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Home My WebLink AboutBuilding Permit #559 - 27 PARKER STREET 2/22/2007 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 0f "0 or: . o 3? ,��. 4_•• • 0 Permit NO: � 1 Date Received +► ! + Date Issued: cMust� IMPORTANT:Applicant must complete all items on this page LOCATION 91 ?r,.r6 r- 'c� not PROPERTY OWNER -Da , 1 DV Y1Pt" i Print MAP NO.: PARCEL: 3 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 ❑Alteration No. of units: 'Repairreplacement ❑Assessory Bldg ❑Commercial ❑ Demo]itto ❑ Moving relocation ❑Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED e�L%P J2\AC2 1AG��YI�u�S 'I Identification Please Type or Print Clearly) OWNER: Name: "DwV% CAL k—ayrler Phone: Address: CONTRACTOR Name: IA6me- e ow-V Phone: Address: ) CAr eeY)Woo a S-+ 7 o rCp c.,4e s- C-*-5(moi__S7 (o Supervisor's Construction License: Exp. Date: ! Home Improvement License: aLP Ct Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ bbU FEE:$ HS Check No.: -1 (�� t� Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Swimming El Art ❑ g Pools Public Sewer Well 1-1Tobacco Sales ❑ Food Packaging/Sales El❑ Permanent Dumpster on Site Private(septic tank,etc. F1 Permanent Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund Signature of Agent/Owner Signature of contractor _�Q 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 FIDE DEPARTMENT -Temp Dumpster on site yes no Fi a 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/Signature& Date Driveway Pen-nit Building Setback(ft.) 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 Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan3006 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 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:INSPECTIONAL SERVICES DEPARTMENT:aPFORMOS Page 4 of 4 NORTH Town of itAndover No. 0-- ........... over, Mass.,m2 0 LAKE 11 COCHICKEWICK ORATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System IA.14 BUILDING INSPECTOR .......................................... .. .......... THIS CERTIFIES THAT... ... .. ... . .......... . ....... Foundation ........... buildings on .(9�......fa has permission to erect ......................... Rough erect...... respect Final irA .......................................... Chimney to be occupied as..... ... provided that the pqri� g t�iiXr-iWi-ih—all—in.e**v.e..r.y............ conform to the terms of the application 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 MON TrV ELECTRICAL INSPECTOR UNLESS CONsr sTAXs je7 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. 02/18/2007 06:47 978-663-5557 TIM O'StLLIVAN PAGE 04 HOME IMPROVEMENT CON'T'RACT Sold,VmMidled and Imtalled by: THA Al llotne Services,Ilan. Branch Name: t `L Cc�(1 ate: �� dlbta The Home Depot At-Rome Services 145A Greenwood Street,Worm"L, 01607 job#: Toll Free(800)657-5183; Tax:508-756-2859 ti Branch Number,, '^' pede,al M#75-2698444 ME Lic# 4359 0126"3CT Lic#565523; MA Iron*Ifullmv l�— lasralWion Address! .,-• n 3'G��-City State zip r. WortcPhtwe Epo�eePhoet: jhircr'a IAC.$& � 9 ta' _ - 4 Home Address: State zip (If different froze Installation Address) City E-mail Address(to receive updates and promotions from The Home Dcp(t)' located at the above installation address,offex to Proieet informatlttu_: I/We/You("Purchaset'7,the owners of the Mem and arrange for the installation of ail materials as contract with Home Depot U.S.A.,Inc.("Home Dei,r)to f mlishI incorporated herein by reference and made a part hereoL described on the attached Spec Sheet 0 -VJ u� t ncorp°La� Home ihpot reserves the right to Cancel this Contract if,upon ire-inepeetion of the job,Nome Depot"I'mitres that It cannot perform its obligations due to a structural problem whb 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 fund verification wd/or credit Approval_) 1. Cheek.Cashiers Cbwk or US Festal Service Money Order CONTRACT AMOUNT $ iMR&paYabte to The home Depot)- *LESS DEPQSIT $ �(�, 2. C��*°0&gr otber payment optigm-Chick Chit Below Visa MaatarCartl Discover Americas Espreas BALANCE DUE Thu r4ca,c Depot Home tmprovement Loan Home Depot Credit C� ON COMPLETION � �-F ❑ Aerneat �sfatittg Aceoaet (II[U-&EDCC ONLY) *Minimum 25%e( oatract Amount due open Available Credit 3 �� (HIL&Noce ONLY) encUMon of this contract. 01 Acetlf: )DaIG Name as it appcws on card;b,&J t A 4 V.0:W tAi29- Indicate Payment Method For •)3y my/o 2,erZced nature below,I/We agree to allow Home Depot to BALANCE DUE ON COMPLETION: My a credit card for the deposit z sated, da ature �� HIL or H CC Authorization Cadet sit I Filial Payment # eptsk.13"? I # aISZy 1,0 Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certiftcate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement:Ibis agreement and its attachments,including any financing agreement,contain the emnplete agreement between the parties and can not be amended or modified unless in writing 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 signs. Keep it to protect your rights. Do not sign a Completion Certificate 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 canmpWon of the work to be performed tinder 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 tight. 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, IIWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. FWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. BY MY/OUR SIGNATURE BELOW,I/WE UNDERSTAND THAT THE.AtGRFEMENT IS SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WIr AUTHORIZE HOW DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCiJRRED INADVERTE T OMISSIONS OI ERRORS- SU$MI HY: Date: 2-- i-7—CZ ACCEPTED BY: Date: —d 0 Date: --(PI '07 omeowna NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 7-1"s CSC White-Brunvh Fie Yellow-Customer Pink-Sales Consultant �e AT-HOME Installed ;y Siding and Windows fic�sr..xr Dire<E , F 1 Board of Quilling Regulations and Standards License or registration valid for individul use only N HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 126893 Board of Building Regulations and Standards One Ash u P 8/3/2008 b rton Place R m 1301 Type: Supplement Card Boston,Ma.02108 THE Home Depot At-Home Servic 9UNROEUN CHHOUY 3200 COBB GALLERIA PKWY#20 r p AtIANTA,GA 30339 -------- Administrator ----.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 I } MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER ATL-001107915-02 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 100492-IPUSA-GWA-03/04 A STEADFAST INSURANCE COMPANY INSURED COMPANY THD AT-HOME SERVICES INC. B N/A DBA THE HOME DEPOT AT-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. 1 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 TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDD/YY) DATE(MM/DD/YY) 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-COMP/OP AGG $ 4,000,000 CLAIMS MADE rx I OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL&ADV INJURY $ 4,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 1,000,000 MED EXP(Any oneperson) $ EXCLUDED AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO ALL OWNED AUTOS BODILY INJURY $ SCHEDULED AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACHACCIDENT $ AGGREGATE $ EXCESS LIABILITY EACH OCCURRENCE $ UMBRELLA FORM AGGREGATE $ OTHER THAN UMBRELLA FORM $ G WORKERS COMPENSATION AND 6610998(AZ,ID,MD,VA) 03/01/06 03/01/07 X I TORY LIA ITS OER 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 $ 1,000,000 PARTNERS/EXECUTIVE E OFFICERS ARE: EXCL 6610999(NY,WI) 03/01/06 03/01/07 EL DISEASE-EACH EMPLOYEE $ 1,000,000 OTHER WORKERS E COMPENSATION CONTINUED 6610997(FL) 03/01/06 03/01/07 D 16610996(CA) 03/01/06 03/01/07 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL 3 DAYS WRITTEN NOTICE TO THE CITY OF LYNN CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR 250 COMMERCIAL STREET LYNN,MA 01905 LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE,ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. BY: Walter Gilstrap 'lf/af.� �iZdp MM1(3/02) VALID AS OF:02/24/06 DATE(MMIDDIYY) ADDITIONAL INFORMATION ATL-001107915-02 02/24/06 PRODUCER COMPANIES AFFORDING COVERAGE MARSH USA,INC. COMPANY ATTN:BRENDA BOOKER (404)995-2594 MAYA MCCLURE(404)995-3206 OR E ILLINOIS NATIONAL INSURANCE COMPANY TAMI ROUSE(404)995-3430 FAX(404)760-5663 3475 PIEDMONT ROAD,SUITE 1200 COMPANY ATLANTA,GA 30305 F 1004 92-I P U SA-G WA-03/04 INSURED COMPANY THD AT-HOME SERVICES INC. DBA THE HOME DEPOT AT-HOME SERVICES,INC. G NATIONAL UNION FIRE INSURANCE COMPANY HOME DEPOT USA,INC. 2455 PACES FERRY ROAD NW BUILDING C-8 COMPANY ATLANTA,GA 30339 H TEXT CERTIFICATE HOLDER CITY OF LYNN 250 COMMERCIAL STREET LYNN,MA 01905 MARSH USA INC.BY Walter Gilstrap ? AAW -d.i p Page 1 ne i-ommonweatrn uf,lvlussucnu�cu� ' Department of Industrial Accidents �`� Office of Investigations a 600 Washington Street " Boston, MA 0 111 ww%,.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors'Electricians/Plumbers Applicant Information — Please Print Legibly Name (Business/Orzanizationrindividual): �t't Address: l `LC �1 City'State'Zip: \1.� `_��V Phone , �f1 — `�UA Are you an employer' Check the appropriate box: Type of project (required): 1. I am a employer A-ith 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and/or part-time).* have hired the sub-contractors rl r •�_.,- listed on the attached sheet. * ® Remodeling L.U • aiTi a aGie prop=.%*--, vt parner- ship and have no employees These sub-contractors have S. ❑ Demolition %working for me in any capacity. workers'-comp. insurance. 9. Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.i7 Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption 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' l3.1E1 Other comp. insurance required.] 'Anv applicant that checks box 1 must also fill out the section below showing their workers'compensation policy 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.police information. I am an employer that is providing workers'compensation insurance for.ny employees. Below is the polig-and job site information. \ Insurance Company Name: Policy or Self-ins. Lic. #: 12 ( n Cl Expiration Date: ; l—b Job Site Address: City/State/Zip.- Attach ity/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 S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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 of perjury that the information provided above is true and correct Signature: —A ,k LoP Date: Phone �fl — `1 l-� 1— -7 J�,1 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority (circle one): I. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector i 6. Other Contact Person: Phone#: I Location No. Date ! � r NORTH TOWN OF NORTH ANDOVER 3? � •• OL � P • ; ; Certificate of Occupancy $ cMuBuilding/Frame Permit Fee $ s� st Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 19999 Building Inspector