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HomeMy WebLinkAboutBuilding Permit #049-2016 - 16 ANDREW CIRCLE 7/10/2015 �II AtW 1" VFNORTH BUILDING PERMIT61q6 'to o TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION "70 4 eb # Permit No#: Date Received A0"ArED ass ACHUsit Date Issued: IMPORTANT: Applicant must complete all items on this page f / / LOCATION C,•�)y Prin _ PROPERTY OWNER 9? Print 100 Year Structure yes no MAP�_PARCEL:061 ZONING DISTRICT: Historic District y s no Machine Shop Village y no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑-New Building _4wi�he family ❑Addition ❑ Two or more family ❑ Industrial ❑61teration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer l DEcJRIP�T N OF WORK TO BE PERFORMED: Ir Ald Identification- Please Typepr Print Clearly OWNER: Name: ( ) Phone:q2,6 i�_ ' Address: Contractor Name-.A14h2gb�Cn Address: 1�4I ,� ..tet�- �'f1�7 Supervisor's Construction License: c�22' Exp. Date: Home Improvement License: _ ! �'� /3 Exp. Date: /� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$_.12.000 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1➢ U/`� - FEE: $ c? Check No.: l "l X11 Receipt NoZ4es�guarAHLV14wd_ : NOTE: Persons contracting with unregistered contractors Flo not ha Signature of Agent/Owner Signature of contractor Location "`f p 2 No. oil-i i' �� Date . - TOWN OF NORTH ANDOVER • T ED • • Certificate of Occupancy $ Building/Frame Permit Fee s- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE"OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swirmning Pools ❑ 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS 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: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS I 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: 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 Doc.Building Permit Revised 2014 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 u Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses u Copy of Contract u Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application o Certified Surveyed Plot Plan u Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract u Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) u 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 a Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Copy of Contract o Mass check Energy Compliance Report Li Engineering Affidavits for Engineered products 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 NORTH own of t E ,� ndover O �+ ti ver, Mass, �14 �� e�.a 5 o coc Nlc Nlwlc" ��• X5,9 QORATeD rPp��S S U BOARD OF HEALTH PER IFood/Kitchen T D Septic System THIS CERTIFIES THAT ....... Av..Vy%0� BUILDING INSPECTOR .... ................ ....... .sr..... ..... ............. ....... .................. has permission to erect ... ........... b ildings on ...1*.....A.��t.14...�� Foundation `` Rough to be occupied as ...1►...... .�..... ....... 0� ... Chimney p provided that the person accepting this permit shall in eve �relopetconform to the terms of the applicationp p p g p rFinal 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 MONT ELECTRICAL INSPECTOR UNLESS CONSTRUr N S T 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. HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name:Boston North&South Date.q_Lol,L:�' THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal 11)#75-2698460;ME Lie#C 02439;RI Cont.Lie#16427 CT Lie#HIC.0565522;MA Home Improvement Contractor Reg.#126893 Installation Address: _f6 Atti"d3('Z c"_t`•�� N. Awnoyy-_( . City State Zip Purchaser(s): Work Phone. Home Phone: Cell Phone: Home Address: P& AAA- )2 f- (if different from Installation Address) 16ity State Zip E-mail-�., Address(to receive project communications and Home Depot updates): i �-I t { Q t dA,,, KI DO NOT wish to receive any marketing cmails 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 a: (.t—.,x.R—) Products Spec Sheets #: Protect Amount Roofing LISiding 1M Windows F1 Insulation iGuttcrs/Covers ❑Entry Doors ❑ Roofing LISiding Ll Windows U insulation ❑Gutters/Covers ❑Entry.Doors ❑ $ j� Roofing Siding Windows Insulation 1'� []Gutters/Covers ❑ ry•EntDoors❑ $ ✓1 Roofing Siding Windows Insulation ❑Gutters/Covers ❑Entry Doors ❑ $ Minimum 25%Deposit of Contract Amount due upon execution of this contract ��� Maine Purchasers may not deposit more than onr $ third of the ContractAmount Total Contract Amount } ff 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,if 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 conccros, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary # 1� ' , 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 termination, plus any other OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMO UNTS LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. WITHOUT Acce "Fe 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 oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. . AC pt d l a Su �t fitted v ,' WINDOW SPECIFICATION SHEET Spec,Sheet A:.I�i s, a", sheet of Customer,_.. ., _ y/ `� tww«_ Job NI }, Consultant:„ T '} + Date:_ NewtHinclow Existing Window Measurements Grids Product Options Labor HFrominge toutside,s Options Left to Right Bays,Bows, Location Color Rough Opening R of bars 8 of bars Csmnsts,I Pni, use L.R or 5 Glass Miscltems Hardware Code For doors use 21 e LL c 4 C cT11 .15 SMull s 5"=stationary or Style Wraps9 "X"=operating Room Floor Code Y!N St le Code Series CodeTi �ld° y ICc ( IN/ P Gv' w ~` rf ' x 3 4 3 6 7 e 4 le /1 1 13 SPECIAL CONSIDERATIONS: Wrap color Z Interior Casing Type Bay or Bow window: aatboard Mste,14(viny1 only-Birch or Oak) Bay PmJection Angio 130e0145°) Bay Flanker Type MK SH or Csmnt) Top ofwindow to soffit(inches) If tied to soft col.of soffit material _ t Mav r*we d and agree with all the e°ffcadons above and the Construct Rod(Yes or No) ' Sped ITermtan Cond'nionsts c_pg6of the yellow(Cusrorner)cupy. Garden Window; Starboard Mstedak(vinyl ordyWhite P onite,Ditch or OuW \\VX WailTNckrgss,(Inches) Customer Sionatute Additional Shelf(Yes.No) I.iM1Csli ntl9vuaAeetMtnaN rWaJINxVlmrrt6dA4grtlw. ucw+nva.:r t> White-Th.Hams napol Mallow•Curtomot 7HIM60 I,/ y� WINDOW SPECIFICATION SHEET Spec.Sheet fl , 5heet: /of Customer— ..__C�� _ _`��__- Job�fl-a- ah-L Consultant.. . �_°*aF '3 -. Dater �J ...r New Window Hinge Loiat)ons E%istiFlQWindow Measurements Grids productoptions Labor From outside, Options. Left toRight Day's,Bows, Location Color Rough Open)ng 0 of bars f)of bars Csmnts,i PM, use L,R or S m Hardware Code For.doors use Screens Glass Miscltems _ LL m � o a o Q "5"=stationaryof Style Wraps d v e o Y + R Mull X."=operdting �R�oonntm; Floor Ee Code /(�Y,/pNN)._ St via Code Series Code a 3 w 3 11 11 SPECIAL CONSIMRATIONS; Wrap colo)' InterlorCasing Type Say or Bow window: saatboarA M1tateda:aylny)onlyRfrchar OSk) pay Projection Angle (300or4S a) Day Flanker Type(pH,SH or C=m t) .Top of Window to soli¢(Inches) If tied to soffit,calor at soffit material dhad rav)ew d and agree with all thea. -fications above and the Construct Rubf(Yes or No) ` _ - Sped ITermsan Condidonso ' of the yellow(Customer)copy, Garden Window; soatbgard M1ialedal:(vinylonly-\Nhice pioniic,8hchar Oak) WaIlThtckngss,(Inches) Yustemer Srgnatwe Additlonal Shelf ryes ar No} LthtlaaneyvrerAce:Mevs'n rWn9lssxvp„unkewnnordee. src`vmaz>so wwe,-Tse Hgmq nepril Yartasy-Onrteme, tRPrco. f The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Avylicant Information i Please Print Le 'bl Name(Business/Organization/Individual): Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.❑I am a employer with employees(full and/or part-time).' 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.❑I am a homeowner doing all work myself[No workers'comp.insurance required.]t 10 E]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 11.❑Electrical repairs or additions p rietors with no employees. 12.E]Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Ropf repairs _ These sub-contractors have employees and have workers'comp.insurance? 04-i 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14. they 152,§1(4),and we have no employees.[No workers'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 indicating 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 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 insurancefor my employees.. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: W� 0 Expiration Date: i J1 /li�� Job Site Address: /'J/ �di� =`��(J City/State/Zip: o u /W— Attach a copy of the workers'compensation policy declaration page(showing the policy itimber and expiration date).- �L 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 copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi and naltie erjury that the information provided above is true and correct 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 OATS(MMR)15D(YYYY) A o D® CERTIFICATE OF LIABILITY INSURANCE 0 020 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY CONFERSAND NO RAGE COVERAGE CERTIFICATE FFORDED BY THE Ek THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND 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 poiicy(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 endomement(s). CONTACT PRODUCER NAME: FAX MARSH USA,INC. PHONE AJC Nd: TWO ALLIANCE CENTER .MAIL 3550 LENOX ROAD,SUITE 2400 ADORESS- ATLANTA,GA 34326 INSURER(S) AFFORDING COVERAGE. NAIL 11 100492-HomeD-GAW-15'16 INSURER A Steadfast Insurance Company 26387 INSURED INSURER 8:Zurich�ncan Insurance Co 16535 THE HOME DEPOT,INC. New Hampshire Ins Co 23841 HOME DEPOT U.S.A.,INC. INSURER c 2455 PACES FERRY ROAD,NWINSURER D Illinois National Insurance Company 123817 BUILDING C-20 INSURER E ATLANTA,GA 30339 INSURER F COVERAGES CERTIFICATE NUMBER: ATL-003155301.06 REVISION NUMBER-0 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. TXPOUCY A OL SUER POLICY EFF POLICY EXP LIMITS TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMDDIYYYY9.000.000 IABILITY ULU4887714-05 03101(2015 03101(2016 EACHOCCURRENCE sAMA OREN ace)I S 1,000,000 ERCIAL GENERAL LIABILITY P ny�n nLIMITS OF POLICY XS MED EXP(Any one person S EXCLUDED LAIMS•MADE OCCUR 9000OF SIR:SIM PER OCC PERSONAL b ADV INJURY SGENERAL AGGREGATE S 9,000,000 REGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 9,000,000 a nPRO- n LOC COMBINED SINGLE LIMIT 1 B AUTOMOBILE LIABILITY BAP2938863-12 '03101/2015 0310112016 Ea awdent BODILY INJURY(Per person) $ X ANY AUTO ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Par accident) S AUTOS NUTOS ED PROPERTY DAMAGE $ AUTOS Per accident AUTOS � � I $ UMBRELLA LIAR OCCUR EACH OCCURRENCE 15 EXCESS LIAB_ CLAIMS-MADE I AGGREGATE S DED RETENTIONS I I S CTAND ORKERS COMPENSATION WG017731493(AOS) 0310112015 0310112016 LE-L WCSTATU• - OTH- EMPLOYERS'LIABILITY WC017731495(AK,KY,NH,NJ,VT) 03A1l2015 !MM112016 EACH ACCIDENT $ 1.000,000 CY PROPRIETORIPARTNEWEXECUTIVE YIN N FICERIMEMBER EXCLUDED? 0NIA WC017731494(FL) 03)0112015 0310112016 1000'andatory in NH) E.L.DISEASE-EA EMPLOYE Ses,tleaTn under Conitnued on Additional Page E.L.DISEASE•POLICY LIMIT S1'�'�SCRIPTION OF OPERAT{ONS below l 1 DESCRIPTION OF OPERATIONS I LOCATIONS i VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If mora span Is required) 'Y CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16000SGOODST. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER.MA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE m.. of Marsh USA Inc. ManashiMukherjee ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Massachusetts -Department Cf Public Satzfi;, Board of Building Regulations and Standards CanstracSion SUpLr+'isor Spcciaits . License: L.-OM99 „%.-. ROBERTPOCZOJWT 572WIALLRSL Salem MA 01970- � �~ Comrrssioner C2,�s��a�?: F'OrmtJerVICeS / 4U1 Lob'zbot1 P•� I c�71 C252 Office of Consumer Affairs and Business Regulation r 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement-Contractor•Registration Registration: 126893 Type: Supplement Card Expiration: WY2016 THD AT HOME SERVICES, INC. RICHARD TROIA ------ 2690 CUMBERLAND PARKWAY SUITE 300 . -- ATLANTA, GA 30339 -- _.....__.. ........-.___ Update Address and return card.Mark reason for change. SCAT `/ 20W-0-511i - Address '- Renewal -.mplayc-rc�C :,<rstL'arL, — Orrticc of Cunsucaer Affairs&Business Regulation License or registration valid for individul use only 40ME IMPROVEMENT CONTRACTOR before the expiration date Cf found return to: Office of Consumer Affairs and Business Regulation v, s Registration: .1268,93 Type: 10 Park Plaza-Suite 5170 Expiratiorr.813!2016 - Supplement Card Boston,MA 02116 THD AT HOME SERVICES,INC. THE HOME DEPOT AT'HOME SERVICES RICHARD TROIA 2690 CUMBERLAND PARKWAY S A°l t GA 30339 Undersccreorq Not valid w' out signature I 1 )i f i