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HomeMy WebLinkAboutBuilding Permit #310-13 - 13 HARWOOD STREET 10/15/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: to _ I L_ Date Received Date Issued: 1 lC;l lZ IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER��,� �tPJ - Pnnt 100 Year Old Structure yes N MAP NO: PARCEL: ZONING DISTRICT: His isfiict ye chine Shop Village yes TYPE OF IMPROVEMENT PROPOSED Residen ' Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alt ion No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic D Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPT ORK TO ��TIED'l JAP46fication P ease I r Print Clearly) OWNER: Name: Phone: Address: CONTRACTOR Name: .. l�f�� k��Phone: Address: Supervisor's Construction License: C*1Exp. Date: 4.1/f 114 Home Improvement License: Exp. 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: Check No.: Receipt No.: r NOTE: Persons contracting with unregistered contractors do not have access the u ran and Signature of Agent/Owner Signature of contr or Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 0 S a ped Plans ❑ 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 COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments I Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT =Temp Dumpster on site yes no Located at� 41Main Street: _ F Fire Department signature/date COMMENTS i 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 2010 I 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 a Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report Li 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: Doc.Building Permit Revised 2012 Location ( � 1 `"r t1w C;) G1 ' No. 3 Date • - TOWN OF NORTH ANDOVER . Y10)1 ff' s Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Check# 25837 Building Inspector NORTH Town of � E : ., 6 ndover No. o�— - 03 � zn _ -- _ % h ver, Mass, d I 'L-- c0c.41c..ew.cw 1' �d A�RAT E O S IJ BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT (7— J. 1�.a.......� �t.�:! :, , ............................... BUILDING INSPECTOR .......................... ............ ............... Foundation has permission to erect ............................ buildings on ..... . ..... 12:w.v.O.0 .........�.r............. .., Rough tobe occupied as ..........1.........� :':.. ........IN.I1'tG1;0 ................................................................. Chimney provided that the person accepting this Permit shall in every 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 S ELECTRICAL INSPECTOR UNLESS CONSTRUCT RT Rough Service ..................... ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE OCT-5-2012 22:35 FROM: TO:18009863610 P.1/7 HOME IMPROVEMENT CONTRACT PLEASE READ THIS J / Sold,Furnished and Installed by: Branch Name: Boston Date: �a/'2r /1� THIS At-Home Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Toll Free(800)657-5182;Fax(508)756-8823 Branch Number.31 Federal ID#75-2698460;MF.1_ic#C 02439;RI Cont.Lic#16427 Cr L,iic 41 HIC.0565522;MA Hume Improvement Contractor Reg.#12093 Installation Address: 4-� �l-n Ni9j. ,�v�r l2 /9 t Z A6' City State Zip t�urc99haser(c): �) Work Phone: r- Home Phone: Cell Phone: Gt 1r1. �. _!tSJ 1177j] l'(/tSJ�TiSs�' I I Home Address: (If different from Installation Address) City State "Lip Amail Address(to receive project communicalion5 and Home Depot updates): I DO NOT wish to receive any marketing emails from The Home Depot Pro.icet Information: Undersigned("Customer'),the owners ul'the property located at the above installation address,agrees to buy, and T14D At-TTome Services,Tnc_("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Sheet(s),all of which are incorpnmred into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): doh#: o""''d Rd6"'r Products: Spec Sheet(s)#: Project Amount Rooting LJ8idjng.N Windows U Insulation 2 $ ©Guucrs/Covers []Entry Doors ❑ 5_72>74>44- Rooling ElSiding 0 Windows 0 lu'ulalion $ .•JJ���� OGuttorr/Covers DE�ntry Dom RW,-MW, osidipg In windows M Imulatiun []Gutter:/Covers OEntry Doors[I $ - -- -- Rooting OSiding WiWo_w_F_.0 Insulation ©Gutters/Covers ClEntry Doom [3- $ Mlnlmum 25%Deposit of Contract Amount due upon executhm of this amb-ad 1'u491 Contract Amount $ tt9tshre t'urchawis may not deposal more than ure4h¢d nettre t:entrar4AmnmrL Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by tut individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Pf0dLiCt(S)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it Cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,ashestos or lead paint,other safety concerns,pricing errors or hecause work required to complete the job was not included in the Contract. Pa ment Summar 1S The Payment Summary# 4 701)3 , included as part of this Contract, sets lurth the total Conduct am(runt and payments required for the deposits Fuld Proal payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Hume Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms ofmid has received a copy of this Agreement. Ac cc Submit by: X c/ Lb/��_ X �� Cu, mer's Signature Date Sales Consultant's Signature Date�— X Telephone No. Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (as applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DF,POT BY MIDNiGHT ON THF, THTRD RiICTNFSS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHFD HERETO CONTAINS A VORM TO USE IF ONE IS SPF,CTFTCAT.LV PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON JHh.RF,VVRSR SIDR AND ARE PART OT TIRS CONTRACT 04-11-11 C-SC White-BranchFas Yellow-Customer I {I)! All Y. n ,WV1.0- k UTQ u n a v B U d Dr.ers p en,j Name (Business/OrganizatioiVIndividi-,ail,; Addressc D Art� City/Statei'Zip: '30-WI Phone#:_ Are you an employer? Check the popropriate box: Type of project(required): 1.9.. I am a employer with 4. ❑ 1 am a general contractor and 1 6. []New construction ' have hired the sub-contractors I employees(full andVr part-time)-* listed on the,attached sheet. 7. C]Remodelin 2.❑ 1 am a soleg proprietor or partner- These sub-contractors have 8. [-]Demolition ship and have no emplqybes employees and have workers' working forme in anycapacity. 0 9. D Building addition comp.insurance. [No workers" comp.insurance additions S. ❑ We are a corporation and its 10.0 Electrical repairs or required.] I l.n Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their mbing myself. [No workers' comp. right of exemption per MGL 12.®R repairs . 152i §1(4),and we have no insurance required.11 c13. Other MAY)2Z employees. [No worker-.' comp.insurance required] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homedwriers who submit this affidavit indicating they are doing all work and then hire outside contractors must submit-a new aMdavit indicating such. # additional sheet showing the name of the sub-contractors and slate whether or not those entities have. .Contractors that check this box must attached an employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. ......... am an employer that is providing workers'compensation insunvice for my employees. Below Is'the po IICY and Job site information. Insurance Company Name:, eco —Ila Policy#orSelf-ins.Lic.M ul C o 1 1 f1300 Expiration Date: Job Site Address- �j I city/State/Zip: Attach R'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_pbnalties 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 Dkk for insurance coverage verification. I do hereby n certify shies oof*riury that the Informadon provided abope true and correct n A" RIP Signature- Date: Phone .Q lclal use only. Do not write In this area,to be completed by cagy or town officiaL City or Town; Permit/License ssuingAuthority(circle one): 1.Boar.d of Health 2.Building Department 3.Ctty/Town Clerk 4.-ElectricaUnspector 5.Plumbing Inspector 41 6.Other k x C_ I A ........ F 'Ell {}ES NOT 'OR NECATiVELY G,R Lf_E R' iriLi' BEL01.111. THIS CERITIFIC.ATE OF HNSUIRANCE DOES N07 C01S7."17U,'M C,. RF -PRESENTATWE OR PRODUCER,AND THE CERTIFICATE HOLDER. IT 31j, 1­0,a�\-T!C, lit ths tarms and corditio'ns Di tiip- poficy,certain podcic-3 ala.v rqulrs a;'l A oan"N 3 J_ ns no-'-- con"le-, ;`qih.'�',,n 'I ji rn_;q,-I-'� _1 ifica,­jjQjj-af 1ji iieaii rf s)udh andiwse 'n� 1-36"0 95S-.6L CONT ACT ilAill XarG'n UST.. _Enc PHONE N 1 1: jAl; fAjC.N ,AIL com A ".33: Two Alliance Center, 3560 Lenox Road, Suit 2400 INSURERSj AF-FORDING COVERAGE L NAIL 9- Atlanta, GA 30326 Fax (212) 948-0902 INSURER A: Steadfast Ins Co 26367 INSURED INSUPER B: Zurich American ins Cc 16535 The Home Depot, Inc. INSURER C: New Hampshire ins Co 23341 Home Depot U.S.A., Inc, 11 2455 Paces Ferry Road NW INSURER D: Illinois Natl ins Cc 243817 Building C-20 INSURER E: NATIONAL UNION FIRE INS CO OF PITTS 119445 Atlant,d, GA 30339 _Ins Co 27960 INSUP,ERF: Illinois Union REVISION NUMBER: ­EOVER4�GE7S CERTIFICATE NUMBER: 25776028 — 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 13 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. – —) ADDLSUBR POLICY EFF POLICY EXP TR PE OF INSURANCE POLICY NUMBER (MMIDDIYYYY) (MMIDDNYYY) LIMITS A GENERAL LIABILITY E-04887714-02 03/01/1 03/0.1/13 EACH OCCURRENCE $ 91000,000 DAMAGE TO REN COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurencs $ 1,000,000 r_1__I MED EXP(Any one person) $ EXCLUDED CLAIMS-MADE I - I OCCUR W_ Z7� $ 9,000,000 X LIMITS OF POLICY XS PERSONAL&ADV INJURY X OF SIR: $1M PER OCC GENERAL AGGREGATE $ 9,000,000 G,ENI AGGREGATE LIMIT APPLIES PER: PRODUCTS COMP/OP AGG $ 9,000,000 X POLICYF–]jPRO- -F LOC $ 03/01/1, 03/01/13 C (EM BAP 2938863-09 OBINED SINGLE LIMIT B AUTOMOBILE LIABILITY a accident) - $ 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ — ALL OWNED F---J*SCHEDULED BODILY INJURY(Per accident) $ — AUTOS AUTOS PROPERTY DAMAGE NON-OWNED (Per accident) HIRED AUTOS AUTOS X SELF INSUR DR PHY DMG UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR 1 -1 CLAIMS-MADE AGGREGATE $ DED.I I RETENTION$ $ C WORKERS COMPENSATION WC019736915 (AOS) 03/01/11 03/01/13 X V' STATU• 0TH" AND EMPLOYERS LIABILITY YIN D ANY PROPRIETOMPARTNERIEXECU11VE WC019736917 (FL) 03/01/1 03/01/13 E.L.EACH ACCIDENT $ 1,000,0no ❑ NIA OFFICER/MEMBER EXCLUDED? E (Mandatory In NH) WC019736916 (CA) 03/01/1 03/01/13 E.L.DISEASE-EA EMPLOYE O$ 1,000,000 If ns,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below SIR (AOS)/SIR (GA) IM/750,000 E Workers Compensation WC1192494 (QSI) 03/01/1 03/01/13 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/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 ROADNWAUTHORIZED REPRESENTATIVE BUILDING C-20 ATLANTA, GA 30339 USA C 1981;'2010 AC 0RD CORPORATION. All rights reserved. Tu. Amnon -1 I,nn aro ronli-ztprad marks of ACORd", O fit:e of Consumer Affair and Business Regulation (�. = 10 Park Plaza - Suite 5.1.70. Boston, ssachsetts.02116' T�loizie T�mprove . ' ontiacto�r'Registi .tion Repistratlon: ..12138$3 ; Type: supplement Carr1 Explratlon: 6/3/2014 At-Home Servi `" The Home Depot _. RICHARD _rALLQNE 26,9D CUMBERLAND PARKWAY m� 'r y a 1;0 ATLANTA, GA 30339 . v , Af ;y4�� Update Address and return card.Mark renson.for chnngc. (� Address Renewal Q .Employment (�] Lost Cnrd bFs-C;�i �d 50PA•U4IOh•G101218 . ✓Iia (pamto�wouu¢a �.�f /, .. �s ti duce otConsumer Arfntrs RcSusmess Regulation Lieonse or registration vatid.far lridlt idul use Only before tlta expiration date. If round returntoe OME IMPROVEMENT CONTRACTOR Office of Consumer Aflalrs and Business Regulation .� Registration. .126803 9 .Typo: 10 Park Plazn-Suite 5170 supplement Card. Boston MA 02116 ' Expiraf(tin~ ' Supp � ., . The Home Depot:AI-N4fne: _erVlF�es RICHARD FALLf5N0 ?ti 2690 CUMBERLAIQ.'!?A�2IZE�1i/A`�5 fj Cqt l�a,`GA 30339 '! '.'` of Valid lYith ut sl nature Underse.eretnry - � i .s 4.✓ �1 ��T "i•,� ��1` tti�e�<�"�,�e� '' '- z�'�^ ��J� '�i`�`�� ``j .,�, y�� �' "t^` '"������ ��t� 3 y.d�"',��3%�'Yi3�s ro"'< r`y4 s��•a� "`�'"���� '1 dk � .�^a g� 'i''+ e+k.� ,� �� •i..rx 1 � .:�.,�'� `4x � .d f\, �_¢ ^.al y3 risk .: `�'�`Y+'$,. } V�' c"hca�~.t�cs^.. .+Y6��`�� §�•r�•�.f t� rayt�:m .�YrM 3ft ,.�-..�'F"5 �ir"�¢t'�k i"°t•,i�ro�C M'i tea v;'ji,�.�,�rs ts.ayAtc�u 'bt"�� "� •'� � � n ve ^ •�eu.+�r�9 e� ?t�3 a c � :t r 5 7 t A i a�.._ t �r f i�W 9 1 '+n'1. �3 '�]%t.� .G 1 y M^ _ 4 h r�'MeEV'w�b {• ,N a 4El. e. $ k 4 ti f4 SAaka .,, i t v 41�a'Fa7�S'�' 3 W r f i Ili VIA ji s� y+Y�• p� ,.��'°N. �'�'�'� lav �' ��'C�'3^I.•� � >:, fu ".� � n ,,,. ,c hj:.Fle .. ray,�, �,,, �wf�` �' 1.°p.�". 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