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HomeMy WebLinkAboutBuilding Permit #211-15 - 221 BOXFORD STREET 8/27/2014 j TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print. PROPERTY OWNER Prihf 100 Year Old Structure yes MAP NO: 1 V Y PARCEL�ZONING DISTRICT: Historic District yes ' Machine Shop Village yes TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building -6 One family ❑Addition ❑Two or more family ❑ Industrial -ONteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 6Septic '6Well ❑ Floodplain ❑Wetlands ❑ Watershed District Water/Sewer Y DESCRIPTION OF WORK TO BE PERFORMED: ,ovv—5 Identification Please Type or Print Clearly) OWNER: Name: 1? VC_1\v, Phone: t- !C • '\I 5-'9151- Address: ?—Z(- CONTRACTOR ZlCONTRACTOR Name: VCA_ ,. Phone: b 5 33 r'- -Address: `t. rd F"� �- S�- t ,,.. . ?.��►•w•�. _ ti Supervisor's Construction License: PS-3 _)5.!1 Exp. Date: 15" Home Improvement License; Exp. Date; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Q, 512-0 FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Slgnature_of Agent/Qwnel ( Sig=ature of contractor. Plans Submitted LJ Plans Waived Certified Plot Plan ❑ StampedIan Location �a ��GG l` a� o No. Date . - TOWN OF NORTH ANDOVER e Certificate of Occupancy $ Building/Frame Permit Fee41 � Foundation Permit Fee $ u , Other Permit Fee $ TOTAL $ ' Check# A0 y6 27 ,' 55r Building Inspector Op f Date....... .........��.. ' s . NORTH S °`<�``°:•�"° TOWN OF NORTH ANDOVER.10 g % PERMIT FOR WIRING ,SSACNUS� to Q1 / ` O t. L. 4 S�'�< �i``��.. This certifies that ........ '....�.:.... .s.............................................................. has permission to perform ....... ....... ................. wiring in the building of... ... .1. . (.y. ........................................................ at.....v��.t....�).QY. .0 `..... ....J....................... .North Andover,Mass. Fee..&Q........... Lic.No. t.3.Z17.............................................................. ELECTRICAL INSPECTOR WHITE:Applicant CANARY:Building Dept. PINK:Treasurer Plans Submitted ❑ Plans-Waive ".-Certified-Plot Plan ❑ . Stamped Plans o- TI'PE_OF-SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑. . Swimming Pools ❑ Well ❑ Tobacco Sales 0 •Food Packaging/Sales ❑ Private{septic tank,etc._ ❑.-- Permanent D empster on-Site THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM - DATE REJECTED: DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ } COMMENTS i CONSERVATION Reviewed on Signature COMMENTS _ I HEALTH Reviewed on Signature . i COMMENTS r Zoning Board of Appeals: variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connectionisignature Date Driveway Permit R TD]PW Tows Engineer: Signature: - Located 384 O oo Street I , =1RE DEP;4�Til41 :NT Temp Dumpster on site yes no Located at-124;Maim Street {' Fire Deplrtme'it Signatbire/Ctl2te COMMENTS f I ` Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area., sq. ft.: ELECTRICAL: Movement of Meter locationast-or service chop requires approval of :Electrical Inspector Yes No DANGER.Z®NE LITERATURE: Yes No MGL.Chapter166.Section 21A—F and G min.$100=$1000.fine NOTES and DATA— For department use El Notified for pickup - Date t ; Doc.Building Permit Revised 2010 Building Department The fohowing"is a=list of•the required forms to be filled outlor.the appropriate permit to:.be obtained. Roofiv,g, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And70rC.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) _ o _ Engineering Affidav__its 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 cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apuaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doc.Bui?ding Permit Revised 2012 NORTH own of O No. o h ver, Mass, 8 2' y' C OC NIC"a WIC" �s,9 RATED S tl BOARD OF HEALTH Food/Kitchen PERMIT T/ mJJ LD Septic System THIS CERTIFIES THAT ^ v�� .�1............. . BUILDING INSPECTOR / Foundation has permission to erect buildings on �g eelnze':l_W S .......................... ......... ................ .... .. ........................................ Rough to be occupied as ..........,� 1:! �...�� . c ................................... Chimney .. ..... Q.... ............................................ 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI STARTS Rough Service ....... ..... G r:........ ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin,:; Rough Display in a Conspicuous Place on the Premises - Do Not Remove Fina! No Lathing or Dry Wall To Be Done ' ° ¢' T "E"T \1nt11 Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. rDATE A � CERTIFICATE OF LIABILITY INSURANCE 6/25/01A)4D1 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 endorsements. PRODUCER CONTACTSandi Munroe M P ROBERTS INS AGCY INC PHONE978 683-8073 F"" No:(978) 683-3147 1060 Osgood Street EMAIL North Andover, MA 01845 RE .san i mpro ertsinsurance.com INSURERS AFFORDING COVERAGE NAIC# sUR - MERCHANTS INSURANCE INSURED KEVIN MURPHY BUILDING & REMODELING INSURERB: GUARD INSURANCE 169 BOXFORD STREET jNSURER C! NORTH ANDOVER, MA 01845 INSURER D: INSURERE NSURER COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSLED 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 ISSLED 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 BYPAID CLAIMS. INSLTR TYPE OF INSURANCE N pMa. Y MBER POLICY EFF POCK EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE Q OCCUREMIoccurrence) $ 500,000 BOPI068945 11/22/13 1/22/14 MED EXP one person) $ 15,000 A PERSONAL&ADV INJURY INCLUDED GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY JECT ❑LOC PRODUCTS-COMP/OPAGG $ 21000,000 AUTOMOBILE LIABILITY COMBINED SINGLE UMIT $ 1,000,06T accident) ANYAUTO BODILY INJURY(Per person) $ A AUTOS ALLOWNED X SSC/TEEDULED MCA7013608 01/23/14 1/23/15 OS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS t $ UMBRELLA UABOCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS UAB HCLA1MS-MADE AGGREGATE $ 1,000,000 CUP9145304 11/22/13 1/22/14 DED RETENTION WORKERSCOMPENSATION X T AND EMPLOYERS LIABILITYER B A cEROPRIEF2 PARTNEERIE ECl1TNE Y NIA E.L.EACH ACCIDENT $ 500,000 EX-(Mandatory in NH) KEWC527844 07/01/14)7/01/15 E.L.DISEASE-EA EMPLOYEE I$ 500,000 Ifyes,descrbeunder DESCRIPTION OF OPERATIONS belowT 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached ifmore space is requred) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 OSGOOD STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHOR12ED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD AOL The Commonwealth of Massachusetts.fment o - Department Industrial Accidents P Office Investigations .ff of Investb' IF 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/EIectricians/Plumbers Applicant Information PIease Print Lep-ibly Name(Business/Organization/Individual): l�,.v►. �1 i�-�p _ Address: 118 rye Ste,r City/State/Zip:_ tj,,. P�.�.�,,.,`, f�.� o\VqT- Phone#:_ ``� ` t l l -5 3 5— Are Are you an employer?Check the appropriate box: Type of project(required): 1-H I am a employer with 4. ElI am a general contractor and I ' employees(full and/or part-time). have liired the sub-contractors 6. ❑New construction 7. Remodelin _ I g listed o e on attached sheet 2.❑ I am a sole proprietor or partner t. ship and'have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑Electrical repairs or additions 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),andwehaveno 12.'13R.00frepairs insurance required.]t employees. [No workers' 13.❑Other comp.insurance required.] !Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. T Homeowners who submit this affidavit indicating they aie doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showingthe ' name of the sub-contractors and their workers comp. lie information. policy I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site Information. Insurance Company Name: Cy Policy#or Self-ins.Lic.#: `L%E�7 5 2'Z ee,q`Av.. Expiration Date: V l t 15"- Job Site Address: Z-Z- I t-4--/- 5��-� City/State/Zip: Nv, a�,�-, Mc. 0 i S' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder Section 25A of MGL e. 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. I do hereby cert6 under the pains and penalties of perjury that the information provided above is true and correct. - Simature: Date: Phone#: "1 - 3 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#: Kevin. Mur • 98 Forest Street � u �/ • NorU�Andover,MA 01845 1 1 ,/ PH:978-688-M5 Building Contractor FAX:978-688-7207 j Proposal To: Rich&Dorothy Varga 221 Boxford Street All Home improvement Contractors and Subcontractors engaged in home improvement contracting,unless North Andover, Ma 01845 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with the COMMon wealth of Massachusetts.Inquiries about registration and Status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place, From: Kevin Murphy Room 1301,Boston,MA02108,(617)-727 8598 CC: Date: 8/26/2014 .lob: Roof/windows Date of plans: None 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 8/25/14. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 9/30/14.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 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 Page 1 of 4 Kevin Murphy Page 2 of 4 Building Contractor 98 Forel Street Nodh Andover,MA 01845 PH:978G8&53W FAX 97&68&7207 General Proposal is to re-roof main section of exisitng house, replace four windows, and other miscellaneous repairs. Building permit will be obtained by contractor. Demolition Existing roof will be stripped. Building New roof will be 25 year,three tab shingles to match existing. Ice and water sheild will be installed along first six feet of roof. Any damaged / rotted plywood will be removed / replaced. Four Harvey all vinyl replacement windows will be supplied and installed. Any rotted trim around windows will be replaced with composite materials. Electrical ri cal Existing second floor bathroom fan will be replaced with new Panasonic unit. Fan will be vented to exterior wall. Waste Removal All demolition/construction debris will disposed of by contractor. I Kevin Murphy Page 4 of 4 Building Contractor 9 98 Forest street North Andover,MA 01845 PH:97846885335 FAX 978588-7207 Section IV-Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of... ... ...... ... ...... ...... ... ... ....$ $10,500 Payment to be made as follows: Percentage/ltem Description Arnount 1 Permit obtained $2000 2 Job complete ".100 Total 2 $10,500.00 Notice:No agmament for Home improvement contracting work shall require a down payment(advance deposit)of more that ons third of the total contract price of the total amount of all deposits or payments which the contractor must make,in advance,to order and/or otherwise obtain delivery of special oda materials and equipmentt,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 DateI 2]bl rte_ Signature Date