Loading...
HomeMy WebLinkAboutBuilding Permit #750-2017 - 110 FOREST STREET 1/31/2017 L NORTH BUILDING PERMIT o� �tLeo 161641 z a TOWN OF NORTH ANDOVER F APPLICATION FOR PLAN EXAMINATION * _ �p 't No#• 1 6b/ Date Received �y" rE0 Perms SSACHV`'� Date Issued: MPORTANT.Applicant must complete all items on this page �„ „:4, 'C '+'x d�� Xaa a Yrs E - t t - �'• �5 .� � �_If' ..+� " RST )� �; »w � -, _ r + i;I,b�l`"i��a+.aR�s+"• - LOCATIbNq',` 1 w� � tr , r ,� r�✓ "; Print r PROPERTY"OWNERx 1-.A L1� `7i " \i Pant loo Year Structure MAP i�PARCEL ZONING,DISTRICT r Historic District .'�.. - . . <.• _ r .. , . . Machine Shop g, {'•�,yes,. rtt� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building %One family [I Addition ❑Two or more family El Industrial t>AIteration No. of units: El Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ Wee 7ETlaas` ,:.. ' Water�sheDr DESCRIPTION OF WORK TO BE PERFORMED: )Q a L2 u e,vc l o..,►LS-0—_. Identification- Please Type or Print Clearly OWNER: Name: J,o c-�iL- 'D^-Cs c.o \,l Phone: a�Y, °113 `�3 3 Address: 1Phone�C {Email ems. 10>✓ 1 . m :� ice; ;',, �,� _ Address: Date: �' + s +.' Super'visor'skGonsttuction`License b5-1' E '4HomeRlmprovemertY'aLicense. �:� c�i -t,� -�; Exp: Date: 6 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: $ 2-0, 000 FEE: $ 2-S'0 Check No.: 1 Receipt No.: 1`CQ1 NOTE: Persons contracting wit unregistered contractors do not have access Ltheuarantyfun ner -- — Location r r No. 2c Date TOWN OF NORTH ANDOVER N Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 1j + T 1 Al r E //,41n ;, building Inspector Plans Subrnitte Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OFSEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ } Well01 ] Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ 4 COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on I71 i fl �i Si nature <- - 41.1 1 COMMENTS bo 2 ( / pr" Q Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: 84 FIRE DE A�T � r Temp Durnpster on sit des 3noO Located sgoo Street Loeated at 124 al- S?eetx Fire Departmen sign ture`�%ate Dimension I� 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.$1oo-$1000 fine I NOTES,and DATA (For department use) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 OTE: 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/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Energy.4 Mass check Ener Compliance Report (If Applicable) 4 Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4 Building Permit Application 4. Certified Proposed Plot Plan 4. 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 2014 1 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 20,800.00 m $ 249.60 Plumbing Fee $ 31.20 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 31.20 Total fees collected $ 412.00 110 Forest Street 750-2017 on 1/31/2017 3/4 bath in basement NORTH own o d ndover No. IIRt* ,� 0 ?�► i1 � z _ _ . y oL^K2 Ads h ver, Mass CONIC«l WICK y1' ADRATED t'Pa,`�5 S U BOARD OF HEALTH PERIM T D Food/Kitchen Septic System kg.TH ._ IS CERTIFIES THAT .. BUILDING INSPECTOR . .........,. Foundation has permission to erect M.................. buildings on ...11�......���$. ..... a. 0 Rough to be occupied as ...... ...... ...�� .:....Iw�....�� 1-terms �►� .... Chimn y rovided that the erson acce tin this ermit shall in eve res ect conform to of thea lication ep p p g p rY ppp � Final on file in this office, and to the provisions of the Codes and B -Laws relatin to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. ' t PLUMBING INSPECTOR eck" UP-W% Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. g Final PERMIT EXPIRES IN 6 M9,NTHS ELECTRICAL INSPECTOR_ UNLESS CONSTRUCTIO RTS Rough Service ............ .. .C .. ... .. ....................................... 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. o► , y . 98 Forest Street Kevin. Mur h, , • North Andover,MA 01845 PH:978-688-5335 Building Contractor • FAX:978-688-7207 Proposal To: Jack&Nancy Driscoll 110 Forest 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: 1/30/2017 Job: Add three quarter bath in basement Date of plans: None Architect: None Location: Same Work Schedule Section 1- r 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 2/1/17. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 3/30/17.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 II-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 III-Scope of Work Page 1 of 4 Kevin Murphy e 2 of 4 � Y Pa 9 Building Contractor 98 Forest Street North Andover,MA 01845 PH:978£885335 FAX:978888.7207 V General Proposal is to build hallway and add a three quarter bathroom, in existing unfinished basement area. Permit will be provided by contractor. Building All frame materials will be provided to build hallway and bath area. Walls will be 2x4. Bottom plate will be pressure treated. Plumbing Plumbing required to add three quarter bath with ejector pump, and relocate laundry connections will be provided. Plumbing fixtures to be provided by owner, installed by contractor. Electrical Electrical work required to wire bath to code will be provided. Panasonic fan/light will be supplied and installed. Any surface mounted fixtures(vanity light)to be supplied by owner, installed by contractor. Electric heat will be installed in bathroom. Insulation Walls will be insulated to code. Plaster Walls in bath and hallway will be blue boarded and skim coat plastered. Ceilings will be suspended. Interior Trim/Doors Pre-primed interior trim and doors will be supplied and installed to match existing. Bath vanity to be supplied by owner, installed by contractor. Flooring Floor in bathroom and hallway will be tiled. An allowance of$6 per square foot has been included for bathroom tile materials. Tile in hall way to be supplied by owner. Painting No allowance has been made for any painting. Waste Removal Any construction debris will be disposed of by contractor. Kevin Murphy Page 4 of 4 Blanding Contractor 98 Forest Street North Andover,MA 01845 PH;97888&5335 FAX 978688.7207 Section IV-Price Schedule. We hereby propose to furnish material and labor-complete in Accordance with above specifications for the sum of... ... ... ... ... ... ... ... ... ... ... ....$ 20,800 Payment to be made as follows: Percentage/item Description Amount 1 Permit obtained / deposit 1800 2 Framing complete $5000 3 Plastering complete $8000 4 Trim /the installed $4000 5 Job complete $2000 Total 5 $20,800.00 —Notice:No agreement for Home improvement contracting work shall require a down payment(advance deposit)of more that one-third of the total contract price of the total amount of all deposits or payments which the contractor must make,in advance,to order arid/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. 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 Date 03 u 1 t-I Signature Date I i ��� � � r �, -� �° sir �'�`�"� '��� `s,.ora'9�3'"�' ` -�k�g, .._.,r�s-�a.7-yes—'a.� .,�.,� y `Y I IV" The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lee7ibly Name (Business/Organization/Individual): Address: City/State/Zip: T-ly , Phone#: S-3 3 j Are you an employer?Check the appropriate box. Type Of project(required): I. I am a employer with �Ployees(full and/or> -time).• 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. fg Remodeling any capacity.(No workers'comp.insurance required.) 30I am a homeowner doing all work myself.[No workers'comp.insurance required.) t 9. El Demolition 4. I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑ Building addition ensure that all contractors either have workers'compensation insurance or arc sok 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions S❑I am a general contractor and I have hired the sub-contractors listed on the attached short These sub-contractors have employees and have workers'comp.insuran� 13. t ❑Roof repairs 6.❑We are a corporation and its offices have exercised their right of exemption per MGL c. 14.❑Other 152,§1(41 and we have no employees.[No workers'comp.insurance required.) 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 sbect showing the name of the sub-coatractors.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: Policy#or Self-ins.Lic.#: wC. Expiration Date: -R; t t--I Job.Site Address: l Vb rev,-,, J1 S -r City/StatelZip:tJv,, Mit-, 0 1$q.i 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 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 of Investigations of the DIA for insurance coverage verification. I do hereby,cer-ttfy tpdsr,t w pains and penalties of perjury that the information provided above is true and correct 1 Date: Phone#: " Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License ft — Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#: ACORCI CERTIFICATE OF LIABILITY INSURANCE OATE(MMlDDYYYY, 12/12/16 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; Sandi. Munroe M.P. Roberts Insurance Agency_ -PHONE - FAX (978) 683-3197 1060 Osgood Street j E INAI �c), (978) 683-8073 (A1C,Nol, I ADDRESS: sandi@mprobertsinsurance.com North Andover, MA 01845 --�_--INSURE R(S)AEF9!!NNG COVERAGE.,,_, „ -INSURER A:Merchants Mutual Insurance--Co____.. INSURED INSURERB..GuardInsurance KEVIN MURPHY REMODELING INSURER C ------------ _.- __- _ ._._�_ .___.___ _.. ... 98 FOREST STREET INSURER D NORTH ANDOVER, MA 01845 — _-- ---- -� INSURER E: INSURER F: 1 ; 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, EXCLUSIONS ANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. IN's ADDL SUPOLICY EFF 1 POLICY EXP I LTR TYPE OFINSURANCE INSR D!ER POLICY NUMBER MMIDDNYYY MMIDDIYYYY LIMITS A GENERAL LIABILITY E$OPIO68945 11/22/16 11/22/17 EACH OCCURRENCE $ _1.,000_,000__ �.... DAMAGE 70 RENTED .X COMMERCIAL GE NE RAL LIABILITY i I I,RREMISUIEa,.o9cutrence)__ CLAIMS-MADE }{ OCCUR I L 0 EXP(Arty one person) $ 15,000 r'L $ GENERALAGGREGATE $ 2,000,000AGGREGATE LIMIT APPLIES PER j PRODUCTS CAMPIOP AGG $ 2,000,OOOPRO- LOC POLICY i $ AUTOMOBILE LIABILITY 1 1/23/16 1/23/171 COMBINED SINGLE LIMIT A .MCA7013608 � ANYAUTO i BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) S— AUTOS X AUTOS111111 NON-OWNED 9 PROPERTY DAMAGE $ X HIREOAUTOS X AUTOSPeracedent) I I _.-_._ $ A UMBRELLA LIAR OCCUR I CUP9145304 11/22/16 11/22/171 EACH OCCURRENCE $ 1,000,000 EXCESSLIA9 CLAIMS-MADE II I I �AGGREGATE $ 1,000,000 _ DED RETENTION$y WORKERS COMPENSATION KEWC726509 7/1/169 ?/1/17' }{ ORY.IMIU OER._._....._....-.-...--____..,..__._...... AND EMPLOYERS',LIABILITY YIN i �`"" ANY PROPRIETOR/PARTNER/EXECUTNE NIA Li L- CLI AC CI OENT -�$ 500 1000 OFFICERIMEMBER EXCLUDED? (Mandab y In NH) j E.L_DISEASF.--_EA EMPLOYEEI$ 500,000__ Ues,describe under SCRIPTIONOFOPERATIONS below I E.L.DISEASE-POLICYLIMIT $ 500,000 i DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space Is regti red) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER, MA 01845 AUTHORIZED RE PRE E�`SA ((/ ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: I j e Cpai� �zo�nruea/�.d� iro� craeG/� i Office gf'Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR _ t istratio Re _ 9 n:,,Zy 101874 Type: - ;; Expiration__.==6%29!2098 Individual KEVIN MURPHY Kevin Murphy 98 FOREST ST. N.ANDOVER, ' _+ .: ��_r ,.,• �. _ ER, MA 01845 i Undersecretary Massachusetts Departmentfo Public Safety Board of Building Regulations and Standards License: CS-053099 t Construction Supervisor KEVIN W MURPHY 98 FOREST ST r tan .� NORTH ANDOVEftt M d<1$4Q ,1��/►L^M CA—_ Expiration: Commissioner 06/29/2017