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Home My WebLink AboutBuilding Permit #376 - 261 CARLTON LANE 11/7/2006 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Of NORTH Permit NO: Date Received ` y O T 0 LAA- 2" ( tM1. T Date Issued: 'j►'+�s4roo SSAC HUSt� IMPORTANT: Applicant must complete all items on this page LOCATION ' �\ EC4 \�V\,- Ul- 1 Print PROPERTY OWNER -� rn cvah Pri t MAP NO.: / PARCEL: �� ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial XAlteration No. of units: Repair, replacement ❑ Assessory Bldg ❑Commercial Demolition- Moving Movin (relocation) ❑ Other ❑ Others: Foundation onl DESCRIPTION OF WORK TO BE PREFORMED IL Identification Please Type or Print Clearly) OWNER: Name: �C.meS ,c- Phone Address: Ave— �4S\ Lk CONTRACTOR Name: \�d d`t\e_ ��7p-�- Phone Address: `A�� Supervisor's Construction License: Exp. Date: Home Improvement License:_ ��_<<,� Exp. Date: _ IK - ?j-DS ARCHITECT/ENGINEER Name: Phone: Oddress: � g. No. � •� FEE SCHEDULE:BULD/NG PERMIT.-.51200 PER.S/000.00 OF THE TOT,4L EST/.MATED C ST BASED ON a125.00 PER S.F. Total Project Cost :$_ \�'j , w FEES I S- Check No.: Receipt No.: Pal e 10t'4 -' .---. - - - --=- -- --- V ., - : _ .' , I. ..r.. ..- om. ... .. 1. .. '.. .. . _. v: ... ...'.: .-.. . .. .. .. ... ... .- i:.. .. - .. ... .. - .... .....:. ... ....-. - 4 1. 1. _ _ - .. 1. ' .. i. - ,: ' t s . .. ..: .. w yam. � � . . . ,. �. . .P. Location / r6tIL L 14 , . No. - -& Date f`"� V { NORTH R TOWN OF NORTH H AN DOVE 0 3? � , �6 0 c 0 F a . * • Certificate of Occupancy $ o .._. ,SSACMUSEIt Building/Frame Permit Fee $ , 1. - x.. Foundation Permit Fee $ ` Other Permit Fee $ TOTAL $ - - .. I. Check # f5 'J� L -r- _ 1 97.7 Buildingo . - :- ' . .. Y M _ ✓-- M �t§ e _ _t - . - y �. r S -. ....- __ - - .. - _ - -:. -. .. _ ... ..... ... ..-. .. _ .. .... .. I� -..: . .. -.. . -- - - — _ .. - - -_ 1 .- _ _ _ ....- _ .. .... . .: _' ... 1. _. .. ..::-_- _ ... '-a - - - • ... . .,: .. .....a.. '....-. .- .. ... �. .. .. e2e41 ti ' .. .. .��: "_ I TYPE OF SEWERAGE DISPOSAL Swimming Pools ❑ Tanning/Massage/Body Art Public Sewer iJ Tobacco Sales F] Food Packaging/Sales Well r, Permanent Dumpster on Site Private(septic tank,etc. ! Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor Plans Submitted ❑ Plans Waived ❑. Certified Plot Plan ❑ Stamped Plans ❑ 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 . .FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer connection/Siunatuee& Date Driveway Permit __ i i Building Setback ( Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use Pa y3of4 Doc:INSPECTIONAL SERVICES DEPARTMEN'r:BPFORM05 Ocafed AMC Jan-'006 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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:INSPH TIONAL SERVICES DEPARTMENT:BPFOR9i05 { Page 4 of 4 i 1 , The Commonwealth of Massachusetts Department of Industrial.Accidents EHi ; Zl Office of Investigations 600 Washington Street Y, Boston, MA 0 111 %,wx,.mass.gov/dia «'orkers' Compensation Insurance AffidaNit: Builders/Contractors,"Electricians/Plumbers Applicant Information Please Print Legibly Fame Business/Orgaruzationlndividuall: Address: f �`� ` -P C 111 ,( ( . City/State.Zip: C\Sc r Phone -- C-"1�- �vG�_ ►�-� lc Are you an employer' Check the appropriate box: Type of project (required): 1.( ] I am a employer ,;6th 4. ❑ I am a general contractor and I 6. I❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I ;,�;, a aG1G pi�ly,—actor or panner- listed rn the attached sheet. * !� Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition %vorkin for me in any capacity. workers' comp. insurance. g p [No workers' comp. insurance 5. ❑ We are a corporation and its 9. F71 Building addition` required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemprion per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152. §1(4), and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13,❑ Other comp. insurance required.] Any applicant that checks box=1 must also fill out the section below showing their workers'compensation police 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 their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. \ Insurance Company Name: Policy=or Self-ins. Lic. =: Cl ej 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 S 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 5250.00 a day against the violator. Be advised that a copy of this statement may be fonvarded 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 Simature: A �n�P Date' Phone Ojj<cial use only. Do not write in this area,to be completed by cit}•or town official. Cit. 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#: NORTH Town of 0 No. o dover, Mass., • O T O LAKE I� COC NIC KE WICK V %d�oRATE D 0'? 2 7v ` BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System ' BUILDING INSPECTOR THIS CERTIFIES THAT.......�AW.M�......�........ .w!M.T............. .... ..................... .................... ..................... Foundation has permission to erect........................................ buildings on ..&.L.1.......C.01 r a..�.0k. ........�...*....... Rough to be occupied as....... Chimney provided that the person accepting this permit shall in eve spect conform t 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 Final PERMIT EXPIRES IN 6 MONTHS 1 ELECTRICAL INSPECTOR UNLESS CONSTRUCTT S Rough ..... .... Service TUE. .. .. .... . .. ........ LDING 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. FROM OUIMET FAX NO. : 12074329359 Oct. 31 2006 04:48PM P5 "OML rMPROVEMENTCOV'I'RACT Branch Name Date: Sold,Furnished and Installed by. _ ,�i�d THD At-Home Services,Inc. Job d/b/a The Home Depot At-home Services Branch Number: 345A Greenwood Street,Worcester.MA 01607 --�� #: // Toll Free(Sop)657-5182; Fax:508-156-2859 Federel Ill#75-2698460 ME lic#C 02439 RI Cont.[icA 16427 �� CT Lic d 565522; MA Home Improve eat COntracKor Reg, #16427 instaQation Address; City a/� PorehaE a, tate Zi P La bt 4 "" Of()river's Lie#&Ex o/Yr: r Work 1?h � One• Home Phone: ( ) Home Address; ( ) (If different from Installation Address) City State ZIPE-mail Address(to receive updates and promotions from The Home Depot):_ Project Informs inn; I/Wafyou(°purch�r.) the owners of the rope contract with Home Depot U.SA.,Inc. ('Flome De of to fu P 1 �located at the above installation address,offer to described on the attached Spec Sheet# mish,de iver and arrange for the installation of all materials as incorporated herein by reference and made apart hereof. Home Depot reserves the right to cancel this contract if,upon re-inspection Of the job,Home Depot determines that it cannot perform its obligations dire 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 (Subject to fwd ver?Gcalion and/or credit approval) CONTRACT AMOUNT Check,Cashiers Check or US Postal Service Money Otdor� (Made payable to The Home Depot)- "LESS DEPOSIT S O 2, Credit Card"and/or other payment options-Chris One Below Visa MasterCard Discover American Express . BALANCE DUE, The H epot Horne improvement Loan Tlie Houle Depot Credit Card ON COMPLETION s��' y` , ew Accowft ❑Existing Account t tH1L ks]fmCC ONLY) *Minimum 25°fo of Contract Amount due upon gvaiFablc Crulit:Y ca�r�! /`� `~� oxeeudonor this contract (HIL&IlDCC ONLY) Ac j#(O 3,6-32W—' /.«$- xp Date:_ Name as it appears on card:_'J L d=4_t Indicate Payment Method For •$ /0ur siVature be w,JJWe agree to allow Home Depot to BALANCE DUE ON COMPLETION: ;canrWgeh�Birefe ed credit card for the deposit indicated.Dart HIL or HDCC Authorbmtion Codes Deposit Plnal Payment Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Pwcbaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement:This agreement and its attachments,including any financing agreement,contain the Complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties, NOTrCu 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 Certificate before this project is complete. Law prohibits home repair cootraetotrs from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction at 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 25%of the contract amount if the job is cancelled by Purchaser AFTER the third business day. BY MY/OUR SIGNATURE BELOW, I/WE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. I(WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MYIOUR SIGNATURE BELOW,I/WE UNDERSTAND THAT THE AGREEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH ENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED K INADVER ,OMISSIU OItS. SUBMITTED B _ Date: lehy If 6 Sa u ACCEPTED BY: Date: Homeowner Date: Hamernvmr NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 4-07-06 GSC white-Branch File Yeilow-Customer Pink-Sales Consultant MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER ATL-000915907-11 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE ATTN:BRENDA BOOKER (404)995-2594 POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE MAYA MCCLURE(404)995-3206 OR AFFORDED BY THE POLICIES DESCRIBED HEREIN. TAMI ROUSE(404)995-3430 FAX(404)760-5663 COMPANIES AFFORDING COVERAGE 3475 PIEDMONT ROAD.SUITE 1200 ATLANTA.GA 30305 COMPANY 00492-IPUSA-GWA-03/04 A STEADFAST INSURANCE COMPANY INSURED COMPANY THD AT-HOME SERVICES INC. B ZURICH AMERICAN INSURANCE COMPANY DBA THE HOME DEPOTAT-HOME SERVICES,INC. HOME DEPOT USA,INC. COMPANY 2455 PACES FERRY ROAD NW C NEW HAMPSHIRE INS COMPANY BUILDING C-8 ATLANTA,GA 30339 COMPANY D AMERICAN HOME ASSURANCE COMPANY COVERAGES This certificate supersedes and replaces any previously issued certificate for the policy period noted below. 3 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. TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LTR DATE(MM/DD/YY) DATE(MMIDD/YY) LIMITS A GENERAL LIABILITY IPR 3757 608-01 03/01/06 03/01/07 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMPX)PAGG $ 4,000,000 CLAIMS MADE �OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL&ADV INJURY $ 4,000,000 OWNER'S&CONTRACTCR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 1.000,000 MED EXP(Any oneperson) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-03 AOS 03/01/06 03/01/07 X ANY AUTO COMBINED SINGLE LIMIT $ 1,000.()00 ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) XqELF-INSURED AUTO HYSICAL DAMAGE PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ EXCESS LIABILITY AGGREGATE $ EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ G WORKERS COMPENSATION AND 6610998(AZ,ID.MD,VA) Q3/Qt/06 Q3/Ol/07 X TOCSTATTS ER _ EMPLOYERS'LIABILITY C 6610995(AOS) 03/01/06 03/01/07 EL EACH ACCIDENT $ 1.000,000 G THE PROPRIETOR/ X INCL 6611326(OR) 03/01/06 03/01/07 EL DISEASE-POLICY LIMIT $ 1.00(),000 PARTNERS/EXECUTIVE E I OFFICERSARE EXCL 6610999(NY,WQ 03/01/06 03/01/07KERS EL DISEASE-EACH EMPLOYEE $ 1.000,()00 OTHER -WOR E COMPENSATION CONTINUED 6610997(FL) 03/01/06 03/01/07 D 6610996(CA) 03/01/06 03/01/07 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLESISPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE FXPIRAnoN DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAL RQ,DAYS WRITTEN NOTICE TO THE FOR INSURANCE PURPOSES 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: WalterGilstrap (;K +Y. MM1(3/02) VALID AS OF: 02/27/06 l , AT-HOME Ons ailed u Siding and Windows 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 I;TJNROEUN CHHOUY 3200 COBB GALLERIA PKWY#20 A AtIANTA,GA 30339 Administrator Not valid without signature Pro(ldiy sold.furnished and installed by RMA Home Services,Inc.,a Home Depot authorized contractor. 345 Greenwood St. Unit 2•Worcester, MA 01607•508-756-6RRR•Fav F0R_7rA.')ar0.T-ti r.,.,,0— ,,