HomeMy WebLinkAboutBuilding Permit # 2/3/2016 0� %40RTH
BUILDING PERMIT T`eo
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINATION * Z
Permit NO: V Date Received "y
�AATED
Date Issued: 9SSgCHuS��
IMPORTANT:Applicant must complete all items on this page
LOCATION TA,r\
PROPERTY OWNER 10 tr►1+ (e
Print
MAP NO:A 7 PARCEL:6� ' ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building the family
o Addition ❑ Two or more family ❑ Industrial
I eration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
El Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
E4ater/Sewer
/�
Identification Please Type or Print Clearly)
OWNER: Name: Mbbyk) COOAt Phone: (7�
Address: O b�� >e, wee-7- tt)t And oll
CONTRACTOR Name: � 1 O � Phone:
Address; \ p BVI C�✓t
cit
Supervisor's ConstrucAon License: Exp. Date:
Home Improvement License: Exp. Date: TI
— 22-1
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ 5� FEE: $
Check No.: aG} . Receipt No.:
NOTE: Persons contracts g wi h unregistered contractors do not have acc s a
Signature of Agent/Owner ignature of contract
Town of
Andover
2
p
Pat I
�O IAKE h ver' ass,
COCNICKE WICK ��•
A�RATEO ►'4a,�'(5
S UBOARD OF HEALTH
PF. RMIT T Lu Food/Kitchen
Septic System
... BUILDING INSPECTOR
THIS CERTIFIES THAT ....... .......... . ........ ......... ....................................
.. Foundation
WW
has permission to erect .......................... buildings on ... Zir .... ..... ... .....
...
Rough
to be occupied as .........W.0ow.rw.... ....... . . .. ....................>rL ...... .. ..... . Chimney
provided that the person accepting this permit shall in every respect conform to the terms 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
r Final
PERMIT EXPIRES I T ELECTRICAL INSPECTOR
UNLESS TI ?, AR(Ls=j� Rough
Service
... . .......................... Final
BUILDING INSPECTOR
GAS INSPECTOR
ccupancE Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove
Final
No Lathing r Dry Wall To Be one FIRE DEPARTMENT
Until Sect the Building Inspector. Burner
Street No.
Smoke Det. ,
A. F. Watson General Contracting Estimate
3 Edgemont Street
DATE ESTIMATE#
Derry,NH 03038
Tel. 603-661-5360 10/11/2015 1622
Cell#603-661-5360
NAME/ADDRESS
Tom&Brenda Comerford
135 Johny Cake St.
N.Andover,MA 01845
TERMS PROJECT
Due on receipt Master Bed Rm.Closet
ITEM DESCRIPTION QTY COST TOTAL
2 1/4"oak Flooring Allowance 9 70.00 630.00
Plastering Plastering Allowance 1,600.00 1,600.00
Electrical Electrical work allowance 1,000.00 1,000.00
Subtotal labor&Materials 12,715.43
Cont.fee Contractors 10%Fee profit+overhead 10.00% 1,271.54
TOTAL/. r,986.97
SIGNATURE
OWNERS SIGNATURE
Page 2
A. F. Watson General Contracting Estimate
3 Edgemont Street
Derry,NH 03038 DATE ESTIMATE#
Tel. 603-661-5360 10/11/2015 1622
Cell#603-661-5360
NAME/ADDRESS
Tom&Brenda Comerford
135 Johny Cake St.
N.Andover,MA 01845
TERMS PROJECT
Due on receipt Master Bed Rm.Closet
ITEM DESCRIPTION QTY COST TOTAL
Engineering Engineering Allowance 800.00 800.00
labor Carpenter's labor Allowance 104 45.00 4,680.00
1.Install Beam,support post with new header and jack
supports at door way in garage ceiling to support floor of
Closet.
2.Add 2"to floor joist to match floor heights.
3.Install 3/4"sub floor per plan.
4.Sister in rafters as needed to frame two Skylite
5.Frame perimeter walls and doorway per plan.
6.Add framing to sloped portion of roof to allow for
insulation.
7.Install ceiling joist,and strapping as needed.
8 Install blue board walls and ceiling.
9 Install door,flooring,and baseboards.
LVL 13/4"x 18"x 24'-0"LVL 3 367.01 1,101.03
Materials Materials for posting down under beam allowance 200.00 200.00
2x6x 18 2"X 6"X 18'-0"KD 10 11.24 112.40
avantech TX 8' X 3/4"T&G Subfloor 12 26.95 323.40
2x6x10KD 2"x 6"x 10'-0"KD Spruce 40 4.90 196.00
1 x3x I 6strapin I"x 3"x 16-0"Strapping 24 2.70 64.80
BlueBd. Tx 8'x 1/2"Blue Board 30 17.13 513.90
R-21 R-21 6.5 X 15 Kraft Face Insulation 3 60.15 180.45
R-38 R-38 Kraft faced 15"x 48"bats 5 42.69 213.45
2'-6"PreHung 2'-6"x 6'-6"x 13/8"Six Panel Prehung Pine Door Unit 200.00 200.00
Skylite Skylite 2 350.00 700.00
2-8 9 Lite Insulated door unit 200.00 200.00
TOTAL
SIGNATURE
Page 1
Massachusetts Home Improvement Sample Contract
Ibis 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 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 1-888-283-3757 or on our website.
Homeowner Information Contractor Information
N� Como v11✓ P IT� �F(
�Iry1 ���0l�il IN�n+ ✓�ISa�U 1LJ CC_'Pf(�CUI/)T
Street Address(o not use a P t Office Box address) Contra for/salesperson/Owner Name
J,b �v n �w_ I rtkur kbtL)
City/rown C, Stat Zip Code / Business Addres (must include a strfet address)
�ir-..e Phone E mg Phone City rvn State Zip Code
03 02
Mailing Address(It different from above) I Business Ph deral Employer ID or S.S.Number
Home ba'`Conuaner Reg.Numbs E�pnatioa date
raRee��th.ime:theme I
im'mr eatt.mr tnumorsha,'e
v lid reghtraft. ber
The Contractor agrees to do 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 if necessary.)
SC
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 u less circumstances beyond the contractor's control arise
(Owners who secure their own permits will be ff
excluded from the Guaranty Fund provisions of �� / ate when contractor will begin contracted work.
MGL chapter 142A.)
Date when contracted work will be substantially completed.
Total Contract Price and Payment Schedule
The Contractor agrees to perform the work,famish the material and labor specified above for the total sum of: 43 926,
/7 (*)
Payments will be made according to the following schedule:
$ o upon signing contract(not to exceed 1/3 of the total contract price or the cost of special order items,whichever is greater)
$c4,&�O by -----r or upon completion of kd(moi st
� by or upon completion of
j
$ (Ob t 1 7upon completion of the contract. (Law forbids demon payment until contract is completed to both party's satisfaction)
The following material/equipment most be special $�to be paid for
ordered before the contracted work begins in order
to meet the completion schedule.(**)
NOTES:(*)Including all finance charges(**)Law requires that any deposit or 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.
Express warranty-Is an express warranty being provided by the contractor? No❑Yes(all 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 agreement
Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the
contract 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.
• 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 of Home 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 confirm coverage,or ask to
see a copy of a"proof of insurance"document.
• 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 dran the contractor's normal place of business,prov4cdhey the
contractor in writing at his/her main office or branch office by ordinary mail posted,by telegrams t or by delivery,nodnight ofthethird business day following the signing of this agreement. See the attached notice of eancellatio form for an explanatit.DO NOTSIGNTHIS CONTRACT IF THE A BLANK SPATrim identical copies of the contract must be completed and signed.One copy should got the hom mer copy sh Id be k
Homeowner' � ature Contractor's Signature
Date Date
I
t PROFESSIONAL° t STRUCTURAL ENGINEERING
E. HAM xPSTEA0 NH ` ;. ``�N Of
4f,41DESIGN SEFMCES
O� S VA O9 J.
