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HomeMy WebLinkAboutBuilding Permit #016-15 - 233 OSGOOD STREET 7/3/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION' . ._ int PROPERTY OWNERT�Xrn _ Print 1.00 Year Old Structure yes no MAP NO: _ ..___..PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT. PROPOSED USE Residential Non= Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DE PTION OF WORK TO B PERFORMED: w1ev i Identificat'on Please TvDe or Pri I arly) OWNER: Name: 1Phone: Address: CONTRACTOR Name: 7��. Phone: `� r ✓% � Address: '1f� L �'�1jJL Ap- Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: !O :3� 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: $ Check No.: �a Receipt No.: NOTE: Persons contracting reg' t co moors do not have access to tAaLrarqty fu _• r Signature of Agent/Owner Sionature of contractor �+ Plans Submitted Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ Plans Submitted ❑ ' Plans Waived-❑ Certified Plot Plan ElStamped Plans F1 •TYPEOF°:SEWERAC3EDiSPDSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco.Sales 0 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.APPR-OVED PLANKING & 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 Nater & Sewer Connection/Signature& Date Driveway Permit DPW'Todv.! Engineer: Signature: Located 384 Osgood Street FIRE -EPARTIVIF' jertip Dump'ster on site yes.. no Located-at 1241mair, Street re-b-,-'- time►itsignature/date , COMMENTS , . t i -Dimensltyli 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.$10041000 fine NOTES and DATA— (For department use I ® Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The fo0owing'it'a list of the required.forms to be filled but Wthe.appropriate.permit to be obtained. J Roofing, Siding, Interior Rehabilitation Permits ❑ Bailding Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/0'r 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the apo•?al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAted with the building application Doc: Doa.Building permit Revised 2012 Location No. v Date j . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ � Building/Frame Permit Fee $� / Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 'Jr f Building Inspector NORTH F Town of 2Andover O No. �o h ver, Mass, • C OCNIC Ml WIC y1' A°RArED S U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System THIS CERTIFIES THAT ......... ..6A� .. . ........ +. .... � ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, BUILDING INSPECTOR i has permission to erect .... buildings on .a.'. ....... .... .1. , .....4 Foundation Rough to be occupied as ................ ....... ... ..........o....... ..Q...................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 CONSTRUCTIA4 S TS Rough Service ............... ........................................................ Final BUILDING INSPECTOR. GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT A Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. DO not rer�ove until final code inzzmcGon. Save label for tuture raterence. NIHIM for area d'r r �_ r.i �i 15 Canada ` I staratcean •- .J ..r- :�", :�1, energy - tT mcan.va N C Q]CC ' E ,W (' Q Eel G d VE eargon �TOYst ��OuanfiodlAdmiseibta ts`xftG And6INDOWSND-09080.A -N 74 s 4 'tVood/Vinyl Composite IF -••-•--• -- Dual Argon Law-E4 SmartSun P oduct Type: Double Hung ENERGY PERFORMANCE RATINGS U-Factor Solar Heat Gain Coefficient 0.29 1 .65 0.21 U.S.A-•P Mebic/Si ADDITIONAL PERFORMANCE RATINGS _ Visible Transmittance 0e48 taanvraeouer70PLtam u meraanpCo. totvkameWIM toraeteant.n %mcet*oamt F,ertormance. HFPC ravrip are detemwW for ammo Sew and a aPecrc POd'/.i 3R- nc'pG aces not reCMa.eM anti Product and aces rMt targKU4 SVRilmttiN ah'podtRt tar ay` use . Cmwe W a 3mr"Rum"tora"W o 'Jttor mom krdrnaWL - •Wiftemp tiw.rr - CCL 12944-9 nr - ersen O : -Hung :x r Cv smnuarm Standard Rating AA4LN"MMM t0U-S.2%4&•QB Si:2 t?St9j CF xQSF-1-11C t IOU.,'aAddM Lam'K"-.PSI May 01 14 02:39p Rick Odonnell 6033780151 p. l HOME IIbIPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Na a Boston Date: THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Toll Free(800)657-5182;Fax(508)756-8823 Branch Number:31 fcderdl ID#75-26994W ME Lic#C 02439;RI Cont.Lic#16427 Cr Lic#HIC.0565522;MA Home ImprovementContractorContractor Reg.#126893 Installation Address: IZ3 V e /(,®7 cxg; ,r City State Zip Pumbaser(s): Work Phone: Home Phone: Cell Phone: [ l C l [ l Home 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 Info oration: Undersigned("Customer'),the owners of the property located at the above installation address,agrees to buy, and THD At-Home Services,Inc.("The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced.Spec Sheet(s), all of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(gle etyvte]ty, "Contract"): 91V-SA,' � C� Job#: uncal W mnco Products: Spec Sheet s)#: Pro'ect Amount []Roofing ❑Siding Windows Insulation Q l J ❑Gutters I Covers ❑Entry Doors ❑ /7 ( $ ❑Roofing ❑Siding ❑Windows ❑Insulation ❑Guuers/Covers []Entry Doors ❑ $ Roofing Siding 0 Windows El Insulation ❑Gutters/Covers ❑Entry Doors❑ $ ❑Roofing ❑Siding ❑Windows [:]Insulation $ ❑Gutters/Covers ❑Entry Doors ❑ Mininmm 25%Deposit of Contract Amount due upon execution of this contract Total Contract Amount $ Maine Purchasers may not deposit more than one-third of the Contract Amount Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one 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 Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its 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 tth�e Contract. Payment Summary: The Payment Summary # 0� 7a,�Z =,fl , 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). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(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 termination of this Contract,Customer agrees to pay The Home Depot the costs 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 HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home 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 acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Accepte Submitted by: r X X �-7s Cato, is ignature Date Sales Consultant's Sig/5 4 ure Date X Telephone No.__6103"` �? . Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (as applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS 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. NOTIC!ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART Of THIS CONTRACT r DATE(MMIDO/YYYY) ACC?R o . CERTIFICATE OF LIABILITY INSURANCE 0211912014 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 Ileu of such endorsement(s). CONTACT NAME: PRODUCER MARSH USA INC. PHONE FAX TWO ALLIANCE CENTER A1C No 3560 LENOX ROAD,SUITE 2400 E-MAIL ADDRESS• ATLANTA,GA 30326 INSURERS AFFORDING COVERAGE NAIC fl 100492-HomeD.GAW-14.15 INSURER A:Steadfast Insurance Company 26387 INSURED INSURERa:Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC. _.. New Hampshire Ins Co 23841 DBA'THE HOME DEPOT AT-HOME SERVICES INSURER C: 2455 PACES FERRY ROAD INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003242685.01 REVISION NUMBER:3 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 WITH 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. INSR TYPE OF INSURANCE POLICY NUMBER ADDLISUBR MM DYW- MMIDD/YYYY XP LIMITS LTR A GENERAL LIABILITY GLO4887714-04_ 03/01/2014 0310112015 EACH OCCURRENCE $ 9,000,000 DAMAGE TO RENTEff 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Me rren $ CLAIMS-MADE M OCCUR LIMITS OF POLICY XS MED EXP Any one person $ EXCLUDED OF SIR;$1M PER OCC PERSONAL 6 ADV INJURY $ 9,000,000 GENERALAGGREGATE $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 9,0 ,000 X POLICY E-1ECT 1PRO- LOC S. B AUTOMOBILE LIABILITY 9AP 2938863-11 03101/2014 0310112015 COMBINED SINGLE LIMIT 1,000,000 Ea accident)_ X ANY AUTO BODILY INJURY(Per person) $ ' ALL OWNEDSCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS NON-OWNED OS PROPERTY IDAMAGE $ HIREDAUTOS AUTOS S UMBRELLA LIAB- H6CCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE $ DED RETENTION $ C WORKERS COMPENSATION W 4 101882(AOS) 03!0112014 0310112015 WC STATU- OTH AND EMPLOYERS'LIABILITY YIN WC049101884 AK,AZ,VA 03/012014 03101/2015 1,000,000 C ANY PROPRIETORIPARTNER/EXECUTIVE� NIA A ( ) E.L.EACH ACCIDENT S . D OFFICER/MEMB H)EXCLUDED? WC049101883(FL) 0310112014 03/012015 E.L.DISEASE-EA EMPLOYE S 1'000'000 (Mandatory In NH) H yes,describe under E. DISEASE-POLICY LIMIT S 1'000'000 DESCRIPTION OF OPERATIONS below C WORKERS COMPENSATION WC049101885(KY,NC,NH,VT) 031012014 0310112015 (EL)LIMIT 1,000,000 C WC049101886(NJ) 031012014 031012015 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If mon space Is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukhedeeu- ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i f f CV/1 %/! fficc of Consumer Affairs& Business Regulation License or registration valid for inriividul use only OME IMPROVEMENT CONTRACTOR ` before the expiration date. If found return to: - Y:E Office of Consumer Affairs and Business Regulation �. Registration: P `126893 . T n x %f Ex 8/3/20 10 Park Plaza-Suite 5170 14 Supp!erner•t and Boston,MA 02116 The Horde Depot At-Home Services { RICHARD TROIA 2690 CUMBERLAND PARKWAY S A`tft°1�`A, GA 30339 Undersecretary Not valid without signature The Commonwealth of 3fassaehusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 w� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): o ,� 2e Com" V/G.� S Address: ' eL City/State/Zip: Lo:::�V Vrz, . 303 1 Phone Are you an employer?Check the appropriate ty- Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition workingfor me in an capacity. employees and have workers' Y P h'• $ 9. ❑Building addition [No workers' comp.insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.[1 Other comp.insurance required.] •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. $Contractors 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 thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.M W 0 L/q 0f Q/g v2 Expiration Date: 3 Job Site Address: 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 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 d the lains an en ' s of perjury that the information provided above is true and correct. • f r/ Signature: Date: _ Phone#: 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 Person: Phone#: r}3111 41V.�T"'1�+,.rtr�"I�tH!j�in'r•� �an�y.'S1:� ri{,•' �`��v°�Y�.�q [a: 1. ,Y,�i 1N�+� y44 ���,��,21 ,EM•CS''�1 a sv n4!'Ff',it�w�'� Y�rq'f' i�'a "17 fi✓a ;F^ ✓r�=rl r F �,r ,u;;+r �.�s4.;��y,3,fi`i�cd,. �IA'4i i��ja�5•'T ,;'"y7 n'� {. �� � t'�q��''k:'J;'GJ.Y'a �i't�t Via.rj1.4.U:�t t�v.t4' "`4�'v '.,I",��817�1� �+� S�"t�;� `+r;.k a>Sv3+ �.-, "w"rh�'!9s '{! ;s a.,• mx,•-;.. . 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