HomeMy WebLinkAboutBuilding Permit #442-2017 - 25 FARRWOOD AVENUE 10/29/2016 µoRry
Q4 A,,) L,� BUILDING PERMIT �Oh iLED bq•�O
`( TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION * .T
Permit No#: ` Date Received
ArED
�SSgcHus���y
Date Issued: 0
IMPORTANT:Applicant must complete all items on this page
L0CATI®N, _ . S od r(' 00
P"rat
_. l [ /Roe, b�cl�
PROPERTY OWNER, _
--Print 1 DD Year Structure' yes no '
MAP y _ PARCEL: ZONING DISTRICT: Hi0ofic 1 is-tfjct ye no,
Machine Shop.Village y s: no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Xiding ❑ One family
❑Ad ion ❑Two or more family ❑ Industrial
❑ teration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic l]Well ❑ Floodplain b.-Wetlands [I Watershed.District
O-Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
�y k it-Ax,4-
(l�U � ze`�� rJ.G�4 Chq`g4ef)
Id ratification- Please Type or Print Clearly /
OWNER: Name: `Ott �cic Phone: 916'
Address:
S� Farr wv v Y
Contractor Name:
A �a� o.wM: __ h
-rc.2/ Pone:.
Email:
Add0.7g
Supervisor'sConstruction License: Expo Dater
®®_
HDrne7lmpr- ementt License:. _ . _ . —.� Exp: ®ate;,
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.
CV
Total Project Cost: $ •3 Ya 3 FEE: $
Check No.: ) Receipt No.: 1 ��
NOTE: Persons ntra ting with unregistered contractor o not have access to th guaranty fund
-- �✓L-_- •tet,��',--_ __ _ ...-— - - - -- -- -�Sf
Signature o Agen Owner S nature of contractor
Location 0N//
No.
/• ' - Date 141
• - TOWN OF NORTH ANDOVER
s " •
Certificate of Occupancy $ dam•
Building/Frame Permit Fee $ 4Ltl
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
r,
Check# ,
y �� Building Inspector 0 !
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
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Siqnature
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
Locafedlat 124.Maint treef
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 Call Email
Date Time Contact Name
Doc.Building Peimit Revised 2014
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/Cross Section/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:Building Permit Revised 2014
NORTH
own of t a ndover
O ..moi'• ., { .
I
No.
T ? b
o"h ver, Mass,
coc NICHRWICK �'�•
X1,95 RwrEo �.P�`�,�5
U BOARD OF HEALTH
Food/Kitchen
PERM11T T TT y� Septic System
THIS CERTIFIES THAT ..• N. .rAr*&Q**A...C0 ut ..ip. j!"�• BUILDING INSPECTOR
�j /�/� Foundation
has permission to erect buildings on ZIr 7 M1�/. .....� ��......�.
.......................... . . .... . .. .... ... .
Rough
to be occupied as -11004,wo...Ft- MLM-OT...I)ATI-0-9.0.00L y
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 CONS TIO Rough
Service
.. .. .. ........... ... ........... .. Final
BUILDING INSIDE R
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinw 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.
Home Depot Contractor License Numbers:
MA Home Improvement Contractor Reg. # 126893
Salesperson Name and Registration Number:
Leonard Racite : R-1-073-14-00023
Home Improvement Agreement
THD AT- HOME SERVICES, INC ("Home Depot") or Service Provider named below will furnish, install
and/or service the equipment listed below at the price, terms and conditions as outlined on this form.
Customer Information:
Bill Roebuck 9601247 1
First Name Last Name Branch Name Lead#
25 Farrwood 1 [NORTH ANDOVER MA 01845
Customer Address City State Zip
F(978) 258-1618 11
Home Phone# Work Phone# Cell Phone#
leonard_s_racite@homedepot.com
Customer E-mail Address
NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR
OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT:
908 Boston Turnpike Unit 1 Shrewsbury MA 01545
Address City State Zip
or Email CustomerCancellationNorthEast@homedepot.com
BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE
SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT
CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOURISTATE.
YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME
DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME
DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME
CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU.
OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT
HOME DEPOT'S EXPENSE.
THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT
TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL
AND WRITTEN NOTICE OF YOUR RIGHT TO CANCEL.
Acknowledged by: I
X �, . -�'� 09/28/2016
Customer's Signature Date
1
Distribution: White- Home Depot Yellow-Customer Copy
Simonton Windows
6500 VantagePointe
ai IR, Double-Hung kfiny- 1/8"Glass Argon•Lova-E•No Laminated Glass
.ca With Grids
'a;'V�adF!'im-sras=3r, Ventana de doble guillotina•Vin!!o•3.18 mm Viddo•Arg6n Low-E-Sin
g", Cc! 4' video laminado•Con rejil!as
CPD:SBP-A-44-21042-00002 07-75 DH
ENERGY PERFORMANCE RATINGS
EVALUACION DE RENDIMIENTO ENERGETICO
U-Factor Solar Heat Gain CoetFcient
Coe5;ien:a:Ganarcia re Ere..ria ka:
0.29 1 .65 0.24
ADDITIONAL PERFORMANCE RATINGS
a
EVALUACION SUPLEMENTARIA DE RENDIMIENTO
Visible Transmittance i
de_.1Z Vsbo I
I
0.45
fitanu-mu,ersfipu:atas teat lY.psa re@nigs cor orm:c aep5caNe NFRC prr-edur-s for de!er:r:rcny-whole prodLx!paiorr:.arce.NFP.c:afirgs are
deter:r:.-h I'.Gr a Ned Set cten`nroimetra&Jonwo:s sedaspac`.c produtsza.NFF:G do as rot ra;cr„mend any product and does no!warrant re
SLt!3:A.`1j or anyp-odrei`..N ary spee;x Use i,D:61;C.T.ariW{aClUra„'a!ii5ra ra'Gr��ar Gr6d•JC:pa�0:(".i2rram�JrmEl:Ori.wflY.;t(tC.Jry
s:e tahs_2rla�sfipuk eve va!oras:ump;a.^.io^Ids prxac:mierMo op cal ;,e N FRC para daterminer a,nGiTAen:G Val del prodxtd.:os valore3
wad:,pG:tv=RC son.,*ermina'urn por un�onioto`:;o ca conalcicnes amisrawn a..i3mano de fl-oduclm no recomienda
'gu ?ri, ue a erodu tsea 2dA uac0?5 a un:so esoec`wo.Co,mta con al!aceto jej iczn;a oa.a at we apropiado de
eve pro&xtw4 nice orp
Unit qualifies for ENERGY
STAR(®ion(s):Northern,
,• North Central South Central
Southern.
STC:29
~ �Ot:rrtN1F4+
IND:Rein 00/Glass ProSolar/H-LC25
Q P.+.2 5/-25 Tested Size:48”x 80”
Florida Product Approval:FL5167
Applicable Test Standard(s): ANSI/AAMAAVWWDA 101A.S.2-97,AAMAMfDMA/CSA
101A.S.2/A440-05,AAMAANDMA1CSA 101A.S.2/A440-08,
A440S1-09 Canadian Suppl
r
8858790!01 g0333 HS Howard 6400094A
Keep:-`s enp:`cr,i13s;G e EXERGY ST.A;I&re:,atas 1 o iee.T:mnJre vini wwwv we: a ar:,u.
C.:Leae ma e!ICueta Cs.Gles:eernorjiSGs E�ERGY STARO.Pena ccnr;,er T:$s ace�a de esl.%v;le u.ww.ener ystar gov.
The Commonwealth of ffassachusetts
' Department of Industrial ccidents
office of Investigations
") 1 Congress Street,Suite 100
Boston,ltil4 07114-201?
r {
www.mass.gov/din
Workers' Compensation Insurance 4ff'idavit: Builders/Contractors/Electricians/Plumbers� ase Prine bb
A 1X2-4 h-Enrmation
Name (BusinesslClrganizatioo/indi idual): �i
;1 _
Address:
City/State/Zip: 1.
k l�l 0 ,05 Phone
Are you an employer? Check the ap ropriate box: 7_7
Type of project(required):
4 1 azo a general contractor and I 6 ❑New construction
1.❑ I am a employer with have�e wed the sub-contractors
employees(full and/or part-time).* 7. Remodeling
listed on the attached sheet. ❑
2_❑ I am a sole proprietor or partner-
These sub-contractors have 8. ❑Demolition
71
i
ship and have no employees employees and have workers' g ❑Building addition
working for me in any capacity. comp.instmce.x I
[No workers' comp.insurance 5 ❑ We are a corporation and its 10.❑Electrical repairs or additions
required-] officer have exercised their 11.❑P1 g repairs or additions
3. I am a homeowner doing all wor'r
Myself [)`To workers' comp. right of exemption per 1VIGL 1�,0 of repairs
c. 152,§1(4),and we have no 13. Other �4
insurance required] t =ployees. [No workers'
LM
comp.insurance required.] c f U
►s,fly applicant hat checic�hox 1 must also 5D out a a ia eJ�work and then hire outside howing their workers' contractor.must submit new affidavit indicating Bach
t Homeowners who submitthis affidavit indicating they g
tcontractors that check this box must attached an additional.sheet showing the name of-the l.ic ber.and state whether or not Mose entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.p y ;I
I am an employer that isproviding workers'compensation insurance for my employees. Below Is the policy and job site
information.
Insurance Company Name: � CW
pZ �� Expiration Date:
policy#or Self-ins.Lic.#: C-1 0/15 ` - I
c.l. dtr
City/State/Zip: �'�
Job Site Address:
Attach a copy of the workers' compensation policy declaration page(showing the policy number and esp a aitiesaof a 1
Failure to secure coverage as required under Section 25�A Il aMGL c. 11552 ci�methe oth�STOP w0�ORDER and aline
fine up to$1,500.00 and/or one-year Impn t, �
of up to$250.00 a day against the violator. Be advised thatverification.copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverag
Ido hereby t.
cern er the pains and penalties of perjury that the information provided above��S�c��
✓lam Date: ( l/
Si
Phone# r U
official use only. :Donolwrite in this area,to be completed by city or town officiaL
t
City or Town'
Permit/License# 4
Issuing Authority one):
1.Board of Healtilding Department3.City/Town Clerk 4.Electrical Inspector 5.Plumbing]IRSIMetOr
6.Other i
Phone t#:
Contact Person:
'"1
c
t`l `=�/_6 ���C1� '� �J'l-t��+ ��f'Cv'C' �• C�.;f�(������i��i.�;�C�C'�tiGC
Office of Consumer Affairs and Business Regulation
. 10 Park Plaza - Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 126893
Type: Supplement Card
Expiration: 8/3/2018
THD AT HOME SERVICES, INC.
MARK NIADNA --- --�-
2455 PACES FERRY ROAD, HSC C-11 -
ATLANTA, GA 30339
Update Address and return card.Mark reason for change.
-
(� Address 0 Renewal 0 Employment E] Lost Card
SCA I Li 2011-05/11
y, r '�JIi•V r'%Ill/IIn/r/l vvl�/�r/!�'ll r�;7iNr•��i.;t•�/1
fi7ce of Consumer Affairs&Business Regulation License or registration valid for individual use only
`l'P,,1'...; �, before the expiration date. If found return to:
111}` OME IMPROVEMENT CONTRACTOR
Office of Consumer Affairs and Business Regulation
ti\ � f Registration; 126893 Type: 10 Park Plaza-Suite 5170
Expiration: 8/3/2018 Supplement Card Boston,MA 02116
THD AT HOME SERVICES,INC..'
THE HOME DEPOT AT HOME SERVICES
MARK NIADNA
2455 PACES FERRY ROAD,HSC �;:.-r-• _l,r•; ( - ��
ATLANTA,GA 30339 Undersecretary Not valict without signature
y,
lassa- 1
r
Boa
g }
Lfcense ,- CS-029328
ns !
. CHARDRl
L KEYES 11
16 LAWRENCE RD
SAL
N ' 0 30 79 „ -
2
Commission er 09111/2.EXpiration :