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Home My WebLink AboutBuilding Permit #860 - 115 VEST WAY 6/28/2007 O�NO oT 6q�0 BUILDING PERMIT o? 4� , o� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ '° P e w 9• Permit NO: Date Received AUSS�4 Date Issued: r� 9SSC H IMPORTANT: Applicant must complete all items on this page CA LOCATION- � Print PROPERTY,OWNER nnt12 ; MAP NQ: PARCEL: BONING CIISTRICT:,, HISTO* DI.�"RICT yes no, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VOne family ❑ Addition ❑ Two or more family ❑ Industrial Ga/Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ..Cl Well D odplai` UVetlarid"S � ��VVaterahedm�3iStfiic D Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: o- oyLj Identification Please Type or Print Clearly) OWNER: Name: 1 cia bo'4 Phone: Address: \J a a� ` gym. CONTRACTOR Name- �ADM'4 = �>'dn'6 �� .,Phone ti.. ._ Address: ` i Supervisor's Consfructio Lic&, Q Ex . Dato: Home Improvement License , \:, :' ,.Q Ex : 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: $ /l Check No.: / Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner c_ Signature of contractor 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ ,,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 Located at 384 Osgood Street FIRE DEPARTMENT , Te Dempster onsite'-`yes no �.- LocatedStreet,124 Main �. Fire De artment si na#ere/date" p g tet; COMMENTS , s _ w n. 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 .................._................. ......................................................................................................................._....................................._.......... ............................................................ 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 ❑ Workers Comp Affidavit Li 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 Location K *S+ W P t - 2 No. _I � t"�— Date d NaR,M TOWN OF NORTH ANDOVER ` Certificate of Occupancy $ CwBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # r 2054, E �1 Building Inspector NORTH 0 0 6Andover No. ` 0 0L '� dover, Mass., O I� LAK COCHICKEWICK �. 7�S RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THISCERTIFIES THAT..... ........... ....... ...J.4.... ....r.................................................................................... Foundation��J... has permission to erect........................................ buildings on ....I/ew .. .............................................. Rough Ato be occupied as.......1//../�... ..l ........q.�.... I .....�....� ... Chimney ....................................................................provided that the person acc ting thislt 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 I (� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI 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. HOME IMPROVEMENT CONTRACT ��, , Sold,Furnished and Installed by: Branch Name: n Date: i Q7 THD At-Home Services,Inc. k` d/b/a The Home Depot At-Home Services 345A Greenwood Street,Worcester,MA 01607 Branch Number: 3Job#:3 t 17 9(jO� Toll Free(800)657-5182; Fax:508-756-2859 federal ID#75-2698460 ME Uc#C 02439 RI Cont.Lie#16427 CT Lic#565522; MA Home Improvement Contractor Reg.#126893 Installation Address: 1 V Pis�VI�Ci(,U r /u r J IJ�t l� lip City State Zip Last 4 Digits of Driver's Purchaser(s): Lie.N&Esp.Mo/Yr. Work Phone: Home Phone: p I 0 d Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): Project Information: I/We/You("Purchaser"),the owners of the property located at the above installation address,offer to contract with THD At-Home Services,Inc.("Home Depot")to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet# /A,:a-2.n ,incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if,upon reinspection 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 (y r ^ (Subject to fund verification andfor credit approval.) CONTRACT AMOUNT i, Check*,Casbiers Check or US Postal Service Money Order —T (Made payable to The Horne Depot). tLEss DEPOSIT S 3.a��f• 2. Credit Card"and/or other payment options-Circle One Below BALANCE DUE �/ (Qf� Visa MasterCard Discover American Ex cess ON COMPLETION S The Home Depot home Improvement Ivan The Home Depot Credit Card tMiaimum 25%of Contract Amount Idue upon D New Account f3'L� -ieg Account (HIL&HDCC ONLY) execution of this coutraet Available Credit:S (HIL&HDCC ONLY) Indicate Payment Method For X03 3 201 JJ6b3 3`A`P Date; BALANCE DUE ON COMPLETION: Nam as it appears on card: `r **By my/our signature below,glMe agree to allow Home Depot to charge a abo afcr?:nit card for the deposit indicated. When you provide a check as payment.,you authorize us either to use information from your check to make a one-tithe electronic Ider's rgnalme D t fund transfer from your amount or to process the payment as a chink bwissctiom when we use information from your check to gH,or HOCC Authorization Codes make an electronic fund transfer,funds may be withdrawn from your account as soon as the payment is received,and you win not Deposit Final Payment receive your check back. # ()aAJ—Z�J # Ong 0711?� 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-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 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,I/WE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I1WE 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, WJE AGREE TO BE BOUND BY TEE TERMS OF THIS CONTRACT. WJE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. SUBMITTED BY: Date: t ACCEPTED BY: Date: 7— Purchaser Date: Purchaser NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 4-2-07 C-SC Whtte–Branch Fie Yellow–Customer Pink–Sales Consultant rt9 AT-HOME installed 55 ERV ES Siding and windows �R6 i¢8#bfiKEfYbtL�Qif�R�Jl�ldddfZQrdlidd�. ' HOW 0. qMWMff OMRACTM »Yonct[�f Baildliag E?telntloasi atnd Stantlsr�t Re �THE v ' 7 RUNRf)LUH CH z ref j =0 Cosa C- MWA,CA M ,� A�nlntetradttr Proudly sold,furnished and installed by RMA Home Services,inc.,a Home Depot authorized contractor. 345 Greenwood St. Unit 2•Worcester,MA 01647.508-756-6686•Fax 508-756-2859•Toll Free 800-657-5182 CERTIFICATE F INSURANCE � oMAfaH A�1023NUMBER 4 01 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS PRODUCER NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE MARSH USA,INC. 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 C AMERICAN HOME ASSURANCE COMPANY ATLANTA,GA 30339 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 NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR TYPE OF INSURANCE DATE(MWDD/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 a OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL&ADV INJURY $ 4,000,000 OWNER'S 8 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 BODILYINJURY $ (Per person) SCHEDULED AUTOS BODILY INJURY HIRED AUTOS (Per accident) I $ NON-OWNEDAUTOS T X ELF-INSURED AUTO PROPERTY DAMAGE $ HYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ OTHER THAN AUTO ONLY ANY AUTO EACH ACCIDENT $ I I_ AGGREGATE $ A EXCESS LIABILITY IPR 3757 608-02 03/01/07 03/01/08 EACH OCCURRENCE $ 8,000,000 AGGREGATE $ 5,000,000 X UMBRELLA FORM $ OTHER THAN UMBRELLA FORM WC STATU- OTH- C WORKERS COMPENSATION AND 2921209(CA) 03/01/07 03/01/08 X I TORY LIMITS ER EMPLOYERS'LIABILITY 03/01/08 EL EACH ACCIDENT $ 1,000,000 E 2921210(FL) 03/01107 — F THE PROPRIETOR/ X INCL 2921211 (AZ,ID,MD,VA) 03/01/07 03101/08 EL DISEASE-POLICY LIMIT I$ 1,000,000 PARTNERS/EXECUTIVE 2821208(AOS) 03/01/07 03/01/08 EL DISEASE-EACH EMPLOYEE$ 1,000,000 D OFFICERS ARE: EXCL — 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 1HEREOF. THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL An DAYS WRITTEN NOnCE TO rHE 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 MM1(3102) VALID AS OF: 02/28/07 f ne Lommonwealth of'Massachusetts Department•of Industrial Accidents Office of Investigations 600 Washington Street Boston,AIA 02111- v SJ�v www.mass.gov/dia Tobin Df Arliniaton Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl Name (Business/Organization/individual): Address: D _ j-`.Q. fALAD00L 5-a- City/State/Zip: lA ']r,Yt o r Phone#:_ you an employer?Check the appropriate box:[Are _ 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 ❑New construction 2.❑ 1 am a sole proprietor or partner- Iisted on the attached sheet. 1 2- Remodeling ship and have no employees These sub-contractors have working , 8- ❑ Demolition for me i n an capacity.panty. _workers comp. insurance. [No workers co insurance 5. 9• ❑ Building addition mp ❑ We are a corporation and its required.] officers have exercised their 10-❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions Myself [No workers' comp. c.']52,§1(4),and we have no insurance required.] t. l2:❑ Roofrepairs eq ) employees. [No workers' ❑ comp. insurance required.] 13. Other' *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 their workers'comp,policy inforTnation. I am an employer that is providing workers'compensation insurance for my employees Below is the polity and job site information Insurance Company Name.- Policy#or Self-ins.Lic.#:_ aC[�ta � Expiration Date: Job Site Address: ` ` City/State/Zip: 1-3 Attach a copy of the workers' compensation policy d claration 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 cert under the pains and penalties of perjury that the information provided above is true and correct Si ature- _ Phone#: '--1 Oficial use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1_ Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person Phone#: