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HomeMy WebLinkAboutBuilding Permit #393 - 23 MOUNT VERNON STREET 12/11/2008 BUILDING PERMIT TOWN OF NORTH ANDOVER 3z APPLICATION FOR PLAN EXAMINATION tow Permit NO: J-!� Date Received /1 °4 i ��SSAArao CHus���� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ? lYIA Print- PROPERTY rintPROPERTY OWNER Print - MAP NO:: PARCEL: ZONING DISTRICT: Historic District yes no Machine,;Stiop Village( yes noa TYPE OF IMPROVEMENT PROPOSED USE Re si Non- Residential New BuildingOne f Addition Two or more family Industrial Alt No. of units: Commercial Re air re lacement Assessory Bldg Others: Demolition Other Septic Well � � Floodplain Wetlands Watershed Districts Water/Sewer DESCRW-IID OF W TOBE PREFOR ED: t VIA C04,Id n 'frcatiease Type or Print Clearly) OWNER: Name: Phone: Address: 5 \.. •CONTRACTOR, Narne: Phoned leT Eli ; Addres$: -. Su.pervisor's Construction License:_ ���,-, Exp. Date: f rl Horne Improvement License: r' + Exp. Date: J C : 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: $ �UlFEE: $ Check No.: Receipt No.: ► NOTE: Persons contracting w' un egis re contractors do not have access to e g ar ty fund i5 gnature4of.Agent/Owner nature of contractor T 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 Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 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 124 Main Street fire.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 Doc.Building Permit Revised 2008 V E 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 f ❑ 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 o Certified Surveyed Plot Plan ❑ Workers Comp-Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li.. ..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 I 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 o 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 Application Revised 2.2008 Location 0 P-N a No. �:?q3 Date _ MaATM TOWN OF NORTH ANDOVEF • 0 ^ Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ s Other Permit Fee $ TOTAL $ Check # r 21752 Building Inspector t tAORTH; '9 ® ® over . No. o o.-:z �` clover, Mass., O COCMICMEWICK A. ��RATED P'PG "♦� BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT.........JU4 ........CA.�........................................ ................................................ ••••••••••' Foundation has permission to erect........................................ buildings on ....6G....... T:......V."W om......I................ Rough to be occupied as..... . ........ .......tj�1.K1 1 a................ Chimney ... . .................................................................... provided that the per on accepting is permit shall 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU TART Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Doi Not Remove, Fina, No Lath/ng or Dry Wall To Be Done, FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. .SEE REVERSE SIDE Smoke Det. NOV-07-08 03t09PM FROM-RMA Home Services 5097562959 T-914 P-003/004 F-402 The-afto t website of the Ex&Cu*e OMCO at Public Safety and Securky LEOPS? Public Safety mazkov Home of+S WW EOPSS Homo MULGav Homo State ABetCISS State NOW Services _. Department of_Public_Safety CETIseeComplaints._ License Type Conaruction Supervisor License# 100696 (restriction W5 Name Alan Painten City,State,Zip Haverhlll,MA,01830 Expiration Date 8/21/2012 Status Current No complaints found for this Licenw. Sack To S�arGh http://db.state.ma.iWdp&JlicdeMils.asp?txtSearcbLN eCSL100696 11/7/200$ The Conunon wealth of Massachusetts M. Department of Industrial Accidents Office of In vestigations 600 Washington Street Boston,. 1L4 02111 www.niassgovAlia Workers' Compensation Insurance Affidavit: Builders/ContractorslElectricians/Plumbers Applicant Information Please Print Legibly Name (Bus iness/Organization:Individual): Address: City/State/Zip: Phone #: A ren employer?Check the appropriate box: . Type of project (required): I a employer with4. ❑ I am a general contractor and 1yees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction sole proprietor or partner- listed on the attached sheet 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. E] Demolition working for me in any capacity. workers' comp, insurance. [No workers' comp. insurance 5. 9. [] Building addition ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL l l.❑ Plumbi,g repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12-E] of repairs insurance required.] t employees. [No workers' comp. insurance required.] 13. OtherLA *Any applicant that checks box illmust also fill out the section below sho t wing their workers'compensation policy information. Homeo%.ners who submit this affidavit they are doing all wont and then hire outside contractors must submit anew 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 providi*g workers'compensation Insurance for my employees Below is the policy and job site information. Insurance Company Name: I Policy#or Self-ins. Lic. #: Expiration Date: 1 Job Site Address: City/State/Zip: [;L 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 c of un er t e pa i s and penalties ofperjurr that the information provided above is true and correct. Si nature: � ,, Date: Phone Official use on{),. Do not write in this area,to be completed by cin,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 ' DATE(MM/OD/YYYY) �ACORD,, CERTIFICATE OF LIABILITY INSURANCE 02/26/08 PRODUCER 1-404-995 3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMALIOfJ Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR homedepot.certrequestC-marsh.ccm ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOLN._ 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 1NSUREiRS AFFORDING COVERAGE NAIC#—.._— ' ;INSURED INSURERA:steadfast Ins Cc 26387 Home Deno U.S.A., Inc. The Home Depot, Inc. INSURERS:Zurich American Is Cc 16535 2455 Paces Ferry Road INSURERC:Illinois Nati Ins Cc 2381'1 Building C-8 Atlanta, GA 30339 --- INSURER D:American Home Assur Co 19_390 —J INSURERE:New Hampshire Ins Co 23841 COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWI f,)(S rmq)Ir•.IG ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED CIR 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. INSR00' POLICYEFFECTIVE POLICY EXPIRATION LIMITS TR NSRD FIN POLICY NUMBER OA7 MM 00 YY GATE M D YY __.__ A GENERAL LIABILITY IPR 3757 608-02 03/01/08 03/01/09 EACH OCCURRENCE - $4,000,000—_ DAMAGEO RENT D X COMMERCIAL GENERAL LIABILITY LIMITS OF POLICY ARE EXC SS PREMISES Eaoccurence $ 1,000,000 CLAIMS MADI OCCUR "OF SIR: $1,000,000 PER CC" VIED EXP(Any one person) $EXC=LUDED_ PERSONAL BADV INJURY $4,000,000 GENERALAGGREGATE $4,000_000_ GEN'LAGGREGATELIMIT APPLIESPER: PRODUCTS-COMP/OPAGG $4.000,000 POLICY PRO- LOC _ X JECT B AUTOMOBILE LIABILITY HAP 2938863-05 03/01/08 03/01/09 COMBINED SINGLE LIMIT X (Eaaccidenq $1,000,000 ANY AUTO ALL OWNED AUTOS BODILY INJURY .. SCHEOULEDAUTOS. . .._____. ....._...___..-._ (Perperson) $ HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (Peraccidenl) $ X SELF INSURED-AUTO PROPERTY DAMAGE $ _— - PHYSICAL DAMAGE (Peraccident) _— GARAGE LIABILITY AUTO ONLY-EA ACCIDENT S ANY AUTO OTHER THAN EA ACC $ AUTOONLY: AGG $ _ A EXCESSIUMBRELLA LIABILITY IPR 3757 608-02 03/01/08 03/01/09 EACHOCCURRENCE $5,000,000 X OCCUR CLAINISMADE - AGGREGATE $ 5,000,000 DEDUCTIBLE RETENTION $ s `_TIC WORKERS COMPENSATION AND 1928757 (FL) 03/01/08 03/01/09 X STATU- 0TH• CRY MIT EMPLOYERS'LIABILITY - 1928756 (CA) 03/01/08 03/01/09 E.L-EACH ACCIDENT $1,000,0011 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBEREXCLUDED7 1928755(AOS) 03/01/08 03/01/09 E.L.DISEASE•EA EMPLOYEE $1,000,000 If yes,describe under I SPECIAL PROVISIONS below E.L-DISEASE-POLICY LIMIT $1,000,000- OTHER i TX Employers Excess TNS-045197967 (TX) 03/01/08 03/01/09 ccurrence/SIR 25M/2M f Workers Compensation 1928759 (QSI) 03/01/08 03/01/09 -- — Workers Compensation 1928758 (KY, 140, DIY, WI) 03/01/08 03/01/09 SCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS i OR EVIDENCE ONLY --- :RTIFICATE HOLDER CANCELLATION _ SHOULD ANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 711E EXPIRATI011 HOME DEPOT, INC. DATE THEREOF.THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS VIRITTEN NOTICE TO THE CERTIFICATE HOLDER NANiED TO THE LEFT,BUT FAILURE TO 00 50 SMALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR 5 PACES FERRY. RD., t7.W. BUILDING C-9 REPRESENTATIVES. ANTA, GA 3 D3 3 9 AUTHORIZED REPRESENTATIVE USA a el �A� ^ ORD 25(2001(08)datkinscn @ ACORD CORPORATION 1988 8213215 I 05 _;L_VI3 43-43 DH YSn;i 1 ,Yiniia 3 5 j1 Product Va...:na d¢ dobla g,aL1L�t _ u£: Argon/?=o�,�ia_ I Arjbn/?ra3o_;= Natlor+alFsnestratlon 3,'32" :1:�9 12.3d sssa Yidrio Raft cards No Laninatad C1aa9 1 gin vilria laaiinado lvo Crid9 ( 91n rajilla9 . ENERGY PERFORMANCE RATINGS EVALUACI0N DE RENDI 9(M EIVGETICO U-Factor Solar Heat Gain Coefficient t ectoru eoddenoc Gananda de Energia Solar /0'. 32 1 . 8 Q . 29 ULM ADDITIONAL PERFORMANCE RATINGS BYAWAcWN SUPUBAWAM DE PDOMMM Visible Transmittance Thnodslon de LaVWble 0 . 52 .fttes thee these rai$ipe oadbrm to applkabM Mi1C s °"ee tar detenn�lp wt1�product p t�1C . "W aro determlrod for a Ibred set d envlronmeltml oordtla>I and a spm*product stte.?M dose not mcmlunerd M G� end does Trot wertarrt the sutmbl9ht o!?nY pradud 1br any uea�dtnwn��aer's tdera0ie for air product pe�fornrence - htmai n.wwrrnhe o►0 — -——.— --— --- tebttrsnte eet�ula Ore esme velore�aanolen can be pro erdoe ds M'i1C per:de0ermtr sr sl nndtrnlerdo toW dd producao.lm wane use"por NRIC son dowminclOe por un mnpft w de cordobnee amblenhlea y un ta+rnrro de ptodron WN111co.WRC w mcomlende*pproducto Y re Pmdta�d P M.Bbml q Pers un up*Mwj m�cond .. 1hQeb dd tlehrtcante pen d u a rpr°pmdo de er+b pradudo xrVrrsrdrLorp Unit gnaliiiaa for ENERGY STAR r¢QLOA(2): VOrthAVd, NOrth ' Cantral, South Cantral, southawn. 5NE86f STAR La unidad aaLiiiea_pasa 13(0) cejienti2) ONERCY.STA A: Norte, Norte Cantral, 9-Ar Cantral, 9ur. IND: .Et¢1.n 04/01a92 3/32"/H-R43 . Tast¢d 9122: 36" x 63" /1 IND: Baivar2o 00/Yidrio 2.39 1a1n/H-RAS DP : +45/—4 S Taxaao probado: 41.4 CK x 164 M E59�Cg�f C1 40773. N9 Hotis+ark 2931120. Keep Iha bbd for po 6 ENERGY SW mbft To loom mom VW www.energystar.par. Guards asla 8*0 para posibles reembehm ENERGY SW Pao conaat mds a=de oto,01 ww►+>.enerpystar pox . I—.�,p� ✓ne�o•►ivmoveu�ea�� o�✓l�aaeaai'aeeQ2. �-\ Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR r' \vj Registrtigr 126893Ic. EKp-1r tlt_i 12010 peu plement Card F� L The Home Depot'A WOm �� —z. ; ' RICHARD FALLON� /_,r Y• C-U 3200 COBB GALL EfF�FIEVdI!;#20 DEC-1-2008 10:50P FROM: T0:18009863610 P.7 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and installed by: Branch Name: Rolston Date:i/-4.158_ THD At-Home;Services,Inc. d/b/a The Home Depot At-Home Services Branch Number: 345A Greenwood Street,Unit 2,Worcester,MA 01607 ❑North 33titruth 31 Toll Free(800)657-5182; Fax(508)756-8823 f'edaal ID#75-2698460;ME Lis#C 02439;RI Cont.Uc#16427 Cf Lic*565522;MA Horny Improvement Contractor Rcg.#126893 Inftallatlon Address: . N. Ptr-)CI 61g4 klx...• b� City Ste Zip Pu a I'Chaser(). Work Phone- Home one:P Cell Phone; Phone: [ ] [ ] lq7m as?- 19, 3 Rome Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing emails from The Home Depot Project information: Undersigned("Customer j,the owners of the property located at the above installation address,agrees to buy, and'1HD At-Horne Services,Inc.("The Rome Depot'l agrocs to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the mforenaed Spcc Sheet(s),all of which are incorporated into this Contract by. this reference,along with any applicable State Suppkment and Payment Summary attached hereto and any Change Orders(colltxxtvoly, "Contract"): Job#: omarowta,r ,4 P acts: sh s N: ProjW Amount Roofing QSidlng L3 Windows rf Insulation (]Gutters/Covers ❑entry Doors ❑. Roofng 0siding 0 Windows 0 Inundation $ C ❑Gutters/Covers ❑F,ntry Doors ❑ J Roofutg 0SIding 0 Windows El Insulation ©Guu=/Covers on"Doors C $ Rnnfatg Siding 0 Windows insulation ❑Gutless/Covers ❑Entry Doors ❑ $ 5 1Ak Minbntmt 25%IXTosit of Cwthact Amount due upon etecunon of this cornier. Total Contract Amount S Moine Purchases may not dgwAt mom than ooe4k d tithe ContraetAmounk Customer agrees that, immediately upon completion of the work for each Product,Customer will execute a Completion Certitieate (one for each Product as defined by an individual Spec Sheet)and pay any balance due, As applicable,each Customer under this Contract agroas to be jointly and severally obligated and liable hcrounder. The Horne Depot heaves the right to issue a Change Order or terminate this Contract or any individual Products(s)included herein,at is discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary#D?.3%5 t , included as port of this Contract, sets forth the total Contract amount and payments required for the deposits and final paymcnta by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely tilted-ill copy of the Contract at the time you sign. Do not alga a Completion CeRificate(note: there Is one Completion Certificate for each listed Product as defined by Individual Spec Sheets)before work on that Product is complete. In the event of terminatlou of this Contract,Customer agrees to pay The Home Depot the caste of materials,labor,expenses and services provided by The home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth In this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE ROME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT I.101'IITINC TILE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS Aecentanee and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Tome Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer ocknowtcdgcs and agrees that Customer has read,understands,voluntarily accepts the terns of and has received a copy of this AgreenrcuL Accep Submitted by: yv\ �� des X Cuswrncr's gnat4r Date v Sales Consultant's Signature Date �_. Telephone N. 450- y0� Customer's Signature Date Sales Consultant License ND. CANCELLATIO!I: CUSTOMER MAY CANCEL THIS (as aWicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION S �Q P�jv�-� BY DELIVERING WRITTEN NOTICE TO THE HOME 0707-4h h L DEPOT BY MIDNIGHT ON THE THIRD BUSINESS y DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDnIONAL TERMS AND CONIMUONS ARE STATED ON THL REVERSF.SIDE AND ARE PART OF THIS CONTRACr 84*48 CSC White—eranchRe Yellow—Customer Pink—Sales Consultant