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Home My WebLink AboutBuilding Permit #239 - 121 HERRICK ROAD 9/27/2007 BUILDING PERMIT 0 poRrh q tt�a° 'a ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * ,� Permit N0: 33� Date Received "`"""'"`"" Date Issued: ' ��.V IMPORTANT: Applicant must complete all items on this page LOCATION '- t L '?-d Print PROPERTY OWNER Print MAP NO PC) PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne farm Addition wo r more family Industrial Alteration No. of units: Commercial Repai replacement Assessory Bldg Others: Demo 10 Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: gei_2102 44k)1rX-_qoG0S tjymj! ntification Ple s ype or Print Clearly) OWNER: Name: p Phone: Address: �-e rr tr✓'� CONTRACTOR Name: ori Phone: �,—I g- S ePR-�7Go Address: 1.t=, e�►c,�e c�wvf� ` � cc�ecc � Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: -3�c�$! 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: $ �y Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund !� Signature of Aggnt/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 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 - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date i 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 2 1 A—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 E3 Photo Copy Of H.I.C. And/Or C.S.L. Licenses E3 Copy of Contract o 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 o Building Permit Application o 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 a Mass check Energy Compliance Report (If Applicable) o 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 o 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 �C7y No. � ' Date NORTp TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ sACMUs<�' Building/Frame Permit Fee $ 30 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # zob %kd S Building Inspector SEP-25-2007 12:10Pi1 FROIFHDME DEPOT 978 640 4206 T-204 P.004/004 F-754 11UME 1N1rKUVt'Mt;N'1LUVN'1'RAU1' Sold,Furnishtd afld Installed by' Branch Name: ��_Date: g(azl rr7 TFID At-Home Services,Inc. tt" d/b/a The Home Depot AT-Home Services 345A Greenwood Street,Worcesicr,MA 01607 Branch Number: , _Job#: Toll Free(800)657-5182; Fax:508-756-2859 Fedcrxi iP#75-2698460 ME Lie tl C 02439 Ri Cont.Lich 16427 CT Lic#565522.• MA Home improvement Ctmuactor Reg.6126893 Installation Address: 2 �4 ,_h A)/.Q,.LfL-�l S'e�S City state Zip Pur clWs s) Last 4 Digits of Driver's Lie.#&E .Mo/Yr Work Phone: Home Phone: 1A I (t'7y)frr,.�i n (fW)6W_ Home Address: '3b. (If different from Installation Address) City State Zip E-mail Address(m receive updates and promotions from The Home Depot): Project Information: t/We/You(`Petrchasee),the owners of the property locawa at the above installation address,offer to contract with THD At-Home:Services,Inc.("Home Depot")to furnish,deliver and arrange fpr the installation of all materials as described on the attached Spec Sheet#3'ty f L ,inoorporated herein by reference and made apart hereof. Home Depot reserves the right to cancel this eouttmct if,upon reinspection of the job,home Depot determines that it cannot perform its obligations due to a structural problem with the bome,pricing errors or because work required to complete the jab was not included in the Spec Sheet or Contract. 13. N►tr,X1,% ". z�,E i•.lraK DEPOSIT PAYMENT OPTIONS (Subject w fiord verifwarion and/or credit approval.) CONTRACT AMOUNT $ I. Check•,Cashiers Check crus lh stul Service Money Order I (Made pxynblc to The Home Depot). (LESS DEPOSIT S M f - -� z Credit Cant*+andror other prymcm optics-Cade Om Below BALANCE DUE (� ( Visa MasterCard Discover American Express ON COMPLETION $ / 9 b The Ham Depot Home improvemmi Loan The Home Repot Cerate Card tMiatmam 25%of Contract Amount due upon 0 New Atrnurt u Existing Amount (JUL&HDCC ONLY) execudon ofthis conwmeL Arralahle Ctedic s l0 03 (ffiL&HPCC ONLY) Indicate Payment Method For Acatu:&#?a T.}ax )M SAW Exp.Date: BALANCE DUE ON COMPLETION: Name as h appears on recd:�,a-/�7��.'h ._ •*By my/our signature below,T/We agree to allow Home Depot to chargeXbove referenced qrqt card for the deposit indicated. 'When you provide a dheek as paytncnr,you authod w as either n `� to use inrotmntion from your check to make a one-time elearnnic eirdholdcri'siJdaturc Dan find transfer from your aou mr or to process the payment As a check nausaction.When we use information from your dke&to make an decmnnin fwd transfer,funds may be widxhuwa from NII+or HDCC Authorization Codes yow account as soon ut the psymrnt is received,and you will not DC Final Payment receive your check back, # # Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance duc. Purchaser also agrees Lobe jointly and severally obligated and liable heratnder. Entire Aereemer}t 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 panics. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-an 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. taw prohibits home repair contractors from requesting or accepting a Completion Certificate signed by dee owner prior to the actual completion of the C work t4 be fottined under fisc OntYACt. P Pct You may cancel this transaction an time prior to Midnight of the third business da after the date of this contract See Y Y P S Y Notice of Cancellation for an explanation of this right. There will he a service charge equal to 10%of the contract xP rIg . erg amount if job is cancelled by Purchaser AFTER rhe third business day,but BEFORE mateeWa 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 IIWE AUTHORIZE HOME DEPOT TO VITRIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILTTY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATURE BfLAW, 1/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. UWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. SUBMITII?D BY: ` Date:1912 21a-7 Cprtgutdstdt ACCEPTED BY: I A tx Date:V_01/4) tehascr " Fain: Purchaser NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE S'T'ATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT G1-07 .av4-2-07 CSC Whita—tvanah FBo Yabw—Customer Pink—Sales Consurtant NORTH 0 0 � _. Andover - _ _ _ TNo. Z 3 06. - 4` o dover, Mass. T 0 - LAK 1 1 COCHICHEWIC K �� 7�S RATED PC.7 BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............� ......... �. .........................................�................................................. Foundation has permission to erect........................................ buildings on ......1.24...... ...... "'............ Rough to be occupied as.... K !!! � 4! • Chimney provided that the person accepting t s 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 �O PERMIT EXPIRES IN 6 MONTHS - ELECTRICAL INSPECTOR UNLESS CONSTRU N TARTS 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. AT-HOME Installed SERVICES Siding and Windows Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2008 THE Home Depot At-Home Services BUNROEUN CHHOUY 3200 COBB GALLERIA PKWY#200 AtIANTA, GA 30339 Update Address and return card.Mark reason for change. 'S-cA1 C, SOM-05/0.&Pc8490 Address El Renewal [] Employment Lost Card nLl ✓fie �am�noozu�ealtlz o�',il�aaaac�uaelta - 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: 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 ATJNROEUN 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 CERTIFICATE NUMBER 111YA,/l"llRSH r GEiT �ICATE'OF { CSt�RAIC:E 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 hOrl'ledepOt.CertreGUe51c0I11arsh.COt11 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 00492-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 Iu COVERAGE zr rs Cettlfi1 supersedes ndtep[aces any preinQusly issued cerfl$Gate.,oC the,pof ey,period,n�f�d below, 2 w. m ... . 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. _ POLICY EFFECTIVE POLICY EXPIRATION LIMITS CO TYPE OF INSURANCE POLICY NUMBER LTR DATE(MWDDIYY) 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 AI 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 neire FIRE DAMAGE Ano ) $ 1,000,000 MED EXP(Any oneperson) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 29381363-04 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 I $ (Per accident) NON-OWNED AUTOS —�---- -- XPELF-INSURED AUTO PROPERTY DAMAGE $ HYSICAL 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 UMBRELLA FORM AGGREGATE $ 5,000,000 OTHER THAN UMBRELLA FORM $ 77777 C WORKERS COMPENSATION AND 2921209(CA) 03/01/07 03/01/08 X 1 TORY uMTirs DBR .,.:. .-.';:.... EMPLOYERS'LIABILITY 1,000.000 ' E 2921210(FL) 03/01/07 03/01/08 EL EACH ACCIDENT $ �_— F THE PROPRIETOR/ X INCL 2921211 (AZ,ID,MD,VA) 03/01/07 03/01/08 EL DISEASE-POLICY LIMIT _ $ 1,000,000 PARTNERS/EXECUTIVE D OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE $ 2921208(AOS) 03/01/07 03/01/08 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-044642086(TX) 03101/07 . 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LIABILITY SIR 2,000,000 DESCRIPTION OF OPERATIONSILOCATIONSNEHICLESISPECIAL ITEMS I Y° `CERTiF(CA,TE 140L0ER , x ' ' � x w•� SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL_30.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: MaryRadaszewskiyr;7:t VALID AS 0 02/28/07 g x i F M � ne I-ommonwealth ofMassachusetts Department of Industrial Accidents x Office of Investigations 600 Washington Street _ Boston,MA 02111- N yV,ti www.mass.gov/dia 191DWIT Of ArlingtDll Workers' Compensation Ins Applicant Information urance Affidavit: Builders/Conm tractors/Electricians/Plubers Please Print Le ibl Name (Business/Organization/Individual): Address: �jl-l`� - City/State/Zip: l,t 7n Phone #: '1 6 -15 ei AV ou an employer? Check the appropriate box: 1. am a employer With. 4. ❑ 1 am a general contractor and I Type of project(required): ami loyees (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. 1 2• [Remodeling ship and have no employees These sub-contractors have working forme in any capacity. workers' comp. insurance. 8. 0 Demolition [No workers' comp. insurance 5. ElWe area corporation and its 9. [1 Building-addition 3.❑ required.] officers have exercised their 10•❑ Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c.'152, §1(4),and we have no insurance eequired.] t. employees. [No workers' 120 Roof repairs 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 1Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers' workers, comp.policy information. I compensation insurance for my employees. Below is the policy and job site am an employer that isproviding information. Insurance Company Name: �� 1 0 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 of up to$250.00 a day against the violator. Be advised that a ccivil penalties in the form of a STOP WORK ORDER and a fine copy of this statement ma Investigations of the DIA for insurance coverage verification. y be forwarded to the Office of I do hereby certify,under the pains and penalties of perjury that the information provided above is true and correct Si ature:_ Date: Phone#: '---� Oficial use orrly. 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 actor 5. Plumbing t ng Inspector6. 011ier Contact Person: Phone#: