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HomeMy WebLinkAboutBuilding Permit #057-13 - 242 APPLETON STREET 7/24/2012 NORTH BUILDING PERMIT °`<t`�° �b�tio TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION civ ° . . Date Received � °RATE° Permit NO: gSSACHl1S DateIssued: IMPORTANT:Applicant must complete all items on this page 77 ....+ �, a Y=v-a-� '•'--- �• Y3 i'*';d �n � 's+ a , DOWNER' PROPERTYr z - t PARCELZONINGDISTRICT ;f HistoncDistnct yes i, no i / ��- r r...x d'r. MAPNO r a �.r <.< 4h { Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Res' Non- Residential New Building - One fa Addition Two or more family Industrial eration No. of units: Commercial Repair, replacement Assesso ry Bldg Others: Demolition Other F '-`x Floodplairi`i 'Wetlands :H g= 4 Watet,Fhe' Disfrict T, r 1 "Septic—' Ft .t �- r = DESCRIPTIQR TO B FORM D: f Identifica io Please e r Print Clearly) OWNER: Name: Ioi Phone: � Address: , 112111 l' p.� 0 .. CONTRACTORyName }: a hone'. �. c - 45 a C s r 15 Supervisor=stConstructioriLicenser f uExP 04tb; - ! a . z - 6? Exp cFlome Improvement License tr. _,=+ arae a.- 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. ' Proect Cost: $ FE $ � Total � �� Check No.: 2jg`C_ Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to a ra fund Signature of Agent/Owner -:Signature of contract n l-r Location - U j No. V ` - [ DattTJ A "q, • ' TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 25536 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/MassageBody 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 Zoing 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.i` `' °` r Yrno Locat tl at d 24 MainStreet f 1ren epartment's gnatureLdate� ,= - �f • i r:._ �_v ,fry . . �; �+� t �''�,,. COMMENTS •�, s ,.0 �, r <,,: .. ,: .r .e. .,�r � 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 Doe.Building Permit Revised 2008 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 i 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 2.2008 r 1: NORTH - W- . 2 :t . .. ,c . . ver i wl r No. o h ver, Mass,j Z41 Z-a 1 2. A- CO MIC Kl wicK ��• 7�pDRATED /.Pa�,�S BOARD OF HEALTH Food/Kitchen PERMI.T T. LD Septic System THIS CERTIFIES THAT .1�L01.00.40....... .......................................... BUILDING INSPECTOR ................. . ..... . has permission to erect .......................... buildings on .....� �. I ........ p ..... � Foundation Rough to be occupied as .......... ' .. ..... 1.110.:.. ........... ..... .K��Qw! .... .......................... Chimney provided that the person acce Ing 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 3� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR• UNLESS CONSTRUCTI0 Rough Service. .....................T. ................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. Smoke Det. SEE REVERSE SIDE 02 J A Q� J 1 11 1 V A. VV k e r S C o_ra e r�Sa i C,n S-u V2 `Z L H.E %-v J-C B- 1 i e -s v-j pp F�ease Prmt Legiihjv Na Tie (BaSil!eSS/OTgRniZLitlop/T--cd:'vidi:a"' .Address: ------ City/state/zip: IM Phonelk Are y942n employer? Check the appropriate-box. Type of Pr 4. 1 am a general contractor and I (requh-pd): 17 1 ar New cons—ation, o a em U 11A. r.ployer with bave hired the sub-contractors elr'ployees(full anNor�Part-ti_-kric).* listed on the attached sheet. T F]Rcuiodeling -2.0 1 ain a�61e proprietor-r or partne-l'- These sub contractors have 8. L-]Demolition ship and have no employees and have workers'employees working for me in any capacity. 9. 0 Building addition [No workers comp.insurance.?' comp.insurance 5. We are-a-corporation and its 10.n Electrical repairs or additions 3.❑ 1 required.]a homeowner doing all work officers have.exercised their 1111Plumbing reimirsor additions am myself. [No workers' comp. rnp. rijht of exemption per MGL 12.[]Roof repairs insurance required.]t c. 152,§1(4),and we have no 13. then employees. [No workers' comp.insurance required.] *Any Applicant that checks box#1 must also fill out the section below showing their'workers'.conipensadon 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. lContractors 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. Ifthesub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that 1s providing workers'.compensation insurance for my employees. Belowjs the policy and joh site. information. Insurance Company Name: ka 41- Policy#or Self-ins.Lic. Lei Expiration Date: JobSite Address: City/State/Z _�yAttach a copy of the workers' compensation policy eclarat on 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 Agaodt-ffi'�Viola.tor. Be I advised that a copy of this statement may..be forwarded to the Office of investigations of the DIAfor inst4ance cove iage verification. information provided above is true ndcorrect. Ido hereby certify and r the pa s Mdalti o Lperjury that the Signature: r Date k2 7 Phone 0: 2&0-75 Official use only. Do not write in this area,to be completed by city or town officiaL IiCity 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#: 4 URANC I ---WATE F UABfl--'f'T'Y NSU CO f iji;2 —M E HCL 71"ER. I 'T-ms CE'R71FICATI IS ISSUED AS A MATTER OF INFORMATION ONL'TA 76 CONFERS NO FRIGHT-55 UPON THE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE C-aVERAGE AFr-0R,0F -D B r THE iPO L'jC J E'b BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A COMTIRUXT B2.71PIEEN THE ISSUiNG INSURER(S), A0110p5iaD 1 7 REPRESENTAT WE OR PRODUCER,AND THE CERTIFICATE HOLDER. jjicli;i�! INSURED.the pojlcy�;05) Must be end'orsed. 11, IMPORTANT: �.r w kro I#the holder is on. i znifica�a dops-not' "Ab Nhik a policy,certain policies fnaY requIF'a ars endorsement. Astatannent,011 ne terms and conditions o#the holder in iiaL,of such andorsament(s). CONTACT PRODUCER 1. NAME: PHONE Ain, A/C No Ext): E-MAIL homedepot-cartrequest@marsh.com ADDRESS homedepot.certrequest@marsh.com e e " ITZtnom Road,Two Alliance center, 356.0 Lenox Road, Suite 2400 INSURER(S)AFFORDING COVEPLAGE NAIC# 'IN- -I I — CONTACT' NAME. PHONE 'C N E-MAIL ADDRESS: 'C Atlanta;, GA, 303216 INSURERA: Steadfast ins Co Co26387 Fax (21�2) 948-0902 SURE' �n 16535 INSURER B: Zurich American Ins cc INSURED Cc 2!1941 The Rome Depot, Inc. INSUREIRC: 14— Ham ins cc Home Depot U.S-A-, Inc- INSURERD: Illinoiii Nati ins Co 23817 IRS INS ITTS 2455 Paces Perry Road NN co OF P TS 19445 Building C-20 INSURER E: NATIONAL UNION FIRE INS Atlanta, GA 30339INSURER F: I I ilinois Union Ins Co 27960 COVERAGES CERTIFICATE NUMBER: 25776028 REVISION NUMBER: 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 S RPOLICY EFF POLICY EXP LIMITS INSR PO. .1-0=0 MIDDly MMIDO LTR TYPE OF INSURANCE — GL04887714-02 03/01/1 03/01/13 EACH OCCURRENCE $9,000,000 A GENERAL LIABILITY DAMAGE TO REN D $1,000,000 PREMISES(Fa occurrence L COMMERCIAL GENERAL LIABILITY MED EXP(Any one person) $EXCLUDED CLAIMS-MADE I il OCCUR PERSONAL&ADV INJURY %91000i000 LIMITS OF POLICY XS 0 GENERAL AGGREGATE $9,000,00 .OF SIR: $lX PER OCC PRODUCTS-COMPIOP AGG $9,000,000 EITL AGGREGATE LIMIT APPLIES PER: $ X POLICY PRO- LOC BAP 293 03 01 103 01 13 COMBINED SINGLE LIMIT 1,000,000 Ea accident) B AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ X ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED PROPERTY DAMAGE AUTOS AUTOS $ NON-OWNED Per accident HIRED AUTOS AUTOS $ X SELF INSUR PRY D14G EACH OCCURRENCE $ UMBRELLA UAS OCCUR AGGREGATE EXCESS LIAB CLAIMS-MADE DED RETENTION$ WCS C WORKERS COMPENSATION WC01973 03/01/1 03/,01/13 X I TORY ENT $1,000,000 AND EMPLOYERS'LIABILITY D ANY PIROPRIETOPJPARTNER[EXtE:tCU'lll,V�E-joy" IAC019736917 (FL) 03/01/1 03/01/13 E.L.EACH, XN I OFFICERWEMBER EXCLUDED" NIANCO19736916 (CA) 03/01/1 03/01/13 E.L.DISEASE-EA EMPLOYE $1,000,000 E (Mandatory In NH) If as,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DE sc ipnoN OF OPERATIONS below C11921494 (QSI) 03/01/1 03/01/13 SIR (AOS) SIR (GA) 1M/750,000 33 Workers Compensation WC019736918 (141) 03/01/1 03/01/13 C workers Compensation 03/01/1 03/01/13 occurrence/SIR 30M/1M P TX Employers XS Indemnity TNSC46566397 (TX) DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD iOl,Additional Remarks Schedule,It more space Is required) RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN THE HOME DEPOT, INC. ACCORDANCE WITH THE POLICY PROVISIONS. HOME DEPOT U.S.A., INC. 2455 PACES FERRY ROAD NW AUTHORIZED REPRESENTATIVE BUILDING C-20 ATLANTA, GA 30339 USA ©1984 2010 ACORD CORPORATION.All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered markilef ACOkV"!� �l2G V09?2!I�269ECIfCCLLGit O�✓!�(,CL041�'LLlQP�6. Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Registration .126893 Type, Expiration 8/312012 Supplement The Home Depot�At F4ome.Seririces RICHARD FALL ONEF 2690 CUMBERLAI�fD A�'CrAf `A,GA 30339 .Undersecretary - I � II JUN-15-2012 10:28 From:KEN SANDELL RSW 603 782 8726 To:l•{oml2D©S U HOME iMPROVEMENT CONTRA('9' PLEASE READTHIS Sold,Furmshcd and installed by: Branch Nagle: Boston Dale: THD At-Homy,Services.Inc. LJ_L*_L_L. d/b/a The f tome Deptn At-Home Services 345A Greenwood Street,Unit 2,Worcester.MA 01601 Full bice(800)6.57-5182;Fax(508)756-8823 Branch Number:31 Prxkral ID A 75-2(f1A460;MR 1 is#C 02439:RI Cont.Licit 16427 7 }� (T Lic#HIC.050ii22.MA/Home Improvement Connytr ctrn Rc #126893 IrlNtallatiem Addr�cN: �_�_, �7� ._.N Aj�(Q N 6fy7�/r�tly�- /V�4 0�� Ciy Slalc Lip 1'urrhaRer(s): Work Phone: Horace Phone: Cell Phone: Ilome Address: (If different from Installation Address) City �^ �State Zip E-mail Addrera(to receive project communications and I(ogue Depot updates):� eN r to 17CrConncq,S-v,r NrT ❑1 DO NOT wish to receive any marketing cmails from The Moine Depot Project Information: Undersigned('Customer"),the owners of the property located at the above installation address_agrees to buy, azul THD At-Horne Services_Inc_(''`The Home Depot")agrees to furnish,deliver and ummgc for the installation("linctapalion")of J all materials described on the below and on the referenced Spec Sheel(s).:ill of which ale incorporated into this Contract by (his _ reference,along with any applicable State Supplement and Payment Summary aatuchcd hereto and any('hangs Orders(collectively. Jnhk: inK-uriM.or.l .ducts: S S -6)M Pn)j(YtAglounut - E (.(Kawting Siding indowR ❑Insulation 63 b�t ❑L;alrers. /Covers 013„try Doors ❑_ 5 1 Ok rj ❑Rexefng ❑Siding ❑Windows U lnwlation l-IGuttraa/CVM% ❑burry INKR: ❑ $ Roofing ❑Siding Ll Windows ❑inudation DGuners/Covem ❑Frilry fk%ars❑_-, ❑Roofing ❑Siding ❑Wirulows ❑insulatnm - ❑Gaacrs/Covers FltntryDoors ❑ $ Minimum 25%L%Vn it of tanih=l Anawd duc upon cxmution of dik rnntracL Total Contract Amount 4 ,`/ Mute Pu rhaw-m may not dtylcrit mKr than one4bird oftbe Cauadact Amunt- / Cusumter agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Celtificalc (one for each Product as delined by an individual Spec Sheet)and pay any balance due. Ax applicable,each Customer under this Contract agrees to be jointly and severally obligated and liahle hereunder. The ilnme Depot reserves the right to issue a Change Order or tetminale this Contract or any individual Pmduct(s)included herein.al its discretion;if The ilonle Depot of its authorized service provider detenni n:s that it cannot perform its obligations due to a structural pmhlenl with the linins,envirnnmFntil haiaids such as uatld.ashestm or lead paint,other safety eoncemv,pricing ours or herause work required Io complor thr joh was not included in die Cuutracl. gaymSpt 5u Umary: I tic Payunnt Summary# 63312,2 - __ included as pail of this Contract, a tx forth the tutal Conlracl amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUS TOMiiR You are entitled to a completely filled-in copy of the Contract at the time yna sign. Do not sign a Completion Certificate(mote: peers is one Completion Certificate for earn litdrd Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of lrrnlittalion of this Contract,Customer agrreF to pay The Home Depot the costs;of material,lahor,expenses and service%provided by The Home Depot or Authorized%ervire Provider through the date of termination,plus any other atn otm(N set finih in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED 11) IIIN HOME DEPOT FROM THE DEPOSIT PAYMENT OR O-I HER PAYMENT4. MADE, WITHOUT LIMITING TILE HOME DEPO'T'S OTHER REMF,DiES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authaiiration: ('nosier agrccs and undcrslamds that this Agreement is the entire agreemEnt bC(WCL-n Custnoter and The Home Depen with regard to the Prodncta and lustallalwn:wiviceN and supersedes all prior discussions anil agreements.either oral ill writico.uelalang to said Products and In%(allation.This Agreement cannot he IRsigned wutiended except by a writing signed by Cuslunicr and 1IK Roan Vrpol.Luslurucr acknowlcdW%and agrees that Cuitomcr has read,tntderr.tunds,voluntarily m cepts the terms of and ha received a copy of this Agreement. Accepted Submitted b LN 6 1 t�- ��� 6 �Z C r s tgnam Date Saks Consultants Si mature y�,rte X _ Telephune No._ �,L64 I \7� Customer S Signature Date Sale.Consultant License No. _ CANCELLATiON: CUSTOMLR MAY CANCEL THiS to aliphUba•) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DFLIVFRiNG WRITTEN NOTICE TO THb: HOME Dtar(Yl" BY MIDNIGHT ON TILT Tii1RD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. Till; STATE SUPPLEMENT ATTACIIED HERETO CON 1 A1NS A FORM I-O USE iF ONE 1S SPECIFICALLY I'RF4;("RiRPD ItY LAW IN r CUS IY)M LR`S%l A I E. NO i l(F:-'%DD11111NA1 1 FRNIS AND l-(1X111 I IONS ilRL STATED ON 111E RF VF'RSF.SIDI!AND ARF:PART OF'1 HIS C(/NTRA4 t 1004-11 C SG While-tlrarei Fle Yellow-Customer � '"}ip e'iy y,s .,reY 5, ;# r.^ s :79 yj: „ £ gid } 'j ✓-r ,+��,$ "^. mss. '�`+ a�5 y s�., _ sk«, a Y l r �' XON `" • '' f m:;t 1 lC z e-, ]L '�v +. •g ;i.. ?� �Y f �x n .e3 F g ¢ t � L � � � �s' ! M!�$E� �r+d C R_ n 'fic .'4 3S fie.. � ,��a•�R � 3.' .,g Sys.. ` ���°��' h . .,fnq�'4 "�+ "kap ya' j,,,�I[y^'y, ! •+�, ..:; R �*�7��'.[��.](� •�. �,� ��5 j;Gu� -. �� � 3 ��rs�. p� �,,. rlih ,w �, Y v M •:L�'^'»'.1{�� y kt"! .�`}}'' � �/�(�]/_ L ` son � mr4 b k� .X.: 13.1 1 L1:7 039 t:'YA if Moon t'"` � a'"��*'�'•rp;sti y.. ,.,: _ .,K^1.P v.s,, b,.%�x� :.�• + y"�.3 r:.,,. 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