HomeMy WebLinkAboutBuilding Permit #476 - 103 FARRWOOD AVENUE 12/3/2013 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0: T Date Received )e9A�
Date Issued: �- — s
IMPORTANT:Applicant must complete all items on this page
LOCATION -
4UP9
PROPERTY OWNER "I�IGi_r.��!�2
�
� Print 100 Year Old Structure yes nno
MAP NO: PARCELDJ U� ZONING DISTRICT: Historic District yes
Machine Shop Village yes
TYPE OF IMPROVEMENT. PROP SED USE
Res' ential Non- Residential
❑ New Building One family
ElAddit' n ❑ Two or more family El Industrial
❑Al ration No. of units: ❑ Commercial
❑ epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District
11 Water/Sewer
DESCRIP N OF
)In TO qE PERF O MED:
95
Iden ' icagon Pleasq Type or Print Clearly)
OWNER: Name: Phone: rl D
Address:
CONTRACTOR Name: _ Phone:
Address:
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: $ .3 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have 4accessogua myfund
ignatureof Agent/Owne _l
r "� Signature of contraPlans Submitted L.� Plans Waived ❑ Certified Plot Plan ❑ d Plans ❑
Location r
No. `� 14 Date �Z—�
• - TOWN OF NORTH ANDOVER
e•
Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $"
TOTAL $
Check#�
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 - U FORM
. DATE REJECTED DATE.APPROVED
PLANNING & DEVELOPMENT ❑ ❑
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
Water & Sewer Connection/signature Date
Driveway Permit
DPW Toivar Engineer: Signature:
-- Located 384 Osgood Street
FIRE DEPARTMENT --Temp Dumpster on site yes no
Located at 124 Mair Street
Fire Departine►it 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
® Notified for pickup - Date
Doe.Building Permit Revised 2010
■
Building Department
The foi;'owing is-a-list of the required forms to be filled out for the appropriate.permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
o Ruilding Permit Application
o Workers Comp Affidavit
Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o Copy of Contract
o Floor Plan Or Proposed Interior Work
L3 Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
o Building Permit Application
L3 Certified Surveyed Plot Plan
o Workers Comp Affidavit
u Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
a Mass check Energy Compliance Report (If Applicable)
a 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)
Li Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
Li 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 apnaal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Building permit Revised 2012
NORTH
own of
0
41 soh ver, Mass ce �►h� 3 2���
COC...0 NlWK..
A°RATE o �'P�`',�'C5
s �
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
•
THIS CERTIFIES THAT .,. .,... BUILDING INSPECTOR
....... .. . X1,�....... �M ►....................................
has permission to erectg � , Foundation
.......................... buildin son .' .. .... ................................
Rough
to be occupied as ........me�am......... .:.�A" &................................................. 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
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION TV Rough
Service
....................... ........................................... Final
BUILDING INSPECTOR
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.
SEE REVERSE SIDE
HOME IMPROVEMENT CONTRACT —�
PLEASE READ"PHIS
Sold.Furnished and Installed by:
Branch Name:Roston North&South Date:_!—! THD At-Home Services,inc.
d/b/a The Home Depot At-Home Services
Branch lumber:31 and 33 908 Boston Turnpike.Unit I.Shrc%%sbury.MA 01545
Toll Free 877-903-3768
Federal ID#75-26951 O\iE Lie#C 112439:RI Conn.Lick 16.127
CT Uc k HIC.0565522:NIA Home Improvement Contractor Reg.k 1261191
Installation Address: � 18'QC((ICZKS)� r J-1- /1'.1a
tj"1L _ City - State Zip
Purchaserts): 1Cork Phone: �,Home Phone: Cell Phone:
15-?1 387- L J 18I 13o?-JA
Home Address:
(If difierew front Installation Address) City State Zip
E-nail Address(R)receive project communications and Monte Depol Updates):
❑I DO NOT wish to receive any n)arketing email.from The Home Depot
Proiect hil'ormation: Undersiened("Customer •).the owners of'tile property located at the above installation address.agrees to buy,
and DID:1t-1 lorne Services.tile.("rhe Home Depot')agrees to tumish,deli\er;aid arrange fix die installation('"Installation")of
all materials described on the below and on the referenced Spec Sheelts). all of which are incorporated into this Contract by this
reference.;hong with:uiy applicahle State Supplement and Payment Sunimarl anached hereto and atn Change Orden(collectiveh.
"Conh'act"r
.lob#: ,tm—w Product,: ti
ec Sheetls)#: Proiect lrnou
konline Biline \\'indo,c. ❑q rS
1 `�� nt
� ❑Guttas!Cuser, ❑Gnu-y Ducar. ❑ — _ —— --— — `�
i�❑Krwting r Sidinc windo" o Imuhuion'
❑Cutters/('nyet•s ❑tints Dtxnx ❑. _ — I I � —
Itouflng Siding M\ ..doll,rf I .ulatieu r'{
— —— ❑6uuers/Cover, ❑Lntn thxxs❑_
_ (/(j, ,
_ '
❑Enters/covers ❑l!ntry Dour, ❑
I
4 Minimum 3;Cr Ikprfsit of C'artr:ut:lrtruunt dux up(r)cx(•ctuimt t>f Thi,cnnlnK4.
UainePurchasen may not dep(rsit more than onedhird Jibe C(Hililad mount. I'olal Contract Amount
Customer agrees that. inunediatell upon completion of Ilse cork for each 1'roducl.Cusionier will c\ecute a Completion jCertiliwte
(one for each Product as defined by an individual Spec Sheen and pay ally balance title, As applicable.each Customer under this
Contract agrees a)bejointly and scveralh ohli_ated and liable hereunder.
"ilio Home Depot reserves the right to issue a Change Order or tenninate this Contract or iin%individual h-oduct(s)included herein,at
its discretion.it l'hc Home Depot or its audwriictl ser%ice provider determines thai it canna(perl'orni its obligations due to a structural
problem with the home.cnLtronmenlill har:trds such a,nwld.asbestos or lead paint.other safety concerns.pricing errors or because
work required io complete the job%%a,not included in the Contract.
Payment Suntniarv: The Payment Sunmiary # __included .is part of This Conn-act. sets forth the wta)
Contract amount and payments required For the deposits and final payments by Pritluct(as applicable).
NOTICE TO C'US'1'OyIER
You are entitled to a cornpletely filled-in copy of the Contract at the lime 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 ol'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 or termination. plus any other
amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNT'S
MM) TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT
LIMITING THE HOME DEPOTS OTHER RENIEDif S FOR RF,COYERi.OF SL C'H AMOUNTS.
Acceptance and Authorization: Customer agrees;in([understands that this Acrecniem is the entire agreement between C'ustonier
and The home Depot%kith regard to the Products and Installation services and supersedes all prior discussions and agreements.either
oral or written.relating io said Products and Iinsudlation.finis Asrecment cannot he assigned car amended except by a writing signed
by Customer and The florae lkpot.Customer acknowledges and agrees that Customer has read.understands.voluntarily accepts the
terms of and has revel%, u cop%of ibis Agrecnxnt.
t:
Accilint�) I Suhnii y:
it iotner's Si ur- Dale I Sale , nsudtant's Si_naturc Date
X — 'telephone No.
Customer's Sitnalure Date
Sale,Consultant License No,
C'ANCEI LATION: CUSTOMER MAY CANCEL THiti art„(hls•t
AGREEMENT WITHOUT PENALTY OR OBLIGATION
BY DE1.1vERING wizn"CEN NO'r1CF. TO THE HOME
DEPOT BY NUDN1GHT ON THE THIRD BUSINESS
DAY AF FER SIGNING THIS AGREEMENT. 1 Ht;
STATE SUPPLEMENT AT'1'ACHFD HERETO
CON"rAINS A FORM TO USE IF ONE iS
SPF,CIFiCALLY PRESCRIBED BY LAW IN
CUS'TOMER'S STATE.
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06-04.13 White-Branch File Yellow-Customer
1
Massachusetts-Department of Public Safety
Board.of Building Regulations and Standards
Coustructiou Supervlsor
License:CS-088756
t SCOTT A MA*M'I
10 PARK AV , �'•%
SALEH
M N . 307 't
✓_..�,... . �. �. Expiration
Commissioner 03!2912014
T,
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Insurance Co pane Name: _ --
=,
0a6m.,LI,.IP
Attach a ceps,o?the workers'compcnsation police declaration page tshoWing•the poky number anti e iraiion uatel.
Failure tc se vre coveraYF a�required under Secti m=-rA of MM c. 15"'earl lead tcl the irnnos;tion of cr;mina': per,aif es o a
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(teal.use only. Do riot write in.this area.io be.corrcin'cplCLed h1t n1'.r.0luai njliei.a.0
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. ..
I City or Town: Permit/License 4 �
IIssuir-a.Authoriiv tcircie.nner
11.$oaT-d of Flealtn 2,Buiininc Deparim,-nt ..C ity/Town Clerk 4.Electrical inspector Plumbing Inspector
,i
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Contact Person; Phone 9:_�—_ I;
i
i
92ae ellll-ollllue .
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
F1t �IOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
Registration12893 Tyne, 10 Park Plaza-Suite 5170
Expiratinrf 813[2014 Supplement }and Boston,MA 02116
The Home Depot At,i9rne Services
RICHARD r"=ALLOVE 1 _ s
2690 CUMBERLANR PARKWAYS
A — — - --
'�tP N` 1,GA 30339 ., Undersecretary q of valid 4ithout signature
A
E MATE OF LkBUTYI NS U RANCE
R IF]
Cc: TiFIC
C-FITIF."A"E IS ISSUEO AS A '§!AT71E1R CF INFORAMATION ONLY AND CQflF`R5 NO 1�1`0!�T� UPOM T.KE
_._sits PCATF nas NOT AFIRi1,ATIVElY 01R, NEGATINE.ILY AMEKI, FY.77'_END 03'1 A171FR T,TIM C01::RAGE AFFOR- OF1 8'i TliE
F
Z7;1_0YV4 THIS CERTIFICATE 07 iNSURAvICE GOES NOT CONSTITUTE-' A CO?,17RACT ESTI VIr .N "Iri
L
If th-n
raquire zin andixas inn-,nit. A on this cc-rtirle
"P_�'Ms 6111d cc-,ditions of Llhe Policy, 001i'Gi9ls nlaY rja do-,.5
N11"R
KSH USA,INC,
'iVlo ALLIANCE CENTER
E-MAIL
3560 LENOX ROAD,51-1171 E 21Z 0 A
AT LANNAM 4
TA,GA 30326 INSURER
(5)
N,URER A:
Zuddi American Insurance Co 116535
INSURER.B:
THE HOME DEPOT,INC. INSURER C:New Hampshire Ins Co 23841
HOME DEPOT U.S.A.,INC. 23817
2455 PACES FERRY ROAD,NW INSURER D:Illinois National Ins Co
BUILDING C-20 INSURER E:
ATLANTA,GA.,30339
COVERAGES CERTIFICATE NUMBER: ATL-003159546-04 REVISION NUMBER:7
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 ALI.THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
POLICY
'oF IN 01) 1 UMTS
T U�j I MMIDD (MNUD2=y)
LTR TYPE OF INSURANCE POLICY NUMPOUCYEXP 0-00,000
_6M
dU048EI7714-03 0310112014 'EACH OCCURRENCE s_
-TA—MA-6E TO—RENTED 'I'000,000
X
PREMISES_ iE_2_0c_c U_11 E-n-r JeL S
COMMEIRCIALGENEPAL LIABILITY 7-EXCLUDED
A GENERAL LIABILITY
R -
NE
9,000,000
P LL
GE � 'A B'L'TY
INI't
C L Ll
EPCIAL GENENABILITY
S LIMITS OF POLICY XS MED EXP(Any one person).—
CLAIMS-11ADE M OCCUR
LA D S9,000,000
OF SIR:SIM PER OCC PERSONAL&ADV INJURY
GENERAL AGGREGATE
UCTS-COMPIOPAGG- $
L T L MIT P
h
LI
GEN'L AGGREGATE LIMIT APPLIES PER: S
X "L'CY 1 PRO. LOC
7X -POLICY F "T -1 LOC
nTL F COMBINED SINGLE LIP41-F 000
B AUTOMOBILE LIABILITY BAP 2938663-10 0310112013 031,0112014 (Ea accident) - S
x ANY AUTO I I BODILY INJURY(Per person) S —
ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident).S
AUTOS AUTOS PROPERTY DAMAGE S
NON-OWNED Per accident
HIRED AUTOS AUTOS
UMBRELLA LIAR EACH OCCURRENCE
OCCUR
AGGREGATE
+310112013 1 --4----
;ROPERTY DAMAGE
Per _Id.,t
C OCC P 1,
;H OCCURRENCE
EXCESS LIAR CLAIMS-MADE
DEE) RETENTIONS TO—TH-
W STATU
VIC033575314(AOS) Y t
C I I —FTWOCR -LE13-
wopr'ERS cwPENSATION T_Q_R_Y_U_MllIci_I
AND EMPLOYERS'LIABILITY YIN k�033575315(AK,AZ) 0310112013 10310112014 1 1,000,0(10
ANY PROPRIETOWARTNEPVEXEGUTIlT ACCIDENT
11-,�,IC RIMEMISER EXCLUDED? NIA 1.0w,ow
D E 03101120131 0TO-1120A E.L. EA 00PLOYEd S
DISEASE
(Mandatory In NH)
If ns,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS below
C WORKERS COMPENSAT[ON WC033575317(KY,NC,NH,VO 0310112013 3101/2014 (EL)LIMIT
1,000,000
WC033575318(NJ) 0310112013 03'0112.014
D'sS'CRIFITION OF OPERATIONS I LOCATIONS I VEHICLES(Aft,,min ACORD 101,Additional Rerwiikn.Schedule,If more space 11,4 required)
EVIDENCE OF COVERAGE
L
CERTIFICATE HOLDER CANCELLATION
THE HOME DEPOT INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
HOME DEPOT USA,INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
2455 PACES FERRY ROAD,NW ACCORDANCE WITH THE POLICY PROVISIONS.
BUILDING C-20
ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
Manashi Mukherjee 019
019&0-2010 ACORD CORPORATION. All rights reserved.
ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD