HomeMy WebLinkAboutBuilding Permit # 7/22/2015 BUILDING IT
TOWN OF NORTHV a
APPLICATION FOR PLAN EXAMINATION
Permit Date Received
Date Issued:
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IMPORTANT:A2plicant must complete all items on this page
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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
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Identification Please Type or Print Clearly)
OWNER: Name: �,t„°���1�' °� l.W.ccs Phone'
Address:
TCM PltOtle L Imo'
11"arrte .., '
Sly„ rl( 77777777-1-1
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ARCHITECT/ENGINEER -,Sc ► c ' °c �, � _"II Phone: III- � - I
Address: C o, --ma.�A- (A i\ 1 .� err Reg No.
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FEE SCHEDULE:B&kDING PERMIT: 12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ gt ff FEE: $ /
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Check No,: Receipt No.:
NOTE: Persons canh acting witch unregistered contractors do not have access to the guarantyfund
signature of Agent/Qwner, .,, ,. Signature of contractor ,, ,IM
tkORTH 1-adover
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Town of
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LA E h ti ver, Mass,
COCHICHtwicK y�•
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BOARD OF HEALTH
Food/Kitchen
rERMIT T Septic System
THIS CERTIFIES THAT ........ UBUILDING INSPECTOR
�has permission to erect .......................... buildings on ...av....... b,R1!1. ... �ivC' ............... Foundation
+ Q Rough
to be occupied as ...... ....... ... ./. ..... ` ....... ..... ..... ...............O / ..�R........ Chimney
provided that the person accepting this permit shall in every respect 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
PERMITOL PI IN WONTUS1 ELECTRICAL INSPECTOR
® UNLESS CONSTRUC ST
Rough
Service
............ ... ..... ..................................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® 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.
significant improvementwithout having this reviewed by an architect or other design
professional is probably the first cousin to that lawyer! Capisci?)
Homeowner Information
Name:
William Lins &Rebekah Petronio
Street Address: (not post office box)
80 Bonny Lane
City/Town State Zip Code
North Andover MA 01845
Contractor Information
Company Name: ;
Contractor/Owner Name
Robert Kristiansen Jr.
Business Street Address
7 Manor View Dr.
City/Town State Zip Code
Raymond NH 03077
(Note: You need full,names, federal id #and addresses (not PO Boxes) of the parties,
which must appear in the contract. Don't forget to include names of any salespersons
involved and Contractor's Registration Number(on the first page of contract))
Salesperson(s): Contractor Registration#:
Exp. Date-
2
Expected Date of Completion: Ote: This is the date when contracted work will be
substantially completed, meaning that the work is sufficiently completed to a point of
completion where'the home improvement can be used or occupied by the homeowner.)
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
The Contractor agrees to provide the work, furnish the material and labor specified above for the
sum of$ 11,000.00 . (Include all finance charges in this amount.)
Payments will be made according to the following SCHEDULE:
$_2750.00 upon signing the contract.
(Note: the deposit shall not exceed 1/3 of the total contract'price OR the cost of special
order items,whichever is greater.)
$_2750.00 by_/ / or upon completion of
_Framing
$_2750.00 by / / or upon completion of
_Decking
$_2750.00 upon completion of the contract. (Note: The law forbids
demanding full payment until the contract is completed to both parties satisfaction.Put
another way,if the homeowner is not satisfied with the contractor's services, the contractor
is not entitled to final payment.)
In order to meet the completion schedule, the following material/equipment must be special`
ordered before the contracted work begins:
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DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
(Note: Identical copies of the contract should go to the homeowner and the contractor.)
Homeowner's Signature Contractor's Signature.
Date Date
4
homeowner to get a different contractor. A good and substantial warranty should be seen
as effective marketing. Providing an insurance certificate to the homeowner for his job
without his having to demand it should be seen in the same light. Remember, a principal
marketing concept is that everyone knows two hundred and fifty people. And, all
homeowners have'a ready pool of potential customers. They are otherwise known as
neighbors!)
Please note that all home improvement contractors and subcontractor shall be registered and any
inquiries about a contractor or subcontractor relating to registration should be directed to:
Director,Home,Improvement Contractor Registration, One Ashburton Place, Room 1310,
Boston, MA 02108, 617-727-8598.
Unless otherwise noted within this document, the contract shall not imply that any lien or other
security interest has been placed on the residence.
ARBITRATION
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 such dispute to a
private arbitration.service which has been approved by the Secretary of the Executive Office of
Consumer Affairs and Business Regulation and the consumer shall be required to submit to such
arbitration as provided for in MGL C. 142A.
Contractor: Homeowner:
Date: Date:
NOTICE: the signatures of the parties above apply only to the agreement of the parties to
alternative dispute settlement initiated by the contractor. The owner may initiate alternative
dispute resolution even where this section is not separately signed by the parties:
ACCELERATION OF PAYMENT
Homeowner's Financial1nsecurity. '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.
Contractor's Financial Insecurity. 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 from said
account would require the signatures-of both parties.
OTHER CONTRACTUAL'DOCUMENTS
This contract includes as contract documents the following additional enumerated documents:
(NOte: If you intend for a proposal to be part of the contract or specific plans and
specifications or catalogue cuts to be part of the contract,'be sure to reference them here.
As a matter of contract law,"where there is a proposal and then is a subsequent'contract
6
which both parties,sign which does not reference the proposal, the proposal has no
remaining contractual significance or effect unless it is specifically incorporated as a
contract document in the contract.)
NOTICE OF CANCELLATION
YOU MAY CANCEL THIS TRANSACTION, WITHOUT PENALTY OR
OBLIGATION, WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE.
IF YOU CANCEL, ANY PROPERTY TRADED IN, ANY PAYMENTS MADE BY
YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS
EXECUTED BY YOU WILL BE RETURNED WITHIN TEN BUSINESS DAYS
FOLLOWING RECEIPT BY THE SELLER OF YOUR CANCELLATION NOTICE, AND
ANY SECURITY INTEREST ARISING OUT OF THE TRANSACTION WILL BE
CANCELLED.
IF YOU CANCEL, YOU MUST MAKE AVAILABLE TO THE SELLER AT YOUR
RESIDENCE, IN SUBSTANTIALLY AS GOOD CONDITION AS WHEN RECEIVED, ANY
GOODS DELIVERED TO YOU UNDER THIS CONTRACT OR SALE; OR YOU MAY, IF
YOU WISH, COMPLY WITH THE INSTRUCTIONS OF THE SELLER REGARDING THE
RETURN SHIPMENT OF THE GOODS AT THE SELLER'S EXPENSE AND RISK.
IF YOU DO MAKE THE GOODS AVAILABLE TO THE SELLER AND THE
SELLER DOES NOT PICK THEM UP WITHIN TWENTY DAYS OF THE DATE OF
CANCELLATION, YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY
FURTHER OBLIGATION. IF YOU FAIL TO MAKE THE GOODS AVAILABLE TO THE
SELLER, OR IF YOU AGREE TO RETURN THE GOODS TO THE SELLER AND FAIL TO
DO SO, THEN YOU REMAIN LIABLE FOR PERFORMANCE OF ALL OBLIGATIONS
UNDER THE CONTRACT.
TO CANCEL THIS TRANSACTION, MAIL OR DELIVER A SIGNED A DATED
COPY OF THIS CANCELLATION NOTICE OR ANY OTHER`OMTTEN NOTICE, OR
SEND A TELEGRAM TO (Name of Seller), AT (Address of Seller's Place of Business)NOT
LATER THAN MIDNIGHT OF (date).
I HEREBY CANCEL THIS TRANSACTION.
Date: Buyer's Signature:
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CONSTRUCTION ws �a�.,�l y L N,
12 Pient Street ®
NEWBURYPORT, MASSACHUSMS 01950 CALCULATEDBYbail
Phone (979) 5.2216
Fax (979) 4633522 av- Dn
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The Commonwealth of Massachusetts
Department of IndustrialAccidents
b 1 Congress Street,Suite 100
Boston,MA 02114-2017
www mass.gov/dia
Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name(Business/Organization/Individual): c,
Address: ` c� M Q-A,- E ,,
City/State/Zip:j rte^`�- V� y'' �11 Phone#:
Are you an employer?Check the appropriate box: Type of project(required):
LVI
am a employer with employees(full and/or part-time).* 7: E]New construction
2. am a sole proprietor or partnership and have no employees working for me in $, Remodeling
any capacity.[No workers'comp.insurance required,]
3.E]I am a homeowner doing all work myself.[No workers'comp,insurance required.]t
9. El Demolition
10 n Building addition
4,❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11,0 Electrical repairs or additions
proprietors with no employees.
12.(]Plumbing repairs or additions
5.0 I am a general contractor and I have hired the sub-contractors listed on the attached sheet
These sub-contractors have employees and have workers'comp.insurance.t 13 Roof repairs
6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other
152,§1(4),and we have no employees.[No workers'comp,insurance required.]
*Any applicant that checks box#t must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
1 am an employer that isproviding workers'compensation insurance for my employees. Below Is the pollcy and job site II
Information.
Insurance Company Name:
Policy#or Self-ins.Lie.#: Expiration Date:
Job Site Address: City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up 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 of up to$250.00 a '
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
.T do hereby certify under tdse pains and peraaltles of pe:fur, that the lnformationprovided above Is true and correct
Signature: Date:
7i/zprS
Phone#: 6 _ W4VJl,
Offlcial use only. Do not write in this area,to be completed by city or tmvn offletal
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4:'Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
VMassachusetts - Deparl.rnent W "Wj��('
-F
I.Jcense: CS-072583
ROBERT E KRISTIANSEN JR
R41
PO BOX 2353 -
Seabrook NH 03974
C orra ms.tc)n c r 05I07/2016
offce of Cons n u -ter Affairs&Business Regulation
DOME IMPROVEMENT CONTRACTOR Type:
5.1egistration: 181148
Expiration: 3/5/2017 individual
"gr ;tip
ROBERT E.KRISTIANSEN JR.
ROBERT KRISTIANSEN JR.
7 MANORVIEW DRIVE
RAYMOND,NH 03077 Undersecretary