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HomeMy WebLinkAboutBuilding Permit #834-14 - 158 DALE STREET 5/19/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: ✓ Au IMPORTANT: Applicant must complete all items on this page LOCATION t .\ S ire i Print ; PROPERTY OWNER e.z- Print 100 Year Old Structure yes MAP NOO PARCEL �'� .. ZONING DISTRICT: Historic District yes U Machine Shop Village yes no TYPE OF IMPROVEMENT, PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial t&Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic ❑Well 0 Floodplain El Wetlands ❑ Watershed District Water/Sewer �- .((^^ DESCRIPTION OF WORK TO BE PERFORMED: QA—p e /t S Identification Please Type or Print Clearly) OWNER: Name: Phone: GV-L- to • P(ON-1 Address: CONTRACTOR Name: Phone: YS-It -5733.4 Address: �rG Supervisor's Construction License: 053 U RA Exp. Date: b .2.41t.57 Home Improvement License: a t 4�'1`'l Exp. Date; �. 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: $ 1 o,-35 D FEE: U 0 Check No.: �Z2 Receipt No.: 21 NOTE: Persons contracPtnk with unregistered contractors do not have access to the guaranty fund Signature of Agent%Ownelgnature of contractor- -- � -f Plans Submitted a Plans Waived Certified Plot Plan ❑ Stamped Pla s Location No. s 5 LA — j q Date -[ • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee s 211 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# > T L Buildind-lApector - Plans Submitted ❑ Plans Waived':: Certified Plot Plan ❑ Stamped Plans ❑ JYP OFSEWERAGEDISPOSAL" Public Sewer ❑ Tanning/Massage/Body Art ❑. . Swimming Pools ❑ Well ❑ Tobacco.Sales ToodPackaging/Sales ❑ -Private(septic tank,etc. - _ =Permanent Dempster on=SiteEl THE-FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM _:__ DATE REJECTED: - DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS :CONSERVATION Reviewed on Signature COMMENTS I HEALTH Reviewed on -Signature , COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes z Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Con nection/S_ignature& Date Driveway Permit DPW Tod .. Engineer: Signature: Located 384 Osgoo# Street FIRE DE10 RTil ENT ='Tenip Dempster on site yes no Located"at:124 Mair, Street Fire-Departme►it signature/date-"' 4 COMMENTS ' 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 DANGERZONE LITERATURE: -Yes No MGL.Chapter-166.Section 21A.--F and G min.$100=$1000.fine NOTES and DATA— (For department use Ll Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fol:-)wing'"is�a=list of,the required forms to befilled out for:the appropriate.permit to be obtained. Roofirfg, Siding, Interior Rehabilitation Permits o ' Bluilding Permit Application a Workers Comp Affidavit I I' ❑ Photo Copy Of H.I.C. And/Or C.S.L- Licenses o 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) Englneer_ing_Affida_v_its 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 roof of recording the Registry of Deeds. One co and g that the apvaal period is over. The applicant must then get this recorded at g y copy p must be submAted with the building application Doc: Doc.Building Permit Revised 2012 NORTH Town of 2 � _ Andover w�`. No. ?Pq_,w_ Iq - h * z ver, Mass G �� Z h , , o A- COCNiCMWICK 7,y RATED ►QP��(5 S U BOARD OF HEALTH Food/Kitchen PER IT T LD Septic System MPe_ � H e.. C,1.{`` BUILDING INSPECTOR THISCERTIFIES THAT ..................................................... ............................................................... ���.. ..,. ... Foundation has permission to erect .......................... buildings on .. ....... ......We...............................;. T ��pp Rough �- !. Pmk-� Awes ..4.....o.�C.'.....RS..ep.AAA$......... Chimney tobe occupied as ......................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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. L_.. /ILU' ((JO'Y7UJY2492L!/BCC(�71 Ci�.��GCGJ1Cl-G 2UJ . 1 Office of Consumer Affairs&Busibess Regulation OME IMPROVEMENT CONTRACTOR Type: egistration: 101874 Individual xpiration: .6129/2014 KEVIN MURPHY Kevin Murphy 98 FOREST ST. gam= N.ANDOVER,MA 01845 Undersecretar-;y _ —--- ent of and public Safety Massachusetts -Department Standards ' Regulations Board of Building Construction Supen'isor l License: CS-053099 "a KED W MBRP r 98 FOVXS'T ST (44 01 North Andover NCS+ r Expiration 0612912015 J I Commissioner The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations IV 600 Washington Street Boston,MA.02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electrician/Plumbers Applicant Information (� Please Print Legibly Name(Business/Organization/Individual): 16_MA . Address: City/State/Zip: Nt. 4�,..�c �"�-- L f Phone 3 3,15"' Are you an employer?Check the appropriate box: Type of project(required): 1.16 I am a employer with k — 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.F1 am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and'have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. workers'comp.insurance. 9 y p tY• E]Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 3.1:11 am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roofrepairs insurance required]t employees. [No workers' 13.❑Other comp.insurance required.] !Any applicant that checks box#1 must also fill out the section below showingtheir 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 sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. n Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: �-S_Y) DoAx- City/State/Zip: 019-'46- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cert under thepains and penalti perjury that the information provided above is true and correct Si ature: Date: L q Phone#: C'� - Official use only. Do not write in this area,to he completed 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#: fYYYY ACORa CERTIFICATE OF LIABILITY INSURANCE 7%T7(%013 ) 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 M P ROBERTS INS AGCY INC P ONEFAX Arc No E)d: (978) 683-8073 'VAC. ): (978)683-3147 1060 Osgood Street E-MAIL ss:S �@probertsinsurance.com North Andover, MA 01845 INSURER(5) AFFORD"G COYEIRACE I uuca INSURER A: PROVIDENCE MUTUAL INSURED RENIN MURPHY BUILDING REMODELING INSURERB:MERCHANTS INSURANCE 169 BOXFORD STREET INSURER C-GUARD INSURANCE NORTH ANDOVER, MA 01845 INSURER D: 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, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUER P LICY EFF POLICY EXP LTR INSO wvo POLICY NUMBER MM/DDJYYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCUnINJURY $ 1,000,000 CLAIMS-MADE OCCUR PREMISES E $ 500,000 MED EXP(Anone $ 15,000 A BOPI068945 11/22/12 11/22/13 PERSONAL& $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 2,000,000 POLICY L PRO n tOC PRODUCTS o r e 000 000 ECT ROD S-COM.!OP P.G 2; ; OTHER: $ AUTOMOBILE LIABILITY BINED SINGLE Ea accident $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALL OWNED 'SCHEDULED MCA71113608 01123,/13 01123/14 B I AUTOS X AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ I UMBRELLA LIAR I OCCUR I EACH OCCURRENCE 5 1,000,000 B EXCESS LIAB CLAIMS-MADE CUP9145304 11/22/12 11/22/13 AGGREGATE $ 1,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION I PER OT AND EMPLOYERS'LIABILITY YIN i X STATUTE ER C oOFFICERNE�nlnel-R EE�ccwDEED E IS NIA E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) KEWC422467 07/01/13 07/01/14 EL DISEASE-EA EMPLOYE $ 500 000 If yes,describe under i DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY OMIT S 500,000 i DESCRIPTION OF OPERATIONS/LOCATIONS r VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER BUILDING DEPT. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCE 1MITH THE POLICY PROVISIONS. AUTHORIZED REPRES A r 1 � ' ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD Kevin urh . 98 Forest Street North Andover,MA 01845 PH:978-688-5335 Building Contractor • FAX:978-688-7207 Proposal To: Kevin&Kristine Mclellan 158 Dale 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: 5/19/2014 Job: Door/Dining room Date of plans: None Architect: None 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 4/1/14. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 5/9/14.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 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 Page 2 of 4 Building Contractor 98 Forest Street North Andover,MA 01845 PH:978F8&5335 FAX 978-688-7207 General Proposal is to renovate dining room and install new exterior French door unit. Door unit to be supplied by owner. Building permit will be provided by contractor. Demolition Existing rear wall, and dining room ceiling will be gutted. Building All frame and siding materials required to install new door unit, will be supplied/installed to match existing. Any materials required to level/support existing dining room floor will be provided. Miscellaneous materials required to install single exterior door unit in other section of house,will be provided. Second door unit to be provided by owner. Plumbing No allowance has been made for any plumbing work. Electrical Minor electrical work required in dining room ceiling, and to install exterior light, will be provided. An surface q 9 9 9 P Y mounted light fixtures to be supplied by owner, installed by contractor. Heating/Air Conditioning No allowance has been made for any heating/air conditioning. Insulation Exterior wall will be insulated to meet code. Plaster Dining room ceiling and exterior wall will be blueboarded and skimcoat plastered. Ceiling and wall will be smooth. Interior Trim/Doors Interior trim to be supplied by owner, installed by contractor. Two interior french doors to be supplied by owner, installed by contractor, in existing openings. Painting No allowance has been made for any painting Waste Removal All demolition/construction debris will be disposed of by contractor. Kevin Murphy Page 3 of 4 Building Contractor 98 Forest Street North Andover,MA 01845 PH:9786885335 FAX 978588-7207 Flooring No allowance has been made to supply/install/finish any flooring. Kevin Murphy Page 4 of 4 Building Contractor 98 Forest Street North Andover,MA 01845 PH:978£88-5335 FAX 97868&7207 Section IV-Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of... ... ... ... ... ... ... ... ... ... ... ....$ $10,350 Payment to be made as follows: PercentagelItem Description Amount 1 Deposit/ Permit obtained $2350 2 Exterior doors installed $6000 3 Job 100% complete $2000 Total 3 $10,350.00 'Notice:No argeernent for Home improvement contractor worts shall require a down payment(advance deposit)of more that one-third of to total contrail price of the total amount of all deposits or 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 �� �UC� Date ,sjy; Signature Date