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HomeMy WebLinkAboutBuilding Permit #545-14 - 82 SAUNDERS STREET 1/14/2014Permit NO: J". > I Date Issued: l 144 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Sep#ic ❑-Well w 0 F[o©dplin Wetlands re ❑. 1/taershecl District U Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: '5) v wl Phone: Address: f2— 4 CONTRACTOR Name:: �� 4" Pune: Address: Supervisor's Construed©n Licens ; -� � � Exp? D�teV Home' Improvement Libe' l se Epp: Date J 10"% 1, ARCHITECT/ENGINEER Phone: Address: 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: $ lf'94 f OC? FEE: $ '�W Check No.: Receipt No.: 11" I NOTE: Persons contracting ditp unregiste tractors do not have access to the guaranty fund Signature of Agent/Owner `Signature of Contractor rt 1 10 r -• r � J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ,-TYPE_OF--:=SEWERAGEDISP.OSAL Public Sewer ❑. 'I'anning/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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE:APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Comments Zoning Decision/receipt submitted yes . Conservation Decision: Comments Water &Sewer Connection/Signature & Date Driveway Permit DPW Tovvo Engineer: Signature: Locatea M4 Usgooa Street FIRE DEPARTIiIIr_NT : Temp Dumpstbr on site yes: no Located-at;l24;Mair, Street,'; Fire`Departme�itsigriatureldate COMMENTS i -D iiiiens ion Number of Stories: Total square feet of floor area, based on Exterior dimensions Total land -area; sq. ft.: ELECTRICAL: Movement of Meter location, rdast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL-Chapter 166 Section 21A -F and G min.$100-$l000..fine NOTES and DATA — (For department use ® Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department The fol'l-Ming is =a=list of the requlred forms to be filled out for the. appropriate. permit lobe obtained. Roofivg, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L Licenses o Copy of Contract o ;_Floor Plan Or Proposed Interior Work u Engineering Affidavits for Engineered products NOTE: All dumpster. permits require sign off from Fire -Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application a Certified Surveyed Plot Plan u Workers Comp Affidavit a Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract u Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) u 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) o Building Permit Application u Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li Mass check Energy Compliance Report u 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.tted with the building application Doc: Doc.Builjing Permit Revised 2012 Location —Sr7AAk4e(2S No. ftDate' (�'+ r TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 6-0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24'�3 Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 30,100.00 m $ - $ 361.20 Plumbing Fee $ 45.15 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 45.15 Total fees collected $ 551.50 82 Saunders Street 545-14 on 1/14/14 Bath Remodel Second Floor o: r L 7O F� J = CC c N U u Y O LL y Ln u Y O_ N O N Z m c fC = LL L O w C _ L U LL O W Z Z J a O C LL O a ? V J W -Cutio p d' cu V1 LL cc 0 w a ,� to O W LL z C a O LL v 7 m O Z Y Y N Y to O V v O W U) W W W N ° � o 'Q eLv CL g; �n : ,�• E d r L Q. N O O •'tet �:��• ` E _ 0.- "4E aL M 1z > _ (n L is N -0 o s w G1 E o c a,o Z Q.N. `i.rno° - O:Z.vs 3 > o Q c. m �•1-; ,.�/ ass O 0 to a, v O = C Q i L � •Q 2 as 41 Q. F- O M V m O W C b.O ° G d % O = CL O Aa .v r V W d L V a% O •O as +� am (n N S '>" r_O ° �- t , Q O L) O V v O W U) W W W N ACOROP CERTIFICATE OF LIABILITY INSURANCEDATE(MM/DD/YYYY) llik�'" 1 01(14; 2014 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 CONTANAME: CT DALE E. JOHNSON UGONE-JOHNSON INS. AGENCY, INC PNN�Nrj x,;978-887-8304 ,WC N,; 978 887-5517 E-MAIL ss:DALE_JOHNSON@FARM-FAMILY.COM DALE JOHNSON -AGENT 7 GROVE STREET- SUITE 201 TOPSFIELD, MA 01983 INSURER S) AFFORDING COVERAGE NAICa INSURER A: FARM FAMILY CASUALTY INSURANCE INSURED INSURER B INSURER C; DUNN CONSTRUCTION MANAGEMENT INC INSURERD: 65 ROWLEY BRIDGE RD INSURER E: TOPSFIELD, MA 01983 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. NSR LTR TYPE ADDL I R SUER WVD POLICY NUMBER POLICYEFF MM/DD/YYY POLICYEXP MM/DD/YYY LIMBS A GENERAL LIABILITY 2005X0885 405/2013 4/05%2014 EACH OCCURRENCE $ 1,000,000 PREMISES Eaoocurrence $ 50,000 COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR MED EXP (Arty one person) $ 5,000 X PERSONAL & ADV INJURY $ 1,000,000 CONTRACTORS ADV GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER: PRODUCTS-COMPiOP AGG $ 2,000,000 $ X POLICY PE LOC A AUTOMOBILE LIABILITY 2001C4987 