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Home My WebLink AboutBuilding Permit #441 - 19 ALCOTT WAY 12/18/2009 BUILDING PERMIT of "�oT"_qti 1 TOWN OF NORTH ANDOVER „° ° ; r APPLICATION FOR PLAN EXAMINATION * "A Permit NO: Date Received 'pq , Date Issued: !/ IMPORTANT: Applicant must complete all items on this page `LOCATION Print PROPERTY OWNER _ Print MAP NO: �� PARCEL_: ZONING DISTRICT: Historic District yes no Machine'Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE R92§' Non- Residential New Building One family Addition Two or more family Industrial No. of units: Commercial Repair, replacemen Assessory Bldg Others: Demo Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTIOWORK TO BE P1117-7) EFORME Identific io "e e Ty e o Print Clearly) OWNER: Name: Phone: Address: .E w to CONTRACTOR Name: Address; Supervisor's Construction License: la'-f 71�12 Exp. Date: rfi I Home.Improvement License: Exp Date: n ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 6_ 1 FEE: $ 7,� Check No.: Receipt No.: 02� NOTE: Persons contracting wi unregisterd con actors do not h the gu my nd r signature of Agent/Owne Signature of cont i 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 INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS L 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/slate m COMMENTS Location No. T Date N°RTq TOWN OF NORTH ANDOVER O 9 ' Certificate of Occupancy $ �'�s'•^°•'<�' Building/Frame/Frame Permit Fee $ -J =�cHust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2200 Building Inspector Dimension i 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 - Date Doc.Building Permit Revised 2008 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 o Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o 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 Li Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C.'And C.S.L. Licenses o 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 L3 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) o 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 FORTH Town of 4 over No. �. - AK E dover, Mass., /off-!l� •a 9' COC NIC NE WICK 7,9 A�RATEo p �C `s E BOARD OF HEALTH Food/Kitchen PERMIT T Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.......... ... L.,.... `y. .a. .................................. .................. . ....................................... Foundation has permission to erect........................................ buildings on .......1....1........ ........................ Rough - 1 Ox.to be occupied as..... — ►�L !�.? ............-r Chimney ..... ... ..... ...... ......... .. ....... . . 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 S PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU STARTS Rough Service ............... ................................................... .....: . BUILDING INSPECTOR Final Occupancy Permit Required to Occupy 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. �333 d,—aJ .r < n: U �aocr Solar He� GainCoeficient Facmrj Co2Adc--�E(uwr4dada&trgia Solar "0 . 32 1 . 8 0 : 27 rVl A.DO TIONAL PERFORMANCE RATINGS sible Transnitmncehwxrtslw dt Ua 1AID4 0 . 52 uarwicnr.r I'd No atr's m7am m vo=tr M:Rc pvoarti tr ar*rntay_Icw l7alld mftn m we rtt�v,SrIDrmb�ed rtr[leas nc Q.raorvner�01�,rd►�cflf 7o�d�+.)fat dxt roc rltxrro�m.or)r a� " ni±W re wvrkM TV Llaa+4t at+r T)10—kr py VN.dk unt aisdt rtaa,acnr,r:brun 16r oe+r paic.ptrierrrakr= -" tdcrtr�rn wv,-�fYrzav rib tiurslS-s�� 7.7 a a„pe,m,t�p�r�e pA�a�trfac psa dr�,ntm r rtie�nlefm t�Ol di—: R��lat Ab-a uaim Ga tf zr dwrrtvdm xr i l at+ ft t is a rrtw1w s y t brwv do Grp' OW-EO,4RC ro r—M&dl HPVs XUdJ='f ra WTD QLA it 7U1jdn nt!d—--'M.0o t w w UPKA n Q rw�ft and _. lobes dd SLYL7r 0 pR J uo tsmp�do da ev 700.[.X.W�kArCn'Q UaLt T';ILLrlta Zoc t:1•IGRCY 3t1R caglo�'(oj::: 1lfi:ccnicA, No�tii . c A6 r STAS G-1.on Ld.Ad oallYlCa.FX.1 1A(D) . - ccq LdCNaRcz ITXA: Noctt. - - NOctt Ctntcal, cantcal, S.c_ ' IND: Ra1n. 00/c h it 3(3Z"/K—R:3 � '' Ltitcd 9Lzt: 3C.• ,. GJ' - I)4O: fl-ar..a—a Oa/YLdxLo 2-39 1en/K,RJ3 DP-: x-45/'7g5 ZLxLzAo pcobado: 91.1 C.X. x'164 cA' K3 Karrdln 2s3t12a. G�ph�nit�6+lforpaa�hQiCYG'(SUk''X.6717.Tol�mnmon'rdltww.mirgrthagm .. . Wed.xm�rtNdv porn ganbin rrrrbo6u EHEt6T SUl~t'oro mrocer rtm aorm�c1o,Y�ih rwx x�uyrtiLtQcr Board of Building Regulations and Standards r HOME IMPROVEMENT CONTRACTOR Registration:, 126893 ' Expiration,_'g(312010 Type.`=Supplement Card The Home,Depol At Home Service RICHARD FALLONE 2690 CUMBERLAND PARKWAY S GA 30339 Administrator The Commonwealth of Massachusetts Department of Indiatrial Accidents m Office of Investigations 600 Washington Street r Boston,MA 02111 v . www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Indivi dual): { �� 01 Address; ALL City/State/Zip: F _ c ' Phone#: Ase you an pter withloyer? Check the appropriate box: Type of project(required): I.❑ a em o _ D-V 1 am a general contractor anb td I p y 4. ❑ El 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, 0•Demolition and have workers' working for me in any capacity. employees9. E]Building addition [No workers' comp.insurance comp.insurance.t required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions , 3.❑ I am a homeowner doing all work. officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs insurance required.]t C. 152, §1(4),and we have no employees. [No workers' 13. ther comp.insurance required.] *Any applicant that cheeks box-41 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 him 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. tam an employer that is providing worlcets'compensation insurance far my employees. Below is thepolicy and jab site iifor?mlion. _ Insurance Company Name: Policy 4 or Self-ins.Lic. Expiration Date: Job Site Address: City/State/Zip: JQ JAI- Attach a copy of the workers' compensation policy declaration p ge(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL . 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlor 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 Investigations of the DLA for insurance coverage verification. I do hereby certify der h in nd enaliies of perjury that the information provided aboveis t ue a d correct. Si ature: Date: Phone# 0113 41-1 L6.Other se only. Do not write in this area, to be completed by city or town oj�cial own: Permit/License# uthority(circle one): of Health 2.Building Department 3. CitylTown Clerk 4.Electrical Inspector 5.Plumbing Inspector Person: Phone#: NOV-24-2000 00:58AiA FROII-HOiEDEPOT PLAISTOW + T-286 P.001/004 F-076 PLEASE READ THIS Sold,Furnished and Installed by: Branch Name: Huston Date: JIQ9 - THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number:31 Toll Free(800)657-5182; Fax(508)756-8823 Federal ID#75-269&780:ME Lie#C 02439;RI Cont,Lie#16427 Cf Lic#5655522;MA Homc Impmvement Contractor Reg.#126893 InshrllationAddress: r/9 /7/COr� �,1�p.� /V. e -e; City State Trp FntrchasWs): Work Phuoa: Home Phone: C eII Phone: X89-z9"I- 161'79'12X4 [ 1 I l I l [ 1 ;game Address: (If different from installation Address) City Stan Zip E-mail Address(to receive project communications and Home Depot updates): M I DO NOT wish to receive any marketing emails from The Home Depot Project 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 Depat")agues to furnish,deliver and arrange for the installation("Installatiod')of all materials described on the below and on the referenced Spec Sheet(%),all of which are incorporated into this Contract by this mferenee,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract.,): Job#: tt.fi-t na—) PtvdoctsSpec Sheet(s)#: Project Amount Roofing ElSidior,0 Window-61Insulae on $ // _ O V 7 7$2 19 QGutren i Coven ❑Entry Doors ❑ j/ S t5 9 (J []Roofing USiding Windows Insulation n- �� 7 7 3 S$17 ❑tuners r Cove"' ❑entry Doors El -;L) 6/ $ S 3 6 Y Roofing ❑Siding Windows insulation $ ^t"� pGuttdre(Covets pEruy Doors❑ ❑RooPng Siding ❑Windows ❑Tri-lation $ ❑Gutters/Covers C31-:ntry Doors n Mh1hou a 25%Dgtadt of Contarkt An""t due upon execution of this contract. Total Contract Amount $ 6'17 S Man Purchacrrn may not deposit more than one third of the ContactAmmtnt. Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product a+defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this Contract aegams 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 us mold,asbestos or lead paint,other safety concerns,pricing errors or because work nxluired to complete the job was not included in the Contract. Payment Summary: The Payment Summary#__LLJA / , 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(notes 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 amounts set forth in thtc Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE ROME DEPOT FROM THF 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 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 dopy of this greerttent. Acte .f Submitted 1 . Cu&6erfglgnaE6` Date Sales Consultant's Signature TYate Telephone No.t/5493-S'7. 7 Customer's Signature dam Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT A7TACHED HERETO CONTAINS A FORM TO USE IF ONE 1S SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE, NOTtCt:ADDTTIONAL'r6RMS AND CONDITIONS ARe STATED ON THE RRVERSE SiDE AND ARE PART OFTHIS CONTRACT 6-10-09 c-SC White-Branch File ymow-Customer Pink-Sales Consultant r_. Jul Wj Utj U�Ij:�Ilba micnaai "eciara P.r N S'dt 11 t I It-I VIII 0 r i't!I)I I k. i'.`,illii 1130 N (k Ill. ic -5A SOViFRSET,NIA 0:,"; Expiration: 9119/2012 10262? d l I �. 11'lassachusetts- Department of Pultlk Safety Board of Building; Regulations and Standards Construct onT.Supervisor Specialty.pcense License: CS SL 99124 Restricted to M JOHN A kA6 12 CA�2RIAGE CHACE LANE ATKINSON;NH;0381'1 c- Expiration: 7/16/2012 (omni'iss,ioner Tr#: 992:14 I