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Home My WebLink AboutBuilding Permit #746-2017 - 182 RALEIGH TAVERN LANE 1/30/20174�11 mw BUILDING PERMIT , TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 1� Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial I/Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ,Septic > [].,,Well q Floodplain W etlands•: < '' gyp- Watershed District 7- -❑-Water/Sewers Identification Please Type or Print Clearly) 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 Cast: $ FEE: $ 1 " Check No.: L Receipt No.: NOTE: Persons contracting i , unregistered contractors do not have access to the guarantyfund of Agent/Owner Signatureof contractor 1. TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION, permit NO; n_+_ Received Date Issued:— IWORTANT: Applic -M= LIN 'Cv" Lt must complete all items on this page 777--" ,f -int Print 10 Year Old Structure 7yes no �yyes' [Dis r n o IS TLkl Histo -ITF �-J ist s hi, A �_ Ina Mes Jn o-41, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 0 Addition El Alteration El One family El Two or more family No. of units: 0 Industrial Ei Commercial 0 Others: -rshdd-Disthct -ate - El Repair, replacement 0 Demolition 4, tWel tzin 0 Assessory Bldg [I Other od' �n- 0 d s ffetra��n f%K1 nl: 1AMP141 TO RF PERFORMED: 1- - . - - - - - OWNER: Name: Identification Please Type or Print Clearly) — Phone: ARCHITECT/ENGINE . E 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: FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund f:.con rac or ignatUM.. "I""bk4b, oA-A bi 8 t _gen., Plans Submitted F1 Plans Waived ❑ Certified Plot Plan El Stamped Plans El 41* Flans Submitted ❑ Plains Waived ❑ 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 DATE REJECTED PLANNING & DEVELOPMENT ❑ DATE APPROVED ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning,Board of Appeals: Variance, Petition N tPlannin� Board Decision: Comm Zoning Decision/receipt submitted yes Conservation Decision: Comments Water & Sewer Connection Driveway Permit DPW Towi,, Engineer: Signature: Located 384 Osgood Street FIRE DEPARTi� ENT - Temp Dumpster on site yes no Located -at ,124 Main Street Fire Departmerit signature/elate COMMENTS Doc.Building Permit Revised 2010 Building Department Tine fol[owing is a list of the required forms to be filled out for the appropriate permit to be obtained. FZoofing, 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 DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two F=amily) ❑ 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all c®.scs if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the; apt}, -al 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.Bui?ding Permit Revised 2012 Location , ,4 1 rA v No. "t lam:I r Date t 1 • TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL xo C ° C � t7qQ CD uqCD CD Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 15,500.00 m $ 186.00 Plumbing Fee $ 23.25 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 23.25 Total fees collected $ 332.50 182 Raleigh Tavern 746-2017 on 1/30/2017 Kitchen Reno � . z CD O C r a1 �- CL D c. O 00 CD C cr CD O W W O to CD 5 CD �k O �Wj 0 n C i -v @ CD CD CD 9 CND. U) IC) Z !--PL CD O CD i z rrm �� ic U) n rn X Z �m Vn o Z Z cn O 'a O O as = N � CD cCD CD n 0 CD n 5 .Q m o fu 0 0 n 0 m D a y cn m p --1 CD CD 2 CL � C n -Di Qo rt s' -'o • CD O O' y�, - H, 'a N CD O , cr rt rt D CCD y Q O O Q _ (O <Q N CD O C Wdop � . rCD cD:� ♦c .4 N. �` O cD o :� Iva C1 =r. O ° Ax �j "� C Co a - -14:2 rt -1.0 D CD <D 'Q •`0 �• � _rt �C O - O • VI N W T Z7T (n .Z7 T Z7 T r) 70 T (n T 3 p (D O ( r* fD '��' z C i T m D -1 z d O -C. 3 H y m n d (D < rD p C S � m n r Z N m = v p C S C W Z m 3 d S 7 < O C 5 O C Q ^. O 3 W C p Z � m 0 (D '6 n N rNi 3 O O \ T S W D "n m D x s �` 122 WaLnut.S,. Saugus t A 01:j06 (� �14�t1'lit�lQ11 (� 0i1lQd11V mcniitrvcc Lr tot„cis* zet Contractor Agreement THIS AGREEMENT made the 26th day of January, 2017 by and between McNuljY Construction Company Hereafter called the Contractor and Brendan and Amy Doucette, hereinafter called the Owner. WITNESSETH that the Contractor and the Owner for the considerations named agree as follows: Scope of Work The Contractor shall furnish all materials and perform all of the work on the property at 182 Raleigh Tavern Lane North Andover, Ma 01845 Work Performed The demo and complete renovation of existing kitchen. The renovation will be completed as per plans provided by homeowner (see attached). The price includes all labor required to complete the full renovation. Any changes to the work requested or any unforeseen factors discovered during the renovation will be discussed on an individual basis written out on an individual work order Contract Price The Owner shall pay the contractor for material and labor to be performed under the sum of $15,500.00. Progress Payments Payments of Contract Price shall be made as follows 1/3 upon the signing of the contract. 1/3 when the renovation is approx. half complete and the final payment upon completion. Signed this 269-' day of January, 2017 Owner Contractor / 4-,Z 3 d c c� LA Y �u)o r 0CID-()0)MN � OD.n (nm RI -orn—oo Inmo Dr �°° N*— =fro F� 3mU)N A 0 -� mm >m x M r 2 2 mn0w 0Zco �a < m D x N z r O > Z Z 0 0 - - z -n o . K Z --I �mmz r0 0 � U) 0 .N f 9NIN3dO N ,,ZL X M uSZ•9£ d330;,9'9Z X 341M „gZ'96 Z - 3 AN -C Z af mmm ;a �" 0 aaz 0 o FO Z C n cn Z -moi m CL I OD I 00 .> � C: W rA �'''oz � m LA � � W ai 4/ ' I� IW I€ 0 I F.1 W n 003 row) ax '. C 1 1 CD I 0 "rs CD � 1 (D (DQq. it x 11 co a ------- �b 0 00 � � a O r_ f 9NIN3dO N ,,ZL X M uSZ•9£ d330;,9'9Z X 341M „gZ'96 Z - 3 AN -C Z af mmm ;a �" 0 aaz 0 o FO Z C n cn Z -moi m I J00 D W ai r ' I� IW I€ 0 I I I€ I D 2 rn m '. 1 If Y: c4 IE w Ii co I IE I I€ I C € W I€ I i O I!3 f 9NIN3dO N ,,ZL X M uSZ•9£ d330;,9'9Z X 341M „gZ'96 Z - 3 AN -C Z af mmm ;a �" 0 aaz 0 o FO Z C n cn Z -moi m al: (VO..98) nom 5'V£ .,S'1-13 6£8EM 9NISVO Ot v4nmININ Id s 1 OD O AI- I J00 D W I� r D 2 rn m '. O al: (VO..98) nom 5'V£ .,S'1-13 6£8EM 9NISVO Ot v4nmININ Id s 1 OD O AI- The Commonwealtltt ofilfassachuseffs Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.massgovldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly -Name (Business/Organization/Individual): (11N A Y k � , f � o� u \ (X t c lam) �c t{-� t � k!& C: o Address: % t?cod L -D04 A U _�—, 61"t, City/State/Zip: 50 ,tSt-xs Are you an employer? Check the appropriate box: Phone #: '7 Si 93 3 ` 9 t0'3,9 LE] I am a employer with employees (full and/or part-time).* 2.VI am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3.Q I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.# 6. ❑ 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): 7. ❑ New construction 8. (Remodeling 4. ❑ Demolition 10 ❑ Building addition I LE] Electrical repairs or additions 12. F1 Plumbing repairs or additions 13. E] Roof repairs 14. ❑ Other *Any applicant that checks box #I 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 tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. lam an employer that isproviting workers' compensation insurance for my employees Below is thepolicy and job site information. Insurance Company Policy # or Self -ins. Lie. Expiration Date: Job Site Address: City/State/Zip: 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 $250.00 a day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify u er hepains and alts of erj ry that the information provided above is true and correct. Si nature: Date: t� -V,_ 41. r2 2. ! 0g33 -146 qq Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: A� V CERTIFICATE OF LIABILITY INSURANCE �i/2�/20�' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 terns 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 CONTACTWhit@ NAME: Mary Joseph A. Curley Insurance Agency, Inc. PHONE (781)245-0033 FAX (781)246-1490 AIC No tggk,:maryw@curleyins.com 35 Albion Street INSURERS AFFORDING COVERAGE NAIC # EACH OCCURRENCE $ 1,000,000 1NSURERA:Main Street America Ins. Co. 29939 Wakefield MA 01880-2811 INSURED INSURER B : INSURER C: Mark McNulty, DBA INSURER D: McNulty Construction Company INSURER E : 122 Walnut Street INSURER F: Saugus MA 01906 COVERAGES CERTIFICATE NUMBEROaster 2016 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. ILTR TYPE OF INSURANCE ADDL SUER POLICY NUMBER POLICY EFF POLICY! FRCP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE aOCCUR MPT6414N 5/6/2016 5/6/2017 EACH OCCURRENCE $ 1,000,000 _ DAMAGE TO RENTED PREMISES orS 500,000 MED EXP (Any one person) $ 10,000 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ JECT F-1 LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOPAGG $ 2,000,000 Employee Benefits $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNEDSCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS - COMBINED SI GLE LI IT $ Ea accident BODILY INJURY (Par person) S BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident S UMBRELLA UAB EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑NIA OFFICERIMEMBER EXCLUDED? (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below I PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Residential Carpentry mcnultycc@comcast.net Town of North Andover North Andover, iA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ®1988-2014 ACORD CORPORATION. All riahts reserved. ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD INS026 (2014D1) Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -101644 Construction Supervisor MARK S MCNULTY 122 WALNUT STREET SAUGUS MA 01906 Expiration: Commissioner 07/2912018 Mee of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR registration: 16,2258 Type: xpiration: :219/2017.DBA MCNULTY CONSTRC TIORCOM"AMY MARK MCNULTY 122 WALNUT ST SAUGUS, MA 01906 Undersecretary