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Home My WebLink AboutBuilding Permit #315-2016 - 425 BOXFORD STREET 9/11/2015 SCSI wrvCb le BUILDING PERMIT 0 NosrH " �tLeD ,6 ti TOWN OF NORTH ANDOVER 02 APPLICATION FOR PLAN EXAMINATION IPermit No#: Date Received q7ED Pp y c / SSAC HU`�� Date Issued: i ORTANT+: Applicant must complete all items on this page LO-CATION' ?. - .- rint w E IMAF � ,. .4_.PARGEL �ZONINuG'®IST�RICT. �HlstorC ®stmt Yyes -- Villa , x TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building --60ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r �' Septrc tuella DFI odp aI n 0 Weflantls � eWatershed tlS ft Ict aWater/3Sewer�._. � g DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: rs'► , I- �t>�`a J Address: A&:njtractor Name �G� -Pi.;Phone R=� b9 S 3 3 - - _�. .. r I S"upervisor�;ac-b.�n,tract ILicensea IH4orneImp-roement�ILcene� c L ��cr �1� IExp _ � ARCHITECT/ENGINEER 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: $ '�-lC) FEE: $ kO Check No.: �2-9 (,oL" Receipt No.: NOTE: Persons contracting with unregis eyed contractors do not have a cess to the guaranty fund Signature of tAgent/Owne�- _.; ig.nature hof confract _, Location o r Date s; . - TOWN OF NORTH ANDOVER Il4j7 . - Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ a TEO x TOTAL $ Check# 2.v ::'1353Building Inspector Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TYPE"OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ 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 Reviewed On Signature_ COMMENTS 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 Town Engineer: Signature: _ Located 384 Osgoofi Street FIREDEPARTMENT TempDumpsteron site es r� — �Y, � ono _ . . rLocatedeat'124Main;Street _`_" " r dire Deparme�ntsgnature/d,�ate� - y �OMMENTS f 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 Call Email- Date Time Contact Name Doc.Building Pen-nit 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 ❑ 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 p p q 9 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 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 Sprinkler Plan And ❑ Two Sets of Building Plans (One To Be Returned) to Include S p 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:Building Permit Revised 2014 NORT11 own of S E ndover O y" h ver Mass o� > COCHICNewIcw y1' �d A�RgTED Pp�,�'�5 S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....7 �� BUILDING INSPECTOR .. .... . ....... .... .. ..... .. .... .... Foundation has permission to erect .......................... buildings on � �j go Rough to be occupied as ..........�a ►e !�.. G�t.�.... Qlt'�rn4...................... 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 I MONTV ELECTRICAL INSPECTOR UNLESS CONSTRU ST T Rough Service .............:.................................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. 98 Forest Sheet - --- -- -- NorltAndover.MA01845 PH:978-688"`'335 FAP- Yr FAX:978-688-7207 i Building Contactor Ptelpeselands unless of ChapW Tom&Wendy Ventl area p,o„es tw by pm,i,is exemPl m 03red the To: 425 Boxford Street WwficeboUl 1a iye 9e(,M usetts,u+a� DDwedo HWV Ma. 01845 co�rnna> show As►,tx „P North Andover, reglrrii ,,C,*,+eg ns,n727859 ROM 1301, Kevin Murphy ROM. CC. Date: 911012015 Replace ex's deck Job: Dow of pts, None None Same this agreement,unless sp�W here in schedule following the signing of�ctlOtll—Work materials before the third day feted by 925115.The owner hereby acknowledges as in the��or order thut9114115. considered Contractor will beg work on or about �will be comp • b the Contractor shall no be ung ce�,ctor will begin wo rs control,the wo that are nurnstot avoidable Y ani beyond Contac d that such delays Barring Delay caused by dl g dates are approximate and agrees this agreement• violations for a period of 1 year and worlunanship or materials,or frDrn defects in materials defect in worknranshipDn of any Job, $ectlOn 11—Watt>re Y In the event Y ear ae tidied,rePal ,°r work fumished hereunder shall be is reement vAh'n one Y in that the wo th the requirements°f s or gents,is discoveredreplace,or cause on Pe The Contractor warrents dors,employee)wh remedy repair correct Pies shall survive any inspe� following completion by thew t comply h s I hiso own expense,fodh'^ . The foregoing' e caused by nVactor shall,at his o ficmanshiP- damag cleanup,the Co m materials or`N0 including lean such damage or such defect replaced, with the agreed-upon work• Section 111-Scope of Wim` Page 1 of 4 r t f � itop- I.M.00 I +I I I 1 I { I I I t I t I { i 1 The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMMING AUTHORITY. Applicant Information ` Please Print Leeibly Name(Business/Organization/Individual): `�►p��..� �✓�a Address: 't?j i7tvro,seS Sir •"� City/State/Zip: Qv, f�v..J�,t,w.� tLk ._ ON,� �Phone#: fx- �_ 6 TV •S'3-7 Are you an employer?Check the appropriate box: Type of project(required): 1 I am a employer with _employees(full and/or part time).t 7. New construction 2. I am a sole proprietor or partnership and have no employees working for me in S. Remodeling any capacity.[No workers'comp.insurance required.] 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9. Demolition 10 Q Building addition 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I vr71 ensure that all contractors either have workers'compensation insurance or are sole I Ln Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance? 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. i I ant an employer t/tat is providing wor/rens'compensation insurance fol•my employees. Below is the policy andjob site information. i Insurance Company Name: �y v e e�_ r..r Policy#or Self-ins.Lic.#: C— t S'.3"1 3 Expiration Date: Job Site Address: kA-7-� v City/State/Zip: t.Jrj Attach a copy of the tivorkers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be foiwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido here y certify rittder thepaitts atidpeitaltie _petjuty that the information provided above is ttwe and correct: Si nature e—�� Date: Phone#: ''.'1 c laty`5-31 S", Official use only. Do not write in this area,to be completed by city or tmvtt official. City or Town: Permit/License# Issuing Authority(circle one): ; 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector• 6.Other Contact Person: Phone#: i I DATE(MMIDD�WY1') CERTIFICATE OF LIABILITY INSURANCE F7 THIS CER71FICATEIS ISSUED AS A MATTER OF INFORMATIONONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATEHOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELYOR 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 REPRESENTATTV®R PRODUCER,AND THE CERTIFICATEHOLDER. IMPORTANT:H the eertMeateholder Is an ADDRIONAUNSURED,the policy(los)rust be endorsed.H SUBROGATIONIS WAIVED,subtest to the terms and conditions of the poliryFertain poiiciesnayrequireanandomemerd.A statememon thiseertificatedoes not conferrights to the certifieateholder in lieu of such endorsemam(s). PRODUCER CONT CT Sandi Munroe M P ROBERTS INS AGCY INC PHONE FAX 1060 Os good Street (AC,No. (978)683-8073 A�Ne, (978)683-3197 g ADDRESS: sandi@mprobertsinsurance.com North Andover, MA 01845 INSURER(S)AFFORDING COVERAGE NAICa INSURERA: MERCHANTS INSURANCE INSURED KEVIN MURPHY BUILDING 6' REMODELING INSURER B: GUARD INSURANCE 169 BOXFORD STREET INSURERC: NORTH ANDOVER, MA 01845 INSURERD: INSURER E INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT TI-E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE MSURFD 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 TIE TERMS, EXCLUSIONSANDCONDITIONS OF SUCH POLICIES LIMITS SHOWNMAY HAVESEEN REDUCED BYPAID CLAIMS. am POLICY EFF POLICY EXP TYPE OFINSURANCE POLICY NUMBER LIMITS X COMMERCALGENERAL LABILITY EACH OCCURRENCE $ 1 000 000 CWMSMADE rX OCCUR PREMISES a ammerra $ 500,000 MED EXP(Anyonepemmn) $ 15,000 A BOPI068945 1/22/14 1/22/15 PERSONAL SADV INJURY $ INCLUDED GEN'L AGGREGATE UMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO- JECT LOG PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER $ AUTOMOBILE LIABILITY COMBINED SINGLEUMIT $ 1/OOO OOO Ea aa9derd / ANYAUTO SODILYINJURY(Perpen—) $ ALL OWNEDX AUTOS SCHEDULED MCA7013608 1/23/15 1/23/16 AUTOS BODILY INJURY(Per accltlem) $ p, NONOWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS aaiderrt UMBRELLA UAB EACH OCCURRENCE $ 1,000,000 AEXCESS UAb +1 ClA1MSMADE AGGREGATE $ 1,000,000 RCUP9145304 1/22/14 1/22/15 . DED RETENTION $ WORKERS COMPENSATION X I PER 7-71-- AND EMPLOYERS'LIABILITY YIN STATUTE ER B NIA E.L.EACH ACCIDENT $ 500,000 (Menaatoyn NN)Lu KEWC633734 7/01/15 7/01/16 E.L DISEASE-EA EMPLOYEE $ 500,000 If yas.dasalba ander 500,000 DESCRIPTION OFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OFOPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additlonal RemakaSdhedde,may be ate Bred If-we space is req*ed) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN nim BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD f Massachusetts -Department of Public Safety • Board of Building Regulations and Standards Construction Supenisor i License: CS-053099 KEVIN W MURPIy-Y 98 FOREST ST f' North Andover Na 01845,} 954— Expiration Commissioner 06/29/2015 ` U/ae tpao��,zaraauea�o�C�/�,cr�cc�ar�eGla Office of Consumer Affairs&Busi be Regulation OME IMPROVEMENT CONTRACTOR egistration: f0187 Type: xpiration: :_,6/29120%1:6.. Individual KEVIN MURPHY Kevin Murphy 98 FOREST ST. g � N.ANDOVER, MA 01845 Undersecretary y