HomeMy WebLinkAboutBuilding Permit #605-13 - 162 Kingston Street 3/13/2013Permit N0: ^-
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
n Print
PROPERTY OWNER 1' Gto\r,�
,-Z Print 100 Year Old Structure yes no
MAP NO: _PARCEL: lvN DISTRICT: Historic District yes no
LoeMachine Shop Villaqe yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Resid ntial
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
D SCRIPTION OF WORK Tp BE PERFORMED'
OJO
IF kul, cabi
(Waw �Acoki=a lr�t� cefaa-ytc :6 (as I RQ40 I
o -Nw(i N Cwro
Identifica ion Please Type or Print Clearly)
OWNER: Name: d6 0 y -c caNuD Phone:
Address: la RIeGS�onriOc�-k Prd >Oj QF AAA
CONTRACTOR Name: AX- o\v\JtRW bf Phone:
Address: 63 W b� � S � do,��41 \ C)S�
Supervisor's Con�-Construction License: 'y L05 /0 Exp. Date: /D a5 0?1��.3
Home Improvement License: 1 ��- Exp. Date: /� �o�6
ARCHITECT/ENGINEER /�(/'G�S L�� Phone:
Address:/6 M6a 14111) S -q,4 Reg. No. 33 yyy
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ l"11 O l5 FEE: $ S:q
Check No.: /0 Receipt No.:
NOTE: Persons lontracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractXSta;;ed
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 11 Plans ❑
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming Pools 0
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
COMMENTS.
Reviewed o
Sianature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comm
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Tower ]Engineer: Signature:
FIRE DEPARTMENT - Temp Dumpster on site yes
Located at'124 MainStreet
Fire Departmerit signatureldate
COMMENTS
Located 384 Osgood Street
no
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
IVU 1 t5 ana UA I A — II -or aepartment use
El Notified for pickup - Date
Doc.Building Permit Revised 2010
Building Department
The following 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 app: al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm;¢ted with the building application
Doc: Doc.Building permit Revised 2012
LocationA& 46-v�
No. Dateg!6 - L15 -
Check# / 0 :;�q -
26207
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $-
Building Inspector
The Commonwealth of Massachusetts Print Form
Department of Industrial Accidents
Office of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2017
www mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): MDJ INC
Address: 16 WOODLAND ST
LAWRENCE MA 01841
Phone #:978-685-5691 978-804-7588
Are you an employer? Check the appropriate box:
1. I am a employer with 3 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet.
ship and have no employees These sub -contractors have
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.:
required.]
❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. P Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12. ❑ Roof repairs
13. ❑ Other
*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: CONTINENTAL CASUALTY COMPANY
Policy # or Self -ins. Lic. #: 5B711072 Expiration Date: 11 /20/2013
Job Site Address: 1602 ??5102gs U� City/State/Zip:
Attach a copy of the workers' cd 6pensation 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.
provided above is true and correct.
O V--- 7-5—B
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 #:
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Construction Supervisor License
License: CS 47056
MARCOS A DEVERS
16 WOODLAND ST
LAWRENCE, MA 01841
Expiration: 10/25/2013
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Office of Consumer Affairs & Rusibess Regulation
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OME IMPROVEMENT CONTRACTOR
eglstration: 106698 Type:
xpirstiion- 7/24/2014 Private Corporatic
MDJ INC.
Marcos Devers
61 WOOD LAND STREET
LAWRENCE, MA 01841 Undersecretary
COMMONWEALTH OF MASSACHUSETTS/
ENGINEERING
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REGfPROF CIVIL ENGINEER
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ISSUES THE ABOVE LICENSE TO;
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MARCUS A DEVERS
16 WOODLAND ST
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LAWRENCE MA 01841-2315
33846 06/30!14 183309
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LICENSE NO, EXPIRATION DATE SERIAL NO.
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e lmmxovement
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. Seely legal 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 1-888-283-3157 or on our wehsite_ '
Homeowner Information
Contractor Information
i,mme
abso
(�
Company Name
Hoc Q" �" 11,3 C,
Street Address (do not use aPost Office Box address)
Contractor/ Salesperson/ Owne ame
� '��
Sin ��
(;�-�.b�-2r• 5�
City/Town
Norte
state Zip Code
Abva.r , KA, A4poi
Business Address (must include a street address)
i -N t
Daytime Phone
I � - -31
Evening Phone
q 123(
City/Town State Zip Code
q -t%- qq -* 9 -(F --96q--7514 -
Mailing Address (It different from above)
Business Phone I.Fecieral Employer M or S.S. Number
•
Law requires tLat most lsomc
improvement contractorshave
valid registrationoinbe
Home Improvement ContrectorReg: Number
7
/066 0n
Expiration data
y_/2y//y
x tte % utnracLor agrees to no 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 ifnecessary.)
We aacha 0 e"
Required Permits - The following building permits are required
and will be secured by the contractor as -the homeowner's agent:
(Owners who secure their own permits *will be
excluded from the Guaranty Fund provisions of
MGL chapter 142A.)
Tntal r'.nntrnf-f Priya n"R Ua.,,,.r ..t. Q -a, a.At
Proposed Start and Completion Schedule - The following schedule will
be adhered to unless circumstances beyond the contractor's control arise
Date when contractor will begin contracted work.
Date when contracted work will be substantially completed.
The Contractor agrees 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:
$ /00upon signing contract (not to exceed 1/3 of the total contract price or the cost of special order items, whichever is greater)
al? Y l l or upon completion of 6/•�6jV-17 1_��� �-
-ad�by l I or upon completion of pjd l-/)
$L— 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 $ toXep
ordered before the contracted work begins in order
to meet the completion schedule.(**) $ tofor
NOTES; (") Including all finance charges C**) Law requires that any depositor down payment required by the contractor before work begins 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.
lxpress Warranty - Is an express w tyrant* Ueine provided by the
❑''Sees (11i terms of the warrinty mast be •tttRched to the con act)
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 ftu'ther agrees to be solely responsible for alt payments to all subcontractors for
materials and labor under this a Bement
Contract Acceptance -Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the
conVact 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,
• 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 ofi-Iome 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.
o Does the contractor have insurance? Aslc the Contractor for his insurance company information so that you can confirm coverage, or aslc 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 Improvement 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 of the
third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right.
DO NOT'SZGNTMI S CONTRACT IF THERE ARE ANy BLANj< SJPACES2!
Two identical copies of the contract must be completed and signed. One copy should go to the Homeowner. The other copy shouldbe kept by flee contractor.
/ Homeowne 's Signature
'Date
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 f -m which has been approved by
the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consmner shall be required
to submit to such arbitration as provided In Massachusetts General Laws, cchapier_1.4.2A.:.
Homeowner's Signature ant 's ignattiire
INOTICEi: 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 t1i.e contractor they choose is not properly registered as prescribed by law.
Homeowners who secure their own building permits are automatically exchuded'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 worlananlike mauler. Homeowners may be entitled to other specific legal rights if the contractor
guarantees or provides an express warranty for workmanship 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 ffe 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 sip 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 ](ept 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 patties 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 founds 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 OCABRwebsite at 1L-P://wuryv.mass ,ovlocabr/
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 H[C website at b=://vP w..mass.aov/ocabr/
Go online to view the status of a Home Improvement Contractor's Registration: .
htA.)-//db.state.m,,i.us/l.ol-neiMprovel-ne.ni/lice-nseelist.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
508-652-4.800, 508-755-2548 or 413-734-3114•
Version 2.1-11/22/2010
Demorla Design & Build
63 WEBSTER STT HAVERHILL MA 01830 (978) 994-5497
Building Repair Proposal
2/24/2013
Owner: Fabio Franco Job Site:
162 Kingston St. North Andover MA
Address: 162 Kingston St Use:
dwelling
North Andover, MA Construction Type: Wood -framed
Job Breakdown and Cost:
Materials
Labor
Subtotal
& Equipment
I. Interior:
a. Replace kitchen cabinets and countertop
$2,000.00
$1,250.00
$3,250.00
b. Install hardwood 1 st Floor
$1,000.00
$1,245.00
$2,245.00
c. Install ceramic tiles and paint (2nd floor bathroom)
$900.00
$1,100.00
$2,000.00
d. Install ceramic tiles (1 st floor 1/2 bathroom)
$300.00
$300.00
$600.00
e. Install laminated floor in one bedroom
$200.00
$470.00
$670.00
f. Replace livingroom/kitchen ceiling
$500.00
$1,000.00
$1,500.00
Totals
$4,900.00
$5,365.00
$10,265.00
Total Amount to be paid for the work to be performed under the contract is
$10,265.00
The Job will be completed within 30 business days.
Beginning within 5 business days after the closing date and completed within 30 business days thereafter.
The homeowner is entitled to his/her three-day cancellation period under MGL c 93 s48, MGL cl40D or 255D sl4 as may be applicable.
The owner has all warranties on the owner's rights under the provisions of and MGL c. 142A.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
The contractor and the owner hereby mutually agree in advance that in the event
that 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 Office of Consumer affairs and Business Regulation and the
consumer shall be required to submit to such arbitration as provided in MGL c. 142A
Owners who secure their own construction -
related permits or deal with unregistered
contractors shall be excluded from access to the
Guarantee Fund.
All home improvement contractors and
subcontractors shall be registered and any
inquaries about a contractor or subcontractor
relating to a registration should be directed to:
Office of Consumer Affairs and Business
Regulation
Ten Park Plaza, Suite 5170
Boston, MA 012116
Phone: (617)973-8700
Owners: \ Date: 3 /3 �13
Fabio Franco
Contractor: Date:
Demorla Design & Bull
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