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HomeMy WebLinkAboutBuilding Permit #783-13 - 274 CHESTNUT STREET 5/16/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: _,J� Date Received t�j I � 1�_ Date Issued IMPITRTANT: Applicant must complete all items on this page LOCATION % tf C122 �-A;�� n / / / Print PROPERTY OWNER 1-04141,5 Print 100 Year Old Structure MAP NO: PARCELLLC ZONING DISTRICT: Historic District Machine Shop Villa yes yes 91 TYPE OF IMPROVEMENT PROPOSED USE Phone: ;),CLPC07 6 Residential Non- Residential ❑ New Building VOne family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition 0 Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District B'Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: /2C✓��� Please Type or Print Clearly) OWNER: Name: 67 CONTRACTOR Name: O l Phone: ;),CLPC07 6 Address: 16 Z "2r_J 116 Supervisor's Construction License: CS Exp Home Improvement License: ARCHITECT/ENGINEER Exp Date: ;4!` r `/ Date XV/ 47i— ARCH ITECT/ENGI NEER 7 Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST ABASED ON $125.00 PER S.F. Total Project Cost: $ lis' Oc> FEE: $ 1 O Check No.: Receipt No.: a(iff.09— NOTE: Persons contracting with unregistered contractors do not have access to the uaranry and Signature of Agent/Owner Sig=nature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El Location 2-�f No. -78 3—c2---� Check # S W S 26412 Date L5 I I TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ l VD Foundation Permit Fee $ Other Permit Fee $ TOTAL $ M Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Ari ❑ 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 COMMEN DATE REJECTED u DATE APPROVED ❑■ 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 Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Tow;! ]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Departmerit 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 No MGL Chapter 166 Section 21A -F and G min.$100-$1000 fine NOTES and DATA — Wor department use 0 Notified for pickup - Date Doc.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. Roofivg, Siding, Interior Rehabilitation Permits ❑ Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract a Floor Plan Or Proposed Interior Work o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li 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 o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract a Mass check Energy Compliance Report o 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 api). al 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 Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 15,500.00 m $ - $ 186.00 Plumbing Fee $ 23.25 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 23.25 Total fees collected $ 332.50 274 Chestnut Street 783-13 on 5/16/2013 Remodel Second Floor Hallway _ LL 0 cc 0 m cu L v O LL f E ate+ ? N y Q to cr 0 CLLLI Z z m c O + c 7 U- 7 d' % E U LL o Z Z m J C to 7 OC Fo LL 0 H Z Q u W W t D d' > Ln C LL O a Z ( to 7 R' LL z W cc W o 25 = LL a E m O zO v L Ln Y O (n : LL " =o V W : cn y mow: :Z �. 0 2 o u = L y0+ O V+ Jz V F- P OO��Q' o � N CD O > Cl) W OC o o 0 0 H y U) Z o W 0 0 V �QC0 ( cn cn N.o Lu W J ���� a.Z 0 O F- 0 !/� _ c Q i i LC 'a 0 N d V m O y •• V� W_ � 'a� O O � LL C LU . • O NE=wwZ W E 0oc0 Q 0> w .6- J ti H 0 O Fam =- t CL- > �' E z in The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual); Address: ,A?C v City/State/Zip:, 006�-r_ / Q/8 Yr _Phone #: ou an employer? Check the appropriate box: AWI Type of project (required): 1. am a employer with Z 4. ❑ I am a general contractor and I 6. Now construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have liiredthe sub -contractors listed on the attached sheet. 7• Remodeling ship and'have no employees These sub -contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. 9. D Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work officers have exercised their right of exemption per MGL I LEI Plumbing repairs or additions myself. [No workers' comp. c.152, §1(4), and we have no 12.QRoofrepairs required.] insurance . re uired employees. [No workers' 13.❑Other comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 7 Homeowners who submit this affidavit indicating they ire doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors 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 Policy # or Self -ins. Lie. #: Expiration Date: Job Site Address: City/State/Zip: 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 ofMGL o. 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 maybe forwarded to the Office of investigations of the DTA for insurance coverage verification. I do hereby cert ,FrrYlet thepAn�An penalties ofperjury that the information provided abs is true and correct. Phone#: Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # 3 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 #: 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 ofhire, 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 ofpublic 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 phonenumber(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 LL C or LLP does have employees, a policy is required. Be advised that this affidavit maybe 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 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 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 (ifnecessary) 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 burn 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: Tho Gommoawoalth of M—assaftsetts Department ofbdustrial Accidents Office o�Iu�estigatians 600 Washlvoa Street Boston, MA 02111 TeX, # 617-727-4900 oxt406 or 1.-877MASSAFE Revised 5-26-05 Fax# 617-727-7749 trxcrxsrxmnnn r.....t.i.:.. R.S. HEBER'T Construction & Remodeling Inc. 102 Adams Ave. No. Andover Mass. 01845 (978) 686-0786 Phone/ Fax Lic. #:058241 Reg. #: 153811 DATE 5/12/13 Job Bryan Foulds Z 7 y Chesnut St. North Andover Ma. 01845 PROJECT: 2"d. Floor Hall I. PARTIES This contract (hereinafter referred to as "Agreement") is made and entered into on this _12 day of May. 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. 1. Supply building permit. 2. Convert hallway to sitting area. 3. Remove built in desk and closets and trim. 4. Demo sheetrock from walls, ceiling. 5. Install 6 recessed lights & 6 recepticals. 6. Blueboard and plaster walls & ceiling. 7. Install two new door units & new baseboard. 8. Install new baseboard heat covers. 9. Replace 4 double hung window units complete with trim to match. 10. Paint all new walls,ceilings and trim with 2 coats. 11. Paint 2"d. floor bathroom walls and ceiling. 12. Screen and refinish hardwood floor. Contractor Owner Owner � � � � � , : � y � .''�',� .Ip�a�i ii���� � � , ,: e� � , -. ,�� ��{{ .. r .� ,�� � � � e � � �� ,.`��� �� ��4 � �. L i iar�.d 9 . I aid i. � ' �,,�. . ,. �', 13. Supply dumpster and remove all trash from site. A. LUMP SUM PRICE FOR ALL WORK ABOVE* $15,500.00 Fifteen thousand five hundred dollars. III. 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 the structure. B. DATE OF WORK COMMENCEMENT AND SUBSTANTIAL COMPLETION Commence work: 5/15/13. 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 Contractor Owner Owner M 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: $5000.00 due when job is started. Second Payment $5500.00 due when blueboard is up. • Final Payment: Balance of contract amount due upon Substantial Completion of all work under contract: $5000.00 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 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 Contractor Owner Owner 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, vandalism, 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. i /3 DATE C NTRA OR'S SIGNATURE I ) 3 k DAT OWNER'S SIGNATURE Contractor Owner Owner CERTIFICATE OF LIABILITY INSURANCEDATE Qp 10 SR RSHEH-1 0 ichaud, Rowe And Ruscak Iris. .O. Box 188 Orth Andover MA 01845 'hone:978 688 8829 Pax:978 SURER ---- 557 2130 102 H begrt Const & Remcd, Inc. AdanAvenue N Andover NA 01845 THIS CERTIFICATE 13 I5:3uEu Ab A WU41 I eK yr mrwmwir i Iv► ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOV INSURERS AFFORDING COVERAGE NAIC s INSURER A. AmGuard INSURER 11: Guard Ifisurance Grow INSURER C' Commerce Insurance Company 34754 INSURER 0: OVERAGES TMC POLICIES Or INSURANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED NAMED ANOVE FOR THC POLICY PERIOD INDICATED. NOTWITHSTANDINO ANY REDUIREMENT. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RL•SPCCTTO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THF INSURANCC AFFORDED BY THE POLICIES DESCRIBED HERCIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH PDLICIES. ACCRECATE LIMITS SHOWN MAY MAVC OCCN REDUCED BY PAID CLAIMS, iRAD fR INCRL TYPE .. OFNSU—NC E POLICYNLINBER POLICY'EF DATE MM DATE M UITs L eFNeru►L LIABILITY X COMMERCIAL GENERAL LIABILIiY UAIMM MADE � OCCUR RSBP303083 05/11/12 05/11/13 EACH OCCUHHtNCE PRCMIuCS Esoom,"w) $1000000 _ $50000 $ 500 0 $ 1000000 MED DEP IAM one person) PERSONALAADV INJURY s2000000 GENERALAGGREGATE 52000000 ` rHOOUCiS-COMPIOPAGG -GEEWLACCRECATLLIMIT'APPLIESPFR: S[ I POLICY ECT RO Lx AUTOMOBILE LIABILITY ANY AUTO BSGMOS 12/19/11 12/19/12 COMBINED SINCLE LIMIT $1000000 ALL OWNED AUTOS X SCHEDULED AUTOS ROPILY INJURY (Per porion) $ X I IIRCO AUTOS X NON -OWNED AUTO$ BODILY INJURY (Pw eccbenq $ PROPCRTY DAMAGE (Pcr occident) y GARAGE LIABILITY AUTO ONLY- FA ACCIDENT S — OTHER THAN EA ACC AUTO ONLY: AGO ANY AUTO $ S EXCESS 1 UMBRELLA LIABILITY EACH OCCURRENCE 3 _ OCCUR n CLAIMS MADE AGCRE(,ATL DEDUCTIBLE RETENTION S = 8 WORKERS COMPENSAT10N AND JE14PLOYEP—T LIABILITY ANY PROPRICTOILPARTNERIEXECUfIv � (MandatoryIn NHI EXCLUDED? L _1 RSWC346459 01/01/12 01/01/13 _TORY LIMITS ER E.L. EACHACCIDCNT $100000 E.L. $100000 $500000 It yue, aowribe undcx SPECIAL PROVISIONS 00110w £LDISEASE -p01.ICYLIMR OTHER IESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES I EXCLUSION$ ADDED BY ENOORSEMENTI SPECIAL PROVISIONS �r :ERTIFICATE HOLDER CANCELLATION Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supenisor License: CS -058241 RONALD S HUfiRT 102 ADAMS JIVE N ANDOVE# MA 01845 r -JA Commissioner Expiration 01/08/2014 p� c;� Tpomv�no�aureccll�i o�C�/G%aaaac�zccsetl3 Office of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR ' = egistration: 153811 Type: xpiration. 1/9/2015 Private Corporak R.S. HEBERT CO. &REMODELINGINC. RONALD HEBERT 102 ADAMS AVE. NO ANDOVER, MA 01845 Undersecretary