HomeMy WebLinkAboutBuilding Permit #796-14 - 88 LINDEN AVENUE 5/6/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: �� X41 Date Received
Date Issued: 6
M ORTANT: Applicant must complete all items on this page
-
LOCATION,4'& �-� /✓ pN 19'Y1''7(rti"
PROPERTY 01NNERikC
Print 1 ob-8ear, Old, MAP NO: nn PARCEL:. �___. ZONING DISTRICT: H storic District
yes nn"
�r� o
Machine Shop Village yes,
no
.TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
❑ New Building
XOne family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
;Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
d Septic ❑ Well '�
'El -Other
❑ Floodplain ❑ Wetland`s
D Watershed District°
D Water/Sewer
DESCRIPTION OF WORK TO 6E NtK1-UKM1-_U:
6F -Mb 6dT f 2nM &Y8 /l►'S,' 1-L /YM lel 11V IBES //Y sAif6- I.D G4� 041,
Identification Please Type or Print Clearly)
OWNER: Name: Mik.E 9�- IYDL621Z Phone: 77t-706°-61!ES3
Address: /Irn t/E
CONTRACTOR Named�Y
__ /�U, _A, *C)3/5 Phone: ml__(�'3" 6?
C#. , .�CO, i _ _
Address: -70 0/ r
Supervisor's Construction License. _ �"D3.?a/- __..Exp. Date 3
:Home Improvement- Licepse:. _ 1 O%-4/ 10. _ _ .- . - - _Exp,. Date: __
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: $ A/ // D- FEE: $ ��• �__
Check No.: �C2 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
}Signature of�/:Agentl0vvner�� ��
Plans Submitted Li Plans Waived ❑
Certified Plot Plan ❑ Stamped Plans ❑
Building Department
The fal.. wing is�a=lrst of -the' requirred:forms to be4iIled out'foethe a ppropriate.permit to .be obtained.
Roofing, Siding, Interior Rehabilitation Permits
o Building Permit Application
❑ Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S:L: Licenses
o Copy of Contract
❑ 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
❑ Certified Surveyed Plot Plan
a Workers Comp Affidavit
o Photo Copy of H.I.C. And C.S.L. Licenses
Li Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
o 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
❑ 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
o 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 apu,?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.Bui?ding Permit .Revised 2012
-: Plans -Submitted ❑ ' Plans -Waived ❑: ..;;_Certified Plot Plan ❑ Stamped Plans ❑
:TYP1✓ OFSEWERAGEDISP-OSAL :.-.
Public Sewer ❑
Tanning/Massage/BodyArt ❑
Swimming Pools ❑
Well ElTobacco.Sales
❑
Food Packaging/Sales El
Private,(septic tank, etc _❑
-•• = -
-Permanent Dempster 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
1 ,
r
Conservation Decision: :Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Tow; Engineer: Signature:
Located 384 Osgood Street
FIRE UEPARTM. NT "-'Temp'Dumpster on site yes no
L6cated'at;124 Mair; Street _ `x
Fire Departine�it signature/date
COMMENTS 5.
..Dimensian . -
Number of Stories:
:Total land area; sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
ELECTRICAL:-Movement:of.Meter, location, niast-or service drop requires approval of
Electrical Inspector Yes No
DANGER.Z®NE LITERATURE: =Yes No
MGL.Chapter 166. Section 21A --F and G min.$100-$1000..fine
NOTES and DATA — (For de
® Notified for pickup - Date
Doe.Building Permit Revised 2010
use
Enter construction cost for fee cal -
North Andover Fee Calculation
Construction Cost
$ 219110.00
m
$ -
$
253.32
Plumbing Fee
$
31.67
Gas Fee 100 comm.
$
10.0.00
Electrical Fee
$
31.67
Total fees collected
$
416.65
88 Linden Avenue
796-14 on 5/6/2014
Bath Remodel
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Massachusetts - Department of Public Safety .
Board of Building Regulations and
Standards".
Construction Supenisor
License: CS-033217
FRANCIS A HEBB`
70 Lake Shore Roads
Boxford MA 01911 1
Expiration '
Cornmissioner
03/26/2016
,per`` L�.✓tie Znomrinzunure�_a�at,/u.�aei!a
�\ __ Ofn"of-ConsnmerA#fair§&BnsmessRegutation
HOME IMPROVEMENT CONTRACTOR.
Registration: _,37p7916 Type-
Expiration: 8/a'ai2014 Private Corporatio
F CIS HERB COA7S7 UCS` 0
Francis Hebb L'
70 Lake Shore
W. Boxford, MA 01921" ..,,. Undersecretary
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FRANCIS A. HEBB CONSTRUCTION CO., INC.
DESIGN/BUILD CONTRACTOR
CONSTRUCTION MANAGEMENT AND CONSULTING
Residential, Commercial Building & Renovations
Construction Supervisory License #033217
Home Improvement License #107916
CONTRACT TO BUILD
70 Lake Shore Road, Boxford, MA 01921-1115
Shop (978) 3S2-6123
Fax (978) 352-5068
Cell (978) 423-6637
RESIDENTIAL CONTRACTING AGREEMENT
Designated Registrant's Name: FRANCIS A. HEBB CONSTRUCTION CO., INC.
Registration Number: 107916
This agreement is made on April 29, 2014 (date) between FRANCIS A. HEBB
CONSTRUCTION CO., INC. of 70 LAKE SHORE ROAD, BOXFORD, MA 01921 (978)
352-6123 hereinafter called "Contractor" and Mike and Stephanie Nolan (Owner) of 88 Linden
Avenue, North Andover, MA 01845 hereinafter called "Owner".
I. DETAILED DESCRIPTION OF WORK TO BE PERFORMED
Contractor agrees to perform in a good and workmanlike manner all work detailed below for
bathroom renovation project. Such work consists of the following:
Redo full bathroom on first floor. Work to include complete demo of floor, walls and ceiling.
Install new fiberglass tub, toilet and 4' vanity whop.
Install new tile floor, bead board on walls and new exhaust fan vented through roof. Install
fan/light unit.
Allowances:
Vanity and top $2,000.00
Tile $ 180.00
Price does not include lights over vanity.
Note: North Andover may require an HVAC contractor to install duct work for exhaust fan. If
so, this will be considered an extra.
H. PRICE
Contractor agrees to do all work described in Section I for the total price $21,110.00.
III. PAYMENT
Payment will be made as follows:
$4,500.00 payment due upon completion of demolition,
$4,500.00 payment due upon completion of rough plumbing and electrical work;
$7,000.00 payment due upon completion of blueboard plaster, finish trim and painting;
$4,000.00 payment due upon completion of tile floor installation and clean up;
and $1,110.00 upon verification of the work by Owner and Contractor as having been
satisfactorily completed, which verification shall take place promptly after completion.
Costs do not reflect any permits required or labor required to obtain permits and related
inspections. Final payment will be adjusted to reflect these costs.
Notice: No agreement for home improvement contracting work shall require a down payment
(advance deposits) of more than one-third of the total contract price or the total amount of all
deposit or payments which the contractor must make, in advance, to order and/or otherwise obtain
delivery of special order materials and equipment, whichever amount is ffeater.
IV. COMMENCEMENT AND COMPLETION OF WORK
Contractor will not 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 the work on or about
May 19, 2014 (date). Barring the delay caused by circumstances beyond Contractor's control, the
work will be completed by June 20, 2014 (date). The Owner hereby acknowledges and agrees
that the scheduling dates are approximate and that such delays that are not avoidable by the
Contractor shall not be considered as violations of this Agreement.
V. NO ACCELERATION OF PAYMENTS BUT ESCROWING ALLOWED
The Contractor may not require payments to be made in advance of the times specified in Section
III (Payment) above for the reason that he deems himself or the payments to be insecure. If,
however, he deems himself to be insecure, he may require, as a prerequisite to continuing the work
described herein, that the balance of the payments under this contract that are in the control of the
Owner, shall be placed in a joint escrow account that requires the signature of both the Contractor
and the Owner for withdrawal.
VI. INSURANCE
Contractor will be responsible to Owner or any third party for any property damage or bodily
injury caused by himself, his employees or his subcontracts in the performance of, or as a result of,
the work under this Agreement. Contractor agrees to carry insurance to cover such damage or
injury.
VII. SUBCONTRACTING
Contractor agrees that, notwithstanding any agreement for materials and/or labor between
Contractor and a third party, Contractor is responsible to Owner for completion of all work
described in a timely and workmanlike manner.
VIII. CONSTRUCTION RELATED PERMITS
The following construction related permits will be necessary in order to complete the scope of
work included in this Agreement: Building, Plumbing and Electrical Permit (Price not included).
The Contractor under provisions of Chapter 142A of the General Laws is required to apply for and
obtain all construction related permits. The Contractor shall not be deemed responsible for delays
in the work described in this Agreement caused by regulatory, permit granting or inspectional
agencies, authorities or individuals.
Notice: If the homeowner obtains his own construction related permits for the work described
under this agreement, the homeowner is hereby advised that in the event of a dispute, judgment
and nonpayment of the contractor, the homeowner will not be entitled to make a claim to or collect
from the guaranty fund established by Chapter 142A, M.G.L.
IX. MODIFICATION
This Agreement, including the provisions related to price (Section II) and payment schedule
(Section III) cannot be changed except by a written statement signed by both Contractor and
Owner.
X. CONSTRUCTION CHANGE ORDER
Construction change orders will consist of any change to the original scope of work, such as
hidden conditions and changes requested by Owner. These conditions may require adjustment in
the overall price and time frame to complete the necessary work related to this Agreement. In
such case the Contractor shall inform the Owner of such conditions forthwith and when necessary
a written amendment to this Agreement will be negotiated and executed by the Contractor and
Owner.
XI. WARRANTIES
The Contractor warrants that the work furnished hereunder shall be free from defects in materials
and workmanship for a period of one 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 replace such damage or such
defect in materials or workmanship. The foregoing warranties shall survive any inspection
performed in connection with the agreed upon work.
All warranties for equipment supplied by the Contractor under this Agreement shall be those given
by the manufacturers of such equipment, which shall be and are hereby passed through directly to
the Owner. Under such manufacturers' warranties, the Owner may be required to register or mail
in a warranty card or other evidence of workmanship and use of such equipment in order to
activate such warranties. The Owner's failure to mail in or register such documentation, which
failure voids the manufacturer's warranty, shall not create any responsibility for the Contractor to
warranty such equipment.
This warranty gives the Owner specific legal rights, and Owner may also have other rights which
vary from state to state.
XII. COMPLETENESS OF AGREEMENT FOR EXECUTION
The Owner is hereby advised that he should not sign this Agreement unless and until all blank
sections have been filled in or marked as void, deleted or not applicable, and until all exhibits and
related or referenced documents that are incorporated herein are attached hereto.
XIII. COPY OF AGREEMENT TO BE GIVEN TO OWNER
It must be executed in duplicate, and an original signed copy hereof given to the Owner at the time
of execution. No work under this Agreement shall begin prior to the signing of the Agreement
and transmittal to the Owner of a copy thereof.
HOMEOWNER:
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
c Ab �.-
Signature)
Date Signed 4112 0 y
(Owner's Fgnature) /
Date Signed //I 'I /�
(Contractor's Signature)
Date Signed
- �L\_ The Commonwealth of Massachusetts , -
Department of Industria[Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.massgov/dia
Workers' Compensation Ynsurance Affidavit: )Builders/Cony°actors/Electricians/Pliimbers
Applicant Information Please Print Legibly
Name (Busvness/Organizationlin(Hvidual):
Address: 7b C S #� 46
City/State/Zip: 66 �fi a Phone
Are you an employer? Check the appropriate box:
Type of project (required):
1. NI am a employer with 3
4. ❑ I am a general contractor and I
6. ❑ New construction
employees (fall and/or part-time).*
2. El am a sole proprietor or partner-
have hired the sub -contractors
listed on the attached sheet.
7• 'Remodeling
ship and1ave no. employees
These sub -contractors have
8. [( Demolition
worldng forme in any capacity.
workers' comp. insurance,
g. F1 Building addition
[No workers' comp. insurance
5. ElWe are a corporation and its
1011 Electrical repairs or additions
required.]
3111 am a homeowner doing all work
officers have exercised.their
right of exemption per MGL
11. ❑ Plumbing repairs or additions
myself. [No workers' comp.
c. 152, §1(4), and we have no
1211 Roofrepairs
insurancere fired.] i
employees. [No workers'
13.❑ Other
comp. insurance required.]
Mny applicant that checks box#1 must also fill out the section below showing their workers' comp ensationpolicy information.
f Homeowners who submit this affidavit indicating they 2•re doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached m 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:
A- ,' .
14117VIA,
40 tw
iprAJ C 0
Policy # or Self -ins. Lic. #:
A'lttf
qn —7" 6 /
f — .Z!) /
Expiration Date:_ 1
Job Site Address, HE City/State/tip:�l y_ ,, I 0/���
Attach a copy o#the workers' compensation -p olley declaration page (showing the policy number and expiration date).
Failure to secure coverage.as requiredunder Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a
flue 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 maybe forwarded to the Office of
Investigations of the DIA. for insurance coverage verification.
I do hereby cert under the pains and penalties o f perjury that the information provided above is true and correct.
Sienature• Date:
LJ , --A
Official use only. -Vo not write in this area, to be completed by city or town official.
Cily 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 de%ted as "...every person in the service of another under any contract of hire,•
express cr implied, oral or wxitteu."
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 fnistee of individual, partnership, association or other legal entity, employing employees. However the
owner of a dwelling house having notmore 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 employes."
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 phonenumber(s) along with theircertiffcate(s) of
insurance. Limited Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees oilier than the
members or partners, are not required to carry workers' compensation insurance. If au 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, not the Department of
Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers'
compensationpolicy, 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" 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
towir):' 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 -ii 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 ox 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 attd fax number:
T`hoGax .oamaMof iassa..chvsPii -
Dopartment offndusWal .Accidents
Office of fAvedtigatiom
600 Washuxgtm 8fxeet
Boston, MA02111
TOL # 617-7-27-4900 -7.27_4900 a 406 4x 1-8,77-M
AS,9AFE
Revised 5-26-05 Fax # 617-727-7749
w�w.zua�s,g¢�fdia.