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Home My WebLink AboutBuilding Permit #407-12 - 104 MIDDLESEX STREET 11/10/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 7 ��2 Date Received Date Issued: //0/// IMPORTANT:Applicant must com lete all items on this page LOCATION D (1„ �,� (,�� e 0�, Print PROPERTY OWNER "J ?kC Av A 11 C26- ,� ��cJ S� Unit# Print MAP NO: PARCEL:2S'- ZONING DISTRICT: Historic District yes Machine Shop Village yes 100 year-old structure yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building G6One family ❑Addition ❑Two or more family ❑ Industrial gAlteration No. of units: ❑ Commercial i6Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑Floodptam ❑ Wetlands D Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: (Identification Please Type or Print Clearly) OWNER: Name: J a i.+,j v Address: 1o`c A•� � se �-.. S'�,�..,,_ -�' CONTRACTOR Name: � "�� !�,.�,1..�� Phone: 3 3 !r- Address: Supervisor's Construction License: p' U qcN Exp. Date: Home Improvement License: t, -tom Exp. Date: ARCHITECT/ENGINEER �,�,�rZ, 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: $ 3 FEE: $ 2— Check No.: 10711 a 7 Receipt No.: � y� `� NOTE: P s ns contractin �ithun�registe�red contractors do not have access to the guaranty fund Signature of AgentiQwner y`" Signatureof contractors LL i 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: Doe.Building Permit Revised 2008mi Plans Submitted ❑ Plans Waived-A 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 I Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 4 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 E 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 i ❑ Notified for pickup - Date i i Doc:.Building Permit Revised 2011 June/mi Location �� '� Ai NORTH Town of oAndover . 0 o , dovex, Mass., OLAKE coC HIC HE WICK �k. 0RATED i BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES.THAT...................... ....../.��.,,..C2.6r':..........'........... ..................................................................................... Foundation has permission to erect...........:.:.......................... buildings on ./P (r'......W1.r-� ............� ......V........................... Rough psl to be occu pied as ....................................................... Chimney provided that the person accepting this p rmit shall in every respect conform to the terms of the application on file in Final 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 S/1, RTS Rough ..................... ........cs..o �r .................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. .-� die=Commonwealth i}f'Mussachu #s Department of Industrial Ace' its Office of- -600 Washington Stj'eet Boston,MA 02111 www.massgov/dia Workers'Compensation Insurance:Affidavit:Buildens/Contractors/ElectricianslPlumbers Applicant Information Please Print Lelably r p Name(BusinesstOrpntzattott/lndividnal): ,va�.>kq�j t'�! `• .�•,� ,_ -� r•�. Address: lUk_ City/State/Zip: t.,jit.ZL k�QM Phone.#: Are you an employer?Check the appropriate box: Type-of project(required): 1 1 am a employer wrtb 4. C3 I--am a general contractor and I :6 -E1 New consaruction employees(full and/or part time).* have fired the sib-contrac�cns _ listed ou the auached,.sheeL.$ 7. Remodeling 2. Y amu a sole❑. propnetor"or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition working.for me in any capacity. workerscomp.insurance. _ 9. ❑ Building addition o workers'co insurance. 5 We are a-corporat ion and its ; (N _ []-Electrical repairs or additions officershave exercised theff requ, d] . . 3.❑ I am a homeowner doing all work right-of exemption per MGL 11.[]Phumbing.repars or additions 12, ,and we have no 12. Roof r myself[No workers coP- c. 5 §1(4) � �' ��. �reyuiredj t. employees-[No workers , 13.E Other COMP.insurance required:] ��Y applicantthat cbcdm box#1 must also fill out the secnon below showing their woft&compensation policy ii<forrimtion ;Any who subarit this affidavit indicating they are doing all work and then hire outside contractors mast suit a new affidavit indicating such tContracm that cbea Ihis box mast attached an additional sheet showing 6e wrne of the sub-conhaams and their workers'comp.policy mfarrnstim I am an empkaye that ks providing tvorkets'compensation_insurance for.my empkrryees. Below ft tlsepolccy acrd job site information Insurance Company Name: ��-... �.�•+� � Policy#or Self-ins.Lic.#: G tt✓C L(33-1 < Expiration Date: "A \11 Job Site Address: �a �T City/StatefLip:cyte ti.�-- b ••. . t►t Attach a copy of the workers'compensation policy declaration page(showing the policy number and ezpiration 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 wellas civil penalties in the form.of a SWOP WORK ORDIIR Iand a`fine of up to$254.00 a day against the violator- Be advised that a copy of thus statement may be forwarded to the.Office of Investigations of the DIA.for insurance coverage verification I do here ce ,under dhe urs and penahies of erjury that the information provided above is true and correct:. . Sipmature: Date.: Phone#: �"1 - Officual use only. Do not write in this area,to be compketed by_C or town;o0" City or Town: Permit/Iacense.# Issuing Authority(circle one): 1.Board of Health 2..Building Department 3_CityfTown Clerk 4_Electrcal-Lupector 5:.Plumbing Inspector 6.Other 1 Contact Person; Phone#c 87!11/2@11 87:45 9786833147 PAGE 81/81 4c CE"FiCATE OF LIARiLITY INSURANCE 11/11/2011+� 'MM C.IWM=7E IS MM AS A NAT=OF Iff"W N GMT AND MMM NO IMM WON IM 6Bt VETE MOLMR 7MIB CERT - DOER War AffinnWifty OR IiE6 MST AIMM EXiM OR AL'IM WN AFFOMM BY TILE POI M=L no CEnTIFICA72 OF nWXWM DOES NOT GON$RM A COMMO Ct WFWM TIE MUM MURERM AVnCRM [ SEIfiJ1TfYB OR PRommaK Am THE CERTmRIE HoLow IEePO Mr.- if fila tia11iN is as ADO111ONAI.iN9l D,flap pate }aunt po if&EIMI@ATI�B MWYED.slsi�st 1>� ihs�ora oon�Iero d ffie poli►,�voaetes nlonr�� t on tl+is aSrtlReeee�rat mn� m tAa aertl mft homes in am of emb oou�t ' army m r MOMS INE A=, ncilm 978)683—$073 (978)683-3147 -1060 Osgood street - MimpeAdiI�P—ertelnau>cuanae.c North Andamr, MR 01865 maymm mro,awo A-PRMZDKCZ MUZM Affivm 1ldORM Numme a R>IDDELZ>l NUMB 169 HQ83OBD STABBT mac: eewrss� S ANDOVER, ML 01845 w UFMR E CERIMATE NUtum REVISION MOM TM 1S TO CERM—IwT THE POLICES OF M MRAMCE UffM BELOW HAVE MM MMW TO THE MUM®NAMED ABOVE FOR TIS PMJ0Y PMIOD iNDlCAT60. NOTWfff141'ANmo ANY mcumimT.TERaY!aR OommoN OF ANY ouNTRAcT OR t TmR Dacumm vm Ream TD vAmm TIES CERTi CATR MAY 0 MM OR MAV PERTAEI.THE INSURANCE AFFORUM BY IM POUCES MCRM HERON iS SUBJ=TO ALL 7M TEM, EMLUMONAND CONDMONGFOUCH POLiI M UWM S OMMAYHAVE EM REDUCED BY PAD CLAW TYPE OF INSUPISM POUCT mam umn OPEW uA SAM OOOUNUM S 1,000,000 v S cmuff L amen L1iSRM I ' Ba oea s 100"000 Q 5.000 A CPB0060869 /22/10 1/22/11 MRWN&aM*NMY a 1,000,000 aaT1r s 2,000 400 motel.AMIE UW MWLES FM Pmmc, -tmoP Lute s 2,000 0 O imi"Fi2pLOG t AnOMOCUUAMM a 1,000 000 AWAM 8CI� M=70136 00 l23/11 1123112 8 � g Ja� aooa►.YeutIRY�+ra�a ; HITm areas : s HI L" 0cm EACs+ a EXCM LUIS AGORME sI am I laws s R atra SOUTMO UAILMK'N9MM 't" FL a +r a 500 00 C � aaM ' N� �a13375 /o1/u �/o1i12 Ela _Ea Irl+ 500,000 " E .a -FCM LIST 4 500F000 0EIiCRPT040FOPEROMO ILOa1fC10N61ACM IM,AoraMM Rwaft Sdmduk Im mww mts+aq�alq CAS TCM Or I =2 AIUKI 'ER SHOULD ANY OF THE ABO4a'E OUMM POLIM BE CMCBJM BEFORE ,E1�OR/Sit, 0184b 7M EXPIR 7= DATE THERGM, NOTICE %U BE USAISREO 90 ACCOMM vsffla THE PO=FROYI3(OM& AIrtllor:M M*n y r4Q6I-jr---, DING- OACCRDCORPMATIO1sL AHiIMftfvaefvw. ACOR02SMOM The ACM rAM ami logo Are 19111M R marks of ACM r 169 Boxford Street K av f,,,e 1-nr Idi, j I -. �'�� • North Andover,MA 01845 • PH:978-688-6335 Building Contractor • FAX:978.6WXXXX Proposal To: John Pierog 104 Middlesex Street Ao Home improvement Contractors and sum engaged in home opovement contracting,unless North Andover, Ma 01845 speciftallyacerroftrnregisbafian by Provisions of Chapter 142A of the general laws,rnust be registered with the Connn onweallh of Massachusetts.Inquiries about registration and Status should be made to the Director,Horne Improvement Contract Registration,One Ashburton Place, From: Kevin Murphy Roan 1301,Boston,MA 02108.(6V)-727 8598 CQ Date: 11/8/2011 Job: Replacement windows/Insulation Date of plana None Architect; None Loc at hm: Same Section 1—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 11/10/11. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 12/15/11.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 furnished hereunder shall be free from defects in materials and workmanship for a period of 1 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 111—Scope of Work Page 1 of 4 e Kevin Murphy Page 4 of 4 Building Contractor 169 8oxkxd Street North Andover,MA 01845 PH:97868BZ335 FAX 9780000( Section IV-Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of... .................. ...... ... .......$ 31,800 Payment to be made as follows: Percentage/ltem Description Amount 1 Windows installed $271600 2 Insulation installed $4200 Total 2 1 $31,800.00 "Notice:No agreement for Hare irrpovernent contracting work shad regime a dawn Payment(advarxe deposit)of more that oneahcd of the toW contract price ofthe total amaat of a0 deposits or Wiens which the contactor must make,in advance,to order ardor otherwise obtain delivery of specter)order materials and eq<iprtient whichever is greater Contractor. Kevin Murphy 169 Boxford 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 (.1.I g-1 Signature Date