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Home My WebLink AboutBuilding Permit #591-13 - 209 JOHNSON STREET 3/4/2012 L TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: � I 2j Date Received Date Issued: t L IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER Print 100 Year Old Structure yes no MAP NO: PARCEL: ZONING DIST CT: Historic District ye no Machine Shop Village ye 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 ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WO O BE RFO D: Id.- tifica on P ease I YIPOr in le ✓> f� OWNER: Name Phon ' Address: XCONTRACTOR Name: Phone: Address: Supervisor's Construction License:� l�� 3� Exp. Date: Home Improvement License: Exp. D! 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: $ G t a FEE: $ 3 Check No.: 5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran d r Signature of Agent%Ovvner Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ tamped Plans 91 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes k..Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Torah )Engineer:Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at'124 Mains Street Fire Departinentsignatureldate COMMENTS 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 B Notified for pickup - Date f Doc.Building Permit Revised 2010 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 Comp 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 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 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 app;al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm;¢ted with the building application Doc: Doc.Building permit Revised 2012 Locatio 209 \,/ y A j s J j No. 5AVI�— Date 11-31-1-11113 e • TOWN OF NORTH ANDOVER e Certificate of Occupancy $ d �. Building/Frame Permit Fee $ , Foundation Permit Fee $ Other Permit Fee $ TOTAL $ . Check# '�� 1 v l 26189 Building Inspector Thermal Products. Com an p y NO. MA REG.#100493 272 North Main Street, Natick,Massachusetts 01760 (508) 655-085 - (617) 7314131 -. ,(800) 734-5949 www thermalproductsma.com. dougfross@comca.st.net I/We,the owner(s) of the premises mentioned below,hereby contract with and authorize you as contractor,to furnish all necessary materials,labor and workmanship oto install,construct and place the improvements according to the following specifications,terms and conditions, n pre ises below described with r erenoe hic_ h we ar nt w are the record holders of title. r Owner's Name Tel Job Address r City State SPECT ICATIONS 00, .. •.ice f EST.STAR Tj' EST.COMPLETION SECURITY INTEREST YES 0 NOL In consideration of the labor and materials supplied by the Contractor,the Owner(s)agree(s),to pay to the Contractor Payable;$ f on deposit ' :12 Balance 4: on completion. THE OWNER SHALL PAY FOR THE WORK BY THE FOLLOWINeNiETHOD- IN CASH UPON COMPLETION( ); BY MODERNIZATION LOAN( ); Notwithstanding acceptance of this contract by Contractor,this contract shall be cancellable by the Contractor if the home owner is unable to finance the payment of this work through:an established.bank or other financial institution or within fifteen(15)days. All work performed by Thermal Products is fully covered by Workmen's Compensatiortan&liability insurance in the amount of $100,000 and$500,000. NOTICE TO THE OWNER(S):- If it will be necessary for you to obtain a bank Modernization Loan in order to enable you to pay for said improvements, please see attached form for financial disclosure. 1. Do not sign this Agreement before you read it. 2.You will be given a completely filled-in copy of this Agreement. This Agreement constitutes the entire agreement of the parties and no other agreements,representations and/or warranties, express or implied,shall be binding on either party hereto unless in writing and signed by both:parties. Any alteration or deviation on the specifications listed above involving extra costs of materials or labor will be furnished and performed only upon written order and will be in addition to the cost price of this contract. The Owners)hereby certify(ies)that he has(they have)read this Agreement,that the terms and conditions and the meaning thereof have been explained to him(them) and he(they)fully understand(s)them. The Owner(s) acknowledge(s)the receipt of an executed copy of this Agreement at the time of execution thereof. If any provisions of this agreement are in conflict with any statute,regulation,ordinance or rule of law,then such provisions 1.L)o not sign tnis Kgreemene Deiv+C yuu Fivau it. 2.You will be given a completely filled-in copy of this Agreement. This Agreement constitutes the entire agreement of the parties and no other agreements,representations and/or warranties, express or implied, shall be binding on either party hereto unless in writing and signed by both parties. Any alteration or deviation on the specifications listed above involving extra costs of materials.or labor will be furnished and performed only upon written order and will be in addition to the cost price of this contract. The Owners)hereby certify(ies)that he has(they have)read this,Agreement,that the terms and conditions and them eaning thereof have been explained to him(them)and he(they)fully understand(s)them. The Owner(s) acknowledge(s)the receipt of an executed copy of this Agreement at the time of execution thereof. If any provisions of this agreement are in conflict with any statute,regulation,ordinance or rule of law,then such provisions shall be deemed null and void to the extent that they may conflict therewith,but without invalidating the remaining provisions hereof. COMPANY'S GUARANTEE: The Company guarantees its workmanship fo .v " ,;ears. It will replace faulty material or faulty workmanship within the period of guarantee free of charge. This agreement may be cancelled by an officer of the Contractor but only within three(3) business days from the date of execution and in a similar manner of the Owner(s)right of cancellation. You may cancel this Agreement without any liabilty to you, provided that you send a written notice to the Contractor by midnight of the third business day following your signing of this Agreement, by ordinary mail, posted, by telegram, or sent by delivery. Attached to this Agreement in duplicate is a document entitled "Notice Of Cancellation" which explains this right of cancellation to you and a copy of that document may be used for said purpose. WITNESS our hands and sealthis _ da1204 gy; .., _ Signed—' REPRES IVE / OWNER Accepted Signed OWNER THERMAL PRODUCTS COMPANY OORTH 00% wTT n ® �.. s � . 1* ndover 0 . , No. : X_ h ver, Mass,16 LA 0 CoCMICNl WICK "� �a A0RA'rED S U BOARD OF HEALTH PERM Food/Kitchen Septic System THIS CERTIFIES THAT.................. ..................SZl .. tRV4!F................. BUILDING INSPECTOR has permission to erect .......................... buildings on ..4Foundation0.2.... . . .... .. . ..... Rough w tobe occupied as ........... ... ........' ............l .0�..........a.40.... ........................................ Chimney provided that the person accepting this permit shall in every respect confor o 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 T LD VIOLATION of the Zoning or Building Regulations Voids this Permit. Final 33 + PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 1 UNLESS CONSTRUCTI RTS 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. SEE REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 aV www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Narne(Business/Organization/Individual): Address: City/State/Zi_p�6" j/G � � Phone#:-- � ►re you an employer?Check the appropriate ox: Type of project(required): ❑ I am a employer with 4.1EJ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors ❑ I am a sole proprietor or partner- listed on the attached sheet.# ? ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions ❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.0 Roof repairs ..J insurance required.]t employees.[No workers' comp.insurance required.] 13./[rOther ty applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. )meowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ntractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. w an employer that is providing workers'comp sation insurance for my employees. Below is the policy and job site irmation. urance Company Name: icy#or Self-ins.Lid.#: Expiration Date: Site Address:_._� �i�/�� City/State/Zip: �• � ach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). lure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a 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 1p to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of astigations of the DIA for insurance cov rage verificatio PIZereby certify under the, a' dpenaldes o rj y that the information provided above is.true 07d correct. iature: Date: ne 4: Or ?ffleial use only. Do not write in this area,to be completed by city or town official. :ity or Town: Permit/License# , ssuing Authority(circle one): . Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other '.nnfart Parenn• PhnnP#- Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required" Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)"A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture ( e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, .lease do not hesitate to give us a call. he Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston MA 021.11 Tel.##617-727-4900 ext 406 or 1-877-MASSAFE Rav##617-777-77Q9 a¢ tAORTH Town of �� .. s IF, Andover O ti. to No. > h ver, Mass, *o'a A- COCKICKIWICK 7�A04 ATEO S U BOARD OF HEALTH PER T Food/Kitchen Septic System THIS CERTIFIES THAT .................. .................< .�il .. �. 4w............... BUILDING INSPECTOR Foundation has permission to erect .... buildings on .AARAP.. . .... . . . .... ..... _ Rough to be occupied as ........... .. ......"�.. .l .0'.......... ... ........................................ Chimney provided that the person accepting this permit shall in every respect confor o 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 T LD VIOLATION of the Zoning or Building Regulations Voids this Permit. Final 33 + PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 1 UNLESS CONSTRUCTI RTS 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. SEE REVERSE SIDE - Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Caritractor Registration ---J -~- Registration: 100493 -- — Type_ DBA Expiration: 6/1812014 •Tr# 223463 THERMAL PRODUCTS COMPANY .` Douglas Ross r 272 N. Main St Natick, MA 01760 Update Address and return card.Mark reason for change. __ f ❑ Address ❑ Renewal ❑ Employment ❑ Lost Card SCA 1 v 2014-Wll --_-�%�{� �aSS�G SSct2�-%?�u�`_'.'`_. 1"•i'�._'- =:.�ti-J?e'�1 - i �ozra Lf Buiidirsc �a :i3leLi 15 and Saanda= CSSL-100334 ` DOUGLAS R� 272 NORTE[MAIN SST Natick MA 4#760: �� r�s�si53sr 01/01/2014 From:TWINBR00K INS 02/01/2013 13:20 #652 P.001/001 AC R" CERTIFICATE OF LIABILITY INSURANCE `""'° 2//1/l/ 13 THIS CERIIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THS CERTIFlCATB DOES NOT AFFIRMATIVELY OR NEGATIVELY mm. EXTEND OR ALTER THE COVEIWE AFFOREED BY THE POU43ES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER IMPORTANT. K the certificate holder!s an ADDITIONAL INSURED,the policy(iesj must be endorsed If SUBROGATION IS WAIVED,subjed to the terms and conditions of the poficy,certain policies may require an endorsement A statement onthis certificate does not corder rights to the cera fieate holder in lieu of such endorsement( PRODUCER NANEACT: Donald Staff Twinbrook ins Agcy 781) 843-7000 IMMO: (781) 848-6100 400A Lpraaklia Street Ate: dstaff@tsviubrook.q= Braintree, MR, 02184 9WE AFFORDINSCOVERAGE wCe IWJMA:Azbella Protection MUM iNwRots:Associated Emlovers Ins. Co. Allied Tame improvement INWRERC: Craig C. Middleton INSURERD: 15 Corel Circle INWRERE: Brockton, MIL 02 30 2 INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELON HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTVNTHSTANDNG ANY REQUIREMENT,TERM OR CONDMON OF ANY CONTRACT OR OTHER DO( A34T 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.LMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ROD LIR TYPE OFINSURMCE 1 wiiD POU CYNUH16ER WAD+Y�YYY UNRS A G6NERALLU161LITY 8500008111 10/5/12 1015/13 EACHoccuRRENCE $ 1 000 000 DAlA4GET R ED $ 100 000 X CONMERCALOENERALLHABi1TY CLAW MADE ®OOCUR WOE)P(AN ore Pte) $ 5 000 PERSOWI&ADVIKURY $ 1,000,000 GENERAL AGGREGATE 4 2.000,000 GEN'L AGGREGATE LMR APPLESPEIt PRODUCTS-ODMpjOP AGO $ 2,000,000 POLICY PRO LOC $ AUTOnO84EUABRRY COH.=SNNGLELMIT $ BODLYO URY(Perpeson) i ANYAUTO ALLOWWD SCHEDULED BODLYINJURY(Par sOddert) S AUTOS AUTOS NON-OWNEDNNHG S HIREDAUTOS _AUTOS arae S UNDFAELLA LIASOCCUR EACH OCCURRENCE L EccreSUAB FC1AMS4AACE AGGREGATE S OED RE7BJTION g WORKESCOrPENSAnON WCCS006GS701 1/23/13 1/23114 X WCSTATU 0TH AND EMPLOYERS'UABILm YPROPRETOR)PARTNEERE-NE UrIVE Y� NIA ELLE H/�QCENr 500 000 MFI OFFKErj HM�2 EXCLUDED? I EL_DISEASE-EA EMPLOY 5 0 0 0 00 fAanftWy In NH) M&4exdbeunder EL.OISEASE-POUCYLMR S 500,000 MON OF OPERATIONS below I)ESCRPTIoN DF OPERATIONS I LOCATIONS riMCLES(Atdeh ACORD IM,AdMonal Re.tm SNhedNe,if nw apace b nqd md) CERTIFICATE HOLDER CANCELLATION I SHOULDANY OF THE ABOVE DESCRIBED PO)JCES BE CANCELLED BEFORE THE EXPIRATION DALE THEREOF, NOTICE WILL BE DELIVERED N Thermal Products ACCORDANCEWIIN THE POLICY PROVISIONS. 272 North Min street Natick, ma 01160 AU71-OFUM RBPRESENTATN6 ItToseph Rizzo / do (0 IM 10 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fac( (508) 651-2845 E-Mail: