HomeMy WebLinkAboutBuilding Permit #704 - Exception 5/13/2010Permit NO: 96L(
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Issued: 'a) 4 y ' /a
Date Received
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I IMPORTANT: Applicant must comblete all items on this baize I
LOCATION
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PROPERTY OWNER
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Print
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One family
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MAP 210 T7 .,PARCEL:ZONING DISTRICT: Historic District yes no
Machine Shop Village ves no
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
v 26' , 70
DESCRIPTION OF WOR TO BE PREFORMED:
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A
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ � 4 ,�`� `7.Oo FEE: $ S��
Check No.: V Z `1 Receipt No.: 2 S
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor(' ''2}
Identification Please Type or Print Clearly)
OWNER:
OWNER: Name: ReIrsfasrl Phone:
X00
/7461
Address: 3 7 Oq,4rke
-Rc4,� A&A -A
44bbLol vLs,.*
CONTRACTOR Name: /
j` 1'7,ATW!-ro V Phone: 975 J
r3 900
Address:
Supervisor's Construction Licenser 16-5-7
Exp. Date: Zr,
v 26' , 70
Home Improvement License:
_1 Q %
Exp. Date: AL)
20 20roj
ARCHITECT/ENGINEER
Phone:
Address:
Reg. No.
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ � 4 ,�`� `7.Oo FEE: $ S��
Check No.: V Z `1 Receipt No.: 2 S
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner Signature of contractor(' ''2}
Location 2- J" .40'v1 "
4-Ve 2—
No. ` Date 5-13-1c)
NORTh TOWN OF NORTH ANDOVER
O'.�w ,ti00
L
P
Certificate of Occupancy $
cMuSE Building/Frame Permit Fee $ `y
Foundation Permit Fee $—
Other Permit Fee $
TOTAL $
Check # Z ��
23i3U
Building Inspector
Plans Submitted Plans Waived
Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Well Tanning/Massage/Body Art Swimming Pools
Tobacco Sales
Private (septic tank, etc. Food Packaging/Sales •
Permanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Rev- 7
iewed on
Sianati irA
COMMENTS
HEALTH
COMMENTS
Reviewed on
Si inature
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Water & Sewer Connection/s
DPW Town Engineer: Signature:
Comments
Comments
FIRE DEPARTMENT Temp Dumpster on site yes Located 384 Osgood Street
Located at 124'Main Street pp
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
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
No
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 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: Building Permit Revised 2008
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The Commonwealth of Massachusetts
Department o f industrial Accidents
Office of rnvestFgations
600 Washington Street
Boston, MA 02111
www•mass.gorl&a
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electri
Mlicant Inforcians/Plumbers
mation
Name (Business/Organiza6on/Individual):
Address:
City/State/Zip:OjR�� 7
one #: 3
Are you an employer? Check the appropriate box:
1 • ❑ I am a employer with
4. ❑ I am a general contractor
employees (full and/or part-time).*
2. I
and I
have hired the sub -contractors
am a sole proprietor or partner-
listed on the attached sheet I
ship and have no employees
These sub -contractors have
working for me in any capacity.
[No workers' comp. insurance
workers' comp. insurance.
5. ❑ We are a corporation its
3. ❑required]
I am a homeowner doing all
and
officers have exercised their
work
myself. [No workers' comp.
right of exemption per MGL
c. 152, § 1 �4 ), and we have
insurance required-] t
q ]
no
employees. [No workers'
comp, msuranc
VV
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11-0 Plumbing repairs or additions
12.❑ Roof repairs
e requu ed] I I3. ❑ Other
•-nl' applicant that CL -e% -L, box #1 must also a, out the se,.tioY beeov!
Ming .
Homeowners who submit this affidavit indicatingthrm—
ey , _ ih_^ wort a s' com s_��ou Y,.�c, � --non.
e} are doing aL wort; and thea jure 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 wr,rk affidavit
wn an employer that is Providing workers com enation insurance or m I employees.
Below iS the roll -,,
information. P g P f yP eJ and job site
Insurance Company Name:
Policy # or Self -ins. Lic. #.
Expiration Date:
Job Site Address:
Attach a copy of the workers' compensation policy declaration Pa.e (showing City/State/Zip:
olicy
Failure to secure coverage as required under Section 25A of MGL c.. 152 can lead to the impositionnumber
criminal expiration
penalties
date).
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 $250.00 a day against the violator. Be advised that a copy o f this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby certify� nder the pains and penalties of perjury that the information provided above is true and correct
Official use only. Do not write in this area, to be completed
City or Town:
Issuing Authority (circle one):
by city or town off ciaL
P ermit/License
L Board of Health 2. Building Department 3. City/Town Clerk
6. Other 4. Electrical Inspector 5. PIumbinb Inspector
Contact Person:
Phone #:
. Information an- d Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is defined -as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee of an individual, partnership, association o$- other legal entity, employing employees. However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do main 3nance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of suchemployment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or 10,ca1 licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not produced acceptable evidence of comupliauce with the insurance coverage required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter into any contract for the. performance of public work unr it acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub -contractors) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability partnerships (LLP) with no employees other than the
members or partners,are not required to carry workers' comp ensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sore to sign and date the affidavit. The affidavit should
be returned to the sill or town that the application for the permit or license is being request: d, not the .Department. of
Industrial Accidents. Should you have any questions regarding the taw or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
that must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under `.`Job Site Address" the applicant should write "all locations in (city or
town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit not related to any business. or commercial venture
(i.e. a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to than you in advance for your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone.and,fax.m=ber.. .
The Commonwealtbt of Massachusetts
Department of Industrial Accidents
Office of Investd ,atiFons
600 Washington Street
Boston, MA 02111.
Tel. # 617-72.7-49.00 eXt406 or 1-977-MkSSAFE
Revised 5-26-05
Fu # 617-727-7749
wurw mass. ovfdia
OFFER
QFFFR CTTRMITTFT) To WORK TO RF PFRFO RMFT) AT
NAMF: Andy Beresford NAME: Fernview Condominiums
LiT• ..7 CD• AN L.«:.TT«+'}CTDLII1JAm1\10.4 J 11i 1. 't. 1 1tiIA V ail.
U1LLL L
CITY: Iglurth Andover Ma. C I I Y: North Andover Ma.
TR ,_N('i: 978-6874429 TEL.NO: 978-687-4429
C"WM Constructinn hereby of°fars to provide the fnllnwina matPrialc and labor to:
Replace bath tub and shower, remove all wall tile and replace with two piece shower unit.
Replace vanity and sink, bring electrical in bath up to code. Replace bath door and all interior
doors. Paint bath walls. Remove kitchen cabinets, replace with owners cabinets. Install new sink
and faucet. Install new counter tops. Install new floor the in kitchen and bath.
A'OTF• A
.:. .::::�
Said materials and labor are offered on the below described terms and conditions
1) That said labor will commence on or about June 012010 and be
completed on or about August 30 2010
21 That all materials and labor will be furnished as specified and in accordance with
any drawinj4s and specifications submitted for said work;
31 That all labor will he rmm�lrtrd in a c!ingtantial wnrkrnanlikr manner
4; That said materials and labor will be 'aurnisle! to 0'9\,'I -.-R � !ry
r payment by
()W±, R itr CONTRACTOR in the ciim of 001 UP (10 1 whim to Paraaranh is
Thai laid "rim ac gtated in Parauraph ri inrl! les cperifiC alincatinnc as follows:
.A iiV E_� _ W1 'j,11l jr'j be i(lr iii_tri i iia Eji= !A nr i11 i1x i'f?\i Ili "Iiia :i' yve
. , e �; 2 e fl �?�7 ... u d it :.� a;7u-Mon tai rile St'liie t%- Tat: u
amountsshall b paid by til v l:la an snail e � : =a.
r���+�iaiii! �.
f. l.aCllti.-- ..S'"coli 1 c,
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t,1J�y ! nr_c ! vn� Ytii�i�iyr�'S.
! Y Yy . ! (11 . ;.!! . nnna .i mndl r. -' "ui to E ) tt. ' s: as = ..1•.-. i..ss — I i
a..,.6_f_- • V+'=_. _ x� ..x xxxu_u ux uu -a. r: -• �� Y-. s... u-r:�±.•�.�i �..c ..�....
Int: i!i.!IIIV�` V! h`!!!J antU V k: ijt [LG; -i tt)r C<L�[! �!CS�j!!. nG t
_.11 YY [!I !�l!lCE v`Yi[F c3
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e tl PE Pi!?' �a.EE-e_iiFC:
:ii , AN -
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$5,000.00
Once OFFER is signed
$6,000.00
Once bath is complete.
$6,000.00
Once kitchen cabinets are removed.
$4,547.00
At completion of OFFER
7) OWNER agrees to make payments to CONTRACTOR within 30 days of each
billing invoice date;
8) OWNER agrees that a finance charge will be added to the AMOUNT DUE on
each invoice if payment of said invoice is not made within 30 days of said invoice
date. Said finance charge will be in the amount of (1.5%) of the amount due for
each month payment is not made after said 30 day period. OWNER will also be
liable for payment of all collection costs, including the CONTRACTOR's
reasonable attorney's fees;
9) That the home owner shall maintain adequate fire, tornado, and other necessary
homeowner's insurance for the premises and work to be performed;
10) That all excess materials purchased and/or brought to the work site by the
CONTRACTOR shall remain the property of the CONTRACTOR and will be
removed by the CONTRACTOR upon completion of the labor to be performed;
11) That the CONTRACTOR shall maintain Public Liability Insurance for purposes of
the work to be performed;
12) That any agreed upon time for performance by CONTRACTOR shall be extended
for a reasonable period of time in the event of strikes, accidents, or delays beyond
the reasonable control of the CONTRACTOR;
111 . li ,' ,r arlrlitirznc - eletion"s, or modifications to an of the above stated terms
s y w �_.__n. y
be _icm- _ isF RTTfING ONLY and signed by all parties to this agreement.
F: fthcr, THAT ANY ALTERATION FROM THE ABOVE TERMS AND/OR
CI �.1i IT A TC:14S ivitky IN OIL vE', .`iii ADDM 1 1.07-41AL CNC 1%RGEE 'Ulv ER
F19131NAHTFFD
14) ADDITIONAL PROVISIONS:
15) This offer must be accepted within 30 days of the date submitted or said offer is
withdrawn and is null and void.
SUBMITTED BY: Charles Mathison
on behalf of CWM Construction
DATE SUBMITTED: May 12 2010
ACCEPTANCE OF OFFER
The above offer, including prices, specifications, and conditions are satisfactory
and by my/our signature(s) below are hereby accepted. You are authorized to do the
work as specified. I/We agree to make all payments as outlined above.
I/We further agree that the terms of the above offer are a COMPLETE AND
EXCLUSIVE representation of our Agreement and that all warranties and
representations to me/us have been expressly set forth above.
I/We have read and understand the terms of this offer and acceptance and that this
offer, when accepted, is a binding contract imposing legal obligations on all parties.
DATE: 5-61-110 SIGNATURE:
DATE RY�� o`ZQ l O SIGNATURE:— (���