4/05/2013 4/05/2014 EOa aBINEDD[SINGLE LIMIT BODILY INJURY (Per person) $ 250-000 ANYAUTO ALL OWNED I X SCHEDULED AUTOS ALTOS BODILY INJURY (Peraxidenq $ J00000 NON -OWNED HIRED AUTOS AUTOS PROPERTY ac RdTY DAMAGE $ 250,000 UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION$ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR(PARTNER:'EXECUTIVE Y / N OFFICER;MEMBER EXCLUDED? a (Mandatory in NH) N/A 2005W6936 4/05/2013 4/05/2014 X TORY LIMITS OER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYEE $ 500,000 If yes. describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $ 500,000 MICHAEL DUNN, CORPORATE OFFICER HAS ELECTED TO BE EXCLUDED FROM WORKERS COMPENSATION POLICY DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) LIABILITY POLICY INCLUDES RESIDENTIAL CARPENTRY CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER 120 MAIN STREET NORTH ANDOVER, MA 01845 FAX: (978)688-9542 CD 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 Dale E Johnson 0 1 988-201 0 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and loco are reaistered marks of ACORD Massachusetts - Department of Public Safety Board of Eu;lding Regulations and Standards Construction Supervisor License: CS -086900 ' WCEL4EL A DUro ` 65 ROWLEY BRWGE TOPSHELD MA70190a� )I vo �� Expiration �wcommissioner_ .0211712015 Tfl01l L€a, MA 01983 Undersecretary DUNN CONSTRUCTION MANAGEMENT INC. Michael Dunn 65 Rowley Bridge Rd. Topsfield MA 01983 978-836-7629 CSL #86900 HIC#151071 Home Improvement Agreement 1. This agreement made and entered into this Date 0 1/09/2014, by and between Michael Dunn DBA Dunn Construction Management Inc., 65 Rowley Bridge Road, Topsfield, MA, hereinafter referred to as the Contractor, and (Name)Peter Blum of (Address)82 Saunders St, North Andover, MA, hereinafter referred to as Owner 2. This agreement is drafted pursuant to Massachusetts General Laws Chapter 142A & 2 and the provisions contained herein are intended to comply with the requirements of said statute. 3. Whereas, said Owner is desirous of having improvements made on the premises listed known and derived as: Demo second floor full bath. Install new pan for walk in shower. Install new vanity, and toilet. Install new fan light and update any electrical. Install new tile floor, blue board and plaster where needed and paint.. 4. Now, therefore, said Contract Specifications: See attached Division item 5. Said improvements to be made for the estimation of $30100 Dollars. To be paid as follows: At the end of each week The estimate or contract sum of the said improvements is based on a good faith estimate. The contractor will submit an invoice for a progress payment to the Owner at the end of each week. The payment will be based on actual costs of the project plus 15% profit and overhead. Actual costs of that will receive a profit and overhead fee will be: job materials and subcontracted labor and materials. In-house labor and working supervisors will not incur 15%. The contractor shall keep detailed records of the project and have them available to the Owner upon request. In house labor rate will be billed at $55.00 per man hour 6. The parties hereby agree that the date of commencement of the Work shall be (Date) 01/12/2014 However, the parties further agree that Contractor's failure to commence work precisely on said date shall not be a material breach of this agreement provided that Contractor begins work within seven days of said commencement date. In addition, Owner hereby acknowledges that the commencement date is contingent upon appropriate weather conditions and that in the event that said weather conditions are not appropriate to commence said work, the commencement date as stated in this paragraph shall be tolled until appropriate weather conditions exist. Owner hereby warrants that prior to the commencement date Owner is the lawful owner of the land upon which Contractor shall be commencing the work. The Contractor agrees to achieve substantial completion of the work with 30 Calendar days of the actual commencement of the work subject to any contingencies listed herein. 1 7. Any changes to be subject to the order and direction of said Contractor and must be in writing in substantially similar form to the change order attached hereto. 8. Contractor shall not be liable for any delay or nonperformance caused by Act of God, or any other contingency beyond its control 9. The homeowner is hereby notified that all contractors and subcontractors must be registered by the administrator of the department of public safety and that any inquiries about a contractor or subcontractor relating to a registration should be directed to the administrator. 10. The homeowner is hereby notified of an owner's three-day cancellation rights under Massachusetts General Laws section forty-eight of chapter ninety-three, section fourteen of chapter two hundred and fifty-five D, or section ten of chapter one hundred and forty D as may be applicable. 11. The Contractor warrants to the owner that materials furnished under this agreement will be of good quality and new unless otherwise required or permitted by this agreement, and that the work will conform to the requirements of this agreement The Contractor's warranty excludes remedy for damage or defect caused by abuse, modifications not executed by the contractor, improper or insufficient maintenance, improper operation, or normal wear and tear and normal usage. If required by the Owner, the Contractor shall furnish satisfactory evidence as to the kind in quality of materials and equipment. The Contractor warrants that his work will be performed in a workmanlike manner and that he warranties said work for a period of 1 year from the date of completion of this contract. With respect to any equipment installed by Contractor, Contractor agrees to deliver any manufacture's warranties to Owner and Owner agrees to rely solely upon those warranties. 12. Unless otherwise provided in the contract documents, the contractor shall secure and pay for the building permit and other permits and governmental fees, licenses and inspections necessary for proper execution and completion of the work which are customarily secured after execution of the contract. In Witness Whereof, the parties have hereunto set their hands the day and date first above written * JidSIGN IF THERE ARE ANY BLANK SPACES* * Date Contractor You may cancel this agreement if it has been signed by a parry thereto at a place other than an address of the Contractor, which may be his main office or branch thereof, provided you notify the Contractor in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement See the attached notice of cancellation form for an explanation of this right Signature of Owner acknowledges receipt of attached right of cancellation. Notice of Cancellation You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the Contractor of your cancellation notice, and any security interest arising out of the transaction will be canceled. If you cancel, you must make available tot eh Contractor at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement; or you may if you wish, comply with the instructions of the Contractor regarding the return shipment of the goods at the Contractor's expense and risk. If you do make the goods available tot eh Contractor and the Contractor does not pick them up with twenty days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Contractor, or if you agree to return the goods to the Contractor and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Michael Dunn DBA Dunn Construction Management Inc. 65 Rowley Bridge Road, Topsfield, MA 01983 not later than midnight of (Date) I hereby cancel this transaction. (Date) (Owners Signature) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations quo 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/OrganizatiorAndividual): V r,� n :TI-4� 1f___. Address:l�-�`�,a� �o ��7� 4 City/State/Zip:`T. 1��2!!�&(32f!�Phone #: !7%ez' Are you an employer? Check the appropriate box: 1. [ @ I am a employer with 4— 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. I ship and'have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. 5. ❑ We are a corporation and its [No workers' comp. insurance required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] i employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. F1Remodeling 8. ❑ Demolition 9. ❑ Building addition 1011 Electrical repairs or additions 11. ❑ 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. T Homeowners who submit this affidavit indicating they 2te doing all work and then hire outside contractors must submit anew affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: �Flc1 s Policy # or Self -ins. Lic. #: Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as requiredunder 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. X do hereby cert 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 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. PIumbing 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 ofpublic 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 bum 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 ciuestions, please do not hesitate to give us a call. The Department's address, telephone and fax number: The Commonwealth of`Massarhusetts Department of ludustrial .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