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Home My WebLink AboutBuilding Permit #19 - 10 UNION STREET 7/9/2007 BUILDING PERMIT of "o or ,A TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION b Permit NO: Date Received - 9SSwCHU`�Et Date Issued: • C- 0,1- -IMPORTANT: Applicant must complete all items on this page LOCATION ��►�� S� # A \f v PROPERTY OWNER Y x (JAA bb, Print -10 A Print MAP NO: : PARCECD ZONING DISTRICT: HISTORIC DISTRICT yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition Nr"Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg El Others: ❑ Demolition ❑ Other Public 0. $ewer r' .0 Water 'OF. l000lam ` C3 Vlletlands` ❑ WatershedDistrict DESCRIPTION OF WORK TO BE PREFORMED: entit c tion Ple se Type or Print Clearly) OWNER: Name: Phone: Address: .CONTRACTOR Name: Phone 97e- r Addresst-t -i`�t��c� v 1�.poi cr� er Supervisor's Construction License: Exp Date'` . y. Home Improvement License. l'a rrP �r 2 Exp: Date: �3:O� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ , , 22us FEE: $ �O Check No.:—w�41v Receipt No.: Po 3 NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contractor C'a,*L,��--� Plans Submitted ❑ Plans Waived ❑_ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF-U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS PE OF SEWERAGE DISPOSAL Pd�)lic Sewer, ❑ Tanning/Massage/Body Art ❑ Swimming Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ Zoning 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 Located at 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 I 0 Notified for pickup - Date i Building Department 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 a 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 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/Crossection/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 New Construction (Single and Two Family) ❑ Building Permit Application Li Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location��d No. Date v NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ s',^••t<� Building/Frame Permit Fee $ '3 0 Mus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # I 206c/ J, Building Inspector ,tAORTH Town of over And 0 No. �VW 4 0 dover, Mass., • LAK COCHICHEWIC 0"?ATE D BOARD OF HEALTH Food/Kitchen Septic System PERMIT . T D BUILDING INSPECTOR THIS CERTIFIES THAT................ ..../........... ......... ........................................... .............................. Foundation has permission to erect........................................ buildings on ./40.......(M.0!Q.4...........1.7.0.077...................... Rough to be occupied as..a-.:!!..........(.....4... ...... ....................(0irdpio- ...rFA.................................................. .. Chimney this that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 30- PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ARTS Rough BUILDING INSPECTOR . ......................... Service 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. ROME IMPROVEMENT CONTRACT Branch 7 Name Sold,Furnished and Installed by:Date: �� THD At-Home Services,Inc. p�� d/b/a The Home Depot At-Home Services Branch Number: 3 nob#; 3 3! p 345A Greenwood Street,Worcester,MA 01607 Toll Free(800)657-5182; Fax:508-756-2859 Federal ID#75-2699460 ME Lic#C 02439 RI Cont Lic#16427 y� CT Lic#565522; MA Home lmprovement Contractor Reg.#126993 Installation Address: X Uh O n tS l t,{K t 4 �� m - Q g City State Zip Purchaser(s): Last 4 Digits of Driver's Lic.#&Elp.Mo/Yr. Work Phone: Home Phone: 4[ M Home Address: rfrYb (If different from Installation Address) City Srate Zip E-mail Address(to receive updates and promotions from The Home Depot): Project Information: I/We/You("Purchaser'o,the owners of the property located at die above installation address,offer to contract with THD At-Home Services,Inc. `Home Dmish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet# ,incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection of the job,home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS O CONTRACT AMOUN f (Subject to fund verification and/or credit approval.) S� 1. Check*,Cashiers Check or US Postal Service Money Order (LESS DEPOSIT S (Made payable m The Home Depot). J 2. Credit Card•'andlor other payment options-Circle One Below BALANCE DUE e� 1a o6 Visa MasterCard Discover American Express ON comPLETIorrOA The Home Depot Home Improvement Loan a home Depot Coedit Ca f Minimum 25%of Contract Amount dae upon 0 New Account i47,ztsnng Accooat (HIL&HOCC ONLY) execution of this contract. �vp0able Credo$0-7 'tSCC ONLY) Indicate Payment Methd For ' 20 "T BALANCE DUE ON COMPLETION: 'Date. Name as it appears on card: t C C "By my/our signature below,]/We agree to allow Home Depot to charge the a referenced credit card for the deposit indicated. *When you provide a check as payment,you authorize us either %� to use infomurtion fmm your check to make a one-time electronic CardhWees Siguatwe Rind tranafer from your account or to process the payment as a clack transaction.When we use information fmm your check to make an electronic farad transfer,funds may be withdrawn from HIL or ADCC Authorization Codes your account as soon as the payment is received,and you will not Deposit reocive your check back # Final Pa meat # Sc a Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire— A—yreemert:This agreement and its attachments,including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a t is co completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is prior Lawto prohibits home repair contractors from requesting or accepting a Caletion Certificate signed ec the owner the actual completion of the work to be performed under the con Completion You may cancel this transaction any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 10%of the contract amount if job is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered. be a service charge equal to 25%of the contra There will contract amount if Job is ca b Purchaser AFTER TER materials are order BY MY/OUR SIGNATURE BELOW,VWE UNDERSTAND T14AT THE AGREEMENT MAY B OF MYIOUR CREDIT HIST E SUBJECT TO REV HISTORY AND I/WE AUTHORIZE ��' CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING A GENCYOANDRRELEAIFY SE REVIEW THEM FROM/ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. 13Y MY/OUR SIGNATURE BELOW,I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. /WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. SUBMITTED BY: Date: 7 e� ACCEPTED BY: pe, a 1 Putehasea Date: D D p Purchaser Date: NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 6-1-07 rev 4-2-07 C.SC White-Branch File Yelbw-Custorner Ptak-Sales Consultant tr0 d £L69-469-eW ut!WS 61eI0 Wb 9s:9 Looz`£0 Ainf Aepsenl ` 4 . A AT HOME Installed :SERVICES Siding and Windows It�r _ lid 1,1111 arrt 1 - AA. Proudly sold,furnished and installed by RMA Home Services,Inc.,a Home Depot authorized contractor. 345 Greenwood St. Unit 2•Worcester, MA 01607•508-756-6686•Fax 508-756-2859•Toll Free 800-657-5182 BER MARSH CERTIFICATE OF INSURANCE ATL-001234CERTIFICATE 410-01 ATL-001234410-01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE homedepot.certrequest@marsh.com POLICY.THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE FAX(212)948-0902 AFFORDED BY THE POLICIES DESCRIBED HEREIN. 3475 PIEDMONT ROAD,SUITE 1200 COMPANIES AFFORDING COVERAGE ATLANTA,GA 30305 COMPANY 100492-THD-IPUSA-07-08 IPUSA A STEADFAST INSURANCE COMPANY INSURED COMPANY HOME DEPOT USA,INC. B ZURICH AMERICAN INSURANCE COMPANY 2455 PACES FERRY ROAD NW COMPANY BUILDING C-8 ATLANTA,GA 30339 C AMERICAN HOME ASSURANCE COMPANY COMPANY D NEW HAMPSHIRE INS COMPANY COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. 2 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR TYPE OF INSURANCE POLICY NUMBER DATE(MWDDIYY) DATE(MM/DDIYY) A GENERAL LIABILITY IPR 3757 608-02 03/01/07 03/01/08 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMPIOP AGG $ 4,000,000 CLAIMS MADE �OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL 8 ADV INJURY $ 4,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 1,000,000 MED EXP(Any oneperson) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-04 03/01/07 03/01/08 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULEDAUTOS – — HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS X SELF-INSURED AUTO PROPERTY DAMAGE $ HYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENI I $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ A EXCESS LIABILITY IPR 3757 608-02 03/01/07 03/01/08 EACH OCCURRENCE $ 5,000,000 X UMBRELLA FORM AGGREGATE $ 5,000,000 OTHER THAN UMBRELLA FORM H. $ C WORKERS COMPENSATION AND 2921209(CA) WC STATU- O R EMPLOYERS'LIABILITY O3/01/07 03/01/08 X I TORY LIMITS ER E 2921210(FL) 03/01/07 03/01/08 EL EACH ACCIDENT $ 1,000.000 F THE PROPRIETOR/ X INCL 2921211 (AZ,ID,MD,VA) 03/01/07 03/01/08 ELDISEASE-POLICYLIMII $ 1,000,000 PARTNERSIEXECUTIVE 2921208 AOS 03/01/07 03/01/08 1,000,000 D OFFICERS ARE; EXCL ) EL DISEASE-EACH EMPLOYEE $ C OTHER 2921213(OSI) 03/01/07 03/01/08 E WORKERS'COMPENSATION 2921212(KY,MO,NY,WI)" 03/01/07 03/01/08 G TEXAS EMPLOYERS TNS-C44642086(TX) 03/01/07 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LIABILITY I I ISIR 2,000,000 DESCRIPTION OF OPERATIONSILOCATIONSIVEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THFREOF THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL Ia DAYS WRITTEN NOTICE TO THE FOR EVIDENCE ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: Mary Radaszewski 'i '+'1 (`AFI Lft,Jrl L-a c-oF. MM1(3102) VALID AS OF: 02/28/07 tre t,ommonwealth oj'!llassachusetts ' Department oflndustrial Accidents Office oflnvestigations 600 Washington Street Boston, MA 02111. Workers' Compensation Insw"v.mass.gov/dia Tobin of Arlington Applicant Information urance Affidavit: Builders/Contractors/E)ectricians/Plumbers Please Print Legibly Name (Business/OrganizatiorAndividual): Address: -l`D — T,_R.Q(AUD0(>L 5A- City/State/ZiP I A '7r�rc o4C Phone#: —J Are you an employer?Check the appropriate box: ]. I am a employer with 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub-contractors 6. El New construction 2.❑ I am a sole proprietor or partner- Iisted on the attached sheet. 1 2• ❑ Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers' co 8. ❑ Demolition mp. insurance. [No workers'comp. insurance 5. ❑ We are a corporation and its 9. ❑ Building addition 3_❑ required.] officers have exercised their 10•❑ Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL I1.❑ Plumbing repairs or additions myself. [No workers' comp. c.7 52,§1(4),and we have no insurance Tequired.] t. employees. [No workers' 12-El Roof repairs COMP. insurance required.] ]3.❑ Other *Any applicant that checks box ill must also fill out the section below showing their workers'compensation policy information: t}lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mint submit a new affidavit indicating such tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employ information ees. Below is the policy and job site Insurance Company Name: 0 Policy#or Self-ins.Lic. #: C(�t, � Expiration Date: Job Site Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sigpat=7 _ Date: Phone#.- OV"cial use 0111y. Do not write in this area,to be completed by city or town offcciaL City or Town: Permit/License# Issuing Authority(circle one): L Board of Health 2.Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#• Date..(1 G.:.a.`�... .. 40RTH o� TOWN OF NORTH ANDOVER Mwo PERMIT FOR GAS INSTALLATION ACMUSE�Sy This certifies that . . .l . . . . . '/.'9L/� . . . . . . . . . . . . . . . . . . . . . has permission for gas installation . . . .� f. . . . . . . . . . . . . . . . . . in the buildings of . � .. . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . .. North Andover, Mass. Fee. .3.`.'. . . . Lic. No..0.'. . . :. GAS INSPECTOR Check# 4 5 .1 """% fi)r=r urvlt-uHM APPLIC (Print or T ION FOR PERMIT TO DO GASFITTING 2o— �� OOVL2 ate Mass. i2 �y �6 2t) --I— Building Permit # Lavation (l� (,(r..r� Oo� Owner's Name Type of Occupancy__ 15 t 6 f N-71 Rc_ New ❑ Renovation ❑ Replacement ^� Plans Submitted: Yes❑ No Lam" N N W y N Y z ¢ vi N rL N Q W W Q O N = !- J N. W V m F' S Jf Z O u f. } z z O F- W Q Co N F- :tr 0 W O O H N 0 W ` S H t; a c Y < N R W = C1 W _ < ¢ G W W U W J ¢ W W ¢ W W F- S Z cc t W _ t C F- F- W n 0 > W rW. V J N W 0 OO 'L a 1Ny H O N O CL Su6•--BSMT, BASEMENT 1 IST FLOOR I 2ND FLOOR 3RD FLOOR 4TH FLOOR STH FLOOR } 6TH FLOOR. 7THFLOOR � BTHFLOOR Installing Company Name • Address Check one: Certificate ❑ Corporation Business Telephone ❑• Partnership Name of Licensed Plumber or.Gas Fitter Firm/co. r INSURANCE COVERAGE: I have a curren lability insurance policy Or Its substantial equivalent which me Yes No O ets the requirements of MGL Ch. 142. It you have c ecked Yes, please Indicate the type coverage by checking the appropriate box. A liability insurance - Polrcy Other type of indemnity❑ Bond ❑ OWNER'S INSURANCE WAIVER: I am aware that the licensee does not have the Insurance coverage required by Chapter 142 of the Mass. General Laws, and that my signature on this permit application waives this requirement. Check one: Signature of Owner or Owner's Agent Owner[] Agent ❑ I hereby certify that all of the details and information 1 have submitted(or entered)in above application are true and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit issued for this a„ li o pertinent provisions of the Massachusetts State.Gas Code and Chapter 142 of the General Law ,, be in compliance with all T of License: [Title Plumber S+gnature of Licensed Plu bet r Gas Fitter sfitter City/Town Matter License Number APPROVEDO IC US . NL( Journeyman i } BELOW FOR OFFICE USE ONLY PROGRESS INSPECTION FINAL 1SKETCHES NSPEC710N FEE ------- NO. . APPLICATION FOR PERMIT TO DO GASFITTING NAME a TYPE OF BUILDING LOCATIO14 OF BUILDING PLUMBER OR GASFITTER LIC. 40. PERMIT GRANTED DATE 20 d GAS INSPECTOR