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HomeMy WebLinkAboutBuilding Permit #1105-2016 - 2 WALKER ROAD 4/22/2016 �y �I" BUILDING PERMIT NORTF� TOWN OF NORTH ANDOVER 0` APPLICATION FOR PLAN EXAMINATION e OR y1� Permit No#: ' a Date Received pORATEO " �y + �SSACHU`�Et Date Issued: 4 a� IMPORTANT: Applicant must complete all items on this page LOCATION .tet PROPERTY OWNER C Print 100 Year Structure yes no MAP 3 PARCEL: Vo ZONING DISTRICT:?_Historic District yes no Machine Shop Village yes_ no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Add' ' n ❑Two or more.family ❑ Industrial ❑ ration No. f units: ❑ Commercial Repair, replacement ❑ ssessory Bldg ❑ Others: ❑ Demolition Other o - - --- ❑ Septic. El Wei ❑ Floodplain ElWetlands ElWatershed District El Water/Sewer _ ___-DE C IP OF WORK TO E PERF RMED: .--Identification- Please Type or Print Clearly I I OWNER: Name: Phone: Address: _ Contractor Name: Phone: Email:__ Address: Supervisor's Construction License: cU Exp. Date: Home Improvement License: Exp; Date: 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.: 1 5 Le �7 -7 Receipt No.: a NOTE: Persons contracting with unregistered contractors do not have access the guaranty fund ignatu_re of Agent/Owner C h Signature of contractw<AAW-0— 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 Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Si nature COMMENTS i 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: n,� Located 384 Osgood Street FIRE DEPARTMEN-T Temp pumpste_r on site yes no �. Locatetl at 1244 Mam Street - - --- -- Fire Deparfinent signature/date COMMENTS; _._ 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 NOTES and DATA— (For department use) �I ❑ Notified for pickup Call Email Date _ Time Contact Name Doc.Building Pennit 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 o Building Permit Application ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li 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 o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ 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) ❑ 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 o 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 liance Report o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit p 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 1 � .. Location - �.t_ ff r No. l_ ` ,� , �� Date • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ >L Foundation Permit Fee $ Other Permit Fee $ TOTAL $ _ Check#; - Buil rig Inspector NORTFj own of : ndover O - t^ No. AMP V) ' C h ver, Mass a s a 01 o coc«ic«ew.c« AERATED pPp�,�S S U BOARD OF HEALTH PERM IT T D Food/Kitchen Septic System - THIS CERTIFIES THAT BUILDING INSPECTOR ' � , 1 p�� i. , Foundation has permission to erect .......... buildings on . Q. ..J'u. t r I..�l1Q•�:••.���•�• ••• Rough -�,�c �+� f' a -�- to be occupied as`: ..' ? V1��..�.... ......... ....... .......................W. J.nhWs............ 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS 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 q Sold,Furnished and Installed by: Branch Name: New England Date. l t / THD At-Home Services,Inc. d/b(a The Home Depot At-Home Services Branch Number:31 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal ID#75-26.9$460;ME Lic#C 02439;RI Cont.Lic#16427 CT Lic#HIC.0565522;MA Home Improvement Contractor Reg.#126893 Installation Address: t City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: 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 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 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#: Untemal Reference) Products' Spec Sheets #: Project Amount EIRoofing Siding Windows Insulation []Gutters/Covers EYEntry Doors j 6 Roofing ElSiding 0 Windows Insulation ❑Gutters/Covers []Entry Doors ❑ Roofing ElSiding El Windows El Insulation ❑Gutters/Covers ❑Entry Doors❑ $ Roofing Siding El Windows 0 Insulation ❑Gutters/Covers ❑Entry Doors ❑ Minimum 25%Deposit of Contract Amount due upon execution of this contrail Total Contract Amount $ Maine Purchasers may not deposit more than one-third of the Contract Amount Customer agrees that, immediately upon completion of the work for each Product, Customer will execute a Completion Certificate (onc 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 concerns, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary# ra��s�d� , 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 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 REMEDI FOR R R ECOVERY 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 a copy of this Agreement. Acce ed by: ISubmitted by: t %/rnnAA ► Wi 1. no ._ 1' I Work area will be contained Pre-Renovation Form Date: F $ A 1 27 N T- 9 6 ra This form Is used to document compliance with the requirements of the Federal Lead-Based Paint Renovation,Repair and Painting Program after April 2010. Customer Address Job Number(s) ® Dust will be minimized AJAAdN&1 OCCUPANT CONFIRMATION Pamphlet Receipt have received a copy of the lead hazard information pamphlet Informing me of the potential risk of the lead I hazard exposure from renovation activity to be performed in my dwelling unit. I received this pamphlet before work began. Y�r21 Home Year Built611 (� 41 � /�1� Enter the year my home was built. �"lll if the ear our home was built is Pre--1978,all work will be done following lead safe work practices. o wQ Y 9 ® Work area will be cleaned up Pdnte Nam �t thoroughly Si ature p nt x t l 7" Si at o o rtifying Lead Pamphlet Delivery >` 011- SEE STATE SPECIFIC FORMS ON REVERSE SIDE t ' Fx 4t 4 ne Commonweidlth of Massachusetts Deparbnent of IndustialAccidents 1 Congress Stree4 Suite 100 Boston,MA 02.114-2017 e www mass gov/dia Workers'Compensation Insurance Affidavit:Bnpders/Contracters/Eiectiidans/Plumbers. TO BE FILED Wrl'H THE PERMITTING AuTROPTI'Y. A licant formation Please Print Le MY Name(Business/Organization/Individt4: Address: D City/State/Zip: Phone#: Are you a employer?Check the appropriate box: Type of project(required): 1. I am a employer with-, Ploy=@uu anrvorPart'time).# 7. ❑New contraction 2Q I am a sole proprietor or parbtctship and have no employees working forme in $. Remodeling any capacity.[No tivorkcrs'comp.insurance required.] 9. ❑Demolition 3.Q me 1 am a homeowner doing all work myscl£MO workers'comp.insurance required]* 10 Q Building addition <1 I am&homeowner and will be luring contractors to conduct all work on my property. I will 11. Electrical repairs or additions ensure Shat all contractors citherhave wodmrs'compensation ince or are sole proprietors with no employees. 12.QPlumbing repairs or additions 5.Q I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13,QRoof alis These sub-contractors have employees and have workers'comp.instuance t 14. 6-Q We are a corporation and its officers have exercised their right of exemption per illitsL c. 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 t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new not those entities have indicating such - t that check this box most attached an additional sheet showing the name of the sub-contractus and state whether or not hos employees. ff the sub-conttactArs have employees,they must provide their worker'COMP.policy nurnbcz 1 ant an employer that is providing workers'compensation insurance for my employees. Below is the policy n►rd job site Information.Insurance Company Name: s � Expiration Da +.t Policy#or Self-ins.Lic.#- City/State/Zip:te: Job Site Address. number and expiration date). Attach a copy of the workers'compensation policy declarad n page(showing the poicy Failure to secure coverage as required under MGL e.152,§2e�ocriminal OP WORK ORDER and a fine of up to$50 QQ a and/or one year imprisonment,as well as civil penalties to th may be forwarded to the Office of Investigations of the DIA for insurance day against the violator.A copy of this statement coverage verification. Ido hereby certify an er and enakies of perjury fhat die information provided above's true and correct Date: Signature: Phone#: F[, n nly. Do not write in this area,to be completed by city or town officiaL Town: Permit/License# hority(circle one): ector 5.Plumbing InspectorHealth 2.Building Department 3.City/Town Clerk 4.Electrical Insprson: Phone#: ND CERTIFICATE OF LIABILITY INSURANCE D�iW*116 �Yn THIS CERTIFICATE IS ISSUED AS A MATCER 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 INtSRER(S), AUTHORIZED REPRESEN'T'ATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. if SUBROGATION IS WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. Astatement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME MARSH USA,INC. PHONE Al No: TNO ALLIANCE CENTER E-MAIL 3560 LENOX ROAD.SUITE 2400 ADDRESS:- ATLANTA,GA 30326 INy� AFFORDING COVERAGE NAIC# 100492-HomeD-GAW AI3317 INSURER A:�W insurance Company �� INSURED INSURER s,Zwidl AmeMm hum=CO THD AT-HOME SERVICES,INC. ire IN Co 841 INSURER NewHasnW DBA THE HOME DEPOT AT-HOME SERVICES 17 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER D..rAQiS National Insurance Company ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003746646.14 REVISION NUMBER-:6 .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 tS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AOL R POUCYEFF POMME XP LIMITS LTR I TYPE OF INSURANCE POLICY NUMBER D A X I COMMERCIAL GENERAL LIABILITY GL04BU714.0 031011216 03101r�en EpCHocCURRENce s. s•0000ao CLAIMS,"E �OCCUR PREMISES IEaocarteneel S 1000'000 LIMITS OF POUCY XS MED EJP(Any one person) s EXCLUDED OF SIR$1M PER OCC PERSONAL 5ADV MURY S• 9.0,000 GEN1 AGGREGATE umIT APPLiss PER GENERALAGGREGATE S 9.000.000 X POLICY❑PI LOC PRODUCTS-COMPlOPAGG .5 9,000,000 OTHER COMBIN 3SINGLELfMIT S 1,000,000 B AUTOMOBILE LIABILITY AP 2936663-13 0310112016 03(0112017 BODn_Y INJURY(Per person? S X ANY AUTO ALL OYNNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Par aecideM) S AUTOS AUTOSED PROPERTY DAMAGE S HIRED AUTOS AUTOS etatdden S UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS.MADE AGGREGATE S S DED RETENTION s C ANDEMPLOYERS'NSAFI N v► ,KY 5519215(AOS) 0310112016 03►01Pl01T X Mum ER N 0015519217(AK ,NHNJ Yl) 0310112016 0310112017 E.L EACH�IDF� S 1,000,000 ANY PROPRIETORIPARTNERIE(ECUTIVE D NIA A OFFICERWEMBER EXCLUDED? C01519216(FL) 03/0112016 0310112417 F L.DISEASE-EA EMPL 5 11000,000 (Mandatory)n NH) nyes desenbe under Conftnued on Additional Page E L DISEASE-POUCY LIMIT S 1�'� DESCRIPTION OF OPERATIONS below OESCRIPTION'OF OPERATIONS I LOCAMONS 1 VEHICLES(ACORD 101,Addhlonal Remartca Schedule,may be attached R mom Wee is requlmd) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLM BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhegee ©4988 2014 ACORD CORPORATION. All rights reserved. -ss e office of Consumer Affairs acrid business R-9ulation 10 Park Plaza Suite 5170 Boston, 144��achusetts 02116 Home jmprovemdj..;C-,-qntractor Registration Registration: 126893 Type: Supplement Card Expiration: 81312016 THD AT HOME SERVICES, INC. RICHARD FALLONE 2690 CUMBERLAND PARKWAY So 6-- ATLANTA, GA 30339 Update Address and return card.mark reason for change Address I Renewal 1 Employment Lost Card �j License or registration valid for individul use only EDaffift--frice of Consumer Affairs&Blisiaess Regruladon before the expiration date. If found return to: &E IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation .5 Type: 10 Park Plaza-Suite 5170 IMENWpagistration. 3 - supp�ament Card Boston,MA 02116 Exxpiratibn�7=8-r312010 D AT HOME SERVICEISli FHE HOME DEPOT KT-.H9ML-t RYICES RICHARD FALLONE -`<``--. R' Z690 CUMBERLAND PARKWAY$ GA 30339 Undersecretary Not r lid wi bout Sig ature ,u. it a ve + - .y•: Y ^ : A 2 � a � s HR - 'Y"' ', .: i IS .fix - SALEM NH 0 3079 WFA