HomeMy WebLinkAboutBuilding Permit #822 - 20 PEMBROOK ROAD 6/22/2010Permit NO:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
TYPE OF IMPROVEMENT PROPOSED USE
'150
Non- Residential
New Building One famil
Addition wo or more family Industrial
Arte ion No. of units: Commercial
Repair, ret�lace_men Assessory Bldg Others:.
Demolition Other
DESCRIPTION OF WORK TO BE PREFORMED:
e___
Identification Please Type or Print Clearly)
OWNER: Name: )e-, J /m. __ _,% .
—0
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: $ _ 'S1�00 j v FEE: $ (v`D t V,3
Check No.:
NOTE: Persons Receipt No.: contracting with unregistered contractors do not have access to the guaranty fund
C
Plans Submitted C
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
Q
HEALTF11 Reviewed on Signature
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Os oo Street
F�2ED�EPti4RMt=IT TerrDupster unite fires _ no
MT 0! k x'
Dimension
Number of Stories: `2— 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
r
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
-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
o Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
Li 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: Building Permit Revised 2008
LocationbU 0 e—,M,6 -4--C—
No. ','Z-- Date
TOWN OF NORTH ANDOVER
n
' Certificate of Occupancy $
.�
Building/Frame Permit Fee $ `r
Check # q0
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/FIectricians/Plumbers
A
j2pficant Information Mar& Print Le ibl
Name
Address:
City/State/Zip: t k . vim. ` - c>\%-`iS_Phone #:
Are you an employer? Cheek the- appropriate box -
LN N 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
These 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 Am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, § 1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.)
Type of project (required):
6. ❑ New construction
?- 1.Remodeling
8. ❑' Demolition
9. 0 Building addition
10. 13 Electrical repairs or additions
11 .0 Plumbing repairs or additions
12. ❑ Roof repairs
13.❑ Other
Airy applicant that cbecim box #I must also fill out the section below showing ftir workers' eonvensetion policy infonnatinn
Homeowna s who submit this of idevit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such
-ontractars that check this box must attached on edditwW shat showing the name of the sub -contractors and their workers' comp, policy information.
am an employer that is providing workers' compensation, insurance for sty employees. Below is the -policy and job site
gformdrilm
asurawt Company Name:
olicy # or Self -ins. Lic. #: k<—Gd l� 6\ [ _Expiration Date: 1_
t)b Site Address: . �— _ City/staftrzip: K.4,
►ttach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
allure to secatre coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
ire 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
f up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
avestigations of the DIA for insurance coverage verification.
'perjury that the information provided above is true and correez
CERTIFICATE OF LIABILITY INSUR,ANrE
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1060 Osgood street
'Acmtb Andover, MA 01845
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169 BUKTOM SET
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Building Contractor
Proposal
To: Dan Murphy
20 Pembrook Road
North Andover, Ma. 01845
From: Kevin Murphy
CC:
Date: 6/11/2010
Jolt: Porch repair
Date of plans: None
Atrtchiltecti None
Location: Same
Section 1- Work Schedule
• 169 Boxford Street
• North Andover, MA 01845
•
PH: 978-688-6336
• FAX: 978-688-7207
AM Home improvement Contractors and Subwntradors
engaged in home rtnprovernent contracting, unless
specifically exempt from registration by Provisions of Chapter
142A of the general lawns, must be registered with the
Commonwealth of Mme. Inquiries about
registration and Status should be made to the Director, Hans
lmpr rnrement Contract Registration, One Ashburton Raw,
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 6/15/10.
Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 7/30/10. 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
Kevr"M MUMPBUY
Badding Contractor
169 Boxford sheet
North Andover, MA 01845
PH: 978-6885335
FAX 978688-)0000
General
Page 2 of 4
Proposal is to repair / replace existing front steps, replace decking / rails on existing farmers porch.
Demolition
Owner to remove existing steps.
Building.
New composite decking and railings will be supplied and installed. Decking will be trex ( color to be determined )
Railings will be Endurance ( white composite) .
Waste Removal
Construction debris will be disposed of by contractor.
II$ewaan IYiinnapilny
Stranding Contractor
169 Boxford street
North Andover, MA 01845
PH: 978-6865335
FAX 978&a68-)0000
Section IV - Price Schedule
Page 4 of 4
We hereby propose to furnish material and labor — complete
in Accordance with above specifications for the sum of ..................................... $ $5000
Payment to be made as follows:
"Notice: No agreement for Home improvement contracting work shall require a dorm payment (advance deposit) of more that orteahird of the total contrad price of the total amount of all deposits or
payinents which the contractor must make, in advance, to order ardor otherwise obtain delivery of special order materials and equipment, whidrever 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 thins 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
Date__�1�1 1L�
Signature Date,
Percents elItem
Description
Amount
1
Job complete
$5000
Total
1
$5,000.00
"Notice: No agreement for Home improvement contracting work shall require a dorm payment (advance deposit) of more that orteahird of the total contrad price of the total amount of all deposits or
payinents which the contractor must make, in advance, to order ardor otherwise obtain delivery of special order materials and equipment, whidrever 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 thins 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
Date__�1�1 1L�
Signature Date,