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Home My WebLink AboutBuilding Permit #469 - 12 SAWYER ROAD 12/18/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION O`No°T d,"tio o Permit NO: Date Received Date Issued: ' ��SSgCHUS�� IMPORTANT: Applicant must complete all items on this page LOCATION Pint PROPERTY OWNER _ P1 -311 n a Print MAP NO.:�_PARCEL: 7 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building N'One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: >'Repair, eplacement ❑ Assessory Bldg ❑ Commercial Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED elD I Identification Please Type or Print Clearly) OWNER: Name: keci Iv Phone: Address: CONTRACTOR Name: � Phone Address: ' Supervisor's Construction License: Exp. Date: Home Improvement License: I a/ ,kq3 Exp. Date: �l J ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PER T $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost S p�)n FEE:$ --- Check No.: (� �l Receipt No.: ul/ Page lof4 TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ F1Tanning/Massage/Body Art ❑ g Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales El❑ ❑ ❑ Private(septic tank,etc. Permanent Dumpster on Site Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor k--' i i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 4n FIRE DEPARTMENT - Temp Dumpster on site yes no �C w Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection/Si:!nature& Date Drivewav Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Re uired Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use) Page 3 o f d Doc:INSPEC"I IONAL.SERVICES DEPARTMEN'I':BPFORM05 Created.IMC..lan.'006 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 Addition Or Decks ❑ Building Permit Application ❑ Surveyed Plot Plan ❑ 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) 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 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 DEPAR'r)9ENT:RPFORN105 Pace 4 ot'4 Location No. Date _ !� r �oRTh TOWN OF NORTH ANDOVER IS 4 i Certificate of Occupancy $ �ss�cMusBuilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /10 , 19881 Building Inspector NORTH .q ONM Of No. G - LA o '� dover, mass.,.�o�•��'d� COC KICKEWICK � �ds RATED PPa` �� 7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System i BUILDING INSPECTOR THIS CERTIFIES THAT �.... ................. W.............. .. .�.�..�. �...................................................... .... .... Foundation �. . has permission to erect.................... ...... buildings on ,... Rough .... to be occupied as.... .........,�� ......... �. � . .. k............................................. Chimney Ch' provided that the person accepting this permit 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 ' PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU SIARTS Rough ........ ........... Service I BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal No Lathing or Dry Wall To BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 0 111 wwx,.mass.gov/dia «'orkers' Compensation Insurance AfSdaNit: Builders/Contractors/Electricians/Plumbers Applicant Information -- PIease Print Leeibly Name Bgan usiness/Orization'Individual): 1 ✓. Address: City/State-Zip: Phone Loci— Are you an employer' Check the appropriate box: Type of project (required): 1. ] I am a employer 'Xith. 4. ❑ I am a general contractor and I 6. ❑ -.New construction employees (full and/or part-time).` have hired the sub-contractors rl r ,- listed on the attached sheet. + 7• ® Remodeling l airi a 3G 1C prvy11 tVr ri }3r^..1�7- ship and have no employees These sub-contractors have S. ❑ Demolition Nvorking for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.1:1 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.17 Plumbing repairs or additions, myself. [No workers' comp. c. 152. §I(4), and we have no 12.17 Roof repairs insurance required.] t employees. [No workers' lr comp. insurance required.] ❑ Other Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy intormatiom t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such:,'4 =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the polic}•and job site information. n Insurance Company Name: Policy=or Self-ins. Lic. #: � (� �%1 Expiration Date: (] T Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the police 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 S 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 S250.00 a day against the violator. Be advised that a copy of this statement may be fonvarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certify under the pains and penalties of perjur}•that the information provided above is true and correct Sinature: 2 Date: Phone �'l — .`� l-PA— 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#: CERTIFICATE MARSH CERTIFICATE OF INSURANCE ATL-000915907-11 PRODUCER THIS CERTIFICATES ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE ATTN:BRENDA BOOKER (404)995-2594 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE MAYA M CC LU R E(404)995-3206 OR AFFORDED BY THE POLICIES DESCRIBED HEREIN. TAMI ROUSE(404)995-3430 FAX(404)760-5663 COMPANIES AFFORDING COVERAGE 3475 PIEDMONT ROAD,SUITE 1200 ATLANTA,GA 30305 COMPANY 00492-IPUSA-GWA-03104 A STEADFAST INSURANCE COMPANY INSURED COMPANY THD AT-HOME SERVICES INC. B ZURICH AMERICAN INSURANCE COMPANY DBA THE HOME DEPOTAT-HOME SERVICES,INC. HOME DEPOT USA,INC. COMPANY 2455 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY BUILDING C-8 ATLANTA,GA 30339 COMPANY D AMERICAN HOME ASSURANCE COMPANY COVERAGES This certificatas upersedes and replaces any previously issued certificate for the policy period noted b(aJovo. 3 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 RESPECTTO 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDDIYY) DATE(MMIDD/YY) A GENERAL LIABILITY IPR 3757 608-01 03/01106 03/01/07 GENERAL AGGREGATE $ 4,000.000 X COMMERCIAL GENERAL LIABILITY 'LIM ITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OPAGG $ 4,000,000 CLAIMSMADE JA J OCCUR 'OF SIR:$1.000,000 PER OCC PERSONAL&ADV INJURY $ 4,000,000 CWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 11000,000 MED EXP(Any one person $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-03 AOS 03/01/06 03/01/07 COMBINED SINGLE LIMB $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) X ELF-INSURED AUTO HY$ICAL DAMAGE PROPERTYDAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ G WORKERS COMPENSATION AND 6610998(AZ,ID,MD,VA) 03101/06 03/01107 X C STA EMPLOYERS'LIABILITY TORY LIMITS ER = C 6610995(AOS) 03/01106 03/01107 EL EACH ACCIDENT $ 1,000,000 G THE PROPRIETOR/ X INCL 6611326(OR) 03/01/06 03101/07 EL DISEASE-POLICY LIMIT $ 1.000_.000 PARTNERS/EXECUTIVE E OFFICERSARE: EXCL 6610999(NY,WO 03/01/06 03/01/07 EL DISEASE-EACH EMPLOYEE $ 1,000,000 WORKERS E COMPENSATION CONTINUED 6610997(FL) 03101/06 03/01107 D 1 6610996(CA) 03/01106 03/01/07 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/SPECIAL ITEMS .CERTIFICATE.HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORONG COVERAGE WILL ENDEAVOR TO MAL.'40,DAYS WRITTEN NOTICE TO THE FOR INSURANCE PURPOSES 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. ARSH USA INC. BY: Walter Gilstrap MM1(3102) VALID AS OF: 02127/06 JIM �r 7..... AT-HOME installed Siding and Windows ........ .......... Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: I'n,1 rj Registration: 126893 Board of Building Regulations and Standards �- Expiration: 8/3/2008 One Ashburton Place Rm 1301 Type: Supplement Card Boston,Ma.02108 THE Home Depot At-Home Servic STJNROEUN CHHOUY 3200 COBB GALLERIA PKWY#20 AtIANTA,GA 30339 Administrator Not valid without signature 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 Monday,December 11,2006 7:51 AM Craig Smith 603-594-5973 p.04 HOME IMPROVEMENT CONTRACT Sold,Furnished and Installed by: Branch Name:r �f�— Date- THD At-Home Services,Inc. diva The.Home Depot At-Home Services y 345A Greenwood Street,Worcester,MA 01607 Branch Number: Job 4:a F;D0 Toll Free(800)657-5182; Fax:508-756-2559 =ederal ID#75.2698460 ML Lic#C 02439 RI Cunt_Lic#16427 CT Lic#565522: MA Home Improvement Contractor Reg.#126893 Installation Address: � {�_� q Y%t�0 0-f L I VY)� D (&A� Cay State Zip Purchaser(s): Last d Di'ts of Driver's Lic.#&Exp.PtolYr: Work Phone: Home Phone: >� . Rome Address: (If different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): Proiect Information: I(WelYou("Purchaser"),the owners of the pro[erty located at the above installation address,offer to contract wide Home Depot U.S.A.,Inc. Home De t' to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet#! 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 (Subject to fund verification and/or crodit approval.) 3 1. Cheek,(achicis Check or US Postal Service Money 0,dea CONTRACT AMOUNT $ t— ! (Made p;.yable to The Home Depot). *LESS DEPOSIT $r 2. Credit C ud*and/or other payment options-Cirde One Below Visa MasterCard Discover American Express BALANCE DUE The Home l)epot Home Impmvement Loan The Home Depot Credit Card ON COMPLETION $ I New Accor:nt -1 Existing Account {!HL&HDCC ONt.Y) *Minimum 25%of Contract Amount dut upon Available Credit:S (H[L&HDCC ONLY) execution of this contract. 2r7 2Cr71 2JJ W Lx/ L D5 00"! ar r c ! i p.Date: -- Narue as it ap r n caul: . 1 1✓!s Indicate Payment Method For 'By myI ature elow,I e to allow Home Depth to BALANCE DUE ON COMPLETION": charge ve r card for the depose indicated. EX Cardhoklei s Signature Date */L*,May be subject.to Credit Approval,Fund HIL or HDCC Authorization Codes Verification and/or Credit Card Authorisation Deposit Final Payment # # 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 an:,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 PURCItASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the tune 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 anytime 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 w 11 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 ca ncelled by Purchaser AFTER materials are ordered. BY MYIOUR SIGNATURE BELOW,UWE AGREE TO BE BOUVD BY THE TERMS OF THIS CONTRACT. UWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW,VWE UNDERSTAND THA"THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DI.POT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT-OMISS10111S OR ERRORS. SUBMITTED BY: Date:�/ ACCEPTED BY: )ate: Z ll Home r Date: Homoowncr NOTICE:ADDITIONAL.TERMS AND CONDITION:-ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIP:CONTRACT 10-24.06 C-SC VVhlte—Branch File Yellow—Customer Pink—Sales Consultant