof given to Ule Owner at
tile time of execution. No work under the Agreement shall begin prior u)the signing of the Agreement unit transmittal to the owner of a copy Uuereof.
-- —_------ --- RiGIiTS TO CANCEI, -- -- —_—
The owner may cancel thisagreenu'nt if it has been signed by the owner 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 deliver no ' ► e
t, y �, t later than midnight of tilt.
third business day following the signing of this agreement. See attached Notice of
Cancellation.
i
HOMEOWNER:
DO NOT SIGN THIS CONTRACT IF TIIERE ARE ANY BLANK SPACES.
�S o-
Owne Signature. Date Signed
-- -
Contractor's Signa ate Signed
II (7G 2S%1"2
NORTH
own of QED ' Andover
o -
No. / #77
CO
t dower, Mass., y
DRATE D
1S. H �
BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
1 C a 1 n0 �,..........................%..k.0 BUILDING INSPECTOR
THIS CERTIFIES THAT......,/! ��.
Foundation
has permission to erectAA Y L......... buildings on ....yG D �/4 //� S � . Rough
to be occupied as.t ....�.�!V �...w �ti.�m.wg...�....�� .....R..O.a.1 ... /'* �"� chimney
provided that the person accepting this permit shall in every respect conform to the terms of thea lication on file in
PP Final
this office, and to the provisions of the Codes andB ZN�elating tote Inspection, Alteration and Construction of
Buildings in the Town of North Andover. s-1 0 to 00M PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
PERM 1 EXPIRES IN 6 MONTHS THS Final
UNLESS CONSTRUCTION START 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.
SEE REVERSE SIDE Smoke Det.
Location
No. /1 7'2 Date 3 12,11q,
A 1 r
"Go ,
,y TOWN OF NORTH ANDOVER
. „ Certificate of Occupancy $
41 Building/FWe ermit Fee $ //t
�+s °
CMUSt Foundation Permit Fee $
JA
Other Pe �it Fee $
PAI® By �Se nnection Fee $i
Waer Connection Fee $
? Z TOTAL $ !�
o, pndovev Colled0f 4li�AK
Building Inspector
Div. Public Works
Location
No. Date
,.ORTq TOWN OF NORTH ANDOVER
O?O•tt`,O .•1�00�
Certificate of Occupancy $
41
Building/Frame Permit Fee $
.2 <� Foundation Permit Fee $
3AC1'
ra
Other" permit.Fee $
.v.
Sewer Connection Fee $
" 1W erlConnection Fee $ ~
TOTAL
Building Inspector
Div. Public Works
PERJtIT NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. y PAGE 1
MAP i4O. LOT NO. 2 RECORD OF OWNERSHIP JDATE BOOK 'PAGE
ZONE I SUB DIV. LOT NO. I
-�-
LOCATION PURPOSE OF BUILDING ZZq
OWNER'S NAME NO. OF STORIES SIZE
OWNER'S ADDR S BASEMENT OR SLAB
ARCHITECT'S NAME A 17 SIZE OF FLOOR TIMBERS IST 2ND 3RD
BUILDER'S NAME SPAN
DISTANCE TO NEAREST BUILDING DIMENSIONS OF SILLS
DISTANCE FROM STREET POSTS
DISTANCE FROM LOT LINES—SIDES REAR GIRDERS
AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS
IS BUILDING NEW SIZE OF FOOTING X
IS BUILDING ADDITION MATERIAL OF CHIMNEY
IS BUILDING ALTERATION IS BUILDING ON SOLID OR FILLED LAND
WILL BUILDING CONFORM TO REQUIREMENTS OF CODE IS BUILDING CONNECTED TO TOWN WATER
BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN SEWER
IS BUILDING CONNECTED TO NATURAL GAS LINE
INSTRUCTIONS 3 PROPERTY INFORMATION
LAND COST
SEE BOTH SIDES EST. BLDG. COST / �
i
PA,4,9 j FILL OUT SECTIONS t - 3
EST. BLDG. COST PER SQ. FT.
PAGE 2 FILL OUT SECTIONS 1 - 12
EST. BLDG. COST PER ROOM
SEPTIC PERMIT NO.
ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING 4 APPROVED BY
ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS
PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR
DATE FILED_!S.?i/o7
BOARD OF HEALTH
ATURE OF O R O A ORIZED AGENT
6
FEE
OWNER TELN PLANNING BOARD
.
PERMIT GRANTED �.
A/ CONTR.TEL 0 6
19 CONTR.LIC.#d3 q 0 VG
BOARD OF SELECTMEN
BUILDING INSPECTOR
OCCUPANCY 12 BUILDING RECORD
-
1 ,
SINGLE FAMILYSrORIEs THIS SECTION MUST SHOW EXACT DIMENSIONS OF LOT AND DISTANCE FROM
MULTI. FAMILY OFFICES LOT LINES AND EXACT DIMENSIONS OF BUILDINGS. WITH PORCHES. GA-
APARTMENTS RAGES, ETC. SUPERIMPOSED. THIS REPLACES PLOT PLAN.
CONSTRUCTION
2 FOUNDATION 8 INTERIOR FINISH
CONCRETE _ 3 1 2 13 e
CONCRETE BL'K. PINE �..,...� -^—°•+•'--
BRICK OR STONE HARDW'D
PIERS PLASTER _
_ DRY WALL
UNFIN.
3 BASEMENT
AREA FULL FIN. B'M'TAREA _
'14 '/7 '/, FIN. ATTIC AREA _
NO BMT FIRE PLACES _
HEAD ROOM MODERN KITCHEN
4 WALLS I 9 FLOORS
CLAPBOARDS B 1 2 3
DROP SIDING CONCRETE �_
WOOD SHINGLES EARTH _
ASPHALT SIDING HARDV✓'D _
ASBESTOS SIDING _ COMMCN
VERT. SIDING ASPH. TILE _
STUCCO ON MASONRY
STUCCO ON FR ME
BRICK 05 MASONRY ATTIC STIRS. & FLOOR _
BRICK ON FRAME
CONC. OR CINDER ELK.
STONE ON MASONRY WIRING
STONE ON FRAME _
SUPERIOR I I POOR
ADEQUATE NONE
5 ROOF 10 PLUMBING
GABLE I HIP BATH 13 FIX.) _
GAMBREL MANSARD TOILET RM. (2 FIX.)
FLAT SHED WATER CLOSET _
ASPHALT SHINGLES LAVATORY
WOOD SHINGES KITCHEN SINK _
SLATE NO PLUMBING _
TAR & GRAVEL STALL SHOWER _
ROLL ROOFING MODERN FIXTURES _
TILE FLOOR
TILE DADO
6 FRAMING I 11 HEATING
WOOD JOIST PIPELESS FURNACE
_ FORCED HOT AIR FURN.
TIMBER BMS. &COLS. _ STEAM
STEEL BMS. & COLS. _ HOT W'T'R OR VAPOR
WOOD RAFTERS _ AIR CONDITIONING
RADIANT H'T'G
UNIT HEATERS
7 NO. OF ROOMS GAS
OIL
B'M'T 2nd _ ELECTRIC
1st 13rd NO HEATING