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Home My WebLink AboutBuilding Permit #471 - 100 BRIDLE PATH 1/6/2010 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: v IMPORTANT: Applicant must complete all items on this page LOCATION 9JQf►=, P 'nt PROPERTY OWNER• - Print MAP NO: ,PARCEL; ZONING DISTRICT: .Historic District - yes o 'Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne famil Addition Two or more family Industrial AI No. of units: Commercial Rem Assessory Bldg Others: Demolition Other Septic '`Well :' 1=loodplain _ Wetlands UVatershed Distrct :a Water/Sewer _ DESCRIPTION OF WOE PER F(0RMED: Ide 'ficati Please Type or Print Clearly) OWNER: Name: We-L Phone: Address: 6 ' 3 �CbNTRACTOR .Name `� '" Phone. 15� ID Address: -Supervisor'skConste.d6tioh'License � � Exp: Date: - �l _. - Home`ImprovementLicense Exp.' Dafe: -- -_ Lil 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: $ � FEE: $ Z_01 Check No.: 1' V Receipt No.: 2 v NOTE: Persons contracting with unregistered contractors do not have acces to gu my and Signature of Agent/Owner Signature of contr o Location 20 0 g!?, No. vDate �oRT►, TOWN OF NORTH ANDOVER O Certificate of Occupancy $ Building/Frame Permit Fee Ss�tMusE r Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # V Building Inspector s Af t. Plans Submitted ❑ Plans Waived-0 Certified Plot Plan ❑ Stamped Plans ❑ TYP&OF-..SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body-Art ❑... ..SwimmingPools El 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: DATEAPPROVED PLANNING & DEVELOPMENT ❑ � COMMENTS .CONSERVATION Reviewed on Sionature 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 Water & Sewer Con nection/Signature& Date Driveway Permit DPW Tow:., Engineer: Signature: Located 384 Osgood Street FIRE DEPARIMENT --Tem p Dumpster on site yes.. . no Located'at 124 Mair 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) D Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan a 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) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products NOTE: 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 NORTH own of : 4Andover 7/ - 0 - A K E dover, Mass., Z ` !� • l COC HIC HE WICK �l,9SoRAT E D PPa\ �5 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT r `vi 4 �1�11... BUILDING INSPECTOR ......... G. �� . .�.................................... ""' Foundation has permission to erect ...................................... buildings on ..1.DC).........43C4.rr ...P°4 ............................ Rough t0 be occupied as �!!.,....1. .....G.J.Q.. D ....� �.�..........�. Chimney p 2Z. ................ . ...W.............. : �.. provided that the pers acce mg this permit shall in every respect conform to the terms of thapplication 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 PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTR STARTS Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises Do Not Remove Rough 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. .%if .. �I.(,,:��lunrll� - UtIlarinuul nl ('ultli�' �:llrl� � [iu:tr(I nl� F3uil(lin;; Il�• ul;rli�nt,. an(I 11�tic(I�u-(I� �. Construction Supervisor Specialty License LlCense: CS SL 100696 Restr:Cled to: WS ALAN PAINT EN : . 11 16TH AVENUE _ HAVERHILL•,VA 01830 Expiration: 8!21/2012 ( •unn�i.ci••��:'�' Tr::: 100696 s ne commonwealth of Massachusetts, .Department 6 f Inndusirial Accidents Office of Investigations 1 . 600 FasWngton Street -Bostolsi M, 02711 ss,aov d,ia /o3 Sj C0rCtp2u�ail0IluSi71all C� B�''; TS� O�fra Ctr�rS7n^tT1Ci�I13�1i1T1'r�TS Please Print Ledbl-v A-pplicant Informatio-n Nl amt (Business/0rganization/1n�ividual): f Address: � f City/State/Zip: Phone#: -rflLiAt< Are player? Check the appropriate box: Type of project(required): 1.[]=a ployer with . 4' I am a general contractor and I 6 0 New construction have hired the sub-contractors employees (full and/or part-time). listed on the attached sheet. 7. 0 Remodeling 2.0 I am a sole proprietor or partner- These sub-contractors have g. 0•Demolition ship and have no employees employees and have workers' . ki9. ❑Building addition working for me in any capacity. comp.insurance. [No workers' comp.insurance 5. 0 We are a corporation and its 10.[] Electrical repairs or additions required-] officers have exercised their 11.0 Plumbing repairs or additions 3.❑ I am a homeowner doing all work. right of exemption per MGL myself. � workers'o comp. c. 152, §1(4), andwe have no 12.E] R repairs insurance required.]t employees. [No workers' 13 Other comp.insurance required.] Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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-contractors have employees,they rust provide their workers'comp_policy number. jam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site infornwtion- t Insurance Company Name;__ L- Expiration Date: Policy#or Self-ins.Lic.#: ( f City/State/Zip: Job Site Address: n 1�`it 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`isolator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify der h in nd enalties ofperjury that the information provided above is rue nd correct. Date: Si ature: Phone# 0-113 FL only. Do not write in this area, to be completed by city or town official n: PermitlLicense# hority(circle one): Health 2.Building Department 3. CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector Phone#: rson: 2/2ACORD,M CERTIFICATE OF LIABILITY INSURANCE 0 /00/YYYY). 02/20/09 PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequestOmarsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Steadfast Ins Co 26387 THD At-Home Services, Inc. INSURERB:Zurich American Ins Co 16535 2690 Cumberland Parkway INSURER C:NATIONAL UNION FIRE INS CO OF 'PITTS 19445 Suite 300 Atlanta GA 30339 INSURERO:New Hampshire Ins Co 23841 INSURER E:Illinois Nati 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 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. r. A DD' POLICYEFFECTIVE POLICY EXPIRATION LIMITS ::NSR POLICY NUMBER DATE MM DD DATE MM DD GENERAL LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $4,000,000 DAMAX LIMITS OF POLICY ARE EXC SS PREM ESO RENTED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $ CLAIMS MADE OCCUR "OF SIR: $1,000,000 PER CC" MEO EXP(Any one person) $EXCLUDED PERSONAL BADV INJURY $4,000,000 GENERAL AGGREGATE $4,000,000 GEN'LAGGREGATE LIMIT APPLIESPER: PRODUCTS-COMPIOPAGG s4,000,000 X POLICY PRO- LOC B AUTOMOBILE LIABILITY BAP 2938863-06 03/01/09 03/01/10 COMBINED SINGLE LIMIT (Ea accident) $1,000,000 X ANY AUTO ALLOWNEDAUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS X SELF INSURED AUTO PROPERTY DAMAGE (Per accident) $ PHYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIVMBRELLA LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $5,000,000 X OCCUR EICLAIMS MADE - AGGREGATE $5,000,000 $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION AND C 3566916 (CA) 03/01'/09 03/01/10 X WCYSAMT D R D EMPLOYERS'LIABILITY 3566915(AOS) 03/01/09 03/01/10 E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E OFFICER/MEMBEREXCLUDED? 3566917 (FL) 03/01/09 03/01/10 E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIALPROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 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 OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I 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 ENDEAVOR TO MAIL 30 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 30339 AUTHORIZED REPRESENTATIVE USA ACORD 25(2001108)ckomraus_hd ACORD CORPORATION 1988 11172180 i 1 3 1 V. £ - ��'� ! 1 ! �rai li�l.rC 1�J��•s••^tJ'� ii i I( �t'.� �`+�.11,?fJ,tP�� .itar;l:li•�lir i'�C iM`4.,.'ni�t�C� �. i so[3rHeat lainc0cfficient CoiAx=Gaw4hdt Erugia p(ar /Q; 32 1 . 6 .o : 24 'ADOMONAL PERFORN"CE RATINGS ev a.UA00m_pk_0KD4T,Pul0e RENC041WM Vlsible Tranmnittance ThnpnbJnn do lta WJD4 - • 0 . 52 (r�ati�nr ML*-T'd uc,..a"mdom two"roc X—dja'�,rtAr brvrt+�Fto hob pro�Q�+Trvra Ye JMrl-od kr a ftW it 4 COMM 4 7 Y d, �Q�:li�C der vl ncratvr8 C.ir(vaa� 4-c des re„arrvrt av UUNItr d#71 prale v"r vek u`0,. nr ors ascan -7 Es %i 3. ."W A 4A•sy ar�amd.C+is am*r**s cam'd"PC gym'drmrmros r nr�n e>�bol er pod ffi Caa akry Oa Ffi+C m .d';cr ui ar4fit y rrG✓rtiis y,ui brro v b aallm �perdta 1fRG ro r�rr lr d�4p nd<ID'l ro w+ 17Tacm�. a„ao-pn v+uo 4aler?CLrwA _. t ad lortsA Mn V*Xkalz do ah pu4r= UnIC Q1,alLLlu. :oc f?1EP.^C .9L1R - ctq�o� %:�):: tJactRtcn, I�OcCl1 . �ldld o]LISLci px-A 1A(0) .' cc?Lon(aa) Qfr00.aL,]r .R: Woctt_ ' NocCt CtnCcal, 'Suc Cant.C1L, 9�c" - I -. - IVD: ft�1n. 00/CLiaa 3(�2"�K-R�3 • ` rt3*ttd,3rt: 1C' r. C3' INO: fl.al..tc:o OOfYLd_cio 2-3( qua/K-RJ3 IL„-I.Ao pcobido: 11.1 cn MCO c�► 10'112 - H3 KotCun 2)51120- - 01M, A-M (,r p fia lob.l for paab�fNC�L(SUS nbcrtn.To Ian rton Alt ww.m�grrt¢gvr tua& IM 4*lta pray ycnbla r►�mbo6ar QIEt6T Sf11•Coro mrau rtD aorm afo.�I�.mac +r g1 ctocgoc Board of Buildiog Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:. 126893 Ex0iration `8(3/2010 'Type:_Supplement Card The Home Oepol:Al Home`Ser4ice 12-24-2009 11:10AM FROM- T-550 P.001/005 F-545 uv PLEASE READ THIS Sold,Furnished and Installed by: Branch Name: Boston Date:�p��'1 tTl THD At-Home Services,Inc_ d/b/a The Horne Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number:31 TollFree(800)657-5182; Fax(508)756-8823 Federal I0#75-2698460;ME Lie#C 02439;RI Cont.lic#16427 Cr Lic#50522;MA Home Improvement Contractor Reg.#126893 Installation Address: City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: [ . ] L [ ] Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑I DO-NOT wish to receive any marketing emails from The Home Depot Proiect Information: Undersigned("Custonaer"),the owners of the property located at the above installation address,agrees to buy; and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials described an the below and on the referenced Spec Sheet(s),all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and.Payment Summary attached.hereto and any Change Orders(collectively, "Contract"): 1 Job#: oafmw ecr�l Sec Sheets #• Pro'ect Amount Roofing Siding mdows ❑Insnladob 'U tl []Gutters/Covers ❑En ors ❑ ❑Roofing Siding.. rndows ❑Insulation ❑Gutters i Covers❑Entry Doors,❑ . p. �{ $ Roofing ElSiding. Windows EJ Insulation [30uters/Covers.[]Entry Doors.❑. $ ❑Roofing LISiding Windows El Insulation ❑Gutters/Covers:MEntryDoors ❑ $ Minimum 25%Deposit of Contrua Amount due upon encodon of this contract $ Total Contract Amount Maine Purchasers may not deposit mote than ane-thhtd of the Cont adAmormt ra Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any btdance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change 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 c;mnot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or,lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# _J41 included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-In copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The home Depot the costs of materials,labor,expenses and services provided by The Home 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 DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF.SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Ac by: _ Submit by: Customer's Signature Date Sales Consultant's Signaturei Date X Telephone No. (o v�-ur{r �C r+\ Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOM 11t MAY CANCEL THIS (as applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHID HERETO CONTAINS A FORINT TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL.TERMS AND COMMONS ARE STATED ON THS REVERSE SIDE AND ARE PART OF TEES CONTRACT 11-M-08 CSC White-Branch Fife Yellow-Customer Pink-.Sales Consultant