HomeMy WebLinkAboutBuilding Permit #577 - 79 FULLER ROAD 3/16/2006 Op NORTH 1
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TOWN OF NORTH ANDOVER
�! :* APPLICATION FOR PLAN EXAMINATION
9SSACHU`�Et
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Permit NO: Date Received:
Date Issued: �J `
IMPORTANT: Applicant must complete all items on this page
LOCATION -� 4. F,1
_ rmt
PROPERTY OWNER
Print
MAP NO.: O 5 PARCEL: C ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building JJ,One family
0 Addition ❑Two or more family ❑Industrial
Alteration No. of units:
❑ Repair, replacement ❑Assessory Bldg 0 Commercial
❑ Demolition
0 Moving(relocation) ❑ Other 0 Others:
0 Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
J
4
Identification Please Type or Print Clearly)
11
OWNER: Name:lA/ � Phone: G&3 - 2,11-( b
nature
Address: VJ_ e
CONTRACTOR Name: �'�� c1-�— Phone(gn f'g �W-533
Address: ?i t-_4� 1, ,..,
Supervisor's Construction License: 3 `t Exp. Date: \2_g b
Home Improvement License: Exp. Date: L'L t � 0�
ARCHITECT/ENGINEER Name: Phone: `—
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON
$125.00 PER S.F.
Total Project Cost :$ DD 0 x10.00=FEE:$
Check No.: .2 bs3 9 Receipt No.: Igo(
,•
Location -) 9 f" f le(-C 12
No. Date ' U
�ORTM TOWN OF NORTH ANDOVER
10. �
9
Certificate of Occupancy $
s,CHUsEt�' Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $ 47,1.3
U~l�
Check # W, 10 7
Z
Building Inspector
TYPE OF SEWARGE DISPOSAL Swimming Pools ❑
❑ Tanning/Massage/Body Art Elg
Public Sewer
Well
Tobacco Sales 11 Food Packaging/Sales 1:1❑
P ❑
Private(septic tank,etc. Permanent Dumpster on Site
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of A ent/Owne -
g g )-v Signature of Contractor
Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped P1'4 ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF-U FORM
DATE REJECTED DATE APPROVED
PLANNING & DEVELOPMENT ❑ ❑
❑Water Shed Special Permit
❑ Site Plan Special Permit
❑ Other
COMMENTS
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑ `? , /.� �j fj
f
COMMENTS I /
. l
Zoning Board of Appeals: Variance,Petitio No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer connection signature&date
Temp Dumpster on site yes_no76 Fire Department signature/date
Building Permit Approved and Issued by:
i
Building Setback ( O
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
DIMENSION � 1
Number of Stories: £,mss kTotal square feet of floor area,based on Exterior dimensions.
Total land area,sq. ft.:
NOTES and DATA—(For department use)
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05
Created JMC.Jan.2000
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
❑ Debris Removal Form
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
Addition Or Decks
❑ Building Permit Application
❑ Form U
❑ Surveyed Plot Plan
❑ Debris Removal Form
❑ 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)
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Form U
❑ 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
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:INSPECTIONAL SERVICES DEPARTMENT:QPFORM05
,.10RTH
Town of 4 L Over
No. X77
j 1� ZO CA E " dover, Mass.,
COCMIC ME WICK
AD"?ATE D PPS` �y
H BOARD OF HEALTH
PERMIT T Food/Kitchen
Septic System
•
• 1 I BUILDING INSPECTOR
THISCERTIFIES THAT.......... ....... .1. ! ,,............ ... ........................ ......... .................................................................
�. Foundation
has permission to erect........................................ buildings on ...... ... ........r' ........ A.. ............... Rough
to be occupied as............044t.14%..........R.M.S.C./!..t..F.N..r.......................................................................... chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final
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. (0-/q D PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS
UNLESS CONSTRUCTION � ELECTRICAL INSPECTOR
/��� �. � Rough
:..: :... Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
Rough
Display in a Conspicuous Place on the Tremises — 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.
SEE REVERSE SIDE Smoke Det.
q_S x.41 �'U �^� bL
Rll '^�j -., `I ' '�-P--, M )
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of MGL c 40 S 54, a condition of Building Permit
at: rl T 1F_�v ,.- .J� is that the debris resulting from this work shall be
disposed of in a properly licensed solid waste disposal facility as defined by NIGL
11, S 150 A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
1 OA.
The debris will be disposed of in:
(Location of Facility)
Signatu of Permit Applicant
Fire Department Sign off:
Dumpster Permit
Date
.r•r:war __ mm I V.
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, AIA 02111
ov/dia www.mass.
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Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
r
Name (13usincssn)rgunirution/Individual): .a
Address:
City/State/Zip: Lz,. A ,,....� fv�_ Phone 4:
Are you an employer?Check the appropriate box: Type of project(required):
I. t am a elnplo er with 4. ❑ 1 am a general contractor and I
* have hired the sub-contractors 6. ❑ New construction
employee full d/or part-time).
2.❑ I am a sole proprietor orpartner- listed on the attached sheet.t 7. Remodeling
ship and have no employees These sub-contractors have 8. ❑ Demolition
workingfor me in an capacity. workers' comp. insurance.
Y p h'• 9. ❑ Building addition
[No workers' comp. insurance 5. ❑ We are a corporation and its
10.0 Electrical repairs or additions
officers have exercised sed their
3. 1 am a homeowner doing all work right of exemption per MGL I I.❑ Plumbing repairs or additions
❑ g
myself No workers' com c. 152,§1(4),and we have no 2
Y [ + p employees. No workers' 1- ❑ Roof repairs
insurance required.] [ 13.0 Other
comp. insurance required.]
*.Any applicant that checks box#I must also till 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 4 or Self-ins. Lic.#: s,u ^�1,A t 4 '�Z Expiration Date: r\ � a�
Job Site Address: r\� ��` _. ��dl. City/State/Zip: `Nr ,
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 forth of a STOP WORK ORDER and a fine
Of ftp 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 her y certif u e pains and penalties of perjury that the information provided above is true and correct.
Si Jnature: Date: LD
Phone iJ
O%Jic•ial use only. Do not write in this area,to be completed by city or town oJJicinl.
City or Town: Permit/License#
Issuing Authority(circle one):
I. 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 confinnation 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 till 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 pen-nit/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
Revised 5-26-05 Fax #617-727-7749
www.mass.gov/dia
eet
` r 0 North PH 97&888 er, A 01845
Building Contractor • FAX:978-688-7207
Proposal
To: Mike Rielly
79 Fuller Road All liana improvernen Contractors and Subcortractors
unkm
North Andover, Ma. 01845 specAifically spec /rxrm��e<nent �v exemern pt from registration by Provisions of Chapter
142A of the general laws,must be registered with the
Commormealth of Massachusetts.Irquirfes about
registration and Status shaAd be made to the Director,Horne
Improvement CorMxt Registration,One Ashburton Place,
From Kevin Murphy Room 1301,Boston,MA 02108.(617)-727&598
CC:
Date: 10/4/2005
.lob: Finish existing basement area.
Date of plans: none
Anchitect: none
t ocatiiom same
Section 1-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 12/1/05.
Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 2/15/06.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 fumished 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
EgOyaBp wmnvay Page 2 of
Banding conatuctoa
16913o)dord street
North Andover,MA 01845
PH:978£865335
FAX 978-688-x00(X
General
Building permit will be provided by contractor. No allowance has been made for board of health approval or title
five inspection, if required by town. Proposal is to finish approximately 26'x28' area on one side of stairway, add
3/4 bath, finished hallway, and 12'x14' finished area on other side of stairway. Remaining area will be
unfinished.
Building
All framing materials will be provided by contractor.All walls will be 2x4,with a pressure treated bottom plate.
Plumbing
Plumbing required to add 3/4 bath and laundry connections will be provided in new finished area. An allowance
of$800 has been included for plumbing fixtures ($450 for shower, $150 for toilet, $100 for shower valve, $100
for faucet).
Electrical
Electrical work required to wire basement to meet code will be provided. SWtched outlets will be provided in
each area. No allowance has been made to provide any recessed lights. Phone, cable, and computer lines will
be roughed in by electrician,to be connected by their service provider at owner's expense.
Heating/Air Conditioning
One separate zone of forced hot water heat will be provided for new finished areas. No allowance has been
made for any air conditioning. Make up air will be provided in unfinished boiler area.
Insulation
Exterior walls will be insulated to meet code(R-13). No allowance has been made to insulate basement ceiling.
Plaster
All new walls will be blueboarded and skimcoat plastered.Walls will be smooth,closets will be textured.
Ceiling in finished areas will be suspended.An allowance of $3 per square foot has been included for ceiling.
(Basic ugly suspended ceiling costs about$2 per square foot, a nice one that Maureen will like is about$3 per
square foot)
Interior Trim/Doors
Preprimed, solid core, six panel interior door units will be supplied and installed to match existing. Interior trim,
stair handrail,and balusters will be supplied and installed to match existing.
Painting
All interior painting will be provided.Walls and trim will have one coat of primer,and two coats of finish.Colors to
be determined.
Page 3 of
SuUdIng Contractor
169 Bo)dord Street
North Andover,MA 01845
PH,9786885335
FAX 978-688-XX)OC
Flooring
An allowance of $3000 has been included to supply and install carpets on stairs and in basement
area.(approximately$25 per yard)
Bathroom floor will be tiled. An allowance of $200 has been included for tie materials. (approximately$4 per
square foot)
No allowance has been included for any flooring on first floor of existing house.
Other Allowances
An allowance of$500 has been included for bathroom vanity and countertop.
Waste Removal
All construction debris will be disposed of by contractor.
Mei rhm Wmnjpky Page N of
GlftUding Coantaactoa
169 Bo)dord Street
North Andover,MA 01645
PH:978588-6335
FAX:978588-)000(
Section IV-Price Schedule
We hereby propose to furnish material and labor—complete
in Accordance with above specifications for the sum of... ... ... ... ... ... ... ... ... ... ... ....$ 49,000
Payment to be made as follows:
Percenta elitem Description Amount
1 Permit obtained $3000
2 Framing complete $12,000
3 Rough plumbing / electric complete $10,000
4 Plastering complete $10,000
5 Interior trim / painting complete $8000
6 Flooring installed /job 100% complete $6000
Total 6 $49,000.00
"Notice:No agreement for Home improvement contracting work shall require a dawn Payment(advance deposit)of more that one-third of the total contract price of the total amount of all deposits or
payments which the contractor must make,in advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever is greater
Contractor. Kevin Murphy
169 Boxford 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.
p 9 9� P P 9 P
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 OT SIGN THIS NTRACT IF T ERE ARE ANY BLANK SPACES
Signature Date /_/.-,
v A 7����
y
Signature �'-- 7 Date L� C