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HomeMy WebLinkAboutBuilding Permit # 5/13/2015 I �OFiYy BUILDINGMIT 0 ,g�•y TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �Ssaca+us�c Date Issued: i d` IMPORTANT: Applicant must complete all items on this page O l / t / r i r i T�a Y28C�tifuCtUrC' yes z n0- MNPZONING"DISTRICT Historic District / yes / Machine Shop.,Village, yes "n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building tone family ❑Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic n Well E1FIoodplaii Wetlands E Watershed District titer/Sower<„ ,DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: 5 Phone: �\163 Address: Contractor Name i ii i�i�//iii/4iri//�i�i//��/i / i r '/r r i / % i i i✓ �% / �9 iii o / // /i rig/ / ii riii'i � // i % // i / ✓ i iii/ir i ,,,;,, Super�iasors Construction,License ! , ,�� Exp l//�/D /r% i!/ / / ii �i/ r i/ ii Irnprovement,Licen"se 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: $ , ; � �' FEE: $ b C Check No.: �� 2® Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owne ure of contracto _ µ AM FORTH It own ot Amm ctover ® :. to All% No. a ver, ass, 2b15 �®ADRATED � �T L Lj BOARD OF HEALTH Food/Kitchen IL 11 ER W Septic System ® ® BUILDING INSPECTOR THIS CERTIFIES THAT ............................. moi [.... ........ ......................................... Foundation . ...:........ .... has permission to erect . ........ buildings on ....... .. �*�*` .. .. .. .. ... .. �. . p ................. ... ... ... Rough to be occupied as ....... �► '"G� V•► ...... ... ... Chimney ............. ... .... . . .......... ...... provided that the person acceptin 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRESI y ELECTRICAL INSPECTOR UNLESST A Rough ' t /1 Service ....... ......... ........................................................ Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required t® 0CCUPv Building Rough Final Display in a Conspicuous lace o the Premises — o Not Remove FIRE DEPARTMENT No Lathing or Dry Wall To Be ®one Burner Until Inspected and Approvedthe Building Inspector. Street No. Smoke Det. ® 98 Forest Street . . . fM.'Urphy' ® North Andover,MA 01845 • PH:978-688-5335 Building Contractor • FAX:978-688-7207 Proposal To: George Murphy 47 Huckleberry Lane All Home improvement Contractors and Subcontractors engaged in home improvement contracting,unless North Andover, Ma. 01845 specifically exempt from registration by Provisions of Chapter 142A of the general laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and Status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place, From: Kevin Murphy Room 1301,Boston,MA 02108.(617)-727 8598 CC: Date: 5/13/2015 Job: Windows/Ice damn repair Date of plans: None Architect: None Location: Same Section 1-Work 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 5/11/15. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 6/10/15.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 11-Warranty The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 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 replaced,such damage or such defect in materials or workmanship.The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Section 111-Scope of Work Page 1 of 4 Kevizi ~~u=»=~y Page of Budding Contractor 98 Forest Street North Ambver,MA 01845 PH:978�35 FAX 978-6W7207 &;emema| Proposal is to supply and inob*U six Harvey replacement windows, and repair wall damage due to ice damns. Permit will baobtained bvcontractor. Demolition Section of wall damaged from ice damn/water will be cut out and replaced. Building Six Harvey Majesty neplaoemontwindovvswi|| besupp|iedandinstoUadinaxkstingopenings. AnynoMedbimwi|| be replaced. Interior casing to remain. Windows will have full soroans, and grilles between the Q|oos, to match existing. Plaster Wall will bepatched/plastered aerequired. Painting Minor interior/ exterior painting around windows will be provided. Repaired section of living room wall will be painted. Laundry room ceiling, and stained section of garage ceiling will be primed painted as required. Waste Removal All construction debris will budisposed ofbvcontractor. | � � � ' Kevi.n MurI.Aiy Page 4 of 4 Building Contractm, 98 Forest Street Nath Andover,MA 01845 PH:97&688-5a35 FAX 97888&7207 Section IV—Price Schedule I We hereby propose to furnish material and labor—complete in Accordance with above specifications for the sum of... ... ... ... ... ... ... ...... ... ... ....$ 6675 Payment to be made as follows: Percentage/Item Description Amount 1 Permit obtained / deposit $3000 2 Job complete $3675 i Total 2 T $6,675.00 "Notice:No agreement for Hoare improvement contracting work shall require a down payment(advance deposit)of more that ane-third of the total contract price of the total amount of all deposits or payments which the contractor must make,in advance,to order and/or otherwise obtain delivery of special order materials and equipment,whichever is greater Contractor: Kevin Murphy 98 Forest 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 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 CONTRACT IF THERE ARE ANY BLANK SPACES Signatur .2 � � n Date Signature Date i i The Commonwealth of111assachusetis .Department oflndustrialAccidents a I Congress Street,Suite 100 Boston,MA 02114-2017 "4 wwlumass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/.Electricians/Plumbers. TO BE FILED WITH THE PERAWTTLN G AUTHORITY. Applicant Information Please Print Legibly Name (Business/OrganizationlIndividual): „ t 01 Address: ' 6 f e-5 " S\V­A_ City/State/Zip: t rrm ro. Pholie##: ,,,mow"V­ L1 ., ^ Are you an employer?Checic the appropriate box: Type of project(required): 1 119I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.Q I am a sole proprietor or partnership and have no employees working forme in 8. Remodeling any capacity,[No workers'comp.insurance required.] 9. Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp,insurance required.]t 10'[]Building addition 4.Q I ant a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12,FJ Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance,$ 6.0 We are a corporation and its officers have exercised their right of exemption per MGL G. 14,Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] "Any applicant that checks box III must also fill out the section below showing theirworkers'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. I am an employer that is providiizgipor•Irers'compensation iizsurazzce for uzy employees. Belolv is the policy andjob site information. n Insurance Company Name: a °µ I , ° . t — oe%, Expiration Date: Policy#or Self-ins.Lie.#: � „ � Job Site Address: : tl �a,` kms,. City/State/Zip: Attach a copy of the workers' compensation poky 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 verification. I do heyby certify under the pains and penalties of per ftity that the information provNed above is true and correct. Sienattu Date: a; z Phone#' rY .. Ofjl'cial use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: •� CERTIFICATE OF LIABILITY INSURANCE 6/25/2014 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 CONTAMEACT NSandi Munroe M P ROBERTS INS AGCY INC PHONE (97S) 653-8073 aC Ne:(978) 683-3147 1060 Osgood Street ADDRESS:san i Ldmprobertsinsurance,com North Andover, MA 01845 INSURERS AFFORDING COVERAGE NAIC 71 INSURERA: MERCHANTS INSURANCE ''......,. INSURED KEVIN MURPHY BUILDING & REMODELING INSURER e: GUARD INSURANCE ''.....,. 169 BOXFORD STREET INSURER C: NORTH ANDOVER, MA 01845 INSURER D: NS RERE: 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 PEROD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDmON 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 BYPAID CLAIMS. ILTR TYPE OF INSURANCE POLICY EFF POLICY EXP LIMITS INSD %WD POLICYNUMBER MM/DD' MM U X COMMERCIAL GENERAL LIABILITYEACH OCCURRE ■--. NCE $ 1 ,000,000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence $ 500,000 BOPI068945 11/22/13 1/22/14 MED EXP(Anyone person) $ 15,000 A PERSONAL&ADV INJURY $ INCLUDED GEN'LAGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 POLICY®PRa ®LOC PRODUCTS-COMP/OP AGG S 2 ,000,00-0 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLEIJMIT $ 1, , O Ea accident _ BODILY INJURY(Per person) $ ALL j AMCA7013608 01/23/14 1/23/15 LOWNED SCHEDULED OWN A AUTOS X AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccident $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESSLIAB CLAIMS-MADE CUP 9145304 11/22/13 1/22/14 AGGREGATE $ 1 DED RETENTION $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIE(ORIPARTNERIE(ECUTNE Y E.L.EACH ACCIDENT $ 500,000 B (Mandatory EXCLUDED? N/A KEWC527844 07/01/14 7/01/15 500,000 (Mandatoryin NH) E.L.DISEASE-EA EMPLOYEE $ r ESCRION O O describedr OPERATIONS below E.L.DISEASE-POLICY LIMI S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space's required) i CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF TI-E ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 OSGOOD STREET THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE M N ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I VILE WQa91111L1,1111 N'n�. lIJJCEell"'Jem 2� Office of Consumer Affairs&Busi4ss Regulation OME IMPROVEMENT CONTRACTOR egistration: 101874 Type: 7Expiration: 6/29/2016 Individual KEVIN MURPHY Kevin Murphy 98 FOREST ST. N.ANDOVER, MA 01845 Undersecretary i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor '. License: CS-053099 KEVIN W MURPHY , 98 FOREST Sof r' North Andover iYFA 018 ' Expiration Commissioner 06/29/2095 .I