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HomeMy WebLinkAboutBuilding Permit #228 - 164 MILL ROAD 9/24/2009 Z TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO o` Date Received Date Issued: 'Z IMPORTANT:Applicant must complete all items on this page LOCATION Paint - PROPERTY OWNER ; Print MAP NO: PARCEL: ZONING DISTRICT: Historic Distric# yes ',no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Res' Non- Residential New Building ne fa Addition wo or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic W911 Floodplain Wetlands 1Natershed;Diatrict Water/Sewer - DESCRIPTION OW WD TO � RFOR ED: 7,4 dentification Please T e or Print Clearly) OWNER: Name: Phone: Address: t_W ,"110L CONTRACTOR Name: T Phone; Address. (402 Supervisor's Construction;License: t One = ry Exp. Date:. Home Improvement'License: Exp. [date:_ - ARCHITECT/ENG INEER 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: $ c s Check No.: c7� ( Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t e ua my fund g 9 t. g Si nature of A "ent/Owner � flt? �G Si nature of contracto i i 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 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 ❑ Workers Cbmp 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 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 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: Doc.Building Permit Revised 2008 f Plans Submitted Plans-Waived Certified Plot Plan Stamped Plans l� I 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 INTERDEPARTMENTAL SIGN OFF - U FARM ;�w _r . DATE REJECTED DATE APPROVED 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 i Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT =Temp Dun Aster on site yes no_ Located-at 924.Main Street Fire Departmentsignature/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 i I NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2008 Location No. 1 Date NORTH TOWN OF NORTH ANDOVER 0 P Certificate of Occupancy $ Building/Frame Permit Fee $ s�cMust. Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2244Z Building Inspector c 3,t;a (orn-rn.011:-Veakh of-illa5sa.chuseits �- c'�Vii,dY1Gr2i fn 1d.S";Zt�f frifi� its ;,- � i� ti J is (! :'-i p=; �' . , . , A-A?, -'caN1 kA rani ti it1.3�'s P }} k� N amc (Busine•ss/Organization/Individual): � Address: fid. l A") ,Lav City/State/Zip: Phone.#: � Are yot}an employer?Check the appropriate box: Type of project(required):. 1.Ik— In am a employer with____VkZ 4. ❑ 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. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y P tY� 9. ❑Building addition [No.workers' comp.insurance comp. insurance.# requ,ired.] 5. ❑ We are,a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g P myself o workers' co right of exemption per MGL y [N rap- 12.❑ Roof pairs insurance required.]t _ c. 152, §1(4), and we have no employees. [No workers' 13. er comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors that check this box must attached an additional sheet showing the name of the subcontractors 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: U Policy#or Self-ins.Lic.#: Expiration Date: 1 -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 tip to$:1,5.0.0.00 and/or one-year imprisonment 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 cern un r e ps an penalties of perjury that the information provided above is true and correct. Signature- Date: _ Phone#: Official use only. Do not write in this area, to be completed by city or town official City or Town: PermitfLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector j 6. Other pj�d'.4 g �,� Tz�37 n S �'' ,x' NO R T#q of __ 4 over " _ L O 1 � No. ,-_ LA. E A. dover, Mass., a lb COCMICMEWICK 7,9 ORATED P? �5 `S BOARD OF HEALTH Food/Kitchen PERMIT T Septic System NA BUILDING INSPECTOR THIS CERTIFIES THAT..... 'G... Y�' .�.............�^'� ......... ................................................... ....... ........ .... ... Q Foundation has permission to erect........................................ buildings on ...I.!oA........m .(*....: ......�... ......1".... Rough t0 be OCCUpled as...........C .. .......... .�.....P!.rd 2v./.J ............................................................... Chimney C ' provided that the person accepting this permit shall in every respect conform 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 IN 6 MONTHS J � ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough . ....... ..... Service BUILDING INSPECTOR Final Occupancy Permit Required to Omipy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. _FROM KIMBLY A N0. 6033629675 Sep. 1E 2009 09:35AM P1 IIOMF'-IMPROVEMENT CONI TAUT PLEASC RCAD'T'IlIS Sold,Furnished Laid Installed hy; 8nuneh Name: Boston [)are-. I 1 TIM At-l-iome Services,lnc. d/b/a The[lone Depot At-theme Services Ftraneh Number-- 345A Greenwood Street,Unit�,Worcester,NIA 01607 ❑North 33 [�Soitth 31 -fnii Free(600)657-51 X2; F to(SU)7;64"23 Fedend ID 11 75-269S460:N4F.T.ic#C 024.39;Ill Cont.Lich 14427 CT Liic 0 5,1112-2.Pon Home improvement Contractor Reg.%I 12093 Installation Address: �ilf .! City St to Zip Parchascrtr): Wnrk Phone: home Phonc; Cell Phone: Home Address: (If different from installation Address) City State ZipT E-mail Address(to receive project communications and Home Depot.updates): ©I DO NOT wish to receive any marketing emails fmm The Home Depot Protect Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to bury, and TIID At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arnmge for the installation("Installation")of all materials described on the below and on the referenced Spec Sheet(s),all of which arc incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Cuntracs'�: Job#: (int•.na ad.—R) o ucts: & cc Shee %)1l' Pr�Ject tAmnunt ryRoofing Sidin Windows insulation I` LJz QQg Gutt m/Covers EJEntry Doors❑---�.. d3o?i ✓�� �{j 1_110ofing LJSiding 0 Windows El Insulation ❑Guttas/Covers []Entry Doors [I $ CRooting Siding D Windows Insulation w ❑Gutters/Covers (]Entry Doors❑ RoofingSiding Windows 0 Insulation $ ♦ Gutters/Covers []Entry boots❑ Minimum 25%Deposit of Contrnct Amount due upon execution of this contract. 'Total Contract Amount S y Maine Puretuu ert may not deposit mare thnn nno-third of the Cautmet Amount. Cutstouter ens that,immediate) upon completion of the work for each Product,Customer will execute a Completion Certificate � Y P I, P (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As upplicuble,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 Rome Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,enviromRental hazards such as mold,asbestos or lead paint,other safety concerns,pricing error or because work required to complete the Job was not included in the Contract. payment Summary: TFze Payment Summery Il ka516, , included as part of this Contrack sets forth the total Contract amount and payments required for the deposits and final ayments by Product(as appiieablc). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sipi a Completion Certificate(Dote: there is ane 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 casts of materials,labor,expenses and services provided by The home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this AlZrecmcut or allowed under applicable law. THE HOA11 DEPOT MAY WITT.FlHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE: DEPOSIT PAYMENT OIL OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SI)'CH AMOUNTS. Acceptance and Authorizatiout: Customer agrees and understands that this A.greemcnt is the entire agreement between Customer and The Home Depot with regard to the Products and Installation saMres and superscdcs all prior discussions and agreements,either oral or written,relating to said products and Installation.Tl-us Agreement cannot be assigned or aw-mdcd except by a writing signed by Customer and The Homc Depot.Customer acknowledges and a rrecs that Customer has read,understands,voluntarily accept,the terms of and has received a copy of this Agreement, 4AccePtoy, / Submitted Si Date Sal Dsultant' igna D to ){ Tel qnc No._� p7� Customer's$iEriatirrc Date Sales Consultant License No. CANCEJ.LATfON: CUSTOMER MAY CANCEL TIRS (as noDtt�yhmi AGREENONT WITHOUT PENALTY OR OBLIGATION DY DELIVERING WRITTEN NOTICE TO TIIE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO rnNTAINS A FORM TO USE IF ONE: IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S ST'A'TE. NOTICE:ADDl]'1VN A.i',TERMS AND CONnrTIONS ARE STATED ON THE RP,VERSE:3100 AND A10:),ART OF THIS CONTRACT j '= �l.t�.a�lunetl� - l)cltartmcu( nl f'uhli�• �afrl� Board id, 13uiltlirt.-, S1.111tl.rrd, �. Construction Superriisor Spectztlty License License: CS SL 100696 Restricted to: WS ALAN PAINTEN 11 16TH AVENUE - HAVERHILL, MA 01630 Expiration: 8/211/2012 t • uuut..n,.rr Tr::: 100696 I d 'x 0 F�'t h- ) � fit k a I ENERGY PERFORMANCE WNGS I U-Factor Solar Heat Gain Coefficient Fec5rJJ cotfldwtrGmwdadt Emr9u Alar '0. . 32 1 . 8 0 : 29. ADOMONAL PERFORMANCE RAnNGS ----------------- - ev�oN sua�F+Fxre�uL oe c�a�a>?rto - Visible Transmittance %rmrkwon&LravW4 0 . 52 UUU*Uw OPAM the fto rltYip 1 m mv&d.WIC xumd a�gar d ftft"wh5klo Mdid Wttrtwsa WC f�1!(a Y!datal7it�fQ a IDad��ffV�Mbnhl oaT9llay Ind����(70�Jd�!.)�1C does rol reCdROT1�.@ry D�... !�dM rent wwrutt?a s1401t ar a'Y X01. t qtr Yir Vrrltic tffi ox"mra term"bran kr cea;row porno . - hhX1T1�Y1 WVfRIIrrCaO - rb arttda c"actor yvio-affnO 1 CII1 to pro &rte cabin de tRC pro df*n*Y od m%*nWft bI M pr&cb,La Akira um"pa WFC aan drtemt%sdw Par w ta*s*ik d.=4dow Wble WO y to*ram do p &AZ wpwAm tM no=anlarda n►W X01=y ro pa 9t/at Xmtcta ra aieaadD,pva to uo upm m Cx ub CM d _. kd m dW Strlrmb vn it w*ropbcb do ats RodreL rr*%ts" - UALt qjF .Ilifitj roc nW;y STIR - caglon(1) : Uocthacn, Noctn . Ctnt.al, .9o..l:n C�ntaaL, loy.t�a.n. Ga.unidad oa1111ca ps.a la(a) �N(AGrSTAR ca?LOn(aa) vwatiGY 3TIA: Noct[_ Noctt cantcal, 9,c cantral, 9.c.. IND: R2.1n. Da/CL]9r 3/31"/K-R13 . Tarttd 91sa: 36' x 6.3 IND: Bafuaczo 00/VLdc10 2.31 eft/K-RJ] DP-.: -1-45/ - 45 T"uNo probado: 91.4 c.z x 160 cw 10773 - K9 Koffrun 2931110 Carp rho label(a pamb o DRV SUr rebft,To Iram mrt,&l wtwwrnegI joy Wards xto eligvrto pato poabia rnmboEms EHE.46Y S(UL'para mnau mm sorra�is1o,vhib wwrtrnr�yyttacQayc � �� �- -H�1ze �o�rrrrna�zueall�ro�✓��.agaac><ivae(a 9 •� . s Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration 126893 } Expiration ?8/3/2010 Type Supplement Card { i The Home Depot At Home Service t RICHARD FALLONE " 2690 CUMBERLAND PARKWAYS ? 'j A"I DAM GA 30339 Administrator ACOR�M CERTIFICATE OF LIABILITY INSURANCE 0212 M 0//DO/YYYY). 02/209 PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequestOmarsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 INSURERS AFFORDING COVERAGE MAIC# iNSUk[D —_----------_----- ----- INSURER A:Steadfast Ins Co 26387 ---- THD At-Home Services, Inc. INSURERB:Zurich American Ins Co 16535 7690 Cwil,erland Parkway INSURERC:NATIONAI, UNION FIRE INS CO OF PITTS 19445 suite 300 ------------- ----- -- Atlanta , GA 30339 INSURERD:New Hampshire Ins Co 23841 INSURER E:Illinois Nati Ins Co 23817 COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADDT POLICYEFFECTIVE POLICY EXPIRATION LTR N RD TYPE OF INSURANCE - POLICYNUMBER DATE fMM1DDfYY1 DATE MM/DD/YY LIMITS A GENERAL LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $4,000,000 X COMMERCIAL GENERAL LIABILITY LIMITS OF POLICY ARE EXCESS DAMAGETORENTED 1,000,000 PREMISES Ea occurance $ CLAIMS MADEFX­j OCCUR "OF SIR: $1,000,000 PER CC" MED EXP(Any one person) $EXCLUDED PERSONAL&ADV INJURY $4,000,000 GENERAL AGGREGATE $4,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: - PRODUCTS-COMP/OP AGG $4,000,000 X POLICY JE T PRO- LOC B AUTOMOBILE LIABILITY HAP 2938863-06 03/01/09 03/01/10 COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS - BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) X SELF INSURED AUTO PROPERTY DAMAGE $ PHYSICAL DAMAGE (Peraccident) GARAGE LIABILITY, AUTO ONLY-EA ACCIDENT $ ANYAUTO EAACC $ OTHER THAN AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $5,000,000 X I OCCUR EICLAIMS MADE AGGREGATE $5,000,000 $ DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION AND 3566916 (CA) - 03/01/09 03/01/10 X ORYLIMT OTH ER D EMPLOYERS'LIABILITY 3566915(AOS) 03/01/09 03/01/10 E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E OFFICER/MEMBEREXCLUDED? 3566917 (FL) 03/01/09 03/01/10/ E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER D Workers Compensation 3566918 (KY, MO, NY, WI, ) 03/01/09 03/01/10 F TX Employers Excess TNSC45694422 (TX) 03/01/09 03/01/10ccurrence/SIR 25M/2M C Workers Compensation 4801323(QSI) 03/01/09 03/01/10 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS - RE: EVIDENCE OF INSURANCE - CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THD AT-HOME SERVICES, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 2690 CUMBERLAND PARKWAY IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR SUITE 300 REPRESENTATIVES. ATLANTA, GA 30339 AUTHORIZED REPRESENTATIVE USA ACORD 25(2001/08)ckomraus_hd ©ACORD CORPORATION 1988 11172180