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HomeMy WebLinkAboutBuilding Permit #861-15 - 183 GREENE STREET 4/29/2015A4. ,4 Lf_ BUILDING PERMIT TOWN OF NORTH ANDOVER ,,APPLICATION FOR PLAN EXAMINATION Permit No#• / Date Received Date Issued: iMPORTANT: Applicant must complete all items on this page LOCATION AS Gko-'�a s"�. Print PROPERTY OWNERL,CG),42 c� Print 100 Year Structure yes MAP #r& ARCEL: ZONING DISTRICT: Historic District ye Machine, Shop Village yes /O�ytLeo + 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 1� One family 11 Addition [I Two or more family 11 Industrial "Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Se ptic tlatls O n - ht t ,VVatbrsbd),istric1N DESCRIPTION OF WORK TO BE PERFORMED: T PP,®o rV► —c -P L 4LA. — 1 Xy\.� 1, 17 C>o6Z A c>'� _L(.../© Identification - Please Type or Print Clearly OWNER: Name: Phone: U Address: ) S S 6-; Contractor Name:�o..�r.-�v Q�k��0 Phone' 97S Sa- 3-7 Email: :? t 0-- M cxr o N �-- Address: Supervisor's Construction License: C5 0 (.S Q Q S Exp. Date: I I' is 2y tS Home Im nt License:. Date: ARCHITECT/ENGINEER Al A Phone: Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASEp ON $125.00 PER S.F. Total Project Cost: $ )q, SQ0 FEE: $ 3 Check No.: t 5 q_f/ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t E Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming P001s ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature. COMMENTS CONSERVATION Reviewed on Signature CO(49MENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes f Planning Board Decision: Comments w Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street �fFIR�e�dKl,�2 RT Lo a4C ire De�p-tmei4gr�atur�e/dat�e_�_ 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 Call Email Date Time Contact Name Doc.Buildin; Permit Revised 2014 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 46 Copy of Contract 4. Floor Plan Or Proposed Interior Work 4 Engineering Affidavits for Engineered products IOTE: 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 4 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) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products 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 4. Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 Location A(� No.,�6/—/ r— Date Check Jq �1/z I I , TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $- TOTAL $ ��uilding Inspector Enter construction cost for fee cal - North Andover Fee Cakulation Construction Cost $ 195500.00 m $ - $ 234.00 Plumbing Fee $ 29.25 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 29.25 Total fees collected $ 392.50 183 Greene Street 861-15 on 4/29/15 Create a home office VPIO �I WN rA LL az Q m r _ Y LL ? NaitLo N p LLI CL z m C c LL L d' C U LL O z Z m G J O. t bn d' LL z V W J W L to d' v U N LL oc a Ln Ln Q t to K LL z 2 °c Q Lu O � LL CO O Z ++ N w y o � o CL 4) ma •._ o ;o �E E Q L � �: E a_i O _ O i N Q' J 1: � • v L m ;_ ul L O �: = as > 41 -0 0 O •�L) V;E a, O z 1 CL _ '{a = o o L Q.CLas c� o=c Q L �: L � •LS � 'm _ m uiW= '0 ,_, 0 0 LL Cc N C 'Q t O V V W E V Q 0-0 as N 0 '0 4- C N .Q O 0 45 CL 00 Z F- Cf)M uj F- aCO X Z w0 Cl) Lu W J 0 w a. CO CO z 0 z 0 m �l • N cq E � O O Z AA� a V/ •E • • • m CD ate= 4 AWO �+ + m O 0CL a- = ai Q O � � v_ J •CL O ,a; Z O V N ca � 0 Back River Development 231 North End Boulevard Salisbury, MA 01952 (978) 852-3733 ESTIMATE To: Bill Wolfenden Date: March 23, 2015 Re: Renovations of Residence 183 Green St. N. Andover, MA Scope of services Back River Development will be responsible for the following: - Demolition o Remove door and window from family room o Remove fireplace and fagade from family room o Remove existing wallboard from ceiling and rear wall - Framing o Re -frame rear wall to accommodate new windows and anew entry door o Install 4 new windows and 1 entry door o Frame a partition wall for office area o Frame reach in closet in family room - Plumbing o There is no plumbing included in this estimate - Blue board and plaster o '/z" Blue board and skim coat plaster will be applied to all affected areas from renovations only o Plaster finish will be smooth on walls and textured (skip trowel) on ceiling - Insulation o Insulation and draft stop will be installed to building code regulations in new addition walls only - Finish carpentry o Base board trim and window and door trim will match existing throughout house o A 3068 15 light door will be installed in partition wall - Siding and exterior trim o Will match existing on house in affected areas only - Electrical o Outlets, switches and fixtures will be installed as discussed o Install 6 recessed lights in living room and office area o Fixtures will be supplied by homeowner - Painting o Painting is not included in this contract TOTAL COST $19,500.00 PROJECTED TIME SCHEDULE The following is an estimated time schedule for informational purposes only. This schedule may be adjusted as needed to address unforeseen circumstances, including but not limited to hidden obstacles, bad weather, sub -contractor scheduling conflicts, etc. It is our goal to complete the work in a timely fashion. Week 1 Demolition and framing Week 2 Rough electrical and inspections Week 3 Insulation, blue board, plaster Week 4 Finish carpentry and flooring install Week 5 Floor refinishing and punch list items Terms and Conditions 1. Contractor agrees to furnish all necessary labor, materials, tools and equipment to complete the work outlined in the scope of services. 2. Contractor shall provide copies of a valid builder's license and proof of liability and workers' compensation insurance prior to commencement of any work. 3. Contractor agrees to complete the Scope of Services in a timely, professional manner in accordance with the specifications set forth by the architect and engineers, and in compliance with state and local building regulations. 4. Contractor agrees to clean all debris from construction only and to keep job site in a clean and workable condition at all times 5. Homeowner shall be responsible for any costs occurring from engineering or architectural plans and site work and any costs incurred from permitting, zoning board of appeals, planning or DEP. 6. Any costs incurred from hazardous materials found during construction are the responsibility of the homeowner 7. Homeowner is responsible for contacting utility companies for disconnect and new hook ups, cable, telephone, gas and electric and any costs that results from these services. 8. Manufacturers' warranties will be turned over to the homeowner and become the homeowner's responsibility to file and pursue any defects or problems that may occur. 9. Any materials, products, or labor not specifically mentioned in scope of services is not covered under contract and will be paid for out of allowance fund or billed to homeowner 10. Homeowner is responsible for any price increase in materials prior to signing of contract 11. Homeowner (not lender) is ultimately responsible for payment upon completion of services and receipt of invoices PAYMENT SCHEDULE The payment for the contract will be as follows 25% upon execution of contract 59000.00 25% upon commencement of services 5,000.00 25% upon completion of rough inspections 51000.00 25% upon completion of pro'ect 4,50 .00 0 l 1 lfenden, flomeownCr Brian A. Lydch Back River Development Name The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERIVHTTING AUTHORITY. Address: City/State/Zip: 1-Lg, 0194'-2- Phone #: Are you an employer? Check the appropriate box: 1.�I am a employer with � employees (full and/or part-time).* 2.❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 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.Q 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. 14 ,Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.0 Electrical repairs or additions 12.E] Plumbing repairs or additions 13. [] Roof repairs 14. [] Other, *Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information. i 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 state whether or not those entities have comp. policy number. employees. If the sub -contractors have employees, they must provide their workers' I am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: /�S SG C Policy # or Self -ins. Lic. #: G%G�' COO O 02 D/� Expiration Date: Vl' 2 � % VIA -_-5X7, City/State/Zip: /U- Job Site Address: _ 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 the`pain d penalties of perjury that the information provided above is true and correct. I - Phone #: /??,F szo o 6. 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 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 Department's address, telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax # 617-727-7749 Revised 02-23-15 www.mass.gov/dia ACOR 70CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 4/24/2015 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. LIMITS 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 M P ROBERTS INS AGCY INC 1060 Osgood Street North Andover, MA 01845 06/20/14 CONTACT NAME: HONEEXt: (978) 683-8073 FAX A/C No:(978) 683-3147 AORIESs:Paula@mprobertsinsurance.com MED EXP (Any one person) $ 5,000 NON—CONTRIBUTORY PERSONAL &ADV INJURY $ 1,000,000 INSURER(S) AFFORDING COVERAGE NAICR INSURER A: MERCHANTS INSURANCE GROUP PRODUCTS -COMP/OP AGG $ 2,000,000 $ INSURED BACKRIVER DEVELOPMENT, LLC. AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS INSURER B: 231 NORTH END BLVD BOPI080037 INSURER C: SALISBURY, MA 01952 COMBINED Ea accident SINGLELI $ 1,000,000 INSURER D: ASSOCIATED EMPLOYERS INS CO INSURER E 978 -852 -3733 -Bill $ INSURER F: 978 -804 -9383 -Brian UMBRELLA LIAB EXCESS LIAB 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 LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X I OCCUR X PRIMARY & Y BOPI080037 06/20/14 06/20/15 EACH OCCURRENCE $ 1 0 0 0 O O O DAMAGE TO RFNTED--- PREMISES Ea occurrence $ 500,000 MED EXP (Any one person) $ 5,000 NON—CONTRIBUTORY PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY FX ECT CI LOC OTHER: GENERAL AGGREGATE $ 2 , OOO , OOO PRODUCTS -COMP/OP AGG $ 2,000,000 $ A AUTOMOBILE LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS X HIRED AUTOS X NON -OWNED AUTOS BOPI080037 06/20/14 06/20/15 COMBINED Ea accident SINGLELI $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED I I RETENTION $ $ D WORKERS COMPENSATIONX AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE ❑NIA OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below C50050142202015A 01/12/15 01/12/16 - STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) BILL WOLFENDEN 183 GREENE STREET NORTH ANDOVER MA 01845 ACORD25(2014/01) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLEDEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD U Massachusetts - Department of Public Safety Board of_ Building Regulations and Standards License: CS465M ' = BRIAN A LYNCH= 31 SEVEN STARRD GROVELAND M 01834 W 0 Expiration Commissioner 11M5/2015 a,co�ia>iio�rttcvclf/ ojCJ� -\ Office of Consumer Affairs & Business Regulation _ HOME IMPROVEMENT CONTRACTOR ReglstraUon: 173255 Type: . Expiration:_;= 9/24%20.1.6 Individual BRIAN A LYNCH BRIAN LYNCH 31 SEVEN STAR .'_:'::-- GROVELAND, MA 01834 ,�... Undersecretary