HomeMy WebLinkAboutBuilding Permit #862-15 - 461 SUMMER STREET 4/30/2015iBUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: 1-'& I --
Date Issued:
RTANT:
LOCATION
Date Received
must complete all items on this
PROPERTY OWNER�.,,��`ilA..r
Print 100 Year Structure. yes
!MAP & _�-+PARCEt: ZONING: DISTRICT:
Historic District,yes
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
tOne family
❑ Addition
❑\Two or more family
❑ Industrial
Iteration
N`o. of units:
0 Commercial
❑ Repair, replacement
❑ Demolition
❑ Assessory Bldg
❑ Other\,
11 Others:
%Septic ❑ Well
❑ Floodplain El Wetlands
❑Watershed Distric_ t
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
LA
dentif1 tion - P ease Type or Print Clearly
OWNER: Name: �� t�,r,� ,` cam \U �►.•, Phone:'v6t- 'k.'i_ft - L? -
Address: %.C\;,
Contractor, Name:-lL� �A..._ __, Phone: �,�+ �, 3
Address:.
Supervisor's Construction License: U �5' 3_y_kA\ Exp. Date: _ l k Zrt
Home Improvement License:
Date: __ _. ��'
ARCHITECT/ENGINEERPhone:
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: $ 01,L31/0 FEE: $
Check No.: Receipt No.:�(
NOTE: Persons contracting with unpgisrqed contractors do not have access to the guaranty fund
SS g ature of Agent/Owner � nature of contracto
Plans Submitted ❑
Plans Waived
Certified Plot Plan ❑ Stamped Plans ❑
TYPE"OF SEWERAGE DISPOSAL
Public Sewer ❑
Tanning/Massage/Body Art ❑
Swimming Pools ❑
J
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:
Comm
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384
FIRE DEPARTMENT - Temp •Dumpster on site yes no
Located at 124 Main Street
Fire Depgrtment sig- tureldate
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
I ❑ 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
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
❑ 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: Building Permit Revised 2014
Al I
Location TUI
No. 2- Date
Check_#
-1 2
TOWN OF NORTH ANDOVER
Certificate of Occupancy $—
Building/Frame Permit Fee $/&'d?,
Foundation Permit Fee $
Other Permit Fee $—�— �-,
TOTAL
Building Inspector
Enter construction cost for fee cal -
North Andover Fee Cakulation
Construction Cost
$ 13,300.00
m
$ -
$
159.60
Plumbing Fee
$
19.95
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
19.95
Total fees collected
$
299.50
461 Summer Street
862-15 on 4/30/15
Bathroom remodel
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Kev"nMurphy-
Building
Contractor
Proposal
To: Jen Bilodeau
461 Summer Street
North Andover, Ma 01845
From: Kevin Murphy
CC:
Date: 4/29/2015
Job: Bath Remodel
Date of plans: None
Architect: None
Location: Same
Section I - 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 8596
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 4/27/15.
Baring Delay caused by circumstances beyond Contactors control, the work will be completed by 5/30/15. 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
Kevin Murphy
Building Contractor
98 Forest Street
North Andover, MA 01845
PH: 978888-5335
FAX 978-688-7207
General
Proposal is to renovate existing second floor full bath. Permit will be obtained by contractor.
Demolition
Existing bathroom will be completely gutted.
Building
Any building materials required for renovation will be provided. Existing window to remain.
Plumbing
Page 2 of 4
Plumbing required to renovate bathroom will be provided. Fixtures to remain in same location. All plumbing
fixtures to be supplied by owner / installed by contractor.
Electrical
Electrical work required to renovate bathroom will be provided. New Panasonic bath fan / light will be supplied
and installed. Any surface mounted fixtures ( vanity lights ) will be supplied by owner, installed by contractor.
Heating/Air Conditioning
Existing baseboard heat will be cut back / replaced as required. No allowance has been made for any air
conditioning.
Insulation
Fiberglass insulation will be supplied and installed.
Plaster
Bathroom will be blueboarded and skimcoat plastered. Walls will be smooth. Ceiling to match existing.
Interior Trim/Doors
Interior trim will be supplied and installed to match existing. No allowance has been made for any door units.
Bath vanity / cabinets to be supplied by owner/ installed by contractor.
Painting
No allowance has been made for any painting.
Flooring
Tile floor will be supplied and installed. An allowance of $6 per square foot has been included for tile materials.
No allowance has been made for any other tile work ( around tub /,on walls ) .
Kevin Murphy
Building Contractor
98 Forest Street
North Andover, MA 01845
PH: 97846885335
FAX 9784688-7207
Waste Removal
All demolition / construction debris will be disposed of by contractor.
Page 3 of 4
Kevin Murphy
Building Contractor
98 Forest Street
North Andover, MA 01845
PH: 978688-5335
FAX 978688-7207
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 ..................................... $13,300
Payment to be made as follows:
Percentage/Item
Description
Amount
1
Permit obtained / demolition complete
$3300
2
Plastering complete
$6000
3
Job complete
$4000
3
1 $13,300.00
—Notice: No agreement for Home improvement art -acting work shall require a down payment (advance deposit) of more that orae -third of the total contract price of the total amount of all deposits or
payments which the contractor must make, in advance, to order andlor 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 TH ONTRACT IF THERE ARE ANY BLANK SPACES
Signature Date `�q
Signature Date,
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street, Suite 100
Boston, MA 02114-2017
J' www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Etectricians/PIumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual):"—
Address: t
S
�
City/State/Zip:t/• • '�--L N*-+ r 018 Phone #: b l -3n
Are you an employer? Checkthe appropriate box:
LW am a employer with ` employees (full and/or part-time).*
2.❑ I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
1F] I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
4.❑ I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers' compensation insurance or are sole
proprietors with no employees.
5.❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.1
6.❑ We are a corporation and its officers have exercised their right of exemption per MGI. c.
152, § 1(4), and we have no employees. [No workers' comp. insurance required.]
Type of project (required):
7. ❑ New construction
8.emodeling
9. Demolition
10 E] Building addition
11.0 Electrical repairs or additions
12.0 Plumbing repairs or additions
13.E] Roof repairs
14.0 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.
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 am art employer ilial is providing wor Icers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company NameG,— _
Policy # or Self -ins. Lic. #: `(x, L --C.. 6 1'� Expiration Date: Q�'
T.,1, Q,+. A AA—..- Q _ 6 L (*v Y�L-+ tw i„_ /k. _ .l . - - A— ,019,4511
I?\9,4J
Attach a copy of the workers' 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 forwarded to the Office of Investigations of the DTA for insurance
I do her4y certify under the pains and
—1
that the information provided above is true and
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 Cleric 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person:
Phone #:
CERTIFICATE OF LIABILITY INSURANCE
6/25/2014 �"�`'
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 endorsements .
PRODUCER
M P ROBERTS INS AGCY INC
CONTAAMCT Sandi Munroe
N
PHONE(g78) 683-8073 FAX ND (978) 683-3147
1060 Osgood Street
North Andover, MA 01845
ADE-MAILDRESS, san i Ldmprobertsinsurance.com
INSURERS AFFORDING COVERAGE NAIC#
INSURERA: MERCHANTS INSURANCE
INSURED KEVIN MURPHY BUILDING & REMODELING
INsURFJts: GUARD INSURANCE
INSURER C:
169 BOXFORD STREET
INSURER D:
NORTH ANDOVER, MA 01845
U ER E :
FIN
NSURERF.
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 PEF40D
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 BYPAID CLAIMS.
ILTR
TYPE OF INSURANCE
NSD
VWD
POLICYNUMBER
POLICY EFF
MM(DD'
POLICY EXPLIMITS
ATA ty
X COMMERCIAL GENERAL LABILITY
EACH OCCURRENCE $ 1,000,000
CLAIMS -MADE ® OCCUR
IBOPI068945
UAMAGh 10 KEN I ED
PREMISES Ea occumancel $ 500,000
MED EXP oneperson) $ 15,000
11/22/13
1/22/14
A
PERSONAL& ADV INJURY $ INCLUDED
GEN'LAGGREGATE
LIMIT APPLIES PER
GENERAL AGGREGATE s 2,000,000
POLICY ❑ jE 0. ❑ LOC
PRODUCTS - COMP/OP AGG $ 2 0 0 O O 0 0
$
OTHER:
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT $1,000,000
Ea dent
BODILY INJURY (Per person) $
ANYAUTO
MCA7013608
01/23/14
],/23/15
A
ALLOWNED SCHEDULED
AUTO X OS
BODILY INJURY (Per accident) $
NON -OWNED
PROPERTY DAMAGE $
P d t
HIRED AUTOS AUTOS
UMBRELLA UAB
OCCUR
EACH OCCURRENCE $ 1,000,000
AGGREGATE $ 1,000,000
A
EXCESS UAB
CLAIMS -MADE
CUP9145304
11/22/13
1/22/14
DED RETENTION
WORKERS COMPENSATION
X SEN ATU TE OETR
AND EMPLOYERS UABILnY Y
500,000
ANYPROPRIEFEMB
NIA
E.L.EACHACCIDENT $
500,000
2 t�LUDRDrECUTNE
KEWC527844
07/01/14
7/01/15
(Mandatory in NH)
E.LDISEASE- EAEMPLOYEE $
500 000
Ifyes, descrbeunder
RIPrION OF OPERATIONS ow
E. DISEASE -POLICY UM r
DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (ACORD 101, AddiOond Remarks Schedule, maybe attached if more space is required)
TOWN OF NORTH ANDOVER
1600 OSGOOD STREET
NORTH ANDOVER 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
(/71989-2014 ACORD CORPORATION. All rights reserved
ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD
f -
R
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS -053099 a,
KEVIN W M MIft JI(
98 FOREST ST
North Andover WA 0
J� w w "\ Expiration
Commissioner 06/29/2015.
• Vfae c;-,pa��vr�aaracaea.� C�accciccaeC� �
Office of Consumer Affairs & Busihess Regulation
OME IMPROVEMENT CONTRACTOR
egistration: x`01874 Type:
xpiration:,. -6%29%2016. Individual
KEVIN MURPHY
Kevin Murphy
98 FOREST ST.
g � n
N. ANDOVER, MA 01845 '' Undersecretary