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HomeMy WebLinkAboutBuilding Permit #366-13 - 0 Barker Street 11/5/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: I� Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION \ t8n Print PROPERTY OWNER GCO me C _1,^ Print 100 Year Old Structure yesOnoMAP NO: PARCEO ZONING DISTRICT: Historic District yeMachine Shop Village ye 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 ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District. ❑Water/Sewer DESC, O IP ION OF WK TO BE PERFORMED: IdentificvAion Please Type or Print Clearly) OWNER: Name: CW ° 6L Phone: 7?-6 -5-01 Address: Jt /u, ,00(0yey CONTRACTOR Name: �JQ QS !�C re d�l Phone:9&-69-5-_6_J,;>7 Address: Supervisor's Construction License: p Exp. Date: Home Improvement License: /a� J�7 Exp. Date: �v f ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST ASE ON$125.00 PER S.F. Total Project Cost: $ �3 7®� FEE: $ Check No.: Receipt No.: � �_ NOTE: Persons con racting with unregistered contractors do not have access to the g a ty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location l../ No. Date I k + • TOWN OF NORTH ANDOVER • . Certificate of Occupancy $ .' Building/Frame Permit Fee $ _ Foundation Permit Fee $ 1 Other Permit Fee $ _ TOTAL $ Check 25906 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments e Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW'Tote, Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010 r� Building Department The fohowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ 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) ❑ 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 ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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: Doc.Building Permit Revised 2012 Massachusetts Dome Improvement Samule Contract 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 Iegal 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 may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name Company Name Street Address(do not use aPost Office Box address) Contractor/Salesp &soila0er Name3�I rkd- ra �� � r c City/Town State Zip Code Business Address(must include fa street address) DaytimePhone�� � veiling Phone City/Town state � �/�/ Code Mailing Address(It different from above) Business Phone "/ 71 Federal Employer M or S.S.Number Home Improvement contractorReg.Number Expiration date Lnw requires that most home ` improvement cant n o b r ry� � 1 I valid registration number (Jx [�J( / The Contractor agrees to do the following work for the Homeowner: (Describe in detail the workto completed,specifying the type,brand,and grade of materials to be used,use additional sheets ifnecessaiv.) 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�wffl be excluded from the Guaranty Fund provisions of Date when contractor will begin contracted work. MGL chapter 142A.) H-J 0 1' Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform.the work,furnish the material and labor specified above for the total sum of: v Payments will be made according to the following schedule: $ O0_ 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 completion of $ by or upon completion of $ �0©D upon completion ofthe contract (Law forbids demanding fall ay ment • 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.(]°.j°) $ to be paid for NOTES:(,')Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before workbegins 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 EI-Yes(111 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 further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this aRreement Contract Acceptance Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contn'act 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. o Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear.. o Make sure the contractor has a valid Home Improvement Contractor Re 'stration. The law requires most home improvement contractors and subcontractors to be registered with the Director ofIlome 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 confrm coverage,or ask to see a copy of a"proof of insurance"document. o Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Ianproveme%Contractor Law. You may cancel this agreement if it has been signed at a place other than the contractor's 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 following the signing fthis agreement. See the attached notice of cancellation form for an explanation ofthis right. DO NOYSIG•N TMS CONTRACT IF THERE ARE ANY E LAM<S PACESirr Two identical copies of the contract must be completed and signed One copy should go to the Iiomeovmer. The othar copy shottld be]sept by the contractor. Homeowner's atux 4Coactorfs Signature Date Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 UV. www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Jam,% r^ Address:, 1.g y ,n- Ack(/ City/State/Zip: 4�9 J Y Phone#: 5/ 7 Are you an employer?Check the appropriate box: Type of project(required): 1.VI am a employer with_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.$ E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12:Z? oof repairs insurance required.]i employees. [No workers' comp.insurance required.] 13.❑ Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: 7 5-7 e">^0 Q0/40 j 9- Expiration Date:15_ 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. 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 rtify unde e p ins and penalties of perjury that the information provided above is trite and correct. Signature: Date: I Phone#: I t�✓ �Q� r,5f Official use only. Do not write 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#: 168 Maple Street James Debrecen! Methuen,MA 01844 LIC#99685 (978)683-5127 FMI HIC#122385 ROOFERS & PAINTERS Bill 5 e &C ke-v- Address:re � 3 (3ro V 4,7cj Phone: o,�` Cleef'q 'e14a/ k s _7 4// )eld5e VC0 r ALL WORKMANSHIP GUARANTEED 3 YEARS ESTIMATE INITIAL DEPOSIT CtIQ� fQ 1ST PAYMENT 2ND PAYMENT FINAL PAYMENT GCS ess office'of CAnsumer Affairs 8i BusmCTORg HOME IMPROVEMENT CONTRA Type: Registration: 122385 DBA ' Expiration: 8126/2014 j&.p WEATHERSEAL JAMES DEBRECENf r 2 TANAGER WAS' •: Undersecretary LONDONDERRY,NH 0053_ Massachusetts -Department of Public Safety V Board of Building Regulations and Standards Construction Supen'isor Special0k License: CSSL-099685 . JAMES J DEBRECENl- 2 TANAGER7WAY, ^ }�� . LONDONDE,IRY NH 0305371 �; ifs ��f ?p Expiration Commissioner 12/06/2013 i FORTH own of ? E ndover to lot 2 No. 13 Z h ver, Mass,COC HICHIIWICK 1 �. �d A0RATE0 ► '�C S V BOARD OF HEALTH i . Food/Kitchen PERM LD Septic System THIS CERTIFIES THAT ... ... BUILDING INSPECTOR Foundation has permission to erect ........... buildings on D........eiats.. .... .. • ............. Rough to be occupied as ................. . .. . . ...........�...... ....... ............. ........... .a-AA.. Chimney provided that the person accepting th permit shall in every respect conf 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 IR, TH(S __L!!M ==.V ELECTRICAL INSPECTOR UNLESS CONSTRUC Rough Service ........... ................... ........................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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. SEE REVERSE SIDE