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HomeMy WebLinkAboutBuilding Permit #316-14 - 137 SUTTON HILL ROAD 10/3/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �D f 1 Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print. PROPERTY OWNER Q. .fie- Ok&M Print 100 Year Old Structure yes no MAP NO: �PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT. PROPO D USE Resi ential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑ eration No. of units: ❑ Commercial ®Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCR OF WO TOB ORNEA Ke entifi ation ease Type or Print Clearly) OWNER: Name: Ph ne: s Address: _7AII CONTRACTOR Name: Phone: Address: Supervisor's Construction License:CqL j2 Exp. Date: Home Improvement License: UL61 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER 0.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. _ Total Project Cost: $ I> 4 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not hav&access o th &guantyfund Signafureyof Agerit/Ovvner Sigpature of contr Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE.OF:SEWERAGE DISPO SAL Public Sewer ❑ Tanning/Massage/Body Art ❑. . .Swimming Pools ❑ ❑ 1 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 i PLANNING & DEVELOPMENT. ❑ ❑ ` COMMENTS .CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Seger Connection/Signature& Date Driveway Permit DPW Tow;2 Engineer: Signature: 3 Located 384 Osgood Street FIRE DEPARTMENT --Temp Dump'stno er on site yes.. Located-at 124 Mair. Street -:Fire* Departmerit,§ignature/date`' COMMENTS Building Department ---The fol;,awing is--a list of the required forms to be filled out for the appropriate.permit to.be obtained. Roofir4g, 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 ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from FireDepartment prior to issuance of Bldg Permit Addition Or Decks ❑ 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) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all eases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm:tted with the building application Doc: Doe.Bui ding Permit Revised 2012 i Location � � �' R ` . No. Date • - TOWN OF NORTH ANDOVER LED 6 � • Certificate of Occupancy $ � Building/Frame Permit Fee �? Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#� '. W G j ``Building Inspector NORTIy Town of � No. LAK! h , ver, Mass, &W-� �3 COC NIC Nl WICK �� RATED r S tJ BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System • THIS CERTIFIES THAT � !�!�: .......ClArra „............................... BUILDING INSPECTOR j .� �...\� a�,�... , Foundation has permission to erect .......................... buildings on �+ .................. Rough tobe occupied as .......... ....................... ... ....................................................................... 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service ...... ......... ... .. ..................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 .! FR'E?O-' �1A��a 11 DAY UUL DRIVE �1ash�i� �i ORQ P?141701 A ' Officc ul l u��suaur.lffairs Jc'Ru`ainec, c�a ition ;i. h1ONIE IMPRGVEMFNZ CONTRACTOR Typo: Registration: ;53131 Yd liability Corpar )~ri}iie�tion. 10,1012014. AdG PROPERTIES DR MARK FREEMAN 11 DAYULY DR. .: ... .. -- NASHUA.NH 33062 l'nJcrsrcrcun Sold.Furnished and Installed bv: Tl I D At-Monte Scr\ices. Inc. ci-b�a The I Ionic Depot At-Hunte Ionic Scr\ices 08 Boston Turnpike Unit I.Slirewsbury-MA 1;4j Toll Free 8779M3708:Fax S0(19""01010 Branch Name: Boston North Date:1)26;2101 i ME Lic-( 024')9 RI Cont. Lic- 16427 Branch No: CT Lic#111C.0655-1-1 \t-A Home Imj)rovcmcnt Comractm RcL.-L 12089; Federal ID ji .15-2698400 Installation Address: 1 17 SLIU011 dill Rd North Andover MA OI N41 Cite State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: Ms. Josephine Curro (9718)685-32319 Home Address: 11-7 Sutton Hill Rd North Andover MA 01845 (II'ditTerent from Installation Address) city State Zip E-mail Address (to receive pro'ject communications and Home Depot updates): jcurrwa homedepot.com Marketing entails\x ill not be sent firom The Home Depot. Project Information: Undersigned("Customer").the owners of the property located at the above installation address. agrees to buv.and THD At-Home Services. Inc.( -The Home Depot")a!_m-ces to furnish.deliver and arrange fur the installation(Anstallati on'")ofall materials described on the below and on the referenced Spec Sheet(s),all ol'which are incorporated into this Contract by this reference. alollu, with allN.applicable State supplellICIII and PaVrIlCot SLI111111al-V attached hereto and all\ Chan,c Orders (collectively. "Contract"): Job#:(Internal Reference) Products: Spec Shect(s): Project Amount 71 1,;j I-, Roofill!-- 71 SN.685.90 Minimum 25% Deposit of Contract Amount Total Contract Amount SX.W--,5.90 due upon execution of this contract Cusionicr agrees that. immediately upon completion of the Work for each Product.CUStolIICl-Will CXCCtItC a Completion Certificate Ione for each Product as defined by-,ill individual Spec Shect)and pay any balance due. As applicable.each CUSt011Ier under this Contract agrees to be jointly and severally obligated and liable hereunder. Paviment Summary: The PaN-111CIlt Summary= 71 3,55 11 included as part of this Contract.sets forth the total Contract amount and payincrits required for the deposits and final payments by Product (a,applicable). CENTRAL TLR.NIS AND CONDITIONS Resimnsibilitics. The "011ie Depot: twill provide the Products identified above. make arran-ements to have the Authorized Service Provider put'01,111 the Installation sets ices in 11 professional and workmanlike manner.and arrange proper insurances. Unless otherwise expressly, provided for licicin.Authorized Scrx ice Provider Will obtain required permits and provide IM-11111 numbers. Customer:will idemify any property lines.easements,covenants. underground or overhead utility Hiles. I)I-C-eXiSlilh!I)IIVSiCal or 11/30/12-SA Paye 1 of 7 NOTICE TO CUSTOMER I ou are entitled to a completely tilled-in copy of this Contract,sinned by both you and The Home Depot,at the time you si(n. Do not sign a Completion Certificate before the Installation is complete. Acceptance and Authorization: Customer agrees and understands that this Contract is the entire agreement I)CM en Customer and The Home Depot with regard to the products and installation services and supersedes all price•discussions and agreements. either oral or written. relating to said products and installation.This Contract cannot he assigned or amended except by a writing signed by Customer and The I lame Depot. Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a coPy of this Contract. Customer ackno►►iedges receipt of the Notice of Cancellation,and that The Home Depot has orally informed Customer of Customer's right to cancel. Customer's silmature below constitutes Customer's acceptance and execution of each of the applicable Contract Documents. UO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. You are entitled to a paper coPy of this Agreement if you choose. If you consent to an emailed copy,your consent applies only to this Aureement. By contacting sales office (877)903-3765 .you may update your email address,ivithdrai� your consent,or obtain a paper copy of the Agreement at no charge. By signing below.you confirm the follo%iino: • You consent to receive only an emailed cope of this Aureement • You have access to a computer that can receive and open emails and PDF(Adobe Reader Version 10.1.4 or later)formatted documents. • Your email address is correctly listed on the Horne Improvement Contract Submitted by: Sales Consultant y.tichael Jewett License Name. -- Telephone No. 077)901-1768 Sales Consultant License No. (as applicable) ' T Lam_. CANCELLATION: CUSTOMER MAY CANCEL THIS C'O\"t'IL1C1 11'17'NO "f PENALTY OR OBLtCA7'ION B1' DELIVERING 1N'1217"1'EN NOTICE TO THE HOME DEPOT BY MIDNIGHTON THETHIRD BUSINESS DAYAFTER SIGNING THIS CONTit- I'TO THE ADDRESS LISTED ABOVE. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPLC'IFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. 11/30/12•SA Pace 6 of 7 z,+Ni Cam.#mm�.':i�;al�/�a?'�tiaY _ ..:� y:i;sY/$a7'i�il t' L/� 3�dd13..11a? LaLidL3�7b ice? QTfilae of Zfnveldibat�f1�IJ 11,500 0 i"{z°sd'ti l ist'gto n st...,,,i Be- 1,Ii,bi',rrNS . uyi fir Workers` Compensatiou Insur.-mce_-Vtfidavit; dersiContra a s; l t r° i s!'�atlt:ih rs A� gal t Irt or io _ Please Print L gib )'dame (Business/Organizafidoni?ndividual):i— Address: ,�. City /State/ZiP� hone#: Areou an employer?Check theappropriate box: yType of project(required): 1.❑ 1 am a employer with d• ❑ 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. 7. E] Remodeling s, These sub-contractors have F rl 11Pmnlition F e: employees and nave tivorkers' workin for in any capacity., in addition . � Y # 9. ❑Build g ace. comp. insur n [No workers comp.insurance p 3.❑ required.} 5. ❑ We are a corporation and its 10.KRoofrepairs, repairs or additions I am a homeowner doing all work officers have exercised their 11. repairs or addition, myself. [No workers' comp. right of exemption per MGL l 2 F insurance required.]'i c. 152, §1(4),and we have no 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. - 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 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: — i Policy#or Self-ins.Lie.#: - , �� j Expiration Date: Job Site Address: / I f I iCr.(City/State/Zip: `' _ K Aff2ch 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 u-ivestigations of the DIA for insur/15Roverage verification, Ido hereby certify under the pa ns a pe ltie of p rj ry that the information provided ab ve is true and correct. 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#: (.1,20 213 CERTIFICATE OF LIABU-IIN-URANCE 0 WFORIWICN ONLY ANC CCINFERS NO RiGHTS UFCN THE CERTIFICATE HOLDER. TA DED P-11 Tfi;,E FGL'�CZIES iFIC�A-iz 1;z !SSUED AS A MATTER F TER 1. E COVERAGE AFFOR CE-R71FICATE DOES NOT AFFIRMT111JELY OR NEGATWEI:Y AMEND, EXTEND OF, ALTs. THE G INSURER' 4S), AUTHORMED 11' E01VEEN THE ISSUiN 8---L 0 W. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITLITE A CON' FLAG T Fc.PRESENTA j1V5=OF,PRODUCER,AND THE CERTIFICATE HOLDER. P 'S11 R0 JON IVNANED,SUblee,tc M, _,st be aj,,dzrsd. 1, .5 C-AT IMPORTANT: If the cartificate holder Is an AACOWITIO11--LAL ENSURED;th2 P011CY(ICS) � -�!�) h�D v orsernent. A statement On this certificate does not cOniOT t;0 terms and conditions of the policy,cortall, policies may ra quire an and certiflicats holderin lleu of such L endorsement(.!)_.....- CONTA,—T pr"CIDUCER NAME: 1 ?AARSH USA,INC. PHONEj�12C No TWO ALLIANCE CENTIER --a LENOX ROAD,SLRTE-,4C-0 ATLANTA,GA 30326 INSURSR(S AFFORCINr COVERAGE NMC- Steadfast Insurance COMPanY 26157 IrX4244omeDGAW-1 3-14 INSURE : INSEDINSURER E:Zurich Ameemn IrSu=CO 'PEHOME DEPOT,INC. INSURERC,.New Hampshire Ins Co 3841 HOME DEPOT U.SA,INC, Illinois National Ins Co 23811 24515 PACES FERRY ROAD,NW BUILDING C-20 INSURER E. ATLANTA,GA 30339 INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003159545-04 REVISION NUMBER"I 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.' INIRI P MMID LIMITS LTR TYPEOFINSURANCE POLICY NUMBER (M DD A GENERALUABILITY GLO488T714-03 01101013 0310112014 EACHOCCURRENCE toolix 7X COMMERCIAL GENERAL LABILITY EXCLUDED 7GL04,8 LIMITS mEDwj&j2n _n) E-x1 LIMITS OF POLICY XS _a perso CLAIMS-MADE OCCUR 9,000,000 OF SIR$1M PER OCC PERSONAL&ADV IWURY GENERAL AGGREGATE PROD rs-COMPIOPAGG S 90,0 GEN'L AGGREGATE LIMIT APPLIES PER: - 7X PRO POLICY F�JECT F�LCC, M DINE)—SlN-G—TL7m-T 1880000 AUTOMOBILE LIABILITY BAP 29.18863-10 03MI12013 10310112014 (Ea moddica, BODILY INJURY(per Person)ANY AUTO ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY I RY(Paraccided) 6 AUTOS AUTOS P90-PERTY DAMAGE S NON.OYW4EO tPer aWdontl- HIRED AUTOS AUTOS 3 UMBRELLA LIA N OCCUR EACH OCCURRENCE EXCESS LIAR, HCLAIMS-MADE AGGREGATE [DED RETENTIONS El-- 'ff-0112013 010112014 STAT OTH- WORKERS COMPENSATION WC033575 4(AOS) AND F ..MPLOYERS'LIARILITY N WC033575315.(&K,bl) 03/0ir209 EL EACH ACCIDENT 1,000,0 C ANY PROPRIETORIPARTNERIEXECU"/E -1 F-A EMPLOYE S OFFICERIMEMBER EXCLUDED? F-N NIA 1=20 D (Mandatory In NH) W=35753iS(FL) 0310112013 001IM14 ELOfSEASE- 1.0,000 If yes,d*schbe under I E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below C WORKERS COMPENSATION WC033 531T(KY,NC,NK,VT) 03101013 0310112014 (EQ LIMIT 1,000.000 C WC03357531 0(NJ) 0310112013 0310117014 DESCRIPTION OFO PERATION I LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarhr Schadula,If More$Pace It; III-d) EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION THE HOME DEPOT INC. SHOULD.ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE HOME DEPOT USA,INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD,MAI ACCORDANCE WITH THE POLICY PROVISIONS. 'BUILDING C-20 ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Ina ManashiMukherjee - - - 0198®-2010 ACORD CORPORATION. All rights resented. ACORD 25(2010105) The ACORD name and logo are registered marks ofACORD . . Alull ll- Office cif.CRns¢m rA f�atr. � u mess Regt�lat on Lts ens'GT rebls �ttitat arattd iL,r r` bef6 atheerpirettori dite Iffo=6d..retuizta: .';.'. QNiE 114 PRUV NOT T COnITP�4CTOR _ , .Uffice of�onsuru�t AffArfi.;ii RnSir�ess eguThrion ReBist@tlan; B93 i 1 . Type: xQ 'arY PIRza i Srte 51�{� a ExpI i ' . SuppferleYt;;drd "B.SjOn;1bIA TFhe Home Re RICHE RD'TALL•.1�1 �s r 9 UMBER � ithoutsigratitce . .. . . ' UnaersccCetary �•. �+ ..