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HomeMy WebLinkAboutBuilding Permit #707 - 2211 SALEM STREET 5/2/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this Dace TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ Addition ❑ Alteratio X One family ❑ Two or more family No. of units: ❑ Industrial ❑ Commercial 4 Repaik replacement ❑ Demoliti ❑ Assessory Bldg ❑ Other ❑ Others: Public Sewer . ❑Water Flood ain TCI Wetlands .. :a Watershed Distract DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: 1�—,6„ C _1lr,, a �...1, n Phone: �7,�_. (o —I P 7 4, f Plans Submitted ❑ Plans Waived ❑_ ___ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM i PLANNING & DEVELOPMENT COMMENTS DATE REJECTED El DATE APPROVED ` 1 S ✓ DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS ' 41 DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS `TYPE OFSEWERAGE DISPOSAL ` t Public Sewer❑ Tanning/Massage/Body Art El Swimming Pools El Well ❑ r , - Private ❑ Tobacco TobSales ,_ ❑ Food Packaging/Sales D (septic tank, etc.' Permanent Dumpster on Site ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_ Planning Board Decision: Comments -.d- Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FFIRE DEPARTMENT Temp Dumpster on site yes no. ed at 124 Main Street Department signature/date 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 - Date r 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 o Building Permit Application o Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work a Engineering Affidavits for Engineered products Addition Or Decks • Building Permit Application o Certified Surveyed Plot Plan L, Workers Comp Affidavit • Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract. v Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (if Applicable) a Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o' Workers Comp Affidavit ® Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (if Applicable) • Copy of Contract o Mass check Energy Compliance Report ® Engineering Affidavits for Engineered products 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: INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2007 Location�J� l 'vi t �� No. l)''" Date NORT1y TOWN OF NORTH ANDOVER Of�•`D •,ti0 • OL Certificate of Occupancy $ y s'"^°•E<� Building/Frame Permit Fee $ AC Nus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#171-1r& 2C i 6U" Building Inspector CO)qr m m x CO) m y d S HCD C'7 St Z CO) a. o C, . ? o CL y C", C v CD CDCL o Q �dCD CDo CD C_ O y. CD CO CO) CDO O � v CO3 O 'CD CD Z O CD O CD 11 r� JAA ro rn O 0 s 0 0 2r m r=4 U2 0 CO U2 cclm CL0 y O H mg-5am= y w z ayam 0 CL ti T F ^��• y T r y ...rO=rcyFn W m .a ? N O O y O �O•y IEmR� -i a v o ~� a ' ,O b tyl O m =r ca 7: O m CL h o: CL CD ycrn%• Cl y c OD _a r� �1 O .�' CD: y fOA o- ooi,;r- y "0 O �0:9 caCDIm s Wim: and a� c nc* C O O M O V1 O cn °zcp w 'x wg. "Jt7 'X �'. T F Cr1 'I7 ;z O r m O G91tz ITI OO G, b tyl r O H 0 0 c Monday, April 30, 200711:10 PM Craig Smith 603-5945973 P.06 HOME IMPROVEMENT CONTRACT Sold, Furnished and Installed by: Branch Name: �Date: 07 THD At -Home Services, Inc. d/b/a The Home Depot At -Horne Services ami 345A Greenwood Street, Worcester, MA 01607 Branch Number: s Job #: ai to Toll Free (840) 657-5182; Fax: 508-756-2859 Federal ID N 75-2698460 ME Lie 8 C 02439 RI Cont. Irdf 16427 C- ( C.,/Op Cf Lic N 565522: MA Home improvement Coont�ractorrRRe& 8126893 Installation Address: 07 (� SCL 1 � �� �RN) Q state 01 C — zip city Last 4 Digits of Driver's Purchaser(s): Lie. N & Esp. Me/Yr: Work Phone: Home Phone: 03)8�`f C7[f,I ( � X18.3737 Home Address: rn-`E (If different from Installation Address) City State Zip E-mail Address (to receive updates and promotions from The Home Depot): Project Information: I/WeNou ("Purchaser"), the owners of the property located at the above installation address, offer to contract with THD At -Home Services, Inc- ("Home Depot") to mish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet incorporated herein by reference and made apart hereof. (z &J39gp a" Home Depot reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determines that it cannot perform its obligations due to a structural problem with the home, pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract CONTRACT AMOUNT S � 3.1 O G � j•LESS DEPOSIT S BALANCE DUE ON COMPLETION $�-�_� iJ tMinimum 25% of Contract Amount due upon execution of this contract. Indicate Payment Method For BALANCE DUE ON CCOyMOPLETION: �. —. *When you provide a check as payment, you authorize us either to use information from your check to make a one-time electronic fund transfer from your account or to proem the payment as a check transaction. When we use information from your check to make an electronic fund transfer, funds may be withdrawn from your attonnt as scan as the payment is received, and you will not receive your check back. DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit approval) 1. Chock`, Cashiers Check or US Postal Service Money Order (Made payable to The Home Depot). 2. Credit Card** and/or other payment options - Circle One Below Visa MasterCard Discover AmericanE 11xe Horne Depot Home lmpnrven=t Loan The Home Depot Credit Card 0 New Account 0 Existing Account (ML & HDCC ONLY) Available Credit: S (HIL & HDCC ONLY) �c ct#b 315 3 8 6 3 £s9 D Exp. Date: Name as it appears on card: **By my/our signature below, I/We agree to allow Home Depot to charge the above referenced credit card for the deposit indicated. r y -n o -0^3- Cardholder i Signature Date HIL or HDCC Authorization Codes Deposit Final Payment # # Purchaser agrees that, immediately upon completion of the work, Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement: This agreement and its attachments, including any financing agreement, contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read IL You are entitled to a completely filled -fn copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract- You ontractYou may cancel this transaction any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this righL There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day, but BEFORE materials are ordered. There will be a service charge equal to 25% of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE. BELOW, I/WE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND IIWE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATURE BELOW, I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I/WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. SUBMITTED BY: Date: U Cu ram ACCEPTED BY: _ Date: — — Purchaser Date: Purchaser NOTICE: ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 4-9-n7 C -SC White —Branch File Yellow — Customer Pink —Sates Consultant 4 r AT-HOME SSERVICIES Installed Siding and Windows y �� �� u B"rdof Rnlldh* fteg fictions and Standards Home JIMPROVEMER-t CON7't TOR, Repi3tratiom 12$893. 4 -_ 1 f t p i8ment Card Tt1E Home Dept,ran. 320D COSB GALLIJRW3�— k6 r'. .. �itI NTA GA 3©338 ' Aden } Proudly sold, furnished and installed by RMA Home Services, Inc., a Home Depot authorized contractor. 345 Greenwood St. Unit 2 • Worcester, MA 01607 • 508-756-6686 • Fax 508-756-2859 • Toll Free 800-657-5182 4 MARS H f .i. � �� .���.: J..... PRODUCER MARSH USA, INC. homedepot.certrequest@marsh.com FAX (212)948-0902 3475 PIEDMONT ROAD, SUITE 1200 TE NUMB Tl- N R CE ER. RTI FtCATEO 1 5U AIV � �, .c. sem.. _� ,.. ATL -001234410 01 R OF INFORMATION ONLY AND THIS CERTIFICATE IS ISSUED AS A MATTE I CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE POLICY. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES DESCRIBED HEREIN. COMPANIES AFFORDING COVERAGE ATLANTA, GA 30305 COMPANY 100492-THD-IPUSA-07-08 IPUSA A STEADFAST INSURANCE COMPANY INSURED HOME DEPOT USA, INC. COMPANY B ZURICH AMERICAN INSURANCE COMPANY COMPANY C AMERICAN HOME ASSURANCE COMPANY 2455 PACES FERRY ROAD NW BUILDING C-8 ATLANTA, GA 30339 COMPANY D NEW HAMPSHIRE INS COMPANY Y Th 2 i. COVERAGES z ` rs;certifieale supersedes and replaces -any previously ssued„ceit)fcafe for the,polcy,period' noted below .: . _ " THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CONDITIONS AND EXCLUSIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. CO LTR TYPE OF INSURANCE POLICY POLICY NUMBER DATE EFFECTIVE (MMIDDIYY) POLICY EXPIRATION DATE (MMIDDIYY) LIMITS AI GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY IPR 3757 608-02 03/01/07 'LIMITS OF POLICY ARE EXCESS' 03/01/08 GENERAL AGGREGATE $ 4,000,000 PRODUCTS -COMP/OP AGG $ 4,000,000 PERSONAL & ADV INJURY $ 4,000,000 Fx OCCUR 'OF SIR: $1,000,000 PER OCC' EACH OCCURRENCE $ 4,000,000 CLAIMS MADE OWNER'S & CONTRACTOR'S PROT FIRE DAMAGE (Any one tire) $ 1,000,000 MED EXP (Any oneperson) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-04 03/01/07 03/01/08 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) - — SCHEDULED AUTOS HIRED AUTOS - BODILY INJURY I $ (Per accident) --- -- NON -OWNED AUTOS X ELF -INSURED AUTO PROPERTY DAMAGE $ HYSICAL DAMAGE GARAGE LIABILITY - AUTO ONLY.- EA ACCIDENT $ OTHER THAN AUTO ONLY: ANY AUTO - EACH ACCIDENT $ AGGREGATE $ A EXCESS LIABILITY X UMBRELLA FORM OTHER THAN UMBRELLA FORM IPR 3757 608-02 03/01/07 03/01/08 EACH OCCURRENCE $ 5,000,000 AGGREGATE $ 5,000,000 $ C E F D WORKERS COMPENSATION AND EMPLOYERS' LIABILITY THE PROPRIETOR/ X INCL PARTNER S/EXECUTIVE2921208 OFFICERS ARE: EXCL 2921209 (CA) 03/01/07 2921210 (FL) 03/01/07 2921211 (AZ, ID, MD, VA) 03/01/07 AOS 03/01/07 (AOS) 03/01/08 03/01/08 03/01/08 03/01/08 WC STATU- OTH X TORY LIMITS ER EL EACH ACCIDENT $ 1,000,000 _ EL DISEASE -POLICY LIMIT Is 1,000,000 EL DISEASE -EACH EMPLOYEE $ 1,000,000 - C E G OTHER WORKERS'COMPENSATION TEXAS EMPLOYERS 2921213 (QSI) 03/01/07 2921212 (KY, MO, NY, WI) 03/01/07 TNS-C44642086(TX) 03/01/07 _ . 03/01/08 03/01/08 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LIABILITY SIR 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS Y F CERTIFICATE HOLDER .Y r CJ�NCfLLATION r _ SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. .v THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL _1f1 DAYS WRITTEN NOTICE TO THE FOR EVIDENCE ONLY CERTIFICATE HOLDER NAMED HEREIN, BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE, ITS AGENTS OR REPRESENTATIVES, OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: Mary Radaszewski VALID AS OF:02/28/07 PRODUCER MARSH USA, INC. homedepot.certrequest@marsh.com FAX (212)948-0902 3475 PIEDMONT ROAD, SUITE 1200 ATLANTA, GA 30305 100492-TH D-IPUSA-07-08 IPUSA INSURED HOME DEPOT USA, INC. 2455 PACES FERRY ROAD NW BUILDING C-8 ATLANTA, GA 30339 FOR EVIDENCE ONLY DATE (MMIDD/YY) `A7L`001234410 01` 02/28/07 COMPANIES AFFORDING COVERAGE COMPANY E ILLINOIS NATIONAL INSURANCE COMPANY COMPANY F NATIONAL UNION FIRE INS CO COMPANY G ILLINOIS UNION INSURANCE CO COMPANY H MARSH USA INC. BY MaryRadaszewski The Commonwealth of Massachusetts Department oflndustrial Accidents Office of Investigations UT 600 Washington Street Boston, MA 02111 www. mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Q Address: q t:e R - --- - Ci /State/Zi �' P:r— Gib • 233 _.__ -Phone #: -._. 9b-0 6;2- Are 2 Are you an employer? Check the appropriate box: 1. I am a employer withd_ 4. ❑ I am a general contractor and I employees (full and/or part-time).* 2. ❑ I am a sole proprietor or have hired the sub -contractors listed partner- on the attached sheet. t ship and have no employees These sub -contractors have working forme in any capacity. workers' comp, insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] 3. ❑ 1 am a homeowner doing all work officers have exercised their right of exemption per MGL myself. [No workers' comp. c. 152, §1(4), and we have no insurance required.] t employees. [No workers' y`Af1V Annliranf tl,ot L- i-- L_.. � � _ comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13. ❑ Other �• a��., ..�� VU< Me section oetow showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. ;Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for information. I my employees Below is the policy and job site Insurance Company Name: � TLIJ Co Policy # or Self -ins. Lic. #:_ Expiration Ite: 3111019 Job Site Address: Attach a copy of the workers' compenl City/State/Zip: sation 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 certify under the pains and D"alties of perjury that the information provided above is true and correct QJf1cial 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 S. Plumbing Inspector 6. Other Contact Person: Phone #: