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HomeMy WebLinkAboutBuilding Permit #408 - 1 ELM STREET 11/24/2009 -7� / v �n V& 0--,�fl TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Pnn PROPERTY OWNER ��� � / Print MAP NO: `7 PARCEL:_ ZONING DISTRICT: Historic District ,Ope Machine Shop Village yes j no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One famil Addition Two or more family Industrial Alt 'on No. of units: Commercial lacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTIONOF WO O BE RFORME : Identi ation PI se T e r Print Clearly) OWNER: e)wa c a it Phone: 5� }l _ Address: CONTRACTOR Name: r—dP ne: � r , Address: _ c9cl 0 1 Supervisor's Construction License: - Exp. Date:_- Home Improvement License: Exp. Date: 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: $ �J �� FEE: $ Lai Check No.: �--v 4 I ' --2 ---:t�) &Sg�'—Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access th u anty fund Signature of Agent/Owner �pg 6rGL _Signature of contracto 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 - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zgnjng Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Plai,ning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Location No. _ fi Date �7 NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ ♦ i �'�s�cMusEt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r �C Building Inspector 11-20-2009 14:58 FROM-THC AT HOME SERVICES +508 756 8823 T-197 P.0O1/001 F-140 M-issachu,ettr - Delmmment of Public S.tfctN Board of Building ReIrulations and St�tndards E Construction Supervisor License License: CS 29328 Restricted to: 00 RICHARD L KEYES f! 10 LAWRENCE RD i SALEM, NH 03079 :n•aa,.: �:C•,:na�r urnsv,:: 1 i _ — - '—`- Expiration: 9/11/2011 i ('nmmissionerTri: — 2273 V T40RTH To" of 19Andover No. C) dover, Mass., 2z COC LAKE HICHE w ICK C. 00ATED Pa\ BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System _r BUILDING INSPECTOR THIS CERTIFIES THAT..... ................................... ............................................... Foundation haspermission to erect........................................ buildings on ..... ................................................... Rough Chimney ..... to be occupied as........ ........... ...... Final provided that the person accep ing this permit shall in eve 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 Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU S TS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. a%60 , Town of North Andover - : Machine Shop Village Neighborhood Conservation District Commission 1600 Osgood Street North Andover,MA 01845 Application For EXCLUSION From Certificate to Alter Pot Items 9,10 or 11,provide the following documentation: Photos/drawings of existing doors,windows or siding,as applicable .__.,,Description/Catalog Cuts of proposed materials to be used for doors,windows or siding Plan and elevation of reconstruction for Item II Deaeamination: This project is determined to be A et exempt ,from review by the Machine Shop Village Neighborhood Conservation District Commission. Projects that are not exempt must complete the Application for Certificate to Alter, available from the Building Department and be reviewed by the Commission. Dote made by. , 144-, S1,94aturec, Neighborhood Conservation District Commission . b 'li U � 2-3 0 /y Date MSV NCDC Page 2 �I�t- Sen �" ��ztt� r►r�c��Y�?��'oQ- .. Town of North Andover Machnie Shop Village Neighborhood Conservation Dishict Commission 1600 Osgood Street Notch Andover,KA,01845 =ACHU Application For EXCLUSION From Certificate to ,Anter Certain alterations are excluded from review by the Machine Shop Village Neighborhood Conservation District Commission in accordancewith the Bylaw. Applicants for exempt projects must,ill out the form belmv and submit to the Building Department. Date Contact Name&Address: �^ r r 1 r Project Address: 61 Project Description(attach additional pages,' needed): Exclusion From Review Requested For: ❑ 1.Interior Alterations existing conditions including materials, design and dimensions. E3 2.Storm windows and doors,screen Z9. windows and doors. Replacement of existing substitute doors,substitute siding or substitute ❑ 3.Removal,replacement or installation of windows with new materials that are gutters and downspouts. substantially similar to the existing condition. ❑ 4.Removal,replacement or installation of window and door shutters. ❑ 10.Replacement of original fabric windows or doors with substitute ❑ 5.Accessory buildings of less than 100 windows or doors that maintain the square feet of floor area architectural integrity with respect to form,fit and function of the original ❑ 6.Removal of substitute siding. windows or doors. ❑ 7.Alterations not visible from a public ❑ 11.Reconstruction,substantially similar in was. exterior design,of a burldin&damaged or destroyed by fire,storm or other disaster, C] 8.Ordinary maintenance and repair of provided such reconstruction is begun architectural features that match the within one year thereafter. MSV NCDC Page 1 NOV-01-2009 10:41 HOME DEPOT 3480 P.001 HOME IMPROVEMENT CONTRACT PLEASE READ THIS i • Sold,Furnished and•IntiKxlled'by: Branch Name: 'Boston.' Date: d r�� !: .TI4D At•Home.Sotviom Inc. d/b/a Thel Home Depot At-Home Services 345A Greenwood Street il)nit 2,Worcester,MA 01607 Branch,Number:31 Voll Free(800):657-5182; Fax.(508)756-8823 _ Federal ID#75-2698460;MELic#C 02439;RI Cont,I,io#16427 {+ CT Lic#'565522;MA Home fml FOvement Contractor Rag�93 Installation Address: 'i -- /t1-Am& — I� —Q�L /�' City State 2rp G Parc6aser(s): Worn Phone: Home Pho le: Cell Phone:: Vr LOIfome Address: I. (Ii di creat from Installation Addru s):. City : State Zip -E-mail Addrtm(to receive-project communications and Home Depot updates): 0TDOZWT wish-to receive airy madtetiog emails from The Home Depot 1 - PrMtet'Inform on'::Undersigned.("Customer"),the owners of the property located at the ubovc�'Lkstzllatiorf address,agrees to buy, and 1111)At-IIome Scrviccs,Inc.(`Fite Home Depot")agrees to furnish,deliver snd ammge for°'the installation("Installation")of all.-materials,descn'bed on-the below and on the refameed!Spec,Sheet(s),all of which are�co�t�oorraated into.-this-Contract by,this reference,along with any.applicable State Supplement and Payment Summary attached hereto,ane),any Change Orders(ooTle vcly. "Contract"): I Job#:'t sd..o Project AOnomit •Roofing OSiding Cff windows LJ Insulation �. ©GirttersY Covers ❑6ntry Doorts Q $ 3. j Roofing LJSong Windows insulation 54u,ttcrs 1 Covers pantry Doors• IEIRooQ,.. Siding U Windo".0 Insulation a• 0(3n{tcrs'l Covcrs QEatry Doors❑ ( $ RooSmg MSxliog 0 Windows 0 insulation $ n pGuttcm/Covc% C]rrtryDoors Q Mi�ma�?5°/.Deponit of CoatracCAmoant due upw caw�vti0n.atthi6 torrtrAeti,. Maine Purelne tss may not deposit more than owAlyd orthe ContractAmount ?oral Contract Amount $ �J 1 +� j • Customor.ttgtaes'thatr immediately.aeon completion*of the'work for each Prcxiuct Customer'wil �execirtt a Cat fetion Certificate (one(•or4ch'Product;A'-defined.by an indM.dual.Spcc Select)and.pay.any,balance Aue. As applicable,ekh Ctistomer urn ir'this Contract.agives to be,Ioirnli and severally obligated,and liable hereunder: The Home,Oepot reserves the tigbt to'isstre a'Chanl,,,c Order or terminate this Contract or any individual Product(s)included herein,:at its discretion,if The Home Depot or its authorized service provider determines that it cannot perfor m.its obligations due to a•structural problem,with the.home,environmcn%l.ha7rds such as mold,asbestos or lead paint,other safety.�,oneerns,pricing errors or because work required to ca npictc the job ww. not inpluded in the Contract •. ; I pal"",Summary:-The P'ayrnent Summary#, included•as part of!this Contract,•sets forth'the-total Contract tonount and payments required•foribe deposits'and final paymcnts•byProdticrt(a4 applicable). NOTICE TO CUSTOMER • You are-entitled to'a conplctcly filled-int copy'of the Gontraef at the'time you sign:'Do not sigh`a Com 4b there is orae Completion Certificate for each listed ProductasAcfined by4ndividual Spec•Sheets)before work oOr:that'Pr Educt is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,tabor,expenses and services provided by The Rome Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOTMAY WITHH.Oi,D AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR(OTHER PAYMENTS MADE; WITHOUT LIKITING TIM HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Mee and�%norization: Customer agrees and understands that this Agreement is the entire agreement between Customer Tice Home Depot with regard to the Products and Installation services and supersedes all priordiscussions and agreements,either oral or vgitten,relating to said Products and Tnstallation.This Agreement cannot be assigned or amended except by a writing signed J(�& and The Home Depot Customer aclmowledges and agrees that'Customer has read,understands,voluntarily accepts the as rived a copy of this Agreement. SU gnature DateSales nsultant'sSiignature I Date Telephone No. Customer's Signature Date Salty Consultant License No. CANCELLATiON: CUSTOMER MAY CANCEL THIS <'S aPpliuvbl°> AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE ROME DEPOT BY MIDNIGHT ON THE THiRD BUSYNESS DAY 'AF'T'ER SIGNING THUS AGREEMENT. THE STATE SUPPLEMENT ATTACHED YIERFTO CONTAINS A FORM TO USE 1F ONE 1S SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. Ntyt'ICE.•ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 7.ilC Mt.r:4r Whft* blanch File- YRtrrvv—•tlrsttirrx Piuk�S�4+dt.Crin�tdfr+M A;J'?'J1 Dr," 02 C 9; �TIFE O Ll/.'. 811 LIT 9 INSU�' ANCE ' 02/-LO/03 E2G/09IYYYY). eocuce� 1 I04-39�-3000 THIS CE TIF;C;:TE IS 13-UEEC ?/liT'Tc.R G:= IMFORtl A.T!C11 ,.t- s!7, USA, ll:'.. I CNL.i A14D v�/l:,l`i-'F, ;\.�.; i`�.1:3f':I i G Oiki Il"i:: CER'IlF�r�H.;'c `TE HOLDER. i,IS CcRTiFICATE DOES NOT AMEND, EXTEND cr;D GR ._.._ :ns=. :;_1a_:;a. om ---L_T is CC .'a'=- - -RDC il-1=r - _ --=-li`:l. -'_ � _ 303-T, t E_I A.. "r I. (Suiitit e 3 U 0 CD.mb,.cl�il Pd:7'.. ny NSI;=iCi2 .! 1'.j, IFk4yoCT .VIRE: Ii4sS C:C) Oe VITT19'!•!i --------,--101,-------'------------_—.----'- ' (Atlanta , GA 30339 INSUF(ERO:New Iiampshire Ins Co 23841 L, INSURERE:Illinois Natl Ins Co 23817 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR.C.ONOITION.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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AOD'L POLICYEFFECTIVE POLICY EXPIRATION LTR N R POUCYNUMBER DATE MM/DD DATE MMIDO/YY LIMITS A GENERAL LIABI LITY IPR 3757 608-02 .03/01/09 03/01/10 EACH OCCURRENCE 8410001000 LIMITS OF POLICY ARE EXC SS DAMAGE ORD 1,000,000 CONMERCIALGENERAL LIABILITY PREMISES Eaoccccurence $ X "OF SIR: $1,000,000 PER CC" MEOEXPAn one person) $EXCLUDED CLAIMS MADE �OCCUR (Any P ) PERSONAL&AOV INJURY $4,000,000 GENERAL AGGREGATE 54,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OPAGG $4,000,000 X POLICY PECT r LOC BBAP 2938863-06 03/01/09 03/01/10 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000 X ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY (Perperson) $ SCHEDULED AUTOS HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS - (Peraccident) 5 X SELF INSURED AUTO - PROPERTYOAMAGE PHYSICAL DAMAGE (Peraccident) ; GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANYAUTO OTHER.THAN . EAACC $ AUTOONLY: AGG S A EXCESS/UMBr.,.LLALIA81LITY IPR 3757 608-02 03/01/09 03/01/10 EACHOCCURRENCE S 5,000,000 X OCCUR 0CLAIMS MADE AGGREGATE 55,000,000 5 DEDUCTIBLE 5 RETENTION S $ C WORKERS COMPENSATIONANO 3566916 (CA) 03/01/09 03/01/10 X WC STATU- DTH- T RY IMttT R 0 EMPLOYERS'LIABILITY 3566915(AOS) 03/01/09 03/01/10 E.L.EACH ACCIDENT 51,000,000 ANYP ROPRIETOR/PARTN ER/EXECUTIVF. E OFF ICER/MENIBEREXCU0EO? 3566917 (FL) 03/01/09 03/01/10 E.L.DISEASE-EA EMPLOYEE 51,000,000 1(yes,describe under SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT �S1,000,000 PECIgPRO OTHER D Workers Compensation 3566918 (KY, MO, NY, WI, ) 03/01/09 03/01/10 F TX Employers Excess TNSC45694422 (TX) 03/01/09 03/01/10 ccurrence/SIR 25M/2M C Workers Compensation 4801323(QSI) 03/01/09 03/01/10 DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES!EXCLUSIONS AOOED BY ENDORSEMENT/SPECIAL PROVISIONS RE: EVIDENCE-OF INSURANCE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THD AT-HOME SERVICES, INC. DATE THEREOF.THE ISSUING INSURER WILL ENOEAVOR TO MAIL30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 2690 CUMBERLAND PARKWAY SUITE 300 REPRESENTATIVES.- ATLANTA, GA 3,033.9 AUTHORIZED REPRESENTATIVE USA (d er opn rr1RPnPATION 1988 1 � LNEpcly "11bA�--Ct10C itl;CiPM-14'0 0'$�-TCO U �aCac Solar Her Gain Coefficient Ftc-lnr.t3 CosRGanm+dadoEr�ryi3 olar !0 . 32 1 . 8 0 29. ADDITIONAL PERFORMANCE RATINGS . ew.r_u,�aoH suv�sr:xrsau oe AENOIRQENN Visible Tran<.mittance Thnanlslan do LL¢VtAk 0 . 52 l 3nr a� m wp:gk tRc aooar,r far 4EW pmd ct iia W nG1r���rtmt)ed h7><ttod ast d�tv6wr�nhf��Ev�rd�apC&���.t�done rot rtorsrrvnet+C}rry Ott ' erd acee rot wmrt ev s)fhall d 4rrf prolcd tr mf VedEo lies CX*A mffLj 1rrT bran be oQrr Rvd,ct pfffu nres - - tdcrcr�rn vw.+crncap . 7. Em,'sbr b cM�A(ILA a=c A ru aanpiv an is poc.m*rW is viaas tRC pn do* tmr d renbW dd pm&ZZ,taa Ab-ft Mme per t,"c>m damnNvdm por vi cmc ft 10 do ca)r¢.tna vtWr is y,Lr*rQm de pro:hj= i aaW-Tcn.hRG no nrmJ-il *V-X)d='f-P✓vTtm 71•A d Xt. .pn T=aapaclaca Curdle CM d _. b&M dd hurtsrb Mn d m gropbz as eche p'oQ;r.'b xN.afit ap - •'. , Unit T'lUfLcs fog nCRCY 3t1R caglon(i) Uoccnacn, NOctR . - Can'_.al_ .9u..En C�nt.aL, fo.a�a.n. SHc t6 r STAA L-1.ueLd-ad oaLlflca pa.a 11(D) . cc?Ldn(.�J m4n1k9T 721!1: Nocta_ - Noctt cantcal, Suc Caatral, 9�c_ IND: Rk.L 00/CLI ca 3/32"/H—Rt3 .' L¢�tcd 91:a: 3G' K 93' ` Q IND: Bafuacro 00/VLd-clo 2.39 xm/K-RJ3 DP ' ���( — • � Ii-aAa pcobado: 91.4 x IG0 CA E�9�eg�j e'. 40713 - H3 Hoff,un _ 2331124. L 1p fha lob.!(or pnn�le f}iLFG(SUR°rebates.To lemn ann h1t rwv.margfttatgot. Lumda Z-m arlqurm para pcnbin nerrboEsns DLt6T SD.r Porn CDWU rtm acro 61 iAo,�11�.a KrL xlupftlt✓tgct �/�ie Lamm��i�c of°,,�Gaaaaclu�de�b F Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR { Registration: 126893 I r Expiation:_:.`8/3/2010 Type`"Supplement Card The Home Depot.A(Home Sernce RICHARD FALLONE 2690 CUMBERLAND PARKWAY S XtD M,GA 30339 Administrator 4. �!?? �01:2Y1Z011 `��'Li.'? Df�32,ciSa�C.11�J2TtS Pi?: r' '.�GISLflt+� iClde;1 J . _...__�:.__.-•----•'-------'---------------' o' l ,,t r 'moi r. ;.; 'i Nasne (Business/Organization/Individual):_; Wa ------------- ____��=+ --- nn Address: p -- -- Cit /State/Zi : Phone.#: �_t2-2 � Y � 1 Are yo an employer? Check the appropriate box: r6j] project(required):. 1• am a employer with 4' ❑ T am a general contractor and I w construction employees(full and/or part-tune).* have hired the sub-contractors7. emodeling listed on the attached sheet. . 2.❑ I am a sole proprietor or partner- These sub-contractors have g. [] Demolition ship and have no employees - employees and have workers' 9 �Building addition working for me in any capacity. . comp.insurance.t [No.workers' comp.insurance 10..[1 Electrical repairs or additions required.] 5- ❑ We area corporation and its officers have exercised their - 11,0 Plumbing repairs or-additions 3.❑ I am a homeowner doing all work p of exemptionri ht er MGL myself CNo workers' comp. g12.E] Roof repairs _ c. 152, §1(4), and we have no 13 �er Lf�S insurance required.]t 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. i Homeowners who submit this afdavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. fi tContractors thatchcck this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. Lf the subcontractors have employees,they must provide their workers'comp.pohdy number. I am an employer th`e is providing workers'compensation insurance for my employees. Below is the policy and job-site information. �� Insurance CompanyName: U Expiration Date: Policy#or Self-ins.Lie-#: 1 Job Site Address: I , Ci /State/Zip: pensation policy declaration page (sh.owing the policy number and expiration date). Attach a copy of the workers' com Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penaltiesof a fine tip to $:1,5.0.0.00 and/or one-year imprisonment;a QP - ' ofup to 5250.00 a day against the violator. Be advised that a copy'of this statement may be fbiwarded to the Office of InVesti ations of the DIA for insurance coverage verification. I do hereby cerci un r e p s an penalties of perjury that the information provided above is true and correct. Si afore: Date: — Phone#: Off,-ia1 use only.`Do not write in this area, to be completed by city or town offtciaL City or Town: Permit/License# Issuing Authority (circle one): 1.Board of Health 2.Building Department 3. City(Town Clerk 4. Electrical Inspector S.Plumbing Inspector 6. Other