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Home My WebLink AboutBuilding Permit #171 - 24 NORMAN ROAD 8/31/2007 pORT#1 BUILDING PERMIT o` qa TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION e Permit NO: 1-71 Date Received 39"�gwT.o•�'`cy AC14,j Date Issued: J/ D �SS MPORTANT: Applicant must complete all items on this page LOCATION 9 4- Uo rroa n ' 1 PROPERTY OWNER s9Ctt'1 l t TF;1- 1 Ae Print MAP NO: V5 PARCEL: ` ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Re ' Non- Residential New Building One famil Addition Two or more family Industrial Alteration No. of units: Commercial Repair, �eplacemeDnt ' Assessory Bldg Others: Demoliti Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: Identification P se T pe or riot Clearly) OWNER: Name: �P1�1r1 a i r� C Phone: Q75�—q7?2 l7 Address: 24 Larman-R CONTRACTOR Name: e � Phone: � 1� (�v J Address: 0:,->u ,t�� C.� Supervisor's Construction License: Exp. Date: Home Improvement License: � .(Q��h�j Exp. Date: 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: $ 122 I q,f2oZ. FEE: $ Z6..'z . o a Check No.: ��J Receipt No.: ;3 osSo NOTE: Persons contracting with unregtst ed contractors do not have access to the guaran fund _._�_� _..�--- . .o _ _ _.-.. .. _ :_ _ . . _ - -- ----: .�__� _ Signature of Agent/Owner Signature of contractor 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 DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH 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 Located at 384 Osgood Street IRE 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 2007 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 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 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 DEPARTMENT:BPFORM07 Revised 2.2007 LocationNo. 7 Date G N0WTN TOWN OF NORTH ANDOVER 0L 0 s Certificate of Occupancy $ Hus tBuilding/Frame Permit Fee $ r 6 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # /! F5-�11 2058 Building Inspector NORTH Town of �. Andover No. 1 7 _ o. * dover, Mass., 0 LAKE A_ COC HICHEWICK ADRATED C7 S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System % BUILDING INSPECTOR THIS CERTIFIES THAT �� ..: ........................................... .......................... Foundation ............. ........ ........ .... ....... has permission to erect........... ............................ buildings and � Y..or .4.1.......................... Rough ............... . ....... ..... a to be occupied as r ............................ ......... Chimney C e provided that the person accepting t 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 6 ' PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR. UNLESS CONSTRUCTIO STARTS Rough ....... Service ... . . ............................ BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No- Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. AT-HOME Installed 51ES Siding and Windows Board of Building Regula ions and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card Expiration: 8/3/2008 THE Home Depot At-Home Services BUNROEUN CHHOUY 3200 COBB GALLERIA PKWY#200 MANTA, GA 30339 Update Address and return card.Mark reason for change. 'S-CAI 0 50M-05/06-PC8490pp ❑ Address [] Renewal F� Employment F� Lost Card nLl ✓�ie 770m2m20otuieall�i. 4��GaJ6aCfw.6e�,� Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 126893 Board of Building Regulations and Standards Expiration: 8/3/2008 One Ashburton Place Rm 1301 Type: Supplement Card Boston,Ma.02108 THE Home Depot At-Home Servic ATJNROEUN CHHOUY 3200 COBB GALLERIA PKWY#20 � � AtIANTA,GA 30339 Administrator Not valid without signature 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 FROM KIMBLY FAX NO. : 6033629679 Aug. 28 2007 11:55PM P6 HOMF IMPROVEMENT CONTRACT Sold,burnished and Installed by: Branch Name: fit X/ Date: _ TTID At-Home Services,Inc. d/b/a The Home Depot Al-tiome:Services 345A Greenwuud Street,Worcester,MA 01607 Branch Number: Job#-. 3-Y 5Y3-7 Toll Free(800)657-5192; Fax:508-756-2859 Fedoml lD H 7S-2G98,M ME Lie It C 02479 M Cunt Lic#I(A27 CST L`i/c/#565522; MA Home Improvement Cantrauer Reg.9126993 Installation Address: (/J�/�/� ]f 1 /� j j City State zip Last 4 Digits of Driver's Purchaacr(a): Lie.#&Ir-rp.MolYr. Work Phone: home Phone: Home Address_ (If differentt from installation Address) City State "Lip _ E-mail Address(to receive updates and promotions from The Home Depot): - Project Information: I/We(You CTurcbaset),the owners of the property located at the above installation address,offer to contract with THD At-Home Services,Inc.("Home Depot")to furnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet# incorporated herein by referynec and made a part hereof Home Depot reserves the right to cancel this contract if,upon reinspection 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 DEPOSIT PAYMENT OPTIONS (Subjcd to fund verification and/or credit approval-) CONTRACT AMOUNT S 1. Chale*, ' Chcck or US Postal S 're Money Order r t (Made payuhie to I" Ik��ot� tLESS DEPOSIT $ Fi 2. Credit Card**awl/ olh a pa options-Circle One Below 13ALANCCDUE � '(rise Mesterc Di r AmcricanExpress ONCOMPLVnON $ — '11I Home Depot Home entLoan The RomeDermCreditCard j'Minimm t 2.5%of Contract Amount due upon C New Account ❑Baisti mount (HII.&HDCC ONLY) execution of this contract Avanaryle Credit;S (HII R HllCC ONLY) Indicate Payment Method For Accnrt Exp.Dale:-..- .. BALANCE DUE ON COMPLETION: Name as it appearsqc—ank•By my/our sielow,I/We to allow Home Depot to �jp@(L o9�7aa7D3 OZcharge the aboeed credit c for the deposit indicated. 'When you provide a cheek as Paymcut,you authorize us either -.. In we information from your check to make a one-time electronic Cardholder's Siont ue flute fund trausfi from your account or to process the payment as a - Awl,transaction Whew we use inrurmation from your check to '--•` Hn, I3pCC Authorization Codes mune an cl-tronk fiordfin usasfcr, ds may be withdmwn from your account as soon as the payment is received,and you will not De FIIIal Payment receive your check bacr # # - Purchaser agr&n 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 obligatexl and liable horeunder. Entire Agreement:This agreement and its attachments,including any financing agreement,contain the complete agreement between the parties and can not he amended or modified unless in wt'iting in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion CertMeate 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 contr2et. You 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 right. 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%ofthe contract_amount if job is enncelled by Purchaser AFTER materials are ordered.. BY MY/0UR.SI(rNATORE BELOW,IAVR UNDERSTAND THAT TI-M AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND VWE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT'RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL T.TABILITY INCURRED FROM IN.AD VliRTENT OMISSIONS OR ERRORS. 13Y MY/OUR SIGNATURE BELOW,1/WF AGREE TO BE ROUND BY THE TERMS OF THIS CONTRA(-T_ i/WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. (y SUBbUTTFD Im- orl ACCEPTED BY: Date: g 0� YLY11 ._ Date: haeth�ver —T`" NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON Tick;REVERSE SIDE AND ARE PART OF THIS CONTRACT 6.1407 rsv 4-2-07 C-SC White-Branch File Yellow-Customat Pink- Saiss ConwIla tt MARSH CERTIFICATE OF 1NSURgNCE CERTIFICATE NUMBER 1 ATL-001234410 01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA, NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE MARSHA SA,INC.I(egUesf@rlla(SfI.COnT POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE homedeFAX(212)948-0902 AFFORDED BY THE POLICIES DESCRIBED HEREIN. 3475 PIEDMONT ROAD,SUITE 1200 COMPANIES AFFORDING COVERAGE ATLANTA,GA 30305 COMPANY 100492-THD-IPUSA-07-08 IPUSA A STEADFAST INSURANCE COMPANY INSURED COMPANY HOME DEPOT USA,INC. B ZURICH AMERICAN INSURANCE COMPANY 2455 PACES FERRY ROAD NW COMPANY BUILDING C-8 C AMERICAN HOME ASSURANCE COMPANY ATLANTA,GA 30339 COMPANY D NEW HAMPSHIRE INS COMPANY 2 COVERAGES _ cedlficate supersedes and;replaces any,prevlously:isued oertifieafe,foK fhe pol cy_penod';nofed tbetpw , • 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 POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR TYPE OF INSURANCE POLICY NUMBER DATE(MMIDD/YY) DATE(MMIDDIYY) A GENERAL LIABILITY IPR 3757 608-02 03/01/07 03/01/08 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000,000 CLAIMS MADE a OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL&ADV INJURY $ 4,000,000 w, OWNER'S 8 CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 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 $ ^ ANY AUTO OTHER THAN AUTO ONLY. EACH ACCIDENT $ AGGREGATE $ A EXCESS LIABILITY IPR 3757 608-02 03/01/07 03/01/08 EACH OCCURRENCE $ 5,000,000 X UMBRELLA FORM AGGREGATE $ 5,000,000 OTHER THAN UMBRELLA FORM WC STATU• OTH $ ' C WORKERS COMPENSATION AND 2921209(CA) 03/01/07 03/01/0$ X I TORY LIMITS ER EMPLOYERS'LIABILITY E 2921210(FL) 03/01/07 03/01/08 EL EACH ACCIDENT $ 1,000,000 F THE PROPRIETOR/ X INCL 2921211 (AZ,ID,MD,VA) 03/01/07 03/01/08 EL DISEASE-POLICY LIMIT $ 1,000,000 PARTNERS/EXECUTIVE 2921208(AOS) 03/01/07 03/01/08 1,000,000 D OFFICERS ARE: EXCL EL DISEASE-EACH EMPLOYEE $ C OTHER 2921213(QSI) 03/01/07 03/01108 E WORKERS'COMPENSATION 2921212(KY,MO,NY,WI)-" 03/01/07 03/01/08 G TEXAS EMPLOYERS TNS-C44642086(TX) 03/01/07 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LIABILITY SIR 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSfVEHICLES/SPECIAL ITEMS CERTIFICATE HOLI3ER "` ` CANCftLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL In 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 _`)Plnd., I s 1 /Q2)= fi M 3VALID AS OF: 02/28/07 .r.0 klUM Munwealrn of Massachusetts _ Department of Industrial Accidents OJf1ce oflnvestigations 600 Washington Street Boston, MA 02111 www.mas& ov/dcQ Workers, Compensation Insurance Affidavit: Builders/Contractors/Electricciiansstt Df mrI[TC�1Did Applicant Information /Plumbers Please Print Le ib1 Name (Business/Organization/Individual): Address: 4jL D — S'..?.ea(ADOoL s� City/State/Zip:_t A�e, � r Phone [2.EJ re you an employer? Check the appropriate box: am a employer with�� 4. ❑ I am a general contractor and IType of project(required): employees (full and/or part-time).* have hired the sub-contractors6 New construction I amla sole proprietor or partner- Aisted on the attached sheet 1 7• [91Petredeling ship and have no employees These sub-contractors have working for me in any capacity. .workers' comp. insurance. 8' Demolition [No workers co insurance 5. 9. ❑ Building addition ' mP• ❑ We are a corporation and its required.] officers have exercised their 10•0 Electrical repairs or additions 3.El am a homeowner doing all work right of exemption per MGL I LED Phunbing repairs or additions myself. (No workers' comp. c.'l 52, §1(4),and we have no 12 ❑ Roof repairs required.] temployees. [No workers' comp. insurance required.] 13•❑ Other Any applicant that checks box 711 must also fill out the section below showing their workers'cornpensation policy information: t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a n tContractorsmew affidavit indicating such that check this box must attached an additional sheet showing the nae of the sub-contractors and their workers'comp.polity information. I am an employer that is providing workers'compensation insurance for my employees. Below is lice polity and job site information Insurance Company Name: \\5 t 0 Policy#or Self-ins.Lic. #:_ 9�Ce2i2p� Expiration Date: 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 under the pains andpenalties ofperjury that the information provided above is true and correct Si ature- _ Date: Phone#: FFeD only. Do not write in this area,to be completed by city or town officiat n: Permit/License# ority(circle one):Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector son Phone#: