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Home My WebLink AboutBuilding Permit #056-14 - 78 CROSSBOW LANE 7/17/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION d 1 Permit N0: Date Received Date Issued: I IMPORTANT:Applicant must complete all items on this page LOCATION 'S Print PROPERTY OWNER ";l r,,r�.�-► L� abeam Print 100 Year Old Structure yes no MAP NO: l u PARCEL:o ZyOZONING DISTRICT: Historic District yes Machine Shop Village yes no. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial )KRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Se tic EiWel[ ❑ Floodplain ❑Wetlands ❑ Watershed District, Water ewer DESCRIPTION OF WORK TO BE PERFORMED: 1 e ra .nC- Identification Please Type or Print Clearly) OWNER: Name: 64-.x , sd Phone: 't'2 S• SIV D Address:--Ab Cv�--sSkp'^-- I CONTRACTOR Name: Phone: 533 Address: _`'l ��rC fi S �/� ��.►.�,�.,. 1 _ e Supervisor's Construction License:_p;:; 3 u Exp. Date: U V2R A V-t Home Improvement License: \ 0\,!z'1`'l Exp. Date: 63 22 l ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. K Total Project Cost: $ -'k-0SD FEE: $ Check No.: � r�� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature�of Agent/Owner �gaature of contractor ' �.., Plans Submitted ❑ Plans Waiveu Certified Plot Plan ❑ Stamped Plans Location --1z CrDs-s b L ,,j . � l No. 01t) Date i f • - TOWN OF NORTH ANDOVER MID 1 • Certificate of Occupancy $ � Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector Plans Submitted ❑ Plans Waive4 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS 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: Comments Conservation Decision: Comments Nater & Sewer Connection/Signature& Date Driveway Permit DPW Tow; Engineer: Signature: Located 384 0Streefi FIRE DEPARTMf_NT - Temp Dumpster on site yes no Located at 124 Main'Street Fire be me 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 NOTES and DATA— For department use D Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department Tine fo,lowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofiv,g, Siding, Interior Rehabilitation Permits U: Building Permit Application ❑ ' Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ ' Copy of Contract o Floor Plan Or Proposed Interior Work o ' 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 a 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) L3 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses Li 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 o 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 app,-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must bf- subwted with the building application Doc: Doc.Buh ing permit Revised 2012 NORTH Town of A h , ver, Mass, �.' 11 2a r 3 coc"IcHeWK.. y p�R %J ATEQ PP�`�g5 S U BOARD OF HEALTH Food/Kitchen Septic System LD THIS CERTIFIES THAT ...PERMIT . �►.. BUILDING INSPECTOR .. ...�....... ......... ............ ....................... has permission to erect buildings on • Foundation Rough to be occupied as OPARN%...f.*..... .... ' '. .eel... .... � ........................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 4ONTHS ELECTRICAL INSPECT OR UNLESS CON TRUC I TA Rough S S Service ............. ................................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE 98 Forest street Kevin Murphy NorthAnd35A01845 :9784;88-63 Building Contractor • FAX:9784W7207 Proposal TO: Hilary Bugbee 78 Crossbow Lane M Home inpoMnerrt Contractors and subconhcWrs UrflM North Andover, Ma 01845 � a►horne�re�n by +sloworChapter 142A of the general laws,must be registered with the Con nnveft of Massadwsetts.inquiries about regishatiml and SU&s should be made to the Director,Horne impovarnert Contract RegWalim,one AWx ton Place, From: Kevin Murphy Ramp 1301,Boston,MA 02108.(617)-727 8598 cc: Date: 5/30/2013 Joh Deck repairs Date of PkWW None Affect: None Locatlkw: Same Section i-Work Schedule 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 7/8/13. Baring Delay caused by circumstances beyond Contactors control,the work will be completed by 8/30/13.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 i The Contractor warrants that the work furnished hereunder shah 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 it Page 1 of 4 r Kevin Murphy� Y Page 2 of 4 Building Contractor 98 Forest Street North Ardow,MA 01845 PR'9788BMM FAX 978688.7207 General Proposal is to repair/replace all rot on exisitng deck. Building permit wil be obtained by contractor. 'Demolition All rotted 4x6 posts,and miscellaneous pine trim will be removed. Railing to be saved and reinstalled Building New 4x6 Fir posts will be supplied and installed.Al pine trim around exterior of deck will be replaced with Azek. Missingsections of railing and lattice will be provided. An damaged pieces of decking will be replaced. One 9 y 9 P new Harvey storm door will be supplied and installed. Painting New trim/posts/rails will be painted to match exisitng. Exisitng floor of deck will be sanded and resealed. No allowance has been made to reseal exisitng railings. Waste Removal All demoliiton/construction debris will be disposed of by contractor. i Kevin Murphy Page 4 of 4 Building Contractor 98 Forest Street North Andover,M1A of 8a5 PH:978688,5M5 FAX 978487207 Section IV-Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of............... ...................... 7050 Payment to be made as follows: 'Percents elltem Description Amount 1 New posts /trim installed $5000 2 Painting /sealing /job complete $2050 Total 2 $7,050.00 "Notice:No agreement for Hans nVroveroert corta*V work shall require a down payrned(advance deport)of nate that w*4wd of total con6act price ofthe total ancon of all deposb or paymerrts winch the contactor MM make,in advanoe,to order w4V oltowise obtain delivery of special order materials and equiprnert,wAldever is greater Contractor: Kevin Murphy 98 Forest Street No.Andover,MA 01845 Registration No: 101874 Section V-Acceptance I 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 Signage. Date Signature, Date 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/Organization/Individual): �C Address: City/State/Zip: Nv, LIT- Phone#: elI Y) 5-3 3 � Are you an employer?Check the appropriate box: Type of project(required): 1.6 I am a employer with�_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. T ?•�Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions required.] officers have exercised their ri ht of er MGL 11.❑Plumbing repairs or additions exem tion 3.❑ I am a homeowner doing all work g p p myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#i must also fill out the section below showing their workers'compensation policy information. 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 is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.,Lic.#: -C> 1,...C- 7 l'1�V t> Expiration Date: :N City/State/Zip: Job Site Address: 10;f2 C��s bw-- �''� �ct�--�"�-�ti''�� 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, Y P 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. 1 do h ere1V certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: Date: Phone#: 9,71 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 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-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 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 Office of Investigations would like to thank you in advance for 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 Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 Tel. #617-727.4900 ext 406 or 1-877-MASSAFE evised 5-26-05 Fax# 617-727,7749 a DATE(MM/DD/YYYY) ACORIL7 CERTIFICATE OF LIABILITY INSURANCE 7/17/2013 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 endorsement(s). PRODUCER CONTACT NAME: M P ROBERTS INS AGCY INC PHONE (978) 683-8073 FAX 978 (A/C, /C No Exti: A/C,No):( ) 683-3147 1060 Osgood Street AORIEss:sandi@mprobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: PROVIDENCE MUTUAL INSURED ' KEVIN MURPHY BUILDING & REMODELING INSURER B:MERCHANTS INSURANCE 169 BOXFORD STREET INSURER C:GUARD INSURANCE NORTH ANDOVER, MA 01845 INSURER D: INSURER E INSURER F: 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. ILTR TYPE OF INSURANCE ADDL SUBR - POLICY FF POLICY XP LIMITS INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS i-MADE X OCCUR PREMISES Ea occurrence $ 500,000 MED EXP(Any one person) $ 15,000 A BOPI068945 11/22/12 11/22/13 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY CI JE0 C LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE ITMTT— Ea accident) $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED MCA7013608 01/23/13 01/23/14 B AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY D M $ HIRED AUTOS AUTOS (per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 CUP9145304 11/22/12 11/22/13 DED I I RETENTION$ $ WORKERS COMPENSATIONPER - AND EMPLOYERS'LIABILITY YIN X STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? CI NIA (Mandatory in NH) KEWC422467 07/01/13 07/01/14 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I It 500,000 i �I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE BUILDING DEPT. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRES A E I I� 01988-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD