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
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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
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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
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rHOOUCiS-COMPIOPAGG
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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)
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GARAGE LIABILITY
AUTO ONLY- FA ACCIDENT
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OTHER THAN EA ACC
AUTO ONLY: AGO
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$
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EXCESS 1 UMBRELLA LIABILITY
EACH OCCURRENCE
3 _
OCCUR n CLAIMS MADE
AGCRE(,ATL
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RETENTION S
=
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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
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: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