Loading...
HomeMy WebLinkAboutBuilding Permit #616-2016 - 1490 GREAT POND ROAD 11/18/2015 �Sc�N Ivy a -,2,7 /S- VkoRTH BUILDING PERMIT OF�iLen ,b�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION h T ( f, OrL `0 (e— / Date Received �9"�R`r Pennit No#: to I eo� CHU Date Issued: 4zs�iZ5 IMPORTANT: Applicant must completq all items on this page s" p I.PROPEF29T�YE®WNER?�. 7e, Prm r i1 D r0 Year Stri ure lyes) nor ��MAP' PPS EL ,ZONING4DIS-TRIFOT iHistoncL®istY,Rfe �Ye-6 PO` MchineS,hop;`EVi,.11age� aY, _ TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building kr6ne,family ❑Addition ❑ Two or more family ❑ Industrial ❑ ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other gSeptics ❑WelllFloodp a1 nk �Wetlands '; ®3�1Na elrsie R istr=ictf r DESCRIPMWORKIfO IkE PERF RMED:nhta�n ro Identific tion- P eas Type or Print Clearly OWNER: Name: ) ._ Phone: Address: (Gontractgrt,Naame� - '{Ernailx J. Addressi. S;up�erisor s C©nstructi®n�fLicense 'I ., _. IHomextlrY prou,,ements.lLi ense � w. F _ ,- _ _ T _A:E I�K%— ARCHITECT/ENGINEER Phone: r Address: Reg. No. � FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PEq S.F. Total Project Cost: $ Il billo FEE: $ '�r �— Check No.: t No.: 7— j (oma►3 NOTE: Personspenlra5ting with unregistered contractor" do n ac to the guaranty fund Signature ofaAgent/ her. t t _gnat r o c °tracfor�r n 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 ❑ Engineering Affidavits for Engineered products COTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/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 TOTE: 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 ❑ Engineering Affidavits for Engineered products TOTE: 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 Registry of Deeds. One copy and proof of recording that the appeal period is over. The applicant must then get this recorded at the must be submitted with the building application Doc:Building Permit Revised 2014 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: lies No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) ® Notified for pickup Call Email Date Time Contact Name Doe.Building Permit Revised 2014 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. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH . Reviewed on Signature COMMENTS y Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments IOTE. ;outer& Sewer Connection/Signature & Date Driveway Permit DYW Town Engineer: Signature: IiFLRE; DEPARaTMENtT T�mp�®`umpster,onEsiteiyes;.,.T. - 3no: Y99� _ � - oca e sgoo ree i Loateat`"i1�24Main�Street F,ir00 partment ignatu're/date __ _ CbMNOW-NTtS, Location ' tqop"` ' ✓�^" No. ' v Sp Date f� . - TOWN OF NORTH ANDOVER . ° Certificate of Occupancy $ � Building/Frame Permit Fee $ �— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#3 3 e L e til Building Inspector NORTH Town of ? . t _E �. ndover to No. ' * :t Z a o�h ver, Mass, COCMIC 1 MIWICK � . U BOARD OF HEALTH Food/Kitchen PERM-IT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ......................................................... ... ..... .. ... .. .. Foundation has permission to erect .......................... buildings on ...... ... ..... ..... .... ............................................ . Rough to be occupied as .... ......&1hpermit .. .... . ................. ................ ..�........ .�........ Chimney provided that the person accepting shall in every respect conform to�he 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 CONSTRUCTION ST TS 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. S1000 HOME IMPROVEMENT CONTRACT PLEASE READ THISC G Sold,Furnished and Installed by: Branch Name:New England Date1/t1//2 /5_ THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch Number:31 908 Boston Turnpike,Unit 1,Shrewsbury;MA 01.545 ' Toll Free 877-903-37681,i Federal ID#75-2698460;ME Lic#C 02439;RI Cont.Lic# 16427 CT Lic#HIC.0565522;MA Home Improvement Contractor Reg.#12689 Installation Address: �r✓ City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: [xN], 3-,yggZ [ ] [ ] Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing emails from The Home Depot Proiect Information: Undersigned("Customer"),the owners of the property located at the above installation address;agrees to buy, and THD At-Home Services, Inc. ("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 incorporated into this Contract by this reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): Job#: (Internal Reference) Products.. Sec Sheet(s)#: Project Amount EIRoofinga ElSiding Windows Insulation %77pt, G�c/�,6C 2SZO o }� ❑Gutters/Covers ❑ ntry Doors ❑ i r' *771TV z Roofing Siding El Windows El Insulation /�❑Gutters/Covers ntry Doors El (Q ��— $ 3 4'J ❑Roofing E]Sidiifg LJ Windows LJ Insulation El Gutters t Covers []Entry Doors❑ $ Roofing oSiding 0 Windows 0 Insulation ❑Gutters/Covers []Entry Doors ❑ Minimum 25%Deport of Contract Amount due upon execution of this contract. Total Contract Amount $��' Maine Purchasers may not deposit more than one-third of the Contract Amount. 14 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 an 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 Product(s)included herein,at its discretion,i f 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. asbestos or lead paint, other safety concerns. pricing errors or because work required to complete the job was not included in the Contract. Pavment Summary: The Payment Summary # included as part.of this Contract. sets forth the total Contract amount and payments required for the deposits and final 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 Home Depot or Authorized Service Provider through the date of ternunation, 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 1 oral or written, relating to said Products and Installation.This Agrreement cannot be assigned or amended except by a writing signed by Customer and The Homc Depot. Customer acknowledges and agrees that Customer has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement. Ac�epte I Submitted by: ® Work area will be contained f = $4 -� Pre-Renovation form Date:, D�I _5 j NAT 19276 - This form is used to document compliance with the requirements of the Federal sFV I ; Lead-Based Paint Renovation,Repair,and Painting Program after April 2010. �P Customer Address Job Number(s) 0 86(bZ33 OCCUPANT CONFIRMATION ® Dust will be minimized Pamphlet Receipt j 14* I have received a copy of the lead hazard information pamphlet informing me of URthe potential risk of the lead hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before worts began. v,: fi r�,, Home Year Built `4 q 1 $ .. �< Enter the year my home was built. (pa/ NA If my Home Year Built is Pre-1979,my home requires lead paint testing to determine whether Lead-Safe Worts Practices are necessary per EPA or State regulations. ® Work area will be cleaned u p If my Home Year Built is 1978 or after,Lead-Safe Work Practices are not required. thoroughly y44"Ve_ ted Name of AF* Ownar-occupy t INNi - Lure of Own cupant Sign ure of P on C ifying Lead Pamphlet Delivery "r' SEE STATE SPECIFIC FORMS ON REVERSE SIDE The Commonwealth of Massachusetts 4 W Department of IndustrialAccidents ro = I Congress Street, Suite 100 d Boston,MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Infdrmation F Please Print Le ibl Name(Business/Organization/Individual): Address: City/State/Zip: ',Jone 4: 46r, ?, Are you an employer?Check the appropriate box: Type of project(required): 1.0 I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.F�I am a sole proprietor or partnership and have no employees working for me in 8. E] Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.EJ I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 1 LFJ Electrical repairs or additions proprietors with no employees. . 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. them 152,§1(4),and we have no employees.LNo workers'comp.insurance required.] 1 *Any applicant that checks box##1 must also fill out the section below showing their workers'compensation policy information. 1 t 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. 1 Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: L � ,�A JJCity/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 MGL c. 152, §25A is a criminal violation punishable by 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$250.00 a day against the violator.A coof this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify un er the p s a d pe lties of perjury that the information provided above is true and correct. Si ature: Date: Phone#: tom" Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 1 4 d � l?MjBC^T n-I . ERTF LIABILITY INSURANCE I 1 1 01115201� CEIS CE TFlC OTS 1SSUcI) AS A MATTER OF.INFORh9A ON ONLY AND CONFERS SFE}RIrH T S UPON THE E CER,IF)CA E;(QLDEtZ THIS j CERT{FIGAi DaES.RIOT brf1RNT1fiLY.OR.-IEATtflEf l!-rllygNp, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE"POLICIES EELOVt1:; 'tF1JS-6ERTIFtCATE QF.IN, KASCED02=S'Nf}I COiV9F1Tt1TE A CONTRACT BEi'sVEEN THE ISSUING IN3URER(s'), AUTrfORt2E0 1WRESENTATIVE.OR.P—R6DfJGt~I3,AiIyI�TkIE CE)RTIFIGATE,IiQLDER k tTaIfthe Certi,ieats holder is an At3Ci FIOtfAC 1NSUR thehetermss and candrEty,.-the poltcyffes)must be endorsed. If SUBROGATION IS WAIVED,subject to - terntsons.o€the policy,certarri palic�� may require an indDIr;enlent A statement an this certificate.foes not confer rights to the ceitiriicate 491der in lieu of such endorseTgejr t(s). PRODUC - ' C�FA W; USAJAIC.-- :-•CT TWO ALLIANCE CENTER eRcrie FAX IM-OLENOXROAD,Sum2400 fair Not: ATLMTA,.GA.30326. ADDRESS-. 100432-HomeD-QW'A5.16 " ^" u'1SURER'S AFFORDING COVERAGE NA1C 8 INSURED INSURER A: eadfast hpgi4ilm Company 26387 7HD Al HOMESERVICES,INC. -INSURER a:Zur(d►Atijettt insurance Co 16535 DBA THE HQINE O)pOTAT-HOME SERVICES rNsi c.=flew tfiarrip's,Iuie lnsCa Q CU -: 1 269MBEfWb.PARt(4YAY,SUITE 300 - �_: .