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HomeMy WebLinkAboutBuilding Permit #133-15 - 27 TYLER ROAD 8/16/2014 NORTH BUILDING PERMIT 0F�t�Ec b�ti TOWN OF NORTH ANDOVER o� y� •, o APPLICATION FOR PLAN EXAMINATION nO OH T Permit No#: —�� Date Received �SSACHUS Date Issued: I PORTANT: Applicant must complete all items on this page J. LOCATION 1 PROPERTY OWNER / roll Print 100 Year Structure yes MAP PARCEL: 7 'Z ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑Altepgtion No. of units: ❑ Commercial LJ?e"pair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well q Floodplain p Wetlands ❑ Watershed District ❑Water/Sewer D SC NOF WORK TO BE PERFORMED: yT_ VA 0 Identification- PI"se Type or P int Clearly / l/ OWNER: Name: ltd" Phone Address: -17' Contractor Name: ` Phone: Address: �Ut� � . 1�J Supervisor's Construction License: ^ Exp. Date: 4�3 Home Improvement License: _ 1Z Exp. Date:_. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $�/ �� a FEE: $ 00=7v BSc) i Check No.: _6 ,�l� Receipt No.: --) E(,/ NOTE: Persons contractiZwire iste d contractors do not have acAtgu gnature of Agent/Owner nature of contract i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL l Public Sewer ❑ Tanning/Massage/Body Art ❑ Sw"mning 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 Signature COMMENTS HEALTH Reviewed on Signature r_ 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 i NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit 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 o Building Permit Application o Workers Comp Affidavit o 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 o Building Permit Application L3 Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract Li Mass check Energy Compliance Report Li 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 Location �� WW No. Date Av . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $3c) Foundation Permit Fee $ A Other Permit Fee $ TOTAL $ Check#. S' e ; , r s• `� `J Building Inspector 1____e"1! DATE(MMIDDfYYYY) Ac"4Qz® CERTIFICATE OF LIABILITY INSURANCE 02119/2014 THIS CERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND;EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW:: THIS CERTIFICATE.OF INSURANCE DOES NOT,CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE-CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the POlicy(ieS)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s CON ACT PRODUCER NAME: MARSH USA,INC. PHOFAX NE TWO ALLIANCE CENTER AIC Nol, 3560 LENOX ROAD,SUITE 2400 E-MAIL ADDRESS: _ ATLANTA,GA 30326 INSURER(S)AFFORDING COVERAGE NAIC ti 100492-HomeD-GAW-14-15 INSURER A: Steadfast Insurance Company 26387 INSUREDINSURER e Zurich American Insurance Co 16535 THD AT-HOME SERVICES,INC. New Hampshire Ins Co 23841 DBATHE HOME DEPOT AT-HOME SERVICES INsuRER c 2455 PACES FERRY ROADINSURER D Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E - - INSURER F COVERAGES CERTIFICATE NUMBER: ATL-003242685-01 REVISION NUMBER:3 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. INSR . ADDL UB -- POLICY EEF POLICY EXP _ - - LIMITS LTR TYPE-OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIODIYYYY 9,000,000 A GENERAL LIABILITY GL04887714-04 - - 03/01/2014 03101/2015 EACH OCCURRENCE- S DAMAGE TURTWED 1,000,000 PREMISES a occurrence) S X COMMERCIAL GENERAL LIABILITY EXCLUDED CLAIMS-MADE � OCCUR LIMITS OF POLICY XS MED EXP(Any one person) $ OF SIR:$1M PER OCC PERSONAL d ADV INJURY 5 9,000,000 GENERAL AGGREGATE $ 9,000,000 G PRODUCTS-COMP/OP AGG S 9,000,000 EN'L AGGREGATE LIMIT APPLIES PER: X POLICY PRO' LOC S. SAP 2938863-11 03101/2014 03101/2015 COMBINED SINGLE LIMIT 1,000,OOD B AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) $ X ANY AUTO ALL OWNED SGHEOULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED (per a Iden) HIRED AUTOS AUTOS S UMBRELLA LIAB. OCCUR EACH OCCURRENCE S 4�EXCESS UAB CLAIMS-MADE AGGREGATE $ S D'- RETENTIONS WC STATU- OTH- C woRl<ERs COMPENSATION WC049101882(AOS) 0310112014 03!0112015LIMIT FR 1.1 00,000 C AND EMPLOYERS'UABILITY WC049101884(AK,AZ,VA) 0310112014 03101/2015 E.L.EACH ACCIDENT S ANY PROPRIETOR/PARTNER/EXECUTIVE NIA A 11000,000 OFFICERIMEMBER EXCLUDED? WC049101883(FL) 0310112014 03/0112015 E.L.DISEASE-EA EMPLOYE S D (Mandatory In NH) 1,000,000 Ifes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below 1,000,000 C WORKERS COMPENSATION WC049101885(KY,NC,NH,VT) 0310112014 0310112015 (EL)LIMIT C WC049101886(NJ) 03101/2014 0310112015 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,II more span Is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2010 ACORD CORPORATION. All rights reserved. _s Arnon 1 • CIIgIgySlaLnrcan—Inca D.9c-ca +e• r / r Ilet ta• � :; ov�lulea Remove label.afEer Ctnal inspection; SAVE for future reference Weather Shleld CPD@ 050-A -172 Derating NFRC Model 8108 Double Hung p Alum clad Thermal Frame 314 Inch Glazing E .022 Low—E Argon Fill Grillein Air Space GS �n3 E>uN�ER"GY PERFORMANCEoIRATI---- ��► �-FaIe1 .70 0.30 S11_p lfklrid5l ADDITIONAL RP.ERFORMANCE ORATINGS Ylsl6le lranstttttlaee:e O f 0.40 yrrulrcflrrr clpulaRt hal mra Hangs cmhrtn la C rx"lls xFflC wr n du101 rca br drlcrmlolnq•hde prodtcl ner9f Pte""arce_ and rringr r XFRC d+es Soll inw"'c"d dllml and tpaloc Pndrel du,, edac us+" ls.d ml of rorir�leulW ron 4h 1 rodocl for rr+7 W rnl Proddai and•doet nal""nl ha wl pd , art�'P u lnlannrlorr. Wy pll UCi trcElnl'!AtanW"0r etfio'lodoel perkrnnrn www.nlrc_0 1 a ulrrrnenls C.E"c.,end I.E.C.C. Alr Irtllltnition R Masts or esceedf N•EC•• uuwrruro►JWLS.2—l7 Masts lec7ed tD lKSIf1.1� (DP) .(ps0 li-LC31.4400 1es7er rr ILA u AJW D L/C GA loin UTA"o•-01 ' � � �^ N-LC2!i11tTT2e0(uY901 . U,e Ynl.9ry.brdhd.rnua 1u,a51Y f]C o ole2n ' ' 610lSCp2�11KST0 ' f r 7 NORTH - r _ . w: 1 ic . . ve, No. h ver, Mass, cocNicHaw,cw A�aA7ED 0 C) S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Q 1 Septic System THIS CERTIFIES THAT G�.N!�fir...1..` ............. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ... ........ ....... �.!4 .�+....... ....... ................ Rough p' rT'........t,. ..�. ..�. ® t0 be occupied as ............. .... ........... ........ ............... .............. Chimney provided that the person accep 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOV2A Rough Service ................... ... ................ ............................. Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. r 1NORTh . - W' 0. . : 2 � � E : :. .c ve" '* ti h ver, Mass, COC111C"t WIC" X01. RArED U BOARD OF HEALTH Food/Kitchen PERMIT T D 3.4.k.000. Septic System THIS CERTIFIES THAT .............. �........Cvorw .. BUILDING INSPECTOR has permission to erect ............... buildings on ... �...... Foundation (5N Ap _A Aft komw .... Rough to be occupied as ............. .... ........... ........ ..... .... ........ ..1. 1 .4►....o Chimney provided that the person accep 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 CONSTRUCTIOV2A Rough Service ................... ... ................ ............................. Fina BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Q?1.In voI v 1w0 tv cw wvv �✓.� i ` dx VC/ Office of Consumer Aff - and Business Regulation p 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement-Contractor Registration Registration: 126893 Type: Supplement Card TND AT HOME SERVICES, INC. Expiration: 8/312018 RICHARD TROIA ------ 2690 CUMBERLAND PARKWAY SUITE 300. -- ATLANTA, GA 30339 -- -....._ ._....-- Update Address and return card Mark reason for change. scA1 v am-mil I _ Add. Renewal Employment J Lost Card ?Office of Coosuner Affairs&Rosiness Regolatiion License or registration valid for individul use only '� k10ME IMPROVEtR@VT CONTRACTOR before the expiration date. If Lound return to: " Office of Consomer Affairs and Business Regulation �4 Registration -126993 Type: 10 Park Pian-Suite 5170 . �> Pim-8Ci12016 - Supplement Card Rosto 021:16 THD AT HOME SERVICES.INC. THE HOME DEPOT AT HOME SERVICES RICHARD TROIA C 2690 CUMBERLAND PARKWAYS ��- -- . — A° 111 GA 311339 Undersecretary Not valid*,fthefit signature Permit Services 401 246 2868 P. Board <r.2 j i..i 1 n,q R e q u 7 a-l-'. and i.i S i aP,`v1.Gi r ...i :? c e n•s a CS-088756 ;w SCOTT A MACM .LA,N 10 PARK A`TE r SALEM NH 030' 1 o€ .{ �i .s i r) e 03/29/2016 I Tie vta�tp �u:��Z�.?:iS�.��°�aloS2 S � c2 Co,.✓`a;a;E�n23�J a d+� Department 0jThdust;,hz1A cc1dewnt3 Offdr8 01 32JeS?1g tions 600 Washington Street _ Boston, JUM 02111 www.rnass.gov/d1a Workers' Compensat='on Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information 71 J /J r/ Please Print Legibly Name(Business/Organization/Individual): (1{✓,D0T� �T �!9£� �✓��' Address y i"c LAS �i✓���2y /�f City/State/Zip: t�.N t. _ b�. 303f Phone#: Are you an employer? Check the appropriate x: Type of project(required): 1.❑ I am a employer with 4. [ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ listed on the attached sheet. 7. ❑ Remodeling I am a sole proprietor or partner- ship and have no employees These sub-contractors have g, ❑Demoliltion working for me in any capacity. employees and have workers' 9 ❑ Building addition [No workers' comp. insurance comp.insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions _ myself o.workers.co - . . right oexemption per MGL y [N comp. _ f 12.❑ R of repairs _ insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other j/✓f/t/ 197V comp.insurance required.] *Any 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that isproviding workers'compensation Insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: / �/�� J�t 4 Sf1�J'C' �/(1'S (�o , Policy#or Self-ins.Lic.M W 0- 0 0 g P� Expiration Date: .3j 15J Ziw WZ, Job Site Address: City/State/Zip Attach a copy of the workers' co ensation policy declaration page(showing the policy number and expiration da,41-�rK 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 ' urance covers e verification. I do hereby certify nd the ains an enal ' perjury that the information provided above is true and correct. Signature: Date: _ Phone#: tf!�X 2 L 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: HOME IMPROVEMENT CONTRACT PLEASE READ THIS i Sold,Furnished/and Installed by: Branch Name:Boston North&South Date:/2Q THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch Number: 31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury.MA 01545 Toll Free 877-903-3768 Federal ID#75-2698460:ME Lic#C 02439;Rl Cont.Lic# 16427 CT Lic#HIC.0565522:MA Home Improvement Contractor Reg.#126893 Installation Address City State Zip Purchaser(s): Work Phone: home Phone: Cell Phone: Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑ I DO NOT wish to receive any marketing emails from.The Horne Depot Proiect Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and THD At-Home 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 Shee.t(s), all of ufiich 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"): ,lob#: Itnternal Reference) P oducts: Spec Sheet(s)#: Project Amount ❑Roofing SidinTntry Windows ❑Insulation t � � []Gutters/Covers Doors ❑ t 3q Roofing ElSiding El Windows El Insulation ❑Gutters/Covers ❑Entry Doors ❑ Roofing []Siding Windows Insulation []Gutters I Covers ❑Entry Doors❑ RootingSiding Windows ❑ Insulation 4 ❑Gutters/Covers ❑Entry Doors F-1- Minimum Minimum?5%Deposit of Contract Amount due upon execution of this contract. Total Contract Amount $ �� Maine Purchasers may not deposit more than one-third of the Contract Amount. Customer agrees that, immediately upon completion of the work for each Product. Customer will execute a Completion Certificate (one for each l'roduct 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 Depict reserves the right to issue a Change Order or terminate this Contract or any individual Product(s) included herein; at its discretion.if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home, environmental hazards such as mold, asbestos or lead paint, other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. Pavrnent Summary: The Payment Summary # © � _ �, included as part of this Contract, set, forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in cope of.the Contract at the time you sign. Do 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 agrees to pay The Home Depot the costs of materials,labor,expenses and servgces proAded by The Home Depot or Authorized Service Provider through 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 HOXIE DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OIC SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the 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 Custc mer and.The Home Depot. Customer acknowledges and agrees that Customer has read, understands, voluntarily accepts the terms o and has received a copy of is Agreement. I - ., /1 A y