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Home My WebLink AboutBuilding Permit #59 - 11 WALKER ROAD 7/26/2007 14ORTH BUILDING PERMIT °�tt-aD ,6'�ti TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Received �`��--� 4 `°`".1 - �1 �°h�reo�PP1y(5 �SSACHUS�� Date Issued: (-- d IMPORTANT: Applicant must complete all items on this page LOCATION t k1k , C_P 4- l(� Print PROPERTY OWNER D = e—Q.tlrA IN No Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: k Commercial Repair, eplacemen Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: entification Please Type or Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name:—�\akre _ d1 00 ' Phone: ,tet Address: Vr1,UbQ8 CA , 1A-)a- er Supervisor's Construction License: Exp. Date: Home Improvement License: t Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. JFEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. n e'C, Total Project Cost: $ -d 1 a— FEE: $ I A Check No.: �� & Receipt No.: NOTE: Persons contracting withttnre 'stered contractors do not have access to th ranty fund gnature of Agent/Owner Signature of contractor 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 DATE REJECTED DATE APPR0 VED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED , CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments i Conservation Decision: Comments j Water & Sewer Connection/Signature$Date Driveway Permit Located at 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located at 924 Main Street Fire Department signatureldate COMMENTS i Dimension Number of Totals square feet of floor area, based on Exterior dimensions. Stories: q 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 I .............--.._.................._..................................... ............._._.................................-....--._.................._..............-..................-..................................------.........................................__.-..--...................----....__.....................................--...... Doc.Building Permit Revised 2007 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 ❑ 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 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 L3 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 NOTE: 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 (If Applicable) ❑ Copy of Contract ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 I I i Location // No. S9 Date �7— C;14 Q 7 HORT1y TOWN OF NORTH ANDOVER + Certificate of Occupancy $ �'�s'••°•E<� Building/Frame Permit Fee $ s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ��M Check # Uy� 2 0 e, Building Inspector v' NORTH own of over 0 0 No. _a . a y �, o , l ver, Mass., T O _-COLAKE Jr C MIC ME WICK oRATED P -`C3 N BOARD OF HEALTH Mi Food/Kitchen PER T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT.................................. . ... ...... ................................................. """..........."""""""' Foundation has permission to erect........................................ buildings on ../ .....14.100.... ........ ...................`� ...,.. Rough 041 to be occupied as.. chimney ...... .. provided'that the person a opting this permit shall in every respect conform to the terms of the application on file in Final this office, and to the pro sions 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 y _ PERMIT EXPIRES IN 6 THS ELECTRICAL INSPECTOR UNLESS CONSTRU ON S Rough . Service . ....... .. .............................. BUILDING INSPECTOR 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. Wednesday,July 18,200711:32 AM Craig Smith 603-594-5973 p.04 HOME IMPROVEMENT CONTRACT Branch Name: d XVII Date: 4 Sold,Furnished and Installed by: THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch Number: �..� J 345A Greenwood Street,Worcester,MA 01607 Jotr#aZ � (� Toll Free(800)657-5182; Fax:508-756-2859 Federal ID#75-2698460 M5 Uc#C 02439 RI Cont U,#16127 1 '(, (,T Lic#565 22; MAH a Improvement Cantractor Reg,#126893 Installation Address: lA OuLRr_lr�a :�_ V city State Zip Z �� Purchaser(s): Last 4 Digits of Driver's &Exp.Mo/Yr Work Phone- Home Phone: c VXn a�� Home Address: I2 ( > ( ) (If different from Installation Address) City State Zi E-mail Address(to receive updates and promotions from The Home Depot): — Ct�� Q Project Information: I/We/You("P�haser"j,the owners of the property located at the above installation address,offer contract with THD At-Home Services,Inc.("Home Depot" to famish,deliver and arrange for the installation of all materials1 as described on the attached Spec Sheet KO #AA 9A79 0 incorporated herein by reference and made a part of. Cao"? J 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 tke home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract DEPOSIT PAYMENT OPTIONS + CONTRACT AMOUNT (Subject to fund verillotion and/or credit appmval.) $ � � r O 1, Check*,Cashiers Check or US Postal Service Money Order tLESS DEPOSIT $�p (Made payable to 71te Home Depot). v 2. Credit Card"and/or other payment options-Circle One Below BALANCE DUE Visa MasterCard Discover American Express L ON COMPLETION S /._� Q 8! rt./1 The Home Depot Moate eat Loan (7trc Home Depot Credit Card j'MWmum 25%Of Contract Amount due upon ❑New Account istina Attoant (HIL&HDCC ONLt) execution of this contract �0 y,Available Credit:S &WIL&HDCC ONLY) Indicate payment Method For Acct# 3x01 g t3 a xp.Date. BALANCE DUE ON COMPLETION: Name as it appears on card- - } •'By my/our signature below,I/We agree to allow Home Depot to charge ove ced credit card for the sit indicated. •When you provide a check as payment,you authorize us either /�.. to use information from your check to make a one-time electronic Cardhol is S' u fiorprocess the payment as a d transfer from your account or to Dai check transaction.When we use information fmm your check to make an electronic fund transfer,funds may be withdrawn from HIL or HDCC Authorization Codes your account as soon as the payment is received,and you will notD F Final Pa meat receive yourcheck back. # O # (517 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 Agreement;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 completely filled-iu 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 complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract 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.There will be a service charge equal to 25%of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW,VWE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND UWE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATURE BELOW,I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. SUBMITTED BY: Date. 7i Q ' a ACCEPTED BY: Date. Purchaser Rachaser Date: NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 4-2-07 C-SC White—Branch He Yesow—Customer Pink—Sales Constrthant a th I 9� AT H OM E Installed :SERVICES Siding and Windows 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 CERTIFICATE NUMBER MARSH CERTIFICATE OF INSURANCE 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(MM/DD/YY) 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-COMP/OP 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) SCHEDULED AUTOS — -- HIRED AUTOS BODILY INJURY 1 $ (Per accident) NOW NEDAUTOS RHYSICAL ELF-INSURED AUTO PROPERTY DAMAGE $ DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ 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 AGGREGATE $ 5,000,000 UMBRELLA FORM OTHER THAN UMBRELLA FORM $ WORKERS COMPENSATION AND WC STATU- TH•' C 2921209(CA) 03/01/07 03/01/08 X I TO LIMITS ER EMPLOYERS'LIABILITY E 2921210(FL) 03/01/07 03/01/08 EL EACH ACCIDENT J$ 1,000,000 F THE PROPRIETOR/- X INCL 2921211 (AZ,ID,MD,VA) 03/01/07 03/01/08 EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERSIEXECUTIVE D OFFICERS ARE: EXCL2921208(AOS) 03/01/07 03/01/08 EL DISEASE-EACH EMPLOYEE $ 1,000,000 C OTHER 2921213(QSI) 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 SIR 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 'In 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�,s MM1(3102)' VALID AS OF: 02/28/07 J ne 1—ommonwealth of Massachusetts Departmentof Industrial Accidents 57 - Office of Investigations 600 Washington Street Boston, ]VJA 02111- M yY•y www.mas&gov/dia Tobin of Z.rlingtnn Applicant Information Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Pluimbers Pease Print Le ibl Name (Business/Organization/Individual): Address: Lt`'D5�— City/State/Zip: aXVe�4 .� Phone#: — you an employer? Check the appropriate box: [Are am a employer with. 4. ❑ I am a general contractor and IFE] oject(required):employees (full and/or part-time . have hir _ constructsed the sub contractorson.❑ I am a sole proprietor or partner- listed on the attached sheet. t odeling ship and have no employees These sub-contractors have working forme in any capacity. workers' comp• insurance. olition[No workers'comp. insurance 5. ❑ We are a corporation and its ing addition 3-❑ required.] officers have exercised their I O-❑ Electrical repairs or additions 1 am a homeowner doing all work right of exemption per MGL I1-❑ Plumbing repairs or additions myself. [No workers' comp, c.'I 52,§1(4),and we have no insurance required-] t. 120 Roof repairsem employees- [No workers' ❑ comp- insurance required.) 13 Othr 'Any applicant that checks box#1 must also fill out the section belowshowing their wor t}Inmeowners who submit 1 g kers'compensation Policy his affidavit indicating the are doinga F'o cy bmttnatew tContractors that check this box must attached an additional sheet showing the name of the usub-contractors and tside contmcton their bwrtonrkaenn,c affidavit indicating such comp.policy information. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site informayiom Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date:_� Job Site Address: City/State/Zip: 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 may be 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 Si ature: _ Date: Phone#: --1 Oficial use only- Do not write in this area,to be completed by city or town official City or Town: Permit/License# L uthority(circle one): of Health 2-Building Department 3.City/Towu Clerk 4. Electrical Inspector S. Plumbing Inspector erson: Phone#: