HomeMy WebLinkAboutBuilding Permit # 11/2/2015 %40 R TH
BUILDING PERMIT �ot�t110 ; �°
TOWN OF NORTH ANDOVER �
APPLICATION FOR PLAN EXAMINATION
Per NO: `^ Date Received
DARTED PPPy,�r9
Date Issued: l7/ / �SSgcHus�`R
IMPORTANT: Applicant must complete all items on this page
LOCATION 69 nems+k C)ad
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PROPERTY OWNER 'tOac�C a KGS ry%l F P V-41 7!5,0 '
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MAP N0060r4 PARCEL: ZONING DISTRICT: Historic District yesAV Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building )(One family
❑ Addition ❑ Two or more family ❑ Industrial
❑ Alteration No. of units: ❑ Commercial
V Repair, replacement ❑ Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑ Well ❑ Floodplain L1 Wetlands ❑ Watershed District
❑ Water/Sewer'
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Identification Please Type or Print Clearly)
OWNER: Name: Pct.v l ala w y Perm us®r1 Phone:
Address:
CONTRACTOR Name: Phone: (�zXg-Zli • g yyO
Address:
36 O 14 ey y- i wt a c(L �,a LU rre v,aP MA- o 1,y y�
Supervisor's Construction License: Exp. Date:
Cs - 062a3a 02 IIV)1201
Home Improvement License: Exp. Date:
175'/642 Lao
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: $ it .1/f (2 3 9 FEE: $
Check No.: Receipt No.: C A/
NOTE: Persons contracting with unregistered contractors do not have a s he guaranty fund
Signature:of Agent/Owner Signature of contractor
Cl'
v 'ed,*412
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_t%O R TES
Town of If
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Y.1'.
Andover
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® � LAKE h `' VAI', SSS,
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ACOCMICHEWICK IL
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BOARD OF HEALTH
Food/Kitchen
PErx I LD\ Septic System
THIS CERTIFIES THAT .....MA%AA.... r IAS„ Id„ , ,, ,,,, ,, ,, BUILDING INSPECTOR
Foundation
has permission to erect .......................... buildin s on . .. .... ® . .. ........ ..........................
Rough
to be occupied as . .... ....... Chimney
provided that the person accepting this permit shall in every respect conform to the terms o he 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
UNLESS CONSTRUS TS 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 r all To Be Done FIRE DEPARTMENT
Until Inspected and Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
CONSTRUCTION SERVICES AGREEMENT (short form)
Where the basis of payment is Cost of the Work plus a Percentage Fee
i
Contractor: Owner: Date:
Howell Custom Building Group,inc. Phone: 978-989-9440 Paul and Amy Ferguson October 28,2015
360 Merrimack St. Bldg 5 License:CSL 068232 69 Heath Road Project:
Lawrence,MA 01843 License: HIC 175166 North Andover,MA 01845 Ice Dam Repairs
I. PARTIES &DATE OF AGREEMENT
This contract(hereinafter referred to as"Agreement")is made and entered into on this 14'h day of October,2015,by and between Paul and Amy
Ferguson,(hereinafter referred to as"Owner");and Howell Custom Building Group,Inc,,(hereinafter referred to as"Contractor").
II. SCOPE OF WORK,PAYMENT&TIME
A. SCOPE OF WORK: In consideration of the mutual promises contained herein,Contractor agrees to perform the Work as described in the
attached 3page Scope of Work&Specifications dated October 14,2015.
B. PAYMENT: Owner shall pay Contractor for the cost of Contractor's labor(per the attached rate schedule),plus the cost of materials,
equipment and subcontractors at Contractor's cost plus 20%,as required to perform the Work of this Agreement,not to exceed$23,250.
C. TIME: Commence work on or about November 2,2015 and achieve Substantial Completion of all work in this Agreement on or about
November 27,2015,not including delays caused by: inclement weather,accidents,additional time required for performance of Change Order
work(as specified in each Change Order),delays caused by Owner,and other delays beyond the control of the Contractor.
111.GENERAL CONDITIONS FOR THE AGREEMENT ABOVE
A, PROGRESS PAYMENTS: Contractor shall submit invoices to Owner approximately every two(2)weeks and/or upon completion of
the Work,at the Contractor's discretion. Owner shall make payments within five(5)business days after receipt of the Invoice by Owner.
Payments due and unpaid under this Agreement shall bear interest from the date payment is due at the rate of one and one half percent(1-1/2%)
per month.The Owner shall be responsible for reasonable attorney's fees incurred by Contractor in collecting any sums due hereunder.
B. COSTS TO BE REIMBURSED: The tern"Cost of the Work"shall mean costs necessarily incurred by Contractor in good faith and in
the proper performance of the work. The Cost of the Work shall include: l)Cost of Contractor's labor including supervisory labor,3)cost of time
spent picking up.materials and transporting to the job,4)cost of subcontractors,5)cost of materials incorporated into the Project,6)cost of
permits and fees,7)cost of equipment rental,8)cost of portajohn,dumpsters and trash removal
C. COSTS NOT TO BE REIMBURSED: 1)Office salaries,2)office expenses,3)employee taxes, insurance or benefits(these are
included in Contractor's labor rates),4)commuting time to and from the job site,5)vehicle expenses,6)cell phone expenses,7)tool purchases or
repairs,8)correction of defective work due to the fault or negligence of Contractor.
D. LIMITED WARRANTY: Upon final payment by Owner of the entire Contact Sum including all change orders(if any)due to
Contractor,Contractor warrants to Owner that the Work performed under the Agreement is free from defects,not inherent in the quality used,in
materials,equipment and workmanship for a period of two(2)years after the date of Substantial Completion.
E. ENTIRE AGREEMENT: This Agreement represents the full and complete understanding of every kind or nature between the
parties with respect to the services set forth in this Agreement,and all preliminary negotiations and prior representations,proposals
and contracts,of whatever kind or nature,are merged herein and superseded hereby.
F. OWNER'S 3-DAY RIGHT OF RECISION: Owner may cancel this agreement with no fturther obligations by notifying Contractor in
writing that they wish to cancel the Agreement within 3 business days of the date they signed the Agreement.
I have read and understood,and I agree to,all the terns and conditions contained in the Agreement above.
Dat t Stephen D.Howell,President
Howell Custom Building Group,Inc.
Date Owner
r�
i
D,t6 Owner
Page: 1 of 1 Initials:�t)
Construction Cost Estimate
<title/date of PLANS used for this estimate>
❑Patti&Amy Ferguson ❑
lee Dam Repair Optional Exterior iat � CONTRACT
69 Heath Road
sum
# Categeory Labor Material Subs Totals Labor Material Subs Totals Totals #
2 Demolition 514 - - 514 - - - - 514 2
3 Excavation&Site Work - - _ - 3
4 Concrete - - - 4
5 Mason"i - - - _
- - - - 5
6 Floor Framing - - - _ _ _ _ - 6
7 Wall Framing - - _
8 Roof Framing - - - _ _ _ - 8
9 Roofm&Gutters - - - - 537 193 2,646 3,376 3,376 9
10 Exterior Trim - - - - - - - - - 10
11 Siding - _
- - - 11
12 Exterior Doors&Windows i 585 956 - 1,541 - - - - 1,541 12
13 Porch&Deck Finishes - - - - - - - - - 13
14 Plumbing&Beating - - _
15 HVAC - -
- - - - - 15
16 Electrical - - _
17 insulation 169 119 - 288 - - - - 288 17
18 Plaster - - 1,500 1,500 - - - - 1,500 18
19 Tile - - _
- - - - - 19
20 Int.Doors Trim Millwork 2,418 479 - 2,897 - - - - 2,897 20
21 Cabinets To s&A fiances - - - - - - - - - 21
22 S ecialities - _ _ _
' - - - - 22
23 Floor Cov=ering - - - - - - - - 23
24 Painting - - 4,080 4,080 - - - - 4,080> 24
1 Plans&Permits 215 189 - 403 - 61 - 61 464 1
2Site Preparation 517 302 - 819 - 10 - 10 829 2
25 Clean-up&Dum stern 423 420 - 843 61 - - 61 903 25
26 Supervision&Proi Mgmt 817 - - 817 324 - - 324 1 1,141 26
0-10
®H Indirect Costs £ c3erhead 10.00% of Costs 1,370 10.00°I° of Costs 383 1,753 OR
P IICDt Net Profit 10.00% of Costs 1,370 10.00% of Costs 383 '' 1,753 P
TOTAL PRICE 16,441 4,597: 3 :`
Li
101 ❑
Filename:Ferguson Ice Dam Repairl0-23-15.xlsm Printed: 10/27/2015 Summary:page 1 of 1
The Commonwealth of Massachusetts
Department of IndustrialAccidents
1 Congress Street,Suite 100
µ Boston,HA 02114-2017
www mass.govldia
Workers'Compensation.Insurance Affidavit:Builders/Contractors/Electricians/['lumbers.
TO BE PIED WITH THE PERMITTING AUTHORITY.
Applicant Information dPlease Print Leiib
ly
Name(Business/Organization/tndividual): t?, t i "fid
Address: 3 ° Y',r i W n C, "
61 tf
City/State/Zip: CL LAA- �" Phone#: ''61 LJ (°)
Are you an employer?Check the appropriate box: Type of project(.Tequired):
1.0I am a employerwith_ , ._employees(full and/or part-time).* 7. ❑New construction
2.E]I am a sole proprietor or partnership and have no employees working for me in 8. El Remodeling
any capacity.[No workers'comp.insurance required.]
• 9. El Demolition
3.❑I am a homeowner doing all work myself,[No workers'comp.insurance required.]t
4.
10 [_]Building addition
❑I am 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.❑Electrical repairs or additions
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 fiave employees and have workers'comp.insurance.t
6.Q We are a corporation and its ogers have exercised their right of exemption per MGL c. 14.❑Other i 1 d t
f N
oyees.[No workers'comp.insurance required.]
152,§1(4),and we have nq empl
Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information,
homeowners who suBmit#his affidavit indicating they are doing all work and then hire outside contractors must sgbmit 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 workeis'comp.policy number.
I am an employer that is pi'avidlizg workers'compensation insurance for my employees.'Beloiv is the policy andyob site
information.
Insurance Company Name: !p t R U q
Policy#or Self-ins,Lic.#:ECC6 COq 60660t"( Expiration Date:
Job Site Address:-1,7 �� t 11z 0 City/State/Zip: A °( k i'1 ? �,`
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration datd).
Failure to secure coverage as required under MGL e. 152,§25A is a criminal violation punishable by a fine up to$1,500.00
and/or one-year 6prisonment,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 foivarded to the Office of Investigations of the DIA,for insurance
coverage verification.
I do hereby certify under the pains and petatties ofpeijtay that the information provided above is true and correct.
Sign 0: — Date:
Phone#:
Official 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): i
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
HOWEL-1 OP ID:BC
.4#% R CERTIFICATE OF LIABILITY INSURANCE O06/10/2015Y)
06/1012015
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 endorsemen s.
PRODUCER CONTACT
FosterSuilivanInsurance NAME: Brian Clancy _
163 Maln St. P"�"•No.Ert);978-666-2266 __ Vic,NqL 978.686-641 O_
North Andover,MA 01845 ADDRESS:bclanc - fostemullivan rou com
Michael J.Foster Yj - g—P'— —
_ INSURER(s)AFFORDING COVERAGE_ _____1 NAIC# -
INSURER A:HARLEYSVILLE INSURANCE GROUP 23582
INSURED Howell Custom Building Group, INSURER 0:A.I.M MUTUAL INS CO }
33758
Inc INSURERC: --- ___T .— --- --
360 Merrimack St Bldg 5 Ste4N — — — — — — —
Lawrence,MA 01843 INSURER D:
INSURER E: _
INSURER F: y
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.
IHSRF— TYPE OF INSURANCE JADDLIS - — MMILIDCD IPAAOAlLIDDN XPo LIMITS
POLICY NUMBER
j GENERAL LIABILITY , ( EACH OCCURRENCE _. S 11000,00
A IK COMMERCIAL GENERAL LIABILITY i ISPP44402T 0610112016106101/2016�AGETO RENTED i 3 500 00
(��;; I PREMISES(Ea occunenco _ �
CLAIMS IMOE I�OCCUR MED EXP(Any one person) 3 15,00
_ _ I PERSONAL d ADV INJURY $
1,000,00
..= ----
GENERAL AGGREGATE I S 2,000,00
GEN L AGGREGATE LIMIT APPLIES PER PRODUCTS•COMPIOP AGG $ 2,000,00
I POLICY XI
PRO•JECT I LOC -
AUTOMOBILE LIABIUTYI COMBINED SINGLE LIMIT
(Eaamdent) _ 3 11000,00
A i ANY AUTO BA44403T 06101/2015 06101/2016 BODILY INJURY(Per person) $
ALL OWNED X SCHEDULED BODILY INJURY(Par accudonl) S -
AUTOS AUTOS _
HIRED AUTOS X AUTOS NEO PROPERTY OHMAGE S
AUTOS PERACCIDENT� .
1 1 17 $
X 'UMBRELLA LIAB XOCCUR EACH OCCURRENCE S 3,000,00
AE7(CESS LIAB CLAIMS•MADE CMB44404T 06101/2015 06101/2016 AGGREGATE _ _ _ I $ 3,000,00
^ DED I X I RETENTION$ 10,000 I $
WORKERS COMPENSATION x WC STATU• 0TH-
AND EMPLOYERS'LIABILITY Y!N I TORYLIMITS:_�ER �---
B ANY PROPRIETORIPARTNERIEXECUTIVE I ECC60040006812014A 06101/2015 06101/2016 I El EACH ACCIDENT s 500100
OFFICER/MEMBER EXCLUDED? If N 1 A — --
(Mandatory In NH) �E L DISEASE•EA EMPLOYEE 3 600,00
OIf ESCRIIPTTIIONunder
OPERATIONS bet ow I E,L DISEASE•POLICY LIMIT I $ 600,00
I
I
I
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,N marc,apace Is 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 NORTH ANDOVER ACCORDANCE WITH THE POLICY PROVISIONS.
1600 OSGOOD STREET AUTHORIZED REPRESENTATIVENORTH ANDOVER,MA 01845
01988-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD
� 1 ' Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Y jNe,r,r
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 175166
Type: Corporation
Expiration: 4/29/2017 Tr# 263220
HOWELL CUSTOM BUILDING GROUP _
STEPHEN HOWELL
360 MERRIMACK ST
LAWRENCE, MA 01843
Update Address and return card.Mark reason for change.
Address Renewal E] Employment Lost Card �
SCA 1 w.:a 20M-05/11 I
r�/�,°`d`o oortyerrrrrrc=✓rl�a��s,/� ![ rl�Y�r^�rr.lc`fs
Off-tee of Consumer Affairs&Business Regulation License or registration valid for individul use only
i r t 0ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
4registration: 175166 Type: Office of Consumer Affairs and Business Regulation
3Ex iration: 4/29/2017 Corporation 10 Park Plaza-Suite 5170
p Boston,MA 02116
HOWELL CUSTOM BUILDING GROUP
� p
STEPHEN HOWELL
15 MT VERNON RD
BOXFORD, MA 01921 Undersecretary '" Not valid without signature
,a ,
Massachusetts - Deparlment of PUblic Safety
Board ed of BuHdarrr RegW tions and Standards
t"aw�ua�.G°rdw�ur�a� "��a�r°me��axr.
License:ease: CS-068232
STEPHEN D HOVY$LLM �,�,� C rt
15 MT VERNON RDS
BOXFORD MA 0192
10 Ex pi rabon
p2114/2016
cornmissYoner
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