HomeMy WebLinkAboutBuilding Permit #880-14 - 71 Brightwood Avenue 6/4/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: a —) Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
PROPERTY OWNER
MAP NO: PARCEL:01
`M",
Print 100 Year Old Structure yes
ZONING DISTRICT: Historic District yes
Machine Shop Village yes ((1100
o
TYPE OF IMPROVEMENT,
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
>1:0nro or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
0 Septic 0 Well �.
❑ Floodplain q Wetlands
❑ Watershed District
❑ Water/Sewer
�+DESCRIPTION OF WORK TO BE PERFORMED:
e,1G[ySRJ �°o✓t.� 12► hi l (-e.0 6, (e A ox 1N[ t 1rJu_-5 i /'4S -All m e,- q0x-, d6* t l
Identification
OWNER: Name:
--7
Address: c 1
Please Type or Print Clearly)
kkA 101 mciliaoxY
W
07-X-137
Q � �
CONTRACTOR Name.: { J�`'�t �`�" Phone:
Address: "Lq4
Supervisor's Construction License: Exp. Date: cl _
Home Improvement License: _( Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F.
Total Project Cost: $ 104 SZO FEE: $ / 4961610
Check No.: �/ T�� Receipt No.: o; 76 y rd
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signatureof Agenf/Owner �' _. ___ � �- � - �(�5ig-�atur_e of contractor � y.i
Plans Submitted Li Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
L
1,
Location
No. Date
--7
Check #
2 U' 4, 6
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee $ 1-1�74 66
Foundation Permit Fee $
Other Permit Fee $-
TOTAL $
Building Inspector
-_ Plans Submitted ❑
Plans -.Waived ❑: '_:Certified Plot Plan ❑ Stamped Plans 0
.'TW-E_OF:SEWERAGED3SP-OEAL
Public Sewer
Tanning/MassageBodyArt ❑ ..
Swimming Pools ❑
Well
Tobacco Sales El
Food Packaging/Sales ❑
Private�(septic tank, etc__❑ -:._ .
_permanent DIiimpster on� Site ❑
-THE_.FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
.. DATE. REJECTED DATE:APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
ti COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes .
Planning Board Decision: Comments
� onservation Decision: Comments
Water & Sealer Connection/Signature & Date Driveway Permit
DPW To-vvL Engineer: Signature:
Locaiea ou4 us ooa Street
FIRE DEPARTI!/IE NT. -.Temp Dump-ster on site yes no
Located -at 124,Main Street
-Fire Departme'if signaiture/date _
COMMENTS "` .
_Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions._
_Total land -area; .sq. ft.
tELECTRICAL: movement of. Meter. location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ONE_ LITERATURE: -Yes No
MGL.Chapter 166. Section 21A ..F and G min.$10041000 fine
NOTES and DATA — (For department use
LI Notified for pickup - Date
Doc.Building Permit Revised 2010
Building Department
- The fol',',owing is'a=list of the required.forms to be filled outfor.:the appropriatepermit to .be obtained.
Roofing, Siding, Interior Rehabilitation Permits
Building Permit Application
V°Jorkers Comp Affidavit
�Photo Copy Of H.I.C. And/Gr 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/Crossection/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 apo,?al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.+.ted with the building application
Doc: Doc.Bui?ding Permit Revised 2012
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 10,500.00
m
$ -
$
126.00
Plumbing Fee
$
15.75
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
15.75
Total fees collected
$
257.50
71 Brightwood
880-14 on 6/4/2014
Porch Remodel
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10/31/13
Tom Sinclair
71 Brightwood
address 2
A.P.T. Builders
46 Linden Road
Peabody, MA 01960
PHONE (978)815-2848 FAX (978)530-1580
www.buildapt.com
Project. 2nd Floor Porch
The following is a brief description of all proposed work to be completed by A.P.T.
Builders:
Porch Interior
1. Remove all windows from second floor front porch
2. Remove all interior finishes down to framing
3. Supply and install 8 new double hung windows (Harvey brand)
4. Insulate room as needed
5. Install white vinyl bead board ceiling
6. Install pine bead board or v -groove on walls
7. Install continuous interior window sill
8. Install 3/4"' square pine window trim
9. Install 1x4 fir tongue and groove flooring
10. Install pine base board
11. Install small molding where wall meets ceiling
Porch Exterior
1. Build out exterior window sill and wrap in aluminum or pvc
2. Install new pvc window trim over existing window trim
3. Install vinyl soffit
4. Wrap facia boards in aluminum
5. Install vinyl or pvc above windows on both ends of porch
6. Remove 16' gutter on driveway side of house
7. Wrap facia with aluminum, reinstall gutter
8. Wrap 14' of facia with aluminum on front of house
9. Disposal fees included
10. Permit related fees "not" included
LABOR AND MATERIALS FOR THE ABOVE $10,500
1. Replace interior window between porch and hall
LABOR AND MATERIALS $400
1. Wrap 13 windows with aluminum, $100 per window
LABOR AND MATERIALS 13 WINDOWS, $1,300
4 t,.
�'y
y .A5L The Commonwealth of Massachusetts , -
DepaYtmentoflndustrialAceidie is
Office of fnvestigations
600 Washington Street
.Foston, MA 02111
-www.mass govIdla
Workexs' Compensation Insurance Affidavit: Bufftiers/Conti°actorsfElectr icxanslPIiimbers
Name
Address: G l L, h Jej P(ik
City/State/Zip: declwllfyd q g6LI Phone #• q � S�)- �
e you an employer? Check thappropriate box:
4• ❑ I a contractor and 1
Type of project (required):
1 I am a employer with
am general
6. ❑ New construction.
employees (full andlor part time) *
2. [] I am a sole proprietor or partner-
have Hired the sub -contractors
listed on the attached sheet
'1• ❑ Remodeling
ship and`have no.employees
These sub -contractors have
8. ElDemolition
working forme in any capacity.
workers' comp, insurance,
g. Building addition
[No workers' comp. insurance
5. ElWe are a corporation and its
10. El Electrical repairs or additions
required.]
3. [l I am a homeowner doing all work
officers have exercised.their
right of exemption per MGL
11.[] Plumbing. repairs or additions
myself. [Eo workers' comp.
c. 152, §1(4), and wehave no
12.❑ Roofrepairs
insurancerequired.] i
employees. [No workers'
13.❑ Other
comp. insurance required.]
xAny applicant that checks box#1 must also fill out the section below showingtheir workers' compensationpolicy information.
i "Homeowners who submit this affidavit indicating they 9doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that chedcthis box must attached an additional sheet showing the name of tho sub -contractors and their workers' comp. policy information.
-rain an employer that & providing workers' compensation insurance for any employees Below as the policy and job site
information. I
Insurance Company
Policy # ox Self ins. Lic. #: w�' J �b Expiration. Date:
Job Site Address; -71 _CitylState/Zip:
.A.ttach a copy of the workers' compensation -policy declaration page (showing the policy number and expirations date).
failure to secure ooverage.as requiredunder Section 25A ofMGL o. 152 can lead to the imposition, of criminal penalties of a
fine up to $1,500.00 and/or ones -year imprisonment, as well as civil penalties in the form of a STOP WORD ORDER and a fn.e
of -up to $250.00 a day against the violator. Be advised that a copy of this statementmay be forwarded to the Office of-
investigations
fInvestigations of the DIA ,for insurance coverage verification.
I do Hereby cert uY;Y'er Pepains andpenalties ofperjury that rite information provided agove its true and correct.
K Com- 2&q
Oficial use only. Do not write in this area, to be completed by city or toren official
City or Town: PermitMeense #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. CityfTown Cleric 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person
Phone M
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 Iii the service of another under any contract ofbire,-
express or implied, oral or written."
An employer is defined as "an individual, partnership, association, corporation or other legal entity, or anyiwo or more
of the foregoing engaged in a j oint 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 notmore 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 bean 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 ofpublic work until acceptable evidence of compliance with the insurance
requirements of this chapterhave beenpresented to the contracting authority."
Applicants
Please fill out the workers' compensaiion affidavit completely, by checking ilio boxes that apply to your situation and, if
li.ecessary, 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 Partn rships (LLP) with no employees other than the
members ox partners, are notrequired to carry workers' compensation insurance. If an LLC or LLP does have
employees,apolicyismquired. Be advised that this affidavit may besubmitted tothe Department of Industrial.
Accidents fox 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 thatthe affidavit is complete andprinted 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 peimit/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 "Yob Site Address" the applicant should write "all locations in (city or
town): ' copy of the affidavit that has been officially stamp ed or marked by the city or town may be provided to the
applicant as proof that a valid affidavit -is on file :for fature p ermits or licenses. A, new affidavit must be filled out each
year. "Where a home owner or citizen is obtaining a license ox permit not related to any business or commercial venture
(i.e. a dog license orpeimit to burn leaves eta.) said person is NOT required to complete this affidavit.
The Office of Investigations would like to thank you in advance fox your cooperation and should you have any questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number:
The CQM. monwealth ofMfasSa.,chU oft
DITartaeut of.IndwWal .A,colde to
Ofico of1AvestigaUo=
60 Wuhiu&n ftre t
Boston, U. A 02111
T01. # 617-7.2,7-4900 QA 406 or Z-$` 7-11�EMP,
Revised 5-26-05
�vw.x.�a�s,ggvfclia
ACORD. CERTIFICATE OF LIABILITY INSURANCE
INSR
LTR
ADD'L
INSRD
0DATE
6/06,(MM/DDIYYYY)
04/2014
PRODUCER (978) 745-6464
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
Rose Insurance
66 Loring Avenue
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
A
P.O. Box 958
Salem MA 01970-
INSURERS AFFORDING COVERAGE NA1C #
INSURED
INSURER A: Merchants Insurance
Trufant, Adam dba APT Builders
INSURER B: Liberty Mutual
46 Linden Street
INSURER C:
INSURER D:
06/06/2014
jPeabody MA 01960-
INSURER E:
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,
AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
ADD'L
INSRD
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
DATE (MIWDDIYY)
POLICY EXPIRATION
DATE (MMIDDIYY)
LIMITS
A
GENERAL LIABILITY
/ /
/ /
EACH OCCURRENCE $ 500,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE DOCCUR
BOP9095566
06/06/2014
06/06/2015
DAMAGE TO RENTED
PREMISES Ea occurrence 5 50,000
-MED EXP(Any oneperson) $ 5,000
PERSONAL & ADV INJURY $ 500,000
GENERAL AGGREGATE $ 1,000,000
GEN'LAGGREGATE LIMITAPPLIESPER:
POLICY JECT LOC
PRODUCTS -COMPIOPAGG $ 1,000,000
AUTOMOBILE
LIABILITY
/ /
/ /
COMBINED SINGLE LIMIT
ANY AUTO
(Ea accident) $
ALL OWNED AUTOS
/ /
/ / -
BODILY INJURY
SCHEDULED AUTOS
(Per Person) $
HiREDAUTOS
/ /
/ /
BODILY INJURY
NON -OWNED AUTOS
(Per accident) $ '
PROPERTY DAMAGE
(Per accident) $
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
ANY AUTO
/ I
/ /
OTHER THAN EA ACC S
AUTO ONLY: AGG $
EXCESS/UMBRELLA LIABILITY
EACH OCCURRENCE S
AGGREGATE $
OCCUR FICLAIMS MADE
S
DEDUCTIBLE
RETENTION S
S
B
WORKERS COMPENSATION AND
EMPLOYERS' LIABILITY
WC2-31S-3782223-023
10/08/2013
10/08/2014
X oRYUMITS ER
_
E.L. EACH ACCIDENT $ 100,000
ANY PROPRIETORIPARTNEWEXECUTIVE
OFFICERIMEMBER EXCLUDED?
N yes, describe under
/ /
/ /
E.L. DISEASE - EA EMPLOYEE $ 100,000
E.L. DISEASE -POLICY LIMIT S 500,000
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCLUSIONS ADDED BY ENDORSEMENTISPECIAL PROVISIONS
_ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE
EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL
30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT
Town of North Andover FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE
AUTHORIZED
ACORD 25 (2001108)
mauzo Ioloal.o6
0
O ACORD CORPORATION 1 9R
Page I of 2
" Massachusetts - Department of Public Safety `
Board
-of Building Regulations and
Standards
Construction 'Supert,isor
License: CS -098390
rlk
ADAM P TRUFAN3
46 LINDEN ROAD
I Peabody MA 01940
t ern+A
Expiration
Commissioner
k
08/04/2015
a V fze l0o�rurraanurerc�,/�a a� Oczci2ruJel.�.1
Office of Consumer Affairs & Business Regulation 1 '
ME IMPROVEMENT CONTRACTOR
egistratiori 148622. Type:
xpiration: = 10112/2015 DBA
",)c
F' A.P.T. BUILDERS
ti ADAM TRUFANl�:_
46 LINDEN RD
+, PEABODY, MA 01960 C
Undersecretary '