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HomeMy WebLinkAboutBuilding Permit #325-2017 - 10 DEER MEADOW ROAD 9/26/2014 NORTH BUILDING PERMIT °`�t�E� �b,"4'A4 o TOWN OF NORTH ANDOVER � APPLICATION FOR PLAN EXAMINATION * 'z Permit No#:J1�-S_ -,90/? Date Received -d-O - i ArEU ""c5 GJ gSSACHus�� Date Issued:=!�/�� r✓ TA,NT: A licant must com lete all items on this page MPOR pp p LOCATION > 100 to Print PROPERTY PROPERTY OWNER �n 1�3p FL I ih6 / Print 100 Year Structure yes no MAP / Q PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSFD USE Resioeffial Non- Residential ❑ New Building One family ❑Additio ❑Two or more family ❑ Industrial ❑A I ation No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Septic El Well Floodplain ❑Wetland s Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identif tion- Please Type or Print Clearly OWNER: Name: Phone: Address: C� f Contractor Name:_ Phone: Email: Address: Supervisor's Construction License:_fyi ;:�p Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERM/T.'$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ ^7'T- Check No.: � � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces o the uaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Sw ening Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature - j COMMENTS Zon'ng Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREIDEPARfT:MENT - Temp;Du_mpster on site yes.- E ".no,, Located af.124 Maintstreet Fire, Depar yi.e tsignature/date COMMENTS r ' Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires 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) LI Notified for pickup Call Email i Date Time Contact Name Doc.Building Permit Revised 2014 ■ Building Department FRoofing, ist of the required forms to be filled out for the appropriate permit to be obtained. ng, 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 Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract �. Floor/Cross Se ction/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 Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (1f Applicable) Copy of Contract 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit from the of peals In all cases if a variance or special permit was required et this recorded at he Registry of Deedsfice must stamp the clOne copy and proof of recording that the appeal period is over. The applicant must theng must be submitted with the building application Doc:Building Permit Revised 2014 0 NORTIy '9 Town of s _ IF. e ndover .yam. No. 5 � 1 - ° h ver, Mass, 'Qp COCHKI wKM �,9 °R�rEo ►'Pa,� 5 S � U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .................................. BUILDING INSPECTOR .......................................................................................... has permission to erect ..................:....... buildings ...:.... .0.....b.c. & ..O. ... Foundation Rough tobe occupied as ...................................1.0......... .. .. ...S..................................... Chimney provided that the person accepting 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 Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR 5 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO START Rough .,••....•......• Service ................... ...� .. .. . BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to 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 Approved by the Building Inspector. Burner Street No. Smoke Det. rI Home Depot Contractor License Numbers: MA Home Improvement Contractor Req. # 126894 Salesperson Name and Registration Number: Richard O Donnell : R-1-073-13-00064 Home Improvement Agreement The Home Depot ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: robert bertolino I F I9421534 First Name Last Name Branch Name Lead # 10 deer meadow rd I NORTH ANDOVER 101845 Customer Address City State Zip (617)794-1727 Home Phone# Work Phone# Cell Phone# richard_odonneil@homedepot.com Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 or Email CustomerCancellationNorth East aa..homedei)ot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN.NOTICE OF YOUR-RIGHT TO CANCEL. Acknowledged by' 6=11-1 X _A=w rte" -» 08/26/2016 t� � Customer'sSitjrature u+f Date Contract Price and Payment Schedule: Payment of the Contract Price is due upon completion unless a different payment schedule is specified in the State Supplement. Includes all applicable discounts, rebates, and , taxes. Contract Price $ 4728.00 Excludes finance charges.* Minimum %deposit$ Due Immediately Remaining balance $ Due upon completion 1 WINDOW SPECIFICATION SHEET - Spec.Sheet#: 9421534 Sheet: 1 Of 2 Customer: robert bertolino Job#: 9421534 Consultant: Richard O Donnell Date: 08/26/2016 New Window Hinge Locations Existing Window Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bowls Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use LL c o o Mull "S"=stationary or '= 6 H N "X"=operating LU Style Wraps '6 d rn n o r t: Room Floor Code (YM) Style Code Series Code C w 3 = r 0) U a _r > _ > _ STD,GlassPack:Standard 1 PORCH 1st DH N DH 1200 w w 30.00 54.00 84 STD,GlassPack:Standard 2 PORCH 1st DH N DH 1200 w w 30.00 54.00 84 STD,GlassPack:Standard 3 PORCH 1st DH N DH 1200 W W 30.00 54.00 84 STD,GlassPack:Standard 4 PORCH 1st DH N DH 1200 W W 30.00 54.00 84 STD,GlassPack:Standard 5 PORCH 1st DH N DH 1200 W w 30.00 54.00 84 STD,GlassPack:Standard 6 PORCH 1st DH N DH 1200 W W 30.00 54.00 84 STD, GlassPack:Standard 7 PORCH 1st OH N DH 1200 W W 30.00 54.00 84 STD,GlassPaCk:Standard 8 PORCH 1st DH N DH 1200 W W 30.00 54.00 84 SPECIAL CONSIDERATIONS: rap Color nterior Casing Type Bay or Bow window: eatboard material(vinyl only-Birch or Oak) ay Project Angle(30 or 45) ay Flanker Type(DH,SH,or Csmnt) op of window to soffit(inches) I tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the onslruct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: eatboard Material(vinyl only-White Pionite,Birch or Oak) Nall Thickness(inches) Customer Signature additional Shelf(Yes or No) There is no guarantee that new shingles will match existing color. WINDOW SPECIFICATION SHEET - Spec.Sheet#: 9421534 Sheet: 2 of 2 r c Customer: robert bertolino Job#: 9421534 Consultant: Richard O Donnell Date: 08/26/2016 New Window Hinge Locations Existing Window Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bowls Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use o m Mull "S'=stationary or `o_ t s m H N "X"=operating w Style Wraps S? x 0 �- Room Floor Code (YM) Style Code Series Code w x 5 ui v a > _ > _ STD, GlassPack:Standard 9 PORCH 1st DH N DH 1200 w w 30.00 54.00 84 STD,TMP:Full, 1 LIV 1st PW N PW 1200 W W 65.00 60.00 125 F,GBG WHT,W C ALL 5 4 ALL 5 4 GlassPack:Standard 0 HT SPECIAL CONSIDERATIONS: rap Color nterior Casing Type Bay or Bow window: eatboard material(vinyl only-Birch or Oak) ay Project Angle(30 or 45) ay Flanker Type(DH,SH,or Csmnt) Top of window to soffit(inches) If tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the onstruct Roof(Yes or No)' Special Terms and Conditions on the following page Garden Window: eatboard Material(vinyl only-White Pionite,Birch or Oak) Nall Thickness(inches) Customer Signature dditional Shelf(Yes or No) 'There is no guarantee that new shingles will match existing color. . �� .....v v..« ...e..Var/yvwxwxso ✓� 1eAYLV:JWvnesnu.is.... Deparlinent`of Industrial Acc;dents C Office of Investigations ` 600 Washington Street Boston,MA 02111 a. fvww.rnass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizadon/Indivfdual): Address. • �` ; s City/State/Zip: �ke hone#: Are you an employer?Check the appropriate b Type of project(required): 1.❑ I am a employer with 4. Q I am a general contractor and I 6. ❑New-construction employees (full and/or part time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet.# �• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers' comp.insurance. g• Q Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.E]Electrical repairs or additions 3.F-1I am a homeowner doing all work right of exemption per MGL 11.Q Plumbing repairs or additions myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑ repairs insurance required.] t employees. [No workers' 13. Other comp.insurance required.] 1ny applicant that checks box d1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing•all work and then hire outside contractors must submit a new affidavit indicating such. •. :ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site formation. —, surance Company Name: ; j1 ,licy#or Self-ins.Lic.#: � r'.��( ,�Q �7'�_ Expiration Date: b Site Address:_ City/State/Zip: :tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). ilure to secure coverage as required under Section 25A of MGL c. 152 can Iead to the imposition of criminal penalties of a .e 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of iestigations of the DIA for insurance coverage verification. o Izereby ce i qnd4rth pains and penalties of perfury that the information provided above is true and correct. irature: Date: ane#: Official use only. Do not write in this area, to be completed by city or town officiaL City or Towri: Permit/License# issuing Authority(circle one): t.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector S.Plumbing Inspector i.Other -ontact Person: Phone#: A CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 02!242016 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(ies)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 CONTACT MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHONE CN o Ext• aC No: 3560 LENOX ROAD,SUITE 2400 ADDRESS: E-IES : ATLANTA,GA 30326 INSURERS AFFORDING COVERAGE NAIC 100492-HomeD-GAW-16-17 INSURER A:Steadfast Insurance Company 26387 INSURED THEa:Zurich American Insurance Co 16535 THE HOME DEPOT,INC. HOME DEPOT U.S.A.,INC. INSURER C:New Hampshire Ins CD 23841 2455 PACES FERRY ROAD,NW BUILDING C-20 INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F' COVERAGES CERTIFICATE NUMBER: ATL-003741310-08 REVISION NUMBER.0 THIS 1S 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 MAYWAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDLSUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER MMIDD MMIDDIYI'YY LIMITS A X COMMERCIAL GENERAL LIABILITY GL04887714-06 03101/2016 03/01/2017 EACH OCCURRENCE S 9,000,000 CLAIMS-MADE M OCCUR DAMAGE TO RENTED PREMISES Ea occurrence S 1,000,000 LIMITS OF POLICY XS MED EXP(Anyone person) $ EXCLUDED OF SIR:SIM PER OCC PERSONAL&ADV INJURY S 9.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 9,000,000 X POLICY a JEa �LOC PRODUCTS-COMP/OPAGG S 9,000,000 OTHER: S B AUTOMOBILE LIABILITY BAP 293886313 03/01/2016 03/01/2017 COEa aMBINED SINGLE LIMITccident S 1,010,000 X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY Peracc dent S AUTOS AUTOS t ) HIRED AUTOS NON-OWNED AUTOS PROPERTY DAMAGE S Per accident 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE 5 r—IDED I I RETENTIONS S C WORKERS COMPENSATION WC015519215(AOS) 03/01/2016 03/01/2017 X STATUTEETH C AND EMPLOYERS'LIABILITY YIN ANY PROPRIETORIPARTNERIEXECUTIVE ❑N WC015519217(AK,KY,NH,NJ,VT) 03/01/2016 03/01/2017 E.L.EACH ACCIDENT S 1,000,000 D OFFICERIMEMBER EXCLUDED? N NIA (Mandatory In NH) WC015519216(FL) 03/01/2016 03/01/2017 E.L.DISEASE-EA EMPLOYEE,S 1.000,000 If yes,describe under Continued on Addition2l Page DESCRIPTION OF OPERATIONS below 9 E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16000SGOODST. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER,MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee —JVLoLvufl 1�-L � .ec t erc ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD -,7,� 7 d Business Regulation Office of consumer Affairs an D-170 Suite 10 Park Plaza vi &.1 -usetts, 02116 LNA?�$sach Boston, venj6Xontractor Reestration Home Impro Reostration: 126893ment Card Type: Supple Expiration, 802018 THD AT HOME SERVICES, INC. Rj'GHARD FALLONE 2455 PACES-FERRY*ROAD, HSC ATLANTA, GA 30339 ?address and return card,mark reason for iange. Update Addr Lost Card Renews, — F Address ruptoyment tion valid for individual use only License or registra before the expiration date. ,found return to Consumer Affairs Business Re0adon s Regulation ffice of Affairs and,,uine, Office of Consumer jj0MF NT CONTRACTOR 5170 IMPROVSM.9 5 7 Type' " 10 park P Regis vM_ 6f Card. Supp(erne TI.q)AT HOME SER MW-2W -VICES 00 V -W _ THE HOME DEPO .�d RICHARD FALLONE,-%-7 2455 PAGES FERRY of valid wit t si GA 30339 i BENJAMIN PARKER JFL 43 GRNUH ROAD Plaistow NI-1 03845 02/1112018