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HomeMy WebLinkAboutBuilding Permit #497-2016 - 280 SALEM STREET 10/20/2015(S) "..FD ,v�;y1,s- ()qus Not Sc a -eV L p BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Phi- 2-bl Date Issued: �d %°'�`5 IIMPORTANT: LOCATIONL�y Print PROPERTY OWNER -�- Print. 100 Year structure a no MAP _PARCEL -.MZ ZONING DISTRICT: Historic District yesn�d Machine Shop Village yes no Date Received must complete all items on this NORTH O� 1649NC A. 6 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building %One family Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ 1Nell', ❑ Floodplain Wetlands> ❑tNatershedt Distract ❑ Watef/Sewer'L_ s a = �. DESCRIPTION OF WORK IO tit Ft:K1-UK1V1tu: -5 / yo, C-, ,L:a- ::5 Z( Api)f'7rjc)-Q d 0,,� Pte' 5 A Ide tification OWNER: Name: 'r Pq- Address: Contractor Name: G► �- - Please Type or Print r Phone. .#JO - 142--V/N Phones �/►� Address: -!g;'7- PO- :4N'DCa'Y4 Supervisor's Construction License: �� Exp Home Improvement License:- C ® Exp Date: oti 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. cp Total Project Cost: $�� FEE: $ Check No.: �� Receipt No.: I NOTE: Persons contracting with unregistered contractors do not have access thelparanty Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer x Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales.: ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ o THE FOLLOWING SECTIONS OFFICE INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ o is�ur4�r,�c� COMMENTS Voiu—b,5cb�ea•r_eCi L��.i� z SJNcru fiic�� S Q 0 tHEALTH Reviewed on Signature COMMENTS t r 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 'gown Engineer: Signature: CONSERVATION COMMENTS <<J6CC Reviewed on 41 . p��� \� Si nature o Q 0 tHEALTH Reviewed on Signature COMMENTS t r 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 'gown Engineer: Signature: 1�!��ti 1111 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 Doc.Building Permit Revised 2014 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 4� 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 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/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 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 4. Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 JP;W 102 -1 - Homeowner Information Contractor Information Name Company Name j �.a,�i+�i d e l�l ,.}l' �l VAC'."�' r t ` Y�� r.� �- a -i �.. 2 - 3 n f - C=ice 1.� - i3 if l;• Street Address (do not use a Post Office Box address) Contractor/ Salesperson/ Owner Name City/Town State Zip Code Business Address (must include a street address) Daytime Phone. Evening Phone -- City/Town State - Zip Code 17 Mailing Address (It different from above) Business Phene-- I Federal Employer lu or S.N.-manner Home Improvement Contractor Reg. Number Expiration date Law requires that most home improvement contractors have � f// a valid registration number �} 6.' `yg The Contractor agrees to do the following work for the Homeowner: (Describe in detail the work to completed, specifying the type, brand, and grade of materials to be used, use additional sheets if necessary.) Required Permits - The following building permits are required Proposed Start and Completion Schedule - The following schedule will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded from the Guaranty Fund provisions of ) E: 1 / Date when contractor will begin contracted work. MGI, chapter 142Ae) sem. .c. / °''/Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work, furnish the material and labor specified above for the total sum of =�, -�->. Via;<.` (*) Payments will be made according to the following schedule: $ �d 1/3 of the total contract price or 'the cost of special order items, whichever is greater) $ ��, ( � by or upon completion of F i"A-"' ' & R) N $ -----by-_r=f_ or upon completion of $ L' upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must be special $ to be paid for ordered before the contracted work begins in order to meet the completion schedule.(**) $ e paid for NOTES: (*) Including all finance charges (**) Law requires that any deposit or down -payment required by the contractor before work begins may not exceed the greater of (a) one-third of the total contract price or (b) the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. Express Warranty - Is an express warranty being_ provided by the contractor? No ❑ Yes fall terms of the warranty must be attached to the contract) Subcontractors - The contractor agrees to be solely responsible for completion of the work described regardless of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance - Upon signing, this document becomes a binding contract under law. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on the residence. Review the following cautions and notices carefully before signing this contract. a Don't be pressured into signing the contract. Take time to read and fully understand it. Ask questions if something is unclear. o Make sure the contractor has a valid Home Improvement Contractor Registration. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza, Room 5170,13oston, MA 02116 or by calling 617-973-8787 or 888-283-3757. © Does the contractor have insurance? Ask the Contractor for his insurance company information so that you can confirm coverage, or ask to see a copy of a -"proof of insurance" document. © Know your rights and responsibilities. Read the Important Information on the reverse side of this form and get a copy of the Consumer Guide to the Home Improvement Contactor Law. You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contactor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not 1 ater than midnight of the third business day following the signing of this agreement. See the attached notice of cancellation form for an explanation of this right. D® NOT SIGN THIS CONTRACT IF THERE ARE ANYMAIK SPACES a 9 Two identical copies ofthe contract must be completed and signed. One copy should go to the homeowner. The other copy should be kept by the contractor. Homeowners Signature I/ Contractor's Signature Date Date a CERTIFIED PLOT PLAN PREPARED FOR: ALLAN & STEPHANIE MURPHY A 280 SALEM STREET NORTH ANDOVER, MA. NORTH ESSEX REGlS77?Y OF DEEDS. DK. 12056 PG. 235 ASSESSOR'S MAP. 370, LOT 2 ZONING. R-3 SCALE.- 1"-30' DATE- OCTOBER 14, 2015 NOTE.• EXIS77NG BUILDING DIMENSIONS TAKEN TO CORNERBOARD. rn d Z Q EE S T� 228 g1 PROPOSED FRONS PGE 8'x6' MUDROOM 34.3' �EX�STIN��� 29.1' GARAGE 26.3' \ 30.1' \ Ln 38.2' W r �N p WE z _ OI 7-S 1 o a 02, D o , ss 25.9' LOT 1A ti�90 30, 303 SF. p' 0, �2, W r� PSI" OF MASS IS N0. 3 773 p F ���AL LAS PREPARED BY JOHN ABAGIS & ASSOCIATES, PROFESSIONAL LAND SURVEYORS 9 BARTLETT STREET, NO. 252, ANDOVER, MA. (978)-688-4899 JOB NO. 6197 to`� ROBERT LANGEVIN 795 Dale Street North Andover, MA 01845 Ngo (® 16 "" Oc 1';,r PA*.) NY�VI 7 (apo iN� Cr? E Q ROBERT LA»NG EVIN Building & Remodeling, LLC 795 Dale Street North Andover, MA 01845 (978) 686-3607 HIC # 111990 FID # 26-0816298 www.LangevinBuilding.com Stephanie and Allan Murphy 280 Salem Street North Andover, MA 01845 Job Description Single story mud room 8'6" X 6'0" • All necessary building permits • Hand digging for concrete piers and floor • Pour concrete • Frame floor, walls and single pitch roof • Roofing and siding to match existing • One exterior wood door up to a cost of $500 • One stock Windsor double hung window as close as possible to those on the house • Remove old window in living room and seal the hole (frame and plaster) • Insulation to code, but no allowance for heating • Electrical: move entry light, 1 ceiling light, switching, 1 exterior outlet, 2 inside outlets • Blueboard and skim coat plaster walls and ceiling • 1/2" durock on floor and tile up to a cost of $5 per square foot • Mopboards , door and window trim • James Hardie cement board to seal crawlspace • Harvey Industries Lifetime storm door • Open storage shelving on one wall to your specs • Interior and exterior painting • All cleanup and trash removal Contractor Initials Homeowner Initials www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information -Please Print Legibly Name (Business/Organization/Individual): 6 P Address: City/State/Zip: ®�-_ /4 tip —� m A Phone #: � � � � �� 3 d0 7 Are you an employer? Check the appropriate box: The Commonwealth of Massachusetts i u { Department of Industrial Accidents .. Office of Investigations U e �aeri l 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): 6 P Address: City/State/Zip: ®�-_ /4 tip —� m A Phone #: � � � � �� 3 d0 7 Are you an employer? Check the appropriate box: 1. ❑ I 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. $ hip and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. 0 We are a corporation and its [No workers' comp. insurance required.], officers have exercised their 3111 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 1522 § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6.New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 1011 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 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 arid their workers' comp. policy information. I am an employer th4t is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name; Policy # or Self -ins. Lic. #: 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 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 c�� ify u er the pat and penalties of perjury that the information provided above is true and correc4 Rivnsture- UVl Date: 01? Official use only. Do not write in this area, to be completed by city or town offaciaL City or Town: Permit/License Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone #: Office of Consumer Affairs & Business Regulation '�i)40ME IMPROVEMENT CONTRACTOR .jWimt:qmtvduun; 11.990 Type: �- Expiration : --2ifi61 -7- LLC License: CS -002685 ROBERT LANGEVIN SLOG A:REMOLDING LLC. ROBERT LANGEVIN.-I S X 795 DALE ST N ANDOVER, MA 01845 Undersecretary Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervism- License: CS -002685 ROBERT M 1AN6 EVIN' S X 795 DALE ST N ANDOVER MA 0194.0 lI Expi,ation Commissioner 0212412016 ACORV CERTIFICATE OF LIABILITY INSURANCE °A ' ' TYPE OF INSURANCE : THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HdLDEIC 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 INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTNAME: CT Erik Hays Hays Insurance Agency Inc. P"C. No. . (978)686-3162 ac No : (978)6894425 36 Hawthorne Ave. EMAIL ADDRESS: hay sinsurance comcast.net INSURERS AFFORDING COVERAGE NAIC N MED EXP (Any one person) $ .5,000. INSURER A: Norfolk & Dedham Mutual Fire Insurance Company Methuen Ma. 01844 INSURED Robert Diangevin INSURER B PRODUCTS - COMP/OP AGG $ 2,000,000. $ INSURER C : 795 Dale St. INSURER D: INSURER E: North Andover Ma 01845 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMRER- 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 PAID CLAIMS. MSR j LTR ; TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MMIDD/YYYY POLICY EXP MMIDD/YYYY LIMITS I A L - COMMERCIAL GENERAL LIABILITY. j CLAIMS -MADE OCCUR R0514357A 10/25/2014 10/25/2015 EACH OCCURRENCE $ 1,000.000• -OADAGE TO RENTED PREMISES Ea occurrence $ 100,000• MED EXP (Any one person) $ .5,000. PERSONAL & ADV INJURY $ 2,000,000• ( EN'L AGGREGATE LIMIT APPLIES PER: (_J POLICY 7 E T 7 LOC OTHER: GENERAL AGGREGATE $ 2,000,000• PRODUCTS - COMP/OP AGG $ 2,000,000. $ L AUTOMOBILE I I r~' i LIABILITY ! AN'f AUTO ALL OWNEDSCHEDULED AUTOS AUTOS. NON -OWNED i HIRED AUTOS AUTOS I i COMBINED SINGLE LIMIT $ Ea accident _ rfODiLY INJURY (Per person) $ accident Per INJURY BODILY I $ l I PROPERTY DAMAGE Per accident $ $ l UMBRELLA LIAB OCCUR I EXCESS LIAB CLAIMS -MADE DED RETENTION $ EACH OCCURRENCE $ AGGREGATE $ $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? ❑ (Mandatory in NH) If yes. describe under DESCRIPTION OF OPERATIONS below N / A SPER OTH- I TATUTE OR E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ I 1 1 DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Carpentry North Andover Building Department 1600 Osgood St. Building 20 Suite 2035 North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Ma 01845 W 1VUB-ZD14 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Wd = LL 0 OC m O t Y Y \ O LL TO Ln U N (n cc o N z z G co m O co 'O O LL .� to O d' a) C L U O L.L 0 LLI a N z Z m .=.I d t O OC O LL 0 a N z Q U VQ J LU L O CC O U L Ln C LL 0 U LU Ln z N t = w Co C LL z G o W D W y„ L CO O z .�..� ( j Y Y O (n c c A p. Q l O O �• Q. L cx as c� �a N E Q L; L to A.- c d 7 0 E • O = O CL J N � > Cc c CDL O 'O a O _FM V Q i O Z �o0 ft.:9 >0 = o • Q d) �. C o) I- v O E- U) d CL d N O V m LLIN W = -a - O O li co m coCL — c uii V o c a 04 O -0 d J- fc N -0.O w c i � g 0 0 R u i 2 z G z W w A W H W CL I cj ►.t 1W � s W O O Q CL CF) Q s � J O z CL U) r_