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Home My WebLink AboutBuilding Permit #383 - 13 MAY STREET 11/8/2006 TOWN OF NORTH ANDOVER i APPLICATION FOR PLAN EXAMINATION OR 4,L.190 pORORT►� q4• ? •6 22 0 Permit NO: J Date Received e^ � O*q 9 SA Date Issued: ��D � s CHfJs��y IMPORTANT: Applicant must complete all items on this page LOCATION J— A,/ s�///011A Print PROPERTY OWNER_, Print MAP NO.: ' PARCEL: L3 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ne family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: C�epair, replacement ❑Assessory Bldg ❑Commercial ❑ Demolition ❑ Moving(relocation) ❑Other ❑ Others: ❑ Foundation only DQQCRIPTION OF WORK TO BE PREFORMED 1�1 V P ccs gezr_Ct_1 y Identification Please Type or Print Clearly) r^ OWNER: Name: , / A-pS I'd"` 1&,,;�s Phone: 1 77 -6 Address: / mover 01Ae,5 CONTRACTOR Name: �• S� \_2x A(Ilaplm _1�k Phone:19-e-636 3 11 Address: &C Lea Supervisor's Construction License: G�4 ro O Exp. Date: o��/ G 7 Home Improvement License: C7 Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE.BULDING MIT: ,2 0 POR,$,(Q11,0.00 OF THE TOTAL ESTIMATOPx SED ON$125.00 PER S.F. Total Project Cost :$_ _1�_ J ((JJ FEE:$ CheckNo.: �3 �i Receipt No.: Page 1 of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools 11F1Tanning/Massage/Body Art ❑ g Public Sewer Well F1Tobacco Sales 11Food Packaging/Sales ❑ ❑ ❑ Permanent Dumpster on Site Private(septic tank,etc. Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Ovvner Signature of contractor 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 ❑ ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit ❑ Other COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTI4 ❑ ❑ 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 Temp Dumpster on site yes—no— Fire Department signature/date Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided- Dimension rovidedDimension 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 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan.2006 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 i I permit was required the Town Clerks office must stamp the decision from the In all cases if a variance ors ec a P P q P 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:BPFORM05 PaaP 4 of 4 Location No. SE& Date 140IITh TOWN OF NORTH ANDOVER f • OA ` Certificate of Occupancy $ 9 CHU Building/Frame/Frame Permit Fee $ s�cMust Foundation Permit Fee $ t Other Permit Fee $ TOTAL $ Check # 19787 gilding Inspector t r �•• a Jul 13 06 08: 28a NORTH ANDOVER 9786889542 p. 3 TYPE OF SEWERAGE DISPOSAL - Swimming Pools Tanning.'Massage,Body Art _ Public SeNYer V - Tobacco Sales — Food Packaging.-Sales Well •- _ — Permanent Dumpster on Site Private(septic tank.etc. Electric deter location to "Y project NOTE: Persons contracting with unregist ed contractors do not have access to the guarantl•fitnd Si17nature of A =enVOwner. Signature of contracto/ it - Plans Submitted Plans Waived Certified Plot Plan Stamped Plans J THE FOLLOWING SECTIONS FOR OFFICE USE ONLY ; INTERDEPARTMENTAL SIGN OFF- U FORM fir, DATE REJECTED DATE APPROVED . PLANNING & DEVELOPMENT ❑ ❑Water Shed Special Permit ❑ Site Plan Special Permit X. ❑ Other COMrvIENTS x= DATE REJECTED DATE APPROVED CONSERVATION COtvINIENTS c DATE REJECTED DATE APPROVED HEALTH m COIL'YE •LENTS Zoning Board of Appeals: Variance. Petition No: 7.011111 Decision:recr:ipt submitted des 111annin-, Board Decision-. Comments Conserkation Decision: ,Comments Water& Sewer connection.Sgnature& Date Driveway Pcnnit Tcmp Dumpster on site yes no Fire Department signature date w N0 K UPI '9 of ,. 4 Town -.�_ _ _ - Andover 0 No. .393 -774 z O L A dov r / �- , COCMICMEWICe , Mass., �d ADRATE D i`P�`t�� 1S G G BOARD OF HEALTH PER Food/Kitchen Septic System THIS CERTIFIES THATVBUILDING INSPECTOR �. Ale .. .... r . ..... . Rplkat6nlr-o�ni Foundation has permission to erect........ •••••••.••...............:buildings on .. .. ... .. gh to be occupied as........... .. .... . ... .. . .. . . .... uprovided that the erson ac In � Chimney this oNice, and to the rovisions g is permd shall in every respect conform o the ter of the aile in p of the Code end -Laws relating to the Insp%ction, Alterationand Construction of Final Buildings in the Town of North Andover. �� 3 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION TS ELECTRICAL INSPECTOR Rough .. .... .......................... Service .. .. ......... ......../100z .............. UILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove Rough No Lathing or Dry Wall To Be Done Final Until Inspected and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. SEE REVERSE SIDE Smoke Det. WLlil AM SAm nlir L Customers Last Nem,First Name atote No. Order No. e6 reSe VV e- ,q,vindVCe, c /� e: 15 ' p BiIIInyMailina Addreaa(If d grant Irom arvlos —me) C at s aygms el,No, uetomar'avanldg Tel.No. Sb '� Q ustamera Drives Icense o,or State IdandRaatlon No, CUSTOMER'S INITIALS: 9Y INITIAI.INO,YOU AOgEEE THAT BY YOUR SIGNATURE 6EIAw,FAME DEPOT,ITSAFFIUATES,OR AN AUTHORIZED REPRESENTATIVE MAY CONTACT you 6Y PFxN1E,FAX OR EiAAIL ABOUT OTHER SERVICES THAT MAY aE OF INTEREST TO YW,YOU MAY ALWAYS CHANGE YOUR MIND LATER;JUST LET U6 KNOW, Prlmary Account Number: oma D Prlmary paymentMethod; [�ChecklMoney Order epot Ct"PhOme Improvement Loan ❑AMEX 0 Dlscover ❑MBOURCard ❑VISA Explretlon: / �° y PAcc0 t .tllod C�ecklMoney Order ❑Nome Depot CerdlFlome Improvement Loan ❑AMEX ❑Discover ❑MasterCard ❑VISA Secondary Account Num''6er\\: Expiration: / You agree Your payments will become due on the dates Indicated below and,if You are paying other than by cheeccck or money order,may be automatically charged or deblted(as applicable)to Your designated account(s)when due. Down Payment: f $ ,� Due imrnornatety.Your down payment is NOT an Inetdmem payment under this Agreement. H Final Payment: �3 $ Due on finish date(see below)of Installation. lb• Sales Tax: $ A-• If applicable, Total Amount of Sale: $ Includes all applicable discounts,rebates,and taxes.Excludes finance charges,' 'Any interest payments or otherfinance charges will be determined by your separate cardholder or loan agreement,to which Home Depot Is NOT a parry.Please see this Agreement's General Terms and Conditions for more details as to other charges that may apply, f�SI6lpeted Inetella Inn c�►„ Please note that neither Home Depot nor Installation PTofessl0nal are responsible for delays resulting from events beyond Start Date: Q/_V/ their control including,but not limited to,Changa Orders,incorrect information You provide,legal encumbrances on Your IOPDX71 l f CP L or any tthhlyd partieOr its s,aborstiff$,h'ddaNulnt reseen Phys ctal/hang zardous conditions,iuirements,Your ncluding,but not limited to,enacts;of natu%vironmental Finish Date:._./ hazards such as mold,asbestos and lead paint,or Your noncompliance with this Agreement. 94nh :"You"P'Your"means the customer Identified above."Installation"meansthe Installation services specified In this Agreement."Installation Professional"or"Professional"means an independent contractor authorized by Home Depot(licensed and insured as required by Home Depot and applicable taw)and the contractor's employees,agents and subcontractors."Agreement"means this Special Servlces/Home Improvement Agreement between You and Home Depot U.S.A.,Inc,(Interchangeably referred to as"Home Depot"or"EXPO Design Center"),which Includes this page,the General Terms and Conditions following this page,the State Supplement,the Invoice or Specifications and any other documents expressly made a part of this Agreement,Please see this Agreement's General Terms and Conditions for additional deflNtions, ACSBptal M4—k(AU1h9-1JWjon:By signing below,You authorize Home Depot to(a)arrange for Installation Professional to perform Installation and/ or(b)order and arrange for the delivery of special order merchandise,including special order merchandise that may be custom made,as specified In this Agreement.You understand this Agreement constitutes the entire understanding between You and Home Depot and may only be amended by a Change Order signed by Home Depot(or by installation Professional or its authorized representative on Home Depot's behalf)and You.This Agreement expressly Supersedes all prior written or verbal agreements or representations made by Home Depot,Installation Professional,You,or anyone else,Except as set forth in this Agreement,You agree there are no oral or written representations or Inducements,express or Implied,in any way condlNoning this Agreement,and You expressly dleclaim their existence.Do not sign if blank or incomplete,(installation Profeasional'S/ Permitting Information may need to be provided to You later,)By Slgning,You acknowledge that You have read,understand,and accept this Agreement In s entirety,You further ILCknowledge reeelvin cca d by: �g a complete copy.Keep h to protect Your legal rights. PdmA (J•_i iofWsFull 9~rd*NamE,Aft wandUmm—W,a r 14—m as AWcft, Custody , CUatadlaric,"PADITRIESS al9: Date TO SE PROVIDED ABOVE WIi7 OU�OBTAINING OE VERYRIZE DELIVERY OF CAGENT'$HANDISE LL Ettrft—,(��— SIGNATURE AND AGREE TO INDEMNIFY AND HOLD HOME DEPOT HARMLESS FROM ANY RESULTING CLAIMS. Pralersbnel'a Tel.Na, "`��' b.S^ Submlttedby: Q HomeDapotAaaoclate P eealonaUA thorized Re eanteilve on Nome Depot's Behalf 9F16- ,p A; yANdojPRIN tap a' 11$Igdalure Dste ` Q— C) I•l Aasaciala RepresenylWe:Weasur Salesperaop'e Licanre No,it ApAadk ASAOCIateRapfP.aentaave:Pledf PRINT Cur a in FWI 10 CAeok ApplkeWe Bos AaovO ' HOME DEPOT'S To CANCEL 6 E GENERAL TEeMeI ONDITIOxe �+s•>se,ttmal DISTRIBUTION:White—Homa Depot Copy Yellow—Customer Copy Pink—Installation Professional Copy r 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: 123392 Board of Building Regulations and Standards One Ashburton Place Rm 1301 Expiration: 2/11/2007 Boston,Ma.02108 `Type: Supplement Card US REMODELERS`INC-d.b.a FAC 5AY'FAWRELL 405 STATE HIGHWAY 121 BYPAS J �� ElrVilfS1AttE,TX 75067 Administrator Not valid without signature Alm -Co Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Registration: 123392 Type: Supplement Card Expiration: 2/11/2007 US REMODELERS INC-d.b.a FACELIFTER -- DAN FARRELL 405 STATE HIGHWAY 121 BYPASS STE, 2 Lewisville, TX 75067 Update Address and return card.Mark reason for change. DPS-CAI is 5OM-04/05•PC8698 � Address Renewal Employment Lost Card 4 ' - ��C L/6971/I1t47tlUCQG6�G O��lQ,ddC�G�[ldP�d BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Number: CS 070960 Birthdate: 09/25./1966 ,Expires:09/25/2007 Tr.no: 4319.0 Restricted: 00_ DANIEL H FARRELLYVt 101 POPLAR ST',.-.,\ TEWKSBURY, Mk-01876 " Commissioner 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/P)umbers _A 1p Rlicant Information Please Print Legibly Name (Business/organization/Individual): U. s- Re— I i a e,�ey S —Tva Address: CitylState/Zip: 1 so 5 �L d bq l Phone#:1 Co— 3 H r Arre,pu an employer? Ch ck he;appropriate box: Type of project(required): 1.LvJ I am a employer with X 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet $ ? ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ 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 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information: I Homeowners who submit this affidavit indicalg 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 information. I am an employer that is providing workers'conyensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 0/t) C- Policy#or Self-ins.Lic.#: f [ ! 1 Expiration Date: 6� 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 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 DIA for insurance coverage verification. Ido Hereby ce►7ify u>3� sins and penal ' of perjury that the information provided above is true and correct Signa ��'� Date: 71 � Phone#: Z 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.PlumbingInspector 6.Other Contact Person: Phone#: r 4#1 N 4 «iS)' e G 54ra a k g x�S� §3i3 M n "tin x qr : F DATE MM DD YY 1 ACORD�. � �+ � � . 04/03/06 t PRODUCER Aon S CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY 7325Risk $ervices, Inc. of virginia Beaufont springs Drive D CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS suite 300 CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE Richmond VA 23225 USA COVERAGE AFFORDED BY THE POLICIES BELOW. PHo-E• 866 283-7124 FA*- 866 430-1035 INSURERS AFFORDING COVERAGE INSURED INSURER A: National union Fire Ins Co of Pittsburgh U.S. REMODELERS, INC INSURERB: American Home Assurance Co. Attn: Stephen 'Thompson 405 State Highway 121 Bypass INSURER C: American Guarantee & Liability Ins Co Building A; suite 250 Lewisville Tx 75067 USA INSURER D: w INSURER E: �'31u$' teysa3ofJntended sil�endmsem .. "- .• �' ;�� . .., ants,floe es taans Dons snd;excluswnso hcu,�:�howsu � ,�.�,.�. � �=;,4-'•:. d THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED,NOTWITHSTANDING ANY REQUBIEMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHiCH MRS CERTIFICATE MAYBE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN iS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAiD CLAIMS. P.ISR POLICY EFFECTTVT POLICY EXPIRATION LTR TYPE OF 1XSURA?iCE POLICYNUMBER DATE(MMWD%YY) DATE(MMMMYY) LT�iI IB ien n M A GLNmLUABTLiTY GL1774139 04/02/06 04/02/07 EACH OCCURRENCE $1,000,000 N x COMMERCIAL GENERAL LIABILITY General Liability FIRE DAMAGIi(Any one fuc: $20,000 � CLAIMS MADE D OCCUR MED EXP(Any one rcmn) $5,000 PERSONAL A.ADV INJURY $1,000,000 Ln GENERAL AGGREGATE $2,000,000 GENL AGGREGATE LiMIT A17LTES PER: 1R0 PRODUCTS-COMP/OPAGG $2,000,000 POLICY El JECT � LOC Z, A AUTOMOBILE LIABILITY AL 8262349 04/02/06 04/02/07 COMBINED SINGLELiMIT A Business Automobile (Eaacci&-M) $1,000,000 AL 8262348 ANY AUTO 04/02/06 04/02/07 d X ALL OWNED AUTOS Blasi ness Auto - MA (pINJURY A AL•'8262347 04/02/06 04/02/07 ctp-) V SCHEDULED AUTOS Business Automobile - vA X HIRED AUTOS BODILY INJURY X NON OWNED AUTOS (Pcr=idcnt) PROPERTY DAMAGE (Pcr=Wcnt) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT ANY AUTO OTHER THAN EA ACC AUTO ONLY: AGG C EXCESSLIADmITY AUCS34554901 04/02/06 EACH OCCURRENCE $10,000,000 umbrella OCCUR E] CLATMSMADE AGGREGATE $10,000,000 DEiJUCTiBLE RETENTION B WORKERS COMPEVSATiOV AW WC7171490 04/02/06 04/02/07 x c STAN- OTH- EMPLOYERS,LIABiLiTY Workers Compensation - Aos ORY T R B wc7171491 04/02/06 04/02/07 El.EACH ACCIDENT S1,oO0,000 Workers Compensation - CA E.L.DiSEASEPOLiCYLIMIT 51,000,000 E.L.DISEASE-EA EMPLOYEE $1,000,000 OTHERS DESCRIPTION OF OPE1tATiONS/LOCATiONVnIf LES/EXCLUsIoNS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - Gancellation Provision shown herein is subject to shorter or longer time periods depending on the jurisdiction of, and reason for, the cancellation. �� ERTICil �1 EOLb�R-_ 4r ? ." ;.`. CANEI3.A`1lON . :"s :1. . xi E. r°. _ �� ,4 U.S. Remodel a rs, Inc. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 405''State Highway 121 Bypass DATE THEREOF,THE ISSUING COMPANYWILL ENDEAVOR To MAiL Building A, Suite 250 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Lewi svi l l a Tx 75067 USA BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE COMPANY,iTS AGENTS OR REPRESENTATIVES. } AUTHORIZED REPRESENTATIVE J94"14", /ata, ay�ZY GsCea