Loading...
HomeMy WebLinkAboutBuilding Permit #465-11 - 39 HAY MEADOW ROAD 12/3/2010TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO• S Date Issued: ZI EMORTANT: Date Received must complete all items on this {,.. CLv A ek LOCATION Print PROPERTY OWNER 2 i `�Pr // Print MAP NO:Ib b PARCEL: ZONING DISTRICT: storic District yes Machine hop Village yes TYPE OF IMPROVEMENT ❑ New Building ❑ Addition ❑ Repair replacement ❑ Demolition T OWNER: N Address:, PROPOSED USE Residential �bone family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other ---- ---�. - < y DESCRIPTION OF WORK TO BE PERFORMED: - _ e.^,,_ In CONTRACTOR Name: Address: Identification Please l'ype or Print Clearly) S Non- Residential ❑ Industrial ❑ Commercial ❑ Others: -134 �� � Phone: b ? 3 J Supervisor's Construction License: 625-3 U iG Exp. Date: Home Improvement License: \ o t -2 Exp. Date: 0 ARCHITECT/ENGINEE Phone: Reg. No. Address: 1000.00 OF THE TOTAL ESTIMATED COST BASED ON $25.00 PER S.F. FEE SCHEDULE. BULDING PERMIT. $12.00 PER $ Total Project Cost: $ � 3 � Dy FEE: $ \ 1. . • V Check No.: `0 � Receipt No.: NOTE: Perso�s�,gistered contractors do not have access to the g 1aranty, fund Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. Stamped Plans ❑ Tanning/MassageBodyArt ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS ------------------- DATE APPROVED El Reviewed on Signature Reviewed on Signature 'Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature 8< Date Driveway Permit DPW TOwn Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Locatedno384 sg d Street Located at 124 Main Street Fire Department signature/date CONN.IENTS 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.$1oo-$loon fine NOTES and DATA — For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008 Building Department The fol;owing 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 a 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 o 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 aprn-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm_rted with the building application Doc: Doc.Bui?ding Permit Revised 2012 Location No. Gss�v� �q Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL Check #A7/4 23762 Building Inspector W W s•. m V O v -o w° � cn x O w � a w w�' U w x U w � aczw a�' w o w r2 cin w O H a�4 w w cA o cn Q o cn m V O O cm C 'O LAO �r m m CD CD L O.a O D O o e_ov a a- .; CMQ w o -6-0� C ca Z C3 G3 CL. V O � C C cc CL ' � O C.3 �Cc is mg r s : C2CD 5 : �a a C/) .. 71 o n ECA Z 2r O'D cam;:. Co.U�® C �+ N H U cm m 9 N ._ Cc=CA Z -1 �ti W 0 CD co U Q 3ymm c 92 U) n• p rmU -o c a W ^4 CC N O C p r cc C O` O O. c H Q i C L •O _ Co =m F— WC ep+ vl H py=...�Z O t `� • LD O N G.L C .y Z •m O 'r m O LU C.3 p '®O C �. CL O �aA= O 2 eyv C -Le m V O 0 U) W W 19 W co O cm C 'O LAO �r m m CD CD L O.a O D O o e_ov a a- .; CMQ o -6-0� C ca Z C3 G3 CL. V y C � C C cc CL 0 U) W W 19 W co O z V T-� O r� L uw Oo w u v CO O W b. o w to O w a .� U .G w o '.� to p w2 is G u. W p w '; v J)w � G �o cG G u. �' w v � W ° z , b a) Ca � C/) M- I LL : c o co c c Q L N v C2 is :.dam O. C m A D O +-' c p i coN Ea �. ca D CLN O m �.c Q �o . s cm �o = c�N_cc "Xa-® L o 0 3 • .� cm N O .L" N m 34D C3 N O m 'O Om o c Q: CD C. h O ecv '� Z c o ~ a Q i y m c S as m y=CD .,, o d F- s+ W •N MD cc dt O C = :.; •N S •� V �p V 4D CD cop a C3 45 cm o 'C o -0 S GO` =cc = H s .2 CL= m I �ll a 6 co 0 C L Q Q v Z co CL O y CD Cm IpCA� y w •E m m CD Cl w cc o a C .! CMQ y C 0 .& O CD co CD V Co � C cc c C. uj N LLJ U) W W LLIW U) 169 Boxford street Q`�+ b.QO �� • North Andover MA 01845 Cipi'pC-'i=% =r,7 r`�Er vd` • PH 978-688-5335 FAX: 978-688-7207 Building Contractor Proposal To: Bill & Lisa Riedell 39 Haymeadow Road North Andover, Ma 01845 From: Kevin Murphy CQ Date 12/2/2010 Job: Siding repairs / door & window replacement Date of plains: None Architect: None Location: Same Section 1- Work Schedule All Home improvement Contractors and subcontractors engaged in tome improvernerd contracting, unless specifically exempt from registration by Provisions of Chapter 142A of the general laws, rust be regWaed with the Commonwealth of Massachusetts. Inquiries about registration and Status should be made to the Director, Home Improvenent Contract Registration, One Ashburton Place, Room 1301, Boston, MA 02108. (617)-727 8586 Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 12/2/10. Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 2/28/11. The owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement Section 11- Warranty The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup, the Contractor shall, at his own expense, forthwith remedy, repair correct, replace, or cause to be remedied, repaired, or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Section 111- Scope of Work Page 2 of 4 169 Boxford sins North Andover, MA 01845 PH: 978-688-5335 FAX 978X)00( General Proposal is to replace existing three section french door, kitchen window, and miscellaneous siding. Building permit will be provided by contractor. Building Existing three section french door will be removed and replaced with a new Therma-Tru fiberglass unit Existing kitchen window will be removed and replaced with a new Harvey casement unit. New window will have vinyl exterior and wood interior. Rear wall of existing house, and adjacent wall on addition will be stripped and resided. Six A -dormers on front of house and addition will be stripped and resided. Other miscellaneous trim and siding will be repaired / replaced as required. Exterior walls will be wrapped with Tyvek or equivalent New siding will be wood grained Hardi-plank. All new trim will be Azek. Interior Trim/Doors New interior trim will be supplied and installed around door and window, to match existing. Painting No allowance has been made for any interior or exterior painting. Waste Removal All demolition / construction debris will be disposed of by contractor rer�ws�$ arr�i®a�rg Coaaraa:hhvr 169 Bo)dord Street North Andover, MA 01845 PH: 978&66.5335 FAX 9766W)000C Section IV - Price Schedule Total Page 4 of 4 We hereby propose to furnish material and labor — complete in Accordance with above specifications for the sum of ..................................... $ 13,400 Payment to be made as follows: Percentage/item Description Amount 1 Permit obtained $2000 2 Job complete $11,400 �2— $13,400.00 "Notice: No agreement for Home improvement contracting work stall require a down payment (advance deposit) of more that oro4hird of the total contract prioe of the total amount of all deposits or pay wrls which the contractor must mace, in advance, to order andtor othermse obtain delivery of special order materials and equipment, whichever is greater Contractor: Kevin Murphy 169 Boxford Street No. Andover, MA 01845 Registration No: 101874 Section V — Acceptance Acceptance of Proposal — I have read this document and accept the prices, specifications, and conditions stated. I understand that upon signing, this proposal becomes a binding contract You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction cancellation must be done in writing DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature ; f Date Ui✓� �� l Signature Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 021.11 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lelably Name(Businessforpni?ationtwividuan:_ � ., 1� �� ��,•�, ��� s -- b"^• Address:_ City/State/Zip: U V�qS'Phone #: a1 � �$ `�3 3 � Are you an employer? Check the- appropriate box: (, with �_ 4. ❑ I am a general contractor and I I am a employer employees (fnll and/or part-time).* have mired the sub-wntraetars listed on the attached sheet !. ❑ I am a sole proprietor or partner- ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance officers have exercised their re4uirod.] j. ❑ I am a homeowner doing all work right of exemption per MGL myself. (No workers' comp. c. 152, §1(4), and we have no insurance required.) t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. -0 Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. El Electrical repairs or additions 11. E] Plumbing repairs .or additions 12.❑ Roof repairs 13.❑ Other Any applicamt that checks box #1 must a180 fill out the section below showing their workers' cmmpensation policy information.' Homeowners wbo submit No at`tidavit indwatit>Y they am doing all work and then hire outside oonhactors must submit a new affidavit indicating suck :,onvacwn that check this box mast attached pn additional sheet showing the nam of ft sub•oontrnators and their wo*ets' owl policy information. ant an employer that is providing workerscompensatwn_ insurance for my employees Below is the. policy and job site nformation. usurance Company Name: :�,n •— .5 `—r 'olicy # or Self -ins. Lic. #:LLQ w C. �0�� l Expiration Date: '� `A \ ab Site Address: `� � `^-' "� City/Stav&ip: l,/ti . 1� .-S. r i"`°- • p ��`"t attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). -'aihure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a me up to S 1,500.00 and/or ane -year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a floe cf up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of nvestigations of the DIA for insurance coverage verification. ' ere do hcertify under the pains and penalties of per, jury that the Information provided above is true and correct -. ` A _ nater- k 1,i 'L( ILLS v Phone #: z7) Official use only. Do not write in this area, to be completed by city or town official, City or Town: Permit/I.icense # 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 #. a CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD/YYYY) 1]/29/2010 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. 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 SUBROGATIDN M 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). IRODUCER NAME: M P ROBERTS INS AGCY INC NCDNo (9781683-8073. A)cNo:(978)683-3147 1060 Osgood Street AODREss:mikeQmProbertsinsurance.com North Andover, MA 01845 eliNRtR(s) AFFORNIO c&4fRA6E NAICe INSURER A: asuRED KEVIN MURPHY BUILDING 6 REMODELING INSURER B: 169 BOXFORD STREET INSURER C: 169 BOXFORD STREET INSURER D: NORTH ANDOVER, MA 01845 INSURER E: 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 CERMCrT4-a+1AY-8E ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE -TERMS. EXCLUSIONS AND CONDITIONS OF SI Ir:N Pni W1112 -s 1 IUMQ CbIMUM kAA V NA11C OC=ki — 1— 'R TYPE OF INSURANCE AD Ale BUIER POLICY NUMBER POLICY- EFF MID LIMBS GENERAL LIABILITY X COMMERCIAL GENERAL LtABIUTY CLAIMS MADE OCCUR EACH OCCURRENCE $ 1 PREMISES -R occurrence S MED EXP (Any one person) S 5,000 CPP0060868 11/22/10 11/22/11 PERSONAL aAOVINJURY $ 11000,000 GENERAL AGGREGATE S Z OOO 000 GEN'L AGGREGATE LIMIT APPLIES PER: 7-1 POLICY F—IJEa F-1 PRO LOC PRODUCTS - COMP/OP AGO $ 2.000 000 $ AUTOMOBILE 3 LIABILITY ANYAUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS MCA7013608 01/23/10 01/23/11 accitlent 1,000,000 BODILY INJURY (Per person) S BODILY INJURY (Per accident) S _ Per aooidant S 5 UMBRELLA LIABHCLAIMSMADE EXCESS LIAB OCCUR EACH OCCURRENCE $ AGGREGATE S DED RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS LIABILITY Y114 ANY PROPRIETOWPARn4ER/EXEwrnvE j^' OFFICERIMEMBER EXCLUDED? I I Ifyeslff descnbeeunder I-- DESCRIPTION OF OPERATIONS below I NIA r I +'WC1O9881 07/01/10 07/01/11 r Y ITS OTH- X E E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE S 500,000 E.L. DISEASE - POLICY LIMIT $ 500,000 SCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101, Addkional Remarks Schedule, if more space is required) TOWN OF NORTH ANDOVER NORTH ANDOVER, MA 01845 ORD25(2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS, AUTHORIZED REPRESENTATIVE 01988-2010 The ACORD name and logo are registered marks of ACORO rights reserved.