HomeMy WebLinkAboutMiscellaneous - 89 GRAY STREET 4/30/2018 (2)SeflNw� D j�-Io� 1J p f f$ORTh r BUILDING PERMIT 3?O`i�eo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION l Permit NO: _ Date Received Date Issued: I '- — I ID ® t' IMPORTANT: Applicant must complete all items on this LOCATION b �j 6WAY PROPERTY OWNER Print Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no !Machine Shop Villaae ves no TYPE OF IMPROVEMENT PROPOSED USE t; /,-z r A %/ice, en, etzc,�r 4wb 64 0o., 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 ,QrAf J Ity'J/J /LL I� D /i-� /Y� UJ'c� -�2✓�' c�C. e4.r E- (N l�L/� t� t; /,-z r A %/ice, en, etzc,�r 4wb 64 0o., Identification Please Type or Print Clearly) // OWNER: Name: � j r/,�¢ c��C i2p Phone:/ -7 3/ 7- 6,V, Address: CONTRACTOR Name: /V%�l/nN,t� /U1/ly� �,rPhone: 7 -,5- 7v Address: &Y1,JN MA- ©/qo Supervisor's Construction License: Exp. Date: C'S. Oho/ vs,", Exp. 7 Home Improvement License: J -7 p f& Exp. Date: Y/2 y/G ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. 00 Total Project Cost: $ �✓�p FEE: $ Check No.: /17.1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acct t Ieguaranty fund Signature of Agent/Owner Signature of contractor IL 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 d Building Permit Application Y Workers Comp Affidavit d' Photo Copy Of H.I.C. And/Or C.S.L. Licenses aK 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) 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) ❑ 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) o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location c� No. 'r Check # M V U U Date /- v r r TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector PI Qb ~O O~LLJ LU LL.Z o O m N u o LL a) ? 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C O ci L N 3 N Cc �Lm a ;r �. = L y O V N 0 a O > Nva = O .� E o 0 Z �.r�tm y G O _ ` A) 3 a, a> > o = c 2 � CL a) C' a) 000 0 y: cc.( a' Q i L.O 2 d Q�•S N F- p N O V m N CO) W_ _ '0— O O �' LL d �' N = O .N .Q O LU N = ++ � :.:.r Z rl U Q o '� -W a CO O'j ;F = J U) c O F- .65COCl > O W :a z Z 0 m 2 � G z Cl)� w� a z w0 C-) COI) _y �w az w CDE O z O N CD t/1 O •— O c •E m m ams wWO /+ O c CL a CL National Management Team Inc. 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 ntay obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consuner Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. lFinmonwnnn inf .......a:.._ contractor information 1/e_ ■ ...b...o .v vv me wuy�nng work for The Homeowner: '- (Describe in detail the wrork; completed, spe uwcifyiug the type, brand, slid grade of materials to be used, mise addidonal sheets if necessnm}-,) P7t/P /Iy✓ro /VAo-i,��� jufc>. J. v led € cdm-z;�,z fi�jc2/J rN/moi ���� l��iA�%/JGd4 /LrOGa✓ d.-�✓T. .t'2✓A�"Jlt,c� i✓l7 <l'dryii a1W/ � 7A /f--Aw -ice J°, ,✓6 0 C Required Permits -The following building permits are required Proposed Start and Completion Schedule • The following schedule will and will be secured by the contractor as the homeownees agent: be adhered to unless circumstances beyond the contractor's control arise to (Owners who secure their own permits will be t- excluded from the Guaranty Fund provisions of ZZ 4/ Date when contractor will begin contracted work. SIA MGL chapter 142A.) ►� Z2elAr Date when contracted work will be substantially completed . Total Contract Price and Payment Schedule eva ± The Contractor agrees to perform the work, furnish due material and labor specified above for the total sum of CPayments will be made according to the following schedule: �1 AAS 0 upon signing contract (not to emceed 1/3 of the total contract price or the cost of special order items, whichever is greater) $ ,fir D ?; by I ! or upon completion of r � /h tl,4- S I3 § by _� or upon completion of $_ Q&_ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both top party's satisfaction) The following material/equipment must be special s to be paid for ordered before the coutraoted work begins in order to meet the completion schedrde.M S to be paid for NOTES: (') Including all finance charges (`•) Law requires that any deposit or domes -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 Warranty - Is an express Warranty being Provided by the contractor? No ❑Yes fall ternu of the warranty must be attached to the contract' Subcontractors --Me contractor agrees to be solely responsible for comp lc 'on of dhe-work described regardless.of the actions of any third party/subcontractor utilized by the, contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials in labor under this a£Deement Contract Acceptance Upon signng, this document becomes a binding contract under I - %v. Unless otherwise noted within this document, time contract shag 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 Buie to read and fully understand it. Ask questions if something is unclear. " Make sure the contractor has a valid Home Innmrovement Contractor Reeistn4— The law requires most home improvement contractors and subcontractors to be registered with the Director of Home huprovement Contractor Registration. You may inquire about contractor registration by writing to time Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757, • Does the contractor have insurance? Ask the Contractor for his insurance companv information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. • Know rights kid your g fits responsibilities. Read the Important Information on the reverse side of this form andtaco of the Consumer Guide to the Home huprovement Contractor Law. Py You may cancel this agreement if it has been signed at a place other than die contractor's 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. See the attached notice of cancellation form for an tion of this right DO NOT SIGN THIS CONTRACT IF THERE ARE NY BL K SP CES!!! Two identical copies of the emtuact must be rnntp[eted and signed one copy shoald go to the ho the other should be by du coanactor. Homeowner's Signature Date Nate Company Name e Street Address (do not use a Post Office x address ✓/ t Contractor' SalespersoN Onus Name �SA I A CityTowu State ZipCode Bhhsihhess s (must inchtde a street address) , Daytime Phon 92,(-7 Evanip Phone g om 2r 7 an Tonu state Zip Code - %i/ �, 7J Mailing Address (It ditl'erent from above) Federal Employer M or S.S. Number Business Ph!j_= Law rcgnbrs mmost Home tawm mem omtramuraep. N=Wr EVbflandate regtNraa avaudu int l000n/Y GV ��n■Ud The CnnM"rh........ee.... .t.. .�- a ■___.e_ _ __ _ (/y 1/e_ ■ ...b...o .v vv me wuy�nng work for The Homeowner: '- (Describe in detail the wrork; completed, spe uwcifyiug the type, brand, slid grade of materials to be used, mise addidonal sheets if necessnm}-,) P7t/P /Iy✓ro /VAo-i,��� jufc>. J. v led € cdm-z;�,z fi�jc2/J rN/moi ���� l��iA�%/JGd4 /LrOGa✓ d.-�✓T. .t'2✓A�"Jlt,c� i✓l7 <l'dryii a1W/ � 7A /f--Aw -ice J°, ,✓6 0 C Required Permits -The following building permits are required Proposed Start and Completion Schedule • The following schedule will and will be secured by the contractor as the homeownees agent: be adhered to unless circumstances beyond the contractor's control arise to (Owners who secure their own permits will be t- excluded from the Guaranty Fund provisions of ZZ 4/ Date when contractor will begin contracted work. SIA MGL chapter 142A.) ►� Z2elAr Date when contracted work will be substantially completed . Total Contract Price and Payment Schedule eva ± The Contractor agrees to perform the work, furnish due material and labor specified above for the total sum of CPayments will be made according to the following schedule: �1 AAS 0 upon signing contract (not to emceed 1/3 of the total contract price or the cost of special order items, whichever is greater) $ ,fir D ?; by I ! or upon completion of r � /h tl,4- S I3 § by _� or upon completion of $_ Q&_ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both top party's satisfaction) The following material/equipment must be special s to be paid for ordered before the coutraoted work begins in order to meet the completion schedrde.M S to be paid for NOTES: (') Including all finance charges (`•) Law requires that any deposit or domes -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 Warranty - Is an express Warranty being Provided by the contractor? No ❑Yes fall ternu of the warranty must be attached to the contract' Subcontractors --Me contractor agrees to be solely responsible for comp lc 'on of dhe-work described regardless.of the actions of any third party/subcontractor utilized by the, contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials in labor under this a£Deement Contract Acceptance Upon signng, this document becomes a binding contract under I - %v. Unless otherwise noted within this document, time contract shag 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 Buie to read and fully understand it. Ask questions if something is unclear. " Make sure the contractor has a valid Home Innmrovement Contractor Reeistn4— The law requires most home improvement contractors and subcontractors to be registered with the Director of Home huprovement Contractor Registration. You may inquire about contractor registration by writing to time Director at 10 Park Plaza, Room 5170, Boston, MA 02116 or by calling 617-973-8787 or 888-283-3757, • Does the contractor have insurance? Ask the Contractor for his insurance companv information so that you can confirm coverage, or ask to see a copy of a "proof of insurance" document. • Know rights kid your g fits responsibilities. Read the Important Information on the reverse side of this form andtaco of the Consumer Guide to the Home huprovement Contractor Law. Py You may cancel this agreement if it has been signed at a place other than die contractor's 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. See the attached notice of cancellation form for an tion of this right DO NOT SIGN THIS CONTRACT IF THERE ARE NY BL K SP CES!!! Two identical copies of the emtuact must be rnntp[eted and signed one copy shoald go to the ho the other should be by du coanactor. Homeowner's Signature Date Nate r Conti -actor Arbitration ` The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action (as an alternative to court action) if they have a dispute with a contractor. The same right is not automatically afforded to a contractor, however. The contractor would have to resolve any dispute he/she has with a homeowner in court unless both parties agree to the optional clause provided below. This clause would give the contractor the same right to arbitration as is afforded to the homeowner 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 approved bJ the Secretary of the Executive Office of Consumer Affairs and Business Re lation and t co mer shall be required to submit to such arbitration as provided In Massachusetts General Laws, a t 142 All%., Homeowner's Signature Con . ors tgnatu e NOTICE: The signatures of the parties above apply only to the agr me of the pa 'es alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this 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 in 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 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 manner. 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 cavy 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 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 belowo 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 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 copy of the contract, and the three day rescission 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 balance 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 or need additional information about the Home Improvement Contractor Law or other consumer rights, or if you wish to obtain a free copy of "A Massachusetts Consumer Guide to Home Improvement" contact: Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza, Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the OCABR website at http://www.mass eov/ocabr/ If you want to verify the registration of a contractoror if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law, contact: Director of Home Improvement Contractor Registration Office of Consumer Affairs and Business Regulation 10 Park Plaza; Room 5170, Boston, MA 02116 617-973-8787, 888-283-3757 or visit the HIC website at http:/hv -11-mass ¢ov/ocabr/ Go online to view the status of a Home Improvement Contractor's Registration: httP://db-state.ma.us/homei For assistance with informal mediation of disputes or to register formal complaints against a business, call: Consumer Complaint Section Office of the Attorney General 617-727-8400 AND/OR Better Business Bureau 508-652-4800,508-755-2548 or 413-734-3114 version 2.1 - 1122/2010 c AC L> �., CERTIFICATE OF LIABILITY INSURANCE DATE(/DDI') THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policypes) must be endorsed, ff SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such erxlorsemenf(s). PRODUCER Cirele Ss.. ns . Agcy, Inc CONTACT NAME: 247 Newbury Street PNDNE 978 777-5619 FAx978) 771-4898 Danvers, MA 01923 EMAIL A No: All. INSURED National Management Team Inc. 2 Austin Square Lynn, MA 01905 COVERAGES INSIIRERF: .CERTIFICATE NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSUREDENAMIED ABOVE FOR THE POLICY PERIOD ON NUMBEF-7 INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, TREXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TYPE OF INSURANCE WR SUB POLICY EFF POLICY ERP B GENERALLIABIUTY POUCYNUMBER M/pDly MMIDD/YYYY Y Y LIMITSMPT7965M 2/24/15 2/24/16 Ts _ �nm MERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1 000.000 CLAIMS -MADE OCCUR DACE TO RENTED el s 500 . ono ruc�vwi�a nuvINJURY I s 1 000 , 00( GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2000.00( POLICY g .PRO- LOC PRODUCTS -DJMP/OPAGG 11 2 000OO( B AUTOMO161U TY ANYAUTOAUTO Y Y MPT7965M 2/24/15 2 /24/16 �rINSINGLE LIMIT AULOWNED SSICITHEEDDULED AUTOS $ s 1 000 OOa BODILYINJURY(Perperson) 1 X OS HIREDAUTOSX AO�NOSWNED BODILY INJURY (Per accident) $ C =FO CCUR Y Y 85824I140ALI 2/26/15 2/26/16 $ EACH OCCURRENCE LAIMS-MADE $ 51000,000 DED RETENTION $ AGGREGATE S 5,000,000 A NWRKERS COMPENSATION AND EMPLOYERS'UABIUTY ANYPROPRIEIOPWARTNEWEXECUTp& YIN UB2E71937-6 2/21/15 2/21/16 X WCSTATU- OTH- $ IMITS OFFICER/MEMBEREXCLUDED? (Mandatory In NH) N/A By I ER E.L. EACH ACO DENT b 1 000 000 DE3�RIPT�fON under pPERATIONS E.L. DISEASE below -EA EMPLOY E 1 000 000 D Rental Equipment cover IMC8-454-711 5/21/15 E.L. DISEASE -POLICY LIMIT $ 1 000 000 5/21/16 Limit REPLACEMENT COST 100,000 Deductible 5,000 DESCRIPTION OF OPERATIONS/ LOCATIONS1VEHICLES (Attach ACORD 101, Additional Rene rice Schedule, if more space Isrequlied) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Proof of Insurance THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED M ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Sanet Nichols ACOR25 (2010105) The ACORD name and logo are registered marks of ACORD RD CORPORATION. All rights reserved. Phone:hone: Fax: E -Mail: