HomeMy WebLinkAboutBuilding Permit #337 - 96 LOST POND LANE 10/30/2006 Ot NORTH 1H
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
SSACMUSE �� 1
Permit NO: �7 Date Received: l l
T
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
_ Print
PROPERTY OWNER
p Print
MAP NO.: k V� 1> PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑New Building -6 One family
'gAddition ❑Two or more family ❑ Industrial
❑Alteration No. of units:
❑ Repair,replacement ❑Assessory Bldg ❑ Commercial
❑ Demolition
❑ Moving(relocation) ❑Other ❑ Others:
❑ Foundation only
DEhSCRIPTION OF WORK TO BE PREFORMED
�*--�Identification Please Type or Print Clearly)
-L�,�
OWNER: Name: Phone:
Signature
Address: ��u
CONTRACTOR Name: 4,... Phone: f 533
Address:
Supervisor's Construction License: 05-3-711x Exp. Date:
Home Improvement License: I DA �b-1`J Exp. Date: ZA� D�'i
ARCHITECT/ENGINEER Name: Phone: IV," S1 s�
Address: ' �' ,,.., ,,� lam. K-J— Reg. No.
FEE SCHEDULE:BULDING PERMIT.$10.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON
$125.00 PER S.F. (Z�
Total Project Cost :$ bS-. UJy EE:$
Recei
Check No.: 174 k pt No.:_, J
TYPE OF SEWARGE DISPOSAL
Tanning/Massage/Body Art ❑ Swimming Pools ❑
Public Sewer ❑
Well
Tobacco Sales ❑ Food Packaging/Sales 11❑ i
Permanent Dumpster on Site ❑
Private(septic tank,etc.
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner �� Signature of Contractor
i�r
Plans Submitted Plans Waive Certified Plot Plan Stamped Plan
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
CONSERVATIO ❑
YCOMMENTS a PC 01
DATE REJECTED DATE A VED
HEALTH lD�v{�
COMMENTS
Zoning Board of Appeals: Variance,Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Water&Sewer connection signature&date
Temp Dumpster on site yes_no>j Fire Department signature/date
Building Permit Approved and Issued by:
i
Building Setback
Front Yard Side Yard Rear Yard
Required Provided Required Provides Required Provided
50 3-7
DIMENSION
S ON
Number of Stories: Total square feet of floor area,based on Exterior dimensions.
Total land area,sq. ft.:
NOTES and DATA—(For department use)
I
Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 •
Created JMC.Jan.2006
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:BPFORM05
Location(!�/o /0.$ T 14�vgew
No. 3 Date
HORTM TOWN OF NORTH ANDOVER
Oit„Gu :•,�O
F 9 1
IIL4; Certificate of Occupancy $ y
�'�s'•^''tt�' Building/Frame Permit Fee $ /2. 41x0
s�cMus
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # L
1 97 39v
Building Inspector
GT1e �vomzmonuiea o�,/�aaoar/uraell�
BOARD OF BUILDING REGULATIONS
License: CONSTRUCTION SUPERVISOR
Numbet•. CS, 053099
Birtlidite7:0`11/29/1967
Expires:06/29/2707 Tr.no: 12810
Rebbictatl: 00 t
KEVIN W MURPHY
169 BOXFORD ST
N ANDOVER, MA 01$45
Commissioner
/ze 'om rru ncoec t/a. o1-Aaoac/iu ffS
Board of Building Regulations and Standards
HOME IMPROVEMENT CONTRACTOR
Registration: 101874
Expiration: 6/29/2008
Type: Individual
KEVIN MURPHY
Kevin Murphy
169 Boxford St �.p..��••�
N.Andover,MA 01845 Deputy Administrator
NORTIy
0 0Andover
0
.�: _.
No. X3.3 7 ~
dover, Mass., ' 3 • CO
COCMICMEWICK
ADRATE D i'P�,`�5
S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
ft BUILDING INSPECTOR
THISCERTIFIES THAT.......;adL.V..�.I... ........ r S............................................................................. Foundation
has permission to erect........................................ buildings on ...... .(P.......Lorr..... ..:............ Rough
to be occupied as..,II2-0.-v...013..... Chimney
1 `............................................................................ y
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. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
1240 PERMIT EXPIRES IN 6 MONTHS Final
UNLESS CONSTR N S ARTS ELECTRICAL INSPECTOR
Rough
... .......................... ... Service
.. .... ....... ........... ..... ..............
BUILDING INSPECTOR
Final
Occupancy Permit Required to Occupy Building GAS INSPECTOR
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.
SEE REVERSE SIDE Smoke Det.
The Commonwealth of Massachusetts
Department of Industrial Accidents
s* ;y Office of Investigations
il'lit 600 Washington Street
' Boston, MA 02111
"��;• www mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers.
Aualicant Information Please Print Legibly
Nameitittsin,-hs/()rguniraukm/in (divitluiil):�� «
Address:
City/State/Zip:�,h•. b � ]�...._ uICL-t5" Phone #: ]
Ar you an employer?Check the appropriate box: Type of project(required):
Ii am a em to er with. 4. ❑ 1 am a general contractor and I QNew construction
p y �_ 6.have hired the sub-contractors
employees(full and/or part-time).
2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. * ?• El Remodeling
ship and have no employees These sub-contractors have S. Q Demolition
working for me in any capacity. workers'comp. insurance. q_ Q Building addition
[No workers'comp, insurance 5. ❑ We are a corporation and its
officers have exercised their 10.E1Electrical repairs or additions
required.]
3,❑ 1 am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions
myself. [No workers' comp, c. 152,$1(4),and we have no 12.❑ Roof repairs
insurance required.]'' employees. fNo workers' i3.❑ Other
comp. insurance required.] _...
:Argy applicant that checks hox M 1 must also till out the section below showing their workers'compensation policy intbrination.
ilomeovmcm who submit this affidavit indicating they are doing all work and then hire outside contractors must suinnit 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.
1 am an employer that is providing workers'compensation insurance for my enrlayees. Below is the policy and job site
inform anom
insurance Company Name: ------_.. _.__._._._...
Policy It or Self-ins. Lic. 0: S3 U3 �1 _. Expiration Date: • 0-1
Job Site Address: S �o � City/StatelZip: . 1p� C�.... 6L`
,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 NiGL c. 152 can lead to the imposition of criminal penalties of a
tine 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.
!tto here ceriif a pains and penalties of perjary that the information provided above is�true and correct. —
Si
40 07--
Phone�t "1 IV --- -
()jj1cial use only. LM not write in this area,to be completed nV city or town official
Citv or Tow a: Permit/License#
Issuing Authority(circle one):
1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6.Other
Contact Person: Phone#:
NORTH ANDOVER BUILDING DEPARTMENT
Tel: 978-688-9545
DEBRIS DISPOSAL FORM
In accordance with the provision of NIGL c 40 S 54, a condition of Building Permit
at: Y.,A LaqA 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, S150A.
Also, note Permits are required under Fire Prevention laws Chapter 148 Section
1 OA.
The debris will be disposed of in:
C' , C4,--.,f,
Location of Facily)
Signatu of ermit Applicant
Fire Department Sign off:
Dumpster Permit
Date
a. Provide additional information proving that the existing septic system meets current capacity
requirements. Please consult an engineer to determine the flow capacity of the septic system.
Please feel free to call the Health Office at 978-688-9540 with any questions you may have.
Sincere
x.
S san Sawyer,Public Health D' ctor
Cc: Building Department
File
1600 Osgood Street,North Andover,Massachusetts 01845
Phone 978.688.9540 Fax 978.688.8476 Web www.townofnorthandover.com
� pDRTy�
ti .
CONSERVATION DEPARTMENT
CommunitfDevelopment Division
Jun
t,,21006
Jacquehne, aeobs
96 Lost Pond=Lane
North Aorooex,MA 01845:
Rl✓, t Pond.Lane;:Nor&Andover,MA
Dear LVts�, acobs,
It oras a pleasure meeting you the other day to.discuss the'proposal of-an additionoff the existing
house near the fireplace gou�g-towards the ear`.of your`propetty As:you areiawate,there is a large
lurtsdtctional Bordering Vegetated Wetlands (BVW)assac�ated to Rocky BrookAmitiavi.erses along
north�x!estem portion of the abode xeferenced.property.Ilk sociated Bui f er.Zone does,extenid
gn'to ygnrlproperty,as.shown on the_approved.as=built plan(HEP Nile#242-778),,prepared by '
1 'Thomas E Neve Associates,Inc:,dated November 27,1996 revised through November 12- 19,97.
m uis ectto I re-evaluated the wetland bo to see Jf:was sttli.rd, iyel cob
s�stent
Dung. y p n, undary Y
with that shown on the as built plan."My findings>concluded.tbat the wetland boundary�s grove n
towards your hotise by approximately 5 feet Hoovever,my measutetaents confirmed that:the,Buffer
'one,does not extend,yvtthin the limits of the proposed°addition.Therefore,you would not be
rguired:to file an appheatlon with the North Atidover'Conservation-Commission'(NACC�If you
wish to pursue a bui1 periut foz the addttion,it is highly'recotnmended that your conftactor
uistall tetnporary;erosion:contrgl{staked hay bales,backed by trenched silt.fence)along the limit:of
work to prevent'any,soils from migratuig uto the 100-foot Buffer Zone.
wb $nclosed'- lease find a.:co o"ie.- bu tt: ".lan that Was-` evious• :mentiot<ed for., our review.is
P PyP P ly y
trust this uiformatton is`sufficie�t for your.needs:Should you have any questions or comments.
regarduig this letter,please d6 not hesitate to contact the undersigned':at your earliest,convenience.
Respectfully;
NORTlri ANDOVER•C SgERVATION,HEPARTIITTEN'T
PataeYa A � erpll
ti
C ,.
onservation Aasopate`'
16D0 Osgood Street,Bu`ildm 20 Surfs k2-36,North'Andover,4assochuseNs`--01845
Phone .978 688:9530 fax 978 68$ 542 Web www.h'' //wwwJowhofn6Ohhndover.com/conseruel.htm
FROM M.P. Roberts Insurance FAX NO. :19786833147 J41. 18 2006 11:10AM P1
CERTIFICATE OF LIABILITY INSURANCE DATEm OUly
P4ndxfER
TM18 CERTIFICATE IS J$SU p A3 A MATTER Of INPORR aioiv
M.P.ROBERTS INSURANCE AWNCT INC. MY AND COMM NO RMTS UPON TME CERTIFICATE
1Q6Q OSUOOD STREET ALTER TMe Is CePtIWI Al2 OM Mot AMRNO, extewn oft
COVIRAW A"2m BY TMEPOLIcm aft ow.
NORTH ANDdM MA 01845
976-183-8073 WILIROW APFORDBIO COVERA4E NAICR
KZVIN MURPHY BUILDING f RSMODFLING MMAMA.
tNs,ReR R: .��g__..IN9�NCE
169 BOXMRD STREET tNMAM c __
NORTH ANDOVER, MA 01845
CCVBfRAeps
THE POLICIES OF MISURANCE WED!FLOW MAW BEEN IBSUED TO THE%Stofto NAMIEDABOVE FOR•1-%grOLICY PERIUO MIDIGITEO.NOTWRMSTANOtNG
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ER MAivninOM OfANDOVER,�LOV�IR. A RMOUTAAM/�TI�AWVCf�(.'RWf4 P'OIRNie RE f/VK�14QQ COMP TNF.A1fMRATIf)N '
3� T STREET DATA NR teA neftW.T —Nap"*U Nrb"UOR To ML 10 n.ve tAw rrF4
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MWOM NO OKJOATM OR LYMUTr CO AMY NIM)U7r>fr nQ xrEU t Nnt dA
BUILDING DEPARTMSMT
RERAdE1/TA
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ACORDti(B00tJ08) OAC 000RPORATION"U
1
• ISO Boxford Street
KevinMuxNorth Andover,MA 01845
y • PH:978-688-6335
Building Contractor FAX:978-688-W
Proposal
To: Paul&Jackie Jacobs
96 Lost Pond Lane All Hone rprovenwd Ca*aclm and Subco s
ergageo to home►nprovenrerq unless
North Andover, Ma. 01845 qwOicWr by ChapW
142A of the gererai Ims,must be ragbt3ered vM the
CmM orsaealth of Manaduseft.Inquptes about
mgftaWn axt SWus should be made to ere Director.Home
From Kevin MU Improvement Conbga RnlsVatfon,one Ashburton Place,
Murphy Room 1301,BoWA AAA 02108.(617}727 8596
CC.
Dates 9/6/2006
.lob: Family room addition
Date of pia m 8/06
AndWde* Steve Foster
11.011:1111601r. Same
Section I-Waic 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 9125/06.
Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 1/30/07.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 II-Walmrft
The Contractor warrants that the work furnished hweutxer shall be flee from defects in materials and workmanship for a period of 1 year
following con'Vietion and shall comply with the requirements of this Agreement. In the event any deflect 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 defied in materials or workmanship. The foregoing warranties shah survive any inspection performed in
connection with the agreed-upon work
Sec�on 111-Scope of Work
IIdllevin murphy
If
Badding Coutraacor Page 2 of
169 Ba trd skeet
Man Andover,MA 01846
PH:978688-5335
FAX 9786W)O=
General
Propsal is for 20'x23' one story addition as shown on plans. Building permit will be provided by contractor. No
allowance has been made to obtain a variance, conservation approval, board of health approval, or title v
inspection, if required by town. Plans to be provided by owner.
Excavating
Excavation required to install full basement area will be provided. Any additional fill will be removed from site.
Backfilling and rough grading will be provided. No allowance has been made for any landscaping, lawn
installation,sprinkler relocation or repairs. No allowance has been made for removal of ledge if discovered.
Foundation
Poured concrete foundation will be provided as shown on plans. Footing will be 10"x20", walls will be 10"thick,
grade to be determined in field. Concrete cutting will be provided to gain access to new basement area. Poured
concrete floor will be provided in new basement area, over crushed stone base.
Building
All frame, roof,and siding materials will be provided to match existing/meet code/as shown on plans.All floor,
wall, and roof sheathing will be fir plywood( 3/4 on floor, 1/2 on walls , 518 on roof). Exterior walls will be 2x4,
floor joists and roof rafters will be 2x10. Roof shingles to match existing. Ice&water sheild will be installed at all
roof edges and valleys. Hardboard siding will be supplied and installed to match existing, over Tyvek or
equivalent. Rivco windows and doors will be supplied/installed as shown on plans.
Plumbing
Gas piping required for new zero clearance fireplace will be provided. No allowance has been made to supply or
install a propane tank. No allowance has been made for any other plumbing.
Electrical
Electrical work required to wire addition to meet code will be provided. Six recessed lights have been included.
additonal lights can be added at a cost of$75 per light. Other surface mounted fixtures to be provided by owner
(ceiling fan etc. ). Phone, cable,computer lines to be roughed in by electrician,to be connected by their service
provider at owners expense.
Headng/Air Conditioning
Existing condenser on side of house will be relocated as required. Existing forced hot air furnace and air
conditioning system will be upgraded/zoned as required to property heat/cool existing house and addition.
Insulation
Ail
added areas will be insulated to meet code ( R-13 in exterior walls, R-19 in cellar ceiling, R-30 in first floor
ceiling).
Plaster
First floor of addition will be Nueboarded and skimcoat plastered. Ceiling to match existing,walls will be smooth,
closets will be textured. Patches to be provided as required in existing areas.
t,
Kevin Muwpby Page 3 of
8ni2ding Commacew
169 Box d Sheet
North Andover,MA 01846
P".878-688.5335
FAX:978.6WXXXX
Interior Trim/Doors
P"med interior trim and stair railings will be supplied and installed to match existing house. Interior columns
will be built up in existing kitchen area as shown on plan.
Painting
Interior and exterior painting will be provided. One coat of primer and two coats of finish will be provided on all
surfaces. Exterior to match existing, interior colors to be determined.
Flooring
Hardwood flooring will be supplied / installed / finished with three coats of oil based uerathane in new family
room(to match existing).
Other Allowances
An allowance of$3000 has been included to supply/install/finish gas fireplace and mantle.
Waste Removal
All construction debris will be disposed of by contractor.
Items Not Included
No allowances have been made to built deck shown on pian, provide any landscaping, sprinkler repairs, lawn
repairs, built ins,or finish any basement areas.
I
Kevin MUWP1kY pager of
8aiidtas con tmato r
489 Bocdord Stout
Morlh Andover,MA 04945
PH.97&fi88-5335
FAX:97868840000
Section
IV—Price Schedule
We hereby propose to furnish material and labor—complete
in Accordance with above specifications for the sum of... ... ... ... ... ... ... ... ... ...... ....$ 105,000
PayMnt to bemade as follows:
Percents Item_Description Amount
1 Permit obtained $3000
2 Foundation complete $15,000
3 Roof complete $30,000
4 Siding /windows installed $20,000
5 Rough electric / heating complete $15,000
6 P
lastering corn lete $10,000
7 trim /floors installed $7000
8 b 100% corn lete $5000
L.Total 18 1 $105,000,001
"Notice:No trent forhbnreSff- —oo*.ftV—k shed requiread-nPayment(advancedeposit)dmoretoOneatrrdofthetatsconked
the carwacior mwt malas,n aiMcuroe,a«dor ffidror orianvge abtacr debvay of special order rta0erials end Price of the total amount of ak depWb a
e whtctaewar is gaoler
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 condiitions stated. J
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 ST TONTRACT IF THERE ARE ANY BLANK SPACES
7
Signature 4, Date
Signature Date
-92" 8'-22" 32"
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