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Home My WebLink AboutBuilding Permit #468 - 13 PERRY STREET 12/18/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o��oT 6, L N p Permit NO: 1 Date Received ~ f �4'ODA�TlDpP,y'�y Date Issued: 9'TSA c Husr`� IMPORTANT: Applicant must complete all items on this page LOCATION P ' PROPERTY OWNER P re-k '96ib2on Print MAP NO.: PARCEL: I ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building X One family ❑ Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: XRepair replacement ❑Assessory Bldg ❑ Commercial El Demo litio ❑Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED �.> ,: lC-P ?p l/J1k0nt1-sS Identification Please Type or Print Clearly) OWNER: Name: h L r e'LL R k c)+On Phone: Address: r Z� 9 `7S ` CONTRACTOR Name: be- i2&YL Phone: 1. Address: Supervisor's Construction License: Exp. Date: Home Improvement License: to ?5 Exp. Date: �'3'0e ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING MT:$12. 0 PER$1000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00 PERS.F.Total Project Cost I �� FEES v Check No.: Receipt No.: Page lol•4 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 DEPARTMENT:BPFORM05 Page 4 ot'4 4 J TYPE OF SEWERAGE DISPOSAL Swimming ❑ F1Tanning/Massage/Body Art E] g Pools Public Sewer Well F1Tobacco Sales ❑ Food Packaging/Sales El Permanent Dumpster on Site ❑ Private(septic tank,etc. El Permanent 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 RCAel 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 FIRE DEPARTMENT - Temp Dumpster on site yes no 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/Sianature&Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required 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) Page3 uf4 Doc:INSPECTIONAL SERVICES DEPARTM ENT:BPFORM05 Created JMC..Ian.2UU6 Location r r No. Date MpRT1q TOWN OF NORTH ANDOVER i Certificate of Occupancy $ 3 0� -...�. ,,• � . 3 s''^°•E,� Building/Frame Permit Fee $ ntMus ° Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # / e 19880 Building Inspector NORT►y Town of 4 Andover No. A dover, Mass.,a� •d COC NIC NE WICK y�. ADRA TE D `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System �/ +*A BUILDING INSPECTOR THISCERTIFIES THAT......... t............9............................................................................................... Foundation has permission to erect........................................ buildings on ...I4conorm �� . ...... ... ..... ............................. Rough .. .. .. .. t0 be.ocCUpied as........ :'j .........�j�.111 ................................................... Chimney � hi provided that the person accept"iiwlermit shall in everyrespect 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 IW617H S ELECTRICAL INSPECTOR UNLESS CONSTRURough ............ ..... ........ ....... 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 BeDone FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Bumer. Street No. IFSEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts ------- f o Department Industrial Accidents P Office of Investigations � I rsl 600 Washington Street Boston, M4 0..'111 `_ .•`' wwx,.mass.gov/dia Workers' Compensation Insurance Affida dt: Builders/Contractors'Electricians/Plumbers Applicant Information Please Print Legibly Name Gusiness/ormriization'Individual): l Address: ' uo Citv!State Zip: Phone Are you an employer' Check the appropriate box: Type of project(required): 1. I am.a employer vx ith 4. ❑ 1 am a general contractor and 1 6' (❑ ?y ew construction employees (full and/or part-time).* have hired the sub-contractors F7 r ,- listed cin the attached Sheet.+ ® Remodeling t.II A air a 3Gie pr0Yia�w. .i }..]'T..1�I ship and have no employees These sub-contractor have 8. ❑ Demolition Nvorking for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We area corporation and its l0.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I.❑ Plumbing repairs or additions, myself. [No worker' comp. c. 152. §1(4). and we have no 12.❑ Roof repairs insurance required.] t employees..[No workers' 13 comp. insurance required.] Other •Anv applicant that checks box#1 must also fill out the section below showing their workers`compensation policy information: r Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such =Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.polic%information. I am an employer that is providing workers'compensation insurance for my employees. Below is the polis}'and job site information. Insurance Company Name: Policy=or Self-ins. Lic. #: n 1�qGi_n Expiration Date: 1—b 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 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 5250.00 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. 1 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Si2mature: ` �� o Date: Phone Oficial use only. Do not write in this area,to be completed by city or town official. Citi•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#: MARSH CERTIFICATE OF INSORANCE CERTIFICATE NUMBER ATL-000915907-11 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 ATTN:BRENDA BOOKER (404)995-2594 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE MAYA MCCLURE(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 100492-IPUSA-GWA-03/04 A STEADFAST INSURANCE COMPANY INSURED COMPANY THD AT-HOME SERVICES INC. B ZURICH AMERICAN INSURANCE COMPANY DBA THE HOME DEPOT AT-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 y Thls certificate Supersedes and replaces any prevloUil Issued.certificatarforthe:polley'period noted below 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 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. CO POLICY EFFECTIVE POLICY EXPIRATION LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDDIYY) DATE(MM/DD/YY) LIMITS A GENERAL LIABILITY IPR 3757 608-01 03/01/06 03/01/07 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMPIOPAGG $ 4,000,000 CLAIMS MADE FX]OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL 9ADV INJURY $ 4,000,000 OWNER'S&CONTRACTOR'S PROT rMECD H OCCURRENCE $ 4,000,000 E DAMAGE An one fire) $ 1,000,000 EXP An one person) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-03,AOS 03/01/06 03/01/07 MBINEDSINGLELIMIr $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULEDAUTOS (Per person) HIREDAUTOS ` BODILY INJURY $ NON-0W NED AUTOS (Per accident) iHYSICAL ELF-INSURED AUTO PROPERTY DAMAGE $ DAMAGE 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 C STATU O EMPLOYERS'LIABILITY ( ) 03/Ol/06 03101107 X TORYLIMITS I I ER C 6610995(AOS) 03/01106 03/01/07 EL EACH ACCIDENT $ 1,000,000 G THE PROPRIETOR/ X INCL 6611326(OR) 03/01/06 03/01/07 EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERS/EXECUTIVE E OFFICERS ARE: N EXCL 6610999(NY,WQ 03/01/06 03/01107 EL DISEASE-EACH EMPLOYEE $ 1,000,000 WORKERS E COMOENSATION CONTINUED 6610997(FL) 03/01/06 03/01/07 D 6610996(CA) 03/01106 03/01/07 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESISPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION N. SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAL qA1 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 CERTTFTCATE. MARSH USA INC. BY: Walter Gilstrap MM 1(3102) VALID AS OF: 02/27106 ,r AT-H® E Installed Siding and Windows z 2 Board or Building Regulations and Standards Ik wkik License or registration valid for individul use only(° HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 126893 g Regulations Board of Buildin and Standards Expiration: 8/3/2008 One Ashburton Place Rm 1301 Type:. Supplement Card Boston,Ma.02108 THE Home Depot At-Home Servic 8T1NROEUN 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 508-756-9859•Tnll Fra.-Rnn-F;.9;7-S1R9 FROM : KIMBLY FAX NO. : 6033629679 Dec. 11 2006 03:17PM P4 HOME IMPROVEMENT CONTRA(71' 01) Sold,l'umished and Installed by: Branch Name: 1U Date: THD At-llotttc Services,lnc. d/b/a The Home lhpot At-Ilome Services 345A Greenwood Street,Worcester,lvtA 01607 Branch Number:_3 ((Job#: f7f C q Toll Fru-(800)657-5182; Fax:548-756-2854 Iocderai lD!i 75-2699460 M4:Lic N C 02439 IL1 Cont.Lich 16427 Cf Liicc 4 565522: MA Home Improvement Contractor Reg.#126993 Installation Address: �t � /�U(�/1 JI�C/P2 r�J�1 0/'dL5-_ City �— State Zip Cef{ Purchase s: Last 4 Di nits(if Driver's I.ic.0&Exp.MoMr. -.4Wortt Phone: Humc Phonic. QRTL Rome Address: ..(If different from.In3tallahun Address). City State � Zip E-mail Address(to receive updates and promotions from The Homc Depot): _ Protect Information: •I/We/You("Purchaser"),the owners of the property located at the above installation address,offer to Contra[t with Home Depot U.S.A.,Inc.("Home Depot")to fUMISl),deliver and arrange for the installation of all materials&,; described on the attached Spee Sheet# _,_.. __,incorporated herein by reference and made a part hetes£ Rome 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 (Subioet to tnd verification and/or credit approval.) / r. Qwak, hiets Cheyr US Praia]Service Money Order CONTRA T CaaCheck or payable to The Bonne Depot). �LZ 2. Credit Cath•m(vpr otter paympnnptiorev-(;irde One Sclaw Viva Mastoicard Diseov7 AmerimmExprraa BALANCE DUE 1! �7 ON COMPLETION 4 07 'rhe Hone;Detest Homtl Impmvemegr Lunn The Ru=Depot Credit Cmd n New Acemrnt :l F.s ting A, mint (HIL&Hnt.:C()NI.Y) Minhmmt 251/o cgntrnct.of Contract Amount doe upon execution of this Available Credit:S ;/ (ffiL R SDCC ONLY) Acctlr: Exp,Date:_ Namc w itappmrs Pn cardj' Indicate Payment Method For *By my/our signattat below, a agree to allow Home Depot to BALANCE DISE/JON COMPLETION": charge the above rhfereaced t card for the deposit indicated. Cardholder's Signature Date **May be subject to Credit Approval,Fund :HEL or H(DCC A horizatlon Codes Verification and/or Credit Card Authorization Depotut Finat Payment # # Purchaser agrees that,immediately upon Completion of the work,Purchaser will execute a Completion Certificate and pay any balance clue. Purchaser also agrees to be jointly and severally obligated and liable lien.— under-Entire Agreement:This agreement and its attechmu nLs,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 parties.. NOTICE TO PURCHASER Do not sign this contract before yon read it. You are entitled to a completely filled-in 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. lAw prohibits home repair contractors from"nesting 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 any time 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'will 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 win ':'b x'secvice eh'argaitgoal.to 2S%of the cwiatraci amonnrif job is cancelled by Purchaser AFTER materials are ordered, BY MY/OUR SIGNATURE BELOW,UWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRA4 T ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPI,FTED COPIES OF IM NOTICE OF CANCELLAIJON, BY MY/OUR SICNATURF,BELOW,I/WE UNDERSTAND TIIAT THL AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT"ISTORY AND IVE AUTHORIZE HOME DrPOT TO V};RiFY AND REVIEW MY/OIJR CREDIT RECORD WITH AN INDF..PFNDEDIT WING AGENCY AND RFLEASE THEM FROM ALL LIABILITY MCURREDFROMINAD ;fNrOR ERRORS. SUBMTTTED BY: _._. Date, ACCBPTL`+D BY: Date:Date: /Z — NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF TRIS CONTRACT 10-24-06 .CSC - white-Branch File Yeilaw-Customer_?laic=Sales Consuttant