HomeMy WebLinkAboutBuilding Permit #476-13 - 125 CANDLESTICK ROAD 12/19/2012 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued:
IMPORTANT Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
'Residential Non- Residential
❑ New Building One family
❑Addition ❑Two or more family ❑ Industrial
0!51t ration No. of units: ❑ Commercial
R'Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
� Se tics �TWellya #Food lam 'A �®1Netlands� UVate shedDistrict
®Water/Sewe'r * 3 �
DESCRIPTION OF WORK TO BE PERFORMED:
5}1rtO0iir`ct Cv rerN, -
Identification Please Type or Print Clearly)
OWNER: Name:- Qe"t5e Scc,�el��ry Phone /- Cl)-- 9�S-vS-37 �ekl
Address: IaS C"L2a.)-teL d
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GONTRAORName � 1� ,� 4vc, t�° Phone �F ��
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I'Mald,
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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: $ �(, &66:np FEE: $
Check No.: b 3 ( Receipt No.: Ca(.bq!=(
NOTE: Persons contracting with unregistered contractors do not have access to th guaranty fund
Slgnafure of°Agerit/Owner . ..`.: S._ignature;of contractor
=
Plans Submitted ❑ Plans Waived n C;PrtifiPri Plnt Plan SfamnPr9 Plans. n
Ids--
" Location d
No. / Date -
`i
. • TOWN OF NORTH ANDOVER -
Certificate of Occupancy $ .
Building/Frame Permit Fee Q-0-0
- Foundation Permit Fee $_ir _
Other Permit Fee $
TOTAL $
Check#
26044 Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL ,
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swming 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
s
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes L
Planning Board Decision: Comments
i
Conservation Decision:
Comments
Water& Sewer Connection/signature Date k
Driveway Permit
DPW Tow Engineer: Signature:
SIRE DEPARTMENT =Temp"Dumpster on site yes Located 3n4oOsgood Street .
Located at 124 Mair"Street' .
Fire Department-sigriature/date
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 No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use
B Notified for pickup - Date
i
Doe-Building Permit Revised 2010
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
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
o Engineering Affidavits for Engineered products
VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
i
❑ Building Permit Application
o Certified Surveyed Plot Plan
o Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
o 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)
o Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o 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 subm tted with the building application
Doc: Doc.Building Permit Revised 2012
NORTH
own of � _E Ip ndover
o . .
4� �
No. t -
�O LAN! h ver., Mass,
COC NICNl WICK y1.
RATED
S U
BOARD OF HEALTH
PERMIT . T L.D, Food/Kitchen
Septic System
THIS CERTIFIES THAT �-- Cf,,c,,;, ,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR
.................. ...... ...N.%. ....... .�..... .
Foundation
has permission to erect .......................... buildings on ..�.p�.�.....:5,,.(rl. Gl... .:s. 4r ....... ,.-..•
Rough
�..1.�. .c�a. ou. ...... .. ...... .............................................
to be occupied as ......... .... ..... .... Chimney
provided that the person accepting this permit shall in every resWt t 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
�DD PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUC ST Rough
Service
............ ...... ......................... :�:•:�............. 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.
SEE REVERSE SIDE
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C.S. Murphy Construct'
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Tewksbury, MA 0 376
978.995.3154
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Estimate
PROJECT: Strip current siding and Install new Vinyl Siding
CUSTOMER: Denise Scutellaro
JOB SITE: 125 Candlestick RD North Andover Mass
ESTIMATE DATE: December 6, 2012
ESTIMATE NUMBER: 070
PROJECT SCOPE
Thisr
p oject covers stripping the house and ,installing new vinyl
siding to homeowners specs.
A. Site Preparation & Demolition
a. Prior to demolition and construction homeowner is responsible
for removing all personal items from work areas.
B. General Construction
a. Strip current siding and dispose
b. Tyvek walls. Inspect current window flashing and repair if
necessary
c. Remove and reinstall existing light fixtures
d. Install vinyl siding to homeowners specs.
e. Install composite trim around front door and new composite
trim around garage.
f. Includes all permit fees.
g. Includes having a licensed electrician remove and reinstall
exterior meter per code
h. Does not include current entrance wall (siding yet to be
determined).
�? i. Does not include any additional trim
C. Site Cleaning & Trash Removal
a. Trash will be removed from the premises on a daily basis.
b. Work areas will be swept clean at the end of each work day.
D. Work Performed By Others
a. Licensed electrician will remove and then reinstall electrical
panel in accordance'with building codes
E. Allowances
a. Estimate does not include special order siding sizes or colors
b. Allowable permit fees: $300 .00
F. Change Orders
a. Allowance Cost - if the cost of material the home owner
selects is above the stated allowances, a change order will be
issued.
b. Known & Unknowns - if during the demolition or construction
phase of this project, a condition is discovered that will have
an impact on the progress of the work, a change order will .be
issued.
c. New Work - if work is requested that is outside the scope of
work as listed herein, a change order will be issued and the
work will be scheduled appropriately within the overall project
plan.
d. All change orders will state estimated installation time as well
as labor and material cost.
e. No change order will be executed without prior approval and
sign-off by Homeowner.
G. Cost Monitoring
C.S. Murphy construction understands that cost and schedule control
are an essential part of any home renovation project. We will make
every effort to communicate with you on a regular basis. Our goal is
to consistently give you all the information you need to make an
informed decision given all the options available to you.
r
/ h
'LM s
H. Project Work & Payment Schedule
Options for entry door wall (entry door wall not included in price):
• Cedar Impressions $1480.00
Double Four Vinyl Siding $690.00
+ Stone (price tbd by stone mason)
Task Work Schedule Pa ment Schedule
Proposal Approval Date of contract signing $6,000.00
5.0% Project Estimated one week $6,000.00
-Completion from start date
100% Complete Estimated two weeks $4,660.00
from start date
Final cleaning of work area
Final walk-through inspection
by homeowner
Total Project Cost 16 660.00
1. Timing & Cancellation Policy
a. This proposal estimate is good until January 31, 2013
Homeowner has three (3) days from signing of contract to
cancel their decision and receive their full refund. If contract
is cancelled after the three-day grace period, the deposit
stated in the payment schedule is forfeited.
By signing below I agree to all the terms and conditions listed
above.
1-9i 9n Date
(S e
Print
Oi `topher Murphy Date
t Massachusetts -Department of Pu6hc Saff tY
card 1 toiEd'an Rorg j.Mions and Standards
�('msrrirction Supervisor
License; CS-1062,44
r,
CRWSTOPHER MtWHY:-„,.,: rr.
310 MARSTON STRE TF
Tewksbury MA 01876
Expiration
GammissEaner 06/19/2015
Cl e N)ItA ,Meeth/I,n//C��aaerrc�rrt�r.
Office of Consumer Affairs&Busiess.Regulation
'A OME IMPROVEMENT CONTRACTOR
egistration:. .172291. Type: t
:3 xpiration 6/7/2014 DBA
G.S. RPHY CONS'rRUCTYON i
CHRISTOPHER MURPHY�
310 MARSTON ST
TEVIIKSBURY, MA 01676";';:?" Undersecretary
i
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leeibly
Name (Business/Organization/Individual): (f 5. )%1U,,
Address:
City/State/Zip: v i 2 7� Phone#: / ?r- 3/5-f-
Are you an employer?Check the appropriate box: Type of project(required):
1.❑Em
employer with 4. ❑ I am a general contractor and I 6. ❑New construction
yees(full and/or part-time).* have hired the sub-contractors
2. sole proprietor or partner- listed on the attached sheet. 7• ❑Remodeling
ship and have no employees These sub-contractors have 8. ❑Demolition
working for me in any capacity. workers'comp.insurance. 9. ❑Building addition
[No workers' comp.insurance 5. ❑ We are a corporation and its
required.] officers have exercised their 10.El Electrical repairs or additions
3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself. [No workers' comp. c. 152,§1(4),and we have no 12.F]Roof repairs
insurance required.]t employees. [No workers' 13.❑Other
comp.insurance required.]
kny applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
:ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site
formation.
tsurance Company Name:
:)licy#or Self-ins.Lie.#: Expiration Date:
►b Site Address: City/State/Zip:
ttach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
tilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
le 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
up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
vestigations of the DIA for insurance coverage verification.
to hereby certify under the pains and penalties of perjury that the information provided above is trite and correct.
nature: �' �--- Date o�C- 15 qo(aL
lone#: 1—q) — �5'S��3(54-
Official
4Official itse only. Do not write in this area,to be completer)by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
Information and 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 or 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 maintenance,construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6)also states that"every state or local 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 compliance 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 until 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' compensation 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 sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for the permit or license is being requested,not the Department of
Industrial Accidents. Should you have any questions regarding the law 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 burn leaves etc.)said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank 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 number:
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,M.A.02111
Tel. ##617-7274900 ext 406 or 1-877-MASSAFE
Fax## 617-727-7749
evised 5-26-05
www.mass.unv/clic