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HomeMy WebLinkAboutBuilding Permit #433-13 - 120 CANDLESTICK ROAD 11/29/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ' Date Received Date Issued: l � �{ IMPORTANT Applicant must complete all items on this age F ,0----J-2 N14 -43F 71 + PRO ,PERTY ®WNER� _ c a a= t -rt kyr -.' ) a ,„ X w. rt ,, � � 'Print` 100 year O�Itl Structure MANO f _� PARCEL �Z®NIN�DISTRICT r� t 77 Historic District .� x z.. �� = ,MachineShoP, Vg � Ye o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other P�� .��� ��.�i AFI°otlpla�n. �, � �� � �"°��� ���❑-�Wa' t shed=Districf"� `� ❑!Water/S;ewer: .��, >t w � :� � � �`� -� �� .� .���'� '~ I DESCRIPTION OF WO K TO BE Ppt5OR D: i I IdphtificatAin mease.Type or Print Clearly) OWNER: Name: Phone: Address: CJJ VT �• -mss -. j' ^ " `,�,tik�W-t.2 q, ncti� RACTORNam ON , , �W — y la ..r ,�4'S�. ``°�'k..+�� F'� t� ��"• �Y�� .�`%'�tc .4� �,��3� Y#�"°`; �h�rFP ��ie�n'- a.� e.F-..£'+r�s n �*,. UpNISOr'S COC1StfUCtl01LIC��e'nSe � Home�ImprovementLice ,.rx�,�t�, .em..°as H ��.�_-c;�:�a-�. ,.il�<i.,• .s ....,rr ,-:,s.�'r-..�+,�.t��lG xrtle�:� s-s s ��kI'� .'�..; ,# ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: FEE: $ i 4 Check No.: a Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to th uar my fund Signature of A 461 ent/Ovvnerr� ': g :Sture of contrac_to_r. . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Location ! Date No. �� . . TOWN OF NORTH ANDOVER i SEAQ t i ,'s'S 7i: Certificate of Occupancy $ A g Building/Frame Permit Fee $ Z� to, f M Foundation Permit Fee $ $ Other Permit Fee a TOTAL .--$ Check 5994 99A Building Inspector d 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 j f i COAENTS i i Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted__yes i Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Towi Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124;MainStreet Fire Department signatureldate i rnnnnnPniTc 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 ®ANGEL Z®NE LITERATl1RE: Yes N® MGL Chapter 166 section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use El Notified for pickup - Date i I Doc.Building Permit Revised 2010 i Building Department The foVowing 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 Y 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 j ti ❑ Building Permit Application ❑ Certified 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 Re port (If Applicable) ❑ Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i 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 ITE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg� g P ermit i all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and roof of co ust be submated with the building application p recording Doc: Doc.Building Permit Revised 2012 j NORTH own of E 6 ndover No. 340P t4 - h � # ver, ssMa N9 *. � 20 1L T O LAN! COC NIC Nl WICK � A04ATEID s U BOARD OF HEALTH Food/Kitchen Septic System PER I T D THIS CERTIFIES THATV „�. ' .,.,,,�, ....... , BUILDING INSPECTOR Foundation has permission to er t .......................... buildings on � ue". i*m A.�... Rough to be occupied as ... .• qacctfing ...Rgug ftr. .. ....................... Chimney provided that the person this permit y 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 CONSTRUCTIO TS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Fina' 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 Nov 11 2012 2: OOPM MIKE SIDMAN 6039345514 P. 1 HOME LMPROVEMENT CONTRACT PLEA&Z RXAD THIS Bratchfi01d,Irarni6)ted elft ittstalled.luy: .i:igr)tet Roman Dater THD At-Home S.crric;s,1-- /� d/bia The Home Depot Al-Home Services 908 Boston'Iurnpike.Unit 1,Shrewsbury,MA 01345 'full Free(90D)657.5182;Fax(508)845.6U17 Branch Number:91 Vadcral ED 9"-26 itl460;ME]do*C 02439;RI Cont,4e0 1642) CTUe#NIC.0561522;MA Ildme Imprvvemcni Contractor Ret,N t2"93 InsWItathm Address: !� a�V� ,�Tl�.r .. ✓• A --- City State Zip pitrctlaser(s)' work Phorm darns Phone: _ Cell pbertel AJ Bnme Addras: _ --- --- ---- -- (If diftoront frttun lirstaliation Addinss) City State 'Lf Uill Adtlrear(to.nxcive pe'ojm coraMunicatims,and Homo Depot updates): n�eGbr r'y.0(.,�+m t �. 1 DO NOT wish to receive ury tnuriczting emaiia from Tire Home Deput ffl o t r, Vudatsigacd("Custumssr").the uwnen of the pt-npeny located at the above..instalintion addrers.agrm to hey, as At- ume ervicc3, Inc.("t'he Horne Dtpu+t")ogre"tofamit i,deliver and am net for the inaratl)ation("InsWintiou")of all materials domr1bed on the below and oft tho rt:t'eariced Spec Sheet(s),all of which are incorporated into tbiy Contract by,this reference,along with any applicable-State Suppie,Ltent trod Puyrntnt Summla�y attached hefew and any Change:Orders(collectively, "Contract"). labile- nm�n-ttlrfaasa; Pkat haste #1 PratactAtnuunt 45-601401,.4 RooRnt Siding ISM, ieerularlos ❑Gutter ,co'..mlemq M.,© rig $ Raofiax SidiOyLjwiadrnvs Inudseton ®Ouacrs Ccrvv,b MfAtfy Goers Q Roofing Siding 0 Winduwe Insulaiwa [)Gutters Cpwru [31intry Door+l l $ /�j+��;p� rh1frnR %iding Windows Imulatinn ✓I` ' QGuttens i cavtr� []Entry Ron;a n $ 1 Mahmao25%Depoill of Coaftwi;%motod due upon examtlou of thhuotract ^j Total Contract Atmrunt Malr14 PlleCtioaFB may not deposit I1pFe than une.tlihd of lYe 1:ottteatl Amaeent Custortatr a$km that,i wiedistely upon cornpletion of the work for each Product,-Cuturner.will executo It.Carrrplt:ti.otl Certificate (one for eaah•Praduc:l as defined by Litt indlividual Spec SNCL t)and pay uny bulanm due, -As apphivable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Mottle Depot Nbervcs the right to issue a Change Order or tet adnate this Contue-ct or any individual,Product(s)included herein,at its disunction,if The 9)zne Depot or its authorized service provider determines that it cannot perform ita obtigatioaa due to a struct W problem with the home,anvironmentai hazards such as mold,asbestos or lead point,other mtaty corn amR,pricing errors or because work required to complete-:the job was nor included in the Contract. PaaauoNt StrlluteptarrYt The Puyineett Summary# .7r 2LLrAL included as part of thio Contract.sets forth the total CoMagwnount and payments required For the deposit%and final payments by Prothtot(ae applicable), NOTICE TO CUSTOMER Varu are eniloAd to a comd+�11204n copy of the Contract at the dm yob"sign. Do not sign a Completion Certiflem(nota: there is one Complition a Bate for each IWW Product as defined-by inilMdual Spec Sheets)before worts on that Product is complete, In,the event of termination of this Contract,Customer agrees to payy The Home Depot the costa of materials,lobar,expenses and services provided by The Dome Depot nr Authwined Service Provider thimlEh the date of terrrdnatloo,plus an other atmunts set Hirth In thk Agreement or allowed ander appppl1imbla law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT F OM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT`S OTHER kSM>9D1'ESR p'Q lIECVvf~R)f OF SUCH AMOUN'T'S. Costumer agrees and understands that Ihia Aarecynorl is the entive agrearreat tmtwaan Custotmr and c Hv=Peput with regard to the Products and Installation r;crvices and supersedes all prior dii-&-tr ions wed agrcorricats,either oral or written,relating to said products and lnotaliation.This Agtocment=mot mot ire assigned or amended except by a wrW1lg tiigtted by Costotiror and Tha Honw Depot.Cuxtoaer tick-eowiedges and agrees that Customer has read,ultdt:rsEwtd&,•oluntarlly accept&tht. terms of and has rived u cupy of this Agmernent. Acct b : Snbmttted by: x 1! /e a- x !l IB J Gusto is Signature Dula Sales corigultheI Signature Date X Telephone No. "3— 3'OS_ dry CUSmme,'s Signature Potts Solea CdasuLtaat License No, - - CANCEi-LATIONI CUSTOMER MAY CANCPA, TM fA4 ap(dicabb) AGREEMENT WITHOUT PENALTY OR OBLICA,'T'ION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SVPIPLEMLN'T ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IN SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'$STATE. 14017 CE:APOrrIONAL TERNIN ANP CON4Dt11Oft!l ARB 00*0 ON THE RliVIIRBS RIDE ANP ARB PART OF IRIS CONTRACT 10-11-12 White—BrenahFila Yellow—Gpptomer r From:DZni yj�2'�� ,Fax:(603)505-4508 I To:+14014531367 Fox: +1401451,1367 Page I of 2 81141'2012 11:02 _ Board of Building Regulations and Standards Ci)n.structimi Super%i%&)r Specialty ...... License: CSSL-099823 DZ.N,IITRY BRO'VJN 70NORTON AVE Manchester NE OU Expiration 0612612014 The Cominotmea/th ofMassachuseft i�xl y; Del)artment of 1'ndustrialAccidents i w Office of Investigations 600 Mashing ton Street Foston,K4 02111 uvlvw.mass.gov/dia Workers' Compensation Insurance.Affidavit: Blunders/Contractors/Electricians/Plumbers Applicant Information Please Print Leaibl Name t,,',=siness/organization/Individual): y Addrer-;s: City/fi .i i,e/ ip: 303Nne#: Ar�yqh employer?Check the appropriate box: Type of project(required): employer with 4. [] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.[] 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' insurance.$ 9. ❑Building addition comp.[No workers' comp.insurance p• required.] 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumb repairs or additions myself. [No workers'comp. right of exemption per MGL 12.❑ Ro repairs insurance required.]t c. 152,§1(4),and we have no employees. [No workers' 13. they comp.insurance required.] "Any applicant that checks box#I 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. xContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: / l 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 penaltiesin 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 for surance coverage verification. I do hereby cert under e p 'ns a penal s of perjury that the information provided ab o a is tr and correct. I Si ature: Date: Phone#: Official 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#: } j J .......... 1 7 43fie? 'jj N 4 At, J�-C:lH FRO-MCEER.AND TH.E CEIR-FIFICATEE l�IIPaFTI"1-17 7 11 iks nin RE".0, kl.he � !J!u no., th�� tBnms�!mj ni U14,"x),IQy w loo'I'-lar In lirv'of Such,sndofsa'-nanz CONTA-0 �ql E: !"IC.N E-MAIL t —j a n t a :3',.,c C r". -A OD RE az. E-vio Alliance C:enter. 3560 Leno,- road, Suit-a 2400 2tlanta, GA 30326 INSUREP(5)A-;FDPDI7,jG CrjVEPAGF N A I G t, - pa�s (212) 943-0502 INSURER,'\: Steadfast Ino Co 26387 INSURED --'R a Pa-alprican Tn�" CO 1-6535 !NSURE The Home Depot, Inc. INSURER C; L'ampshire Ins Cc 23541 Home Depot U.S.A.; Ir.c. 2455 Paces Ferry Road ]TPI INSURER D: IllinoiS Natl Ina Cc 23817 Building C-20 INSURER E: NATIONAL LTUIC1,11 FIRE INS CO OF P-1-r-I'S 119445 Atlanta, CA 30339 Illinois Union In. CoI INSURER F 96 0 COVERAGESCERTIFICATE NUMBER: 25776028 REVISION NUMBER: 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 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. A_D_DL_F5U_BR P P POLICY EFF MIDDfYY I f POLICY EX INSR TYPE OF INSURANCEWVD POLICY NUMBER IM YY MMIDO[Y'IYY) LIMITS _LTR A GENERAL LIABILITY, GLO4867714-02 03/01/1 03/01/13 EACH OCCURRENCE $ 9,000,000 X DAMAGE TO RENTED 0 COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 1,000,00 CLAIMS-MADE OCCUR MED EXP(Any one person) $EXCLUDED .......... XLIMITS OF POLICY XS PERSONAL&ADV INJURY $ 9.000,000 OF SIR: $1M PER OCC GENERAL AGGREGATE $ 9,000,000 GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 9,000,000 X POLICYF�M F-]LOC $ B AUTOM0131LE LIABILITY BAP 2938863-09 03/01/12 03/01/13 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO BODILY INJURY(Per person)- $ —1 - ALL OWNED SCHEDULED BODILY INJURY(Per accident) $AUTOS UTOS NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accident SEL DR PHY DMG $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR H CLAIMS-MADE AGGREGATE DED RETENTION$ L WORKERS COMPENSATION /0 01/1 C WC615736915 (AOS) 01 1/1' 03/ 3 C 'r'P --XiT, AND EMPLOYERS'LIABIUTY YIN 03/01/13 Y Op WC019736917 (FL) 03/01/1 E.L.EACH ACCIDENT $ 1,000,000--.— HD ANY PROPRIETOPJPARTNERJEXtlu I I v a LN.I OFFICERIMEMBER EXCLUDED? 111 A E (Mandatory In NH) WC019736916 (CA) 03/01/1 03/01/13 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE 7 POLICY LIMIT $ 1,000,000 E Workers Compensation WC11 4 (QSI)i ..03/01/1 03/01/13 SIR (AOS)/SIR (GA) --1M/750,000 C Workers Compensation WC019736918 (WI) 03/01/1 03/01/13 F TX Employers XS Indemnity TNSC46566397 (TX)- 03/01/1 03/01/13 Occurrence/SIR 30M/1M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOME DEPOT U.S.A., INC. ACCORDANCE WITH THE POLICY PROVISIONS. 2455 PACES PERRY ROAD NW AUTHORIZED REPRESENTATIVE BUILDING C-20 ATLANTA, GA 30339 USA ©198 -`2010 ACbRD CORPORATIOW All rights reserved. rl,_ Ar'r%Pn n:%ma anti Inco are reaistered marks of ACCRD,.: Yk�r 'l��Q.f'9 K/.AEy��G'r`'t1l/`m�•.. J�, S'L:= , "E 9i.t.1LF.f.�.© and i ( 1. ku 85 ?fit 'e&ssa6h1�sP s. �i'�f•l C ra nt vre: 5�tp plement-Carc! . .p } )— f •! i �.� i,`l r)M �)F.:o� .FBsS k ,e +.�.^i f ;I i Q .-��.J' 1''�J) RNL ­690 CUMBERLAN, Cr r•'`rl � .dwv��w jJpdate�n'C_..:'sem E:Y1C x Cfu%n 1ra'Ycrenson:i'or Cl)AngC.• . r z Add esu _3 enesllai .E] .Emptayn►enf F Last Cnrd ✓T` � 'is:satien 4' , rJltfidul .s2 enty anse or reglstr& oa+ f ;Lic ;5 . r� before flea expie•ntlon nate. if s�vsbc rete¢n.fo 1fi7`�`"o ir1F4tE)NIPF:G1/�J111 Iii i CONTRACTOR. office of Consumer Affairs al u Bali-Jess Rc eta:Ion +>I t�� �. r c)�crAf�cit�` �2df3 s 7 y ". Ylao101DarYcPlaaae»Suite,SY70 1„ c, 02116 L tG: f Scx.Ylrat(pn. ;'p Form �pieman[Care l�bms@oras llrt�l. y . r m h i'�m;n Di,.,�ot'}ai t-t�t•1e :3�f.i6s � .. ,`: ,�� !2rj F��LLC9hl yif t /f — 01a }n l; of vnlid Ivit`411 e s" 7iat 1 e� P GA:311.�'i .... UiS[i L'•."S."'.r:ieRr�J. ..