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Home My WebLink AboutBuilding Permit # 10/8/2015 i ga4RTH BUILDING PERMIT o� �4,FD TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION - Date Received Permit Nod: gs�Acwus`�R Date Issued:///- IMPORTANT: Applicant must complete all items on this page LOCATION AA — Print 100 Year St "cture yes no w , PROPERTY OWNER Print MAP PARCEL: ZONING DISTRICT:—Historic istrict yes no achine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ On roily El Addition wo or more family El Industrial ❑ ration No. of units: ❑ Commercial Repair, replacement [I Assessory Bldg ❑ Others: Elem Demolition ElOther + „r ,urrlr /c: fa/ii,/i //,IPl,///Ilrr,,, �//,.,, �ff�/, ❑ ,Wa � „ i /r / r,,,3u�oUr,/. 1�i(I �/,/',./, 9/// �, �oii , � ,, ir/ ,,, ,,,,,✓ell�nd9/r.,/ii/„/. ,/�, .,, r r r ((�� ,��f .. d /,,,,1 .. � t� r�ir/.r � r, � i ,r� � n❑rVV,. ,... �r //rr / r a r ai / r 1/,, ..,,... ,. ,e� f' ///r/r,o,/it� ��f.. .❑.F f,.. ,��,�m �„r,«r a r � / l �( r�r � '! (, WONr ��>�G��d M� DESCRIPTION OF WORK TO BE PERFORMED: Pu d-A &Md i� 4 4A AVO Ne-,j Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: , Phone: � Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 2/14 ARCHITECT/ENGINEER Phone: Address:ess: Reg. No. T: 12.00 PER$100 0.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. FEE SCHEDULE.BUL DING PERMIT:$ ')ss Total Project Cost: $ FEE: $ eceipt NCheck No : '” I®T®TE: , rs ontracting with unregistered con ctors o zot Ii e acc guaranty furze T t%ORTH Andover _t own of 0 N . 1VL T ro ��Ks h ver' X539ID 4 COCMIct4t WICK S U BOARD OF HEALTH Food/Kitchen PERM ,-IT T LD Septic System THIS CERTIFIES THAT ......... ..,..... .�/k�`9' . .. ......... ...................................... ,, BUILDING INSPECTOR .. . .4r6� Joe has permission to erect .............. buildings on .0 Foundation ATZ Rough to be occupied as . .. ............... .. .. , ..�.. .................................................... Chimney provided that the person accepting this permit shall in a ery 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR ' UNLESS CONSTRUCTIO T S Rough Service ............... ..... . ............................................ Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required t® Occui2v BuilclinRough 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. AM t%®RT H It Anu - �. :..•d,., 0-6 0 V el ® No. - - no �O LAKE h ver, 6l.SS' ID ra Aj. COc KIc"t—CR �• S U BOARD OF HEALTH Food/Kitchen rERM I �T� I LD Septic System THIS CERTIFIES THAT ......... .......... BUILDING INSPECTOR ............. .. ......... .4 has permission to erect ........ buildings on . . Foundation ... ......... .. ..� ... ............ .. .. ............. t Rough tobe occupied as ........ .. ............... .. ..� ....�.. .................................................... Chimney provided that the person accepting this permit shall in a ery 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 PERMITI MONTHS ELECTRICAL INSPECTOR UNLESST CTI T S Rough Service ................ ...... . ............................................ Final BUILDING INSPECTOR GAS INSPECTOR ccupancr 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass.govldia ��. Workers'Compensation Insurance Affidavit:Builders/Contractors/Li lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORJTY- Applicant Information Please Print LeOb NaMe (Business/Organization/Individual): v Z,54l=,/ G"I bA4 lqoAddress: ' " i / hone#: - S71 Y City/State/Zip: W P . Are you an employer?Check the appropriate box: Type Of project(required: 1. aemployerwith ployees(fulland/orparttime). 7. E]Now construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 E]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.❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions. j 5.❑I am a general contractor and I haye hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors liave employees and have workers'comp.insurance# ' 6.Q We are a corporation and its of igers have exercised their right o£exemption per MGL c. 14.[)Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit'this affidavit indicating they are doing all work and then hire outside contractors must s4bmit a new 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-coniraci6rs have employees,%ey must provide their workers'comp.policy number. X am an employer that is pi•ovidbig wor-tiers' ompensation insurancefor my employees.'Below is thepolicy and job site information. Insurance Company Flame: Policy#or Self-ins,Lic.#: 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 WORD 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. Ido Hereby rtify un e pain and peva 'es o p Fury that Cation provided above is true and correct. Si ature: Date: 15 Phone#: Official use only. Do not sprite in this area,to be completed by city or town official.. 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#: owner 3MG3 2TRY Jtebcher+s Barks�ztwtttdtl�-4�wlaws 781-858-5134 Homeowner Information Contractor Information Name Company Name Ya"01 t , Street Address(do not use a Post Office Box address) Contractor/Salesperson/Owner Name k Code , Business Address(must include a street address) pp Crty/Town � Stato Zi Daytime � 4� � � � e '." City/Tmvn State Zip Code . Da a Phone Evening Ph p WS LN� Mailing Address(It different from above) Business Phone Federal Employer ID or S.S.Number _ Homelmpmw�mt(:ootraeterReg.iV�bv 'n e Law requires that most home improvement ramraetors tiave .w a vand regrsrranon number 21 The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed,specifying the type,brand,and grade of materials to be used,use additional sheets if necessary.) M) Wra4a svepie_J Ry 110 fv .. p �91/ isoa k oid ailied �a 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 homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of ` Date when contractor will begin contracted work. MGL chapter 142A.) fDate when contracted work will be substantially completed. Total Contract:Price and Payment Schedule The Contractor agrers to perform the work,furnish the material and labor specified above for the total sum of Payments will be made according to the following schedule: $ upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater) $ by / / or upon c pletio f $ or upon completion of / a A l U $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third ofthe 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 beine provided by the contractor? ❑No❑Yes(all terms of the warranty must be attached to the contract) Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor finther agrees to be solely responsible for all.payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall 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 time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the 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 company information so that you can confirm coverage,or ask to Contractor 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 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 In Massachusetts General Laws,chapter 142A. Homeowner's Signature Contractor's 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 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 worlmtanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry 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 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 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://ivivw.mass.gov/ocabr/ 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 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://Vwvw.mass.sov/ocabr/ Oo online to view the status of a Homo Improvement Contractor's Registration: http://dh_state.ma.us/homeimprovement/licenseel ist.asp 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 2A-11/22t201 0 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 YOU 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 DESPOSE 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 AND DATED COPY OF THIS CANCELLATION NOTICE OR ANY OTHER WRITTEN 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: ety Massachusetts -Department 1A Public StUndardF,t I uilding c;Eguiations Board of E . � CG'fiste i7Ci�uCi oul License: CS-090846 DANI TLF DUSSA, T 996 Johnson Street I North Andover 11fA 6 Expiration ��I S 1212612016 ICommissioner 1 ��-�-�� i,e a�xon.aaa�oeu�fla a��aatuc�uve�ty Office of Consumer Affairs&Business Regulation �#fJME IMPROVEMENT CONTRACTOR Type. -- ,egistration: 149853 DBA 3 = xpiration. 211412016., DUSSAULT CARPENTRY _ DANIEL DUSSAULT gg0 JOHNSON STREET gam` ersecretary NORTH ANDOVER,MA 01845 Und {