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Home My WebLink AboutBuilding Permit # 11/5/2015 A*,- � The Commonwealth of Massachusetts FOR € ' Board of Building Regulations and Standards MUNICIPALITY 1 '3s Massachusetts State Building Code, 780 CMR, 7te edition USE Revised ®� Building Permit Application August, 2012 This Section For Official Use Only; Building Nnnit Number: Date Applied: r i Signature: Building Inspector Date SECTION 1: SITE INFORMATION Residential Commercial ❑ Other Description: 1.1 Property Address: 1.2 Assessors Map&Parcel Number . o 1.1a Is this an accepted street? yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 'i 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard i Required Provided Required Provided Required Provided 1.6 Water Supply: (M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: Outside Flood Zone? Municipal❑ On site disposal system ❑ Commercial- Service Size Check if yes❑ SECTION 2: PROPERTY OWNERSHIP' 2.1 Oer'of Record: w � +✓ K5 �l►Y V� to ,r�L Y Y� �� l/ G �1)�DL7 ��Y�L. Jl. !� 'eC�HC �� .�� e'7 Name(Print) Address for Service: ,See INC_- X,7,y - Z/5-7- �,V& Signature Telephone E-Mail Address SECTION 3:-.DESCRIPTION OF PROPOSED ORK2(check all that apply) New Construction Existing Building Owner-Occupied ErTRepairs(s) Alterations) Addition ❑ Demolition c Accessory Bldg. ❑ Number of Units Other ❑ Specify: Brief Description of Proposed Work: oe,-Z SECTION 4: ESTIMATED CONSTRUCTION COSTS Item Estimated Costs: Official Use Only (Labor and Materials) 1. Building $ ��51eev 1. Building Permit Fee: $ 2. Indicate how fee is determined: 2. Electrical $ J 000-- ❑ Standard City/Town Application Fee 3. Plumbing $ d ❑Total Project Costa (Item 6)x multiplier x 4. Mechanical (HVAC) $ 3. Other Fees: $ 5. Mechanical List: (Fire Suppression)_ $ Total A tl "s. ' ? Check 6. 'Total Project Cost: $� Check Amount: Cash Amount: �� SECTION 5: CONSTRUCTION SERVICES 5.1 Licensed Construction Supervisor(®CSL) S 7, J License Number Exp ation a e6 Name of CSW-Iolder pa ` l List CSL Type see below A � T Description i U Unrestricted(up to 35,000 Cu.Ft.) Signature c R Restricted 1&2 Family Dwelling e M Masonry Only RC Residential Roofing Covering UktllTelephone,� WS Residential Window and Siding l f �'ss ��` bo �_ �� '�" SF Residential Solid Fuel Burning Appliance Installation E-mail Address D Residential Demolition 5.2 Registered orae Iinprovempt Contnow, ractor(HIC) HIC Company Name or HI PwgistraAt Name �+ Registration Number CPC/1 d P G�✓1'� C!,r Y6 Addy�� V J2-7 � � V-/ L�`a� s E piratioh Date Signature Telephone E-mail Addres SECTION 6: WORKERS' COMPENSATION INSURANCE AFFIDAVIT(M.G.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 issuanc of the building permit.. Signed Affidavit Attached? Yes .......... No ........... ❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN ON%INF.R'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT as Owner of the subject property hereby 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 OR AUTHORIZED AGENT DECLARATION VC, t,V , as _Authorized Agent hereby declare that the statements and information on the foregoing application are true and accurate,to the best of my knowledge and behalf. Sir,.n:iture of Owner or Authorized Age Date (Si-ned under the pains and penalties o perjury) NOTES: I. An Owner who obtains a building permit to do his/her own work, or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC) Program), will not have access to the arbitration program or guaranty fund under M.G.L. c. 142A. Other important information on the HIC program and Construction Supervisor Licensing(CSL)can be found in 780 CMR Regulations I I O.R6 and I I O.RS,respectively. _. Wl � yen sub.tantial work is planned,provide the information below: Total floors area(Sq.Ft.) Lcea-re, (including garage, finished basement/attics,decks or porch) Gross living area(Sq.Ft.) azze �- Habitable room count ,1� Number of fireplaces - -�e�',,.,� � % Number of bedrooms Llelle-e,j Numbcr of bathrooms - Number of half/baths Type of heating system Number of decks/porches e C.�y_ �� Type of cooling system z✓,�� Enclosed Open f FORTH ,-Town of ndover ® y g6S -r 0 1566 . h ver, Mass, PA COC MIC 11lWKK �� A�RATEU I"? C-) S � BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT ........81.t,^ L ...... ......... BUILDING INSPECTOR has permission to erect .......................... buildings on Foundation Rough to be occupied as ..... .�. ........64L . ........�..... ... .{... 0? /.. .v!'':�............................... 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS T TS Rough .CONSTRUCT 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. GODDARD'S Painting 9 Contracting® Construction 3 Bow Street,North Reading,MA 01864 � goddardpainting@comcast.net 9w 8) 664-22 4Fax: �g7�� ww� 664-2539 mmW w � Ww Ww � JACKIE BLINT / PAUL ACTIS 75 JOHNSON CIRCLE NO.ANDOVER, MA 978-457-9416 CONTRUCTIOI`N CONTRACT *** RESEARCH HEAT SITUATION PRIOR TO CONSTRUCTION WORK NOT INCLUDED Bse4> cvq FULL BATH )PROVIDE AND INSTALL LOUVRE DOOR ON MECHNICAL ROOM/NEW BATHROOM DOOR /BUILD RECCESSED CLOSET INTO MECHANICAL ROOM REMOVE EXISITNG FIBERGLASS BATH TUB / BUILD SHOWER /ONE GLASS WALL/ GLASS DOOR/MIXING VALAVE ON LEFT SIDE /GLASS BY OTHER INSTALL PROVIDED VANITY/TOILET/HEATED WALL UNIT IF RECOMMENDED BY PLUMBER INSTALL PROVIDED TILE IN SHOWER INCLUDING CEILING/TILE FLOOR i, INSTALL ALL PROVIDED ACCESSORIES /LIGHT FIXTURES /VENT/ALL PAINTING HALF BATH BUILD WALL PARTITIONS AROUND OIL TANK WITH ACCESS PANELS /STORAGE CLOSET OVER TOP OF TANK / INSTALL PROVIDED TILE FOR FLOOR INSTALL PLUMBING FOR TOILET TO BE CENTERED IN AREA WHERE EXISTING WASHER AND DRYER ARE /INSTALL PROVIDED VANITY ON OPPOSITE WALL 1 MUDD ROOM INSTALL NECESSARY PLUMBING FOR WASHER / SLOP SINK/DRYER ALONG NOTED WALL / BUILD WALL PARTITION AS DISCUSSED FOR UNITS/ PAINT UP MOVE EXISTING GARAGE DOOR THREE FEET TO THE RIGHT INSTALL NEW DOOR TO ELECTRICAL ROOM /ALTER EXISTING CLOSET r--tiLL- Oa C"Fi II I GODDARD'S Painting ® Contracting a Construction 3 Bow Street,North Reading,MA 01864 goddardpainting@comcast.net (978)m664-2274 -� Fax: (978)T664-2539 OWNERS TO PROVIDE: ALL TILE & GROUT/TOILETS/VANITIES /SINKS/FAUCETTS ALL LIGHTING, GLASS AND ACCESSORIES CONTRACTOR TO PROVIDE: ALL BUILDING MATERIALS, ELECTRICAL& PLUMBING CONTRACTORS,ALL NECESSARY PERMITS AND INSPECTIONS i CONTRACT PRICE $24,000.00 TWENTY FOUR THOUSANDS PAYMENT TERMS $2500 UPON SIGNING CONTRACTS UPON DAY OF START $4000 THREE PAYMENTS OF $5000 BALANCE ON SATISFACTORY COMPLETION $2500 I 4 I w ............ACCEPTED .4.........................DATE...... f .r ACCEPTED ...........DATE CONTRACTOR ..... ..........................................................................DATE........................... i w, 9P ry.. x-14 hoe V53 Lj <Who v .13 GODDARD'S Painting Contracting Construction 3 Bow Street, North Reading, MA Ol 864 978- 664-2274 r Date: 20/s PROPOSAL 9 YI&, Owner's Name �g -��r Telephone/FAX 97b - �1,e- 7 • /�6 We hereby propose to furnish all material and equipment and perform all labor necessary to complete the following work: The contracting agents full name is Richard S.Goddard.Richard is a state registered contractor in good standing with the Commonwealth of MA. This information has been made available in accordance with MA general law. All material is guaranteed to be as specified.All work is to be performed in accordance with the drawings and specifications submitted. Any changes involving extra costs will be executed in writing upon signed mutual agreement by both parties with additional charges noted.All agreements are contingent upon strikes, accidents,schedule or shipping delays beyond our control. Richard is insured for liability and workers compensation as required by law,copies of certificates available upon request. Owner to carry all other necessary insurance.All canceled material orders are subject to a 10%restocking charge.All special orders are a non-refundable final sale.Manufacturer's material warranties are the contractors warranty.All work to be completed in a substantial workmanlike manner for the sum of With payments tQ be made as follows: You,the buyer,may cancel this transaction at any time prior to midnight of the third business day.After the window for cancellation by the buyer has passed said cancellation shall be deemed a material breach of this contact which entitles the contractor to 20%of the total contact price.Cancellation without lawful excuse is a violation of the law.It is the obligation of the contactor to obtain all permits,the cost of which has not been included in the above noted price.The building inspection shall be called for by the contactor upon receipt of final payment.Homeowners that secure their own permits or deal with unregistered contactors shall be excluded from the guaranty fund provisions of chapter 142A of Massachusetts General Law.All home improvement contactors and subcontractors shall be registered and any inquiries about a contactor or subcontractor relating to a registration should be direct to: Office of Consumer Affairs and Business Regulation,Ten Park Plaza, Suite 5170,Boston 1A 02118 (617)973-MO. CONTRACTOR: y This proposal may be withdrawn if not accepted within 10 days. ACCEPTANCE You are hereby authorized to furnish all material,equipment and labor to complete the work described in the above proposal, for which 1,we,the undersigned agree to pay the amount stated in said proposal in accordance with the terms thereof. Any change involving extra cost of labor or materials will be executed only after submission and acceptance of a written change order. By signing this contract the signatory acknowledges that they are authorized to do so and assume all fiduciary responsibilities for this contacted agreement. OWNER/ Date AGENT R ted, Date Zo iS� Goddard'S Painting Contracting Construction 3 Bow Street, North Reading, MA 01864 978-664-2274 c:;o- ��,s`r_.ft ➢v�3,.°!� k��)! 1 r ��F2 s[ iii' Pursuant to MGL c142A and/or contract # 9L//& namely: ei,,j , dated: /S, For the purpose of this document the "Buyer" as noted below is the signatory power of the"above noted contract"baring the above written number. (Said contract hereinafter referred to as the ANC). The below noted signatures concur that these statements are both truthful and binding by both parties. • There are currently no liens or security interests on this or any other owned residence by this party as a consequence of this or any previous contract. • Richard S. Goddard (hereinafter referred to as RSG)uses and assumes all manufacturer's material warranties as the sole and only warranty for materials used. All labor comes with a one year warranty unless otherwise stated in writing. • Buyer understands and agrees that RSG is not responsible for any work not specified in the scope of work pertaining to the ANC. • Signatory for the buyer acknowledges that he/she is hereby authorized to execute this agreement and the ANC. • Customer agrees to refrain from sharing or leaving accessible this or the ANC with any of RSG's agents, subcontractors or staff and that any questions they may have regarding these agreements must be directed to RSG by the concerned parry. • Any materials purchased by RSG to perform work regarding the ANC are part of the customer's deposit payment. Some or the entire purchase price for these items may be non-refundable should the customer cancel the job after the date of the "right to rescind"has passed. • Buyer holds harmless and fully indemnifies RSG and/or his agents for any damage to any electronics in the customer's possession moved or handles by RSG and/or any of his agents during the course of job performance. • Buyer acknowledges that the buyer relies on no other statement of representation by RSG and/or any of his agents other than those statements contained in this agreement and the ANC. • Buyer agrees to refrain from additional work negotiations with any of the labor force of RSG and/or any of his agents and that any such requests/demands shall be brought solely to RSG's attention. • During winter months RSG reserves the right to cancel or postpone work without recourse or consequence in the event of inclement weather. • In the event the buyer does not adhere to the noted payment agreement as outlined and agreed to in the ANC a charge of 2%per month may be added to the Buyers total for each calendar month or part thereof in which the above amount is not paid. • In the event collection is necessary, Buyer agrees to pay all costs of collection including reasonable attorney fees. • The contractor and the buyer hereby mutually agree in'advance that in the event that the contractor has a dispute concerning the ANC,the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulations and the buyer shall be required to submit to such arbitration as provided in MGL c 142A. • Buyer(s) • Contractor upervisor chard S Goddard • NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. • Any homeowner who deals with unregistered contractors shall be excluded from access to the Guarantee Fund; MGL c142A The Commonwealth of Massachusetts Print Form _ Department of Industrial Accidents ®face of Investigations ' 600 Washington Street Boston, MA 02111 `T www.mass gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: `� &tom' .. r'( City/State/Z6Y%5-, Phone#: Are ygwan employer?Check the appropriate box: Type of project(required): 1. I am a employer with % 4. ® I am a general contractor and I have hired the sub-contractors 6. ®New construction employees(full and/or part-time).* 7. Remodelin 2.El am a sole proprietor or partner- listed on the attached sheet. g ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 ® Building addition [No workers' comp. insurance comp.insurance.# required.] S. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.F1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]f c. 152, §1(4),and we have no employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks box#1 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 new 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,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information, Insurance Company Name: 21r Policy#or Self-ins.Lic.#: Wif, 3/ S f j � ' Expiration Date: n vc t' ct V c,. City/State/Zip:t � Job Site Address: �� t Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 152 can lead to the imposition of criminal penalties of a tine up to 51,500.00 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pailis a onalties ijury that the information provided above is true and correct. Si ature: Date: — Phone# � t ' L2 Official use only. Do not write in this area, to be completed by city or town offieial. 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#' � y DATE ABILITY INSURANCEiMMraDrvvYYl CERih� �6 �CATE OF �[ 10/15/2015 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 ISwUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cerifficate Folder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If 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 endorsement(s). PRODUCER CONTACT Barbara McDonough Gilbert Insurance Agency, Inc. PHONE (781)942-2225 FAX (791)942-2226 137 Main StreetE-MAIL ADDRESS: gg bmcdonou h@ ilbertinsurance.aom INSURERM AFFOPMING COVERAGE NNC# Reading MA 01867-3922 INSURERA:SafetY Insurance Company 39454 INSURED mwRERe-LibertyMutual Ins. Co. 0030 A & R Goddard Corp. INSURER C 3 Bow Street rdsuRER D- INSURER E North Reading MA 01864 INSURER F, COVERAGES CERTIFICATE NUMBER.-15-16 MASTER REVISION NUMBER:- THIS UMBER:THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN SR ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURAPICE 5 POLICY NUMBER MMiD M$M1D LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE TO RENTED CLAIMS-MADE —1 OCCUR PREMISES Ea occurrence S MED EXP(Any one person) $ PERSONAL BADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY n JECT- 1:1 LOC PRODUCTS-COMPIOP AGG $ OTHER: $ AUTOMOBILE LIABILITY OMBINED SINGLE LIMlT $ 500,000 (Ea acaderd ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED COAT 6229448 7/10/2015 7/10/2016 BODILY INJURY(Par a-dent) $ AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Medica{ meats $ 5,000 UMBRELLA LIMB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION I PER 0TH- AND EMPLOYERS'LIABILITY y I N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E.LEACHACCIDENT $ 100,000 B OFFICERIMEMBER EXCLUDED? ❑NIA . (Mandatory in NH) WC231S311865045 9/19/2015 9/19/2016 E_L_DISEASE"AEAEM�LOYE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe aUached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE PROOF OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE M Gilbert, CTC/LINDSE - — - -- -- ®1999-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/611 The ACORD name and fogo are registered marks of ACORD tNS025 r�nlentl Office of Consumer Affairs and IYuslness Regulation `a 10 Farb Plaza - Suite 5170 Boston, Nlassacl asetts 0211 Home Improvement C01 , 'actor Registration _ Registration. 168420 Typo_ Corporation Expiration: 2/15/2017 Tr# 262031 A & R GODDARD CORP. RICHARD GODDARD s� �y�130t}T7gp J ST i NO. READING, IIIA 0186 Update Address and return card.Burk reason for chance tee. y L1 Address ❑ Renewal ❑ Employment n Lost Card nes-GAI e— � s Offi.Fkke e mp� nsines` s�egu�a oi� a gt R .��. $.iCerLSe of re stratia€n valid for individul ns..on. HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: --468420 Type' Office o€ConsuSneFAffairs and Business Regulation Expiration: 2Mj; . 017 Corporation 10 Park Plaza-suite 5170 Boston,MA 02116 Amu t GODDARD;ttMEN t_-.4 RICHARD GODDAR -�� 3BOWSTmss' �t 24% r NO.READING,MA 6� � Undersecretary Not valid wihout signature i 9 ��2sscci use �s -3� � rn2r DL c t6 t t-c,iE t� - t License: CS-055395 Vl 1 �! RICHARD M DEVlRGII 12 PINE AVE = MIDDLETON MA 01944 11/14/2096 t