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HomeMy WebLinkAboutBuilding Permit #389-2016 - 15 HOLBROOK ROAD 9/25/2015 BUILDING PERMIT "O RT b'�ti I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 7q�0R,7en SSACHU`�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATtON PROPERTY O.WNER__ � . fft—r 1__ ____�: Pnnt s 00 Year Structur 1e :yes rno_ y, MAP �ZPARC;EL. A ZQNING DIST=RICT Historic Disfnct y Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Oeration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other j __ _ _ ­_1_______ _ ,. .. _ ; Q Septic ❑Welf 0 Floodplain u Wetlands 0 Wtitershed District 0 Water/Sewe_r DES BiIR�10 OF TO B PERFORM I' ). 11 - - �1 , Iden if c tion- Ie se Type or Print Clearly P OWNER: Name: Phone: ' Address: Contractor Name _ }z. � i ,f�i _. Phone -_ s Email: Y Address: rt -- Supervisor's Construction License: '/' _ Exp: Date: Home Improve p_ License 4 _ Exp. 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.: L11 NOTE: Persons contracting with unregistered contractors do not have access the uaranty f nd gnatuce of.Agent/Owner Signature-of cont'Facta 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 ti INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature— COMMENTS i nature 9 — COMMENTS CONSERVATION Reviewed on Signature COMMENTS r . HEALTH Reviewed on Signature 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 DPW Town Engineer: Signature: yes .- 'LocatedOsgood 38 s od Street "p. �Lte�d�at��124�,MainSt�eetk � r F r6e.fDepartmentrsignature/dat _ - - s n Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. i 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 Call Email Date Time Contact Name _= 3 Doc.Building Permit Revised 2014 h 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 a Workers Comp Affidavit o Photo Co Of H.I.C. And/Or C.S.L. Licenses Copy d o Copy of Contract 1 ❑ Floor Plan Or Proposed Interior Work Li Engineering Affidavits for Engineered products NOTE: 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan Li 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 o Engineering Affidavits for Engineered products III 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:Building Permit Revised 2014 Location l 40 0 V 2-0 Date ` TOWN OF NORTH ANDOVER IM, . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ ' Other.Permit Fee $ TOTAL $ �r Check# 1; 29418 Building Inspector �`� µORTH own E ndover 0 0 . t 'AM No. - % Ah ver, Mass, I1 A- cocH�c„twit.. y1' DR%�TED PS S U . - BOARD OF HEALTH rERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ............. % 'l. .J✓ BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ....... ...... .a, ..c?.. ....... ...... .. Rough to be occupied as ........ ,)........ ........l�fd j..®......................................... 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 CONSTRUCTIObd S TS Rough Service ................ ...... .... .................................................. BUILDING INSPECTOR Final 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. MA Reg#146589 M q...... Contract# f CT Reg#D605216 Federal ID#20-2625129 !! RI Reg#26463 Home lmproyemenf 5olwons Corporate Headquarters,26 Cedar St.Woburn,,MA,(P)890-342-2211(F)781-933-9828,www,newpro.mm /j /,��, THIS CONTRACT MADE THE17S day of yr 20�between ��/rr "7' _ 11 Gvrs rr�! 114vxpAy 77/- 33g of les .do tz N-q (Aewe&y Z-/. a� Via,-/ the"Owner"and NEWPRO Operating,LLC,"NEWPRO". (E-Afaloforpropdetary use way NEWPRO herebyagrees that it Wit for the consideration hereinafter mentloned,fumish all labor and matodef necessary to install the following described wo t the premises located at: ��Q/4 e The job address Is a condominium. (JcU�AdGPe�`saf - - .9;CHL. - .R� w o.:atr WI{ ge {_ �BR) 1MGeo Grids:LJ YES Ja NO ❑CONTOUR SDL IJEUIRO DIAMOND Window calor QTY IWindowcolor OTY OBBITMP:([aoenav umi. ❑SOTTOM Int: Int: SCraens:(Exterior color Full Scraen Standard) HALF FULL E"d: Ext: oto UYES NO Capping Color: :10013fit33}?ttc AVC LJ SmoothLJ omafLj No Cap InSLJ Slt In®;GIi(au(D TKs'.P/eese lnit�l.• i MOD t. bM<;.r:�.r<:xi 'i a'r =``hIO� L"#'3';4 <:: 1r Color In: Out; Rouble Hung Active: Left Cantor Right Customer urdonfandsaratNEWPROS 2Lite Slider HDWR: BN BS BGB WH does not do any palatllgorstalnrng. 3 Lite Slider fva,r a,tµ) ritiyc_`(fb[-, iB'i':r t '7 (le:when mmauf g or replacing Inlador 3Lite Slider ws,im,va) lColor In: Out: atopsortrim).NEWAROBts.natraspe- Casement(Hfnged Rlght) Fiberglass Steel nslbl a far condifions arcircumstenoes bey. Casement(Hinged Left) HDWR: SN BB AGIR AB ORB ondltavordrellncfudingoondensatlonresu Twin Casement it1II 3,.1`r Iling from ofdeefc preealstirrg conditions Stationary Casement Color In: Om: (dreteone) Triple casement (114.10,V41 S : CASH TrtpleCasement ttn.ue.va) Color In: Out: salanoe aamp]eticn PictumWlndow HDWR; SN BB AGB AB Sash Only kart Hinge Right Nine FINANCE Hopper ` �s,,� -_.._._ ::���-�a7!�?.;_s�".I I Bank cdmpletlon form signed at Instatlatlon Awning Color In: Out Garden Window Rbargiass Steef Bay WihdowtRootrsaRq HDWR: SN' .BB AGB AB '"ORB t Hs . BowWindow(rioorlSoftiq e;po�i7¢• .4 1�%"" ` 41S50"60 '' "0+ o" Other Color In: Out: ku d ( J Other t1DWR: DESCRIBE WORK B PROMOT/ONSAPPUED, Est.Start pate: ivf 't.Comp.Date: Customer understands this Is an"estimated date" Owner has read and agrees to the terms and conditions on the front and the reverse of this Agreement. Owner specifically agrees to the(1)Total Cash Price;(2)work being performed;and(3)work not being performed. Owner understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been orally advised of his right to cancel this transaction at any time prior to midnight of the third business day after the date of this transaction and Owner was provided with two(2)copies of a cancellation form explaining this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. (Rhode Island Sales Only): Notice to buyer: (1)Do not sign this Agreement If any of the spaces Intended for the agreed terms to the extent of then available Information are left blank. (2)You are entitled to a copy of this Agreement at the time you sign it. (8)You may at anytime payoff the full unpaid balance due under this Agreement, and in so doing on maybe entitled to receive a partial rebate of the finance and Insurance charges. (4)The salter has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased under this Agreement. (6)You may cancel this Agreement if It has not been signed at the main office or branch office of the seirer,provided you notify the seller at his or her main office or branch office shown In the Agreement by registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on which the buyer signs the Agreement,excluding Sunday and any holiday on which regular mail deliveries are not made. See the accompanying notice of cancellation form for an explanation of buyer's rights. (Rhode Island Sales Only): Owner acknowledges receipt of required Contractor's Registration and Licensing Board consumer education materials. (Ownees initials) By: t/[.rGS t' EIN# Signed: PrAlopen f3M=ay� Signed: st/�, A C'Naring,LL"Ignatum) Owner ' 1 IRAN WFr1TC• Q—..r`n.vY VC[1 not- r+::....mo/a/`.Ym, -V. The Commonwealth ofAfassachusetts Department oflndusirialAccidents Ojrwe of Investigations ' l Congress Street.,Suite 100 Boston,MA 02114-2017 www mass govldia Workers'Compensation Insurance Affidavit:Builders/Contractors/FIectrieianslPlumbers Applicant Information Please Print Leldbly Name(Business/Organizatioallndiv_idaal): r-, tL)P ;j_ � j f Address: �' tc tI moi- � - City/State/Zip: 00 ✓�':-ttJ . /7 - �f 8E Phone#: I- V 3 Are you an employer?Check the appropriate box: 1.JZ I am a employer with 5_0 4. ElI am a general contractor and I `YPQ of project(required): employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7_ [,Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working forme in any capacity, employees and have workers' [No workers' comp.insurance comp.insurance.1 9 ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 EIectrical repairs or additions 3.❑ I am a homeowner doing all world officers have exercised their. (� g pais or additions � 11. Plumbing re myself [No workers' comp. Tient of exemption per MGL i insurance required.]t c.152,§1(4),and we have no 12 insurance employees. [No workers' 13.ZOther _�A r-o". comp.insurance required] ! *Any applicant that cheeks box#I mustalso fill outthe section below showing their workers'compensation policy information. T Homeowners who submitthis affidavit indicating they are doing all work and then hire outside contractors must submit a newaffidavit indicating such_ tContractors 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'camp.policy mmmber_ I am an employer thatis providing workers'compensation inswancefarmy employees. Below is the policy and-job site information C G C11hisurance Company Name: Policy#or Self-ins.Lic.#: 0 L?� ��' Expiration Date: Sob Site Address: Elio brMV 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. l52 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 fne 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 I do hereby certify under the p p ies a perjury That the information provided abov is true and correct Signature: Date: i Phone#: I Official use only. Do not write in this area,to be completed by city or torn official Ci T City orown. 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 i Contact Person: Phoma#• _1.1 't CERTIFICATE OF LIABILITY INSURANCE r DATE(MIMDDIYYYY) 5/1/2015 THIS CERTIFICATE 1S ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.. THIS.CERTIFICATE OF INSURANCE.DOES NOT CONSTITUTE A.CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). j PRODUCER NAME. lissa Pflug Mackintire Insurance Agency Inc PHONE (50.8)366-6161 C Ido E FAX No:(508)366-5202 11 West ?4ai n Street EMAIL melissa ADDRESS: P@mackintire.COM Westborough INSURERS AFFORDING COVERAGE NAIC X g M� 07 581-1931 INSURED INSURER A Netherlands ,24171 "- INSURER 8 3, bert Mutual/Peerless. 24198 NeiTro Operating LLC INSURER c Acadia. Insurance Co- 26 Cedar St. JJ INSURER 0: 1 INSURER E T•70burn LdA 01801 INSURER E_ .( COVERAGES CERTIFICATE NUMBER:Master 14-15 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES QF INSURANCE LISTED BELOVd HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVATI-iSTANDING 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 JS SUBJECT TO ALL THE TERBdS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOVdN I,1AY HAVE BEEN REDUCED'BY PAID CLAIMS. INSR! AOOL(SUBR - - _ LTR i TYPE OF INSURANCE _I IVND POLICY.iUMBER LIMITS I POLICY EFF POLICY EXP I rLSLUDQ }.td6VOD ! I X�COMMERCIAL GENERAL LIABILITY I I ' EACH OCCURRENCE 1 S 1,000,000 P_ CLAIh;S-t.1ADE ` j Oi:CUR 1 j I j DAMAGE TO 0R-TED I . 1 I f PREMISES(Ea e_cun>nce) I S 100,000 I CB? 6563577 I12/31/201C 2/31/2015 MED EXP An cna —) I _ i y person) Is 5,000 L.J I iPERSONALnADVIIJURY I. 1,000,000' . GEN'L Acs=;:c^T=uMu-,:PrLles Res: � j I tilI IPRO- I II GENERAL AGGREGATE IS 2,000,000 _1 POLICY L_! I LOC JEC7 I I II 2,000,000 .PRODUCTS-COt'P/OP AG OTHER: - I AUTOMOBILE LIABILITY COA951NED SINGLE LIMIT I Is i3OOD,DOD y I j ANY ALSO Ee a ddenq _ I BODILY INJURY tPer person) I s I� A5--TOS SCHEDULED I i� a_ i j AUTOS I I ���_r. 1 /31/201,4112131/20151 BODILY INJURY(Paracddeni)I HIRED ALTOS F- N SO -S, _ I Atr05 I j I PROPERTY DAL:Av'E I - i i I I 1 raereccidanl) 15 _._._ . UMBRELLA UABI Urdnsz:red ma(OrLatBt sbfi limit I S 2-3,000 `';f OCCUR EXCESS L(P.8 I _ I EACH OCCURRENCE 3 {1�: ! i CL4IIMS-Noce• i !I! I I l AGGREGATEI S 5 000,OOU I 10=D 1--XI REicNTICiQs lO,OQD 1 i CU e582578 }12/33/2032,'12/33/20151 i s WORKERS COMPENSATION AND EMPLOYERS'LIABILITYY!N I I I I I X I SPP TATUTE I OE I ANY PROPRIETOPJPA.RTNERiE,iECU11VE t OFFICER/1,1 MBEREXCLUDED? I NIA L I ELEACH ACCIDENT is SDD,ODD C I(Mandatory In NH) Ili yes,d=_scrI i I"C-20-20-003506-02 I i3/1/2016 I E.L.DISEASE Er.,. RPLO Ey S 500,000 DESCP.iPTION OF OPE'ATIONS b_W:: i ` I ; 4 E.L.CISEASE-POLICY LIMIT 1,S S00 ODD 1 ! 1 C DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached it mom space is requimd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE To Whom It May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Timothy Novnagh1MEL ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025/9naen+t Board at t3WIdin3::R4iutations and$tandar..d; kor i Seekonk M'4 02711' t "� Exati. Gnrnrnissii ner 04A 20 . `�""'�. I� �� �e�r�z 3dz,�2tfrdltir�e�',,. �' �:�J��/zC•�;d•L`l�Z�. Officeof Consumer Affairs zd Busness Regulation . 10 Park Plaza -;Suite 5170 Boston, Massachusetts 021'1.6 Home rmprolvement Contractor Registration Regfstration; 1.46589 l TYPe: Supplement Card Expire#ion: S/5/201.7 NEUVPRO OPERATING:,; LLC. TOM PE'AdOCK 26`C5DAR ST.. t 1NQBURN, MA 0180:1 Update Address and return card.Mark reason for'change:. Renewal :Employment (] I.,ogt'Card SCA d�, :90W05e11 �lnrirrrl/M,4d ; q . .. flice of,Consutner AFfairs&Business Regulation Ltconse or registratioa;palid for inalVidui ust oni"q ' ME'IAAPROVEMENT CONTFiAGTQR befoft expiration date it.found.retuirn to:: ogee of Consumer Affairs and Business Regulation egistrratlon 146549 TYPgi 10 Park Plaza Suite 5.Y70 Expiration ;5/512Q1 SuppiemenfC Mrd; )Izgston,:MA 0211.E NEWPRO oP.RJ, NG,LLC T0M PEACOCK WOt3tJRN,MA:0.8t3111' 01+iiersecrcEery: Not vlhoutatgnaturc