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HomeMy WebLinkAboutBuilding Permit #420-13 - 40 DUNCAN DRIVE 11/27/2012 BUILDING PERMIT of N°oT b TOWN OF NORTH ANDOVER 32 '`- ° o APPLICATION FOR PLAN EXAMINATION * - Permit NO: Datq Received Q°RwrE° Date Issued: � C2641 l 1 rj 4SS CHUSE'C IMPORTANT:Applicant must complete all items on this page LOCATION { - Print PROPERTY OWNER Print _ MAP NO: PARCEL-ob ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 1;5,One family ❑Addition ❑Two or more family ❑ Industrial -Z4lteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other -1 Septic *Nell ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PREF R%ED: l R lvv �.. d �,F-;.'E+-•-. i.�-�- I��,A .ice.) Identification Please Type or Print Clearly) OWNER: Name: `�'� R�I�L� Phone:eno • X33-7 , 9 b-7 Address: CONTRACTOR Name: ` ,�-.,� [ ,t-��,, Phone: gnji (it- 53 3 Address: C�O Pou Q-k- Supervisor's Construction License: jD S-3 'k!) Exp. Date Home Improvement License: til' Z`'� Exp. Date: �IF J l ARCHITECT/ENGINEER !NA* -� Phone: ' Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ P1 \7 v U FEE: $ SLk , =J-0Check No.: t I q6-2-- Receipt No.: Q -� NOTE: Persons contracting with unregisteredecontractors do not have access to the guaranty fun Signature of Agent/Owner Signature of contractor Location O\� (Ati� ��v No. Date �( 40z-, 130;&A (-Ce+ • • TOWN OF NORTH ANDOVER • Certificate of Occupancy $ . = Building/Frame Permit Fee $ } e, f r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# ' 1 1 25981 uil ing Inspector Plans Submitted ❑ Plans Waiver Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer „ ❑ Tanning/Massage/Body Art ❑ Swinunmg Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECT ONS FOR OFFICE USE ONLY INTERDEPARTMENTA SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ %/ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed o Sionature COMMENTS Zoning Board of Appeals:Varianc , Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Conn Ction/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 O oo 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 No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 FORTH Town of . ? E ., Andover 0 No. _ - ., ver, Mass, R �Z- ,f C0CNICH2WICM y1. 7,9 A°R�►rE o ►'PP,�45 S U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System I, .,.. BUILDING INSPECTOR THIS CERTIFIES THAT ........k�ie.04.................... � ............................. ................. Foundation has permission to erect .......................... buildin s on .......4 . .L&A Rough ?k..to be occupied as ................ A ............................................................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC RT3 Rough a00Service .............. .......................................................... " Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE D 4 , - l , 98 Forest Street o 1 North Andover,MA 01845 PH:978-688-5335 FAX:978-688-7207 Building Contractor Proposal To: Karen Mello Duncan Drive All Home improvement Contractors and Subcontractors engaged in home improvement contracting,unless North Andover, Ma 01845 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with the Commonwealth of Manwhusetls.Inquiries abod registration and Status shordd be made to the Director,Home Urtmd Registration,One MNxdw Place From: Kevin Murphy Ro�i301, o2 7278 ' CC: Date: 11/19/12 Job: Roof Date of plans: None Architect: None Location: Same Section 1-Work Schedule 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 11/26.12. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 12.15.12.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 1 of 4 L Page 2 of 4 �it�l�l�ag�oa4aaa4orr 98 Forest street North Andover,MA 01845 PH:978888b.'i35 FAX:978888.7207 General Proposal is to strip and reroof rear section of main house, and upper front section of barn roof. Building permit will be obtained by contractor. Demolition Both section of roof will be stripped of the existing shingles. Building New drip edge will be installed at all roof edges. Ice and water sheild will be supplied and installed at first three feet of roof areas. Thirty year shingles will be supplied and installed to match existing. No allowances have been made to reroof any other areas of existing house or barn. Waste Removal All demolition/construction debris will be disposed of by contractor. f � a Boveu�pb�7 Page 3 of 4 f3ml�d�rsQ�oGs4>?aa4oa 98 Forest Street North Andover,MA 01845 PR 9786885335 FAX:9786887207 This page is intentionally left blank. 73oo�a C+3��pL5f7 Page 4 of 4 E'3mladE::a��otsltgtaoCorr 98 Forest street With Andover,MA 01845 PR 978£885335 FAX:978MB-7207 Sectimm IV-Price Sclteckde We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of... ...... .................. ..........$ 7000 Payment to be made as follows: Percentage/item Description Amount 1 Deposit/ Permit obtained $2000 2 Job complete $5000 Total 2 $7 000.00 "Notice:No agreementfor Ham inpovement oor[rac*g work shat require a down payment(advmw deposd)of more that one�trd of ft blot eorkact price of ft total amorrt d d daposb or payments which the contractor must make,in advance,border and/or otherwise obtain dekvery of special order materials and equpment,wtidrever is greater Contractor: Kevin Murphy 98 Forest 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 IS CONTRACT IF THERE ARE ANY BLANK 7;7/,, Signature Date 9 112— naui afee A The Comnwnwealth of Massachusetts .Department gf lndmirid Accidents Office oflnvesiigadons 600 Washh9ton Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Eiectricians/Plumbers Auulicant Information n Please Print Legit Name(Business ownization/lndividual): V Auw Address: City/State/Zip: Qy, k��vv-n-, .. 0 tVf jPhone Are you an employer?Check the appropriate box: Type of project(required): 1.15 I am a employer with_ 4. ❑I am a general contractor and 6. ❑New construction employees(full and/or part tine)* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.t 7- {�Remode ship and have no employees These yrs have 8. []Demolition working for me in ani►capacity. workers'comp.insurance. 9. n Building addition [No workers'comp.insurance 5. ❑We are a corporation and its 10.Q Electrical repairs or additions � -1 officers have exercised their qu 3.0 I a homeowner doing all work right of exemption per-MGL ll-[]Plumbing repairs or additions myself[No workers'comp. c.152,§1(4),and we have no 12.[-]goof repairs insurance l t employees.[No workers' 13.[]Other, camp.insurance required.] *Any applicant that check box#1 must also fill out the section blow showing their workman'compensation policy information. f Homeowners who submit this affidavit indicating they an:doing all work and then hie outside conhactors must submit anew affidavit indicating suck t'Contractors that check this box must attached an additional sheet shoe ft Bre name ofthe subcontractors and ffieir wodws'comp.policy information. I am an aVloyer that 1s providing workers'compensation&=rmteefor my employees. Below is thepolicy and job site information. Insurance Company Name: (,�.iv®'.r..�• `�a.�3 `a.+.. .�+t� - ;1L Policy#or Self-ins.Lic.#: ��.l�tom/C. 3�"% !300 Expiration Date' nN k-,- Job Site Address: D �-�-� „^� City/StatiefLip: t�Jy. A.�„�vw-.L ut4�,� 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 do 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 hereli certify under the pains and penailies That fhe information provided above is true and correct 5i tures ate: Phone#• C -) Official use only. Do not write in this area,to be completed by city or town offWaL City or Town: PermitUcense# Issuing Authority(circle one): L Board of Health 2.Building Department 3"Cityfrown Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F817/2012 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 SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: M P Roberts Insurance Agency Inc a°Nr� Ext. 978-683-8073 (FAAc.No):978-683-3147 1060 Osgood Street ADDRESS: sandi@mprobertsinsurance.com North Andover Ma 01845 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: PROVIDENCE MUTUAL INSURED KEVIN MURPHY BUILDING & REMODELING INSURER B: MERCHANTS INSURANCE 169 BOXFORD STREET INSURER C: GUARD INSURANCE INSURER D: NORTH ANDOVER, MA 01845 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. LTTRR TYPE OF INSURANCE ANSR SUBFUU -t-W /o POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYYY) LIMITS GENERAL LIABIUTY EACH OCCURRENCE $ 000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 100,000 CLAIMS-MADE CI OCCUR MEDEXP(Anyoneperson) $ 5,000 A CPP0060868 1/22/11 1/22/12 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $ 2,000,000 riPOLICY E Q LOC $ AUTOMOBILE LIABILITY1,000,000 Ea accident) cddent $ IANYAUTO BODILY INJURY(Per person) $ I AALLOOWNED FI SCHEDULED MCA7013608 1/23/12 1/23/13 BODILY INJURY(Per accident) $ B NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident) $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ $ WORKERS COMPENSATION XOW STATU- OTH- AND EMPLOYERS'LIABILITY TORY YIN LIMITS ER ANY PROPRIETORIPARTNEMEXECUrIVE ❑ NIA E.L.EACH ACCIDENT $ 500,000 C (MandEatory E H)EXCLUDED? KEWC317800 0 7/01/12 07/01/1 3 El DISEASE-EAEMPLOYEE $ 500,000 If yes, be DESCRIPTION uOFeOPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS]LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPT THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ANDOVER MA 01810 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED E SENTATI M ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD25(2010/05) The ACORD name and logo are registered marks of ACORD