HomeMy WebLinkAboutBuilding Permit #659-13 - 75 FOREST STREET 4/11/2013TOWN OF NORTH ANDOVER
��l
APPLICATION FOR PLAN EXAMINATIO Permit NO: — Date Received 1)
I IMPORTANT: Applicant must complete all items on this pane I
LOCATION 1�
�Print
PROPERTY OWNER
Print 100 Year Old structure yes no
MAP NO: PARCELOI-7 0 ZONING DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
'd One family
❑ Addition
0 Two or more family
0 Industrial
Iteration
No. of units:
❑ Commercial
❑ Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
0 Other
c ❑ Well
❑ Floodplain ❑ Wetlands
❑ Watershed District
'6Wate Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
\s t -i ntS
Identification Please Type or Print Clearly)
OWNER: Name: ew Phone: 1,, k-1 - r6'0-1 - 0125 -
Address: `15- N-,fi---
CONTRACTOR Name: Phone:
Address: `t% ��vrv—.s'f Ste"
Supervisor's Construction License: 0573 U`k?) Exp. Date:
Home Improvement License:
—1
Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BOLDING PERMIT. • $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $ b`,
Check No.: � L ��� Receipt No.: .2&-12-10
NOTE: Persons contracting w :th ' tered contractors do not have access to the guaranty fund
Signature of Agent/owner Signature of contractor
Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑
Location -P5 +b -C-04
No.—(Cr-��) —1 -5
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Fee
TOTAL
Check #
26270 duilding Inspector
Plans Submitted ❑ Plans Waive Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
E ;
Public Sewer 13
Tanning/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
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
c
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
]DPW Tower Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT - Temp Qum
pster on site yes no
Located at 124 Main Street:
Fire Departinerit 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 No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc.Building Permit Revised 2010
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
o Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Li Copy of Contract
❑ Floor Plan Or Proposed Interior Work
Li 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
Li 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
o 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: Doc.Building Permit Revised 2012
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 589000.00
m
$ -
$
696.00
Plumbing Fee
$
87.00
Gas Fee 100 comm.
$
100.00
Electrical Fee
$
87.00
Total fees collected
$
970.00
75 Forest Street
659-13 on 4/11/2013
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Office of Consumer Affairs & Busi ess. Regulation
I}+OME IMPROVEMENT CONTRACTOR
,legistration: „1b1874 Type:
xpiration 6/29/2014 Individual
KEVIN MURPHY I
Kevin Murphy
98 FOREST ST.
N. ANDOVER, MA 01845" Undersecretary
Nlassachusctts - Depar-trttcnt oi' Ptittiic S:tfct�
Board of Building Regulations and Standards
Construction Supervisor License
License: CS 53099
i
i
KEVIN W MURPHY
ti 169 BOXFORD ST
N ANDOVER, MA 01845
Expiration: 6/29/2013
CommissionerTr##: 16666
CERTIFICATE OF LIABILITY INSURANCE
DATE M,DD,YYYY)
12/4/20 /4/2012
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 polky(ies) must be endorsed. if SUBROGATION IS WAIVED, subject to
the tenns and conditions of the Policy, certain policies may require an endorsement Astatement on this certificate does not confer rights to the
certificate holder in Tieu of such endorsement(s).
PRODUCER
M P ROBERTS INS AGCY INC
1060 Osgood Street
North Andover, MA 01845
NAME:
PHONNo 97$ 683-8073 {n c. No): (978) 683-3147
CSL sandiftprobertsinsurance.com
MSURER(S) AIDING COVERAGE NAIL#
INSURER A: PROVIDENCE MUTUAL
INSURED gEVIN MURPHY BUILDING & REMODELING
98 FOREST STREET
NORTH ANDOVER, MA 01845
INSURER B: MERCHANTS INSURANCE
INSURER c_ GUARD INSURANCE
INSURER D:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER_ RFVISInfJ til 1u np:p-
THIS 1S TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTIMTIHSTANDING 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.
1 NSR
TYPE OF INSURANCEINSR
WO
POLICY NUMBER
(MKODA-fM
(MM7DDIYYYY)
LIMITS
GENERAL LIABIL!`Y
EACH OCCURRENCE $ 1,000,000
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE � OCCUR
m
PREMISES (Ea onaee) $ 500,000
MED ECP(Myompaserr) $ 15,000
A
BOPI068945
1/22/12
1/22/13
PERSONAL aADyINJURY $ 1-10-0-0-10-00
GENERAL AGGREGATE s 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PM
PRODUCTS - COMPIOP AGG $ 2,000,000
PRO LOC
POLICY F1
$
AUTOMOBILE LIABILITY
WMINNO
aooNerrl $ 1,000,000
BODILY INJURY (Per person) $
BODILY INJURY (Per awdeM $
B
ANYAUTO
ALLOWNED SCHEDULED
AUTOS AUTOS
MCA7013608
1/23/12
1/23/13
NON -OWNED
HIRED AUTOS AUTOS
PROPERTY DAMAGE S
(Per ami)
i
B
ExcEss LIAB
ExcEsLLA LIABHCLAIMISAIADE
OCCUR
CUP9145304
1/22/12
1f22113
EACH OCCURRENCE $ 1,000,000
AGGREGATE $ 1,000,000
DED RETENTION s
$
C0FFKMRAM3VWM
WORKERS COMPENSATION
AND EMPLOYERS' LIABIUTY YIN
ANY PROPRIETORMARTNEIMD(EMTME
EXCUJDED?ElNIA
(Me
en atwy In NN)
KEWC317800
7/01/12
7/01/13
T�YSLIMITS ER
EL EACH ACCIDENT $ 500,000
EL DISEASE- EAEMPLOYEE s 500,000
Et DISEASE - POLICY LIMrr I s 500,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OFOPERATIONS /LOCATIONS /VEHICLES XA ACORD101,Ad66o"RenteftSdredrledmaespaceisregrind)
a =M r I n nur "rn I - .
TOWN OF NORTH ANDOVER
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
NORTH ANDOVER MA 01845
THE EXPIRATION DATE THEREOF, NOTICE WLL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED THE YI&I610or
v lyes* -ZULU At;ORUCORPORATION.AII rights reserved.
ACORD25 (2010105) The ACORD name and logo are registered marks of ACORD
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office Of Investigations
600 Washington Street
Boston, MA 02111
www.mass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Orgmizadon/Individual):
U
Address:_ Tit
City/State/Zip: ,F,�`1„ f� � � ,,�,�, 1k,_ Phone #: g-7 S 6 -5$ - S3 3 -r-
Are you an employer? Check the appropriate box:
16 I am a employer with t 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-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required]
3 . ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
listed on the attached sheet. t
These sub -contractors have
workers' comp. insurance.
5. ❑ We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, §I(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. IDRemodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11. El Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information.
l 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 their workers' comp. policy information.
I am an employer that isproviding workers' compensation insurance for my employees Below is thepolicy and fob site
information.
Insurance Company Name: ,,`� s� C"".
Policy # or Self -ins. Lic. M 31-70-01) Expiration Date:_M ��- ( t --
Job Site Address: 'is �� rc f -Y— S �ti.. _ .'t" City/State/Zip: 1.A ul •._ .�w-ti, �, U t�1.t
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date).
Failure to secure coverage as required under 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 DIA for insurance coverage verification.
I do hereby cerfb5, under the pains and penalties of perjury that the information provided above is true and correct.
Official use only. Do not write in this area, to be completed by city or town oKwiaL
City or Town:
Permit/License #
L
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 M
'(4
:er-p.
Building Contractor
Proposal
To: Andrew Devore
75 Forest Street
North Andover, Ma 01845
From: Kevin Murphy
CC:
Date: 4/11/2013
Job: Kitchen renovation
Date of plans: 2/13
Architect: Owner
Lacation: Same
Section 1- Work Schedule
• 98 Forest Street
• North Andover, MA 01845
• PH: 978-688-6336
• FAX: 978-688-7207
AO 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 Con h 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 4/1/13.
Barring Delay caused by circumstances beyond Contactors control, the work will be completed by 5/30/13. 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 111- Scope of Work
Page 1 of 4
3
Kevin Murphy
Building Contractor
98 Forest Street
North Andover, MA 01845
PH: 978-688-5335
FAX 978{688&7207
Page 2 of 4
General
Proposal is to renovate existing kitchen / dining area as shown on owner's plans. Building permit will be
obtained by contractor.
Demolition
No allowance has been made to perform any demolition, or dispose of any related debris.
Building
All frame and siding materials will be supplied to perform renovation. Ten Anderson casement windows will be
supplied / installed as shown on plans. Pre -primed cedar siding will be supplied to match existing. Exterior trim
will be Azek. Any framing materials required to relocate / remove interior petitions will be supplied as required.
Plumbing
Plumbing required to relocate kitchen sink, install pot filler, two dishwahers, and icemaker will be provided. Gas
line for stove will be relocated / installed as required. No allowance has been made to supply any plumbing
fixtures. No allowance has been made to relocate any plumbing or heating lines to second floor.
Electrical
Electrical work required to wire kitchen to meet code will be provided. Twenty recessed lights have been
included. General layout is based on kitchen plan. Final layout to be approved by owner prior to rough. Any
surface mounted fixtures ( pendants / undercabinet lights ) to be supplied by owner, installed by contractor. No
allowance has been made to upgrade existing electrical service. Phone / cable / computer lines to be roughed
in by electrician, to connected by their service provider, at owner's expense. Appliances to be supplied by
owner, installed by contractor.
Heating/Air Conditioning
Forced hot water baseboard will be removed. Two new toe kick heaters will be supplied and installed. Ductwork
for high velocity air conditioning will be installed in ceiling. A credit of $1000 will be given, if this is deleted.
Insulation
All renovated areas will be insulated to meet code.
Plaster
Renovated areas will be blueboarded and skimcoat plastered. Walls and ceiling will be smooth. Ceiling in front
foyer will be plastered ( smooth )
Interior Trim/Doors
No allowance has been made to supply or install any interior trim.
Painting
No allowance has been made to provide any interior or exterior painting.
Flooring
Kevin Murphy
Building Contractor
98 Forest Street
Nath Andover, MA 01845
PH: 9784588-5335
FAX 978-68&7207
Page 3 of 4
Hardwood floors will be supplied / installed / finished in new kitchen area. Three coats of oil based urethane will
be applied. No allowance has been made to replace or refinish any other existing floors. Option to refinish
hardwood floors in two additional rooms, ( approximately 490 square feet) would add a cost of $1225.
Waste Removal
Construction debris related to work performed by contractor, and his subs, will be disposed of. No allowance
has been made to dispose of any demolition debris, or debris generated by others.
Items Not Included
There have been no allowances made to supply or install any kitchen cabinets or countertops.
Other Allowances
No allowance has been made to provide any tiling
Kevin Murphy
Building Contractor
98 Forest Street
North Andover, MA 01845
PH: 978£885335
FAX 978-688-7207
Section IV - Price Schedule
C Total
Page 4 of 4
We hereby propose to furnish material and labor — complete
in Accordance with above specifications for the sum of .....................................$ 33,000
Payment to be made as follows:
Percentage/item
Description
Amount
1
Permit obtained
$2000
2
Windows installed
$8000
3
Plasteiing complete
$10,000
4
Trim / floors complete
$8000
5
Job 100% complete
$5000
5
$33,000.00
Notice: No ageernent for Home improvement contracting work stall regime a down payment (advance deposit) of more ttet one4vrcl of the total contract price of the total amount of an deposits or
payments which the mrrtracor must mace, 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
Sig
Signature,
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
Date y�lU�l3
Date