HomeMy WebLinkAboutBuilding Permit #608-2017 - 252 GRAY STREET 12/6/2016BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#:(Q Q 0_ - Or)
Date Received % (9- d--01 (o
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
9 One family
❑ Addition
❑ Two or more family
❑ Industrial
9 Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
0 Septic ' D 1Nell
❑ Floodplain D Wetlands
0 Watershed- Distract
d.Vllater/Sewer, w w.. l
n.-� r --a .�. Y i •
-f -.3
DESCRIPTION OF WORK TO BE PERFORMED:
0/5 d Ald &d ltidli;K Qp 4A,".
OWNER: Name:
Address:
S�_
- Please Type or Print Clearly
a.
Phone: 7gj'%y-t fl
Contractor Name: t -L . %SS P_ hone: �� _ �/ �� ✓`�
,Address: kil-
XP.
U[Lic se S" .01176 4•'*Date
_NomejImprovemerif,License t��% 27 <"�, t Exp, rDate
ARCHITECT/ENGINEER
Phone:
Address: Reg. No,
FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F.
�. Total Project Coit: $ FEE: $ '00
Check No.: 0 3 3 Receipt No:: .3 `71
NOTE: Persons contracting with unregistered contractors do not have: access to the guaranty fund
5ignatufe of_Agent/Owner S gnature df contractIV
or''
11 /1 -
Location 0' S" �- (3—,- 1A
No.& o? - P v1-7
S—/ -
Date iA-4- ;-0/(,
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
Check #
Building Inspector
31291
Plans Submitted ❑
i
Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑
•TypF-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
PLANNING & DEVELOPMENT Reviewed On
COMMENTS
CONSERVATION Reviewed o
COMMENTS
HEALTH
COMMENTS
Reviewed on
Signature.
nature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
D
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street i
Fire Department signature/date r
COMMENTS
limension
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 dro
Electrical Inspector p .requires approval of
Yes No
®ANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
r
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
o 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/Cross Section/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
act
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
40TE: 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 2014
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t
E W DEMMONS HOME IMPROVEMENT
December 4, 2016
Ensminger Residence
Re:252 Gray St. North Andover, Ma.
Third Floor
Enclosed is our agreement for the above referenced project. My price is based upon our discussion of how
you would like yout and bathroom finished.
�
Base Bid $13,350
• Frame walls and strap the ceiling in designated third floor area.
• Insulate third floor to code.
• Demo and make safe existing wiring
• Furnish and install new circuits, receptacles to code for the third floor.
• Furnish and install new recessed lights.
• Finish walls with blue board and plaster.
• Install half bathroom where pre installed bathroom plumbing was.
• Painting and carpet is the home owner's responsibility.
Oualiflcations
• This agreement applies to the third floor project as discussed.
• All materials supplied by contractor unless stated otherwise.
• All work to be completed during normal working hours.
• Proposal is valid for 30 days.
• All work to be done in accordance with current codes
• Any work over and above this proposal will be completed at an additional price.
If you have any questions concerning this proposal please do not hesitate to contact me. Thank you for your
consideration.
Eric Demmons
EW Demmons Home Improvement
(617) 599-2629
151 Tyler St.
Methuen, MA 01844
Jon u n ■
n a nspill881
Phone (617) 599-2629
demmonse@hotmaif.com
MEMO 1110200
1
E W DEMMONS HOME IMPROVEMENT
December 4, 2016
Ensminger Residence
Re:252 Gray St. North Andover, Ma.
Third Floor
Enclosed is our agreement for the above referenced project. My price is based upon our discussion of how
you would like yout and bathroom finished.
�
Base Bid $13,350
• Frame walls and strap the ceiling in designated third floor area.
• Insulate third floor to code.
• Demo and make safe existing wiring
• Furnish and install new circuits, receptacles to code for the third floor.
• Furnish and install new recessed lights.
• Finish walls with blue board and plaster.
• Install half bathroom where pre installed bathroom plumbing was.
• Painting and carpet is the home owner's responsibility.
Oualiflcations
• This agreement applies to the third floor project as discussed.
• All materials supplied by contractor unless stated otherwise.
• All work to be completed during normal working hours.
• Proposal is valid for 30 days.
• All work to be done in accordance with current codes
• Any work over and above this proposal will be completed at an additional price.
If you have any questions concerning this proposal please do not hesitate to contact me. Thank you for your
consideration.
Eric Demmons
EW Demmons Home Improvement
(617) 599-2629
The Commonwealth of Massachusetts
Department oflndustrialAceldents
1 Congress Street, Si ite 100
Boston, MA 02114-2017
www mass.gov/dia
Compensation Insurance Affidavit: Builders/Contractors/EZectricians/Plumbers.
TO BE FILED WITH THE PERWIT NG .A.T1T-ff0R7Y-
bT...,c.o prinf �
Name (Business/Oigariization/Individud):
T WW1r--X'1'2 4Y
3AWn
. n
Address:
Cii-Y /StatelZip: 0� ��✓, Phone #:
Are you an employer? CJi _.Ic the appropriate box:
1. ❑ I am a employer with employees (full and/or part time).`
2. XI am a sole proprietor or partnership and have no employees working for me in
any capacity. [Noworkes' comp. insurance required_]
3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required ] r
4.11]I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractats either have workers' compensation insurance or are sole
proprietors with no employees.
5. ❑I am a general contractor and I have hired the sub-confraetors listed on he attached sheet.
These sub -contractors have employees and have workers' comp. insurance.
6. Q We are a corporation pnd tis, offices have exercised their right of exemption per MCL c.
1 4 and We have no empldyd9s. [No workers' comp. insurance required.]
Type of project )regnixed)
7. ❑ Nevw construction
S. El R.emodelvig
9. ❑ Demolition
10 ❑ Building addition
11.0 Electrical repairs or additions
12. []Plumbing repairs or additions
13'. []Roof repairs
14.L] Other
applicant that checks box #1 must also M out the section below showing their work"'' compensation policy information
*Y FP
Homeowners who submit tbig affidavit in they are doing all work and then hire outside contractors muss submit a new affidavit. tigting such
tCoutractors that check this 130X- must attached'an additional sh then wearkers' comname of e.poolic sub -contractors state whether or not (hose eniifies have
employees. If the sub -contractors have employees, they must Provide F P Y .. ....,.
X am an employer that isprovidingworkers' compensation insurancefor my employees. Below is tliepolicy arxdjo/i site
information.
Insurance Company
Policy # or Self -ins. Lic.
ExpirationDate,
City/State/Zip:
Job Site Address:
compensation policy declaration page ('housing the policy number and expiration date
Attach a copy of the �cvorl�ers' -
uired under MGL c. 152, §25A is a criminal violation punishable by a flue up to $11,500.00
Failure to secure coverage as req
and/or one-year imprisonment, as well as civ" epenalties innt may be forwarded to the Offloe, e form of a STOP ce O InvCesg�ns of the DIA for insurance
a
day against the violator. A copy of this sta Y
coverage verification.
X do Iierelry certify u er the gins andpenaliies ofperjury that the information provided move is true anJcorrect
i--? /r / j/
Phone #: 417,41V o e
IF -
Official z�se only. Do not write in this area, to he completed by city or town official.
City or Town:
Permit/License
Issuing Authority (circle one):
3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
1. Board of Health 2. Building Department
6. Other
Phone
Contact
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
receivefor 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 ofthe
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 b6 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 w116 has not produced -acceptable evidence of compliance with the insurance coverage xequi red."
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=contractors) name(s), address(es) and phone number(s) along with their certificates) 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. B e advised that this affidavit may be submitted to the Department of Industrial
Accidents for continuation 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
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 Iuvestigations 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 Department's address, telephone and fax number:
The Commonwealth of Massachusetts
Department of Industrial. Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 wwwmass.gov/dia
L12/105/2016 12:39 978-777-9804 JOHN J DOYLE INS PAGE 01/01
DEMOER1 OP ID: DR
DATE (MMIODIYYYY)
Ro,. CERTIFICATE OF LIABILITY INSURANCE 05112/2016
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
BELOW.
CERTDOES NOT IFICATE
CERTIFICATE FIRMATIVELY OR OF INSURANCE DOES NOTLY AMEND, EXTEND OR ALTER THE CONST CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZGE AFFOR05D BY THE ED
BELOW.
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER- les must be endorsed. If SUBROGATION IS WAIVED, SUbJect to
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy( )
the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the
—PtIfirato holder in lieu Of such endorsemen S - .•. TAr.T
PRODUCER
lohn J Doyle Insurance Agency
15 Constitution Lane Ste 2H
)anvers, MA 01923
Levin C Lawrence
IroeuRED Eric Demmons
151 Tyler Street
Methuen, MA 01844
Kevin C Lawrence
,I, 978-777-6344
TaURER A : Safety Insurance
INSURER D ;
INSURER E
978-777-9804
OVERAGES CEK 1 IYIVA 1 C wvww�r`•
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR
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 REDUCEDIC PAICucLAI PS. LIMITS —
TYPE OFINBURANCfi
-------- P^1 MY
EACH OCCURRENCE $ �—
T
MERCIAL GENERAL LIABILITY 02/2712016 02/27/2017
BMA0023240 PRFMISEs•(p°reu"a `o $ -
CLAIMS -MADE CI OCCUR 10
MED EXP (Any one poson) S—PERSONAL & ADV INJURY GENERALAGGREGATE 5 11000
GEML AGGREGATE LIMIT APPLIES PFR: PRODUCTS - COMPIOP AGG $
` POLICY F JECLLOC $
OTHER COMBINED SINGLE LIMIT $
AUTOMOBILE LIABILITY
BODILY INJURY (Per parson) $
JANY AUTO BODILY INJURY (Per eooldanl) JS
L OWNED SCHEDULED
TOS AUTOS DRU RTY D AGE $ —
NON -OWNED Por ecCldonl
RED AUTOS AUTOS S
EACH OCCURRENCE $
UMBRELLA LIAR OCCUR _
AGOREGATE S
—I EXCESS UAB CLAIMS -MADE
WORKER13 COMPEWSATION
AND EMPLOYERS' LIABILITY Y 1 N
ANY PR,I
OFFICERIMEM ER EXCLUDED?ECUTNE 171 NIA
IMandatory In NH) u
P.L. EACH ACCIDENT a
E,I- DISEASE • EA EMPLOYE!= S
DESCRIPTION OF OPERATONS I LOCATIONS I V2MICLFS (ACORD 101, Addltlonxi Remaro Sohedulo, may Ao ottaehed U mors epsoo le r.galred)
LIMIT
SHOULD ANY OF THE ABOVE DeSCRoarm POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVSRED IN
DONALD DELANGER ACCORDANCE WITH THE POLICY PROVISIONS.
1600 OSGOOD ST
NORTH ANDOVER, MA 01845 AUTHORIZED REPRESENTATIVE
Kevin C Lawrence
B 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
aIP
���e �orivrx�"r.�uecr,C� a�-
_�_ Office of Consumer Affairs &Business Regulation I-
OME IMPROVEMENT CONTRACTOR, Ty
Registration 178177
Individual
Expiration—g-312fl/2018
ERIC W DEMMONS Y
ERIC DEMMONS
151 TYLER ST g
METHUEN, MA 01844 ✓ Undersecretary
k,
t Massachusetts Department
of Public Safety
�! Board of Building Regulations and Standards
License: CS -101976
Construction Supervisor
r
W -
ERIC W DEMMONS
151 TYLER STREET-J,ry
�
METHUEN MA 01844',
i
Commissioner
Expiration:
06/14/2018
� V/ze Tparivr�z.naattuaa, acv, a�tunc zic6e(�
_ Offiee of Consumer Affairs & Business Regulation
TOME IMPROVEMENT CONTRACTOR - Ty
Registration: Y*;178177
aZ Expiration, 312-T-2Q e8
Individual
ERIC W. DEMMONS-
t
ERIC DEMMONS y "
151 TYLER ST
METHUEN, MA 01844 ' Undersecretary �I
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
Vjr
License: CS-101976,:.f
Construction Supervisor
ERIC W DEMMONS'
151 TYLER STREET j
METHUEN MA 01844:
Commissioner Expiration:
06/14/2018