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HomeMy WebLinkAboutBuilding Permit #38 - 217 BEAR HILL ROAD 7/14/2009 BUILDING PERMIT No DT baa 4r o TOWN OF NORTH ANDOVER c - Z. i APPLICATION FOR PLAN EXAMINATION * - � o� Permit NO: Date Received � Arm �SSACHUS Date Issued: IMPOR ANT:A licant must complete all item I pp p son this page LOCATION' ri P PROPERTY OWNER Print A MAP NO: _PARCE ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential -New BuildingOne family �C y 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 WORK TO BE PREFORMED' Idtific tion Please Type or Print Clearly) OWNER: Name: Phone: Address: Nb I� e�tr� CONTRACTOR Name: - - l e (Phone: Address: Supervisor's Construction License;_ —1 C_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: $ o?SLp'"— FEE: $ �� Check No.: Receipt No.: C3 NOTE: Persons contracting�vA unregistered contractors do not have access to t uaran fund __ig5� nature_of Agent/Owner � `( Signature of contractor ' Location No. Date NORTH TOWN OF NORTH ANDOVER F p + Certificate of Occupancy $ s'••••+c MusE Building/Frame Permit Fee $ Foundation Permit Fee $ �L Other Permit Fee $ TOTAL $ Check # c��1 .2 22, 10 _ Building Inspector i Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Swimming Pools Public Sewer S Tanning/Massage/Body Art 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 r r 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 324 MainStreet Fire Department signature/date COMMENTS +I 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 2 1 A—F and G min.$100-$1000 fine NOTES and DATA— For department use i 1 i ❑ Notified for pickup - Date Doc.Building Permit Revised 2009 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 h 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:Building Permit Revised 2008 e10RTH Town of � - 4 � Andover V" L A K E dover, Mass.,• • -01 C OC NICK WICK A0RA7ED S BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT d......,.., . ... '�... .t. t... ................................... ....... .... ............. Foundation ghas permission to erect buil ings on ..... .... ....... . t.C�..... ............ Rough to be occupied as Chimney provided that the person accepting this permitsha I 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 PERMIT EXPIRES IN 6 MONTHS Final 00"� UNLESS CONSTRUC M'T'S ELECTRICAL INSPECTOR Rough .................................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. ACORD-.. CERTIFICATE OF LIABILITY INSURANCE FU 2/20 /DD/YYYY) o2/zo/o9 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.certrequest@marsh.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 NAIC# INSURED INSURERA:Steadfast Ina CO 26387 THD At-Home Services, Inc. INSURERB:Zurich American Ina Co 16535 2690 Cumberland ParkwayNATIONAL UNION FIRE INS CO OF PITTS 19445 Suite 300 INSURER C: Atlanta , GA 30339 INSURERD:New Hampshire Ins Cc 23841 INSURERE:Illinois Natl 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. INSR7DD'LPOLICY EFFECTIVE POLICY EXPIRATION LT POLICY NUMBER DATE MM DD DAT M DD LIMITS AGENERALLIAgILITY IPR 3757 608-02 03/01/09 03/01/10 EACHOCCURRENCE $4•,000,000 X COMMERCIALGENERAL LIABILITY LIMITS OF POLICY ARE EXCESS DAMAGE TO RENTED 1;000,000 PREMISES Eaoccurence $ CLAIMS MADE OCCUR "OF SIR: $1,000,000 PER CC" MED EXP(Anyone person) $EXCLUDED PERSONAL&ADV INJURY $4,000,000 GENERAL AGGREGATE $4,000,000 GENI AGGREGATE LIMITAPPLIES PER: PRODUCTS-COMP/OPAGG $4,000,000 X POLICY PROT- LOC B AUTOMOBILE LIABILITY BAP 2938863-06 03/01/09 03/01/10 COMBINED SINGLE LIMIT $1,000,000 X ANYAUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULED AUTOS (Per person)- $ HIRED AUTOS BODILY INJURY $ NON-OWNEDAUTOS (Peraccident) X SELF INSURED AUTO PROPERTY DAMAGE $ PHYSICAL DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO ` OTHERTHAN EAACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $5,000,000 X OCCUR F�CLAIMS MADE AGGREGATE $5,000,000 DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION AND 3566916 (CA) 03/01/09 03/01/10X WCSTATU- OTH- EMPLOYERS'LIABILITY TORY LIMIT E D 3566915(AOS) 03/01/09 03/01/10 E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE E OFFICERIMEMBER EXCLUDED? 3566917 (FL) 03/01/09 03/01/10 E.L.DISEASE-E4 EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below I E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER D Workers Compensation 3566918 (KY, MO, NY, WI,WV) 03/01/09 03/01/10 F TX Employers Excess TNSC45694422 (TX) 03/01/09 03/01/10 ccurrence/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— I 77 --- 77 C _ Board of Build' rng Regulations and Standards LIcellSe or registration valid for indi ul use o1.n' HOME.IMPROVEIVIENTOONTJV RAPTOR before the expiration date. If found return to: Registratrorr .126893: I Board of Building Regulations and Standards ERl)ra_ion W-8/2010 One Ashburton Place Rm 1301 0 s Boston,lvla.02108 Tyae Supplement Card The Home Depot AfHome'Sernce RICHARD FALLONE r,l .3200 COBB GALLERIA IK-W #20 : TLANTA, GA 30339 f. Administrator Not vali without signature The Commonwealth ofMassachusetts Departinent of Industrial Accidents Of fee of Investigations _ r 000 4• 'as it i tars,crux .l o,eeet Boston, 111A 02111 !°M MiJw.Mass. pov1dia Workers' Conlpensatiou Insurance Affidavit: Build ers/Coraractors/Electricians/PllIMbCI'S Aplilicant Infformation Please Print Le ibly Name (Business/Organization/Individual): Address: j Q640k-�4yiWzry City/State/Zip: C �-�`�, �fl Phone.#: ��f LI 5t9 Are yoy an employer?Check the appropriate box: Type of project(required):_ 1. I am a employer with ) 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. F1New construction 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 h'• 9. ❑ Building addition [No workers' comp.insurance comp. basurance.t required.] 5. ❑ We are a corporation and its 10-0.Electrical repairs or additions officers have exercised 11. Plumbing 3.�] I am a homeowner doing all work hid their ❑ big repairs or additions. myself o workers' co right of exemption per MGL y [N comp. 12.0 Roof repairs insurance required.] t c. 152, §1(4), and we have no ,,—, ��// employees. [No workers' 13 Lldtimer 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, tContractors 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: C� Policy#or Self-ins. Lic.#: �, Expiration Date: -�3 l Job Site Address: �P4City/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$:1,5.00.00 and/or one-year imprisonments-well,�w-�^ _of a STOP Wn 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 certi un r e ps an penalties ofperjury that flue 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: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: FROM : Panasonic TAI)/FAX PHONE NO. : +872 9599 Jan. 30 1999 07:58AM P03 I HOME IMPROVEMENT CONTRACT' PLEASE READ THiS i Sold;FltrAV14d and InstalServices. Inc,Branch Name: Boston Date: / THI)At-Dome Services,lac, d/b/A The Home xkpot At-home Services Branch Number: 345A root, orcester,MA 01607 ONarth 33 (]South 31 1'o Irree 800 657.51 Fax(508)756.8823 Federal 10 75-2698460;ME Lie 39;Rt Com,1,W 16427 T f 5655 ;MA Ho ne im)roverr eht Contractor Reg,f!126893 //ma�yy� Installation Addre,(:a: y� 1q, City State ip '�`''t� Purchuwer(s): - 'Work Phone:• Home Phone: Cell Phone: �y IlomcAddress: __ (11'difycn-m from Installaiion Address) City State Gip E-mail Address(to receive pmject.cummunicatinns and Home Depot updates): El DO NOT wish 10 receive any marketing;emails fmm'1'hc[ionic Depot Proict t informa/ion: Undersigned("Cutdolner"),the owners of the property located at the above installation address,agrees to buy, and'1"IID At-horde Services,inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials(Imerihed on the below and on the referenced Spec Sho t(s),all of which arc:incorporated into this Contract by this reference,along with any applicable Stale Supplement and Payment Summary attached hereto and any Changs Orders(collectively, "Contract"): Job Ni p.rc,a.0 u:•rt,c"n> Pr "cut. _ Si)ee l±hecl(R)th. __. Project Amount r6Q.U Window ris'v anon - — — '7 Ol-mter9/Covers [JEntry Doors Ronfing Siding 0 Windows ❑insulation rJouvcn/Covers ❑EntryDoors ©. Koofing OSldtng Windows Insulation O(.muers/Covers []EntryDuum EJ_-,—_ - - —0Roofing Sidin} 0Windows )nsulallo+) [](;utters/(:overs OHntryDoors ©...__ . Minimum 250/a Deposit of('ontrad Amount duce upon execution of this-cootrael Total Contract Amount. Maine Po.rhasers may not deposit more than ono-third of the(imtrad Amount g Customer agreetr that,immediately upon completion of the work for each Product.Cuslonrcr will execute a Completion C.rrtiiicaic (onc for each Product aR definul by an individual Spec Sheri)and pay any balance due, As applicable,each Customer under this Conit-det agrees to be Jointly and severally obligated and liable hereunder, The Hone Depol reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Hume Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such its mold,asbestos or lead paint,other safety concerns,pricing arors or because work required to complete the job was not included in the Contract.. Pavrrlent SammarX: The Payment Surnmary # _ /�. �—,included as part of this Contrast, sets forth the total Contract amount and payments required for the deposits and tool paylmmis by Product(as applicable). NOTICE.TO CUSTOMER You are.entitled to it 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 cornpfete. 4,4 LAO bithis<CJonttmt,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided by The Home Depot or Authorised Service Provider through the date of termination,plus any ollidw amountR set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE IIOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING;T'IIE HOME DEPOT'S OTI`1VR REMEDIES FOR RECOVERY OF SUCH AMOUNTS.' Aceeptatic A 1[ ri 't n: Customer agrecc and understands that this Agreement is the entire abrevincnt between Customer and The Home Depot with regard to the Products and Installation.wrvioes and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement ennnol be assigned or amended tixcxpt by a writing signed by Customer and'11ie Ilon)c lh:pmt.Customer acknowledges and agrees that Customam -CPL.,bas read,understands,voluntarily aepts the terns of and has received a copy of this Agreement. Acre by: ` Subm 1 by: x X— CusSignaturc Date Sales .t .ultant's, gnature Date x Telophonc No. Glstomer's Signature Datc Sales Consultant IAcmiw No. CANCELLATION: CUSTOMER MAY CANCEL THIS (asapptioable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DEIJVERING WRiTTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AN IXR SIGNING THIS AGREEMENT, THE ST)VI - SUPPLEMENT A'I'TACitED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFiCALLY PRESCRIBED BY LAW IN CUSTOMP.R'S STATE. NOTICE:ADl)1'IYONAL 9'ERMS AND QONDi,YIONS ARlt%I'A'1'ISn ON 77IP RRVF,Itsl{NiI)F.ANI)AItE l'AIYI'OP'nllh(.'ON'IUAC'T 104.08 rev a-08.68 C•SC Whfta-©ranch File Yollouv=Customer Pink y 86169 Conaultart i I °'-� �lax,,:•hu.�.ylt - 1)clrarintc'nt i)f J'irhiic`:;tfct� lin;tr t! in 13uiltlirt� ith ulatiuns And I:rrirl;trrJ --' Construction Supervisor S,recialty License Lir-pose: CS SL 102622 Restricted to: IC Ai KEVIN KEVIN LEGER4 1311 COUNTY STgUET SOMERSET, MA 02726 i I E�pir1 rt: 102622 ---_-_ ation: 8/19/2012 le - Board MBlui9i/nIdain R� at&ag gns andStandards - One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement`4 tractor Registration Registration: 152091 Type: Supplement Card Expiration: 7/28/2010 INSTALLED BUILDING PRODUCTS LLC KEVIN LEGER •.-- 495 SOUTH HIGH ST SUITE 50 COLUMBUS, OH 43215 U .Address and return card.Mark reason for change. P Renewal " DPS-CAI ii 40M•OB/08.OBSLIFORFACA7082t2008 Address �J lJICmploymcnt _� Lost Card. -> oa.an:orr+ue�cll/ o`✓lla:kt�uael76 Board or Building Reguiations and Standards HOME IMPROVEMENT CONTRACTOR License or registration valid for individul use only C a before the expiration dnte. If found return to: Registration: 152091 Board of Building Regulations and Standards }^� Expiration 7/Z8/2010 One Ashburton Place Rm 1301 a�> : Type: Supplement Card Boston,h1a.02108 INSTALLED BUILDING PRODUCT REVIR LEGER 495 SOUTH HIGH ST SUITESO COLUMBUS,OH 43215 ��� Administrator Not valid Fvithout signature 'I 'j i i