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HomeMy WebLinkAboutBuilding Permit #036-2017 - 180 MILL ROAD 7/12/2016 ( t%ORTH F q BUILDING PERMIT ED TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION " . ry Permit No#. till Date Received �Q"oR 9ATED SSACHUS Date Issued: IM ORTANT Applicant must complete all items on this page z:' ,'^MrV,er ca xFZn1 w+'� -+tia+ LOCATION �,� �� :• r Pant, s PROPERT,YiOVVNER . u�� z +� .i•• "" '' +et �.�'°-r '�N +-"ten r t- Fwa"tea - .K 'ice, r r }� '1:�? w :. t tze° 'y. �' f.,� +.� t r r P(Int.�i �� i'7F•�_+t��1+�u�o�Y2�1}fi�},.5�t(UCtU(@ �`�,t`�s�+,.y�� 'L� EMAIP ., `" `PARCEL"" "' ZONING DISTRICT . flistonc District �: 4 `yes .�?: � ... .� +. €,Y 7'l:� 1 s. `� 5�•�+�,��imh8'ta..�i,'�'f"'•"�.i�:.w._i'7 r �+C.. :k } ti 1" ;r; Machine Sfiop;Village. 'yes . TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ifi>One family ❑Addition ❑Two or more family ❑ Industrial t&Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition Other 7V-El �CF41fQ ��L' etlands �-�' ®_ 4�Vte�she D si rich t F Se`we nn o DESCRIPTION OF WORK TO BE PERFORMED: 43 9}-.:..s r.na.f Identification- Please Type or Print Clearly OWNER: Name: Phone: On?, 6j2-�- 0054 Address: k IA' 12on� i�vi5 ;�,- r n •a .+,t• r •+r'.., -;. > r, � :r -,.n.t rl ',- '�^txi j > ;h�r . ::ri"���+;4et%t, e 3.: ' ?F a � xdK^'i e 7�.`; { r ���x�s +� ,r.•. _>:...w:� .:h wK r�:..� r 1"t -,`'.^-4 j*' �"a ��s ^...^`tom a'�'y''r�• �r., yr ay i .4•t C P h ��. .•� ^1 r,�,..w {.: :+' "i''"x^� t 4kit r.�„ f fir �i:, «iiy ,. Contractor Name` !Email.r��t<;�.'VLVw:'�1n�'�:/+O�c..+.�e..1'.A��w-ik..•LOj+,+�' j�j.�>2'lr,_ L'ln�+,+at'a�+.��+><.+� `�.S•uessa✓1'A�h�rws�'a+d`l+•�+VNr,x...,? /Addressa '. a 'hw.J�-� 'er ..*.3NU4,ab•.NL\N-��� r-a�.,rlu".a+"r{' '�.rr' ,'`' ,� '1+'. `Z�+b 'Fo rr t- Sir Supervisor>stConstructiont_Licerse 05 3 .g i �r. Ytx ti, J Y sd'�ifi s:• ? �`�`' 't,7ts^� -, F 4, +at ,Y `4^r rt �- "n c _�. yF r.aft yAs`�it.t +r ra a. z a x� >vr Tr x x M*r r `rovement�License. Date, Home ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ I2_ S57t3 0 D FEE: $_ 3o Check No.: Receipt No.: � NOTE: Persons contracting with 6registered contractors do not have°access to the guaraunty fund --- - Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. I Roofing, Siding, Interior Rehabilitation Permits 4. Building Permit Application 4. Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses � Copy of Contract 46 Floor Plan Or Proposed Interior Work �L 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) 4. Mass check Energy Compliance Report (If Applicable) & Engineering Affidavits for Engineered products g 9 OTE: 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 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 Plans Submitted.❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packagiag/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY f INTERDEPARTMENTAL SIGN OFF - U FORM I PLANNING & DEVELOPMENT Reviewed On Signature COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature I COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 0. Planning Board Decision: Comments Conservation Decision: Comments Watei& Sewer Connection/Signature�Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgo d Street FIRE DEPARTIOflENT �,Ternp °®wmpster on sit yes Located at 124 Main Street ;1 t ,, _ - Fire partmen gnature/date � � � � #; � �,S. �;,4,,a u_.5'1�,r•, - r y.,v_ cr e,Y'a� 3.�,Y Vy^`'# sr"..y. .. �4n•F t��,7 5?*. .q,,«�.. 1 �r I .i. i Dimension Number of Stories: Total square feet of floor area; based on Exterior dimensions. I 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 I . NOTES and DATA— (For department use) i I I i . ❑ Notified for pickup Call Email E Date Time Contact Name 3 Doc.Building Permit Revised 2014 Location No.Q tD; .fit T Date # • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ �, Building/Frame Permit Fee Foundation Permit Fee $__ Other Permit Fee $ ' TOTAL $ f 'r Check# 7 c607 Building Inspector �f 6 � Enter construction cost for fee cal - North Andover Fee Cakulatlon Construction Cost $ 25,300.00 m $ - $ 303.60 Plumbing Fee $ 37.95 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 37.95 Total fees collected $ 479.50 180 Mill Road 036-2017 on 7/12/2016 Remodel Master Bathroom i I OF BUILDING PERMIT NORTH �t�eo ib�'b0 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION ` 70� v��� Date Received �4'�R "^y Permit No#: q 1T4U SSACHUSE Date Issued: IMPORTANT- Applicant must complete all items on this page LOCATION n Pnnt t , PROPERTY OWNE4.,+Mh � �j MAPCEL: ZONING'DISTRICT. HistoncDistr'ict yes vtfb „ Machine`ShopVillage yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 60ne family f ❑Addition ❑Two or more family ❑ Industrial 0,Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: -V'?, 600 - 0054 Address: Contractor Name: V M , ���, Phone: `Email ley � b1d� ::�..��:_� 1 � _. f Z�• a'' ,�, Add[ess. ' �-�r - i�..9 3' 6Es 'IAV:t tiLN✓� 3 } 1 s fY Supervisor's Construction License 0�' `�` Exp n V Nome Improvement License :: Exp Dade ,,..;.bZ �..1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.•$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2,53 O,o FEE: $ .30 Check No.: Yl Receipt No..: 4 NOTE: Persons contracting with 6registered contractors do not'have•access to the guaranty fund NORTH Town of : E ndover No. �� _ 2a� � zT 0 � LAKI h ver, Mass, p COC NICHEWICK X1.95 RATED U BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT l.. BUILDING INSPECTOR .............. .... ..... .4(wr* .. ... ................................. i has permission to erect ... ildings on . �... .. - Foundation Rough to be 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TIO S Rough Service .. ...... ... ... ....... ... Final BUILDING ECT R 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. • 98 Forest Street e®®�j Y` Murphy North Andover,MA 01845 • PH:978-688-6336 Building Contractor • FAX:978-688-7207 Proposal TO: Richard&Holly Goldman 180 Mill Road AD FlorT1Birnprovement Co*aaors ora Subcontractors ervagm oontrac",unless North Andover, Ma. 01845 N home�from registration Prowsions of Chapter 142A of the w al ISN",must be registered with etre CommorNmith of Massadtusetts.Inquiries about ragistratim and Stotts stwuld be made to the Director,Horne FR�n: Kevin Murphy Contract Registration,one Ashburton Place, y Room 1301,Boston,MA 02108.(617)-727 8598 CC: Date: 417/2016 Jolt Master bait Date of plans; None Arohiibec t: None Location: 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 5/1/16. 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 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,fbdhwkh remedy,repair correct,replace,or cause to be remedied,repaired,or replaced, such damage or such deflect 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 Kevin Murphy Page 2 of 4 Building Contractor 96 Faea Street N0M Andover,MA 01W PR 9788885336 FAX 978888.7207 General Proposal is to remodel existing master bathroom. Tub will be eliminated, toilet and shower will be relocated. Permit will be obtained by contractor. Demolition Existing bathroom will be completely gutted. Plumbing Plumbing required to relocate toilet and shower will be provided. Sink to remain in roughly the same location. Copper pan will be provided for shower. An allowance of$1200 has been included for plumbing fixtures($500 for shower valve/controls,$300 for toilet,$300 for faucet,$100 for sink). Electrical Electrical work required to wire bathroom to code will be provided. Panasonic fan / light will be supplied and . installed. Three recessed lights will be supplied / installed. Surface mounted fixtures ( wall sconce/ vanity lights)to be supplied by owner, installed by contractor. Heating/Air Conditioning Heat will be relocated as required. Insulation Existing insulation to remain. Plaster Bathroom will be blueboarded and skimcoat plastered. Interior Trim/Doors I Pre-primed interior trim will be supplied and installed to match existing. Existing door to bathroom to remain. Painting Interior painting will be provided. One coat of primer, and two coats of finish will be applied to all painted surfaces. Flooring Batrhroom floor and shower will be tiled.An allowance of$6 per square foot has been included for file materials. Other Allowances An allowance of$2500 has been included for cabinets/counter. Kevan Murphy Page 3 of 4 Building Conk,, ' 96 Foreg skeet NoM Andover,MA D1845 PH:9788885335 FAX:978688-7207 Waste Removal All demolition/construction debris will be disposed of by contractor. Items Not Included No allowance has been made to supply or install any glass shower door. I I Kevin Murphy Building ConPage 4 of 4 taac6or 98 Forest Street Nath Andover,MA 01845 PH:9788885395 FAX 978886.7207 Section IV=Price Schedule We hereby propose to furnish material and labor-complete in Accordance with above specifications for the sum of... ... ......... ...... ...... ... ... ....$ 25,300 Payment to be made as follows: Percentage/item Description Amount 1 Permit obtained / deposit $2300 2 Demolition complete $5000 3 Plasterin corn lete $8000 4 Tile complete $7000 5 Job 100% complete $3000 i Total 5 $25,300.00 '"Notice:No agreement for Home OnPrOvemeM aontrac"work shy mqm a doom payment(advanw deposit)of nae that anted of the total corroad s payments wt*h the arrrector must nuke,in advarm,to order andcr otherwise otNsin delivery of speda!Oda materialand W of the total amount of eft deposits a egcriprtrart,wtricYrever 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 Date i5Ld ,_ . Zoo, Signature Date The Commonwealth of Massachusetts Department of IndustrialAccidents t 1 Congress Street,Suite 100 Boston,MA 02114 2017 www.mass gov/dur Workers'Compensation Insurance Affidavit:Buflders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/OrganizatiowUdividual): Address: T City/State/Zip: Nv ,, �,�. ►vac., ®l a`-1 Phone#: S-3 3 a Are you an employer?Check the appropriate box: - Type of project(required): Qn 1 am a employer with < employees(full and/or part-time).• 7_ New construction 2131 am a sole proprietor or partnership and bane no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required] 3 1 am a - 9_ Demolition homoownc loin all work m t: o work t 8 Y� 1N workers'comp.insurance 4.[]I am a homeowner and will be hiring contractors to conduct all work onmY Pr'oPatY- I will 10 E]Building addition enstue that all contractors either have workers'compensation insurance or are sok I LE]Electrical repairs or additions proprictors with no empbyoes. 12.❑Plumbing repairs or additions 5.a 1 am a general contractor and I have hired the sub-contractors listed on the attacbed shell. These sub-contractors have employees and have workers'comp.instaance.t 13.❑Roof repairs 6.[:]Weare a corporation and its officers have exercised their right of exemption per MGL a 14.[]Other 152,§1(4).and we have no employees.(No workers'comp.insurance required.] •AnY applicant that checks box#1 must also fill out the section below sbowing their worlxers'compensation polity information t Homeowners who submit this affidavit indicating they are doing all work and then hive outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sbect showing the name of the subcontractorsand 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'corapensadon insurance for my employees. Below is the policy and job site information. Insurance Company Name: �- Policy#or Self-ins.Lic.#: k�tN� 1't_b 50 1 Expiration Date: —t Job_Site Address. l y)0 M�1L f1 ra.1L City/State/Zip: Ii... 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 ofthe DIA for insurance coverage verification_ I do hereby,cthe pains and penalties of perjury that the information provided above is true and correct Si azure: Date: "l 12. I Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#- -- DATE(MM�DOM'Y1� w CERTIFICATE OF LIABILITY INSURANCE 7/11/2016 THIS CERTIFICATEIS ISSUED ASA MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELYOR 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 REPRESENTATIVBDR PRODUCER,AND THE CERTIFICATEHOLDER. IMPORTANT:N the cerNficateholder is an ADDITIONALINSURED,the policy(ies)nust have ADDITIONALINSURED provisionsor be endorsed. If SUBROGATIONS WAIVED,subject to the termsand conditionsof the policy,certain policiesmayrequirean endorsement A statementon this certificatedoesnot confer rights to the certificateholder in lieu of such endomement(s). PRODUCER CONTACT NAME: Sandi Munroe M P ROBERTS INS AGCY INC PHONE FAX 1060 Osgood Street �e•�d: (978)683-8073 /c A ,No: (978)683-3147 7 ADDRESS: sandi@mprobertsinsurance.com North Andover, MA 01845 INSURERS)AFFORDING COVERAGE NaCft INSURERA: MERCHANTS INSURANCE INSURED KEVIN MURPHY BUILDING 6 REMODELING INSURERB: GUARD INSURANCE 98 FOREST STREET INSURERC: NORTH ANDOVER, MA 01845 INSURERD: INSURER E INSURERF: :OVERAGES 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, EXCLUSIONSANDCONDITIONS OF SUCH POLICIES.LIMITS SHOWNMAY HAVEBEENREDUCED BY PAID CLAIMS. POLICY EFF POUCY EXP TYPEOFINSURANCE a POLICY NUMBER LIMITS X COMMERCl/LLGENERAL LIABILITY EACI OCCURRENCE $ 1,000,000 CLAIM DE OCCUR PREMISES Ea oceunerlce $ 500,000 MED EXP(Anyone person) $ 15,000 BOPI068945 1/22/15 1/22/16 A PERSONAL BADV INJURY $ INCLUDED GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY [3 IPERC El LOC PRODUCTS-COMPMPAGG $ 2 000 000 OTHER: $ AUrOMOBILE LIABILITY �MBIc d D SINGLEUMIT $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ OWNED SCHEDULED MCA7013608 1/23/16 1/23/17 }[ A AUTOS ONLY AUTOS BODILY INJURY(Peraccident) $ HIRED NON-OWNED PROPERTY DAMAGE AUTOS ONLY AUTOS ONLY Per accident $ $ UMBRELLA LIAa IX:CIJR EACH OCCURRENCE $ 1,000,000 A :j:[EXCESS LIAR H—'.—E AGGREGATE $ 1,000,000 DED X RETENTION $ 10,000 CUP9145304 1/22/15 1/22/16 $ WORKERS COMPENSATION X PER OTFF AND EMPLOYERS'LIABILITV STATUTE ER _ t'Y/'STN ' 500,000 B arstcsan�saue ezc�oeo�i�� 1 1, 1 N/A EJ-EACH ACCIDENT $ i (Mandatorlln NH)tu 11�� KEWC726509 7/01/16 7/01/17 E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OFOPERATIONS below E.L DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Sdtedule,may be atlarhed if more space is mqulmd) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER 1600 OSGOOD STREET SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD25(2016/03) The ACORD name and logo are registered marks of ACORD ��e�°4���Z�y�zcrsett�(�a�vvcaada-c�tu6eC�1 Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR e. 091 Registration: . 101874 Expiration: .29/?0,18 Individual KEVIN MURPHY _ t r = Kevin Murphy 98 FOREST ST. p` N.ANDOVER,MA 01845 Undersecretary Massachusetts Department of Public SafetyBoard of Building Regulations and Standards License: CS-053099 Construction Supervisor lF I KEVIN W MURPHY- 98 URPHY98 FOREST ST p "> NORTH ANDOVER MAU04846' � t .wjii Expiration: Commissioner 06/29/2017