HomeMy WebLinkAboutBuilding Permit #756-14 - 461 SUMMER STREET 4/28/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued: 4
IMPORTANT: Applicant must
LOCATIONS
Print:
`PROPERTY OIIVNE _ . -._ ► . ;_
all items on this
TYPE OF IMPROVEMENT.
MAP'NO: ARCEL:
Prinfi
ZONING DISTRICT:.
100 Year Old Structure
Histone District
yes.:
yes
Non- Residential
❑ New Building
IYOne family
Machine Shop Village
yes
TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
❑ New Building
IYOne family
❑ Addition
❑ Two or more family
❑ Industrial
Alteration
No. of units:
❑ Commercial
'lid Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
'68e tic 11 111
Floodplain ❑Wetland's
❑Watershed District:
a %Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
Identi cation Please Type or Print Clearly)
OWNER: Name:3•\�d.��,•.-
Address: �4- 61
•'1Z�
CONTRACTOR' Name: Lem:._ IM.. r�t�„ _ Phone:
SAddress: � � wrti,r_ __ __ _ R . - - - __ . _r•,h... _.h�y-,tel.`, ...._.(�.,�.,.._..__ -
Supervisor s Cgnstruction License: U; *3.v C __y _.:Exp.. Date:. 6
Home Improvement License; l.D 1 ` `' r :. Exp 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.
Total Project Cost: $ \\.SyQ FEE: $ V3
Check No.: 12:1-3-7, Receipt No.: � �q
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Plans Submitted FE Plans Waived Certified Plot Plan ❑ Stamped P
Plans -Submitted. ❑ Plans-Waivel- Certified Plot Plan ❑ Stamped Plans" ❑
TY,PE-OUEW,ERAGE-DISPDSAL.
Public Sewer ❑
Tanning/MassageMody Art F1
Swimming Pools ❑
Well ❑
Tobacco -Sales 0
'Food Packaging/Sales 11
Private=(septic tank, -etc-
Pennaii6ftt Dimpster on Site ❑
THE. FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT'
COMMENTS
_:-._-DATE REJECTED: DATE APPROVED
F1 F1
-CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
4. 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 Toiv;2 Engineer: Signature:
Located 364 UscloociStreet
FIRE DEPARTIVIE"NT Temp Dumpster on site Yes no
Located "bt24iWiri Strdet:-,,,. zY,
'Fire-I)d
p me a
-Dim�e�si�n
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 Pp requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL.Chapter466.Section 21A. --F and G min.$100=$1000 fine
NOTES and DATA — (For department use
® Notified for pickup - Date
Doe.Building Permit Revised 2010
Building Department
`-The foli'swing'is•a-list of.therequired forms to befilled out for. the appropriate. permit to.be obtained.
Roofhilg, Siding, Interior Rehabilitation Permits
❑ ' Building Permit Application
o Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L Licenses
o Copy of Contract
o 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
❑ Certified Surveyed Plot Plan
o Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
o ___Engneering__Affidavts 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)
o Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
Li Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
Li 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 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 subm:tted with the building application
Doc: Doc.Bui'ding Permit Revised 2012
Location %c�V m rhe -4
No.
No.
Check # Z.
2748
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
U1 www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/OrLranization/Individual): � (,_ _ ;. s
Address:
City/State/Zip: A N,-_ O W41"Phone #: C� S-3 3
Are you an employer? Check the appropriate box:
Type of project (required):
IV I am a employer with �
4. ❑ I am a general contractor and I
6. [J Now construction
employees (full and/or part-time).*
have hired the sub -contractors
7• ❑ Remodeling
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet #
ship and'have no employees
These sub -contractors have
8. ❑ Demolition
working for me in any capacity.
workers' comp. insurance.
9. ❑ Building addition
[No workers' comp. insurance
5. ❑ We are a corporation and its
1011Electrical repairs or additions
required.]
3. ❑ I am a homeowner doing all work
officers have exercised their
right of exemption per MGL
11. ❑ Plumbing repairs or additions
myself. [No workers' comp.
c.152, § 1(4), and we have no
MaRoof repairs
insurance required.] t
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.
t Homeowners who submit this affidavit indicating they aie 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 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 Name:. V VIA v- 0�_ L"s , �u
Policy # or Self -ins. Lic. #: ALL - `l2Z �(,(� 'L Expiration Date: 'Z L V 1
Job Site Address: b Ste- M---�- Sa'^f-•-r City/State/Zip: 11ir �t�,k�•�--1-- . a�b"�D
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as requiredunder Section 25A of MGL c.152 can lead to the imposition of criminal penalties of a
flue 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 DIA. for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
n
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. PIumbing Inspector
6. Other - - -
Contact Person: Phone #:
Kevin M4,urphy,
Building Contractor
Proposal
To: Jennifer Bilodeau
461 Summer Street
North Andover, Ma. 01845
From: Kevin Murphy
CC:
Date: 4/28/2014
.lob: Garage repairs / roof
Date of plans: None
Architect None
Location: Same
Section 1— Work Schedule
• 98 Forest Street
• North Andover, MA 01845
• PH: 978-688-5335
• FAX: 978.688-7207
All Home improvement Contractors and Subcontractors
engaged in home improvement contracting, unless
specifically exempt from registration by Provisions of Chapter
142A of the general laws, must be registered with the
Commonwealth of Massachusetts. Inquiries about
registration and Status should be made to the Director, Home
Improvement Contract Registration, One Ashburton Place,
Room 1301, Boston, MA 02108. (617}727 8598
Contractor will begin the work or order the materials before the thins day following the signing of this agreement, unless specified here in
writing contractor will begin work on or about 5/1/14.
Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 5/30/14. 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 III - Scope of Work
Page 1 of 4
Rr ,
Kevin Murphy
Building CorATactor
98 Forest Street
North Andover, MA 01845
PH: 978-88-5335
FAX 97888&7207
General
Page 2 of 4
Proposal is to repair and reroof existing two stall garage and connected family room . Building permit will be
obtained by contractor.
Demolition
Existing roof will be stripped.
Building
Center post between two garage doors will be repaired / replaced as required. Ceiling / roof of garage will be
jacked up / straightened. Rotted trim around garage doors will be replaced. New roof shingles will be supplied /
installed to match existing. Ice and water sheild will be installed at all roof edges / valleys. Flashing around
chimney will be replaced as required. Ridge vent will be installed.
Plaster
Ceiling in family room will be repaired from water damage.
Waste Removal
All construction debris will be disposed of by contractor.
Other Allowances
An allowance of $3000 has been included to replace the two existing garage doors and openers. ( $1500 per
door/opener)
Items Not Included
There has been no allowance made for any painting
Kevin Murphy
Building Contractor
98 Forest Street
North Andover, MA 01845
PH: 9788885335
FAX 978688-7207
Section N - 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 ..................................... $11,500
Payment to be made as follows:
Percentagentem
Description
Amount
1
Roof complete
$6000
2
Ceiling repaired
$2500
3
Garage doors installed /job complete
$3000
2
$11,500.00
"Notice: No agreement for Home improvement contracting work shall require a down payment (advance deposit) of more that me -third of the total contract price of the total amount of all deposits or
payments which the contractor must make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever 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 THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Signature Date tl.
Signature Date
ACCORV CERTIFICATE OF LIABILITY INSURANCE
7%17(120113
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(ies) 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
M P ROBERTS INS AGCY INC
1060 Osgood Street
North Andover, MA 01845
CONTACT
NAME:
PHONE (978) 683-3147
Arc No Ext : 978) 683-8073 FAXAIC,No
ADDRESS: sandi@tnprobertsinsuranee.com
BOP1068945
11/22/12
INSURER(S) AFFORDING COVERAGE NAICk
INSURER A: PROVIDENCE MUTUAL
PREMISES Ea occurrence $ 500,000
INSURED KEVIN MURPHY BUILDING & REMODELING
INSURERB:MERCHANTS INSURANCE
169 BOXFORD STREET
INSURER C: GUARD INSURANCE
INSURER D:
NORTH ANDOVER, MA 01845
INSURER E
AUTOMOBILE
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.
INSR I
LTR
TYPE OF INSURANCE
ADDL
LNSD
SUBR
IWO
POLICY NUMBER
POLICY EFF
MM/DD/YYYY
POLICY EXP
MMIDDNYYY
LIMBS
A
X I COMMERCIAL. GENERAL LIABILITY
CLAIMS -MADE L.-- 1 OCCUR
BOP1068945
11/22/12
11/22/13
EACH OCCURRENCE $ 1 , OOO OOO
PREMISES Ea occurrence $ 500,000
MED EXP (Any one person) $ 15,000
PERSONAL &ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER
POLICY � ECT 1—t LOC
OTHER:
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMPIOP AGG s 21000,000
$
B
AUTOMOBILE
LIABILITY
ANYAUTO
ALL OWNED SCHEDULED
AUTOS X AUTOS
NON-0WNED
HIRED AUTOS AUTOS
MCA -7013608
01/23/13
01/23/14
COMBINED SINGLE LIMIr—
(Ea accident) $ 1,000,000
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PR RTY DAMAGE$
Per accident)
$
B
UMBRELLA LIAB
EXCESS LIAB
1 OCCUR
CLAIMS -MADE
CUP9145304
11/22/12
11/22/13
EACH OCCURRENCE $ 1,000,000
AGGREGATE $ 1,000,000
DED I I RETENTION $
$
C
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY YIN
ANY PROPRIETOR/PARTIJERIEXECUTIVE
o�^� in NH) ElEMBER EXCLUDED?
If yes, describe under
DESCRIPTION OF OPERATIONS below
NIA
KMC422467
07/01/13
07/01/14
OTH
X I STATUTE I !ER
E.L. EACH ACCIDENT $ 500, 000
E.L. DISEASE - EA EMPLOYEE $ 500,000
E.L. DISEASE -POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required)
L;EHIIFIC:ATE 1101_0ER I"LLWI=l I Wrinm
TOWN OF NORTH ANDOVER
BUILDING DEPT.
NORTH AHdDOVER MA 01845
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 REPRES A
1
' I
(91988-2013 ACORD CORPORATION. All rights reserved.
ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD