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HomeMy WebLinkAboutBuilding Permit #214 - 20 PEMBROOK ROAD 9/9/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:_a At Date Received Date Issued: MPORTANT: Applicant must complete all items on this page r . LOCATIONS - - - — - M ►��. - - .I _- - -_. _� 5 z I PFZ ERTI Y+011VNER'iZu — y - Punt; 100'YearfOld Structure+ yesy . MAP4NQ:QI - , PARCEL: ZONING'D:ISTRI,CT Historic DlstCict� yes, d _ ;Machine SliopVillage} -- TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building iNOne family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ [j Septics ❑�1Nell+ ❑;Floodplain 9,-Wetlands ❑ UVatersl edtDtstricti ' i A_ { DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: S1�i bg lel Address: Zo I - _ - ,Phone. S'1: Supervisors?Constructlorilcer se i Exol ®ate: x Ho^meImpro�ernent L+lcense ' ®ate �0 2;� -�� =- �f ARCHITECT/ENGINEER Nz�)t-610 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: $ k4 0 , V U 0 FEE: $ 4(6 0 Check No.: t Receipt No.: 3" \ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofrAgent/Owner=.\z � ,,,�R' _ S�gnature;of contractor --- Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ Plans'Waivtl" Certified'PI t Plan ❑ Stamped Plans ❑ TYPE-OF SEWERAGE DISPOSAL J Public Sewer Swimming Pools ' 0 Tanning/MassageBody Art ❑ 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 a DEVELOPMENT ❑ ❑ COMMENTS l CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes JPlanning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW To-wo Engineer: Signature: Located 384 Os od treet FIRE DEPARTMI �NT ''-Temp Dumpster on site yes no Located at'124 Mairj'Street Fire Depaifrnent-signature/date COMMENTS i 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 i 0 Notified for pickup - Date Doc.Building Permit Revised 2010 i i Building Department IT me fol:-)wing 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 ❑ 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 1 ❑ 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) a 7 ❑ 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 Family) I ❑ 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 o Engineering Affidavits for Engineered products NOTE: All dumpster perm..its'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 app•-al.period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording mast be submated with the building application Doc: Doc.Building permit Revised 2012 Location ` . No. 47 Date o - TOWN OF NORTH ANDOVER ® Certificate of Occupancy $ Building/Frame Permit Fee $ R Foundation Permit Fee $ Other Permit Fee ` "11,v :Nva TOTAL $ Check# I r `" `'Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 40,000.00 m $ - $ 480.00 Plumbing Fee $ 60.00 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 60.00 Total fees collected $ 700.00 20 Pembrook Road 214-14 on 9/9/13 Kitchen Remodel � tIORT11 --� dover Town of �' '' O " 4� �AH. h ," ver, Mass, Cl I__z COCHICHlWKH y1' �d A04^YED S U BOARD OF HEALTH Food/Kitchen P ..ER T T LD Septic System . . . BUILDING INSPECTOR THIS CERTIFIES THAT .................. . ....'�1.!!I................................ ......... ................................................. ^^^^1� ............. Foundation has permission to erect .......................... buildings ontXC)........�..10. .. Rough tobe occupied as ............ . .......�C. .. .I ......rr............................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC� ,_tS Rough Service ................ ............................................. ............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE Ker, ,•' y� 1I`, 98 Forest Street V,1 _ i"°s �-1;l ll�/ North Andover,MA 01845 •J9 PH:978-688-6336 Building Contractor 0FAX:978-688-7207 Proposal To: Dan&Sheila Murphy 20 Pembrooke Road All Home improvement Contractors and Subcontractors engaged in home improvement contracting,unless North Andover, Ma 01845 acv exempt from registration by Provimns 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 From: Kevin Murphy R�;,301 a�onaMA02108 Registration,One CC' Date: 9/9/2013 Job: Kitchen Remodel Date of plains: 7/13 Architect: None Location: Same Section 1-Work Schedule 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 9/1/13. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 11/15/13.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 furnished hereunder shall be free from defects in materials and workmanship for a period of 1 year following completion and shall campy 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 III-_Scope of Work Page 1 of 4 Kevin Murphy Page 2 of 4 Building Contractor 98 Forest Street North Andover,MA 01845 PH:978,6885335 FAX 978688-7207 General Proposal is to renovate existing kitchen. Permit will be obtained by contractor. Demolition Exisitng kitchen area, and dining room ceiling will be completely gutted. Building New Harvey casement window will be supplied and installed. Window will be relocated as required. Siding to match existing as available. No allowances have been made for any structural changes to existing house. Plumbing Plumbing required to renovate kitchen / install appliances will be provided. Sink / faucet / appliances to be supplied by owner, installed by contractor. Electrical Electrical work required to renovate kitchen to meet code will be provided. Ten recessed lights have been included. Any surface mounted fixtures ( ceiling fans / pendants ) to be supplied by owner, installed by contractor. Heating/Air Conditioning Exisitng heating to remain. No allowance has been made for any air conditioning. Insulation Exterior wall will be insulated to meet code. Plaster Exisitng kitchen area and dining room ceiling will be blueboarded and skimcoat plastered. Ceilings and walls will be smooth. Interior Trim/Doors Pre-primed interior trim will be supplied and installed to match existing. Cabinets to be supplied by owner / installed by contractor.Countertops to be suppllied by owner/installed by vendor. Painting No allowance has been made to provide any painting Flooring Existing hardwood floors will be sanded and refinished with three coats of oil based urethane. Kevin Murphy Page 3 of 4 Building contractor 98 Forest Street North Andover,MA 01845 PH:9786885335 FAX 97868&7207 Other Allowances Tile backsplash will be provided.An allowance of$5 per square foot has been included for the materials. Waste Removal All demolition/construction debris will be disposed of by contractor. Kevin Murphy Page 4 of 4 Building Contractor 98 Forest Street North Andover,MA 01845 PH:9786885335 FAX:978688-7207 Section IV—Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of... ... ...... ... ...... ... ... . ......$ 20.000 Payment to be made as follows: Percentage/ltem Description Amount 1 Permit obtained $3000 2 Plastering complete $10,000 0 3 Job 100% complete $7000 Total 3 $20,000.00 Notice:No ageemerd for Home improvement contracting work shall regime a down paymer t(advance deposit)of more that orre-ttmd of the total contract price of the total amort of all deposits or payments which the contractor must make,in advance,to order andlor otherwise obtain delivery of special order materials and equipment,whichever is greater Contractor: Kevin Murphy 98 Forest 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 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature V Date Signature Date The Commonwealth of Massachusetts -" Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): e v�. ✓ Address: `'y — �" LI City/State/Zip: Nv LS �hone#: q'i T- S Are you an employer?Check the appropriate box: Type of project(required): 1I am a employer with_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- These on the attached sheet.# 7• Remodeling 8. Demolition These sub-contractors have ❑ shipand'have no employees - workers'comp.insurance. orlon for in an capacity. p Building addition w y p ty 9. Bu g g . We are a [No workers 5 ❑ comp. corporation and its p required.] 10. Electrical repairs or additions officers have exercised their ❑ 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.E].Roof repairs insurance required.]t employees.[No workers' q ] 13.0 other 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 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. ��++ Insurance Company Name:. 91rw0S Policy#or Self-ins.Lie.#: ���W�— Z. -. b`1 Expiration Date: �. r Job Site Address: 2,1? ���.�,.w��/t City/State/Zip: kZV,�i Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido here y cert under tlzepains andpenalties o erjury that the information provided above is true and correct. Si ature: `-----� Date: Phone#: "i1 r 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-contractor(s)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 - . I 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 bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The ConiTonwealth.of Massachusetts Department of Industrial,Accidents Office of Intvestigations 600 Washington Street Boston,MA 02111 TO. 617-7274900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www-mass.gov/dia ® DATE(MM/DD/YYYY) ACOORO CERTIFICATE OF LIABILITY INSURANCE 7/17/2013 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 endorsement(s). PRODUCER ' CONTAC NAME: M P ROBERTS INS AGCY INC PHONEg78 683-8073 FAX (978) 683-3147 1060 Osgood Street EMAILoE AIc,No: g ADDRESS:sandi @mproberts insurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAICH INSURER A: PROVIDENCE MUTUAL INSURED KEVIN MURPHY BUILDING & REMODELING INSURER B:MERCHANTS INSURANCE 169 BOXFORD STREET INSURER C:GUARD INSURANCE NORTH ANDOVER, MA 01845 INSURER D: 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. INSR TYPE OF INSURANCE ADDL SUER P LICY EFF OLI Y EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY /Y MM/DDYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE I()KEN I L CLAIMS-MADE CI OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 15,000 A BOPI068945 11/22/12 11/22/13 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICYCI PRO CI JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident ANYAUTO MCA7013608 01/23/13 01/23/14 BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED B AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 CUP9145304 11/22/12 11/22/13 DED RETENTION$ $ WORKERS COMPENSATION X TT - AND EMPLOYERS'LIABILITY Y/N STAATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1500,000 C+ OFFICER/MEMBER EXCLUDED? �I N/A (Mandatory In NH) KEWC422467 07/01/13 07/01/14 E.L. DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below 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) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPT. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRES A E pd*lt -1 ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD