HomeMy WebLinkAboutBuilding Permit #517-2016 - 675 GREAT POND ROAD 10/26/2015BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: I (�-'I Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
,LOCATIONi
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;P'RQPERTY QINNER 101-
- '' Pnnt '�} 100 Year Stiucture
MAP PARCEL: `t L , ZON,ING DISTRICT _ Historic District-
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
0( One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
K Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
O Septic 1.1N -11, �V
' 0 Floodplain Wetlands
D 1Naters.hed Distrief
EY 1Nate YSewer_
DESCRIPTION OF WORK TO BE PERFORMED:
t� > s��� kA
Identification - Please Type or Print Clearly
OWNER: Name: Vi i.c Qyu—. Phone: RZ&—G_'I-00N
AddrP.s:
'.e
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.
Total Project Cost: $ Sio,to FEE: Z
Check No.: b o� Receipt No.:
NOTE: Persons contracting with unregistered 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 ❑
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
Reviewed on
Signature
Sianature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No:
Planning Board Decision:
Conservation Decision:
Comments
Comments
Zoning Decision/receipt submitted yes
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
LOcatea M4 , . AR�TMENT TempDurnpster��®rsiteyesno _
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Located at 124tMain�Street
FrelDe�artment si nat=urMe/date._,_
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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
Nu I t5 ana UA I A — (F -or department use
❑ Notified for pickup Call Email
I Date Time Contact Name
Doc.Building Pennit 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)
o 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
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
Doc: Building Permit Revised 2014
Location e -0 —4-101K
N66�
Date
TOWN OF NORTH ANDOVEO
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
29.5.0
$
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♦Y
FRANCIS A. HEBB
DESIGN/BUILD CONTRACTOR
CONSTRUCTION MANAGEMENT AND CONSULTING
Residential, Commercial Building & Renovations
Construction Supervisory License #033217
Home Improvement License #107916
CONTRACT TO BUILD
70 Lake Shore Road, Boxford, MA 01921-1115
Shop (978) 352-6123
Fax (978) 352-5068
Cell (978) 423-6637
RESIDENTIAL CONTRACTING AGREEMENT
Designated Registrant's Name: FRANCIS A. HEBB
Registration Number: 107916
This agreement is made on _October 23, 2015` (date) between FRANCIS HEBB of 70 LAKE
SHORE ROAD, BOXFORD, MA 01921 (978) 352-6123 hereinafter called "Contractor" and
Paul Creamer (Owner) of 675 Great Pond Road, North Andover, MA 01845 hereinafter called
"Owner".
I. DETAILED DESCRIPTION OF WORK TO BE PERFORMED
Contractor agrees to perform in a good and workmanlike manner all work detailed below for the
store and house roof projects. Such work consists of the following:
Re -shingle entire roof, strip existing roof shingles, install new 30 -yr IKO architectural black
shingles, ice and water barrier up 6' on edge of roof and valleys. Ice and water barrier over entire
dormer roof. Metal ice belt on lower edge of dormer roof. Remove all rubbish and clean up.
Redo step flashing on dormer cheeks. Install ridge vents.
Additional work may be needed to replace any rotten wood once roof is stripped.
II. PRICE
Contractor agrees to do all work described in Section I for the total price $23,530.00.
III. PAYMENT
Payment will be made as follows:
Payment due upon beginning of project $ 5,000.00
Payment due upon complete $15,000.00
and the remaining $3,530.00 upon completion verification of the work by Owner and
Contractor as having been satisfactorily completed, which verification shall take place promptly
after completion.
Price does not include permits and labor to obtain permits. Cost of permits will be added to the
next applicable payment after obtaining permits.
Notice: No agreement for home improvement contracting work shall require a down payment
(advance deposits) of more than one-third of the total contract price or the total amount of all
deposit or payments which the contractor must make, in advance, to order and/or otherwise obtain
delivery of special order materials and equipment, whichever amount isegr, ater.
IV. COMMENCEMENT AND COMPLETION OF WORK
Contractor will not 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 the work on October 27,
2015 and completion is scheduled for November 3, 2415. The Owner hereby acknowledges and
agrees that the scheduling dates are approximate and that such delays that are not avoidable by the
Contractor shall not be considered as violations of this Agreement.
V. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED
The Contractor may not require payments to be made in advance of the times specified in Section
III (Payment) above for the reason that he deems himself or the payments to be insecure. If,
however, he deems himself to be insecure, he may require, as a prerequisite to continuing the work
described herein, that the balance of the payments under this contract that are in the control of the
Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor
and the Owner for withdrawal.
VI. INSURANCE
Contractor will be responsible to Owner or any third party for any property damage or bodily
injury caused by himself, his employees or his subcontracts in the performance of, or as a result of,
the work under this Agreement. Contractor agrees to carry insurance to cover such damage or
injury.
VII. SUBCONTRACTING
Contractor agrees that, notwithstanding any agreement for materials and/or labor between
Contractor and a third parry, Contractor is responsible to Owner for completion of all work
described in a timely and workmanlike manner.
VIII. CONSTRUCTION RELATED PERMITS
The following construction related permits will be necessary in order to complete the scope of
work included in this Agreement: Building and Demo (Price does not include permits and labor
Lo obtain).
The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and
obtain all construction related permits. The Contractor shall not be deemed responsible for delays
in the work described in this Agreement caused by regulatory, permit granting or inspectional
agencies, authorities or individuals.
Notice: If the homeowner obtains his own construction related permits for the work described
under this agreement, the homeowner is hereby advised that in the event of a dispute, judgment
and nonpayment of the contractor, the homeowner will not be entitled to make a claim to or collect
from the guaranty fund established by Chapter 142A, M.G.L.
a
IX. MODIFICATION
This Agreement, including the provisions related to price (Section II) and payment schedule
(Section III) cannot be changed except by a written statement signed by both Contractor and
Owner.
X. CONSTRUCTION CHANGE ORDER
Construction change orders will consist of any change to the original scope of work, such as
hidden conditions and changes requested by Owner. These conditions may require adjustment in
the overall price and time frame to complete the necessary work related to this Agreement. In
such case the Contractor shall inform the Owner of such conditions forthwith and when necessary
a written amendment to this Agreement will be negotiated and executed by the Contractor and
Owner.
XI. WARRANTIES
The Contractor warrants that the work furnished hereunder shall be free from defects in materials
and workmanship for a period of one 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 replace such damage or such
defect in materials or workmanship. The foregoing warranties shall survive any inspection
performed in connection with the agreed upon work.
All warranties for equipment supplied by the Contractor under this Agreement shall be those given
by the manufacturers of such equipment, which shall be and are hereby passed through directly to
the Owner. Under such manufacturers' warranties, the Owner may be required to register or mail
in a warranty card or other evidence of workmanship and use of such equipment in order to
activate such warranties. The Owner's failure to mail in or register such documentation, which
failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to
warranty such equipment.
This warranty gives the Owner specific legal rights, and Owner may also have other rights which
vary from state to state.
XII. COMPLETENESS OF AGREEMENT FOR EXECUTION
The Owner is hereby advised that he should not sign this Agreement unless and until all blank
sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and
related or referenced documents that are incorporated herein are attached hereto.
XIII. COPY OF AGREEMENT TO BE GIVEN TO OWNER
It must be executed in duplicate, and an original signed copy hereof given to the Owner at the time
of execution. No work under this Agreement shall begin prior to the signing of the Agreement
and transmittal to the Owner of a copy thereof.
HOMEOWNER:
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Date Signed
(Contractor's Signature)
Date Signed to t 2,31 o,
The Commonwealth of Massachusetts
Department of IndustrialAccidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information + = 9 11 Please Print Legibly
Name (Business/Organization/Individual): �_KOIW_A& L id 621M T
Address: `zc-"> "to— S1.,Q,1
City/State/Zip: 5oK&4 4yv, Phone #: riV? 2 I
Are you an employer? Check the appropriate box:
1. [M I am a employer with 3.: 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.Q 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.
6. ❑ 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. 0 Remodeling
9. ❑ Demolition
10 Building addition
11. F1 Electrical repairs or additions
12. FJ Plumbing repairs or additions
13.] Roof repairs
14.0 Other
*Any applicant that checks box 41 must also fill out the section below showing their workers' compensation policy information.
i Homeowners who submif 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, aiey must provide their workers' comp. policy number.
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.
Policy # or Self -ins. Lie. #: INWC', —Am— '7cy(o?44 ^ 2-o15)4 Expiration Date: `t (za C 4(0
Job Site Address: Lo 2 ear, P -A WcAnxl Ii City/State/Zip: j�\. ikkc , tr ii
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 hereby certify under the pains and penalties of perjury that the information provided above is true and correct.
Phone #: Q Z�3"(eCe 3'1
Official use only. Do not write in this area, to be completed by city or town official
City or Town:
Permit/License #
2SP
Issuing Authority (circle one): ;
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: 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 defined as "an individual, partnership, association, corporation or other legal entity, or any two or more
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, or the
receiver or trustee 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 required."
Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall.
enter into any contract for the performance of public 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 -contractors) 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 the permit 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
that must submit multiple permit/license applications in. any given year, need only submit one affidavit indicating current
policy information (if necessary) and under "Job 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 may be 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 not 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
10/28/2015 10:14:19 AM
8740 10 02/02
A60cpR 47 CERTIFICATE OF LIABILITY INSURANCE
DATEIMIMDOIYYYY)
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10120/21115
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 certiticate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to
the terms and conditlons 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 04298 - 01
CC11ITACT
BKM Inc dba Cross Insurance Peabody
139 Lynnfield Street Ste 210
Peabody, MA 01960
aAlttc1NEEry .Ext : (978) 532-5445 ale. No.:
EMAIL
ADDRESS:
l GENERAL LIABILITY
COMMERCIAL GENERAL LIABILITY
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INSURERA: A.I.M. Mutual Insurance Company 133758
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70 Lake Shore Rd
Boxford, M 01921-1115
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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.
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DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, IF more space is required) v
CERTIFICATE HOLDER
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 REPRESENTATIVE ._
s reserved.
ACORD 25 )2010/05) The ACORD name and logo are registered marks Of ACORD ,
2069
Massachusetts. - Department of Pubis ' Safety-
Board of Building Regulations and
Standards
Comtruction Supen isur
License: CS -033217,
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FRANCIS A HEBB' #
70 Lake Shore Road i`=
Boxford MA 01921
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expiration-
Commissioner
03/26/2016
c�/fie tOamvmaf�zurea.�t� a���atacfucaella
Office of Consumer Affairs & Business Regulation
ME IMPROVEMENT CONTRACTOR
teiegistration: 107916 Type- $.
piration 8/10/2016 rp
Private Cooration
FRANCIS HEBB CON STRk1CTJON = M
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Francis Hebb `
70 Lake Shore Rd
Boxford, MA 01921
Undersecretary
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