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HomeMy WebLinkAboutBuilding Permit #1173-2016 - 72 Elm Street 5/10/2016 BUILDING PERMIT OF N,aLE.t) q tT D 6 TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION h Permit No#: Date Received AD " 7.e ADR.ITED .PP��y SSACHV`'� Date Issued: PORTANT: Applicant must complete all items on this-page LOCATION �, ,e 5 Print PROPERTY OWNER /?�/�t'lc A2/,0,Co Q;r,41 "Print' 100 Year Structure no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village Cyes5 no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial BfRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition --- ---- El Other El Septic- 0 Well ❑ Floodplain 0 Wetlands ❑ Watershed District 0 Water/Sewer D SCRIPTION OF WORK TO BE PERFORMED: f�2ys Identification- Please Type or Print Clearly OWNER: Name: Phone:929 Address: 2a Z—i M S� Contractor Name:z. S� Phone: Email: Address: 6 v6s �vcn eta. �i� , Supervisor's Construction License:_ -0,!rg?Yl Exp. Date: Home Improvement License: // Exp. Date.- ARCH ITECT/ENGI NEER ate:ARCHITECT/ENGINEER Phone: _ Address: Reg. No. - FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATMCOST'BASED*Off.$125.00 PER S.F. 1 Total Project Cost: $ ' , FEE: Check No.: 3a��Z W+3 Receipt 111b-:- . . . _. NOTE: Persons contracting with unreg' tered contractors do not have;access:ta.t -e guarantyfund l- Location i Z_ iv '\ --71 No. t ': �.. � * Date TOWN OF NORTH ANDOVER a Certificate of Occupancy $ Building/Frame Permit Fee $_ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ T Check# n 3 3 5 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools , ❑ , well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ ' Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM ti PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street fflilE DEPuARMENT Temp ®ump er�onsi�fe ye a atecl'at1,2„4 Main Street; ' F�,i�r a Dep rtment° � g a ure%atm _ C®MMENJS _ _ � Dimension Number of Stories: Total square feet of floor area, based.-An---Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Deter location, mast or service dropo quires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.S gilding Pen-nit Revised 2014 - i Building Department 1 The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit ! Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4- Building Permit Application .46 Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses ik Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 � NORTIy Town o � L ndover IP � a - a � � z _ y hA ver, Mass, (A4 T O LAN! COC NIC Nl WKM X1.95 RATED L) BOARD OF HEALTH Food/Kitchen PERMIT T Septic System ;A*A ri •�hti•.a THIS CERTIFIES THAT lk.%.14. BUILDING INSPECTOR . ... ..... ..... . ..' t has permission to erect .......................... buildings onU ...... .... .................... Foundation Rough to be occupied as ......(71?* .... ... ..��. ..�. . ... Chimney provided that the person accepting this permit shall in every respect conform to the terms,f 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. 5uAr0da& PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough Service .......... ....... ................... ................................ Final BUILDING INSPECTOR . GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. R.S. HEBER'T Construction & Remodeling Inc. 102 Adams Ave. No. Andover Mass. 01845 (978) 686-0786 Phone / Fax Lic. #:058241 Reg. #:153811 DATE 5/5/16 Job: Trinitarian Congregational Church Elm St. North Andover Ma. 01845 Phone. 978-686-4445 PROJECT :Bathroom & Lounge I. PARTIES This contract (hereinafter referred to as "Agreement") is made and entered into on this 4th day of May. by and between The Trinitarian Congregational Church (hereinafter referred to as "Owner"); and R.S.Hebert Construction & Remodeling Inc., (hereinafter referred to as "Contractor"). In consideration of the mutual promises contained herein, Contractor agrees to perform the following work, subject to the terms and conditions below: II. GENERAL SCOPE OF WORK DESCRIPTION 1. Remove hardwood floor from bathroom. 2. Install 3/4" plywood to floor area where hardwood was removed. 3. Install VCT floor tile. 4. Install new door unit to bathroom stall area. 5. Install new 2' x 2' suspended ceiling in lounge area 17' x 17' 6. Install 4 new sets of door hardware. 7. Box steam pipe riser in lounge area. 8. Install 1/4" birch plywood over the cork on wall in lounge. Contractor Owner Owner A. LUMP SUM PRICE FOR ALL WORK ABOVE* $ 6200.00 Sixty two hundred dollars. III. GENERAL CONDITIONS FOR THE AGREEMENT ABOVE 2. STANDARD EXCLUSIONS: Unless specifically included in the '"General Scope of Work" section above, this Agreement does not include labor or materials for the following work: Plans, engineering fees, Testing, removal and disposal of any materials containing asbestos (or any other hazardous material as defined by the EPA). Custom milling of any wood for use in project. Moving Owner's property around the site. Labor or materials required to repair or replace any Owner-supplied materials. Final construction cleaning (Contractor will leave site in "broom swept" condition).,correction of existing out-of-plumb or out-of- level conditions in existing structure. Correction of concealed substandard framing. which may be discovered in the removal of walls or the cutting of openings in walls. Removal and replacement of existing rot or insect infestation. Failure of surrounding part of existing structure, despite Contractor's good faith efforts to minimize damage, such as plaster or drywall cracking and popped nails in adjacent rooms or blockage of pipes or plumbing fixtures caused by loosened rust within pipes. Exact matching of existing finishes. Cost of /testing/remediating mold/fungus/mildew and organic pathogens unless caused by the sole and active negligence of Contractor as a direct result of a construction defect that caused sudden and significant water infiltration into a part of the structure. B. DATE OF WORK COMMENCEMENT AND SUBSTANTIAL COMPLETION Commence work: on or about 5/5/16. Construction time through substantial completion: Approximately 5 days, not including delays and adjustments for delays caused by: holidays; inclement weather; accidents; shortage of materials additional time required for Change Order and additional work; delays caused by Owner, Owner's design professionals, agents, and separate contractors; and other delays unavoidable or beyond the control of the Contractor. C. CHARGES FOR ADDITIONAL WORK: CONCEALED CONDITIONS, DEVIATION FROM SCOPE OF WORK, AND CHANGES IN THE WORK Contractor Owner Owner 1. CONCEALED CONDITIONS: This Agreement is based solely on the observations Contractor was able to make with the project in its condition at the time the work of this Agreement was bid. If additional concealed conditions are discovered once work has commenced or after this Agreement is executed which were not visible at the time this Agreement was bid, Contractor will point out these concealed conditions to Owner, and these concealed conditions will be treated as Additional Work under this Agreement. Contractor and.Owner may execute a Change Order for this Additional Work. Contractor is released, held harmless, and indemnified by Owner from all pre-existing mold, fungus, mildew, and organic pathogen problems and is not responsible for costs or damages associated with correcting, containing, testing, or remediating the same. • D. PAYMENT SCHEDULE AND PAYMENT TERMS 1. PAYMENT SCHEDULE: First payment when work starts. $3000.00 Final payment when work is complete. $3200.00 2. PAYMENT OF CHANGE ORDERS/ADDITIONAL WORK: Payment for Additional Work is due upon completion of either all or part of the Additional Work and submittal of invoice by Contractor. E. WARRANTY Thank you for choosing our company to perform this work for you. Your satisfaction with our work is a high priority for us, however, not all possible complaints are covered by our warranty. Contractor does provides a limited warranty against material defects on all Contractor- and subcontractor-supplied labor and materials used in this project for a period of one year following substantial completion of all work. This warranty covers normal usage only. You must contact the Contractor upon discovering an item in need of warranty service. Additionally, Owner's hiring of others or direct actions by Owner or Owner's separate contractors to repair a warranty item are not covered by this warranty and will not be reimbursed by Contractor. No warranty is provided by Contractor on any materials furnished by the Owner for installation. No warranty is provided on any existing materials that are moved and/or reinstalled by the Contractor Owner Owner Contractor within the dwelling or the property (including any warranty that existing/used materials will not be damaged during the removal and reinstallation process). One year after substantial completion of the project, the Owner's sole remedy (for materials and labor) on all materials that are covered by a manufacturer's warranty is strictly with the manufacturer, not with the Contractor. Repair of the following items and related damages of every kind are specifically excldded from Contractor's warranty: problems caused by lack of Owner maintenance; problems caused by Owner abuse, Owner misuse, vandalism, Owner modification, or alteration; and ordinary wear and tear. Damages resulting from mold, fungus, and other organic pathogens are excluded from this warranty unless caused by the sole and active negligence of contractor as a direct result of a construction defect which caused sudden and significant amounts of water infiltration into a part of the structure. Deviations that arise such as the minor cracking of concrete, stucco, and plaster; minor stress fractures in drywall due to the curing of lumber; warping and deflection of wood; shrinking/cracking of grouts and caulking; fading of paints and finishes exposed to sunlight are all typical (not material) defects in construction, and are strictly excluded from Contractor's warranty. I have read and understood, and I agree to, all the terms and conditions contained in the Agreement above. DATE CONTRA R'S SIGNATURE DATE OWNER'S SIGNATURE CUSTOMER HAS THE RIGHT TO CANCEL CONTRACT THREE DAYS AFTER SIGNING. Contractor Owner Owner The Commonwealth of Massachusetts z' Department ofXndustiria Aceidents •M.. y d 1 Congress Street,Suite 100 - Boston,MA.02114-2017 „ :, z�.. www mass::govldza Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILER WITH THE(PERMITTING AUTHORITY. Applicant Information �^ Please Print Legiibly Name(Business/Organization/fndividual): S d�� �a�. .I 0122�t 1/4C—1Z�ze Address: A�/,7'c City/State/Zip: ft's �57. Phone#: Are you an employer?Check the appxopriato box: Type of project(Tequired): 1. ? I am a employerwith l employees(fall and/or part-time).* 7. WRemode:ew couction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, g any capacity.[No workers'comp.insurance required] 3.❑I am a homeowner doing all work myself[No workers'comp.-insurance required.]i 9. [I Demolition [� 4.F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11..[[Electrical repairs or additions proprietors with no employees. ' 12.[J Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contraotors listed on the attached sheet. ❑ 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and ifs officers have exercised their right of exemption per MGL c. 14.[JOther 152,§1(4),and we have no.employees.LNo workers'comp.insurance required.] *Any applicant that checks box#1 must als6 fill.out the section below showing their workers'compensation policy intormation. 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-con[ractors have employees,they m,ust:provide their workers'comp.policy number. i I am an employer tfiat is piovidiiag workC rs'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: %�S(� ��� �/ Expiration Date: Job Site Address: 7oZ C /Girl tate/Zip: IV Q/Y� 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 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 cert u der tlae pains and penalties ofperjury tlaat the information provided.above's true and correct. signafore: ��ss 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contra t`bf Me, expres's or implied,oral or written.." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or'any two or more of the foregoing engaged in a joint enferprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of anotherwho employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment b6 deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority.". Applicants Please fill-out-the workers' compensation affidavit completely,by checking tha boxes that apply to your situation and,if necessary,supply sub=contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited.Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents foi•confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of In.dustrial Accidents. Should you have any questions regarding the law or if you'are required to obtain a workers' compensation policy,please call the Department-at the number listed below. Self-iir'sured companies should'enter'their' self-insurance license number onthe appropriate line, City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"fob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant,as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 1.00 Boston,MA 021.14-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia RSHEB-1 OP ID:KM CERTIFICATE OF LIABILITY INSURANCE °0510412016"' �--�� o5roM2ols 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 Michauuud,,Rowe And Ruscak Ins. NE: Lawrence R.Michaud,CIC P.O.Box 188 MME Ea 978 688 8829 1N,;978 557 2130 North Andover;MA 01845 �L Lawrence R.Michaud,CIC am,lmichaud@mrrinsurance.com INSU S AFFORDING COVERAGE NAIC# INSURER A:COmmerCe Insurance Company 34754 INSURED R S Hebert Const&Remod,Inc. INSURER a:NorGuard 102 Adams Avenue INsuRER c:AITIGuard N Andover,MA-01845 INSURER D: INSURER E: 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. INSR TYPE OF INSURANCE LTR POLICY NUMBER MfD EXP ULM C COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00( cwMSMAOE ❑ocCUR RSBP619273 00112016 0511112017 DAMACE'TO RENTED--PREMISES(Ea ocarreuce $ 50, X Business Owners MED EXP(Arty one Person) $ PERSONAL&ADV INJURY $ 1,000,00 GLNL AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,00 POLICY❑P�RcaT -Loc PRODUCTS-COMPIOPAGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY C [NED SINGLE LIMIT $ 1,000,000 A ANYAUTo BBCM08 12/19/2015 12M9016 BODILY INJURY(Per person) $ AUTOS OOSWIVED X AUTOS BODILY INJURY(Per aoddent) $ HIRED AUTOS NON-OWNED AUTOS (Per $ $ UMBRELLALL40 JCLAIMS44ADE CCUR EACH OCCURRENCE $ EXCESS LIAR AGGREGATE $ DED I I RETENTIONS $ WORKERS COMPENSATION YEW LIABILITY PER TA FR B AN°CMI VE YIN RSWC759421 01101/2016 01101/2017 ELEACHACCIDENT $ 100,0 OFFICERIMEMBER EXCLUDEIr ❑ N I A IMandatory in NN) E.L.DISEASE-EA EMPLOYE $ 100,00 N desWm under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 600100 PROPERTY 6,00 DATION OF OPERATIONS I LOCATIONS/VEHICLES{ACORD 101,AdMonal Rem wits Sdre W maybe attached IP more apaceis required} CERTIFICATF=HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Trinitarian Congregational THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g� ACCORDANCE WITH THE POLICY PROVISIONS. Church 72 Elm Street AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ©199388-2014 ACORD CORPORATION. All rights reserved. ACORD 25(201M01) The ACORD name and logo are registered marks of ACORD �7- 1 fie �amvi�wmu�ea�/ a�✓�aaaac/iueelld � - Office of Consumer Affairs&Business Regulation HOME IMPROVEMENT CONTRACTOR Registration:.-5A153811 Type: Expiration: ..1/9/2017 Private Corporatio R. EBERT C0:-WREMODELING:INC. ! RONALD HEBERT, .,y E 102 ADAMS AVE. �•� NO ANDOVER,MA 01845_ Undersecretary _. t i Massachusetts Department of Public Safety Bo and of Building Regulations and Standards i License: CS-058241 Construction Supervisor RONALD S HEBERT 102 ADAMS AVE N ANDOVER MA 01845 r ^^^ Expiration: Commissioner 01/08/2018