FA's � �� o
�u�.rl�� �corp �
r
STRUCTURAL CA
A
N0.33287 E 5 T
TITLE �: 'w;)" vsz('l # a 9 O Q
s JOBp°
SUBJECT . ... N";2
SHEET NO,
DESIGNED BY ATE f C 9 E C I E D BY DATE
x =` w.
m—t ee
r
ili
d&"04&aw
PROFESSIONAL
STRUCTURAL ENGINEERING
DESIGN SERVICES
P.O.Box 958
E. HAMPSTEAD, NM 03M SALVA
(6M 329-&W MOCCIA Cvt: rv--r
FAX(SM)3294406 PESIDENTL&•C SMNSFML " V)^ EN vru.,a i I e n VA rx
0.33287
TE EST
TITLE JOB No
SHEET NO ,
SUBJECT Ll BA
DESIGNED BY DATECHECXED BY
DATE
n z vrlz
(p
(ry
vL k(,) ra
to w vw I.
7-14-
(4 b
o
j
* 'd tit,� — -
ow
e
ma*"� '1 i
L "I PROFESSIONAL
gWSda1&4jVM& STRUCTURAL ENGINEEFUNG
DESIGN SERVICES
P.O. BOX 968 ALVATIPR
E. HAMPSTEAD, NH 03826 MOC61A M
(WM 3294W
STRUCTURAL
FAX(803)3294M RESIDENTIAL i C •
VJ FSS�O0
NAI� EST so
TITLE Lsz moo- JOB-1
SUBJECTmv {AfAW-r& SHEET NO,
DESIGNED BY— DATE IZ CHECXED BY DATE
W
-s -7
----------
17,
e
�� v�fg4l
Del
V1,
VAV7 *11NANA
eft
C 0�
'Cl re 1c,\
Z lit, IN
is z. 1
�,55 ry T�57
(SIA
2V
/1
-u YG
HZva A
vftw '-jCA!p-wjV,.,
OR 1130�,
*ON to
ISE
Miami (m)xv:1
Ivunlonuls OKSIM(MR)
V100ow 9UCO HN'af3luWH'3
VA age xos'O'd
S33ft3S NOIS30 VIYAWS
9NlW33Nf%a TMUOtWIS
. NAL
P'FOFESSia
STRUCTURAL ENGINEERING
P.O.Box 958I ( � DESIGN SEITVtM
�O� SAL-HAMPSTEAD,NN 03M
AT0 J, G I
(em OCCIA
FAX WM 3OM406
RESIDENTIAL 87 , a
TITLE TER�G\���4 EST. HD.
x JOB
SUBJECT f VA .._ t. _: SHEET NO.
DESIGNED BY DATECHECLED BY DATE
FOCI
LJjay
` ". l 'A
DATE(MWDD/YYYY)
ACO/?" CERTIFICATE OF LIABILITY INSURANCE
02/02/2016
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 ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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
NAME: Gregory Porziella
PAUL T. MURPHY INSURANCE AGENCY INC. accoNN Ext: (781)321-9700AX No:
E-MAIL
ADDRESS: greg@ptminsurance.com
628 BROADWAY INSURERS AFFORDING COVERAGE NAIC#
MALDEN MA 02148 INSURER A: LM INS CORP 33600
INSURED INSURERS:
ARTHUR WATSON INSURERC:
DBA AF WATSON GENERAL CONTRACTING INSURERD:
3 EDGEMONT STREET INSURER E:
DERRY NH 03038 INSURER F:
C_OVERAGES CERTIFICATE NUMBER: 28417 REVISION NUMBER:
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.
INSR TYPE OF INSURANCE AD YEXP
LTR
im_Wn POLICYNUMBER MMIDDIYYYY MM/DD LIMITS
COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $
DAMAGETORENTED
CLAIMS-MADE D OCCUR -PREMISES
Ea .'T...)
'T... $
MED EXP(Any one person) $
N/A PERSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ '..
POLICY F—I JECTPRO F—]LOC PRODUCTS-COMP/OP AGG $
OTHER: $
AUTOMOBILE LIABILITY CEa accOMBINED SINGLE LIMIT $
ident
ANY AUTO BODILY INJURY(Per person) $ '..
ALL OWNED SCHEDULED N/A BODILY INJURY(Per accident) $
AUTOS AUTOS
NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOS Per accident
$
UMBRELLA LIAB OCCUR EACH OCCURRENCE $
EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $
DED RETENTION$ $
PER
WORKERS COMPENSATION X I STATUTE EERH
AND EMPLOYERS'LIABILITY
ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000
A OFFICER/MEMBEREXCLUDED? I NIAJ NIA NIA WC531S601278016 01/14/2016 01/14/2017
(Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 '.....
If yes,describe under
DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 500,000 '..
N/A
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required)
Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to
employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts.
This certificate of insurance shows the policy in force on the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this
certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at
www.mass.gov/twdlworkers-compensation/investigations/.
Sole proprietor has not elected coverage.
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of Andover 36 Bartlet St ACCORDANCE WITH THE POLICY PROVISIONS.
Job Loc 135 Johny Cake St
AUTHORIZED REPRESENTATIVE
North Andover MA 01845 Daniel M.Crg4ey,CPCU,Vice President—Residual Market—WCRIBMA
@ 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
The Comoro wealth ofMassachasetts
Department ofIndustrlalAcczdents
X Congress street,suite 100
Poston,MA 02114-2017
^' 1vwW.mass.gov1dza
Wovkers'Compensation Insurance Affidavit:Builders/Contractors/El ectxicianslPlumbey s.
To BE J['MEf D WITH TETE I'F M TT)NG A.UTROMY.
A cant Information
Please Print I.eibl
Name(Bixsiness/oiganization/fudividii
w
..,
Address: 2
w
Czty/Sfi;ate/Zig: � s
/(, Phone#:
Are you In,employer?Check t&approprlate box; Type of project(]'equired):
.,. : em la ces full and/or art time * '7. El Now constturtion
1.[i am a employer with P Y ( p )''
?-El I am a solo proprietor or partnership and have no employees working forme in $. �'"l�emOdelirig
any capacity.[No workers'comp.insurance required•] q, El Demolition
1E]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10E]Building addition
4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will
'
ensure that all contractors either have workerscompensation insurance or are sole
11.C(Electrical repair's or additions
proprietors with no employees, 12:E Plumbing repairs or additions
5.FJ I am a general contractor and I have hired the sub-coirtractois listed on the attached sheet. 13.n Roof repairs
These sub-contractors Bade employees and have workers'comp.insurances 14.❑Other
6.Q We are a corporation and its of1igers have exercised their right of exemption por MGL c,
1.52,§1(4),and we have na,en}ployees.[11'o workers'comp,insurance required.]
*Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information.
I Homeowners who sirlirriit This affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such.
t'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. lfthe sub-contrad&s have employees,they must provide their workers' comp.policy number.
X am an employer that ispr'avit/619VpAcers'compensation insurance for my employees'Below is the policy and lob site
information.
Insurance Company Name: '
Policy 9-or Self-ins,Lie #. C, �" @ c'. �...._ r�� o r fly ( _
'. C,4/State/Zip: '
fob Site Address
Atttacli.a copy of the worlreps' ,c: r'ompcT ,
rs tion polrcy declaration page(showing the policy number and expiration date).
Failure to 8e0i7re 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 form 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 oflrrvestigations of-the DIA for insurance
coverage verification
ago lam eby c rti y p p _ tips ofperjuy that the information provided above is true and correct.
u der the pains pial
Sign
f
Phone
official use only. Do not write in this area,to be completed by City or'town Official
City or Town:
Per'mit/License#
Issuing Authority(circle one): i
1.Board of Health 2.Building Department 3.City/ 'own Clerk 4.E+Iectricalinspector 5.PlumbingInspect-or
6.Other
Contact Berson: Phone Vit:
cv/4 �paazr��zoouaeal a�C�/Ir%uaaa�uae r
Office of coriN.umer Affairs&Ousiness Regulation
ORAE IMPROVEMENT CONTRACTOR
egistration, 198848 Type'
Expiration: .4/28/20'f7; DBA
A F WATSON GEN CONTRACTING
ARTHUR WATSON
3 1=-DGEMONT ST-
DERRY, NH 03038 —
Undersecretary
a z
Bciaird of
h
comtri9:;taonvper�kor 9 0 fl!
Lk.-ense,- CSFA-063168--'
if
ARTHUR F WAT�b�N, �_
3 EDGEMONT ST -
DERRY NH 030 $
Jill
i
�
1,IJ ` Expiration
Commissioner 0211212016