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HomeMy WebLinkAboutBuilding Permit #295-15 - 106 WAVERLY ROAD 9/23/2014 BUILDING PERMIT °� NORTN q�• tttlED TOWN OF NORTH ANDOVER �� y"'- =h. °� APPLICATION FOR PLAN EXAMINATION Permit No#: t �1_J Date Received �RATEO gSSACHU`��� Date Issued: PORTANT: Applicant must complete all items on this page LOCATION - /- Pr t .. - PROPERTY OWNER a `�.� z Print 100 Year Structure yrnMAP PARCEL �__ l ZONINGDISTRICT Historic District Machine Shop Village TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addi '6n ❑ Two or more family ❑ Industrial ❑AI ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well ❑ Floodplain ❑Wetlands 0 Watershed District ❑Water/Sewer SCRIPTION OF WOPK TPJ3E PERFORMED: FP,-�6,7& 4 L ke,-.1 Ident'fi ation- Please�T ��r .�'pint Clearly ����U�,_2��� OWNER: Name: I �j Phone: Address: 14 W)90 ®�I� A Contractor Name _ Phone: Address: Supervisor's Construction License:C.�Z-d�W2,-3, ,Exp. Home Improvement License. _196e: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: $ � ° FEE: $ (P ,(W Check No.: *e­7 a ( Receipt No.: 2_1�cO NOTE: Persons contracting with unregistered contractors do not have access t th g n Signature of Agent/Owner Signature of contracto i� 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS f 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 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 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 Call Email Date Time Contact Name Doc.Building Permit 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 ❑ Building Permit Application ❑ Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work Li 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 ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract Li Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ 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 o Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report ❑ 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 Location No. 201L2 Date . - TOWN OF NORTH ANDOVER �! • Certificate of Occupancy $ Building/Frame Permit Fee $ tw YFoundation Permit Fee $ Other Permit Fee $ 1 TOTAL $ -1 Check#_ 28049 Building Inspector NORTH Town of _ � _ Andover 01 t'i'. ..�•- oil h ver, Mass, t VD COC NIct4twtcx x,95 RATE D ►'PP,�'�y_ U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �t ,04. ............................... BUILDING INSPECTOR has permission to erect .. ....... buildings on .......... AFoundation Rough to be occupied as .... .. .........r ..r.....0`.Kd ..................... 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 6N4TH ELECTRICAL INSPECTOR • UNLESS CONSTRUCT S 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. HOME IMPROVEMENT CONTRACT PLEASE READ THIS a : f Sold;Fumil� stCao Branch Name:Boston North&South � THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch Number: 31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal.ID#75-26.98460;ME Lic#C 02439;RI Cont.Lic#16427 CT Lic#HIC.0565522;MA Home Improvement Contractor Reg.#126893 Installation Address: OU /fo 401 City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: 761 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("Customer"),the owners of the property located at die 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 on the belowand 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"): Job#: (mterrmi Reference) P oducts.: Sec Sheet(s)#: Project Amount 77Z© Roofing Siding Vindows In"Z tP ❑Gutters/Covers Entry Doors ❑ � 322- Roofing OSiding ❑ Windows Insulation ❑Gutters/Covers ❑Entry Doors ❑ $ []Roofing OSiding El Windows Insulation ❑Gutters/Covers ❑Entry:Doors Roofing ElSiding 0 Windows 0 Insulation ❑Gutters/Covers ❑Entry Doors ❑ Minimum 2.5%a Deposit of Contract Amount due upon execution of this contract. Total Contract Amount $ Maine Purchasers may not deposit more than one-third of the Contract Amount. 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 balance 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 cannot,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 # 017[-5 q/ included as partof 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 tilled-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 WI'T'HHOLD 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 haw �copyofgreement. A 1 - -- Nermn zservices , 4U Z40'00t$ p.Z -moi' •:��,� /^iG/J-//�`n /�/� J �/���f��/�� �/j / �/(////, �J /fir ,�i 7(/ � \�:�Y��t��t[•LJ�.j{%C�'(/.i Office of Consumer Affai and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor•Registration Registration: 126893 Type: Supplement Card THD AT HOME SERVICES, INC. Expiration: 81312016 RICHARD TROIA ------ 2690 CUMBERLAND PARKWAY SUITE 300 . . -- ATLANTA, GA 30339 __ _.....__ ............__ Update Address and return card.Mark reason for change. SCA t ,-, 2074•0:711 -_ Address C Renewal 0 Employment J Lost Card 11 y 0 ,•. -omcc orCuasumtr Affairs&Business Regulation License or registration valid for individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return Once of Consumer Affairs and Business Re. --'ion s Registration: .126893 Type: IO Park Plaza-Suite 517B ratiorr•813/2016 . Supplement• Exp+ PP! Boston,MA 02116 •• THD AT HOME SERVICES.INC. THE HOME DEPOT AT HOME SERVICES RICHARD TROIA 2690 CUMBERLAND PARKWAY S XM5M GA 30339 Undersccretzry ! Not valid wiihout si ature 'i i - r _ ise CSSL-099823 DZM.ITRY BROVIN 70 NORTON AVE Manchester NH 03109 V mn 4,:on 06/26/2016 i 7 aco CERTIFICATE OF LlAB1LITY INSURANCE ° ► '�° ' TGS CATS IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLD THIS CERTIFICATE DCES 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 REPAESENTAM OR PRODUCER,AND THE.CERTIFICATE HOLDER, IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcypes)must be endorsed. If SUBROGATION IS WAIVED,subject to '< the Is ns eondltlona of th4i pollry,certain PO holder may requlre'an endorsement. A statement'on this certificate does not confer rlghts to the �eeitlficate holder In lieu of such endorsement(s). ►RODUCER NON�AGi MARSHUS1 PIC } ►NONE s FAA TWOALLUWCECw-m Ar Ne. :550 t ENOX R=MTE 2400 4•M L ATLWA,GA 70325 NFJe I ' - INSURER(S)AffOROING COVERAGE 100452-HomeO GAWiL15 INSURER A:SleaCaSt InS=:e CDrrlpuly 25351 INSURED INSURER 9 r 2UA,11AnIer=II11Uf=e CD 15535 THD AT•HOM=SERVICES,INC; 23541 DUTHE HOME DEPOTAT•HOME SERVICES INSURER c:New HampSNre Int CO I 2455 PACES FERRY ROADINSuaeR o,iiinols National Insuran:e company 123817 ATLANTA,Gv 7:339 . ... . . INSURER'E i I . HSURER I* COVERAGES CERTIFICATE NUMB=_R: ATL•0032426E5.01 REVISION NUMBER:3 ',,:5 IS TO CERTIFY THAT T;:E POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TH.E POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDEO BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR L n POLICY E POLICY E%P _ • LIMITS LTR I TYPE OF INSURANCE I ca n I• POLICY NUMBER IM M/D Dr I RMMlDD"Y' A GEHERALUABILSTY GLO4557714-N 0310112014 0310111015 EACHOCCURREN:E I i 9,000.000 X COMMERCIAL GENERAL LIABILITY �X S CWMS•MADE OCCLIMITS OF POLICY X UR ME.. xm( ena oenonl I S EXCLUDED OF SIR:SI M PER OCC PERSONAL 6 ADV INJURY S 9'ODG•G GENERA-AGGREGATE S 9.000.000 GEKL AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMPIOP AGG I S 9.D00.000 X POLICY I I Pc t 7 LO: �• __i 8 AUTOMOBILE UABIUTY BAP 2538253.11 C310112014 031J111015 I COMBIN D InGL`uMli • X ANY AUTO —`^1LY INJURY(Per penonl ALITALL OptyNEp S'HEDULD SELF INSURED AUTO PHY OMG BODILY INJURY(Per a deeN)I S AUTOS NON-0WNEO PROPERTY DAMAGE S HIRED ALTOS H AUTCS - 11 HUMBRELLA LIAR. OCCUR EACH OCCURRENCE I S EXCESS UAB CWMS•MADE I I AGGREGATE i S DED-1 RETelln0N S II S C I WORKERICOMPENSATIOH 7,04910182-2(ACS) 01(1014 03'0112015 X I pYTATtY (ITS Oce I C ANO EMPLOYERS'VABILTY WC049101884 1,000,DDO ANY pRopRIETOR/PARTNERIEJCECLmVE Y, H A (A4�VA) 01018014 03N1R015 EL EACH ACCIDENT I S 0 OFFICELMEMBER FX--LUDED? LJ W;N9.1011:J(FL) 010112014 0 3MJ12015 E.L.DISEASE•EA EMPLOtT f 1.0'•� luendabry h NH) K ns.dum�e unor 1,000,000 DESCRIPTION or OPERATIONS oe'o+• EL 0!551055•pOULY LIALT S C WORKERS COMFENSATIO4WC049101825(KY,NC,NH,VT) 0101/2014 019111015 (EL)LIMIT 1,000.000 C. �.I I IW„0491C18!6(NJ) C110I=i4 On 111015 I , DESCRIPTION OF OPERATIONS l LD:ATIONS I VEHICLES (AnaCA ACORD 101,Aadluontl R,maru Scn,dul,•If men,pace it raqulr,d) ' NIiENCE OF INSURANCE I CERTIFICATE HOLDER CANCELLATION T.•OAT•HOME SERVICES.INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE U�ITHEHOME C:POTAT•HOMESERNCES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 24!5 PACES FERfi ROIJ ACCORDANCE WITH THE POLICY PROVISIONS. ATLA4TA GA 7'223 i AUTHOR=D REPRESENTATIVE of MLrinSA In- ' ManashiMukhedea O 1986.2010 ACORD CORPORATION. All rights reseryoU, .. � z' :,� cnelgY>lar.nrcan—rncan.gc.ca r • D e label.aner Culal Inspection; . nc e SAVE lar tolurc relerP v Weather Shield CPDa 050 172 NFRC Model B10B'0ouble Hung Op°r�ling Alum clad Thermal Frame 314 Inch Glazing li trry r'rrcT:n oz ZO—E .022 Low—E 1� Argon Fill Grille in Air SP3cc ENERGY PERFORMANCE RATIGDSf1—.n1 Sol,:h.4 G 0.30 11 .70 N.511_p 1*1fil1 ADDITIONAL P:ERFORMANCEtndrDRI�Fiitsslit YlJiblt l lynttrtlllao> 0 i 0.40 llctblt Nrn:ptoctduat ultttt htt l,ta ntngt c°t`n to HFRC ningt' Fr,dHntl br t Yrtultcuiti the rtdvti err XFRC dou tot rtctr*R�d duurrfolnq vhdt prodtcl tn'try1 perbm CL edlc ua. stnW conditonf tnd r41gY oPur�prvdod br t^T E Lx d ¢I nl ttrlrn 4h trbnn►nt,Inbrmt0on. 'MI DI�un tnd'dett All ntirt{l ht wl Cvtcull mmul+:mni f F1+nUrt br ethe{l,j.j1 p toulrtmtnls www.nlrz.o trd I.E.C•C• 0,Inlillrttfo n fl trot Irrts.J-►7 ' k,ttl� Dt. elt6ldT �•F L•• teoed{�1KSYla�uK1T putr_tt ` � Itsd a uutnY Y ,otn slttyD-qs . t ) p_C.CJS i1ttZS2tDl G3 V.l Ynu Sitrb�a �' @ Dtt:n ' 1 r 610ISCG2111HSiD crfl zd-71: 1 --.• - - ar+c: vd ailclssacllus(.'fI5 Depar•tinent of-DidiistrialAccidents Oki" of r4vestia ations r 1 Cort;ress Sheet,Suite 100 Bostoi?-MA 02114-2017 • , . www.nsass v/ f • . VS1orkers'Compensation Insurance Affidavit:Builders/Contracto'rs/Electricians/Plumbers A licant Information' Please Print Le 'b`l/v. } N, e(BtuinesslOrganization/Individual): AT G Address: � � �., • Ci /StatelZi — T Phone#: T0� 6 ��� tY P• Are you an•employer? Check the appropriate b,/o�. df project(required}: 1.Q'I am a employer with 4. D I am a general contracior aNew construction employees full and/or part-time).* Have hired the sub-contrac 2.❑ I am a sole'proprietor or partner- listed on the attached sheeRemodeling ship and have no employees These sub-contractorshavDemolition workin for me in an ca aci employees and haveworkers g y capacity. 9. []Building addition [No workers' comp:insurance comp. insurances required.]' ' 10. ' Electric 11 repairs or additions . 5. [] We are a corporation and its . � • • 3.❑ I am a homeowner doing all•work officers have exercised their 11:❑Plurnbi: =repairs or additions myself. [No workers'.comp.%• : right of exemption per MGL 12 [] I r :�i;s C. 152, §1(4';and.we]ive.no insurance required.] t ,.P. � • ,. 13. Other � ,.mployees. [No workers coihp.insurance required.] Any applicant t1;_* hec}s box;U 1 at.,, till out the section below showing their workers''compensation policy information. t Homeowners who submit t is affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached an additional shut showing the name of the sub-eontmetois and'stat:whether or not those entities'have employees. If the sub-contractors have employees;they must provide their workers'comp.policy number. • - ranii wi employer that is providing workersconipensatioit insurance for my employees. 'Below is the policy and job site' ••'•iitforntation. �� .=� ,�,• .' • Insurance Company Name: `v�iY ` Policy or Self-ins.Lic. r: !/v� ��1 �: Expiration Date:• ;Y1 Job Site Address: City/StatJZi . Attach a copy of the workers' compensation polic 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 nne'up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of.a STOP WORK ORDER and a cine of up to$250.00 a day against-the violator. Be advised that a copy of this statement may be forwarded to the Ounce of Investigations of the DLA for insurance.coverage.verincation I do hereby cerci' pa and et alti erjU7 that the information provided above is true and correct Signature: r Date: Phonef Official use only. Do not write in this area, to be completed by city or town official. �+ City or Town: PermitlLicense r Issuing Authority (circle one): y 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone n: