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Home My WebLink AboutBuilding Permit # 3/26/2016 thORTfl BUILDING PERMIT �� V,D x.16 TOWN OF NORTH ANDOVER ° w � W APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: � �(�els us� IMP RTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 1X016 , °°w Print t " MAP NO: PARCEL: ZONING DISTRICT: Historic District ni Machine Shop Village yes id TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential I I New Building .One family Addition 1-1 Two or more family I I Industrial [r; Iteration No. of units: U Commercial Repair, replacement U Assessory Bldg I Others: L-1 Demolition U Other 1.1 Septic I:1 Well 0 Floodplain U.Wetlands I 1 Watershed District %Water/Sewer 17 Identification Please Type or Print Clearly) OWNER: Name:. ... t �. �� ,w.�:�w. .., Phone: �-, � Address: CONTRACTOR Name: Phone: , 'gy m.. Address, Supervisor's Construction License: Exp. Cate: Home Improvement:License: Exp. Date: ARCHITECT/ENGINEER L-Av 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: $ ti i)D FEE: $ l > Check No.: -ZY-'.'I .2 - Receipt No.: t NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner- Signature of contracto 2�® w NORTH Town of Andover O :. IST � * �- - - 2(p .� h ver, Mass o� i coc«ic«ew�c« P S RATEO ll BOARD OF HEALTH or Food/Kitchen Aft Septic System P E T i THIS CERTIFIES THAT �. . ............................L...........D.......... BUILDING INSPECTOR ....... . ............. ...... . ... . ... .. ....... Foundation has permission to erect.... ..... ............... buildings on . . . ..... ...... Rough tobe occupied as ......... .... .. . ........... .. .... ........................................ 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 CONSTRUCTION STARTS Rough Service ................. .... . . . .. . ..�„P,-r+............................ 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. di0 98 Forest Street Kevin. 0 North Andover,MA 01845 0 PH:978-688-5335 Building Contractor 0 FAX:978-688-7207 proposal To: Rick&Diana Gaudet 835 Chestnut Street All Home improvement Contractors and Subcontractors engaged in home improvement contracting,unless North Andover, Ma. 01845 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and Status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place, From: Kevin Murphy Room 1301,Boston,MA 02108,(617)-727 8598 CC: Date: 3/20/2016 Job: Bathroom Date of plans: Architect' Location: Same Section I—Work Schedule Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 4/1/16. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 6/30/16.The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement. Section 11—Warranty The Contractor warrants that the work fumished hereunder shall be free from defects in materials and workmanship for a period of I year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup,the Contractor shall, at his own expense,forthwith remedy, repair correct,replace,or cause to be remedied,repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Section III—Scope of Work Page 1 of 4 | � Ke,(,�i n,&��ml j Page 2of4 | ftfflding Um it rxtok, eoForest Street � mmm Andover,MA 01845 � PH:978-68&5335 FAX 97&68m207 Gmmmmm| Proposal istoadd second floor bath � Building � Any framing materials will beprovided Plumbing Plumbing required to provide new three fixture bath will be provided. Owner to provide plumbing fixturres. Electrical Electrical work required towire bath tocode will beprovided Heating/Air Conditioning Existing heat will berelocated/added aerequired. Noallowance has been made for any air conditioning. Ansm|mt|mn Bath areas will have fiberglass insulation installed tomeet code. Plaster Bathroom will be plastered Umte,imrTrim/Dmmna Pre-primed interior trim will be supplied and installed to match existing. Bath vanity/countertop to be supplied by owner. Flooring Tile floor will be provided in bathroom.An allowance of$6 per square foot has been included for tile materials. Painting Noallowance has been made for any painting. Waste Removal Construction debris will bedisposed nfbycontractor. I evi i Murphy Page of 4 llftp IC011)"4.°asauStan°N:a'w 98 Forest Street North Andover,MA 01845 PH:9788885335 FAX 978888-7207 Section IV-Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of... ... ... ... ... ...... ... ... ... ... ... .$ 12,500 Payment to be made as follows: Percentage/Item Description Amount 1 Permit obtained $1000 2 Rough plumbing complete $3000 3 Plastering complete $4000 4 Trim /the complete $3000 5 Job 100% complete $1500 Total 5 $12,500.00 "Notice:No agreement for Home improvement contracting~trod(shall requite a down payment(advance deposit)of more that one-third of the total contract price of the total amount of all deposits o payments which the contractor must make,in advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever is greater Contractor: Kevin Murphy 98 Forest Street No.Andover, MA 01845 Registration No: 101874 Section V—Acceptance Acceptance of Proposal—I have read this document and accept the prices, specifications, and conditions stated. I understand that upon signing,this proposal becomes a binding contract. You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction cancellation must be done in writing DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature . -. a., Date >�. .: iw Signature Date The Commonwealth of Massachusetts Department ofIndustrialAccidena I Congress Sheet,Suite 100 Boston,MA 02114-2017 www.mass.gov1dia Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED MTrHTHF PERI ITTING AUTHORITY Applicant Information Please Print LeL4ibl Name (Business/Organization/Individual): z Address: f.t City/State/Zip: t,,_ L, Phone#: 1,� 'kAS 5XV;� Are you an employer?Cliecic the appropriate box: Type of project(required): LfE]I am a employer with Jemployees(full and/or part-time).* 7. El New construction 2.❑1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp,insurance required.] 9. Demolition 3.Q 1 am a homeowner doing all work inysulf.[No workers'comp.insurance required.]t 10 Fj Building addition 4,F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are;sole I Ln Electrical repairs or additions proprietors withrm employees. 12. Plumbing repairs or additions 5.n I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 14J-1 Other 6.F-1 We are a Corporation and its officers have exercised their right ofexemptionper MGL 0. 152,§1(4),and we have no employees.[No workers'comp,insurance required.] *Airy applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners wlio submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContTactors 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. Iatitaijeiiil)loyei-iliatispi,ovidiiigiporIcei-s'compensation iiisui,(iticefoi-myemployees Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic. 3 -13 '1 Expiration Date: Job Site Address: S31 City/State/Zip: t�4 o k Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine tip 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 tip to$250.00 a day against the violator.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 pains and penalties of perjury that the information provided above is true and correct Signature: ...... Date: Phone#: Official use only. Do not sprite in this area,to he completed by city or town official. City or Town: Permit/License Issuing Authority(circle one): i 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone 11: DATE(h MDD'YYY'N CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED ASA 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 REPRESENTATIVEOR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificateholder is an ADDITIONAUNSURED,the policy(les)must be endorsed.If SUBROGATIOMS WAIVED,subject to the terms andconditions of the policyPertain policie"ayregldrwri endorsement A statementon thiscertificatedoes not conferrights to the certificatehotder in lieu of such endorsement(s). PRODUCER CONTANAA1E CT .ndi. Munroe ROBERTS IHSS AGCY INC PHONE (978)683-80'73 (978)683-3147 Ed: NC,tQo: 1060 Osgood Street p A�ES3: :pan,di@cn�,arobe tsinslu nce.com North dove :, A 01845 INSURER(S)AFFORDING COVERAGE NAMN INSURERA: MERCHANTS INSURANCE INSURED ,�qq^'^(�7"IN F?H BUILDING REMODELING INSURER B: (DC7 II D INSURANCE CI 169 9 &OXFORD ST a x°T INSURERC: ''.... NORTH ANDOVER, MA 01845 INSURERD: INSURER E INSURER F: '.. COVERAGES CERTIFICATE NUMBER: 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, '.. ELCLUSIONSANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWNMAY HAVEBEENREDUCED BYPAID CLAIMS. POLICY EFF POUCY EXP '.. TVPEOFINSURANCE POLICY NUMBER h7 M V LIMITS V py p� COMMERCIALGENERAL LIABILITY EACH OCCURRENCE $ 1 000 o oto CLAIMS-MADE FI]OCCUR PREAdISES Ea o urrenco $ 500,000 a f �^ryr '. nn,e±^^�y c MED EXP(Anyone person) $ 15 to 4A V BOP.�.tf GYf3945 11/22/14 11/22/1.5-r PERSONAL&ADV INJURY $ 2,000,000 INClaC�DEr�) ''.,"..... GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ [q1.LJCY LOC PRODUCTS-GOMPrDPAGG $ 2,000,000 PRa JECT OTHER: 1,000,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 0 Ea accident)_ BODILY INJURY(Per person) $ ANYAUTO * Cyt t✓1 ALL OWNED SCHEDULED MC A Fy 3608 01/23/15 01/23/16 '''... AUTOS AUTOS BODILY INJURY(Per accident) $ NON,OWNED PROPERTY tLGE $ HIRED AUTOS AUTOS Pcr acciden $ r� UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,0 V EXCESS LIAB —..JADE AGGREGATE $ 1,000,000 C:UP9145 04 11/22/14 11/22/15 DED RETENTION S $ WORKERS COMPENSATION PERI DTH- STATUTEER AND EMPLOYERS LIABILITY Y I N500,000 EL EACH ACCIDENT $ wsu.rnn,saea oeo reunrve. NIA pp,qq�^, +. �g.�y 500,000 . (Mandstoyn NHl -WC63 /l4 r/01`/1"CJ' /�r/�1'/1"6 E.L.DISEASE-EA EMPLOYEE $ I��,�� If yes,describe under 500,000 DESCRIPTION OFOPERATIONS below E.L.DISEASE-POLICY Uh11T $ DESCRIPTION OFOPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If mos space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH A14DOVER MA 01.845 AUTHORIZED REPRESENTATIVE d 1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name arid logo are registered marks of ACORD 4. &fee�poay��ac?urlea E�/ 6a�uveCta Office of Consumer Affairs&Busi ess Regulatian OME IMPROVEMENT CONTRACTOR — e egistration: 101874 Type: Expiration: .6/29/2016. Individual KEVIN MURPHY Kevin Murphy 98 FOREST ST. N.ANDOVER, MA 01845 Undersecretary ,y Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-053099 Construction Supervisor KEVIN W MURPHY.- 98 FOREST ST �, NORTH ANDOVER M - v, Expiration: ('nrnmie�inncr flC/9019l197