HomeMy WebLinkAboutBuilding Permit #642-2017 - 50 BRADSTREET ROAD 12/14/2016BUILDING PERMIT
TOWN OF -NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#:_U'4'_2,— 2-6 k�
Date Received
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
0 One family
0 Addition
0 Two or more family
0 Industrial
0, Alteration
No. of units:
0 Commercial
Repair, replacement
0 Assessory Bldg
11 Others:
0 Demolition
0 Other
❑Septic 0 Wn.
&
Fl0odP'lai'
11 Watershed District
...
E -S"
i -V,
V aier/
DESCRIPTION OF WORK TO BE PERFORMED:
P 0a.
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Identification - Please T or Print Clearly .
OWNER: Name: 'S e _ 111 _T;� A�� M Phone: '7:?7 3W
44ZI
Address: ,V/
tol"" CA 4-
Obn#eittb'r'Naf.ne: Phohe-.. -2.7fr.46J2,7�_a7?
Address :
Su erisor
o hibm eep§
p.1xp. Date,,
Home
Improvement Lite Exp,
ARCHITECT/ENGINEER
Address:
Phone:
Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
otall Project -Cost:
C'
FEE: $
Check Nq
Receipt No'"
N6TE: Persons contracting witli unregistered contractors do not have: access to the guara fund
7�imgure of cohlrabtor`.'�,
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Plans Submitted ❑
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Typ�-OF SEWERAGE DISPOSAL
Public Sewer
Tanuing/MassageBody 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
Signature
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:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT -.Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department signature/date
COMMENTS
-Mmension
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.si 00-si Ooo fine
No
Doc.Building Permit 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
a 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
o 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
40TE: 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
l
Doc: Building Permit Revised 2014
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Date: 12/13/2016
Proposal
Sean & Jennifer Murphy
50 Bradstreet Road
North Andover, MA 01845
PROPOSAL — Master Bath Renovation
Item 1: Permit
Acquire Building Permit.
Item 2: Remove existing bath fixtures, ceiling and wall board, subflooring.
Item 3: Plumbing
Install rough plumbing for new tub, toilet, vanity and laundry appliances. Install finish plumbing.
Item 4: Electric
See attached description.
Item 5: Insulation
Install insulation as needed.
Item 6: Framing
Install floor joists on existing, shim shower walls, frame closet doorway. Install new subfloor
and new underlayment for tile. Install closet door.
Item 7: Board and Plaster
Install %" blue board on walls and ceiling. Skim coat with 1/8" plaster, smooth finish.
Item 8: Tile
Tile bath floor and shower area. Natural stone the to be additional.
Item 9: Finish Carpentry
Install base board, window and door trim.
Desmond Construction, Inc., P.O. Box 41, North Andover, MA 01845 Phone: 978-682-2279 /FAX: 978-682-2279
bm-desmond@comcast.net
11'Page
D"I ev on =�t`
Item 10: Paint
Prime bathroom ceiling and walls. Apply 2 coats finish paint. Paint new closet door and finish
trim.
Item 11: Laundry Area
Install dryer vent, board and plaster areas opened for plumbing and electric.
Total
$ 23,825.00
Note:
Homeowner to supply tile, tub, toilet, vanity and sink combo, plumbing finish.
Closet shelving TBD
Hallway painting TBD
Glass shower door TBD
All material is guaranteed to be as specified, and above work to be performed in accordance
with the drawings and specifications submitted for above work and completed in a substantial
workmanlike manner for the sum of $ 23,825.00
25% upon signing $ 5,956.25
25% upon start of completion of plumbing/electrical rough $ 5,956.25
25 % upon wall enclosure $ 5,956.25
25% upon completion of project $ 5,956.25
Desmond Construction, Inc., P.O. Box 41, North Andover, MA 01845 Phone: 978-682-22791 FAX. 978-682-2279
bm-desmond@comcast.net
2/Page
,.
r � .on i Co €structir n1jn�,r
An interest charge of 1.5 % per month will be applied to any balance due 30 days after
completion of this project. Any alteration or deviation from above specifications involving extra
cost will be executed only upon written orders and will become an extra charge over and above
the estimate. All agreements contingent upon strikes, accidents or delays beyond our control.
Owner to carry fire, tornado and other necessary insurance upon above work. Workmen's
Compensation and Public Liability Insurance on the above work to be taken out by Desmond
Construction, Inc.
Respectfully submitted
per Matthew Desmond
NOTE: This proposal may be withdrawn by us if not
accepted within days.
ACCEPTANCE OF PROPOSAL
The above prices, specification and conditions are satisfactory and are hereby accepted. You
are authorized to do the work as specified. Payment will be made as outlined above.
Signature:
Signature:
F I
M�� L , Date:�V V U
l
Date:
Desmond Construction, Inc., P.O. Box 41, North Andover, MA 01845 Phone: 978-682-2279 /FAX. 978-682-2279
bm-desmond@comcast.net
3/Page
The Commonwealth of Massaehusetts
Department of indugtrzalAccidents
X Congress Street, ,S' Ite 100
F Boston, MA 02114-2017
www mass gov/dia
e�M SVS"
• V�alkexs' Compensaiionlnsurance.A.fhdavit: BuiTdexs/Conixactors/Electxicians/�'lwnbexs.
TO BE FMEA WITH TNM PERMg.0 t'TG AUTItORiTi'.
' ..Please PrintI.,e 'bl
A licaut Information
Name (Business/Orgariizaiion&dividual): 0 W1_6A La a S;f A,; / I d (-
Address: I 9 ss It Aar
City/State/Zip:_
Are you an employer?
PlA_ Phone #: -Ir-0
the appropriate box:
1. ❑ I 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 -3
3.❑Iamahomeov,*.ner doing all work myself [Noworkers'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.
s. ❑ I am a general contractor and I have hired the sub-confractors listed on. the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.
6.C1 We are a corporatioli 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 ()Vequired);
7. ❑ NdVT'd6nstd6 ion
Remodeft
8. �
9. ❑ Demolition
10 (] Building addition
11.❑ Electrical repairs or additions
12,,]M- mbing repairs or additions
13-4jRb6frepairs
14. [] Other
*Any applicant that checks box#1 must also fill out the section below shoWingtheir Workers' compensationpoficy "oforma$on
hire outside
Homeowners who submii•tbis affidicating they are doing all work and then contractors must submit a new affidavit indicating
davit insuch.
Contractors That check his Box rimst attache additional sheet showing the name of the sob -contractors and state whether or not fhose entities have
employees. If the sub -contractors have employees, they must provide their workers' comp.po�icynumber.
f am an employer that is providing workers' compensation ins=nce for my employees. Below is tliepolicy arsd)o/i site
information.
Insurance Company Name: d`+T' c' J►1'•nr
Policy # or Self -ins. Lic. #:
AP 4.6 >�, _ Expiration Date:. 3 yol7
Job Site Address: SV 1), .4 9f ��'Lri• '�� City/State/Zip: A/o A.�' ao ,41- 174, r2%Fi(r
Attach a copy of the yvoxlt ers' compensation policy deelaxation page (showing the policy number and expiration date).
Failure to secure coverage as requited under MGL c.152, §25A is a criminal violation punishable by a fuib up to $1,500.00
and/or one-year imprisonment, as
weas civil penalties in the form of a S'T'OP WORD ORDER. acrd a flue 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
coverage verification.
X do hereby certify
-72
andpenalt ees ofpedury that the information provided al o v e is true anof correct.
matt-.
Official use only. Do not -write in this area, to he completed by city or town offieiaZ.
City or Town:
Permit/License #
IssuiugA.uthoxity (circle one): i
1. Board of Realth 2. BuildiugDepartment 3. CitylTown Clerk 4. Electrical Inspector S. PlnmbingLisp ector
6. Other
Contact
phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees.
Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of hire,
express or implied, oral or written."
An employer is d'efnied as "an individual; partnership, association, corporation or other legal entity, or any two or more
ofthe foregoing engaged in a joint enierpri'se, and including the legal representatives of a deceased employer, or the
receiver"or trastee of an individual, partnership, association or other legal entity, employing employees. • However the
owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the
dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house
or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer."
MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or
renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any
applicant who has not. produced -acceptable evidence of compliance with the insurance coverage xequiored."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall
enter intg any contract for the performance ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapter have been presented to the contracting authority."
Applicants
Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if
necessary, supply sub=contractor(s) name(s), address(es) and phone number(s) along with their certificate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the
members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have
employees, a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial
Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should
be returned to the city or town that the application for thepermit or license is being requested, not the Department of
Industrial•Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensation policy, please call the Department at the number listed below. Self-insured companies should enter their
self-insurance license number on the appropriate line.
City or Town Officials
Please be. sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom
of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant.
Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant
thai must submit multiple permit/license applications in any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "lob Site Address" the applicant should write •"all locations in (city or
town.)." A copy of the affidavit that has been officially stamped or marked by the city or town maybe provided to the
applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each
year. Where a home owner or citizen is obtaining a license or permit rat related to any business or commercial venture
(i.e. a dog license or permit to burn leaves etc.) said person is NOT required to complete this affidavit.
The Department's address, telephone and fax number_
The Commonwealth of Massachusetts
Department of Industrial Accidents
1 Congress Street, Suite 100
Boston, MA 02114-2017
Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE
Fax # 617-727-7749
Revised 02-23-15 www.mass.gov/dia
A0 R& CERTIFICATE OF LIABILITY INSUF
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO I
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BET
REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be ern
the terms and conditions of the policy, certain policies may require an endorsement. A statemi
certificate holder in lieu of such endorsement(s).
PRODUCER
MTM Insurance Associates
1320 Osgood StreetE-MAIL
North Andover MA 01845
CONTACT Victoria Ii
NAME:
PHONE (978)68:
ADDRESS: vickiel@mi
INSUREI
INSURER A ?Travelers
INSURED
Desmond Construction Inc
19 Upland St
North Andover MA 01845
INSURER B -Travelers
INSURER C:
INSURER D
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER -16-17 Master
EACH OCCURRENCE $ 1,000,000
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.
ITR
TYPE OF INSURANCE
A D
UBR
POLICY NUMBER
MPOLICY
NDD EFF
MWDDn XP YYI
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE 7 OCCUR
EACH OCCURRENCE $ 1,000,000
DAMAGE TR ED 300, 000
PREMISES Ea occurrence $
MED EXP (Any one person) $ 5,000
6803A8233671642
7/7/2016
7/7/2017
PERSONAL & ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
X POLICY ❑ JECOT- LOC
GENERAL AGGREGATE $ 2,000,000
PRODUCTS - COMP/OP AGG $ 2,000,000
Non -owned $ 1,000,000
OTHER:
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $
Ea accident)
BODILY INJURY (Per perm) $
ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BODILY INJURY Per acadent $
( )
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE
Per accident $
$
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE $
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
DED RETENTION$
$
B
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED?
(Mandatory in NH)
If yes, describe under
N/A
Beatrice 6 Matthew are
Excluded
IEUB3A83186516
8/23/2016
8/23/2017
8 STATUTE ERS
E.L. EACH ACCIDENT $ 1 000 000
E.L. DISEASE - EA EMPLOYE $ 1 000 000
E.L. DISEASE - POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS/ LOCATIONS/ VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required)
This certificate of insurance represents coverage currently in effect and may or may not be in compliance
with any written contract.
Town of North Andover
Main St.
N 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 REPRESENTATIVE
Mancinelli, CIC/VIc
w 1 VUtl--LUT 4 AGORD CORPORATION. All rights reserved.
AGORD 23 (2074/01) Tne ACCIFTD name ana logo are reglsterea marcs OT AGORD
INS025amenii
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