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HomeMy WebLinkAboutBuilding Permit #Exception - 20 MABLIN AVENUE 5/1/2018 BUILDING PERMIT 0 No Dr b�ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received "� A�RA7ED I•PP '�5 gSSACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION! _ Print PROPERTY OWNER Print 100 Year structure. yes no MAP _ PARCEL _ _-- ZONING DISTRICT: __ Historic District yes no Machine Shop.Village- yes. no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic ❑Welt ❑ Fioodplain. Wetlands ❑ -Watershed District ❑Water/Sewer_ DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address Con'tract'or Name: _ _ - - _- - -_--- --- -- - - --Phone: Email: Address::. I Supervisor's Construction°License _ - _ _ _ __ Exp. Date: _.. _ a _ a-_- �_-... - - HomeImprovement-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. a Total Project Cost: $ FEE: $ ' Check No.: Receipt No.: NOTE: Persefis contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor _ 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 Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses u 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 o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o 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) L3 Building Permit Application Li 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) o Copy of Contract o Mass check Energy Compliance Report o 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ L� 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature 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 rbPW Town Engineer: Signature: Located 384 Osgood Street FI:RF IDEP R �rARTMENT Ternp�kDumpster�onasite eyes a3no fLocated�at 124IVIain�St"reet• J - "` -- " ..�; 'FareDeparfinentsignature �M ' ®MMENTSk_�,._ 1 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.$10041000 fine i NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 E V t%ORTH own of E �, Andover O - No. 41 T _ h Ch , Lver, Mass, o 3 COC MICNE WIC ��• �d A�OATED #'**, y S U BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System THIS CERTIFIES THAT ..................... BUILDING INSPECTOR ........... .r, '.... .... .� -.............. ........... has permission to erect ... .................... buildings on ....... ,,, ,�, ..... Foundation Rough p' y t0 be occupied as ....... . ....... ........... .... rQ .... ®........................ Chimney provided that the person acce ting this permit shall in ev 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 MOKHELECTRICAL INSPECTOR UNLESS CONSTRUC S S Rough Service .............. ... .. ..................................................... Final BUILDING INSPECTOR 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. about:blank 1 - NATIONAL HEAADUARTERS Robert Hallar x 1501 Seaport Drive.Chester PA 19013 w .R« waw C?ctob6 31-72297 C8$$-R OijEL „ 10,2015- MA H1c#168616 CUSTOM REMODELING AND IMPROVEMENT AGREEMENT BuYer(s)'Information and Description of the Property: Project Number:31-72297 potoW10,2Dfift Of 0 Robert Hajar (gfg)685-0513(Home) 20 Mallin Ave North Andover,MA,01645 County:EssmC Township: Buyer(s)listed above hereby jointly and.severally agrees to purchase the goods and/or services of Power Home Remodeling Group and its vendors("Contractor's in accordance with the prices and terms described in this 5 page document and the Product . Specifications,which are incorporated as part of the Agreement(collectively,this"Agreement"),.This Agreement represents a cash sale of goods and services. Buyer(s)agrees to pay the cost of the goods and services purchased as described heroin,regardless of timing or approval of any Buyer(s)may seek for their purchase. Purchase Price: $6,416.04 . Pre installation Inspection Dates: Down Payment: $3,210.00Mon IVAbetween 1:Oep and 2=0 Balance Due on $3,206.04 Estimated Project Start:6 to 7 weeks Substantial Completion: ' Estimated Project Completion:1 to 2 days Method of Payment: Chess auyerts)admoeledpe the+a dermke alert and completion dates are NOT of the essence,oetaya C,owwtort enrol std Included in pwwffv wm trames.see Deiayll)AW-C-4ftw s• Buyers)hereby acknowledges receipt of a copy of the pamphlet,"The Lead-Safe Certified Guide to Renovate Right",Informing Buyer(s)of the potential risk of lead hazard exposure from renovation activity to be performed in or at Buyer(s)'Property,at the ad on above.Buyer(s)received this pamphlet on the date of this Agreement,before commencement of work. Buyer(sy Initials. This Agreement constitutes the entire agreement and understanding between the parties,and this Agreement replaces any and all prior negotiations,representations,or agreements,either written or oral. No amendment,modification or waiver of this Agreement shall be valid or effective unless In writing and signed by both parties. Buyer(s)hereby echo ledges that Buyer(s)1)has.read the entire Agreement and has received a completed,signed,and dated copy of this Agreement,including the two accompanying Notice of Cancellation forms,on the date first written above and 2)was orally Informed of his/her right to cancel this transaction. Buyer(s)also agrees and understands that if Buyer(s)-finances the work with a third-party,the terms of that financing will be contained on separate documents,.Including any finance charge. Future promotions not applicable. , DO NOT SIGN THISiAGREEMENT IF THERE ARE ANY BLANK SPACES. i I have read and ret:efved each pegs of this 3 page agreement. i Power Home Remodeling Group Buyer( i /10/14/15• 115 Sigma ,FIemodeiing Consultant Signal r 1 Nick Schwertschlag Robert air ,YOU,T14£BUYER(S),MAY"CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY' 1 AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION•FORM•FOR AN EXPLANATION OF ¢ THIS GHT:: October 10}241514:26 .' ` 1i �ut�l�lp' �1�ry $ , • _� � RIN �I��) Page 1 of 5 T.y 1 of,1 11/7/2015 10:45 AM NATIONAL HEADO tJARTE RS, Robert-Hajjar . ` 2501 Seaport Drive,Chester,PA 19013 _ 31-72297 October 10;201.5EMODEL]� . ,_ a r�r{'�� .fid •• v��• `' . .. " MA HIC#-168616 Project Specifications Windows: Living room 1 101.0"x50.5" WINDOWS: Models SL 2700 Styles Bay Types None Configs Double Hung Ends tti OPTIONS: Color White/White: Grid Pattern: None I Removal Wood I Upgrade Head,Seat and Jambs Pine I Additional Details None It u a,� � ��_ q' �s x +„ 'f`+. •�•�. a ., - '•fi _ 1 —"x + .... +,... - a,-. .�S i aM -a �{#F ¢ w i T n �wC ! •m•'"Cr f! October 1D 207 51 4 26 ' � M1 ,', z ? l ;a � -.:, f � !,•� gage 2 of 2 r_, y I € � .�.':i 't�' :r;..� _...',- ., „ tin r.. ..� `. ., . ."."� .,�.:�1< `' .t?'.i'c�' ,�'a;-.a � � �..� .__ ,.,�' S. ... _ >. ;. .� .>.�:� -+.M1 . :v,.�5. r, •{`'^ t i:aY. �,'� ... 4'�.. . �R NATIONAL HEADQUARTERS` Robert Halla 2501 Seaport Drive,Chester,PA 19013 ( /► 31-72297 R«�«•g # October 10,2015 888-RIEMO EL t• E •• a��� MAHIC#168616. :: . PRODUCT SPECIFICATIONS Buyer(s)'Information and Description of the Property: Project Number: 31-72297 October 10,2015 Robert Hajjar Date of Agreement.. (978)685=0513(Home) 20 Mablin Ave North Andover,MA,01845 County:Essex Township: Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services listed on the accompanying specification _ sheets,in accordance with the prices and terms described in the Custom Remodeling and Improvement and the Product Specifications (collectively,this"Agreement"). Pre Installation Inspection Date:Your pre installation inspection is tentatively scheduled for Mon 10/26 between 1:00p and 2:00p. Windows-SL 2700 Inclusions: Includes metal reinforced meeting rails and nighttime safety locks on double hung windows only,welded corners,foam injected frames,Sashlite technology, Heatshield,Duraglass,exterior custom capping,installation,clean up and haul away of all job related debris. It is agreed and understood by and between the parties that the Product Specifications,along with the Custom Remodeling and ImprovemenfAgreement,constitutes the entire understanding between the parties,and replace any and all prior negotiations, representations,or agreements,either written or oral. The Product Specifications may not be changed, modified,or varied in any way unless such changes are in writing and signed by both Buyer(s)and Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read the Product Specifications. =.l have read and received,each page of this 2 page agreement. Power Home'Remodellrig,Oroup d Buyer(s) - fi 4 %10/10/15 { _ Signature of Reinodel'ing Consultant ` A Signature ,. Nick Schwertschlag n.a Robert.Ha��a Y YOU;THE':BUYER('$),MAY CANCEL+THIS TRANSACTION AT ANY'TIME'PRIOR TO MIDNIGHT OF THE THIRD BUSINESS;DAY AFTER THE DATE OF THIS TRANSACTION.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF :r. THIS'.RIGHT: rJ y ,k t October 10,20151-4.-.26' R j -- �. � . � t ., � � � 1111111 llllllllllllllllllllllllllllllllllllllllll r - : _�:� � � ��{ �_ � -� ._ ,Page 1 of 2 4 L�L:VL.0 •-:`I:�\� c__—�- - x �{f.i c\" CAV •s 11 � � f "�L.-�j1- � - -£. {+c""- ........ . z E INN-- 4Y N F 0 fie"A NI A7!NC-* II 7s Emm i >nvi"4:L- a�a - - T, '«•cy �ti�s ,�l�e`"is�,.7YMi�is�(• p�Ir�'���'Flr'q�i"k'€h r X� + "'��l ������� ' '' '72 {JtT -a` 3j g? F„ _ , T± 4 d j Y'^ .6�wlf- ATP'aa�i�il +6r`e :. �� t- � ""'��Ys`i.AL7R'",i.'���S-'„�'{ C•� �, Y T -'E-y � ,y i �} 'P K "` sk,� _ �a+.r� Ys �tr F,�t 5^`"�� 't�y�x '�N����3^'� t• e -�n 5 I li POWER-1 OP ID:EL ACOROfl DATE(MM/DDffYYY)CERTIFICATE OF LIABILITY INSURANCE 09/1112015 THIS CERTIFICATE IS 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). PRODUCER CONTACT Lacher&Associates Ins Agency PHONE FAX - Lacher Insurance Group Alc Nn Ext:215-723-4378 Alc No): 216-723-8604 632 E Broad St P 0 Box 64398 E-MAIL Souderton,PA 18964 ADDRESS: Chad Lacher INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Harleysville Preferred Ins.Co 35696 INSURED Power Home Remodeling Group, INSURER B:Harleysville Worcester Ins Co 26182 LLC INSURER C:Nationwide Mutual Ins Company 23787 2501 Seaport Drive Ste B110 Chester,PA 19013 INSURER :Pennsylvania Manufacturers 12262 INSURER E: - INSURER F, COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: 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. INSR TYPE OF INSURANCE ADDL SUB - POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDDIYYYY MM/DDIYYYY - LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1;000,00 CLAIMS-MADE ❑X OCCUR- MPA00000089793N 10/01/2015 10101/2016 REMIDAMAGE T R NTED 1 OOO OO PREMISES Ea occurrence) $ MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 _ POLICY ]PET F—]LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 B X ANY AUTO BA 00000089796N 10/01/2015 10/01/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 C X EXCESS LIAB CLAIMS-MADE CMB00000089794N 10/01/2015 10/01/2016 AGGREGATE '$ 5,000,00 DED T RETENTION$ $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY - X STATUTE ER D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 201500-66-20-96-7 10/01/2015 10/01/2016 E.L.EACH ACCIDENT $ 1,000,00 OFFICER/MEMBER EXCLUDED 9 Y❑ N/A (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,00 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ - 1,000,00 - B Mass Auto BA OOOOOO18227P 10/01/2015 10/01/2016 Auto Liab 1,000,00 B NY Auto BA 00000074849R 10/01/2015 10/01/2016 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION NANDOVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE -EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover --' 120 Main Street - AUTHORIZED REPRESENTATIVE - - North Andover,MA 01845 . ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORI Tie Commonwealth of Missacs efts De PaHment of Indtasnial.Acc8de,js 1 Caangress Street,Sake 106 BOWUtt,kU,02,114-20.17 w mass.geaav/ Workers'CoMpensation hmurartce Affidavit:)$udders/Contractors/Electa icians&lurnbers. BE 1 Vvrr i THE PERMTr3 NG ATiJ1'1LIO 'Y. Applicant Infortxnation TO Please Print Legibly Name(Business/organization/Individual): Address: eSb i City/State/Zip: 4c It PA 10,613 Phone#: Are you an employer?Check the appropriate box: I. 1 am a employer with 1 ees full s Type of project(required): �p oy ( andloapart-tame). 2. I am a sole 1 ❑New Construction. ❑ clot or l�dm partnerahrp and have�employees ivor3vag for mein any capacity.(No workers'comp.iiosuranee 1eguirei] g• Remodeling 3-El I am a homeowner doing all work myself[No workers'comp.insurance regzmed.]i 9. Demolition 4.❑]am a homeowner and wiII be hiring contractors to conduct all work en my property. 1 wrll 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole proprietors with no employees. 11.[]Electrical.repairs or additions S.®I am a general go-tractor and I have lira the so 12.E]Plumbing repairs or additions b-contractors listed on the attached sheet These sub-contractors have employces and have workers'comp.insu,ancc.: 13.®Roof repairs 60 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no1 ees. amp oy [No workers'comp.insurance required,] *Any applicant that checks box 91 most also fill out the section below showing their workers'compensation policy mfomretion. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors mast submit a new affidavit indicating sech ;t ontractors that check this box must attached an additional sheet showing the name of the sorb co�eactors and state submit w not those entities have employees. If the sub-co�ractors have employees,they must provide their workers'COW.Policy number. � P Po"cY I am an employer that asproviding workerscompensation imurrance for information. my employees. Below is thepolicy and job site Insurance Company Name: Art Policy#or Self-ins.Lie.#:_ ZC 15'00' Expiration Date-_®`l_Z®16 Job Site Address:_. /e1(L�/ne 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 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 v " I&hereby the pains eutd per:alties ofPe+7a►Y that the informa&n provided above is true and crorrect. I Si elute: Date: Ph #: 5d8-Zea'Dd "� Oj wkd 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.B110ding Department I City-Nown Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#• i �V i+fi t,(•f.7ilfii..:af1'iia>f�i:�'M�:F'(lfata',tdi� t JI ; fiiee Of Consumer Affairs b?usiness bdpga6ati�n License or registration valid for individui ease wily _}OhriE IN&PROVE.MENT CONTRACTOR before 1he elpiratioia date. If found return 10: �dea�istrali�ir: 6861 Office.of�ORsumer.Affairs and Business Regulation 9` TYpf lopar Plaza-Suite 5a7Q Expiriticn: 31'1812017 Suppl�meri ;2rd POWER HOME REMODELING-GROUP LLC. iE6 �N f l 1,: t MARK MORDINI 1 2509 SEAPORT DRIVE STE E910 OHI=STER,PA 19013 gl�dersecreRary blot valid vvithout signature i I i Awl Massachusetts Department of public Safety Board of Building Regfuiatiorl5 and Standards License:CS,45764.5 �.., 1�i111 UCtiUn i r , n . MARK E MARDINB k`s 9s NEWELL DR NATTLESORO�tIA ' a � Expiration: COhInlissioner p91t8f3�17 .: 4 _ 4 � ry \� -- fil1Yi1EBb1t13UGH#AA. 5 DD 09-22-M941tev6T45-�Q4 t� +fit= -