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HomeMy WebLinkAboutBuilding Permit # 5/8/2015 t%0RT#1 0 BUILDING PERMIT 0 TOWN OF NORTH ANDOVER to APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 04ATe. S CHUS Date Issued: 11 items on thispage "I'll". ................... ................ rrr TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building NfOne family El Addition El Two or more family 11 Industrial [I Alteration No. of units: o Commercial - Repair, replacement ii Assessory Bldg F1 Others: 17 Demolition 11 Other r, r .........�/ "i Wei i oit ..........7/k�; a 010 ei CA, r k�l I entification Please Type or Print Clearly) OWNER: Name: Phone: Address: o� lZ"! On ARCH ITECT/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: $ 1 , FEE: $ 7001 od Check No.: Z2 c Receipt No.: 29"?!2 A' NOTE: Persons contracting with unregistered contractors do not have access to theguarantyfund IN, ill"W11111101 "', tkORTyTown of . 2 s E 1* ® ; Andover E C, LAKEh h ver, ass, �A C0C"1C"NWICK 7,95 RAren �P �C2 U BOARD OF HEALTH rER.. MIT T Food/Kitchen � Septic System THIS CERTIFIES THAT ............. ` ................ BUILDING INSPECTOR has permission to erect .......................... buildings on rte© ��� ,���'�`�c r �CivF Foundation to be occupied as �� ��6 a �'fC /�.,� Rough provided that the person acceptin this ermit shall in """" """""""tion"' Chimney g p every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final Construction of Buildings in the Town of North-Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT ERES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough Service BUILDING.INSPECTOR. Final Occupancy Permit Required t® Occupy Building Rough GAS INSPECTOR Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedy the Building Inspector. Burner Street No. Smoke Det. J Murray and Sons Construction, LLC Estimate 114 Broadway Somerville, MA 02145 ?� :�Estimate 05/05/2015 18154 (781)414-0605 john@jmurrayandsons.com Address" „ Jeff French 100 Old Village Ln North Andover Desaxption,,. Azno�u� • Contractor to demo and remove the cabinets in the kitchen. Contractor will remove 950.00 island. Contractor will leave the walls behind the cabinets. Removal of appliances included. • Contractor has included repair and patching of the walls in the kitchen. Skimming and 1,500.00 plaster included. • Contractor has included purchase and install of kitchen cabinets with allowance of 6,800.00 $2000 on cabinets. Contractor has included an allowance of$2,500 on appliances. All install included. • Contractor has included template and granite with allowance of$1500 2,000.00 • Plumbing to code by state licensed plumber. Fixtures allowance$400. Permit by 2,000.00 contractor. • Electrical by licensed electrician to code. Contractor has included new outlets and 1,800.00 switches in the kitchen. • Paint by owner. Contractor has included new trim and molding.New baseboard 1,600.00 included. ACCEPTANCE OF PROPOSAL-The above specifications and conditions are T0# $16 650�b hereby agreed upon and accepted. J Murray and Sons Construction,LLC is authorized to complete the projects as described. R i' Accepted By ,U u�t L Accepted Date f The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE TILED WITH THE PERMITTING AUTHORITY. Please Print Legib A licant Information --� Name(Business/Organization/Individual): Address: ` City/State/Zip: `"`�_ Phone#: Are you an employer?Check the appropriate box: Type of project(required): to full and/or part-time).* 7. ❑New construction 1.❑I am a employer with em P Yees( 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9, ❑Demolition In I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑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 proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑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.insurance.t 14.Q 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. 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 showhig 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. I am nn employer that is pro iding workers'comperrsatiorr insurance far my employees. Below is the poliey and job site information. Insurance Company Name: �✓ Policy#or Self-ins.Lic.#: ...7 \ Expiration Date: Job Site Address: t City/State/Zip:.. , _— Attach a copy of the workers' compensation p icy 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 fine 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 veri fication. hereby tify urxder the pains arad penalties of perjury that the information provided bov is true and correct. Date: Si ature: Phone#: Official use only. o not write in this area,to be completed by city or town official. City or Town: Permit/License# LLBoard ority(circle one): ealth 2.Building Department3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector on• Phone#: Rightfax N2-1 517/2015 6:39:30 AM PAGE 21002 Fax Server "_ CERTIFICATE OF LIABILITY INSURANCE EQX;A1/DD/YYYYI T . . -�'EFICATE 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 ACONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. IMPORTANT:M the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed- 11 SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement_ A statement on this certificate does not confer rights So the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: QUINN GROUP rNS AGCY INC PHONE FAX 223 MASSACHUSETTS AVE (A/C,No,Ext): (AIC,No): E-MAIL ARLINGTON,MA 02474 ADDRESS: 77HBP INSURE R(S)AFFORDING COVERAGE NAIC N INSURED INSURER A: TRAVELERS INDBNINYPY COMPANY OF AMERICA J MURRAY AND SONS CONSTRUCTION LLC INSURER B: INSURER C: INSURER D: 114 BROADWAY INSURER E: SOMERVILLE,MA 02145 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: Tilts LS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED_NOT\VTTH5TANDIr•IG ANY REQUIREMEN7,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN-THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUaJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVEBEEN REDUCED BY PAD CLAIMS_ NSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTO TYPE OF INSURANCE L R POLICY NUMBER (MDDIYYYY) :LUADD\YYYY) LIMITS GENERAL LIABILITY ACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F__1 OCCUR. REMISES(Ea occurrence) AED EXP(Any one person) $ ERSONAL 8 ADV INJURY $ IGEN'L AGGREGATE LIMIT APPLIES PER: ENERAL AGGREGATE $ POLICY 0 PROJECT a LOC IRODUCTS-COPAP/OP AGG $ AUTOMOBILELIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea ac6denl) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per parson) BOTLY INJURY $ HIRED AUTOS (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ ,'Per accident) UMBRELLA LIA3 OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION ANDWCSTATU-ORY OTHER EMPLOYER'S LIABILITY YIN UMB903936-15 03/302015 03/30/2015 x Limas ANY PRDPERITOR.PARTNERIEXECUTIVE N/A E.L EACH ACCIDENT $ 100,000 OFFICER0.1EM95R EXCLUDED? Fi (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE;$ 100,090 N yes,dow1w under E.L.DISEASE-POLICY LIMIT '$ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS'LOCATIONS/VEHICLESIRESTRICTIONS!SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTTFICATE ISSUED TO TRE CERITFICATE HOLDER AFFT17MG WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION TOWN OF WAKEFIELD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE'THEREOF,NOTICE WILL BE DELIVERED 1 LAFAYETT'E ST IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENT M R'AKEF[F..L.D,MA 01880 ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD 19BB-2010 ACORD CORPORATION. Alliights reserved. 6'd 9££6-9Z9 QL 69) }onJlsuoo suog�R/(r✓JJnW r e8Z:80 9 L 80 l/(�//(/I((I)(((1('C/(I�(� '/1(If J(/(•I((.l('IIJ ..-_Office of Consumer A-fairs&Business Regulation ME IMPROVEMENT CONTRACTOR Type: Fk;l gistration: 179050 �,€(piration: 611712016 Individual JAMES MURRAY JAMES MURRAY 114 BROADWAY 02145 Undersecretary SOMERVIL.LE,MA ,CM# NA..,gachusetts Department of Safety �,T.,1 Board of Building Regulations ansa _;cense: CS-107633 JAMES MURRAY: "- 114 HJKVAW;"i+:- - Somerville MA 02145 °� 03/08/2018 . +�omrnissroner