-- . ATiANTA,GA 30339. INSURER ti. POIS IVahER Insurance Compmy23817 INSURER E': COVERAGES. CERTIFIt14lIttERF•�-•-:a•-., . _ . . ICATE NUMBER: REVIStbN,Ait3M$ER.B... THIS I5 TO CERTIFY THAT 7tiE POL1C1€S.OF L§URAyCl=VJSTFD BELOW HAVE.t IIE7?lIME�TO l'NE,INSURED&AMEPT A@Q�IE.fl7ff THE POLICY PERIOD INDICATED. ;�tOTWIiHSTANDING AIV`(REQUIREMENT,'GERM gR'd0NDI•f10A� O' �.A�y-;-- TRI{CT OR QTjil�DOCU�ITENT 11111Tkt.RES�PEG7 TO 1�hilCH TH[g CERTTFiGATE MAY BE ISSUED QR HIAY.PERTJjjIV,'THE INS(1R.*Rft AFFORDS)BY 7HE•POCICtES E1ESCf IBED NEREtN 15 SLIt#JECT TO ALL THE TFJ2A45, EXCLUSIONS AND C©Nt)(TIONS OF SUCH lyOLICIES.LIMITS S¢1DWh1 MAY HAVE BEEN REDUCED BY PA►C}.GLAIh1S: 145P. ADD UBR LTR .TYPEOFINSURANCE POUCYNUMBER -F0LICYEFE PO YEXp A f X COMMERCIALGENERALLIABILITY WDD/YYYY MID tJMRS GL04887714=05 D3- ----115 031O1YLOj6 X Ft+�H.QCcURtiEric�, s 9,000,000 CLAIMS-MADE ❑OCCUR p A E..O.f Std D, a LIMITS OF POLICY XS P12EM18E5 Ea.d' trance S - 1,000(100. OF SIR:$1 M PER OCC MEO EXP tmy-brie p6rion 5 EXCLUDED GEN•LAGGREGATE LIMIT APPLIES PER: PNE L"$AQVINJ�RY 5 g,oQ0,0D0 X POLICY FRO- F]LOC /IGGPEOATE S 9,(%0D0JECT , OTHER: S-COMP/OPAGG S 9,000,OCO 13 AUTOMOBILE LIABILITY S BAP2938863-12 08101120}5 03/01!2016 COMBINEDSINGLELIMIT X ANY AUTO E�'d-idet5t ALL OWNED BODILY IIS JURY(Per $ AUTOS ASCHEDULED�pS SELF INSURED AUTO PHY DMG BODILY iN IUhY( r aceitlenl} S HRED AUTOS NON:OVMED AUTOS PROPERTY DAMAGE S Peraedden UMBRELLA UAB S OCCUR FJCCESS UAB. EACH OCCURRENCE S CLAIMS-MADE AGGREGATE .. S DER '..• RETENI70N S.- LD AND EMRS COMPENSATION CD17731493 (AOS) D3/0112015 03/01/2016 X PER pm_ S AND EMPLOYERS'UABILUY Y!N.ANYPRoORiE`rOo;U-i7-&Er�CtinVE WC0177-31495(AK,KY,NH,NJ,VT) 031 Ilti3 uV0112D16 A� -ER �FFICEK/L)EM@'e�tEXCLUOED? N!A EL EACHACk1DENT• S 1,000O�GU (Mandatory b till) C01773t494(FL) 03MI12015 03/01/2016 if yas,describe under EL DISEkSE-EA EMPLOY S 1,000,000 DESCRIPT ON OFOPERATIONS below Conitnued an Addifional Page EL DISEASE-POLICY UMIT S 1,"vOQEO- PtSCRIPTION OF OPEPhT10NS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may if more space to tzqulred) EVIOENCE OF INSURANCE ptt CERTIFICATE HOLDER - -• .. . CANCELL.ATION IND AT ROME SERVIEES,INC. DBA THE HOME DEPOT AT•NOME SERVICES SHotkij ANY OF THE ABOVE DESCRIBED POUCIBS BE CANCEL[J;D BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE: WILL BE-0ELIVEREn IN ATLANTA,GA 30339 ACCORDAWCE WITH THE POLICY PROVISIONS: r ' AUTHORIZED OPRESENTATTVE � -_ f 1 'S•.+�j' � .-n J1 1! ^.�J,� �!�•� `�•�"1 i:'• �(.,::1%%'' r 1 - J .. 4 .n.n ._ .}..^_-:."-'.>...� .1 i 7!:_;('.I�3 r : ,!�^-�q(���,4 r::•,. ...:``.ii'! •'-�J-_ �'-��-+7-77 (f` r •Tu �'9_'I 11,✓�+-1=tom 'cbiJ��at'v:i 47 ;.it." �_.ii.+i Coat Fla ice; '85 N15 THD AT H LEO, E Mo-CUMBERMEAPAIR�--XVVAy SU ITE Z-00 Sc70-39 • � � �7}��a�a�ddr��,s�t�d Pb�at�a����k��z»fv�ea7an��. • Addy j�°ra �] J ap��, araq j T as: ti;a ' '=X�',� l'f•A�7111.r+11'tYl�1r�C�`-'_{�r'lJ�Y/!'Ilt.Sr'i�- ' Qion TOM fad w' �la:x�eafCOn3rxrs'I S�izi�>'ss3n51 i u3a6l �,lv Tl3PPr��18_n n z-df 0 pta n a'Ys L{1; r �d`r•[' F M?h,�45v.�*wf tTF�l l`�1 �� n� Ott AVE':Fl a"LS101t;a�r���la srtu ., !'.'�• cpQraroz�5lt ��fi 5u�©lexnant- �ivostittn a6' SEE=f3�1�P F1iUl 5111G l�yu36 GUMB�(;ANCI•F'A�Y.1hlAY SLt7'Ct179'y'' ss h LJ set+,,% - Depiirylent -31 Buildln4-- S Con �Iruttion License CSSL-099823 D22MTRV IRROVE4,\\ 7th NORTONAVS' Msucbester NH (Blog 06/26/2016