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HomeMy WebLinkAboutBuilding Permit # 4/29/2015 txORTH IJIL IN P MIT ®F��,Eo ,6pwo TOWN OF NORTHV � APPLICATION FOR PLAN EXAMINATION10 1 _ '® Date Received Permit 1.NU#H' '9 p�RATED �SSACHUS�t Date Issued: IMPORT VT: Applicant must complete all items on this page LOCATION I B1'u- '-". pp Print PROPERTY OWNER I ,�,��r Print 100 Year'Strueture yes no MAP AR ZONING DISTRICT: Historic District ' ye no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building [A One family ❑Addition ❑Two or more family ❑ Industrial 'Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other DESCRIPTION OF WORK TO BE PERFORMED: r`' a,SL)&Vi v� l 1-J n OA- C-L- K..e-JZ-1 Lu C Lr 9� , c W IUB Y� \ A 01"> lei o o l Identification- Please Type or Print Clearly OWNER: Name: L,�-, Phone: Address: Contractor Name: -��r � Phone a ' Address: �1 Supervisor's Construction License: �3- Exp. Date:' ` ' / ) Home Improvement License: p7 , ZS S Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASLP ON$125.00 PER S.F. Total �Cost:Project )q ,p QO FEE: $ J Check No.: t Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to e ua ty fu gRrr m,u,,,,nn r, a,. ,,brNaa a6iirlcrr //; /i/ it//i�% //r ii i a ilAF ;i i''Ili I'/ry �," «I N'pRTH F ; Town of' ' ,' ' ,.. ® Q :--' y `w to No. WWF, 1#5 -� - ti oh ver, ass, COCNICNl WICK ��� �a ORATED P"Vo V BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THAT ,�l .0m..., (Vzlhelflnd1� BUILDING INSPECTOR THIS CERTIFIES T ..............U.�..� �I ... ....,.......,................. ............................. has permission to erect .......................... buildings on . 3......6--R......... ................. .......................... Foundation D,,,, itl�e Rou h to be occupied as ..C.�. .4...... ... !; .... lc ........ ........... Chimney provided that the person accepting t ' permit shallin every respe onform to 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 IN 6 MONTHS ELECTRICAL INSPECTOR JL UNLESS CONSTRUCTION R Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit required to Occupy Building 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. i Back River Development 231 North End Boulevard Salisbury, MA 01952 (978) 852-3733 ESTIMATE To: Bill Wolfenden Date: March 23, 2015 Re: Renovations of Residence 183 Green St.N. Andover, MA Scope of services Back River Development will be responsible for the following: - Demolition o Remove door and window from family room o Remove fireplace and fagade from family room o Remove existing wallboard from ceiling and rear wall - Framing o Re-frame rear wall to accommodate new windows and anew entry door o Install 4 new windows and 1 entry door o Frame a partition wall for office area o Frame reach in closet in family room - Plumbing o There is no plumbing included in this estimate - Blue board and plaster o %2"Blue board and skim coat plaster will be applied to all affected areas from renovations only o Plaster finish will be smooth on walls and textured(skip trowel)on ceiling - Insulation o Insulation and draft stop will be installed to building code regulations in new addition walls only - Finish carpentry o Base board trim and window and door trim will match existing throughout house o A 3068 15 light door will be installed in partition wall - Siding and exterior trim o Will match existing on house in affected areas only - Electrical o Outlets, switches and fixtures will be installed as discussed o Install 6 recessed lights in living room and office area o Fixtures will be supplied by homeowner - Painting o Painting is not included in this contract TOTAL COST $ 19,500.00 PROJECTED TIME SCHEDULE The following is an estimated time schedule for informational purposes only.This schedule may be adjusted as needed to address unforeseen circumstances,including but not limited to hidden obstacles,bad weather, sub-contractor scheduling conflicts,etc. It is our goal to complete the work in a timely fashion. Week 1 Demolition and framing Week 2 Rough electrical and inspections I, Week 3 Insulation,blue board,plaster Week 4 Finish carpentry and flooring install Week 5 Floor refinishing and punch list items Terms and Conditions 1. Contractor agrees to furnish all necessary labor, materials, tools and equipment to complete the work outlined in the scope of services. 2. Contractor shall provide copies of a valid builder's license and proof of liability and workers' compensation insurance prior to commencement of any work. 3. Contractor agrees to complete the Scope of Services in a timely, professional manner in accordance with the specifications set forth by the architect and engineers, and in compliance with state and local building regulations. 4. Contractor agrees to clean all debris from construction only and to keep job site in a clean and workable condition at all times 5. Homeowner shall be responsible for any costs occurring from engineering or architectural plans and site work and any costs incurred from permitting, zoning board of appeals, planning or DEP. 6. Any costs incurred from hazardous materials found during construction are the responsibility of the homeowner 7. Homeowner is responsible for contacting utility companies for disconnect and new hook ups, cable,telephone,gas and electric and any costs that results from these services. 8. Manufacturers' warranties will be turned over to the homeowner and become the homeowner's responsibility to file and pursue any defects or problems that may occur. 9. Any materials, products, or labor not specifically mentioned in scope of services is not covered under contract and will be paid for out of allowance fund or billed to homeowner 10. Homeowner is responsible for any price increase in materials prior to signing of contract 11. Homeowner (not lender) is ultimately responsible for payment upon completion of services and receipt of invoices PAYMENT SCHEDULE The payment for the contract will be as follows 25%upon execution of contract 5,000.00 25%upon commencement of services 5,000.00 25%upon completion of rough inspections 5,000.00 25%upon completion of ro'ect /4�50 .00 Bil Ifenden,flomeowntr Brian A. Lyrech Back River Development The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia �V•Y Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNIITTING AUTUORITY. Please Print Legib A licant Information Natne(Business/Organization/Individual): c Address: . 1Phone#: Wit.) Vie,& City/State/Zip: Are you an employer?Check the appropriate box: Type of project(required): ees(full and/or part 7. E]New construction l. i am a employer with em Pto Y 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. 0 Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'camp.insurance required.]t 10 ❑Building addition 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12.[]Plumbing repairs or additions proprietors with no employees. 15.F1 I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance3 14.❑Other 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'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 contractors 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. jam an employer that isprovidizzg Ivor/cers'compensation insurance for my employees. Below is thepolicy azzdjob site ilzformation. Insurance Company Name: Policy#or Self-ins.Lic.#; e r ,^ , „ a C, G7/ '.+ Expiration Date: / f City/State/Zip: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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 foe of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. I do hereby certify r th ain dpenalties of pezjuzy that the information provided above is true and correct. . Date: 21' �. Si ature: Phone#: �' � ��°�� � 0 FBOard nly. Do not write in this area,to be completed by city or town official n: Permit/License# ority(circle one): i l. Health i Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: AC40RI ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 4/24/2015 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). CONTACT PRODUCER NAME: M P ROBERTS INS AGCY INC PHONE (g78) 683-8073 (FAX No:(978)683-3147 A/C No Ext: 1060 Osgood Street nDORIEss:paula@mprobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVERAGE NAICN INSURER A:MERCHANTS INSURANCE GROUP INSURED BACKRIVER DEVELOPMENT, LLC. INSURER B: 231 NORTH END BLVD INSURER C: SALISBURY, MA 01952 INSURER D:ASSOCIATED EMPLOYERS INS CO 978-852-3733-Bill INSURER E: 978-804-9383-Brian 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. ADDL SUBR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE INsO wvD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 CLAIMS-MADE �OCCUR PREMISES Ea occurrence $ 500 000 X PRIMARY & BOPI080037 06/20/14 06/20/15 MED EXP(Any one person) $ 5,000 A NON-CONTRIBUTORY Y PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY�JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY (Ea aaccident)SIN LE LIMIT $ 1/000,000 ANYAUTO 06/20/14 06/20/15 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BOPI080037 BODILY INJURY(Per accident) $ A AUTOS AUTOS SNED PROPERTY DAMAGENON-OW $ X HIRED AUTOS X AUTOS Per accident UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN � X STATUTE ER WC50050142202015A 01/12/15 01/12/16 ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500,000 D OFFICER/MEMBER EXCLUDED? ❑ NIA (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 BILL WOLFENDEN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 183 GREENE STREET ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards uctirt,Super for License: CS-065005 Mn BRIAN A LYNCH;-' ' 2' -. � 31 SEVEN STAR RD GROVELAND Na 01834 Expiration Commissioner 11M512015 CJ/'e�o�lc�iio��rue�ilf/o!�/�Ctk7arir/i�delr,; ,.,, - __ - Office of Consumer Affairs&Business Regulation _ HOME IMPROVEMENT CONTRACTOR Registration: 173255 Type: Expiration: ;_9/20/2016 Individual BRIAN A LYNCH BRIAN LYNCH 31 SEVEN STAR RD GROVELAND,MA 01834- Undersecretary