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HomeMy WebLinkAboutBuilding Permit #459-2017 - 183 GREENE STREET 10/31/2016Iell IP-0ICRP'Jep ✓ ;r3,L'i— BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Issued: C 0 " IlVIPORTANT: Applicant must 4-sruUs RTH o� �SLEO 16 �� t C Date Received 1()' 3 ( - 901 Mete all items on this LOEAT10N — t3 ) _..._ (rlL Pnnt PROPERTY OVVNER Pnnt 9OD�Year MAPA__ - - -- PARCEL• -0 ZONING DISTRICT.`Histon I A 1` es Vq ' yes.no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9 One family El Addition El Two or more family ❑Industrial LAlteration No. of units: ❑ Commercial N ❑ Repair, replacement ❑ Assessory Bldg ❑ Others. ❑ Demolition ❑ Other Septic ._ Well_ FI`oodplain q llVetlarids Wafiershed: District 1k1NaterlSevver _ DESCRIP IIUN Ut- YK)MM i U tst ramrvniviEzu. 1\41n,. �jPJ 'T'T�r0oM5 �Jy� �r���tsL� �► I4t2./V1��i W ( N..A S I 0) Identification - Please Type or Print Clearly OWNER: Name:, Phone: Address: Contractor Name Zo.c1. one. `��.� ` a 73 Email: _ Ml ­ a_ Address:. - _ Supervisor's Construction}License Improvement License: -1 J ARCHITECT/ENGINEER Address: Phone: No FEE SCHEDULE: BULDING PERMIT: $92.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED 0$1C� PER S.F. ---- Total Proiect Cost: $ L ry, 5oc) FEE: $ Check No.: g -U-? a-- Receipt No.: 3/1 O Y_ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si nature of contractor Signature of Agent/Owner _ 9 __. _ _ 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 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 COMMENTS HEA►LTH COMMENTS Reviewed On Signature Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Comments Comme Zoning Decision/receipt submitted yes Water & Sewer ConneCtion/Signature & Date Driveway Permit DPW Town Engineer: Signature: _. _ ___ . - . . _. 84 FIRE DEPART FMENT = Temp_#)umpster on site yes3noo' Located Osgood Street Located.at124:MainrSt�eet �-- -- Fire Department,signature/date 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 Call Email Date Time Contact Name Doc.Building 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o 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 o Certified Proposed Plot Plan o 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 submitted with the building application Doc: Building Permit Revised 2014 Location I a No. 1/5cl- "lv/7 Check # 90? a�-- Date /0. 3 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL $ % / Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 483500.00 m $ - $ 582.00 Plumbing Fee $ 72.75 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 72.75 Total fees collected $ 827.50 183 Greene Street 459-2017 on 10/31/2016 3 bathrooms r L O H W LL p co r O1 N N U '}, O. O1 N d Z Z J c OQ t0 'O C 7 O LL L CLO 3 O d' T O1 C E L U — @ O LL � N Z0 Z J a z — C LL O Z U W J W r L O H W LL p co OJ U y \ "O O O LL O1 N N U '}, O. 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Q o_ �c = m M C0 J = 0 }; rz UcnCL CLN D Back River Development 231 North End Boulevard Salisbury, MA 01952 (978) 852-3733 CONTRACT To: Bill Wolfenden Date: October 12, 2016 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 two bathrooms down to framing o Remove closets and designated walls in master bedroom and upper hall o Remove designated windows throughout house (TBD) - Framing o Re -frame walls upstairs to form two new 3/4 baths and closet areas o Re -frame 1St floor bath and laundry area per plan - Plumbing o All rough labor and materials and finish (labor only) are included o Faucets, Vanities, toilets and bathroom amenities will be purchased seperately - 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 open framing walls only - Finish carpentry o Base board trim and window and door trim will match existing throughout house - Siding and exterior trim o Will match existing on house in affected areas only - Windows o Replace 10 windows in house with vinyl replacement windows o New construction window will be installed in master bedroom - Electrical o Outlets, switches and fixtures will be installed per code o Fixtures will be supplied by homeowner - Painting o Painting is not included in this contract TOTAL COST $ 48,500.00 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 2nd floor Week 2 Rough electrical, plumbing and inspections Week 3 Insulation, blue board, plaster, tiling and windows Week 4 Finish carpentry and flooring install Week 5 Demolition 0 floor, finish baths and bedroom on 2nd floor Week 6 Rough plumbing and electrical 1' floor Week 7 Tiling and finish plumbing Week 8 Project completion 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 12,500.00 25% upon commencement of services 12,000.00 25% upon completion of rough inspections 12,000.00 25% upon completion of project 12,000.00 William Ferris Back River Development I/ Bill olfenden omeowner FLOOR PLAN SECOND FLOOR BATH MASTER: NOT TO EXACT SCALE. APPRX. GRID =6" 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 16 18 19 20 21 22 23 24 25 26 27 28129 30 31 32 33 34 35 36 37I 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 Transom windows across the back SHOWER FULL GLASS I ODOR SEALS I Close 8' deep x 6' TV Cable Jack shower m N�sk Bath 8.5x8 Vanity ? Door Closet enter SLANT OF CAPE STARTS NON -STANDING SPACE BEHIND "KNEE WALL" ACORb® CERTIFICATE OF LIABILITY INSURANCEDATE(NM/DDIYYYY) 10/28/16 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 endorsemen s). PRODUCER M.P. Roberts Insurance Agency 1060 Osgood Street North Andover, MA 01845 NAME: CONTACT Am Roberts PHONE 978 683-8073 FAX N10978) (978) 693-3147 E-MAILADDRESS: @m robertsinsurance.com A GENERALLIABIUTY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR INSURE S AFFORDING COVERAGE NAIC# INSURER A : Merchants Mutual Insurance Co BOPI080037 INSURED BACIQZIVER DEVELOPMENT LLC 231 NORTH END BLVD. SALISBURY, MA 01952 INSURER B: Associated Employers Insurance INSURERC: INSURER 0: 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. INR LTR TYPE OF INSURANCE ADDL INSR SUBR INVO POLICY NUMBER POLICY EFF MIDDY POUCY EXP MMIDD/YYYY LIMITS A GENERALLIABIUTY X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE F OCCUR BOPI080037 6/20/16 6/20/17 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 500 000 MED EXP (Ary one person) $ 15,000 PERSONALBADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2 000 000 GEN'LAGGREGATE LIMIT APPLIES PER POLICY j( PRO-JECT F� LOC PRODUCTS -OOMP/OPAGG $ 2,000,000 $ AUTOMOBILE LIABIUTYI ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS _ AUTOS eMBINED NG ELIMIT $ BODILY INJURY (Per person) $ accident BODILY INJURY Per $ ( ) PROPERTY DAMAGE $ eraccident $ UMBREUJI LIAB EXCESS I OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED RETENTION $ $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETDRIPARTNERIEXECUTNE OFFICERIMEMBER EXCLUDED? ((Mandatory In and If yyes describe under DES6RIPTION OF OPERATIONS below N I A WCC -500-5014220-201 1/12/16 1/12/17X WC STATU- OTH- E.L. EACH ACQDENT $ 500,000 E.L. DISEASE -EA EMPLOYEE $ 500,000 E.L. DISEASE -POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (AttschACORD 101, Additional RenedwSchedule, If more spa ceIsregdred) SILL WOLFENDEN 183 GREEN STREET NORTH ANDOVER, MA 01845 %IMMICL-M SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE P ROBERTS 0 1988 2010 ACORD CORPORATION. All riahts rsserued ACORD 25 (2010105) The AC ORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -065005 Construction Supervisor BRIAN A LYNCH 31 SEVEN STAR RD ` x" GROVELAND MA 01834 r -j .CK (�A— Expiration: Commissioner 11/15/2017 .�= Office of Consumer Affairs & Business Regulation ~�t HOME IMPROVEMENT CONTRACTOR -Registration: 173255 Type: �4. Expiration-.. gt20/2016_ IrtdMdual BRIAN A LYNCH BRIAN LYNCH 31 SEVEN STAR RD GROVELAND, MA 01834 gra -Undersecretary The Commonwealth of Massachusetts ..F Department of IndustrialAccidents =T f X Long-ress,S`treet, Suite 100 _ ; d Boston, lYJLJ. 7����A 02x14-2017 �< www massgov/dia •'olAf S��V Workers' Compensation Insurance Affidavit: Builders/ContractorslElectricians/lumbers. TO BE FILED WITH THE PERMITTIlNG AUTHORITY'. Name (Business/Organizaiion/lndividuat): Address: +A-t-�S`�� i� - Phone #: q 7Q= City/State/Zip: • ... • ..: .-.1x,=: �. • - Type of project (required); Are you an employer? Check the appropriate box: em to ees full and/or7pait-time)-* 7. ❑ NeV d6nstrnction 1,F]I am a employer with P y 2. ❑ I am sole proprietor or partnership and have no employees working for me in 8. Remo deliiig any capacity. [No workers' comp. insurance required.] 9, F1 Demolition 3.0 I am a homeowner doing all work myself [No workers' comp. insurance required.] t 10 ❑ Building addition 4.❑ I am a homeowner and will be, hiring contractors to conduct all work on my property. I will 11.❑ Electrical repairs or additions ensure that all contractors either have workers' compensation insurance or are sole proprietors withno employees. lZQ:Plurribjng repairs or additions S. ❑I am a general contractor and T have hired the sub -contractors listed on the attached sheet. 11 Q Roof repairs These sub -contractors have employees and have workers' comp. insmance.t 14. Q Other 6.1M 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.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who suBmitthi P!a h artt indicating ndic an additional doing all showing the -work andname of then hire e sub contride a tors and. state wctors must heth t ae or potthose,thoseenti4es have tContractors that check this s che employees. Ifthe sub contractors have employees, they must provide their workers' comp. policy number. jam an employer that is providingworRkers' compensation insurance for° my employees. Below is the policy and job site information. Insurance Company Name: S L1J Policy # or Self -ins. Lie. #: �� S6�©S©_I�� - --_ Expiration D. e: I7 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 undevrM enalties?mthe form of a25A is a �STOPal violation WORK ORDER and fine of up to $250.00 a and/or one-year imprisonment, as well as p day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. under' tliepains an Date: ofperjury tTiat the information provided above is true and correct X do hereby cert. Date: Signature: Official use only. Do not write in this area, to be completed by city or town offzcial. permit/License City or Town- # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CitylTown Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Phone #- Contact Person' 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 6f an individual, partnership, association or other legal entity, employing employee#. - However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant ofthE 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 b6 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 su—'contractor(s) name(s), address(es) and phone number(s) along with their certificates) 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 wwwmass.gov/dia