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HomeMy WebLinkAboutBuilding Permit #147-14 - 86 FOREST STREET 8/15/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �4 Date Received Date Issued; !M I IM ORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 1A S e. d A- Print 100 Year Old Structure yes n MAP NO: PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village a Y es Md TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District- r/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: r-vn7, Address: ria 6 CONTRACTOR Name: Phone: { Address: Supervisor's Construction License: 05 31) `� °� Exp. Dater I Home Improvement License: \ n \ 9,--L\-f Exp. Date: 1, 9, l5 ARCHITEICT/ENGINEER Phone: Address: Reg. No. a FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. -,- Total Project Cost: $ 2>Z � U Q FEE: $ �-1Z-1 Check No.: t � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the g aranty fund _ Sigratureof Agent/Owner Signature of contractor ' Plans Submitted ❑ Plans Waive Certified Plot Plan ❑ Stamped Plans Location S4 No. q " �, Date • -+ TOWN OF NORTH ANDOVER dd Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# .� Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYP ,:OF`.SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales El 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 I CONSERVATION Reviewed on Signature COMMENTS HEALTH' Reviewed on Signature COMMENTS ti Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments Water & Seger Connection/Signature& Date Driveway Permit DPW To-,v;,- Engineer: Signature: Located 384 Os od S eet FIRE'DEPARTM`NT - Temp Dumpster on site yes no Located at'124 Mair,,'Street Fire Departmer-i#signature/date t; 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 f Building Department C Tine fol,towing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofivg, Siding, Interior Rehabilitation Permits ❑ 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 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 o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o- Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) o 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 i New Construction (Single and Two Family) o Building Permit Application Li 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) o 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 f 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 be submated with the building application ` f Doc: Doc.Buhffing permit Revised 2012 Enter construction cost for fee cal- North Andover Fee Cakulation Construction Cost $ 35,600.00 m $ - $ 427.20 Plumbing Fee $ 53.40 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 53.40 Total fees collected $ 634.00 86 Forest Street 147-14 on 8/15/2013 Remodel of 3 Bathrooms t � NORT►y Town of 2 n ove r o No. - � o h , ver, Mass, �/- COCHICNlW.CN y7. 7.as RgTEO ►'P�,��y U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........a A BUILDING INSPECTOR has permission to erect ............ buildings on Vp.... os Foundation Rough to be occupied as ... ..... 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 INAMTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT TRough 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 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Invesfigations 600 Washington Street Boston,MA 02111 www.massgov/dia Workers' .Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business%organizadon/lndividual)' Address: 13Ad City/State/Zip: tv U Le4Phone#: J Are you an employer?Check the appropriate bog: Type of project(required): 1.ED I am a employer with_ 4. ❑ I am a general contractor and I 6. ❑New construction employees'(full and/or part-ttme)* have hired the sub-contractors 2.E] I am a sole proprietor or partner- listed on the attached sheet # 7. Remodeling ship and have no employees These sub-contractors have 8. E]Demolition working for in any capacity. workers'comp.insurance. 9. []Building addition [No workers' comp.insurance 5- ❑ We are a corporation and its 10.❑Electrical repairs or additions required.]. officers have exercised their right of exem tion r MGL 11.[]Plumbing repairs or additions 3.❑ I am a homeowner doing all work p myself,[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs lf empoyees.[No workers' insurance required.] 1311 Other comp.insurance required] *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 are doing all work and then hire outside contractor;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. Yam 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.#: Expiration Date: City/state/zip--L&, t"." Job Site Address: R(-) h ' 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$250.0 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. Ido here y certify under the pains and penalties ofperjury that the information provided above is true and correcL S' afore: Date: �� 1 Phone#: Official use only. Do not write in this area,to be completed by city or town officiaL City or Town: PermWLicense# 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 M l ® DATE(MM/DD/YYYY) ACOA? 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 PHONEA/C No Ext (978) 683-8073 C No:(978) 683-3147 1060 Osgood Street ADDRESS:sandi@mprobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAIC# INSURER A: PROVIDENCE MUTUAL INSURED KEVIN MURPHY BUILDING & REMODELING INSURER 8: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. INSR TYPE OF INSURANCE ADDL SUER - - POLICY I Y EXP LIMITS LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,600 CLAIMS-MADE X OCCUR PREMISES Ea occurrence $ 500OOO MED EXP(Any one person) $ 15,000 A BOP1068945 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 PRO CI LOC PRODUCTS-COMP/OP AGG $ 2,000,000 PRO- OTHER: COMBINED $ AUTOMOBILE LIABILITY Ea accident $ 1,000,000 ANYAUTO MCA7013608 01/23/13 01/23/14 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ B AUTOS' AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE CUP9145304 11/22/12 11/22/13 AGGREGATE $ 1,000,000 DED I I RETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 500,000 C OFFICER/MEMBER EXCLUDED? CI N/A KEWC422467 07/01/13 07/01/14 )Mandatory in NH) E.L.DISEASE-EA'EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 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 ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD Mev5st Wm Iln � y Page 4 of 4 M uMing Contvactor 98 Forest Street Nath Andover,MA 01845 PH:9785.335 FAX 978.6887207 Section N-Price Schedule We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of... .................. ... ... ... .......$ 35,600 Payment to be made as follows: Percents e/ltem Description Amount 1 Permit obtained $1600 2 Demolition of one bath complete $5000 3 Plasteling of one bath complete $5000 4 Completion of one bath $8000 5 Plastering of second bath complete $8000 6 Second bath complete $5000 7 Job 100% complete $3000 Total 7 F 1 $35,600.00 Notice:No agreement for Hone improvement contradug work shalt req ke a down payment(advance deposit)of more that aeNxd of the total omtraact price of ft total amount of all deposits or Payments which the contractor must make,in advance,to order ardor otherwise ohlam derrmy of spedal order materials and equipment,whidiever is Beater Contractor. Kevin Murphy 98 Forest Street No.Andover, MA 01845 Registration No: 101874 I i j 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 DO NOT SIGN THIS ONTRACT IF THERE ARE ANY BLANK SPACES Sig nature Date Signature Date