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HomeMy WebLinkAboutBuilding Permit #460-15 - 461 SUMMER STREET 11/12/2014BUILDING PERMIT ,Eo ;bgti TOWN OF NORTH ANDOVER a� y''`- - ` 4° APPLICATION FOR PLAN EXAMINATION ~ n h Permit No#: (1 ^/ Date Received,/ 4" 7 peRwr.., P Date Issued: I ( I Z-' 1 IMPORTANT: Applicant must complete all items on this pane LOCATION': L4 ti_t —. nP'nIt PROPERTY OWNER__ yc�e_o►y _ __ Print 100 Year Structure yes no MAP PARCEL: .= ZONING DISTRICT: .Historic District yes _ z ;Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 160ne family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial -6Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ,epic [).Well Q Floodplain ❑ Wetlands ❑ Watershed District Wat /Sewer DESCRIPTION OF WORK TO BE PERFORMED: ��++ rl 7_�e^,, ,` 1/UtA& t /%—, U � / 6)-2 - Please Type or Print Clearly OWNER: Name: Address: q0 S--- v,-� S �- t\b Contractor Name: V.*- ,,- IN,," Phone: Address: + T' S. tiw.•' 1w A�.�.J,.vti.. M�.... 4 tQ L0, Supervisor's Construction License: OSI 04�0�_ Exp. Home Improvement License: C ARCHITECT/ENGINEER "yw—e 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: $ S -Lo 0 , G d FEE: $ (-,Z, 0 Q Check No.: 12, �( b Receipt No.: 0 (�6 NOTE: Persons contract with un5xtW ed contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TYPE"OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiimning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sale's ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Siqnature COMMENTS a HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Commen Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located _384 Osgood treet 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup Call Ema Date Time Contact Name Doc.Building Permit Revised 2014 No 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 o Copy of Contract o 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) o Building Permit Application ❑ Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 Location/ No. Date tj /j/ TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Check 4t 28253 ...- Building Inspector c W) \ \ .� \ � cl § ©� / § 70 c . 0 V) C C CD o � ~� ^ ` \` � \ 0) � CL a) = w ce) -9 r u 0 \ - zz 0 tj V) U)7 LO E z -cc 00 E U o m u 4 (n 'D 0 4, U) 0 2/J ) 10 co (n > LLJ 0 ` �� \ / § . w w > LO 0 00 0 4, LU 0 (n > LLJ 0 z >0 LL w 00 Kevin. MrPby Building Contr7tor Proposal To: Jeniffer Bilodeau 461 Summer Street North Andover, Ma 01845 From: Kevin Murphy CC: Date- 11/12/2014 Job: Doors 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 Commonweafth 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 4 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 11/10/14. Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 11/30/14. 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 Kevin Murphy Building Contractor 98 Forest Street North Andover, MA 01845 PH: 9786885335 FAX 978-8&7207 General Page 2 of 4 Proposal is to replace two existing door units. Building permit will be obtained by contractor. Building Two new fiberglass exterior door units will be supplied and installed in existing openings. An allowance of $2000 has been included for door units. No allowance has been made to supply any new storm doors. Siding / trim will be supplied / installed to match existing. Waste Removal Any construction related debris will be disposed of by contractor. Kevin Murphy Building Contractor 98 Forest Street North Andover, MA 01845 PH: 978688-5335 FAX 97868&7207 Section IV - Price Schedule Page 4 of 4 We hereby propose to furnish material and labor — complete in Accordance with above specifications for the sum of ..................................... $ 5200 Payment to be made as follows: —Notice: No agreement for Home improvement contracting work shall require a down payment (advance deposit) of more that one-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 ftlldf Signature Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA. 02111 www massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name Address: `� F�� 5�•.,�,� City/State/Zip: Nr A A -uv^ , 1�. _ Oq,�TYone #: - b 5-3 3 J Are ou an employer? Check the appropriate box: 1. I am a employer with 1 4. ❑ I am a general contractor and I employees (full and/or part-time)." have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ 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 -S Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12.❑ Roofrepairs 13.❑ 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 tie 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:. C,,/ . Policy # or Self -ins. Lic. #: 5r 2.-1 9W—t- Expiration Date: —1 Job Site Address: �-C � � S _ City/State/Zip: " . � .-Acam. � , k o L b `.t 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 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 DTA for insurance coverage verification. I do her¢�y certo under thepains andpenalties ofperjury that the information provided above is true and correct. Qionafirra n = list[:' l _ k W 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 Phone M Amo H CERTIFICATE OF LIABILITY INSURANCE 777 DATE (MM/DD/YYYY) 6/25/ 014 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 CONTACTSandi Munroe NAME: PHONE 978 683-8073 FAX (978) 683-3147 N,11 (978)683 ooREss: san i mpro ertsinsurance INSURERS AFFORDING COVERAGE NAIC# INSURER A: MERCHANTS INSURANCE INSURED KEVIN MURPHY BUILDING & REMODELING 169 BOXFORD STREET NORTH ANDOVER, MA 01845 INSURER B: GUARD INSURANCE INSURERC: INSURER D: NSURERE, IN URE F; COVERAGES CERTIFI('ATF Nl)MBFR- REVISION Nl)MBFR- THS 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. LTR TYPE OF INSURANCE INSD VWD POLICYN MBER POLICY EXPLIMITS MMX COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1 000 000 CLAIMSMADE OCCUR rPOLICY EM ES Ea ur $ 5OO OOO MED EXP oneperson)$ 15 000 BOPI068945 11/2/13 1/22/14 A PERSONAL&ADV INJURY $ INCLUDED GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY [:] JEC7 [:] LOC PRODUCTS-COMPIOP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea acc d t BODILY INJURY (Per person) $ ANYAUTO MCA7013608 01/23/14 1/23/15 A ALLOWNED SCHEDULED AUTOS X AUTOS BODILY INJURY (Peraccdent) $ PROPERLY DAMAGE $ NON -OWNED HIRED AUTOS AUTOS P ident UMBRELLA LIABOCCUR EACH OCCURRENCE $ 1,000,000 AGGREGATE $ A EXCESS UAB HCLAIMS-MADE CUP9145304 11/22/1311/22/14 DED I I RETENTION WORKERS COMPENSATION X S TATUTE ER ANY AND EMPLOYERS' LIABILITY N 500,000 B PROPRIErOR/PARTNER/DCECUTIVE NIA E.L. EACH ACCIDENT $ 500,000 O EXCLUDED? KEWC527844 07/01/14 7/01/15 (Mandatoryin NH) (Mandatory E.L. DISEASE - EA EMPLOYEE $ Ifyes, descrbeunder 5OO OOO DESCRIPTION OF OPERATIONS1 E.L. DISEASE -POLICY LIMIT DESCRIPTION OF OPERATIONS/ LOCATTONS/VEHICLES(ACORD 101,AdditionalRemarksSchedule,maybeattachedifmorespaceisrequired) r:FRTIFICATF Hoo TTFR CANCFI I ATION TOWN OF NORTH ANDOVER. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 OSGOOD STREET NORTH ANDOVER MA 01845 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD