HomeMy WebLinkAboutBuilding Permit # 6/9/2015 t%0RTH
BUILDING PERMIT � ,6�tio
T NORTH ®� 6
APPLICATION FOR PLAN EXAMINATION
Permit No#: 1 1 Date ReceivedRAo"r^ED "°\y
��SS�caauS��R
Date Issued: d 61
IMPORTANT: Applicant must complete all items on this page
LOCATION ` au f,,, { (;
Print
PROPERTY OWNERIL z, d a+,n
Print 100 Year structure yes O
MAP PARCE ZONING DISTRICT: :Historic District yes
Machine Shop Village yes ng
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building One family
❑Addition ❑Two or more family ❑ Industrial
Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
El
r
El Demolition � d Ooo""vd�
DESCRIPTION OF WORK TO BE PERF RMED:
Ti t r
k,,V �U YG( C� .g �' ' ��kn
o d1 cm, i
Identification- Plea e Type or Print Clearl _
OWNER: Name: ro, ��(� i46tc�,V? Phone: / U. - G�
Address: u -`Cay
Contractor Name: Phone: 2W- 0 CO 7f)-G51)
Email:
Address:.
.- _
Supervisor's Construction License: Exp. Date: f
Home Improvement License: Exp. Date: f
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE,BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ O FEE: $
Check No.: M Receipt No.:
NOTE: Persons contracting with unre ed contractors do not have access to the r ty d
a
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Flans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer TanniaglMassage/Sody Art ❑
Swj171mi g Pools ❑
Well Tobacco Sales ❑ Food Packaging/Sales F1
Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑
j
THE FOLLOWING SECTIONS FOR. OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORD
®P��li ENT Reviewed On � Signature �
LANNgNG � DEVELOPMENT
COMMENTS
CONSERVATION Reviewed an %�. Signature
COMMENTS -_Q._ a_1 0
HEALTH Reviewed on Si nature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
.,,�'
®rater& Sewer Connection/Signature&Date Driveway
Permit
DPW Town Engineer: Signature Located 384 Osgood Street
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MMENTS%i.! ,
I ow
v
thORT H
A -& ver
- town of It E
ndqAj
®
® �(
y ver, Mass,OiN@Ah
COCNIc"tw1CN
o?ATE®
S 11
BOARD OF HEALTH
Food/Kitchen
PER MIT T LD 1 Septic System
THIS CERTIFIES THAT .................KC AV%........ .. ........................................................ BUILDING INSPECTOR
has permission to erect buildings on Foundation
.......................... .. '&4...... .1 ........ :r ... ......
��ryry `, Rough
to be occupied as ...I.4!..�'e ....... .. . . . .......... . ... Eva5..tkn
..... ....... ................................... Chimney
provided that the person accepting this permit shall in every respecform 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
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations voids this Permit. Rough
Final
EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR
0 - A UNLESS T CTI S Rough
Service
................................................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® 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 Approvedy the Building Inspector. Burner
Street No.
Smoke Det.
AW Document A105
Standard Form of Agreement
Between Owner and Contractor
0
for a Small Project
where The Basis of Payment is a STIPULATED SUNT
1993 SMALL PROJECTS EDITION
Because this document bas important leges.1 conseepi aces, we encouragre you to consult with an
altome),before signimg it. Some states mandate a cancellation period or require other specific
disclosures, including war nil,qs for borne improvement contracts, uVien a document such as this will
be used forWor k on the comer's personal r ecideuce. )'our attootel,shotdd insert all language required
try state or local lath to be included in this iVgree meat. Such.statements mitt'be entered in the space
provided beloiv, or if re(Puire[/bit lain, above the slgnaliires ojthe pro-lies.
This AGREEMENT is matte:
tl)rue)
May 27, 2015
BETWEEN! the O%vner:
Kevin Martin
136 Old Farm Rd.
North Andover, MA 01845
and the Contractor:
Summit Design Build
29 Eames St.
North Reading, MA 01864
for the following Project:
Demo all existing railings and deckboards,frame new 4'x10'section of deck and new stairs
as shown in drawings A-1,A-2,A-3,and A-4. Labor and materials as outlined in attached
pricing proposal. Price also includes all drawings and conservation meetings.
The Architect is:
N/A
The. (Oder anti Contractor agree as follows.
!"Cupydght 1993 by 1-lie American Institute of Architect~, 1-35 New York Avenue,NAK,Washinpi n, D.C.30006-5292, Reproduction of the material herein
or suhntawial quovation of its I)rnvisirnls mIhhnul tilt.%Vfitten permission of the:\IA Violates the copt-riytht latus of the Unitetl Stales and will snhiect rht;Violator to
legal pni"Ccullort.
AIA DOCUMENT A105• UWNER CON I K4CTOR 1GREFMF.N r—sDL41.L PROJECTg
EllI TION-4L\ «t 1993 11 IF 1\IT RH:\.N iN.S7111T.,()F ARCI111 ECTS.1-35 NFA\'VORK
YVTNIti:,�'tt,uA;IIIRN TON,I)( (016_52C1 WARNING:Unlicensed photocopying
A
violates U.S.copyright laws and will subject the violator to legal prosecution. A105-1993 1
ARTICLE 1
THE CONTRACT DOCUMENTS
The Contractor shall complete the Mork described in the Contract DOCUInCIMs for the project.1-he Contract Documents consist cif.
.1 this Agreement signed by the Owner and Contractor;
.2 ALA Document A205,General Conditions of the Contract for Construction Of a Small Project,current edition;
.3 the Drimings and Specifications prepared by the Architect,dated
and enumerated as follows:
Drawings:
A-1,A-2,A-3,A-4
Specifications:
None
.4 addenda prepared by the ikrchitect as follows:
None
.5 written change orders or orders for minor changes in the\York issued after execution Of this Agreement,and
.6 Other documents,if any,identified as follows:
Customer may request changes in the work, and if agreed to by contractor, same will be
documented by a written change order, prepared by the contractor, which will document
the changes to be made, the resulting change in the contracted price, and the anticipated
delay in the completion of the work due to the change. In the event that the change order
request delays the progress of the work, verbal approval from the client is sufficient to
begin the change. Contractor shall not be obligated to perform any change in the work
unless and until customer signs such change order. Customer agrees to make payment
of 100% of cost of the change, as shown on the change order at the time of next milestone
payment.
AIA DOCUMENT A105 - 0q'1141iR-CONTRACTOR AGREEMENT—SNIAT.T.PROJECTS
EDr17OiN-AIV-(01993-THE AhtERIOMN INSTITUTF OF ARCFIETECTS,1735 NL•W YORK
AWNUT,N.XV.,uASIIW(;TON, ).C.?WOG-5293-WARNING:Unlicensed photocopying
violates U.S.copyright laws and will subject the violator to legal prosecution. A105-1993 2
ARTICLE 2
DATE OF COMMENCEMENT AND SUBSTANTIAL COMPLETION DATE
The date of commencement shall be the:(late of this Agreement unless othcrreise indicated below.'Fhe.Contractor shad(subst_tntially
complete the Work not later than
subiCCI LO adjustment by Change Order. Work to begin as soon as permits are obtained
(hreert the[teff i•ur numlxtr ojccr/endcrr dtil•,�c ff�!'(bit tG�lrorf i onnnexcenferrf,)
Work to be completed 6 days after start date
ARTICLE 3
CONTRACT SUM
3.1 Subject to additions and deductions by Change Order,the Contract Sum is:
$22,106.27 (Twenty two thousand one hundred and six dollars and 27/100 cents)
3.2 For purposes of pa)lnent,the contract Sum includes rhe fnlloWing values related to portions of the Work;
Portion of Work Value
Deposit due at signing of contract $5,000.00
Due on completion of deck $17,106.27
3.3 The Contn tct Sum shall include all items and services necessary for the proper execution and completion of the Vork.
AIA DOCUMENT At 05 • OR'NER-CONTRACTOR AGREEMENT---SAL%-LI,PROJECTS
Fl)ITIO\•lkle•01993•TIII ADIERIGAN INSTITUTE OFARC HITE(r5,17,137 NEWYORK
AVENUE,N,AG.,V SHL,:GrON,n.C.2(XX)6-5292•WARNING:Unlicensed photocopying
violates U.S.copyright taws and will subject the violator to legal prosecution. A105-1993 3
PAYMENT
4.1 Based on Contractor's Applications for Payment certified by the Architerl,rhe 0t%ger shall pay due Contractor as follows--
11111 pn11/.401z:firr r�utirtrt�r.if-rurl.)
Check due at times outlined in article 3.2
4.2 Paynleols clue anti unpaid under the Ctmtract I)(n:unwn(s::hall hear,.merest from die d.itc pamrent is due at the rate of
18% or in the absence thereof,at the legal rate prevailing ai the place of the Project.
1'srrm Lr rs ours rngrrir nnettJ_a nnr/+r!Lyra rerloral Tnrth in is rrdirrq Ac/,+Inti/ar.;fruu rutrl(n'rr!e7nt rnr r c lit Iruta rued other r ithitioni m rl t•On itecv rant(:mt.
tranor'sp+yrtcipu/places ofhllames,thelocatiolrrjtbePrcijertmer/elsauLumnr�la cttl,ttolirlimgjrbicprnrisirn.)
ARTICLE 5
INSURANCE
5.1 The Contractor shall provide(:ontrtctor's Liability and other Insurance a5 follows:
Drctrrdhciftc l»rroznrce regtrircd by l-t Uu'ner a
Complete liability and workers compensation insurance for the duration of the project
Insurance provided by:
JJ Murphy Insurance Agency
1 Centre St.
Malden, MA. 02148
5.2 The Owner shall provide ONvneC;s Liability and Owner's Property Insurance as follows:
Ibccer7 spctl/rc 11r51aY7)rCP-jra7tiched It),t@az Orr rrer:l
5.3 The Contrretor shall obtain an endorsement ro its general liability insurance policy 10coVer the Contractor's obligations under
Paragraph 3.12 of ATA Document A205,General Conditions of the Contract for Construction of Small Projects.
5.4 Certificates of insurance shall be provided by each party showing their respective coverages prior to commencement of
the Work.
AIA DOCUMENT A105 • OWNF•P.-CONTRACTOR AGREESIENT—SALU-L PROTECTS
EDMON•:11Au'X1993-1111,.,1.411,lUCAN LN1,71111TF OF ARC=-.(7[N,134 NRti'y()RR
AVENUE,NAK,W SHINGTON.rv-2(XW,-5292-WARNING:Unlicensed photocopying
violates U.S. copyright laws and will subject the violator to legal prosecution. A105-1993 4
ARTICLE 6
OTHER TERMS AND CONDITIONS
N!lkrn7 rm,rNhrr l,a-rn+�or c'o,rditir�wr hr•lnrr°.)
None
Thi,Agreement entered into as of the da%l and rear first written above,
Rf`reylr red l p/nu',nrsrrI CillWellaliorr/reriud.disc!-}cures or nlherrr'C1rnhrq XICIAWT Its ohnre>I("?yqunl rr;n;
May 27, 2015
oxxANE'i
L CONTRACTOR t
C, na ure)
(Sl,�-ratr.
vin Martin Summit Design Build
(/'ranter!-rale,tide rand ad(lrecc) (Printed rrmne,title art(I addmss)
136 Old Farm Rd. 29 Eames St.
North Andover, MA 01845 North Reading, MA 01864
iXENSE vc>. 083853
JURISDICTION Massachusetts
I I CAUTION: YOU Should sign an original AIA document which has this caution printed in red.
An original assures that changes will not be obscured as may occur when documents are reproduced.
Sw Instruction Sheet for Limited License for Reproduction of this document.
AIA DOCUMENT A105 • ONX,JER-CONTRACTOR AGREFJIENT—S\fA1.I,PROJECTS
F.DMO\•, 1`•01993•THE,IAIFRtCAN 1NSTn U-M OF ARCHTITC FS,1735 NFW YORK
ttlRvticensed p photocopying U.S.copyright laws and will subject violator to legalosecton
A105—T993 5
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-I Meters Data Sources:The data for(his map was produced by Merrimack
-SR rn--
Valley Planning Commission(MVPC)using data provided by the Town of
Roads North Andover.AddilJonal data provided by the Executive Office of
t7v Environmental Affairs/MassG1S.The informa ion depicted on this map is
E3 Easements for planning purposes only.It may not be adequate for legal boundary
MVPC Boundary odefinition or regulatory Interpretation.THE TOWN OF NORTH ANDOVER
Municipal Boundary MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING
- Trails * THEACCURACY,COMPLETENESS.RELIABILITY,OR SUITABILITY
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Streams CHUS�t
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05/28/2015 09:53 7813210673 JJ MURPHY INS PAGE 01/01
DATE(MMroWYYw)
1-0-4141
CERTIFICATE OF LIABILITY INSURANCE 2915
■ THIS
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED DY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the Certificate holder is an ADDITIONAL INSURED,thePolicy(ies) must be endomad. 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 W the
certificate holder in lieu of such endorsernen s. NTACT
PRODUCER N ME:
Jantea J Murphy Insurance Agenc
NE - L761 324-4064 FAX Noa (791) 321-Ofi73
One Centre street 2nd Floor E-MaAl ss: limins@aol.com
Malden, MP 02148 INSURERS)AFFORDING COVERAGE NAIC0
INSURER A 1 WESTERN WORT.n
INSURED --------•.,�.__.�`---------'-----••----"' --------.�....,.. INSURER B'
slum 1^t Design Build Inc. I URER C:
29 EA4ES SZ']2EET INSURER 0;
NORTH READING, MA 01864 INSURER E:
INSURER F
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE L151-ED 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 ISSUhD 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.
— --"^"— pbucrli FF ..1lO P
LTR TYPE OF INSURANCE POUCYNUMBER MIopN MMmWYYYY
GENERAL LIABILITY LgpPla03640 5/18/15 5/18/16 EACH OCCURRENCE $ 1 000 000
ADAMAGET TED MMPR� $ 10O 000
C
CLAIMS-MADE
GENERAL LIABILITY
OCCUR MED EXP(Anyone ereon) S rJOQO
PERSONAL&ADV INJURY S 1 QOO OOO
GENERAL AGGREGATE 5 2 000-000
PRODUCTS-COMPIOPAGG $ 2 000 000
GEN'L AGGREGATE LIMIT APP LIES PER $
POLICY PRO-C.0 Loc
INED SIN
AUTOMOBILE LIABILITY
Ea ecewort) L IT $
BODILY INJURY(Per person) S
ANYAUTO 80DILYINJURY(Per=ide(lt) S
ALLoWNED SCHEDULED
AUTOS AUTOS
OOWNED PR RTY DAMAGE $
Peracci ent
HIREDAUTOS _AUTOS S
EACH OCCURRENCE $
umaMLLIAOCCUR
AGGREGATE
EXMSS
CLAIMS-MADE
S
OED RETENTION S WC$TATO- 0TH•
1M�RKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN L.EACH ACCIDENT 6
A
NYPROMEMR EXCLUDED?
N I A
E. .DISEASE-EA EMPLOYE S
(rllandatory In NH)
If asalbeunder E.L.DISEASE-POLICY LIMIT 3
0 RIPTION OF Oe9dPERATIONS below
DESCRIPTION OFOPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 161,Addldonel Remarks Schedule,If more$Paco Ls required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
TOWN OF At3DOVER ACCORDANCE WITH THE,POLICY PROVI$IONS.
1600 O$GOOD ST AUTHORIZED RT=P.RESENTA4IVk�
NORTH ANDOVER, MA 01845
.-�"3 1SE8-�p1t)ASO D CORPORATION. All rights reserved-
ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD
Phone: Fax: E-Mail:
The Commonwealth of Massachusetts
f Department of Industrial Accidents
1 Congress Street,Suite 100
Boston,DIA 02114-2017
www.mass.gov/dia
ODM S4.v
- Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMUTING AUTHORITY. lease Print Le bl
Applicant Information
Name(Business/Organization/Individual):
Address: J
City/State/Zip:
Phone#:
Type of project(required):
Are you an employer?Check the appropriate box:
1.❑I am a employer with em to (Rill and/or part-time).* 7. F1 New construction
P Yees
2.❑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
3.Q 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.F1 Electrical repairs or additions
ensure that all contractors either have workers'compensation insurance or are sole
proprietors with no employees. 12:0 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.[❑Other
6.Q 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.
tContractors 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.
ensation insurancefor nzy employees. Below is the policy and job site
I am an employer that is providing workers'comp
information. �t/Y� !U S.
Insurance Company Name: S _
i✓CC 5 O O��3�� a�'— ----- Expiration Date: �` l
Policy#or Self-ins.Lie.#: 7- �J
1 S 6 0/c/ i- i,-M 2 Cf City/State/Zip: lJ�
Job Site Address: Dy�
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
on punishable by a fine up to$1,500-00
Failure to secure coverage as required under MGL c. 15 int
and/or one-yeas imprisonment,as well as civil pen he form of as STOP is a criminal 1WORK 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 hereby certify under the p 'rzs and pen ties of per jury that the informatiotz provided above is true and correct.
ect.
Si nature:
Phone#: /
Official use only. Do not write in this area,to be completed by city or to4vn official.
City 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
Phone#:
Contact Person:
��e �Paa���zoozcueul�a
owOffice of Consumer Affairs&Business gulaf o�n e�
OMEIMPROVEMENTCONTRACTOR
e9istration• 966149
xpiration: 4!2912.1_/'16 Type.
SUMMIT DESIGN BUILD INC. Private Corporatic'3
MICHAEL COUGHLIN
29 EAMES ST
NORTH READING, MA 01864
Undersecretary `
� Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
C:>nstruction Supervisor
License: CS-083853
NIICHAEL S C0IJ6HLIlY,
r
i 29 Eames Street
i
North Reading MA Of
{t r
ti
!Z �� '.,,;j4``` Expiration
05/20/2016
commissioner