HomeMy WebLinkAboutBuilding Permit #642 - 83 DAVIS STREET 5/26/2009BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
Date Issued, y
IMPORTANT: Annlicant must complete all items on this Daae
LOCATION
PROPERTY OWN
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MAP NO: PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes ("n
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
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
or Print Clearly)
OWNER: N
Address: 83
CONTRACTOR Name: 604e X; Phone: 929-4o86 o 296
Address: le ?-
Supervisor's
Supervisor's Construction License: s-yaq/ Exp. Date:,
Home Improvement License: IL""3611 Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No
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FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ 13 k FEE: $ / /� �r
Check No.: -z' 3 13 Receipt No.: dao S
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
signature of Agent/Owner Signature of contract '
Location
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M
Date 0 f
1-j Building Inspector
TOWN OF NORTH ANDOVER
0
Certificate Occupancy
$
of
CHU
Building/Frame Permit Fee
$
Foundation Permit Fee
$J
Other Permit Fee
$
TOTAL
$
3 1,3-
Check #
1-j Building Inspector
Plans Submitted Plans Waived 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 Boar` of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comm
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTMENT = Temp Dumpster on site yes no
Located at 124 Main Street
Fire Department 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
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA — (For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
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
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or 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 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:BPFORM07
Revised 2.2008
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R.S.Wo HE-BoJEWARTa
102 Adams Ave.
No. Andover mass. 01i -4S
(978) 686-0786 Phone f Fax
L!L. ;:S1 g. .i.U.i
DATE 4/18/04
job name. Mr &Tars Phiibrick
83 Davis st.
vo. mndover Moa. u1004
n..e..�.zr.^+-r, fttj a.6...x
rKOJE � . 2-- floor batrri oomi
I. PARTIES
T his contract (hereiriaE er referred to as Agreement") is made an -a' entered
into on this _18th day of April , by and between Mr. and Mrs. Philbrick,
(hereinafter referred to as "Owner"); and R.S.Hebert Construction &
Remodelina Inc.; (hereinafter referred to as "Contractor"). In consideration of
the mutual promises contained herein, Contractor agrees to perform the
folloy..Ing ow,0rlC, si3bje,t 11 the ter/ms and vvr;V14.4V^IIS below:
ii. GVEINE R AL S5C0PE Dr `v`v'vR ID%isC1RUPT 100
Supply all material and labor required to build the following.
1. Supply building permit for complete bathroom remodel.
G. L.IeI i !U VAIZ11i IV 1.l lftt1U 11 tkr1!011 i U 14A 1.0 I rag 1 le
3. Remove window and reframe for new Harvey vinyl awning window
and patch siding supplied by owner.
4. Electrical work to include relocate light over vanity,supply and install
fan lite vented to exterior and wire new air jet tub.
S. Plumbing to include installina new toilet. installing new tub includina
drain,water valve and shower head. All fixtures to be supplied by
owner iliCludling vu-1110y'Cobiii/et,toN ,sink salli.d faiivset.
6. Insulate bathroom exterior wall and ceiling.
/. InjLall Ule bdt.ker to wa115 froi-il flt?Glr and �il in tub area.
Contractor Owner Owner
The Commonwealth of Massachuse#s
kj Department of Industrial Accidents
Office of Investigations
I
1. 600 Nfashington Street
Boston, MA 02111
f Z www mass gov1dia .
Workers' Compensation insurance Affidavit Builders/Contractors/Electricians/Plumbers
APPlicant Information
Please Print Le-bly
Nance (Business/Organizafion/lndividual):
Address: 6 Z A,
City/State/Zip: c� /�% Phone i!; YG G7 96
Are you an employer? Cheett.the appropriate box:
I. ❑ I° am a employer with 4 Type of project (required):
❑ I am a general contractor and T
/employees {full and/or part-time).* have hired the sub -contractors
6' ❑ New construction
2. �I I am .a.sole proprietor or partner- listed on the attached sheet. t 1. [] Remodeling
ship and have no employees These su&contractors have 8. Q Demolition
working for mein any capacity, workers, comp. insurance.
[No workers comp, insurance 5. 9• ❑Building addition
' P ❑ We are a corporation and its
required.] officers have exercised their 10•0 Electrical repairs or additions
3. ❑ 1 am a homeowner doing all work right of exemption per MGL I I.0 Plumbing repairs or additions
myself. (No•workers' comp. c, 152, § 1(4), and we have no
-required.] t 12.0 Roof repairs
insurance
mq � . .employees. [No workers'
comp. insurance required.] 13.[] Other
*Any applicant that checks bo01 must also fill out the section below showing their workers' oompenution policy information
t Homeowners who submit this affidavit indicating they are daring all worts and than hits outside contractors must submit a new affidavit indieatios such
1Contract n; that check this box mustnttachm an additional shares showir� the name of the sub-comrectors and their workers' cc „p. --u—, .,ir�miatiuc
I am an employer that is provw1ng:workerS, compensation insurance for my employees: Below is the Pok information. p k and job site
Insurance Company Name:
Policy # or Self -ins. Lie. #:
Expiration Date:
Job Site Address:
City/State/Zip:
Misch 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 $1.1500.00 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 hereby Certs er the pains penalties of perjury that the information provided ab ve is true and correct
$t ttlre: s/7/. /
Of j`icial 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):
L Board of Health 2. Building Department 3. City/Town Cleric 4. Electrical Inspector 5. Plumbing Inspector
6.Other
Contact Person: Phone #:
Information and Instructions
Massachusetts General Laws chapter 152 requires all emp Ioyers 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 ormore
of the foregoing engaged in a joint enterprise, and including the legal representatives of a deceased employer, ar the
receiver or trmstee of an individual, partnership, association or other legal entity, employing employees. 'however the
owncr.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), addresses) 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 maybe 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, notthe Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required W 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 kill be used as a reference number. In addition, an applicant
that must submit multiple permit/liceme 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 ofthe 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 fixture 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 questions,
please do not hesitate to give us a call.
The Department's address, telephone and fax number.
The CommonwomIth of Massachusetts
Departmcnt of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, IIIA 02111
TeL 9 617-7274900 ext 406 or 1-8.77-MASSAFE
Fax 4 617-727-7749
Revised 5 -26 -QS www_mass.govldia
8. Install the backer to bathroom floor area.
9. Blueboard and plaster remaining wall area and ceiling.
10. Install vanity supplied by owner.
11. Install new trim to window,door and baseboard.
12. Install new the to walls and floor.Tile to be supplied by owner.
13. Supply and install new roof mount attic vent fan.
14. Vanity light fixture to be supplied by owner.
15. Dumpster will be supplied by contractor.
15. Painting is not included in this quote.
17. Install headboard Oft. up from floor in bathroom area.
18. Beadboard material supplied by owner.
A. LUMP SUM PRICE FOR ALL WORK ABOVE*
A. LUMP SUM PRICE FOR ALL WORK ABOVE - $9380.00
Nine thousand three hundred eighty dollars.
A one thousand dollar_, deposit Clue at signing.
III. GENERAL CONDITIONS FOR THE AGREEMENT ABOVE
2. STANDARD EXCLUSIONS: Unless specifically included in the
"General Scope of Work" section above, this Agreement does not include
labor or materials for the following work: Plans, engineering fees,
Testing, removal and disposal of any materials containing asbestos (or
any other hazardous material as defined by the EPA). Custom milling of
any wood for use in project. Moving Owner's property around the site.
Labor or materials required to repair or replace any Owner -supplied
materials. Final construction cleaning (Contractor will leave site in
"broom swept" condition).,correction of existing out -of -plumb or out -of -
level conditions in existing structure. Correction of concealed
substandard framing. which may be discovered in the removal of walls
or the cutting of openings in walls. Removal and replacement of existing
rot or insect infestation. Failure of surrounding part of existing structure,
despite Contractor's good faith efforts to minimize damage, such as
plaster or drywall cracking and popped nails in adjacent rooms or
blockage of pipes or plumbing fixtures caused by loosened rust within
pipes. Exact matching of existing finishes. Cost of /testing/remediating
mold/fungus/mildew and organic pathogens unless caused by the sole
46V
Contractor Owner Owner
and active negligence of Contractor as a direct result of a construction
defect that caused sudden and significant water infiltration into a part of
the structure. B. DATE OF WORK COMMENCEMENT AND
SUBSTANTIAL COMPLETION
Commence work: . Construction time through substantial
completion: Approximately 1 to 2 weeks, not including delays and
adjustments for delays caused by: holidays; inclement weather;
accidents; shortage of labor or materials; additional time required for
Change Order and additional work; delays caused by Owner, Owner's
design professionals, agents, and separate contractors; and other delays
unavoidable or beyond the control of the Contractor.
C. CHARGES FOR ADDITIONAL WORK: CONCEALED CONDITIONS,
DEVIATION FROM SCOPE OF WORK, AND CHANGES IN THE WORK
1. CONCEALED CONDI I IONS: This Agreement is based solely on the
observations Contractor was able to make with the project in its
condition at the time the work of this Agreement was bid. If additional
concealed conditions are discovered once work has commenced or after
this Agreement is executed which were not visible at the time this
Agreement was bid, Contractor will point out these concealed conditions
to Owner, and these concealed conditions will be treated as Additional
Work under this Agreement. Contractor and Owner may execute a
Change Order for this Additional Work. Contractor is released, held
harmless, and indemnified by Owner from all pre-existing mold, fungus,
mildew, and organic pathogen problems and is not responsible for costs
or damages associated with correcting, containing, testing, or
remediating the same.
0_1 ; MRA
W-41 11 A'� iVJ,
2. DEVIATION FROM SCOPE OF WORK: Any alteration or deviation
from the Scope of Work referred to in this Agreement involving extra
costs of materials or labor (including any overage on ALLOWANCE work
and any changes in the Scope of Work required by Owner, Owner's
design professional, Owner's agent, or building inspectors) will be
treated as Additional Work under this Agreement resulting in an
additional charge to Owner. Contractor and Owner may execute a
Change Order for this Additional Work.
D. PAYMENT SCHEDULE AND PAYMENT TERMS
1. PAYMENT SCHEDULE:
* First Payment: $1000.00 due when Agreement is signed and returned
to Contractor:
2"d Payment $2000.00 When work is started.
3rd Payment $3000.00 Rough inspections are complete.
4t' Payment $1500.00 Biueboard and plaster is complete.
* Final Payment: Balance of contract amount due upon Substantial
Completion of all work under contract: $1880.00
2. PAYMENT OF CHANGE OROERSJADDITIONAL WORK: Payment
for Additional Work is due upon completion of either all or part of the
Additional Work and submittal of invoice by Contractor.
E. WARRANTY
Thank you for choosing our company to perform this work for you. Your
satisfaction with our work is a high priority for us, however, not all
possible complaints are covered by our warranty. Contractor does
provides a limited warranty against material defects on all Contractor -
and subcontractor -supplied labor and materials used in this project for a
period of one year following substantial completion of all work. This
warranty covers normal usage only. You must contact the Contractor
upon discovering an Item in need of warranty service. Additionally,
Owner's hiring of others or direct actions by Owner or Owner's separate
contractors to repair a warranty item are not covered by this warranty
and will not be reimbursed by Contractor.
X& -
Contractor Owner Owner
No warranty its provided by Contractor on any materials furnished by the
Owner for installation. No warranty is provided on any existing materials
that are moved and/or reinstalled by the Contractor within the dwelling
or the property (including any warranty that existing/used materials will
not be damaged during the removal and reinstallation process). One
year after substantial completion of the project, the Owner's sole remedy
(for materials and labor) on all materials that are covered by a
manufacturer's warranty is strictly with the manufacturer, not with the
Contractor.
Repair of the following items and related damages of every kind are
specifically excluded from Contractor's warranty: problems caused by
lack of Owner maintenance; problems caused by Owner abuse, Owner
misuse, vandalism, Owner modification, or alteration; and ordinary wear
and tear. Damages resulting from mold, fungus, and other organic
pathogens are excluded from this warranty unless caused by the sole
and active negligence of contractor as a direct result of a construction
defect which caused sudden and significant amounts of water infiltration
into a part of the structure. Deviations that arise such as the minor
cracking of concrete, stucco, and plaster; minor stress fractures in
drywall due to the curing of lumber; warping and deflection of wood;
shrinking/cracking of grouts and caulking; fading of paints and finishes
exposed to sunlight are all typical (not material) defects In construction,
and are strictly excluded from Contractor's warranty.
F. WORK STOPPAGE AND TERMINATION OF CONTRACT FOR
DEFAULT
Contractor shall have the right to stop all work on the project and keep
the job idle if payments are not made to Contractor strictly in
accordance with the Payment Schedule in this Agreement,
G. DISPUTE RESOLUTION AND ATTORNEY'S FEES
Any controversy or claim arising out of or related to this Agreement
involving an amount less than $5,000 (or the maximum limit of the
Small Claims court) must be heard in the Small Claims Division of the
Municipal Court in the county where the Contractor's office is located.
Any dispute over the dollar limit of the Small Claims Court arising out of
this Agreement shall be submitted to an experienced private
construction arbitrator that shall be mutually selected by the parties to
conduct a binding arbitration in accordance with the arbitration laws of
the state where the project is located. The arbitrator shall be either a
licensed attorney or retired judge who Is familiar with construction law.
If the parties can not mutually agree on an arbitrator within 30 days of
written demand for arbitration, then either of the parties shall submit the
dispute to binding arbitration before the American Arbitration Association
in accordance with the Construction Industry Rules of the American
Arbitration Association then in effect. Judgment upon the award may be
entered in any Court having jurisdiction thereof.
H. ENTIRE AGREEMENT, SEVERABILITY, AND MODIFICATION
This Agreement represents and contains the entire agreement and
understanding between the parties. Prior discussions or verbal
representations by Contractor or Owner that are not contained in this
Agreement are not a part of this Agreement. In the event that any
provision of this Agreement is at any time held by a Court to be invalid
or unenforceable, the parties agree that all other provisions of this
Agreement will remain in full force and effect. Any future modification of
this Agreement should be made in writing and executed by Owner and
Contractor.
I have read and understood, and I agree.to, all the terms and conditions
contained in the Agreement above.
SIGNATURE
rXWNER'S SIGNATURE
R'S SIGNATURE
Contractor Owner Owner
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