HomeMy WebLinkAboutBuilding Permit #467-13 - 181 HIGH STREET 12/17/2012TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: I Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION' _.. _ -7k- _.,\..
Print
PROPERTY OWNER 0\-C' _e- 4-
-Print
Print 100 Year Old structure es.
MAP NQ: PARCEL ZONING DJSTRICT 'Historic0istrict yes
Machine. Shop a yes
es
_ -- 9
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
A One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
-Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
0 Septic ❑Well
❑ Floodplain ❑ Wetlands:
❑ Watershed.'District
Water/Sewer
OWNER: N
DESCRIPTION OF WORK TO BE PERFORII IED:
Identificatti�on Please Type or Print Clearly)
Home Improvement
D l Exp.: Date: 6VI—P, k x 3.
ARCHITECT/ENGINEER Nvw-2-
Address:
Phone:
Reg. No
FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $ ?20
Check No.: ,( Receipt No.: g k U 3 t
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
,.;, ..—.,...oma. _.,..w..._ .. _
Signature of A'gentlQwner _ :.Signature�off &itractor..
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped PIa
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 submAted with the building application
Doc: Doc.Building Permit Revised 2012
Plans Submitted ❑ Plans Waive 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
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed
COMMENTS
HEALTH Reviewed on
COMMENTS
Zoning Board of Appeals: Variance, Petition No:
Planning Board Decision:
Conservation Decision:
DATE REJECTED DATE APPROVED
Comme
Com
ing Decision/receipt submitted yes
Water & Sewer Connection/Signature & Date Drivewav Permit
DPW Towo Engineer: Signature:
Located 384 Os ood Street
FIRE DEPARTMENT T - Temp Dumpster on site yes no
Located at -124 Main Street: _ ..
Fire Department signatureldate '' ` w �
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
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — (For department use
® Notified for pickup - Date
Doc.Building Permit Revised 2010
Locatio I O I 41,,-v, 4 -
Nn _ 1 l!� 1— 1 ! V
Check #I I � 15'
26035
Date 12-1 1� i Z
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $3-D 161)
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
0
H
S
LL
p
aco
m
ai
LY
O
LL
E
T?
N
a
cu N
0
N
z
z
m
O
a+
7
LCL
7
CC
C
E
U
LL
O
H
Z
z
J
d
t
7
w
LL
O
Ln
Z
Q
u
W
W
L
7 0
K
U
cuC
(A
LL
OC
V
Wa
Z
L
7
w
C
LL
z
W
a:
W
5
Y.
m
O
Z
v-
{%
�+
v
Y
O
(n
O O
C : H
o V
W
�: n :a
N
?: :Z
CD
�. o • Z
.%§-.o
:o
L E
^ CD 0.
U) m
i
d C
o =
��• O d
C J (fl O
;Lm C Z�
>
vk c mesh W
N
a 4� �a w X Z
N
2 o UJ O
oc
CL to Z a,
�.:.� _ W
v s > 3 c W J
��� az
CLa)
N� m =.
v c `o
0 � C C
H O
•o
Q�.�
F O m
W C .a O O ,F
LL n L N C O
•= .0 O 1
N :3 V uml O
W •Ev O O V
V Q. O N
N O C
N -0 O
1— t . C. o 0 >
91
.ti
F,
01-
0:2 G:2
H �
d
00
o CL
co Q
Cc ca
J
0
Z
CLN
i
E
I
x
LU
o
o
o
co
_
C
Y
O
LL
E
4)
aO
LnT
v
Ln
p
H
Z
—
Z
O
LL
to
O
W
t
U
C
LL
O
Z
Z
J
O
C
C
LL
cic
O
Z
V
W
W
p
U
Ln
C
LL
o:
OW
�
Z
C
to
70
d'
C
LL
F-
Z
W
Or
a
W
S
LL
Nto
m
O
Z
v
r.+
Q
Y
O
Ln
n
V1 „a
o
0
r 71H
y 2c Q
�a
0
E C1
r S Q
U)
<� W
o
v cm
3 c c c
Q h c c
N' NGOP�Q' �• O d
N J N
• ,
U,
O o� 0
c
E c a
i O
Quiz C1
.c oF
�
zcu
Q0•y
co
~ as
�• of N V m d
LUN_
�+
W C. •p ++ O
Li •yN C O
•Q o
LU E �� a O
LU , a
V Q ;a as
CA
�.
N U) -o o `~ c O w CL00 >
O
:
LU
z
z
0
m
zQ
CO �
Z
W
CL Cf)
x O
H /V-)
S V
Gcn
W
LLJ -j
CL Z
1
Cn
O
'N
E
O
O
Z C
O =
CM
4) 0
U
•� m m
CL t
v O O
� O �
a CL
� Q
C� J �
•CL O )
= Z
O
V N
c
CLU)
is
U)
W
W
19
W
�t
x
Q
W
L?
a
m°
v
U
=
O
.Ln
LL
v
N
u
o.
(
0
LU
d
Z
o
m
c
2 O
:
LL
t
c
E
U
_tLo
LL
0
v
N
Z.
Z
m
�
o
a
t
3
d'
_
ca
LL
0
v
N
Z
V
W
s
:3
W
_U
i>
V)
_
m
LL
0
O
a
Z
N
a
U'
t
3
w
_
m
LL
W
a
W
� LL
v
E
CO
p
Z
+
ai
N
O
v
�
O
VI
O
a
cnZ
Z
0
m
za
.Ir 5
E
Z O
to
(A W
W F-
0 .
c x Z
wO
d y
N W
c W J
CL Z_0
cn
0
N
d
t
0
Z
O
H
O
9
w
'-M1
O
2. M4)
�a
c 0
U)
ff
E �
1-;
It
L N
Q:�+ C
al
_
�-
0
cn
m
�
ca
�. 'a
> _
�c
=
° ' N W
o
.__ a) o
w
0
0Q
�0Z
:Q=om
0
Mn 3
o 0
L
_
Q. 0
COL
V Y =
0 �y
tm
F
Q
L
o = c
L IC
Q. CD
m
co
ea 0 •—
=
-0 +�+ 0 O
LL
N
La
N =
C :E
v v
W
C-)
L-
as
O N .__ 0
0-0
U)
CL
w c
'o
2
H
m
s
o = 0
� CL 0 C)
O
a
cnZ
Z
0
m
za
.Ir 5
E
Z O
to
(A W
W F-
0 .
c x Z
wO
d y
N W
c W J
CL Z_0
cn
0
N
d
t
0
Z
O
H
O
9
w
'-M1
r ..V C1 itMu_,�rrphayr
Building Contractor
Proposal
To: Chris & Jill Barker
181 High Street
North Andover, Ma 01845
From: Kevin Murphy
Citi:
Date- 12/11/2012
Job: Repair exisitng side porch
Date of plans: None
Architect: None
Location: Same
Section 1- Work Schedule
• 98 Forest Street
• North Andover, MA 01845
•
PH: 978-688-5336
• FAX: 978-688-7207
All Home improvement Contractors and Subcontractors
engaged in Forme improvement contacting, unless
specifically exempt from registration by Provisions of Chapter
142A of the general laws, must be registered with the
Commomveatth of Massachusetts. Inquiries about
registration and Status should be made to the Director, Home
Improvement Conhract Registration, One Ashburton Place,
Roan 1301, Boston, MA 02108.(617)-727 8598
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 12114112.
Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 120/12. 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 III - Scope of Work
Page 1 of 4
Kevin Murphy
Building Contractor
98 Forest Street
North Andover, MA 01845
PH: 978-688-5335
FAX: 978$88-7207
Page 2 of 4
General
Proposal is to repair/ rebuild floor of existing 5'x12' side porch. Building permit will be obtained by contractor.
Demolition
Floor joists and decking will be demolished
Foundation
Existing footings to remain.
Building
New floor joists will be 2x8 pressure treated. New decking will be 5/46 Azek . Exisitng posts to remain.
Waste Removal
All demolition / construction debris will be disposed of by contractor.
y
Kevin Murphy
Building Contractor
98 Forest Street
North Andover, MA 01845
PH: 978888-5335
FAX: 978888-7207
Section IV — Price Schedule
Page 4 of 4
inhereby propose material and labor — complete
Accordance with above specifications for the sum of ..................................... $ 2350
Payment to be made as follows:
"Notice: No agreement for Home improvement contrading work shall requite a down payment (advancedeposit) of more OvA one4hird of the total contred price of the total amount of all aeposrts or
payments which the contractor must make, in advance, to order andfor 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 ,� Date �Z� X31 tZ
Signature Date.
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Invesfigations
600 Washington Street
Boston, MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/orgmizationandividual): `La • •��. yw�►„ �.. ���, �,-` �# �-�,%t^.
Address: 9�►.,_._sf—
City/State/Zip: ti. ��. A � � Phone #: C\D iK - b<n 05 33
Are you an employer? Check the appropriate box:
1. I am a employer with —1 4. ❑ I am a general contractor and I
emnlovees (full and/or hart time).* have hired the sub -contractors
2. ❑Tam a sole proprietor or partner-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. [:11 am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
listed on the attached sheet t
These sub -contractors have
workers' ,comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, §1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. fN Remodeling
8. ❑ Demolition
9. ❑ Building addition
lo.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
*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 contractor; must submit a new affidavit indicating such.
$Contractors that check this box must attached an additional sheet showing the name of the subcontractors 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.
Insurance Company Name: "A
Policy # or Self -ins. Lic. #: SLE w C 3 1 "1J U Expiration Date: ^1 \
Job Site Address: 4i _I `�,� S'�v�,-, �"� City/State/Zip: NY
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration 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 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.
t do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
... , 1, `_ �� „�*o. l -� 1 ► -, \ � 2
.-,
Official use only. Do not write in this area, to be completed by city or town official
Cityor 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 #'
r
CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DDNYYY)
F12/4/2012
—_
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 Astatement on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER
M P ROBERTS INS AGCY INCwe°,
1060 Osgood Street
North Andover, MA 01845
NAME:
No,978 683-8073 (a , No): (978) 683-3147
At-MAILDDRESS sandi@mprobertsinsurance.com
1fNSURER(S)
AFFORDING COVERAGE NAIL#
INSURER A: PROVIDENCE MUTUAL
INSURED KEVIN MURPHY BUILDING & REMODELING
98 FOREST STREET
NORTH ANDOVER, MA 01845
INSURER B: MERCHANTS INSURANCE
INSURER c: GUARD INSURANCE
INSURER D:
INSURER E:
INSURER F:
Uwcr1mut0 L;EK I II-IL;A 1 E NUMBER_ RFVICInNi w InAQF:P_
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.
ILTRR
TYPE OF INSURANCE
IDOL
VN U
POUCY NUMBER
(MM/DD/YYYY)
(MM/DDNYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY
ICLAIMS -MADE Cl OCCUR
Lu
PREMISES (Ea occurrence) $ '5500 000
MED EXP (Anyoneperson) $ 15,000
A
BOPI068945
1/22/12
1/22/13
PERSONAL &ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'LAGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OPAGG $ 2,000,000
-
POLICY PE o- LOC
$
AUTOMOBILE LIABILITY
CUMBINEL) SING
Ea accident $ 1,000,000
BODILY INJURY (Per person) $
B
ANYAUTO
ALLOWNED SCHEDULED
AUTOS X AUTOS
MCA7013608
01/23/12
1/23/13
BODILY INJURY (Per accident) $
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE $
(Per accident)
UMBRELLA LIAR
HCLAIMS-MADE
OCCUR
EACH OCCURRENCE $ 1,000,000
B
EXCESS LIAB
CUP9145304
1/22/12
1/22/13
AGGREGATE $ 1,000,000
DED RETENTION $
$
C
WORKERS COMPENSATIONWC
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTNER/EXECUI'IVE❑,
Mn
(aH)EXCLUDED?
MnaER�N
If yes, describe under
NIA
KEWC317800
07/01/12
07/01/13
STATU- OTH-
X TORY LIMITS ER
E.L.EACH ACCIDENT $ 500,000
E.LDISEASE -EAEMPLOYEE $ 500,000
E.L DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(AttachACORD101,AdditionalRemarksSchedule,ifmon:spaceisrequired)
(;ERI II-IGATE HOLDER CAN( PI I ATinN
TOWN OF NORTH ANDOVER
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 RE TIVE
U 1988-2010 ACORD CORPORATION. All rights reserved.
ACORD25 (2010105) The ACORD name and logo are registered marks of ACORD