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HomeMy WebLinkAboutBuilding Permit #630-15 - 218 APPLETON STREET 1/30/2015BUILDING PERMIT TOWN OF NORTH ANDOVER (rte APPLICATION FOR PLAN EXAMINATION Permit No#: ✓ Date Received Date Issued: IMPORTANT: Applicant must complete all items on this, 77, o n 0 ,. LOCATION OC tQ , Print 4 _ PROPERTY OWNER �" rint 100 Year Structure yes no MAP QXp'� PARCEL:_ ZONING DISTRICT: Historic District ye no Machine Shop Village y s _ no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 26he family ❑ A 'tion ❑ Two or more family ❑ Industrial ❑ Ateration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ WatershedDistrict ❑ Water/Sewer IdVcar Please Type or Print Clearly OWNER: Name: v1�,�, Aa,( Address: Contractor Name: Address Supervisor's Construction License:Exp. Date:_ Home Improvement License: ARCHITECT/ENGINEER Dater Phone. { Address: Reg. Na. FEE SCHEDULE: BOLDING PERMIT. $12.00LPER $1000 OF THE TOTAL ESTIMATED:COST BASED ON $125.00 PER S,,�. Total Project Cost: $ FEE: $ Check No.: ��� Receipt No.. NOTE: Persons contracting with unregistered contractors do not have ;acces, too g aranty fund Signature of Agent/Owner Signature of contraJY, A Location2 (�e N o. (0-�) L) -IC5 Date Check � � oci 15 2 ;- Z� 61 U . TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL B61ding Inspector Nt _ r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans TYPF OF SEWERAGE DISPOSAL ❑ Public Sewer ❑ Tanning/Massage/Body Art ❑ FFood ing Pools Well ❑ Tobacco Sales ❑ackaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING S GN OFFOFFICE - U FORM E ONLY INTERDEPARTMENTAL PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed On Signature Reviewed on Signature Reviewed on Si nature Zoning Board of Appeals: Variance, Petition No: + AI fanning Board Decision: Comme Conservation Decision: Comments Zoning Decision/receipt submitted yes 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 signatureldate 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 ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit 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 ❑ 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 a 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) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 2014 Branch Name: Boston north S South Branca Number: 31 and 33 Installation Address: Purchaser(s): 140ME IMPROVEMENT CONTRACT In PLEASE READ THIS t' p Sold. Famished and Instalred�by: THD At-l-lonte Services, Inc. d/b/a The Horne Depot At-Homc Services 908 Boston Turnpike, [:nit 1, Shrewsbury, MA 01545 Toll Free 577-903-3765 Fedrral ID 75-269S460: ME Lie 4- C 02439; RI Cont. Lic 16427 CT I_ic f HiC,0565522: \qA [-tonic Improvement Contractor Reg.:. 126593 City State Zip nume Aaoress: (if different from installation Address) Citv state Zip C -mail Address (to receive project communications and Home Depot updates): ❑ i DO NOT wish to receive any marketing ernails from The Home Depot Project Information: Undersigned ("Customer"', the owncrs of the property located at the above installation address, agrees to buy; and THD At-Homc Services, 1-1c. ("The Horne Depot") agrees to furnish, deliver and arrange for the installation ("installation") of all materials described on the be otiv and on the referenced Spec Shcet(s), all of which are incorporated into this Contract by this rci`crerlce, along ��ith any applicable State Supplement and Payment Summary attached hereto and any Change Orders (collectively. "Contract"): Jost f{: (lnmrun! Retrrr.L e) Products; SpeeccjS�heet(s) #: Project Amount q 2 Rooting Siclin� \�'iD ors htsulatio �('�`� 2- ❑Gurtcrc; C'o�ers ❑ ..ntry Duors ❑ i t.J ' Rootin_ Siding indo,,s lnsulatiun ❑Gutters ' Covera ❑Entry Door, ❑ S RoofingSiding E��indows Insulation ❑Gutters," Cover; ❑Entre Doors ❑ S L.IKOOling LJSICIIDg LJ NN`fndows T7 InS:datiOn ❑Gutters ` Covers ❑Entry Dcors ❑ S Minimum 251/.) Deposit of Contract Amount due upon execution ofthis co!.±:11 Maine Purchasers may not deposit more than one-third ofthe Contract:l Contract Amount S ��r1� Customer agrees that, irtmc�iately upon completion of the work for each Product, Custorncr will execute a Completion Calificatc tone 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 Horse Depot rescrvcs the right to issue a Change Orderor terminate this Contract or any individual Product(s) included herein, at its discretion, if The Home Depot or its authorized service provider detelTllinCS that it cannot perform its obligations due to a structural problem t+ith the honk, environmental hazards such as mold. asbestos or lead paint, other safety concerns, pricing errors or because —work required to complete tltc Job was not included n the Contract. Payment Sutnmarv: Tltz Payntcnt Summary �� 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)• You are entitled to a completely tilled -in COPY of (lie OColntra CCE ontract CUSTOMER t the time }yosign. DO not sign a Completion Certificate (note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets) before ~cork on that Product is complete. In the event of termination of this Contract, Customer agrees to pay The Home Depot the costs of matet•ials, labor, expenses and services provided by The Honig Depot or Authorized Service Provider through the date of termination, plus ant• other amounts set forlh in this Agreement or allowed under [applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM TIIE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOU•l' LlmrrING THE HOME DEPOT'S OTHER REMEDiES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer airces and undcrsta:-ids that this Agreement is the entire agrecnncnt between Customer and The Honte Depot with reg g to said to the Products and installation seri ices and supersedes all prior discussions and agreements, either oral or written, relatind Products and installation. This A- cement cannot be assigned or amended except by a writing signed by Customer and The Home Depot. Customer ackno%vlcdgcs and agrees that Customer has read, understands, voluntarily accepts the term; of and ha-cceived a copy of this Agreement. cc / /�. 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Cheek th appropalats toxo Twe of project Omgmtaed): l t arae a employer with 4. ® l am a general contractor and I ®N►const clioaa employees (full and/or part -lime).° 2. ❑ 1 am a sole proprietor or partner - have hired the sub -contractors listed on the attached sheet. . i. ® Reanodeling -ship and have no employees 'These stab-coAtractors have g, ® Demolition working fo.r me in any capacity. employees and have workers' insurance.t .9. ® Bull F! addition [No workers' comp. insurance comp. 5.0 Erle are a corporation and its 10. Electrical airs or additions ® � required.] 3. ® I stn a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [Ido workers' comp. right of exemption -par MGL c.1529§1(4), t� we have no 12.® Ro ears f �q�)�p�l.p 'e4 d�l t ' yii.� W uaa\ib 1 ) 13. Other Other -421 coam9. BnSt3rM= reQtured.l 'Any applicant that checks box #d must also fill out the =don below ahowaAg their wo kw, eataeerawon golicy information. I Homeowmem who submit this affidavit indicating they an doing all work -and then hire eutsida caatract u must submit a neer affidavit indicasiag arch. tContraetom that check this box must anaQhed as additianal sheet showing the same of thl sub-MAU s and state dvlae3lrier or not those entities have .employees. If the sub-cantraetors have employees, they must provide their. vnrkem' ewM. policymember. d aaa an employer that Is prrovong worpken, compensa8dox INSUMacefoe agy employem Below Is ghe potdo Mad job site Insurance Company Policy # or Self -ins. L.ic. Expiralidn Job Site Address l.asyryeaxtrdrey.�. Attmch a coley. of the weyken, compeaeatlon po cy declaaaRlon purge (ehowdng the policy ratzfem6ece>� and ¢ laaRlorm date)- ch to secure. coverage as required under Section 25A of MGL, c. 152 can lead to the imposition of criminal penalties of 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 ofup to $250.00 a day against the violator. Be advised that a copy of ties statement may be forwarded to the Office of - Investigations of the 131**insurance coverage verification. I do hereby certify of peayjamrny daw She Onfror madon provldedl above Is gr and ®a mcf. O, Gaal use oast,/. Do not write i n*ghes mre&4 So be g0MR 49d By ckY ®P RoM Offlceml. tS City er Town: re s�ltll�c ruse # Hsaming Authoilty (circle one): R. Board of -Health 2° gatlfldmag HDepargmelat 3° tClty YMM (Mark 4o F-RecWcd llusgcc dOr 5 rlamblag hapectos, 6° Gthter Phone(Contact reason: #a® �® CERTIFICATE OF LIABILITY INSURANCE DA111801DD/YYYY) 111182014 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 MARSH USA, INC. TWO ALLIANCE CENTER CONTACT NAME: AIC, o aixc No): 3560 LENOX ROAD, SUITE 2400 ATLANTA, GA 30326 E-MAIL ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC S INSURER A: Steadfast Insurance Company 26387 100492-HomeD-GAW-14-15 INSURED THD AT-HOME SERVICES, INC. DBA THE HOME DEPOT AT-HOME SERVICES INSURER B: Zurich American Insurance Co 16535 INSURER C : New Hampshire Ins Co 23841 2690 CUMBERLAND PARKWAY, SUITE 300 INSURER D : Illinois National Insurance Company 23817 ATLANTA, GA 30339 INSURER E: INSURER F: A COVERAGES CERTIFICATE NUMBER: ATL -003242685.07 REVISION NUMRFR'7 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 WTH 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. IL TYPEOF INSURANCE L IN SU R POLICY NUMBER DY EFF MNW jIDYTR MIDNYYY LIMITS A GENERAL LIABILITY GL04887714-04 03/01/2014 03/01/2015 EACH OCCURRENCE $ 9,000,000 X COMMERCIAL GENERAL LIABILITY TO R DAMAGES [ PREMISES E TEDurrence $ 1,000,000 occ CLAIMS -MADE X❑ OCCUR LIMITS OF POLICY XS MED EXP (Annyy one person) $ EXCLUDED OF SIR: $1M PER OCC PERSONAL & ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9,000,000 ' GEN'L AGGREGATE LIMITAPPLIES PER: PRODUCTS - COMP/OP AGG $ 9,000,000 X I POLICY PRI JECTLOC - $ B AUTOMOBILE LIABILITY BAP 2938863-11 03/01/2014 03/01/2015 COMBINED SINGLE LIMIT 1,000,000 Ea accident $ X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS SELF INSURED AUTO PHY DMG BODILY INJURY Per accident} $ .( NON -OWNED HIRED AUTOS AUTOS _ PROPERTY DAMAGE PeraccideM $ UMBRELLA LIAROCCUR HCLAIMS-MADE - EACH OCCURRENCE $ AGGREGATE $ EXCESSLIHB DED I I RETENTION$ $ C WORKERS COMPENSATION WC049101882 (AOS) 03/01/2014 03/01/2015X WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N TORY IMITS ER E. L. EACH ACCIDENT $ 1,000,000 C ANY PROPRIETOR/PARTNER/EXECUTIVE WC049101884 (AK) 03/01/2014 03/01/2015 D ER IXCLUDED? N NIA WC049101883 E.L. DISEASE- EA EMPLOYEd $ 1,000,000 (MandaOFFICEtory In (Mandatory In NH) FL ( ) 03/01/2014 03/01/2015 If yes, describe under 1,000,000 D DESCRIPTION OF OPERATIONS below E.L. DISEASE- POLICY LIMIT $ C WORKERS COMPENSATION WC049101885 (KY, NC, NH, VT) 03/0112014 03/01/2015 (EL) LIMIT 1,000,000 C WC049101886 (NJ) 03/01/2014 03/01/2015 DESCRIPTION OF OPERATIONS/ LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space Is required) EVIDENCE OF INSURANCE I V IAV LYLR THD AT-HOME SERVICES, INC. DBA THE HOME DEPOT AT-HOME SERVICES 2455 PACES FERRY ROAD ATLANTA, GA 30339 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �2avtaor.� tea ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD 1r ~rh A—5i tnq i VlA P1 suite 110 stcla� massach, z� usettsWiH Untr�etor RP Hom,- Imprm"Ment 0 egis -Type: S`upplEmn, vat C THD AT HOME SERVICES, IN(l PUGHAM�A:-A 16 90 - C W B'AR A* -N --D-- _PAR** 3. (MAY SUI i 2_ 300 :CA I AP, WOE 6 ifu: Type, *fH i ��kfb� ljc -THD A. cv, E r;ff AT FIOM� sparivic'Es. . ego C . UNPBERIAND'PARKWAYS 'GA3= Update Addr= and nian tar& Mtric rumn for dva6gt,. Las! Cvvl Addy az usl r I Licapm urragarglion Wore the 0 fAft oF CionDiMer A ad 10 PaikP 1, = suit: 917b m