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Home My WebLink AboutBuilding Permit #887-13 - 23 HOLBROOK ROAD 6/19/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO (V " I� Date Received l 9 Date Issued: lY 147 TYPE OF IMPROVEMENT IMPORTANT: Applicant must complete all items on this page 1' Non- Residential ❑ New Building -% One family LOCA TI®N) - �3 4-1 dIn.nw�ll �L 1►r r u� ❑ Industrial _ - — P,n = -- - . ❑ Commercial � PRQ`FERT1Y� OW.NE_R� ❑ Assessory Bldg ❑ Others: ❑ Demolition Pring 100?YearOld'Structure, yes nos MAP,N j.o-7 ,P, x t ®NING'DISaTRICT r yHistonc Distnctfi _. MachineShopUillage r yesy :k yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building -% One family ❑ Addition ❑ Two or more family ❑ Industrial 16Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑,Septici ❑001 Flood lam : # Vl/etlarids� , p -' ❑ ,; ❑ Watershed istrict, . _ _ DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) G {� b - 3 3 6b OWNER: Name: r� a L� Q Phone: �n t% �. Address: a-3 kkA lcrdol<- AI -.k /\/.\�ITI"1n!?Tl11"1`r �5A1�.-_.. 1 ./ .. .1\ �, - 1"lL nom' M' f ARCHITECT/ENGINEER M) 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: $ k %.A SIJ U FEE: $ D 0 Check No.: I I IV -, Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty/fund / Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Pans 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 Signatu 1 COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments r Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town ]Engineer: Signature: Located 384 FIRE DEPARTMl NT Tema Dumpster on site yes no, Located at 1 4Nain`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 requires approval of Electrical Inspector Yes No DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA — (For departments use ® Notified for pickup - Date Doe.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 ❑ 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 o . Engineering Affidavits for Engineered products. . . . . . . !VOTE: 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 o 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 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 o 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 o 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: Doc.Building Permit Revised 2012 Loc ation No. Dath) TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee TOTAL $ C he c k 26535 Building Inspector O ~ Ja LL mc cu +u_ LL £ a) V1 0 Z C7 Z O J m c LL Lao w c U C LL 00 z Q Z m J a Lon d' c LL 0 a Z Q F- J LU 2' cu " Ln C lL IxZ O0 LLI CL Z Q son nL C ll a w o w a: U. °� CO Z v L l j . } D v Y 0 O� cc O V �+ Q.I �a 0 y C. �• L to CD .10+ 0 O• _O (� L ago Cc U) J � a CO • �.ir > Cc L (jo%o*=°'0 — -.00 � jNC s L o 0 w y z N o .r . > 0 C. m 46C L) cc 0 • r n c rn L c �ocW Q L lC � CL cu W O - O O •0 d c N = wZ w E r V as 0-0 �.. cn s > _ N .Q OCL 0 Fa M f - v v 0 The Commonwealth of Massachusetts Department of IndusitialAccidents Office of Invesdgations 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): Address: q 4�) Fe, City/State/Zip: kil/I Phone 4: (>'tK- 'T- - 3 3 Are you an employer? Check the appropriate box: 118 1 am a employer with _ 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. # 2. ❑ I am a sole proprietor or partner- ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their required.] 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 T-W'Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions I l.F] Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *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. f am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �� o r,.� S C11 > Policy # or Self -ins. Lie. #: V C 3\-) 5 U Expiration Date: Job Site Address: -L3 K0 'k b" r >v,— %-A City/State/Zip: i -,J y 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 certify under thepains andpenalties ofperjury that the information provided above is true and correct. I 'nota• L\4 1 Official use only. Do not write in this area, to be completed by city or town offu:iaL 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 #: 0 tiv-A-� CERTIFICATE OF LIABILITY INSURANCE MIDDNYM 12/4i 012 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON ;SHE 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 INSURERS), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(res) must be endorsed. H SUBROGATION IS WAIVED, subject to the temes and conditions of the policy, certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder In lieu of such endorsemerd(s} PRODUCER M P ROBERTS INS AGCY INC 1060 Osgood Street Andover, MA 01845 CUNIACI NAME, PHONE, N (978)683-8073 106,..r(978)683-3147 A -MAIL Sandi@mprobertsinsTarance.com INSURER(North S) AFFORDING; COVEIIAGE NAICa INSURER A: PROVIDENCE MUTUAL INSURED KEVIN MURPHY BUILDING & REMODELING 98 FOREST STREET NORTH ANDOVER, NA 01845 INSuRER B: MERCHANTS INSURANCE INsuRER c: GUARD INSURANCE INSURER D: INSURER E: INSURER F: a.vvcrv�v�o I r-KIIt-K.AIr-NUMKrK' 09:IACIn1d Idt11AFE1C0- - -------------- 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 PMD CLAIMS. LTR R TYPE OF INSURANCEam VrM POUCYNUMBER(PAMAXYYYYY) (MWDDUYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL UABIISTY PREMISES (Ea om.resce) $ 500,000 CLAIMS41ADE a] OCCUR MED 8P(Arty orrepersa,) $ 15,000 A BOPI068945 1/22/12 1/22/13 PERSONAL&ADVINJURY $ 1,000;000 GENERAL AGGREGATE $ 2,000,000 GEN1 AGGREGATE LIMIT APPLIES PER PRODUCTS - coMP/oP AGG $ 2,000,000 POLICY PRO -LOC $ AUTOMOBILE LIABILITY 1XIMBIRED MIM 1,000,000 Eaacd $ BODILY INJURY (Per person) $ ANYAUFO ALI.OVMEDR SHED CULED NCA7013608 1/23/12 1/23/13 B C BODILY INJURY (Per RY actiidem) $ NON OVMED HIRED AUTOS AUTOS PROPERTY DAMAGE (P-accidMy $ S UMBRELLA UABOCCUR HCLAtMS4&4DE EACH OCCURRENCE $ 1,000,000 AGGREGATE $ 1,000,000 B EMESSUAB CUP9145304 1122/12 1/22/13 I DED I RETENTION $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY WC STATU OT x TORY UMITS ER YIN EL EACH ACCIDENT $ 500,000 C ANY PROPRIETOR/PARn BmDmcunVE EX4Ln®9 ❑ MIA (� KEWC317800 7/01/12 7/01/13 EL DISEASE- EAEMPLOYEE $ 500,000 ayes, describe rarer EL DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS ILOCATIONS /VEHICLES (ABadrACORD 101.AddlarN RemaftSdmU%d more is required) %,crc 1 Irlldi 1 C riVLU=K CANf`CI I ATInKI TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN NORTH ANDOVER NA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUnimom THE ra 19W2010 ACORD CORPORATION. All rights reserved. ACORD25 (2010105) The ACORD name and logo are registered marks of ACORD Kev � _ , rip .. Building Contractor Proposal To: Greg & Cathy Lee 23 Holbrook Road North Andover, Ma 01845 From: Kevin Murphy C.C.: Date- 6/19/2013 Job: Deck Date of plans: None Architect: None Location: Same Section 1- Work Schedule • 98 Forest street • North Andover, MA 01845 • PH: 978-688-5335 • FAX: 978-688-7207 All Home improvement contractors and Subcontractors engaged in tine rtnprovement contracting, unless specifically exempt from registrabon by Provisions of Chapter 142A of the general laws, must be registered with the Commonwealth of Massachusetts. Inquiries abort registration and Status should be made to the Director, Home Improvement Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108.(617)-727 8598 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 6/17/13. Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 6/29/13. 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 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 Building contractor 98 Forest Street North Andover, MA 01845 PH: 978566-5335 FAX 9785887207 General Page 2 of 4 Proposal is to renovate exisitng deck. Building permit will be obtained by contractor. Exisitng deck areas will have decking / rails removed and replaced. Demolition Exisitng decking and railings will be removed and disposed of. Building Decking will be Azek brand. Color to be determined. If a " premium color " ( special order ) is selected, there may be an additional cost Radiance brand railings will be supplied and installed ( white composite) . One new set of stairs to rear yard will be built. Waste Removal All demolition / construction debris will be disposed of by contractor. Kevin Murphy Building Contractor 98 Forest Street North Andover, MA 01845 PH: 9784885335 FAX: 978588-7207 Section IV - Price Schedule Total Page 4 of 4 We hereby propose to furnish material and labor — complete in Accordance with above specifications for the sum of .....................................$ 14,500 Payment to be made as follows: Percentage/ltem Description Amount 1 Permit obtained $2500 2 Job complete $12,000 2 1 1$14,500.00 -Notice: No agreement for Hare improvernerd contracting work shaft req xre a down payment (advance deposit) of more that are-tfrhd of the total contract Vice of the total amount of all deposits or payments which the contractor must make, in advance, to order and/or otherwise obt n defivery 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_2L,jv.�- $ 9- Date Signature Date,