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HomeMy WebLinkAboutBuilding Permit #705-14 - 22 MIFFLIN DRIVE 4/14/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: ..A 4fMPA0kTANT: Applicant must complete all items on this page r LOCATION "6l Print PROPERTYOWNERAdut�P P "� he-. - - Print 1bblly .r Old Structure yes; MAP NO.: ,PARCEL'-: ZONING DISTRICT: _ ,Historic District yes no Machine Shap Village yes .TYPE OF IMPROVEMENT, PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Assessory Bldg ❑ Commercial ,P kepair, replacement ❑ Others: ❑ Demolition ❑ Other ❑ :Septic o ❑Well ❑ floodplain n Wetlantls ❑Watershed Distract El Water%Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name:Acktte PrkaO- Thf Phone Ct 7k PG Coq&s` Address: (4a /QWI,1 nr CONTRACTOR Name:62ze_Phone: 77y S! w Address.:�S3� Supervisor's Constr,uctiori License:Exp Date: lSrlt �_ tI! H'nmP ImnrnvPmPnt.-l-;icense%k� `(o G _ _ _ ._ _ EXp.: Date: _ _ �l.S" 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: $ 2,Q Check No.: Receipt No.:� �( NOTE: Persons con ratting with unregistered contractors do not have access to_* guarantyfund Plans Submitted Li Plans Waived ❑ Certified Plot Plan ❑ Stamp tans ❑ Building Department _- The foll�nwing is'a-Iist of -the requiredlorms to be filled ouf.forthe appropriate.permit to:.be obtained. Roofivg, Siding, Interior Rehabilitation Permits a B,ailding 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 ❑ 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 cas<s if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apw• 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.tted with the building application Doc: Doc.Buh ing Permit Revised 2012 Plans Submitted ❑ Plans=Waived ❑ . Certified -Plot Plan ❑ Stamped Plans ❑ TYPE -_01? SEWERAGEDiSPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑.. .Swimming Pools ❑ Well ❑ Tobacco -Sales ❑ Food Packaging/Sales ❑ Private, -(septic tank, etc._ ❑.."-.: ._permanent D arnpster on -Site ❑ THE; FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE. REJECTED.-... PLANNING & DEVELOPMENT ❑ COMMENTS DATE .APPROVED CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMONTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comme Conservation Decision: :Comments Water & Sewer Connectio111Signature &Date Driveway Permit DPW 'I ow;z Engineer: Signature: Located 384 Osgood Street FIRE DtPARTM� NT Temp Dumpsier on site yes... no Located at 1 4iMair Street Fire"Ded' partmefitsigmture/date C011�M.ENO'S `.` -Dimension - Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter, location, n ast 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 Doc.Building Permit Revised 2010 Location t No. �� "�—``�( Date \` r Check W 27442 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $,-30 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector E w 0 LIJ 2 LL cZ lz O m ai L o o LL E ,4; >.O u a (Uo N v N Z o J m c . m _0 Z3 LL s m o d' (U cu U _ LL O WWa Vf Z 'm J d t 3 o LL Occ Ln Z Q V W W t ago o 0' Z v (n 6 LL p u d Z �, Q (' s o d' LL Z W F- W o W LL L c m Z v {% N o E y O O v O : W :a Q. as •z co.._. z W V J CC) : W N •0 y+ o 0 Cl) . .� �L OC � N G � J i Lm a z F- 0 �M� Cl) .a . 4� y U d s- v) W p O cn . O •p c -0 > p to — A )ma = 1xZ c UJ /J O �L- c c U vSIL oc �� "s 'N 3 W � CD > c W J 0 CD O G.. -c F L - =a Z n n= m :D 0 L ..r cc 0 N o o 'a = _ �` Q L L tQ 0 2 O Q • N I— p U v m N N 1. w W p - O O 2 uj •CL = �+ '- t Z Li "E d ._ 0 V 0-0 G1 ►`. Q N CL FE cc o •O a p 0 I- m CL 0 Ci > 0 w v v O E O .F+ V Z O = I G .- o -a LM �E m m 0 - LM 0 O O a � Q O v J ca .=O }; in Z � U U) m CL 3 )>;` `�+• about:blank NATIONAL HEADQUARTERS � W-holkrPrctva.it.n+ ?Son Sespon rktve. Chester. PA 1401.3 Y/E J1 JXlrl13 y �t zrlla 888 -REMODEL 888 -REMODEL - .. - M6 f.rr7 it . CUSTOM REMODELING AND IMPROVEMENT AGREEMENT Buyer(e)' Information and Description of the Property: Project Number_ 31-00074 Fobruety 21, 2014 Michelle Provost -Tine so.00 Set 311 bal"M 0 Oso and 10 009 22 MAtn Or (976) 376$465 (MichetlaS Celt) mp sldirta n,en.ttom North Ardovor, MA, 01845 (976) 7394"1 (M hose's work) Estimated Project Completion: 4 to 9 days County: Essex Other gvws) > that a datru Hart and =a pwcn de" aro Not a1 ttr esew" ve" .. Township: cawwoes contras not erkxbd u1 cstwiatag mrw fraena See odayAR*n"n C*mftona Buyer(s) listed above hereby jointly and severalty agrees to purchase the goods and/or services of Power Home Remorleiing Group and its vendors ("Contractor') 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 sate of goods and services- Buyer(s) agrees to pay the cost of the goods and services purchased as described heroin, rogardless of timing or approval of any financing Buyers) may seek for their purchase. Purchase Price. $25,058.19 Pre Installation Inspection Dates: Down Payment. so.00 Set 311 bal"M 0 Oso and 10 009 Balance Due on $25,058,19 Estimated Project Start: 8 to 7 weeks Substantial Completion: Estimated Project Completion: 4 to 9 days Method of Payment Other gvws) > that a datru Hart and =a pwcn de" aro Not a1 ttr esew" ve" .. cawwoes contras not erkxbd u1 cstwiatag mrw fraena See odayAR*n"n C*mftona Buyer(s) hereby acknowledges receipt of a copy of the pamphlet, -The Lead -5810 certatea (juide to nenovaie kigni , tnrorming r ) of the potential risk of lead heard exposure from renovation activity to be porformod In or at Buyers)' Property, at the written above. Buyer(s) received this pamphlet on the date of this Agreement, before commencement of work. Buyer(s)' Initials. This mens constitutes the entire agreement and understanding between the parties, and this Agreement replaces arty and all prior negotiations, representations, or agreements, either written or oral. No amendment, modification or waiver of this Agreement shall be valid or effoctive unless in writing and signed by both parties. Buyers) hereby acknowledges 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. i have read and received each papa of this 5 pa agreement. P o Remodeling Group Si B&02t2J/14 !02121/14 Sign a of u ity Assurance Manag r 51 Joseph McCormick Michelle Provost -Tine YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUMNFL'9 DAY AFTER THE DATE OF THIS TRANSACTION, SITE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN LXPLANATiON OF THIS RIGHT. February 21, 2014 14 17 1111�g�1 1l1!1II�I�NRNI1I1pH tttt{lplf!I�CC1(1tII�1��100111 111 five 111pp��iittIIII�11tltl111 EIUIIIfHiIIfil�llililtuU� � tflNiltlBtl Poge 1 of The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www*mass gavldia Workers' Compensation Insurance Affidavit: Builders'Contractorsll;lectriciam/Plumbers Applicant Information Please Print Lel?ibl Name (Buain=x)g; nl=tionudividuw): P(>k16g CCL 6,& C'c�0y1 r Address: s l 5 P , r �e, +_ t� LozEg. 901 S City/State/Zip: Phone #: Are ypd an employer? Check the appropriate box: L 1 am a employer with E 4. ❑ lam a general contractor and 1 employees (full and/or part-time).• have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These stub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' camp. insurance 5. 0 We are a corporation and its required.) officers have exercised their 3.0 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have Ito insurance required.] t employees. [No workers' comp. insurance required.], Type of project (required): 6. ❑ New construction 7. Remodeling 11. ❑ Demolition 9. ![] Building addition 10.0 Electrical repairs or.additions 11.0 Plumbing repairs or additions 12.[}:Roof repairs other, 'Any xMicent that checks box #1 must also fill out the seotiat below showing their workers' occupenAtIonpolicyluftmatim. t Homeowners who submit this afridavit indicating t q art doing all work and then trim outside contractors MoA sotwit a new affidavit indicating sncb. tCowne oes brat check this boat must attached an addidoad sheet showing the name of the wb-comracton and dfe"u wotkrts' comp. policy informa6oa. I am an employer than is providing workers' compensation insurance for my employees. Bdow is the polley and job s&e int'ermadon. Insurance Company 14AKL_6y5ill W-6 W/o4CE-ST.W_ �tV5 C-0 Pot;cy # or sett int. Lic. # - VI%i Q,0 C% ©Vq%Gj Expiration Due•,"—®-� Job Site Addre 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 Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fore up to $1,5M.00 and/or one ear imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine Of up to 5250.00 a y olazor. Be advised that a copy of this statement may be forwarded to the Office of Investigations o the D for ce coverage vchifittioa I do hereby cer* un f er fhe pkkand penalda of perjury that the tnformadon provfded above Is true and correct kill use only. Do not write in this area, to be completed by city or town o,Qf lclaL City or Town: issuing Authority (circle one): 1. Board of Health 2. Building Department 3. 6. Other —_ - - - Contact Person Permit/License Clerk 4. Electrical Inspector S. Plumbing Inspector Phone M r 116WER-1 OP Itir AW '4� RE'n CERTIFICATE OF LIABILITY INSURANCE ���11113 ) 09/17/13 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(les) 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 endorsements). PRODUCER 215-723.4378 ZrT Lacher & Associates Ins Agency Lacher Insurance Group 215.723-8604 632 E Broad St P O Box 64398 B E M^ Souderton, PA 10964 INSURER AFFORDING COVERAGE NAIC # Chad Lacher INSURER A.-Harla sville Worcester Ins Co 26182 EACH OCCURRENCE It 1,000,000 INSURED Power Home Remodeling Group, LLC. Power Home Remodeling Group, Inc. .2601 Seaport Drive Ste B110 INsuRms:,Harle svilie Preferred Ins. Co 35696 'INSURERC Nationwide Mutual ins Company 23787 INSURER D : INSURER E : Chester, PA 19013 _ INSURER F, - $ THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED, NAMED ABOVE FOR THE POLIGY.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 15 SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR NSR TYPE OF INSURANCE AUDL BUSH POLICY NUMBER O E EXP umrrs B GENERAL LIABILITY X coMMERCIAL GEVERALLIABILITY CLAIMS -ME a OCCUR MPA00000089793N-1 10/01/13 10101114DAMAGE EACH OCCURRENCE It 1,000,000 TO -PRE E� ocuornsnool s 100,00 ACED EXP aro $ 10,00 PERSONAL&ADV INJURY V 1,000,00 GENERAL AGGREGATE $ 2,000,00 GENT. AGGREGATE LIMIT APPLIES PER: POLICY X Oi LOC PRODUCTS . COMP/0P AGG $ 2,000,00 $ A AUTOMOBILE LIABILITY- X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS AUTOS BA00000089796N 10/01/13 10/01/14 COMBINEDS 1,000,00 BODILY INJURY (Per person) S BODILY INJURY (Per acddenl) E fp E D AGE $ $ C X UMBRELLA UAB EXCESS LIAS X OCCUR CLAIMS MADE CMBOOC00080794N 10101/13 10/01114 EACH OCCURRENCE S 10,000,00 AGGREGATE $ 10 000,000 STEN S A WORKERSCOMPFNSAVON AND EMPLOYERS' LIABILITY ANY PROPRIETORPARTNEWEXECUTW YIN OFFICERIMEMBEREXCLUDED? © (Mandatory In NH) 0yes, deaa ONunder DESCRIPTION OF OPERATIONS below NIA 000000089795 10101113 10/01/14 X WCSTATU 0T" _ E.L. EACH ACCIDENT $ 1,000,00 E.L. DISEASE - EA EMPLOYE E 1,000,000 EAL DISEASE. POLICY LIMIT 1,000 00 A A Mass Auto Policy NY Auto Policy FBAODO00074649R IBA00060018227P 10/01/13 10101/13 10/01114 10/01114 -S I.JabTlity 1,000,00 Lfmlt; DESCRIPTION OF OPERATIONS I LOCATIONS l VEHICLES (Attach ACORD 101, Additional Remarks Schedule, R more apace to requtreM -- — — — vnlvu=L ten, lura NANDOVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES HE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover lsoo Osgood St AUTHORIZED REPPZ89WATPIE North Andover, NIA 01845 W 1V05-ZU10 AGUKD CUKPORATION. All rights reserved. ACORD 26 (2010/06) The ACORD name and logo arp registered marks of ACORD. Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improve Contractor Registration POWER HOME REMODELING G JUSTIN SMITH 2501 SEAPORT DRIVE STE B11t CHESTER, PA 19013 3CA 1 Co 20M -W11 nice of Consumer Affairs & Business Regulation ME IMPROVEMENT CONTRACTOR. 1. Registraiio_`_1 - Type: Expirai ,3$lif Supplement Card POWER HOME JUSTIN SMITH 2501 SEAPORT DRIVES CHESTER, PA 19013 LLC. Registration: 168616 Type: Supplement Card Expiration: 3/18/2015 Update Address and return card. Mark reason for change. ❑ Address [:I Renewal F-] Employment E] Lost Card License or registration valid for individul use only before the expiration date. If found return to: Off ce of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 ' - Undersecretary Not valid without signature ---- ... ..... ... ._............... ----------------- Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -093980 JUSTIN W SARTW 399 E Hartford Aden Uxbridge MA 01569 Expiration Commissioner 01/05/2016