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HomeMy WebLinkAboutBuilding Permit #177-11 - 242 APPLETON STREET 8/30/2011 NORTH BUILDING PERMIT 0.*"iLr0 16V6 0 '�a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 41 Permit NOVDate Received �SSACHus�� Date Issued: CJ IMPORTANT: Applicant must complete all items on this page .LOCATION O 1(4 Print PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICTHistoric District yes Machine Shop Village yesno TYPE OF IMPROVEMENT PROPOSED USE Resid Non- Residential New Building One famil Addition wo or more family Industrial Alte No. of units: Commercial Re airre laceme Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTI RK O MED: nneLS Identificati lease Type or Print Clearly) OWNER: Name: Phone: YzT7 M37 Address: [5 vy CONTRACTOR Name: Pfio Address: , 1z 7 Supervisor's Construction License: Exp. Date: c, Home Improvement License; Exp. Date: l ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �gRO5 FEE: $ -- Check No.: 3/2--2.,P-- / 2-Z Receipt No.: d 3 3 NOTE: Persons contracting with unregistered contractors do not have access he gua anty fund Signature of Agent/Owner___ ,a C..�} If �S�gnature of contactor Location 2- a Ao Lo J t�✓� No. Date �aRTM TOWN OF NORTH ANDOVER O? ° •• ow t i A 7,91 # Certificate of Occupancy $ Building/Frame Permit Fee $ <+cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #��/ 233 / 6 Building Inspector 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 .....---.........---.............................-----.... --...__.-._................--................—--._...__.....---._..............._..._--...............................................-_.....---...._...---............................................................._.................. __ 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. j 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 2.2008 -'17 3 X03-a3 139 Via•: I .VSnLLo Wort 11r nkri 3,'32- C-113 1 2.33 xm �4^�`b No Lut;n:t=d C'_:�9 I 3in vL,L--ia Li3L.n:dO ?Ja CsLda 13in cs:jL11:, ENERGY PERFORMANCE RATINGS r4U IA=N DE AENDlNXNr0 J1NERGLEI= . .. . U-Factor Solar Heat Gain Coefficient Fa cor-U CoeAdrnttGww4adaEnergiaSolar /.0 . 32 1 . 6 0 . 29. ADDITIONAL PERFORMANCE RATINGS rAMUAgON SUPLMWAFW CE AENDIM WM Visible Transmittance hananhlon de LiaVMII 0 . 52 leendecss,er eltpdito,a>d a+en Tripe aordhrm Io Oftlft aiiC proad M la&bft ft wtnle Pro&dpWbM&j=rM reth+pe.en demrmlrod lar,lewd eet d atveonrttetArl oors9tlone,rd,ep,dEe ptod<td stre.NRtC does not nxea�id Ary Rodtta and doe,fit wwvtt ttr adal ft of XV Ro&d for an*aft Lft(bnt=mficU"®anew for cQrrp'adud perfhrtm= 7 • hdant�ott wwwldr�Arp • Eab tibrtranee�IlDadt aoe web eet txM*ffl con be ploof%oenbe✓ de WC pn ddwmtrmr d erd mwft tw dd prodt�L Lae wdoree ueedoe par NMC do&WmkW=per un oa*mb *de aordidonae anbWMM Y ui htrorto d,pmd M 8wA'co.WZ m recomlerda*qM prod<ttio y ro pe=ft qw d ptu&cb tin a KWO pen w uo etpuhn Cormb con,d _ loft dd fdork,rr01 pen d uo epaPledo de aeb ptttdudo wrwuudrC arp UALt ejuaLLtla, foe irNERCY STAR cagion(a): Noctha=A , Nocth centmal, South Cant.aL, 9o4tha.n. SKEW STM LA QA1dad oaLLilea.pa.a La(s) wel16n(e2) ENERQY.STAR. Nocts, No=te Cantcal, 9uc Cadtcal: 4ec. IND: Ra.lA 40/Cla21 3/32"/tl–Ro3 } Tastad 9L:e: 36" x 63" IND: g3 faac:o 00/V1drlo 2.39 ass/H-R43 DP : +4S/-45 Tasatio.pvobado: 91.0 ctx 160 CA 4G173. t(9 Bosfaan 2951120. Iap Itis lo6ei far possible ENERGY SW te6a m To loam mon M wwv.wgj taps. boards este etlgwta para pos>bles nemb,isns ENERGY SURe Palo mnoter mds atsrrto dr�sto;vriite rnvw enegystncpat ✓rie i�Jan v»zaacuiea a�,/�aaaac�auaelta j Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Registrationz y-&'893 Tyk Expira6tln, 0Supplements The Home DepoIgWQ, ervrces 2\ k j RICHARD FALI-Oh ,3, 2690 CUMBERLAPID frAEF<YUVAS'S � ��— GA 30339p` _'' Undersecretary NORTH To o _ over dower, 1Vlass., COCMICKEWICK 7� 0 RATED U ` BOARD OF HEALTH Food/Kitchen ijERM1 i T D Septic System THIS CERTIFIES THAT 11__ BUILDING INSPECTOR .............�.�.�.1!��r!!���........... ..�..��`............... ............................................. Foundation fv has permission to erect.................... ................. buildings on ..W.%l PP ...................... Rough ........... .... to be occupied as....... T.......... .W�.1 .�>N.1..�............ Chimney provided that the person ac opting this p mit shall in every respect conform to the terms of the application on 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 IPON THS ELECTRICAL INSPECTOR UNLESS CONSTRU S 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. 1 ® DATE(MMIDDNYYY1 AC"RV CERTIFICATE_O_F LIABILITY INSURANCE 02/19/10 114.�PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED.AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON-THE CERTIFICATE HOLDER. THIS CERTIFICATE . DOES NOT A-V END; E;<TEND OR ALTER, T,HE COVE A,F-OF',D4C �.,� 1-H. homedepot.certreq.astsmarsh.com _Tc., c C ., RAGE -- Two Al iance Canter; 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 tN=LRERS,AFFORDING COVERAGE - Fax 2=2) 943-09_02 ---..__------ INSURED j !AlSURER A:Steadfast Ina CO- ------------_____-- _26387...------_. The Home Deoct, Inc. Home Depot U.S.A., Inc. INSURER S:Zurich American Ins Cc 16_535 --_-_---_-- 2455 Paces Ferry Road NW INSURER C:New Hampshire Ins Cc _ --_'_23.8#i-________ Building C-20 Atlanta, GA 30339 INSURER D:NATIONAL UNION FIRE INS-C0OF_PITTS 19445 INSURER E:Illinois Union Ins Co 27960 COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR 4001 POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR POLICY NUMBER D M / N Y DATE M /DD/YYYY A GENERAL LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE $_4,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Eaoccurre.ce) $ 11000,000 CLAIMS MADE ❑X OCCUR - MED EXP(Any one Terson)__x$ECLUDED___-__ PERSONAL$ADV INJURY $ 4,000,000 GENERAL AGGREGATE $4,000,000_ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOP AGG $ 4,00 0',000 X 1 POLICY PRO-- LOC B AUTOMOBILE LIABILITY BAP 2938863-07 03/01/10 03/01/11 COMBINED SINGLE LIMIT X ANY AUTO (Ea accident) $ 1,000,000 ALL OWNED AUTOS BODILY INJURY $ - SCHEDULED AUTOS (Per person) -- —_ — HIRED AUTOS _ BODILY INJURY $ NON-OWNED AUTOS (Per accident) --_—_-_ X SELF INSURED AUTO PROPERTY DAMAGE PHYSICAL DAMAGE (Per accident) $ GARAGELIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO - OTHER THAN - EA ACC $_ AUTO ONLY: AGG $ A EXCESS I UMBRELLA LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE _ $ 5,000,000 X OCCUR U CLAIMS MADE - AGGREGATE $ 51000,000 DEDUCTIBLE -----_.---_--__-- RETENTION $ - $ C WORKERS COMPENSATION WCO20342355 (AOS) 03/01/10 03/01/11 X WC STAT - — OT;_ AND EMPLOYERS'LIABILITY Y I N D ANY PROPRIETOR/PARTNER/EXECUTIVE WCO20342356 (CA) 03/01/10 03/01/11 E.L.EACH ACCIDENT - — $ 1,000,000 OFFICER/MEMBER EXCLUDED? E (Mandatory in NH) WCO20342357 (FL) 03/01/10 03/01/11 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000_ OTHER E TX Employers Excess TNSC46242373 (TX) 03/01/10 03/01/11 Occurrence/SIR 30M/2M D Workers Compensation WC0910566 (QSI) 03/01/10 03/01/11 C lWorkers Compensation WCO20342358(XY,MO,NY,WI, ) 03/01/10 1 03/01/11 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE HOME DEPOT, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN HOME DEPOT U.S.A., INC. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 2455 PACES FERRY ROAD NW BIIZLDING C-20 REPRESENTATIVES. - ATLANTA, GA 30339 AUTHORIZED REPRESENTATIVE USA ACORD 25(2009/01)sthornton_hd ©1988-2009 ACORD CORPORATION. All rights reserved. 14481889 The ACORD name and logo are registered marks of ACORD i The Commonwealth of?tlassach usetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, .11,4 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business:'Oreanization/Individual): tom' Address: .. _J�e�l City/State/Zip: A i + ^� Phone #: Are an employer?Check the appropriate box: . Type of project(required): 1- I am a employer with 4. ❑ 1 am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑New construction 2.❑ l am a sole proprietor or partner- listed on the attached sheet. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers'comp, insurance. [No workers' comp insurance 5. 9• ❑ Building addition p• ❑ We are a corporation and its required.] officers have exercised their ]0.❑Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.El Plumbing repairs or additions myself. [No workers' comp. c. 152, §](4),and we have no 12.0 5paf repairs insurance required.] t employees. [No workers' comp. insurance required.] 13. Other *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeo%wiers 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 rs providiAg workers'compensation Insurance for my employees Below is the polky and job site information. Insurance Company Name: Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: DVt . City/State/Zip: Attach a copy of the workers' compensation pol y 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 certi u der th San penalties ofperfury that the information provided above is ue a d correct Si nature: I I Date: Phone#: �, -'' '�-� Official use only. Do not write in this area,to be completed b y cin,or tonin 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. 2010-08-02 09:52 3485PR 6032278002 6032278002 >> Home Depot AHS P 1/5 ROME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name. Boston Date: THD At-Home Services,Inc. d/b/a The Horne Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number:31 Toll Free(8(10)6.57-5182; Fax(508)756-8823 Federal 1D#75-2698460;ME Licit C 02439;RI Cont,Lie#16427 Cr Lic#565522;MA liume Improvement Contractor Reg.#12 893 Installation Address: C llU � City State Zip Purchaserts). Rork Phone: Home Phone: Cell Phone. Home Address: (If different lion Installation Address) City Stan:. Zip E-mail Address(to receive project communications and Home Depot updates):_ g ❑I DO NOT wish to receive any marketing emails from The Home Depot Project Information; Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and THD At-IIome 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 Shcet(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(collectively, "Contract"): Job#: o.�iaer—) Products: Spec'Sheei(s)#: Project Amount ❑Roofing ❑Siding CWindows ❑insulation ❑Gutters l Covers ❑Envy MK.rs ❑_ .. �� $�. Roofing ❑Siding Windows Insulation =� ❑Gutters/Covers ❑Tintry Doors f-I _ QRoofing ❑Siding Windows ❑Insulation ❑Gutters/Covers ❑Entry Moors❑_- kooting ENdrig_rTW.tid.ws ❑Insulation [)Gutters/C mcrs ❑Entry Wars ❑ Minimum 25%Deposit of Contract Amount due upon tareration of this raMttad Total Contract Amount $a Q01-)Mninc Pur(itrtsers may not deposit more Wen eat dried of the Contract Amount. Customer agrees that,imunediaLcly 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 die right to issue a Change Order or terminate this Contract oC any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider detennincs that it cannot perform its obligations due to a structural problem with the home,environmental hazards such&%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 Paymcnt Summary# ` included'as part of this Contract, sets forth the total Contract amount and payments required for the deposiLc and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy ref the Contract at the time you sign. bo 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 agree:to pay The Home Depot the costs of materials,labor,expenses and services provided by']'he Home Depot or Authorized Service Provider lhrouih 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 OTTER PAYMENTS MADE, WITHOUT LIMITING;THE HOME DEPOT'S OTHER RFMF,DIES FOR RECOVERY OA'SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is I.hc 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. Accepted O -S-u�'y; Cusco cr's.Si4}aettrrg Date Sales Co. Sigpaturc Date X Telephone No. q 3311 ate. Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (uappl'cablc) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING TtHS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HE Jt 1Y) CONTAINS A FORM TO USE IF ONE. IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE y rATFI)ON T1IE IREVERSE SIDF AND ARE PAIrr OF THIS CONTRAC-r 11-30.09 C-SC White-8ranchFile Yellow-Customer Pink-Sides Consultant Bi:tiV11 Wnn-D-4I5-[Id ­­M aPC N"W'IV•N. ea9.i N.M� N nmlypMl�IM i[�41[�wrp�ru�[�6w � O O q<owAl1HIG I�lglla 1 _ O •!4—upIYLIRW co 1 O NPC�41194a14old 44 OA+4=IA4qIePaM,1 PJ­R9Rs IV :Nwpully,uaple9 � 'fd0: (ONJo A)I=d O ayip�-a.,age aual�*JF ogo(ay:11P yY�.,aa3e WPper.�a.�a.-41 Ieya7ew iy p[p igen 9yiosMDaug O Qll (sa4oy;•u�osw nwpuyi.}o dol —. 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