HomeMy WebLinkAboutBuilding Permit #496 - 191 HAY MEADOW ROAD 3/23/2009BUILDING PERMIT oFtt,.�o NURsy ,bgti
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
qq� h
Permit NO: Date Received
Date Issued:
��SSAc►+us
IMPORTANT: Applicant must complete all items on this page
1F6, ,W, 50,N F ��.: !t
-�t
PROPERT�'� `,.R
I1�1P1r10 1� PARCEL`, �iJ�11'NC��TRI,CT�IistonCDis#r�# Vis_
`lach7rehtjvil}ages =ro
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Altera '
No. of units:
Commercial
Others:
C ---Repair, replacemen
Assessory Bldg
De ion
Other
�plic �1N�ll
u�loadp�a�n.�etlancis ij
Uiaiershec��astript {
!� uta%.,rur i 1UN Ul- VVUKK I U BE PREFORMED:
op
Identification Please Type or Print Clearly)
OWNER: Name: S'c Phonef 5-oi) c657'7 - t, 2 -
Address:
Address: p TI -t
�CO�NTR�AC7rDR .larr-e�
Ft
tlid0res, >33
�.�•pie��sor��'�C��►stru��Io�L�cens�� ��';`� �+ :� r , -� . � _ ` �:
iNo�.��Itnpro.��ern,en�,L%��et�se� _ .:.,:._fit?\����- ., �..,<� ���� .:_�� �r�,-��•�.�,.�.
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 Cost: $ S�, FEE: $ b
Check No.: Receipt No.: C�)&�
NOTE: Persons contracting with registered contractors do not have access to the guaranty fund
agn abt�re f qn"t/ �rw Si-> naliare oIfP' l ractoz = -
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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Siqnature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
-Comments
Water & Sewer Connection/Signature & Date Driveway Permit
jig-'D,e7p�raeat�natt�relate
C011�11�IE��',rS _
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
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
NU I t5 and UA I A - (For department use
O Notified for pickup - Date
Doc.Building Permit Revised 2008
No
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 submitted with the building application
Doc: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Location M/ / /74% /%?t/o
/`
No. v Date
r
TOWN .OF NORTH ANDOVER
c
s
Certificate of Occupancy $
E Building/Frame Permit Fee $
s�CHus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
s
Building Inspector
07/09/2008 10;02 FAX 19788833147 X.P.ROBBRTS INSURANCE
A w CERTIFICATE OF LIABt
LITY ttltBtlRAHC
i b4. P. ROOM xm ,i am IIOC noAND Com
�1
1060 ougo a street HOLM. TNW Cl
ALTER COVE
!North fir. m 01845
M6UMM APPOM
A,
nouaeR a
lotD STivlB? Rom Q
NO= AMOVIR, am 01845 MMWA & MMUn ,
a
a
=our 9ERRIgNC� U9W KLOW HAVE MMM ISSUEb TIS THE Ni$Upm1 p ro
IIlIiWI MW OR 00MU ION (W AMY CQNT1iACT OR OTHM 70 V*
AMA WED By E REO{�,ga G !$ QCT TO ALL 7W TEp
PoucyNumam
VA uAKrry
oau�alpyi, eewew. u�eartY
aAaiss�al ®ooa,R
CP'P0060968 11/12/07 11/21/09
A U�
AW.IWL o
RCMDUMDAVM
H��
MMOMMBDA"
QAWM L AU"
7 AWMM
w UMsunY
MASMes,Nba
ollduc"BLE
w:te►rrpw t
wNr
L1 eeaueeor
7MIf277013600
Mg18G913513
Tm4r or ANDO VM, mh
36 JM1RTWT BTDM
AMbom, ML 01810
1/23/08
7/1/08
NO
tool
aTe�nowwy
MAIC*
f PfMM 09CM7W N07�N8TMV M
�����TEMA�OF SUM
0Sake uwr i
I WAM3" :
1173/09
rn�►.00+dMx) a
OTHERIHMM rAACC 16
AUTOONLY; AaWd s
WON s
7/1/09 e -L tomm_
s
500,000
*10klD AW OR 'n% AW& POWC1p>s ee caw
DA7e 7MiRXOF, Tie ISM MB INGLgto VM a � G7M�eMITtOM
Nofl(Yi TO 711E CER7M�CKf6 ro AIERI 11-0 DAYS 1MRtT1'B1!
HOUMR WA n TO THE LM, Mm FA&UM -M op s0 &%ML
&VW MO GKW MSM OR UA@ fV OF AMY MW LVM 7M p MMft "I AMM QR
1o1�rrrnuen
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
r Boston, MA 02111
www
massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Le 'bl
Name (Busimessrorganization/individual): � � �• -- `\ j C,
Address: V �Q` ' V> � 4-,-.i-
City/State/Zip:
-.i
City/State/Zip: Nc w �r.�.c,...,� �G Phone #:
Are you an employer? Check the -appropriate box:
1\'5 I am a employer with -,)—
4. ❑ 1 am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ 1 am a sole proprietor or partner-
listed on the attached sheet t
ship and have no employees
Hese sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. ❑ I int a homeowner doing all work
right of exemption per MGI.
myself. [No workers' comp.
