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HomeMy WebLinkAboutBuilding Permit # 10/14/2015 BUILDING PERMIT 0 %aosary h� 4,,,6 TOWN OF NORTH ANDOVER � - ® APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: IM RTANT: Applicant must complete all items on this page LOCATION b PI—e S Ce'g ° i t PROPERTY OWNER OXV L Q Uk C\Prk,'q Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building Ybne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other b Septrc r ❑Well ❑ Floodplain o Wetlands ❑ Watershed Distract P f 1 ( f i DESCRIPTION OF WORK TO qE PERFORMED: �- (10 r cg- - ron g S 1( Z�ae�.� V-Z tic?t/ C`'4.1�� A�AJQ S; J' Identification- Please Type or Print Clearly OWNER: Name: /YyarrA- LU' z Phone: C/?J?- 6Y-x-909(-/' Address: �6 P>✓' s co Contractor Name: SC�'ff ��� �'�' Phone: Email tjo y- ' Y 0 amn � Lo v,-, Address: - '` Supervisor's Construction License: CExp. Date: / ao l 7 Home Improvement License: b�� �! Exp. Date:- q a017 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 7YO�O, 00 FEE: $ Check No.: Receipt No.: 2� C2 NOTE: Persons contracting with unregistered contractors do not have acCOWs to the guaranty fund AM t%O R TH 2 T E ...'.q. ' " dover fown of ® ..;'. to 4--1 No. ��� �� ® C, LAKE h ver, ass, COCK IC EWICK A04ATEO S BOARD OF HEALTH U Food/Kitchen LD ERMIT T Septic System THIS CERTIFIES THAT ....... �4;bbj. BUILDING INSPECTOR .................................................................. _ Foundation has permission to erect .......................... buildings on ... . ........ ....! ............................... Rough tobe occupied as ..........15...... .... ............. ... .... . ....................................................................... 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 PERMIT EI ES IN 6 MONTHS ELECTRICAL INSPECTOR LESS C CTI T Rough Service .................. ...................................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancV Permit Required to OccupV PuildinRough 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. FREE ESTIMATES PROPOSAL Construction Supervisor Lic.# CS102663 FULLY INSURED H.I.C. Reg,# 138569 WMGHT ® U S AND HOME 1AWROVEMENT All Types of Rooftmg& Gutters 350 BERRY STREET ® NORTH ANDOVER, MA 01845 TELEPHONE: 978-687-2247 PROPOSAL SUBMITTED TO PHONE DATE Mox L® �.k Lt`bb 9-78-683 -- Scwl/ /0 STREET JOB NAME/LOCATION CITY,STATE AND ZIP CODE JOBSTARTDATE I nJ-0vu YYlA 0tr r M00 Chi,-n n e-- �yl-F over eA JD'st�-ZQ-W E C �jO L, �sZ �� V\ C V-k, I�(`'`aGt milvl pkSe, C1kiMney. ` , v 54—c-ip 9—xl's` Y1'i� zik,'A� r 04 C7l*r�l$ dagCJ'I,l,?A L060v2. uso- 6A 0� jte-€' W(&-r Shi on xves. 'U.SQ (ce € cow:-`�e.r' &k e-U aratticl ��lo�slecl waltr Oka/ Ct\, ► +� • 0,se- 3QI� 41+- pgair ah 'kr� �trr*X tA1'nr - hoof de* ck. Re-P©t'nf V-P Q-0--I 1 rv►nQ CPQ Si.t USQ- C-R F I tt rck(I e-cf sk %&S 0A1 -30 ,Pp L, w i+i_c1 cd 6 rc, v e* +1 k+, ccL t,il S � . t:,4t,V"N Jr I'P e(ky O'k o�► CA l l Zavis it k2� • ��rnps ��r—` �2es ��ry►�t �S cvre- cLdhd `le f4tnal ?C0V1j-1;'4 by L�ss C�a►�-�rt�'v�tz;r�otr o-f f- .w"t.MA 40 jest 1"d1l,.4 i [ cke.6 Vr'1s. st C l eun�;,� , �` s ►n c utQee�( �,�I`�` �r� �s z c� 4-a 69-wicte-d We PrOPOSC hereby to furnish material and labor-Complete in accordance with above specifications,for the sum of:$ 7 ®o°()� Payment to be made as follows: ,fir ^� /6�,0Q CLLLe n I`� All material is guaranteed to be as specified.All work to be completed in a substantial workmanlike manner according to specifications submitted,per standard practices.Any alteration or deviation from Authorized above specifications involving extra costs will be executed onlyupon writtenorders,andwill become an Signature extra charge overand above the estimate.All agreements contingent upon strikes,accidents ordelays beyond our control.Owner to carry fire,tornado and other necessary insurance.Our workers are fully NOTE:This proposal maybe covered by Workmen's Compensation Insurance.Non payment by agreed party may result in litigation withdrawn by us if not accepted within days, with penalties including court cost and compensation both real and punitive. / Acceptance Of Proposal - The above prices, specifications and ` conditions are satisfactory and are hereby accepted,making this a valid contract. Signature -),�j 114 You are authorized to do the work as specified.Payment will be made as outlined. Date of Acceptance: Signature The Commonwealth of Massachusetts Department oflndustrialAceldents X Congress Street,Suite 100 F. Boston,MA 0224 2017 R www.mass.gov/dia s,. Wovkers'Compensation Insurance Affidavit:Builders/Contractors/Elsctricians/Plumbers. TO BE FILED WITH THE PERI UTTI NG AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): ��^Q _ ��� ���-� Wp_�`�` �" Address: City/tate/Zip: AT e, �?I Phone#: 9 8? Areyon employer?Checkt&appropriate box: Type of project(required): 1. amaemployerwith (�!?, employees(full nd/orparttime).* 7. New construction I am a sole proprietor or partnership and have no employees Working for me in 8. Remodeling any capacity.No workers'comp.insurance required.] 9. Demolition I[]lam a homeowner doing all work myself,[No workers'comp.insurance required.]t ❑ 10 []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 pro'p'rietors with no employees. 12.Q plumbing repairs or additions 5.0 I am a general contractor and I have hired the sub-contractors listed.on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.t ' � 14.F1 Mer 6.Q We are a corporation and its officers have exercised their right of exemption perMGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit#his affidavit indicating they are doing all work andthen hire outside contractors must submit anew affidavit indicating such. ?Contractors 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,%ey must provide their workers'comp.policy number. I am an employer Mat is providing workers'compensation insurance for my employees.'Below is the policy and joh site information. Insurance Company Name: (.. ` r Policy#or Self-ins,Lic.#: ()J C-5 _3)S 3 37 0/S ExpirationDate: 9 3o /6 Jo-b Site Address: q6 Pres'(011f SST City/State/Zip: A An k vev,/h4 013�S Attach a copy of the workers'c'ompensation•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 fortu of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert der t/ie pains andpenalties ofpeijury tlaat the information provided ah ova is true and correct. Signature: Date: Phone#• 979-60- d-AY7 Official use only. -Do not-write in this area,to he completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: MBassachusetts Home m irovenllent Contract =satisfiess all basic requirements o€tile state's Home Improvement ContractorLaw(MGL chapter 142A),but doesnot include standard ect homeowners. Seek legal advice ifnecessary. Any person planning home improvements should Test obtain a copy of"A onsumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the erNafrs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888.283-3757 or on our website. Horneowner Information Contractor Information Name CompanylA, vr Lou, G Ufteyrs Street Address(d not use a Post Office Box ad ess) Contractor/Salespe' n/OwnerName CO ter e co-tl' St S cot 4�r l Q�t'" — City/ronn Slate Zip Code BusinessAddress(mustincludeas at address) IQ. Andover. (n R d 1SY5 3.570 i3wArr Isf-I DaytimePhone IEvening Phone City/Tovm I State Zip Coda `37$-6$3-$07q �tAmE AL AvldUW /nA 0106, 14failingAddress(Itdi&=tfromabove) Business Phona7 - yFederalEmployerlDorS.S.Number' HMeTmprovem:atCoarraelarR;.Nam6er EapcaGonda'a ran ttquiret tEat melt Looe e tmptoremtnt centroriars Lara ' e'J��t� C.(/�(J/��t avalid reputrstfon number O 7 / The Contractor agrees to do the following work for the Homeowner: l (Describe in detail the.vicsktocompleted,speoiryingthetype,brand,andgradeofmaterialstobeused,useadditionalsheetsifnece>sary.) P I&SP SZe 61. rt., let< Required permits-Thefollowing bnildingpermitsare 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 / /rJ Datewhencontractor will begin contracted work. MGL,chapter 1.42A.) /•j Date when contracted wwkwill be substantially completed. Total ContractPriceand Payment Schedule !/pyL,`rjo �� _ The Contractor agrees to perform the work,finnish the material and labor specified above for the total sum of: A /7 (} Payments will be made according to the following schedule: S 00 upon signing contract(not to exceed 1/3 ofthe tonal contract price or the cost of special order items,whichever is greater) $ �Q by �!j, / or upon completion of $ I tT lg,w by or r� or upon completion of� 1 O h S�QO upon completion ofthe contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following materiallequipmentmust bespecil`— 5---- -...__..__A2 be dfor "ry ordered before the contracted work begins in order to meet the completion schedule.(,") $ to be paid for_ NOTES:(4)including all finance chargcs('t'•`)Law requires that any depositor 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 ofany special equipment or rWtOal made material which must be special ordered in advance to meet the completion schedule. Express Warranty Is an exoresswarrnnty being provided by the contractor 95501 Yes(ill terms of the warranty most be attached to the contrncd Subcontractors-Tho contractor agrees to be soleIyresponsiblo for completion ofthe work described regardless ofthe actions o£any third party/subcontractor utilized by the contractor. The contractor fuuther agrees to be solely responsible for all payments to all subcontractors for materials and laborumder this agreement Contract Acceptance-Upon signing,this dominant becomes a binding contract under law. Unless otherwise noted within this document,die contract shall not imply that any lien or other security interest has been placed on the residence. Revicw the following cautions and notices carefiullybeforesigningthis contract. • Don't bepressuredinto signing the contract Take fine to read and fully understand it. Ask questions ifsomething is unclear. • Make sure the contraetorhas a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director ofHomeImprovement 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 of 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 see a copy ofa"proof ofinsuuance'document. • Kmow your rights and responsibilities. Read the Important Information on the reverse side ofthis form and get a copy ofthe Consumer Guide to the Home Improvement Contractor law. You may cancel this agreement if it has been signed at aplace other than the contractofs normal place of business,provided you notify the 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 ofthe third business day followingthe signing ofthis agreement. Seethe attached notice ofcancellatiou form for as explanation ofthis right DO NOT SIGN THIS CONTRACT IF THERE ASCE ANY BLAND SPACES 111 TWoidendealco •ofmcoehooiTaodwcopyshouldbkoptbythocontractor.o � e a. Homeo vner'sSi nature Contr ctor's Signature Date Date�—T J. Office of Consumer Affairs&Business Regulation —'SOME IMPROVEMENT CONTRACTOR 00 �_� _ �tegistration: •138569 Type: Y,..'Expiration: 4/14/2017 DBA WRIGHT GUTTERS SCOTT WRIGHT 350 BERRY ST. NO.ANDOVER,MA 01845 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza-Suite 5170 Boston,MA 02116 Not valid without gnature assachusetts Department of Public. Safety Board of Building Re pulations and Standards 0 License. CS-102663 onstrur fiorj Bcrpervisor SCOTT W WRIGHT 360 BERRY ST NORTH ANDOVER i ,fC i piratiow Cohirniss,loner 08/12/2017 Unrestricted-Buildings,of any use group which contain less than 35,000 cubic feet(991m)of enclosed space. Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit: www.Mass.Gov/OPS