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Home My WebLink AboutBuilding Permit #394 - 22 SILSBEE ROAD 11/18/2009 BUILDING PERMIT °� NORTH q °. 1'O TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received �DRATED Pp'q`� �SSACNUS�� Date Issued: IMP RTANT: Applicant must complete all items on this page LOCATION 7-Z S T1s q\ ..,A Print PROPERTYOWNER ,l\ ,,,K 1,eiz, Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes ('no) !Machine Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Resmor Non- Residential New Building Addition re family Industrial Iteration No. of units: Commercial epair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District ater/Sew DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Z-- Ix \3-11 Address: .�, . fL.. CONTRACTOR Name:. k .��.:s �,. Phone' I - ,S 3 3 S" Address: k L Supervisor's Construction License: 03 3 D 1\." Exp. Date: kvk t Home Improvement:License: k,0 L43'-1k-( Exp. Date: 16 ARCHITECT/ENGINEER ts./t�,ryl2, 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: $ SD u FEE: $ 6L Check No.: Receipt No.: #2 2-Ce 3<P NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund signature of Agent/Owner Signature of contracto _ Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerSwimming Pools Tanning/MassageBody Art Well Tobacco Sales Food Packaging/Sale's'.;- f 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 Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments f Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os oo Street FIRE DEPARTAAFNT =Temp Dumpster on site yes no Located at 924 Main Street 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 re c uires 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 a ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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- Li 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 t _ Location 2z- No. � Date � MORTh 1 TOWN OF NORTH ANDOVER f O' .•o , •h•C ' e ' Certificate of Occupancy $ SS C" s<� Building/Frame Permit Fee $ Foundation Permit Fee $ i Other Permit Fee $ f TOTAL $ E Check # 2 66 Building Inspector i NORTH Town of �. t 4Andover 0 No. ,37 o dover, Mass., ` 0`0 !) � T LAKE COC1/1CKEWICK V 7�A0RATE0 `r BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System / BUILDING INSPECTOR THIS CERTIFIES THAT.....&.11........� L . ^ � Foundation has permission to erect........................................ buildings on ............................g4..�...s..b -.... ........:.. Rough to be occupied as... .....I.�-- ......... � '` !'� Ow '..................................................... Chimney .................. provided that the em acc tin this permit shall in eve respect conform to the terms of the application on file in i P P P g P every P PP Final 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final �(a PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ARTS Rough ... ................................. Service BUILDING INSPE�R Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. Massachusetts- Department of Public SafetN Board of Building Relgulations and Standards, Construction Supervisor License License: CS 53099 Restricted to: 00 r KEVIN W MURPHY 169 BOXFORD ST N ANDOVER, MA 01845 Expiration: 6/29/2011 Co mmissiuner Tr#: 16540 Al. e.mv�naru�srca//� Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:, 101874 Expiration:;:6/29/2010 Tr# 267315 Type:. ndividual KEVIN MURPHY" Kevin Murphy 169 Boxford Stw N.Andover,MA 01845 Administrator T � on t�� Uv-kmnn c-:_^^�L1--%na 169 Boxford Street �1 J tSC�, �'i[7 ��iL, 71�C1\T • North Andover,MA 01845 • PH:978-M-6335 Building Contractor • FAX:978-688-7207 Proposal To: Bill Boutilier 22 Silsbee Road All Hone improvement Cobras and Subamtradm engaged to tame tmpromTwt contracting,mkss North Andover, Ma. 01845 spedficany from regWrA—byR-isiorrsofOmpter 142A of the gametal laws,must be reg�e�red wim the Comrtanweallh of macaw luseds.trgrrnes about registration and Stag shoLM be made to the Dredor,Hare Improvement Catad Regislrabm,One Ashburton Place, Frortrc Kevin Murphy Room 1301,Boston,MA 02108.(817)-72788 cc: Date: 1119/2009 Job: Replacement windows Date ofP Tans: None Architech None itocat9on: 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 11/16/09. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 12115/09.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 furnished 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 atter 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 °an� nn av�ultar"��n� Page 2 of Mniiding Contractor 169 Box6d street North Andover,MA 01845 PH:9788885335 FAX 9780000( General i Proposal is to supply and install twelve replacement windows in second floor of existing house. Building permit will be provided by contractor. Demolition E)dsting window sashes and balances will be removed and disposed of. Building Twelve Harvey replacement windows will be supplied and installed in existing openings. Windows will be white vinyl interior and exterior. Windows will have half screens and no grilles ( to match first floor windows ) . No allowance has been made to replace any interior or exterior trim. Painting No allowance has been made for any interior or exterior painting. Other Allowances All construction debris will be disposed of by contractor. � a°uao a`nana�c ray Pae of (Building Coaataacloa Page 169 Boxford street North Andover,MA 01845 PH:9786885335 FAX 978688-)000( Section IV—Price Schedule We hereby propose to fumish material and labor—complete in Accordance with above specifications for the sum of... ... ... ...... ... ... ... ...... ... ....$ 5500 Payment to be made as follows: Percents eAtem Description Amount 1 Windows installed /job complete $5500 Total 1 $5,500.00 "Notice:No agreemerht for Hare nhprouernerht coritradngwork shall regrse a down paymert(adva ice deposit)of more that orheahird of the bola!contract price of the total amara[of all deposb or Wflnetts which the wrsractor mat melee,in advance,to order and/or o1herwse obtain delivery of speer oder i.elm acs and eguprrhent,wtxheuer 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 DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES SignatureA� Date ll / �i; _ Signature Date The Commonwealth of Massachusetts Department of Industrial Accidents Q 52 Office of Investigations 600 Washington Street Boston, MA 02111 UIP www mass.gov/dia Workers' Compensation Insurance.Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/drganization/bdividuai): Address:_ City/State/Zip: Nr b..�,.e•�••, -. o k,;c4F-Phone#: C�0Q -S'3 37r, Are you an employer? Check the-appropriate boa: Type of project(required): _ - 4. ❑ I am a general contractor and 1 5. C]New construction C1 I am a employer with, employees(full and/or part-time)." have hired the sub-contractors 7. [3 Remodeling !.Q I am a sole proprietor or partner- These on the attached sheet ship and have no employees These sub-contractors have 8. F] Demolition working for me in any capacity. workers' comp• insurance. 9. ❑ Building addition workers'comp. insurance 5. ❑ We are a corporation and its • 10. Electrical repairs or additions o ❑ ep required j officers have exercised their right of exemption per MGL 11.0 Plumbing repairs or additions 3.❑ I am a homeowner doing all work 2, 1(4), nd c have no myself. (No workers comp. g12.0 Roof repairs insurance required.)t cmployces. [No workers' 13.❑ Otber comp.insurance required.] Any applicant that checks box#I must also fill out the section below showing their workers'compensations policy information; Homeowners who submit this affidavit indiceft they are doing all work and then him outside contractors must subrn it a new affidavit indicating such. Contractors that check this box moat attached an additional sheet dhowh*the name of the sub-contractors and their workers'comp.policy infoYmation. am an employer that is providbrg workers,compansation.insurance for my employees. Bdow it the.poltcy end fob she "formation. nsuranceCorapanyName: C , 'oiicy#or Self-ins.Lic. #:_ ZC w G a U�`\ 3 Expiration Date: fob Site Address: City/5tawaip: t h, knach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). ?11ihue 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 ianprisoAtnent,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 Oflt"ice of [uvestigations of the DIA for insurance coverage verification. f do hereby ce fy under the pains and penalties of perjury that the information provided above is true and correct. Date: ho #: 33 0y x' ial use only. Do not write in this area,to be completed by city or toren o,f�iteral. City or Town: PerrniULacense# Issuing Antbority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector G.Mer Contact Person: Phone#: Co. CER7��ICATE OF t1AR�tiTY INS�lRANCE VA'1''�'°°' ^►, /1100 >Rabpdts �>Yt�xrlagctsl nay 4 CA�CONP 1�315No A8 A MATTER OF MWOMATION 1060 Oa P1xR�9 NC RIONTB UPON YFfB CEIZPIFICAfE �' IZ k "=ER' THS CERTIFICATE DOR�IZ NOT ENE ERTIFO OR blOs t4li 018425 T�Ti{!a cove (a AFF D By TN�P �C DYIR INd �uup ... ...... WtERB AFFpRpINp COVERAGE ...... NAM it tQ�V'Ibi' FEIy X,�Gi INBUfERA .. . ..__,.. 3,69 smaram -I INSUN1ERd = �� MM R. 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