c. 152, ¢ 1(4), and we have no
rn8tu=m -required.) t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. 1% Remodeling
S. [1 Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11.❑ plumbing repairs or additions
12.0 Roof repairs
13.❑ Other
'Puny appliceant that checks box g 1 must also fist out the section below showing their workers' compensation policy utforrtntion
� Homeowneta wbo submit this affidavit indicating they are doing all work and thea biro outside contractors must submit a now affidavit indicating such
-Contiactais dot check this box ntust attadhed an additional sheet showing the name of the sub•cantYaetors and their workers' comp. policy information.
ani an employer that is providing workers' eompensation. insurance for my employees. Below is the.polky and job site
nforrnation.
nsurance Company Name:
`olicy # or Self -ins. Lic. M N'�- v �-- C„ ?1 3 St 3 Expiration Date:*��
O$ Site Address'__ A ``Z 2h. jzN-" iti/ V City/Statocip: NI 1A A 1A . U \'%146.•
Vtach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
'aihme to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ine up to S 1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine
& up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
nvestigations of the DIA for insurance coverage verification.
do hereq certify under the pains and penalties of perjury that the information provided above is true and correct
Ojjicial use only. Do not write in this area, to be completed by city or town ojjRciai
City or Town:
Permit/Llcense #
V
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Cleric 4. Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: ?hose #:
a
c
o
O
w
E
a
v
cn
0
w
z
A
cdG
O
w
O
c�
C
U
C
r4
a
V
w
a
Q'
O
rw
C
w
x
w
�"
u
W
W
O
a2
,`��
y
cn
m
C
U.
x
d
O
rz
C
w
w
A
w
w
E
7
cq
2
cn
Q
cu
o
E
cn
(:.1-0
a� c
c `
N
O c
C'M O
•RO��%
,d 'ate
C cc
c
e3
• O O
C160-
-40
�a
co CE
CD
r0.. a
co
CD
C"
m c
CL*..
m `E a
`
N
v, 3
co
�; • C m O
4_ 2 y
y A c
� O
N
O _
O O
m
N m
:Co¢
A m o
vJ C c o
Z
,.: coo c
a
O
C=0
_ m m=..p3 N
H O
Vi ev =
LLMD
N .y 06..= Z
FS "E S Z aoa N o
CO2 8
Go M in
~ _ $ aMO. .m
LWA
z
0
u
Cf)
v
0
O
0
C2
Z
co
v.
O y
di CM
Ip 'CO
M O O
.— m m
G3 H�
C. I-+
L O �
3�
CO
ai L
M0 CL
C. CMa
c
Cc
O C
•CCLZ O
C3 y
O C
C
C
CO
CO2
0
A
177� 177-1
CC iC 7C Com' t-) C—:C_1 L] cu V
Building Contractor
Proposal
To: Scott Robinson
191 Haymeadow Road
North Andover, Ma. 01845
From: Kevin Murphy
CC:
Date: 3/3/2009
.lob: Deck Repair
Date of plains: None
Architect: None
Location: Same
Section 1- Work Schedule
• 169 Boxford Street
• North Andover, MA 01845
•
PH: 978-688-6335
• FAX: 978-688-7207
All Home improvement Contractors and Subcontractors
engaged in home improvement contracting, unless
specifically exempt from registration by Provisions of Chapter
142A of the general laws, must be registered with the
Commonwealth of Massachusetts. Inquiries about
registration and Status should be made to the Director, Home
Improvement Contract Registration, One Ashburton Place,
Room 1301, Boston, MA 02108. (617)-727 6596
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 4/1/09.
Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 5/15/09. 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 fumished 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 111- Scope of Work
f1l�r+�Q�nsm 6v7nnvv�S]e�
r�>msaa9uaag e:�:nRaac4oa
169 Boxford street
North Andover, MA 07895
PH: 976686-5335
FAX: 978188-)0000
Page 2 of 3
General
Proposal is to replace decking and railings on existing sreened porch and deck. Building permit will be provided
by contractor.
Demolition
Decking in screened porch, on deck, and stairs will be removed and disposed of. Railings on deck will be
removed.
Building
New decking will be Timbertech or equivalent ( samples will be given, color to be determined, prior to start ) .
New posts for railings will be Mahogany. Railings will be coated, stainless steel cables ( samples to be given
prior to start) . Screening in existing porch will be replaced. No allowance has been made to build / replace any
benches. footprint of deck and porch to remain. No allowance has been made to reframe any sections of deck /
porch.
Waste Removal
All demolition / construction debris will be disposed of by contractor.
Revri7-f-
Building Contractor
169 Boxford Street
North Andover, MA 01845
PH: 978fi883335
FAX:978-688-XXXX
Section IV - Price Schedule
Total
Page 3 of
We hereby propose to furnish material and labor — complete
in Accordance with above specifications for the sum of ..................................... $15,500
Payment to be made as follows:
Percenta alItem
Description
Amount
1
Permit obtained
$2000
2
Decking installed
$7000
3
Railings / screens installed
$4000
4
Job 100% complete
$2500
4
$15,500.00
—Notice: No agreement for Home improvement con"cfing work shall require a down payment (advance deposit) of more that orre4*d of the total owbred price of the total amount of all deposits or
payments which the contractor must make, in advance, to order andfor otherwise obtain delivery of speed oder materials and equipment, whichever is greater
Contractor: Kevin Murphy
169 Boxford 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
NOT SIG I ONT CT IF THERE ARE ANY BLANK SPA ES
Signature Date 3 l�
Signature Date