HomeMy WebLinkAboutBuilding Permit #518 - 273 OSGOOD STREET 2/18/2010TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: 5/� Date Received
Date Issued -/ J
IMPORTANT: Applicant must complete all items on this Date
LOCATION_ 7,3 05 �Z>Od S✓,
1.
-�- -
,�-�r�,. Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
One family
Addition
Two or more family
Industrial
Alteration
No. of units:
Commercial
Others:
Repair, replacement
Assessory Bldg
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address:
CONTRACTOR Name:
Address:
Supervisor's Construction License: g G / Exp. Date. //9// Z
Horne Improvement License: I�13 Exp. Date: / ///
ARCHITECT/ENGINEER
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: $ S/ z (/i FEE: $
Check No.: Q` — Receipt No.: —Q C) 5? —
NOTE: Persons contracting with unregistered contractors do not have access to the panty fund
Signature of Agent/Owner Signature of contractor
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
PLANNING & DEVELOPMENT
COMMENTS.
CONSERVATION
C •uu
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
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
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
DANGER ZONE LITERATURE: Yes
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
mi.
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
❑ 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'2008
Location A5
No. �� Date
Check # d
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $�
Foundation Permit Fee $ It
Other Permit Fee $
TOTAL $
226UU
Building Inspector
F
ho
R.S. HEBERT
Construction & Remodeling Zn..
102 Adams Ave.
No. Andover Mass. 01845
(978) 686-0786 Phone/ Fax
Lic. #:058241 Reg. #:153811
DATE 2/17/10
Job name. Bryan Foulds
273 Osgood st.
North Andover Ma. 01845
PROJECT: Water damage repairs
I. PARTIES
This contract (hereinafter referred to as "Agreement") is made and entered
into on this _17th day of Feb. , by and between Bryan Foulds (hereinafter
referred to as "Owner"); and R.S.Hebert Construction & Remodeling Inc.,
(hereinafter referred to as "Contractor"). In consideration of the mutual
promises contained herein, Contractor agrees to perform the following work,
subject to the terms and conditions below:
II. GENERAL SCOPE OF WORK DESCRIPTION
Supply all material .and labor required to build the following.
i. Remove remaining plaster and wood lath from 1st. and 2nd.
Floor ceiling and front walla
2. Chan and seal exposed framing members.
3. Renail ceiling strapping .
4. Remove hardwood flooring.
S. Renail subfloor
6. Insulate ceiling and walls.
7. Install */z" blueboard and skim coat plaster to walls.
S. Install 5/8" blueboard and skim coat plaster to ceilings.
9. Install new window trim, 4" bellyband casing with 5" blocks.
10. Install new 1x8" two piece baseboard where removed.
11. Install new 3-1/4`° oak flooring where removed,1100 sq.ft.
Contractor wrier Owner
LibLiberty Mutual
erty
Mutual,. New England Region
PO Box 1053
Montgomeryville, PA 18936-1053
Office: (800) 566-0323
Fax: (866) 479-8438
Insured: FOULDS, BRYAN & FOULDS, CYNTHIA
Property: 274 chestnut
andover, MA 01845
Home: 274 chestnut
andover, MA 01845
Claim Rep.: Jennifer Gonzales
Business: PO Box 1053
Montgomeryville, PA 18936-1053
Estimator: Jennifer Gonzales
Business: PO Box 1053
Montgomeryville, PA 18936-1053
Claim Number: 013733148-01 Policy Number: H32218136822229 2
Date Contacted:
2/3/2010 9:00 AM
Date of Loss:
1/30/2010 .
Date. Inspected:
2/3/2010 9:00 AM
Price List:
MAEM5B FEB 10
Restoration/Service/Remodel
Estimate:
FOULDS _BRYAN_&_
FOUL
Home: (978) 974-9207
Cell: (603) 545-1363
Cellular: (978) 314-1648
Cellular: (978) 314-1648
Type of Loss: Water Damage - Freezing
Date Received: 1/31/2010
Date Entered: 2/1/2010 4:22 PM
In the following pages you will find the estimated cost of repairs to your home using prices that are usual and customary in
your area. This estimate is based on the replacement cost of repairs less your policy deductible and any depreciation, if
applicable.
We encourage you to work with a contractor of your choice in completing these repairs. If you or your contractor has any
questions or concerns about this estimate, please contact me at your earliest convenience. It is important to call me prior to
repairs beginning, as all additional work must be pre -approved by Liberty Mutual.
You may see your current mortgage company listed on your payment(s). If so, you will need to contact your mortgage
company to determine their procedures for processing claims payments.
Thank you for insuring with Liberty Mutual. We appreciate your business.
�A
12. Sand and finish new flooring three coats of poly.
13. Strip wallpaper from 1t. floor livingroom and diningroom
walls.
14. Patch walls prime and paint two coats.
15. Prime and paint ceilings two coats.
16. Repaint trim and bookcase two coats.
17. Install new ceiling fan and light-
18.
ight1L. Final cleaning of work area including windows.
19. All trash to be put in dumpster and removed from site.
A. LUMP SUM PRICE FOR ALL WORK ABOVE*
$31249.®0
Thirty one thousand two hundred forty nine dollars.
Irl. GENERAL CONDITIONS FOR THE AGREEMENT ABOVE
2. STANDARD EXCLUSIONS: Unless specifically included in the
"General Scope of Work" section above, this Agreement does not include
labor or materials for the following work: Plans, engineering fees,
Testing, removal and disposal of any materials containing asbestos (or
any other hazardous material as defined by the EPA). Custom milling of
any wood for use in project. Moving Owner's property around the site.
Labor or materials required to repair or replace any Owner -supplied
materials. Final construction cleaning (Contractor will leave site in
"broom swept" condition).,correction of existing out -of -plumb or out -of -
level conditions in existing structure. Correction of concealed
substandard framing. which may be discovered in the removal of walls
or the cutting of openings in walls. Removal and replacement of existing
rot or insect infestation. Failure of surrounding part of existing structure,
despite Contractor's good faith efforts to minimize damage, such as
plaster or drywall cracking and popped nails in adjacent rooms or
blockage of pipes or plumbing fixtures caused by loosened rust within
pipes. Exact matching of existing finishes. Cost of /testing/remediating
mold/fungus/mildew and organic pathogens unless caused by the sole
and active negligence of Contractor as a direct result of a construction
defect that caused sudden and significant water infiltration into a part of
contractor Owner Owner
the structure. B. DATE OF WORK COMMENCEMENT AND
SUBSTANTIAL COMPLETION
Commence work: 2/18/10. Construction time through substantial
completion: Approximately 3 week, not including delays and
adjustments for delays caused by: holidays; inclement weather;
accidents; shortage of materials; additional time required for Change
Order and additional work; delays caused by Owner, Owner's design
professionals, agents, and separate contractors; and other delays
unavoidable or beyond the control of the Contractor.
C. CHARGES FOR ADDITIONAL WORK: CONCEALED CONDITIONS,
DEVIATION FROM SCOPE OF WORK, AND CHANGES IN THE WORK
1. CONCEALED CONDITIONS: This Agreement is based solely on the
observations Contractor was able to make with the project in its
condition at the time the work of this Agreement was bid. If additional
concealed conditions are discovered once work has commenced or after
this Agreement is executed which were not visible at the time this
Agreement was bid, Contractor will point out these concealed conditions
to Owner, and these concealed conditions will be treated as Additional
Work under this Agreement. Contractor and Owner may execute a
Change Order for this Additional Work. Contractor is released, held
harmless, and indemnified by Owner from all pre-existing mold, fungus,
mildew, and organic pathogen problems and is not responsible for costs
or damages associated with correcting, containing, testing, or
remediating the same.
D. PAYMENT SCHEDULE AND PAYMENT TERMS
1. PAYMENT SCHEDULE:
* First Payment: $10,000.00 due when job is started.
2nd payment $ 10,00.00 when plaster work is complete.
* Final Payment: Balance of contract amount due upon Substantial
Completion of all work under contract: $11,249.00
2. PAYMENT OF CHANGE ORDERS/ADDITIONAL WORK: Payment
for Additional Work is due upon completion of either all or part of the
Additional Work and submittal of invoice by Contractor.
E. WARRANTY
Thank you for choosing our company to perform this work for you. Your
satisfaction with our work is a high priority for us, however, not all
��
Contractor Ovder Owner
possible complaints are covered by our warranty. Contractor does
provides a limited warranty against material defects on all Contractor -
and subcontractor -supplied labor and materials used in this project for a
period of one year following substantial completion of all work. This
warranty covers normal usage only. You must contact the Contractor
upon discovering an item in need of warranty service. Additionally,
Owner's hiring of others or direct actions by Owner or Owner's separate
contractors to repair a warranty item are not covered by this warranty
and will not be reimbursed by Contractor.
No warranty is provided by Contractor on any materials furnished by the
Owner for installation. No warranty is provided on any existing materials
that are moved and/or reinstalled by the Contractor within the dwelling
or the property (including any warranty that existing/used materials will
not be damaged during the removal and reinstallation process). One
year after substantial completion of the project, the Owner's sole remedy
(for materials and labor) on all materials that are covered by a
manufacturer's warranty is strictly with the manufacturer, not with the
Contractor.
Repair of the following items and related damages of every kind are
specifically excluded from Contractor's warranty: problems caused by
lack of Owner maintenance; problems caused by Owner abuse, Owner
misuse, vandaiism, Owner modification, or alteration; and ordinary wear
and tear. Damages resulting from mold, fungus, and other organic
pathogens are excluded from this warranty unless caused by the sole
and active negligence of contractor as a direct result of a construction
defect which caused sudden and significant amounts of water infiltration
into a part of the structure. Deviations that arise such as the minor
cracking of concrete, stucco, and plaster; minor stress fractures in
drywall due to the curing of lumber; warping and deflection of wood;
shrinking/cracking of grouts and caulking; fading of paints and finishes
exposed to sunlight are all typical (not material) defects in construction,
and are strictly excluded from Contractor's warranty.
I have read and understood, and I agree to, all the terms and conditions
contained in the Agreement above.
DATE CONTRACTOR'S SIGNATURE
6ATt OWN 'S SIGNATURE
Contractor Owner Owner
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
ky 600 Washington Street
Boston, MA 02111
www massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Naive (Business/Organization/Individual):
Address: Z ��5 / y",;
City/State/Zip: A ,44ue�,, & 0 /e yJ Phone d >
Are you an employer? Check the appropriate box:
1. EKI am a employer with 4. ❑ I am a general contractor and I
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
These sub -contractors have
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
., cFjl wu: —nuc uu : f-: mus. also illi out the e h,.l .., '
Type of project (required):
6. [1 New construction
7. ®remodeling
8. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.0 Roof repairs
13. ❑ Other
s on o_.o sno nib =--workerscompensation 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 the policy and job site
information.
Insurance Company Name:
Policy # or Self -ins. Lic. #: 01-C114 &A —00 Expiration Date:
Job Site Address: X73 OSS® ad 57 City/State/Zip: e Az,LOlS cS`
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.
I do hereby certi er the paint' and penalties of perjury that the information provided above is true and correct:
1
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Issuing Authority (circle one):
1. Board of Health 2. Building Department
6. Other
Contact Person:
Permit/License #
City/Town CIerk 4. Electrical Inspector 5. Plumbing Inspector
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 `dint 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 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 Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
Tel. # 617-72.7-4900 ext 406 or 1-877-MASSAFE
Revised 5-26-05 Fax # 617-727-7749
www.mass..gov/dia
Acadia Insurance
1. The Insured:
Acadia Insurance Company
Administered by Berkley Risk Administrators Company, LLC
P.O. Box 939, Pierre, SD 57501-0939 2510 E. Irwin, Pierre, SD 57501
Phone (605) 945-2144 Fax (605) 945-2048 Toll Free (800) 634-4589
NCCI Carrier Code 33391
CERTIFICATE OF INSURANCE
WCIP
R S Hebert Construction & Remodeling, Inc
102 Adams Avenue
N Andover, MA 01845
Policy Number: WC -20-20-001810-00
Tax ID#: F 02-1572816
Policy Period: From: 1/1/2009
To: 1/11/20110
Date of Mailing: 9/16/2009
The Certificate is issued as a matter of information only and confers no rights upon the Certificate Holder.
This Certificate does not amend, extend or alter the coverage afforded by the Policy listed below.
This is to certify that the Policy of Insurance described herein has 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 Policy described
herein is subject to all the terms, exclusions and conditions of such Policy.
TYPE 0>F 1N lIRANC� ,
....
I 1 IuIITS C3 1 t~i�
,
Part One
Workers' Compensation
Statutory
Part Two
Bodily Injury by Accident
$100,000 each accident.
Employers' Liability
Bodily Injury by Disease
$500,000 policy limit.
Bodily Injury by Disease
$100,000 each employee.
Should the above Policy be canceled before the expiration date thereof, the Company
will endeavor to mail 10 days written notice to the below named Certificate Holder, but
failure to mail such notice shall impose no obligation or liability of any kind upon the Company.
Certificate Holder's Name and Address:
Joseph Howshan
6 Pilgrim Road
Lawrence, MA 01843
Michaud Rowe & Ruscak Insurance Assoc Inc
PO Box 188
North Andover, MA 01845
Election Election
Category Status Name
Coverage
State(s)
MA
Officer Include Cheryl Hebert
Officer Include Ronald Hebert
Date Issued: 9/16/2009
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