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HomeMy WebLinkAboutBuilding Permit #797-14 - 2201 SALEM STREET 5/7/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � 1 t Permit NO: ` / / Date Received 1 4 Date TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building EVne family 11 Addition ❑ wo or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: Demolition ❑ Other ,y�c.�#.% .i-�5f ❑ Septic Well � � � �'�T] . L{�?� 5i1h.:,� �® Floodplain _EJWetlands "i"„ 1�'� } - y ®FWatershed ®ist et a oWater/Sewerrr DESCRIPTION OF WORK TO BE PERFORMED: Ftnno-c/ ref (0.4- e*(54-(W .5 20 57uwr'S . Identification Please Type or Print Clearly) OWNER: Name: Ao � �►4hmv ?trih4Mby Phone: y 1y- 3«-16,00 w w . 2A A •1 _ —A-_ Address: «01 Daterr% 0*-. tu,rrnav .`' ►nri- a'r4S �CONT.RAGT®R+ tN me 'Phon6:_O $$ 8 333 �caa±Yr �T ,4ddressA%t.�`i �r� f'irl�? ..r �s L u.f w Supennso sCo s; truction ,e _11 �Expa ate�;wt(7�_; �.owrmC Gem I:Homelmp ementLicenset 1868 �L,_Exp lDate�Id�S`_ ARCHITECT/ENGINEER Nlt+' Phone: t Address: Reg. No. FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ g1`'O1W.6y FEE: $ v 1i3' Check No.: �ZD�j380706y 3a. Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ovvrier cp, = . Signature:of contract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 Siqnature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision:. Comments u Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town ]Engineer: Signature: FIRE DEPARTMENT _ Temp Dumpster on .site yeas Located at 124.Main'Street Fire Departrnert-signature/date ' . COMMENTS Located 384 Osgood Street no 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 i i ® Notified for pickup - Date i 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 MOTE: 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 gOTE: 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 appal 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.Building permit Revised 2012 Location -20\ No. 757—/ Date ri r TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee _ $ Other Permit Fee $ TOTAL $ w Check # K?4-;5 O 6 `aoI�L 275 47 Budding Inspector < o = n0 _ ca = � CD -0 -CD- CL CD 0 CD n • v 0 Q. CC.) 0 f/1 Fn TI �D C rt 00�C s m =ft =r , r co', CD W a .`n 0 N CD CD = ma rt .+ Oto 0 CD p0 o CD) � Z y C = ��� CD O� Z"0 o� M K cpCn CD + CL 2: (A� COc O0CD Cr t0Er a—"'. �•. �. —% 0) Z.� cn =0== T_1 C ® CD - �"' 55 Q < CD 0 ^N cn CD (n CD �• C cn a a �r-OL 0 � y � %CD Z CD C W CD =� -+ rIn CD O Z y rt OI 41D C) W W fi cn Z So 0CD a .q U) y --I no CL CD m 0 Ir cm CD CD CD (D OZ � J ' ^! .-O o ® X c) y = C ZD -0 ►�� CO) < 0 0 Q F CD --i 0: a� o CL V V1 3 X,0 (D rt Ln CD r* O Q] c 7 N 70 v �. m T;o O N O T m — _ N (D N �7 O S m m n � y m 0 _T 7C7 O S M C •O m p _T 5 (7 3 3 O A O S T i Q N o 3 W C v z fA M m 0 In O n N M T O CL \ ^ 3 fD O 0 m D Z' Im The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information ` / Please Print Legibly W Name (Business/Organization/Individual): ) 150V) V`I 0.1leZ Address: i 51 1M0.1V1 5• rfel Llty/tate%Gip:_ 1'1 1ttxQ . / Ih Old f;`7 Phone #• b i Are you an employer? Check the appropriate box: 1. I am a employer with q 4. 0 I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.: required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance reauired.l 333 - Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12Roof repairs 13. Other *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: r4cf— honedtaln Sn5,Uro %-* Con,p.vy Policy # or Self -ins. Lic. #: /e s b 2 Vb y 5o5prill, Expiration Date: Job Site Address: 2 01 So I -em 51 City/State/Zip: 90M1 AnjakA . MA Ot $qS 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 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certi ft under the pairs and penalties of perjury that the information provided above is true and correct. Phone #: z 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 Phone #: 1 Massachusetts - Department of Public Safety Board of Building Regulations and Standards Con,truction Supervisor License: CS -102403 WILSON R VALD�Z 151 MAIN STREET I MILFORD MA 61757 r w `' Expiration Commissioner W2012014 —Office of Consumer Affairs & Business Regulation I ME IMPROVEMENT CONTRACTOR Registration: 148688 Type Expiration: 10/18/2015 Supplement and LOWE'S HOMES CENTERS INC RICHARD CHALONE 136 TURNPIKE RD. SUITE 100 SOUTHBOROUGH, MA 01772 Undersecretary License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature u 09/09/2013 12:04 5086346780 Rightfax N2-1MASTERROOF UNIENVIOS 6/26/2013 8:35:49 AM PAGE 2/002 Fax Server PAGE E2/82 CERTIFICATE OF LIABILITY INSURAN DATE THIS)!PIRATE DOES NOT AFFIRMATIVELY OR NEGATRNELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED pY THE pQL10tEg BELOW. R IFIGAT rHls CERTIFICATE OF INsuRANCE DOES NOTCONSTITUTEA CONTRACT BETWEEN THE ISSUING IN5URER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER AND THE CERTIFICATE HOLDER. he terms If the conditions t holder y, a ADDITIONAL INSURED, the po"VAil must be endorsed. ITS IBROGAT70N IS WAIVED, subject to he terror and conditions of the policy, certain potieies may require and endorsement. A statement on this certce does not confer rights to he GOUClcate holder in !f¢u of such endorsements . PRODUCER Iv1ARICI MG ASSOC INS AGCY" rADDREss. 1 SO [DELLS AVE, 91 FAX 6ct). (A/C, No); NEWTON, MA 02359 73K4P tNsuR�o tNRei(S) AFFQRDING COVERAGE NAIL # VALD�-Z, WILSON DBA IVWTER ROOF & UNID ACE A)�BRIGANINSL�1CB cor,>PANY NVIUUS-1v�B. 'DO BOX 83 11ELFORD1, MA 01757 COVERAGES CERTMOATE NUMl NO IWiTNSTANDIN6 ANY RFQUtREaT sM pR fANU T1pH or ANY CONTRACT OR OTHER DOCUMENT 16yT{t pFSpECt YVr� FOR a4N NUMBER. PERTAIN. THEtNSURANCEAFFOROED Gy POLICIES DESGRJ$Ep HE,RF,Aj is SUBJECT TO ALL THP 7EI2ALS, p(GLi151a0NSArm OGN ITIDNS TF SUCH POLICIES u HAVE BtfTr ttEDUCm BY PAm CLAI�LS. >+RICO CONDITIONS NS OF SUCHMAYBM tjMOOR QV !SR Jbr6 SH 01NN MAY YR TYPEDFINBLIRANUE ACD SUB PDLICYEFF12ATE POLICYEXPDATE L R POLICY NUMBER (emwnmyYt7 (MMIp01YYYYJ GENERAL LIABILITY CMTS COMM6RCIA(, GENERAL LIABILITY CH 0CCURRENCE S CLAIMS MAD5 ®pCCUR AMAGE TO RENTED Is GEIY'L AGGREGA TE LIMIT PER: �n��y vne Person) $ EjPG POLICY F_] PROJECT ® LOC ER ON SAL & ADV INJURY ENERAL g AGGREGATE $ AUTOMOBILE uABILITY ODUCTs . COMP/OP AGO $ ANY AUTO �'�_-------,�M ALL O1M`/t~D AUTOS - COMBINED SINGLE LIMIT (Ea eccia!elt) g SCHEDULA AUTOS P.ODIIY INJURY $ HIRED AUTOS (Perpl NON-OWN9.0 AUTOS BODILY INJURY S (Per accident) ROPERTY DAMAGE 5 (Peraccidont) UMBRELLA LIAR OCCUR EXCESS LIAO CLAIMS -MADE ACH OCCURR6ntrc RETI=NTION $ $ A WoRKr02'scDIyIPErySATiONAND g EOLOYSI LIABR17Y yx UB -4505P574-13 03n5 1 ANY PRC'P1RIr0R/PARTNERIEY,ECUfIVE �0 3 03115/2014 �► LIMITSWC UYpRv oY>iER OFFICER/MBMp$RF.X UCEJ7 NIA LIMITS (Mandraory!n NH) E. L. EACH ACCIDENT OF dg 10 OESCkInB�xll9e 6PERATE-I DISEASE - EA EMPLOYEE DEBCPJ'IdnJ OF fON3 D�low DESCWPJION OF OPERATIONS/LOCATlON aIIC EL DISEASE .POLICY LIMIT S 50t Tdi5 REPLACES ANY PPIOR CLRTIBICATE LSSUPD D�IRESTWCT10NSfSPECIAL ITEIYL4 T112 �ISL'PRD1; IqA WOP.iCEItS COMPANSAIION POLICY AND S LI[ JLTfi HOLDfi17 AFBECTINO WORKERS COMP COVZ�l M +DB 3X THE Lv$[JREp g MA ghVL0yFE4 IN STATES OTE;RR THM MA NO AUTHOHER RT^ A LTES © �ESIIvIpi T AUTHORMES THB PAYM$SN'1' OF BENEFITS FOR CLAD45 THAN) 4A IF THA .T.k iSVRaD HIRES, OR HAS � EMPLOYEESo T GI%W TO I'AY CL.AII.45 FOR DENWITS IN STATES OT,EE TETEU`0PnR3'CCPViPLIVgATIONPOLICYDDESNOTPfiOV(rjgGIJVERAQfiFOkV MA THIS POLICY DOESNOT .PRoVmECOVERAGE FopANY STATEOTItEBT CERTIFICATE lane nFrs E- uII30N, KaNMA LOl COMPANIES INC ATTN: IS INSURANCE POBOX !Ill PL LVZKESBORO, NC 28656 era -AN`eLLATTON SHOULD ANY OF TNE11 BE AIONgOyE DESCRID POLICIES BE CANCELLED BEFORE TRE oxpiRATDATE TFiEREaF, NOTICE WtLt 8 b@,ry IN ACCORDANCE MTN THE PAI (CONTRACT!, 0002276 MASSACHUSETTS EXTERIOR SOLUTIONS INSTALLED SALES ROOFING/SIDING CONTRACT IA -613. f-�.l by .7t _ttf. S,4P6�r j ILLEWOFF G - � ]. 1- C.. ti Tt C - �n A -. Lt C'" t �reert,rn' m:IJ�r�.n.Cr!.. ri-1 CGT�'etev C•t]r: ri e,:. E 11:5 .ZIGN:n .Ih,s 1"on7arf• PLI d.,c RL -,+C ALL TERN,.r..vn o-_t1J Lf,,v5 r; it ,a_, RC inSE `,i.)F Cd nl•S A6E v.t. r,,al 4.rh,� I Af.,.. FiErORF: i;,Gfl N A 14_05 ....._,�-..��•--_--:_. Color Style:nkr; --- �-`-c` 1- r � r� � � . (�:tct�.) Q � ��ra ,i•,t...t2r>, l�C'r Z"FrL� ' Show drawing where shingles or siding will be installed 1 Contract Total /• �,� 'Are permits required for this installation?: ( Yes j J No 'applicable tax included – ,F ______ _ _ 1 ff 4 G NOTICE 70 CUSTOMER: Federal taw squires Lowe's to provide you with the pamplet Renovate Right. By signing this Contract. Customer ' acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO REI VASE Cu tamer rRants to Lowe tra Lr^aw , n,p'nyc is th ° n h r tate t:hr tegraphs of ailwork pe^fo-m.,a at the Premises related to this {: rtr t _ d. t.++, vrr.Vncat`Iy grants it) Loin, a'i r ,ptl, tits( and (Meresl in ,fid to Rif: pholographs for use In all mafkets and media, wO.Ad"ime. ,n perpetuity Ct sign aulhonzes Lor : s to zx1pyrtgrii. use art0 ubbr.h Ulu ltal, ! (- J graphs m parr, and+or electren;Ca!iy, a4n agrees that Lswe's mai Use 5uch r„t. - Aaraphs Or any ;a+,vtul purpose, mclud re,. but not I,mited lo, r+arket!ng. a lveni,-.ng uh. c ty. !IlustratCn, fro ni;Ag and 4Vob content By ,nllialing he C.siorher agrees to the fo-egoog „ _.. ;C�stdmer to mit,at to :tin !«*.5 Work is torc�o_mmenca upon reasonable availability of Contractor andlor any special r rr customer made Good(s) which is anticipated to be —__ if ilia in date)- Estimated completion date is _ I Y [lift in data). ^ Said s samated substantialS �o�mplr tion date is no; of the essence,• A c5s+taytr-,Te^^ of a conlintt)er r tt.it/wou/l t !nal rally c ill in said est m t tl substantial om .lotion (late, i; as fot,o� .:.L �4i..� _ ... �rJ �F5^.L...... .J r f� !TCZ ��^�'��''” f (d apr, u_.,btf., ;n„ed a statment of such ronbnt�encies). � � j -- . _-_-- -- -- -- - IF THE CONTRACT TOTAL IS $1.000 GU OR LESS CusWlmr mu_st pay in lull ._— COkIPLETE THIS SECTION ONLY L4`HEN THE CONTRACT TOTAL EXCEEDS St.uDU o.j C.;stomer to Pay in Ful!: OR I I Customer to use the fo:!u:v!ng payment nchegt]!r: to be pain upon s!ging contract Deposit sho,;rd be 213 the zotil contract price- and ',2) Payment ^ 5: to be paid anytime atter this Con[+act !`. signed ant uelole cGmmenremc'n1 oi,nsta-talion, tWe aa,tho; ize LO.;e-s to do nn(- of the d!ov:,nq (check appropriate box below). - Charge myioof Crew! rand for the amo;]nt of the pnynleat-ndir_.2!ed above wr&mr. atter (fit_ date this CuntraCt is signed, of , 4epce:t mV,'"- f check for Thu amclmt of the paynA,::nt !n(;;Gated abo•a anytime .after lige date 1h;5 CcnttaCl 15 St7ned: and 31 F:nal Paymcnr Of SILO 03 to be paid upon romp !ebon of the tnslaaatr]n and bot.- parties sat!sfaclion. 'i NOTICE REGARDING AgBITRATION /AGREEMENT FOR CLAIMS COVERED BY M G L c 14 A _ - >_O':VE'S AND O`NNER HEREBY 1UTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOVJE•S HAS A DISPUTE CONCERNING THIS CONTRACT, THAT LOVIE'S MAY SUBMIT SUCH DISPU TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT ' IV-- OFFICE LIIN"k NSUNIE " FA AND BLI!SNFSS REGIJUJIONS AND THE OWNER SHALL 13E REDUIRED TO SUBMIT TG SUCH ARBITRATION ASj Pr�t3}IIpELG.L. -Ag� t CZeG�`. Date - _ _ O rc'S Home, Center-., Inc .By O vn _- Signature - - 7Hi SIGNATURES OF THE: PARTIES ABOVE APPLY ONLY TO THE i GREEt.1ENT OF iH[ PARTIES TO At i ERNATIVF DISPUTE RESOLUTION TNI r]A'E[Y SY L<)WE'S PURSUANT 70 frt.G.L C 142A. THE OWNER IAAY BE PE�R%ItTTEf) 11 O INITIATF ALTERNATIVE DISPUTE RESOI.W ION EVEN WHERE THE � 'SF CTtON ABOVE IS NOT SE. ERATELYSI ;NED BN' THE PARTIES j DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND ;CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. ,BY SIGNING BELOW, YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. OTNESS OUR HAND(S) AND SE L(S) BELOW T1n5 DAY OF Lowe's Home Center In _— ——� . pEVAbove - a ` Customer acknowted os r r t of a true co OV nr r -_-- - _ Co-owner -u 4!rlls SS -' 9 p py of this contraci which was completely idled in prior to Customer's exeeuUon hareof. You, tho buyer, rtiay cancel this transaction at any time prior to midnight of the third business day atter the date of this transaction. See the attached notice of cancellation form for an explanation of this right. 49r1Q8,:(Re, 12110i a41 c..es?tm.«: