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HomeMy WebLinkAboutBuilding Permit #910-15 - 47 HUCKLEBERRY LANE 5/13/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION X1-1 1-1 � ltle_� z, -r �-, Le c%e- ` Print PROPERTY OWNER (.it .L r Print I✓ 100 Year Structure yes MAPS PARCELt.�-� g ZONING DISTRICT: Historic District yes Machine Shor) Villaae ves no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building itone family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial fiRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ater/Sewer ,,DESCRIPTION OF WORK TO -r2N?.,.)\A--1 a C -A- &"",j OWNER: Name: Address: A PERFORMED: - Please Type or Print Clearly Phone:ln b W & w \\ 63 Contractor Name:_ ,. �Phone: n t ; Address:. Supervisor's Construction License: Q - v '� aI Exp. Date: Home Improvement License: +,01 t Date: ARCHITECT/ENGINEER bUdt-P,i' 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: $;��`�' �c{1i) FEE: $U V 3 Check No.: I2 -I S 2 Receipt No.: 2-s6' 1(P5 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund gure of Agent/Owne - - ure of contracto nat 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 Doe: Building Permit Revised 2014 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 I ❑ Notified for pickup Call Email 11 Date Time Contact Name Doc.Building Permit Revised 2014 No ,r Plans Submitted ❑ Plans Waive 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 COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS 0 Signature, Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: f Planning Board Decision: Conservation Decision: Comments Comme Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 o d Street no Location No. 1W Date Check# �2*1 � 2- .-I - - 261 t,, TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $-* e7D �4 - Building Inspector O G O ujd z o D m o~ z_ Cl) LLI C X W C.1 �w az 0 w a W O N w a.+ z 0 L d N c c o mm O d Cc °' L O Q CL �a J � O Z th r_ cc CL 0 � u W d N Z O ZcGo m C O LLd' W O T L fD C p u W z Z O Z d 3 O _ O LL O U N z Q U cc W W �h0 O K 41 U L N {n C LL 0 W a H ? N OA Q O K C LL F- w cc Q W O LU LL E O m O Z y y N 0 N O E N .� W 2 U. O G C E m O N Yv le -0 Y O LL u U! O 'a G O ujd z o D m o~ z_ Cl) LLI C X W C.1 �w az 0 w a W O N w a.+ z 0 L d N c c o mm O d Cc °' L O Q CL �a J � O Z th r_ cc CL 0 U! O 'a = O QCL . O O F— f/) O to y v m t `0 4- W O O umi(n 2 AD = N a+ Z. V •E 00.0 W va m o 4-o (n t , Q. O 0 G O ujd z o D m o~ z_ Cl) LLI C X W C.1 �w az 0 w a W O N w a.+ z 0 L d N c c o mm O d Cc °' L O Q CL �a J � O Z th r_ cc CL 0 • 98 Forest Street Ii/�1 Kevin rp • North Andover, MA 01845 • PH: 978-688-5335 Building Contractor FAX: 978-688-7207 Proposal To: George Murphy 47 Huckleberry Lane North Andover, Ma. 01845 From: Kevin Murphy Citi: Date: 5/13/2015 Job: Windows / Ice damn repair Date of plans: None Architect: None Location: Same Section 1- Work Schedule 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 third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 5/11/15. Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 6/10/15. 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 fumished 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 Kevin Murphy Building Contractor 98 Forest Street North Andover, MA 01845 PH: 978588-5335 FAX 978588-7207 Page 2 of 4 General Proposal is to supply and install six Harvey replacement windows, and repair wall damage due to ice damns. Permit will be obtained by contractor. Demolition Section of wall damaged from ice damn / water will be cut out and replaced. Building Six Harvey Majesty replacement windows will be supplied and installed in existing openings. Any rotted trim will be replaced. Interior casing to remain. Windows will have full screens, and grilles between the glass, to match existing. Plaster Wall will be patched / plastered as required. Painting Minor interior / exterior painting around windows will be provided. Repaired section of living room wall will be painted. Laundry room ceiling, and stained section of garage ceiling will be primed / painted as required. Waste Removal All construction debris will be disposed of by contractor. Kevin Murphy Building contractor 98 Forest Street North Andover, MA 01845 PH: 978888,5335 FAX 978888-7207 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 ..................................... $ 6675 Payment to be made as follows: Percentage/Item Description Amount 1 Permit obtained / deposit $3000 2 Job complete $3675 2 $6,675.00 "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 SignaturOK- _ Date SI VLAI,5" Signature Date The Commonwealth of111'assachusetts Department of IndustrialAccidents 0 1 Congress Street, Suite 100 Boston, MA 02114-2017 www. mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/E lectricians/PIumbers. TO BE FILED A'VITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (BAusiness/Organization/Individual): 1 A_ ,.,P� Address: 15 SAN_� City/State/Zip: moi, a,,.�cn� int..,, Phone #: tt.---vk- L -ICI •'53�� Are you an employer? Check the appropriate box: 1.1�6I am a employer with _employees (full and/or part-time).* 2.Q I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp_ insurance required.] 3.0 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 subcontractors listed on the attached sheet. 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. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 7. ❑ New construction 8. 16 Remodeling 9. ❑ Demolition 10 0 Building addition I LF1 Electrical repairs or additions 12. Plumbing repairs or additions 13. Q Roof repairs 14.E] Other *Any applicant that checks box #I 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. #Contractors 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 aziz an ezzzployer tlsat is providizzgiporlcers' conipensatioit insurance for zzzy employees. Below is the policy and job site information. Insurance Company Name:o.�ny sem.► S �, �,t� Policy 4 or Self -ins. Lic. #:�'` �C S"L-1 /' �� Expiration Date: Job Site Address: t -,t�i� City/State/Zip: !—L/, 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 DIA for insurance coverage verification. I do het. by certify under the pains and penalties of petimy that the information provided above is true and correct. q -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 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(les) 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 1060 Osgood Street North Andover, MA 01845 CON,AMTACT Sandi Munroe PHONE (978) 683-8073 FAX N&(978) 683-3147 oRL�.san i mpro ertsinsurance.com INSURERS AFFORDING COVERAGE NaC# 1 SURERA: MERCHANTS INSURANCE INSURED KEVIN MURPHY BUILDING & REMODELING 169 BOXFORD STREET NORTH ANDOVER, MA 01845 INSURER,: GUARD INSURANCE INSURER C: INSURER D' INSURER INSURER F: rnVFRAr,FS rFRTIFICATF NIIMRFR• PM/Minnl A111KARFD- 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 BYPAID CLAIMS. LTR TYPE OF INSURANCE NSo o LI Y MMIDD/LICYYYYYI EFF PO 11 LIOCY EXP LIMITS X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR EACH OCCURRENCE $ 1,000,000 PREMISES Ea o=rrence$ 500,000 one person) $ 15 000 A BOPI068945 11/22/1311/22/141¢DExP PERSONAL &ADV INJURY $ INCLUDED GEN'L AGGREGATE LIMIT APPLIES PER POLICY ❑ jRa 0 LOC GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 AUTOMOBILE LIABILITY MBI aED ent,SINGLE LIMIT $ 1,000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ A ANYAUTO ALLOWNED X SCHEDULED AUTOS MCA7013608 01/23/14 1/23/15 HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE $ 'd t UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS UAB CLAIMS -MADE CUP9145304 11/22/13 1/22/14 AGGREGATE $ i i 000 RETENTION B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY AN PRIMEM89i ARTNEEOIXBCUT� Y OFY(Mandatory in NH) NIA KEWC527844 07/01/14 7/01/15 X I PER OTH- STATUTE E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 If es, deserbe under RIPTION OF OPERATIONSDISEASE 500 , 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101, Addtional Remarks SchedtAe. maybe attached ifmorespace is recItired) CFRTIFICATF HninFR r.ANrFI I ATInN TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 OSGOOD STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. I a AUTHORI2ED REPRESENTATIVE I M N ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACO RD name and logo are registered marks of ACORD ��e (pa���n�2aozureaC� o��/�oaacfcrJefra Office of Consumer Affairs & Busihess Regulation OME IMPROVEMENT CONTRACTOR egistration: 1'01874 Type: .� xpiration: 6/29/2016 Individual KEVIN MURPHY Kevin Murphy 98 FOREST ST. N. ANDOVER, MA 01845 x I I Undersecretary t 1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards 1 Construction Supervisor J License: CS -053099 KEVIN W MURP10 98 FOREST ST U75 North Andover MFA 01 � f Expiration �. Commissioner 06/29/2015