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HomeMy WebLinkAboutBuilding Permit #877-2016 - 28 CEDAR LANE 2/10/2016UP BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#:N�Iuiltf 1- � I Date Issued: LOCATION Date Received RTANT: Applicant must complete all items on this PROPERTY OWNER A MAP PARCEL: O / VO — Print 100 Year Structure NING DISTRICT: Historic District Machine Shop Village V��tLE� F6\ yesno ye no ye no TYPE OF IMPROVEMENT PROPOSED USE Reside,pral Non- Residential ❑ New Building ne family ❑ Ad -on ❑ Two or more family ❑ Industrial ❑ eration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑ Well!. Flo©dplain D Wetlands: s El Watersh . ,®i,stnct; 1Nater4,Sewer- L_ DESCRI K TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Phone: �',z17 �i <9 Ha ca r e5 Supervisor's Construction Licenser Exp. Date: Home Improvement License: ARCHITECT/ENGINEER Date: 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: $ C2/JY-1 FEE: $ � O Check No.: �L� Receipt No.: —1 NOTE: Persons contracting with unregistered contractors do not have acce�tV guyanty fund A � Locationc�? No. 1 -7 7- -7 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $62j� Foundation Permit Fee s - Other Permit Fee TOTAL Check 30000-1 "1 60ding Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Sw�iug Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature r r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i r r Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer ConneCtlon/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIREDEP�,4RT � j • Located 384 Osgood Street +MENITTempDurnpster�on�site,Tay�esa.�=�t.;tno�� qHo ted at 124 Main Street j y' �.,�:: a � +� ' ..._.......- bac +s"t'�1. ::.1144 <<�Y, �'1�'�n.c IFireDepartment sig D y� {Yu t fila+trtu, re/daterz� 1.a, tf'� •, i"f�.'i'! r/, fS ��.t�'�"�Y r>� S` '� i, h". ie v r �::��� .�,t�.t}t',� ���.t n*t r � 'it"Y��"�""y��. +, {a^� "� �i.'� i"�. ,ti'r`V"^".���7ai+�Tff [B1'•tYt�'}'1yk'.,�.� _ '.37'�'w`-�s'+a. 'c?'+^`+� 'ry• .7. } ..\�.—st �� fi�./'i yr,. � 'i�•' � 7 i�� � i ]yx^T„'i�'rtt+`��"� tc �"'•i.....».... n�d,+.� t +1;t'yjN1 ♦a. , Y:. ri'rti '?'t1, e3. f'+ti .a rti .N .ri ati a COTSf;MMENy A•'ki r r � � 3'�'•aM.lf it i��!'+ � r,.^: a `y. � �, er a�t,�f�cS S r }a, ri u�t:,rhy�34�Y.U?! t c�i,.1;n "' f'iFai rift ♦i P7r+.s'ry.t a• t. w �7ti ¢ �tx,' eS� liq" [ YW +1 4 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup Call Email Date Doc.Building Pennit Revised 2014 Time Contact Name m 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 aBuilding 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 TOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. 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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products TE: 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 Doe: Building Permit Revised 2014 J LLJ 2 U. O 0L m N u :teY D O LL v m v'Ji N a N O V CL (A Z Z J c O N 7 LL w N U C LLd' cl: O CL (n Z Z co J d bD LL 9= W CL Ln Z V U {JJ ti to :3 i LL Q U w CL In Z (7 00 cr LL W a ui Q LJ 6L :3N m Z N N +' N uml r.1 i z G CD z mow/ w/ CL w W A O W a. cn a Z GO v z U J m ti w 2 W O Li. 0 0 CD z m O N 0 C I O •E m m 9L o� CD 0 0 O Q a CL �a o � i �CL O = z CD O C.) to Rt C .', _ _c CL 0 C C p :a ,F+ ca p •Q � Q d mQ t • p O ,a,. N V Q L N �+ C .0+ O C • C O t,1 i IA; �►: Q M M Lca � CD enp O V. C Z • Q .Ec0 /r QNZ C N O O C •Z � 3 Co o0 L a s � w c •cc w • rn a) F- Q v L O c = L LC •a 1— O CL ••� to v m N d W C 'a +�-+ O O LL •N N R N C •� am.2 W � V GD yL. O -a dCL N fn d > `� C .0 p 1=— t . 0. O U i z G CD z mow/ w/ CL w W A O W a. cn a Z GO v z U J m ti w 2 W O Li. 0 0 CD z m O N 0 C I O •E m m 9L o� CD 0 0 O Q a CL �a o � i �CL O = z CD O C.) to Rt C .', _ _c CL 0 KITCHEN INSTALLATION ESTIMATE WORKSHEET - USA Stott: 2663 ice Provider. R.J.Construction customer John Raposo, 617-686-9468 Date. 1 1/712016 Cate o .Breakd6v4n . Demo and Haul Away/Window $3,257.00 Electrical $1,290.00 Plumbing $1,330.00 Tile $1,010.00 Drywall/Repair $1,210.00 Cabinetry/Appliances $3,200.00 Additional Charges / Materials/ Permits Grand Total $ $750.00 12,047.00 Customer Signature: Date: Associate Signature: Date; GC Signature: _�. Date: / 7116 e S 1 Z,d 9990LLZ9L6 uos!pen pae4oj!j d90:6096 ZO q9 -A 1)�e "-,tp a-7� 6'd 9990LLZ8L6 uosipew paeyoiU d90:6096 ZOGaj is.-96VVD TM451 24- 34;. 24' 140' 1134" All dimensions size designations given are subject to verification an job site and adjustment to fit job conditions. J-- -- — b15036af.kit C -d 9990LZZ9Z6 61" 1 This is on original design and must l Designed: 11/15/2015 not be released or copied unless I Printed: 2/11/20116 applicable fee has been paid or job order placed. - All DratwinifiN . I [o Scale. UOSIP81N piB401-6 d90: 60 9 L Zo qej 3W awl er 43" G" 24' 2663 JOHN 82!" -RAPOSO 42' 30' 94" • 37;- 24- 24- 36" 36, iO F3; W3333 W93 3 33R,W332424R r FRIDGE 824 01 H C' DAO* L Sa&rdeted 54- Ott the right wait, no disposal. �' VVW11524 2. Drain goes to the right into the 93.75" wall. 3, DW24 83" the nght 130 centered off wall. 4, Stove 30" electric, free standing centered 66" of the Jett wall, 9MIcro, 30" went in. B.tFrld a 33w x 32d x 87 7. Calling salot 89.5' The customer has a hard wood floor which goes under is the exibliniq Wand. In --ISIL.Affil 24� )SORT BMW ViAndow amended from 43 1t2" to 42" wide, ol CtL remains the same. M (to accomodais cabinet with cust's reported need to change) M is.-96VVD TM451 24- 34;. 24' 140' 1134" All dimensions size designations given are subject to verification an job site and adjustment to fit job conditions. J-- -- — b15036af.kit C -d 9990LZZ9Z6 61" 1 This is on original design and must l Designed: 11/15/2015 not be released or copied unless I Printed: 2/11/20116 applicable fee has been paid or job order placed. - All DratwinifiN . I [o Scale. UOSIP81N piB401-6 d90: 60 9 L Zo qej ` Tice GO�tcWrOD-fi9e c m,) assa-Ch (9M Q de Of 1"esfig"Po.S coo Wa' hgBn. sbeet Boston, M92111 o>rL-el�g Com-ll�sedom RmsA lee dAto BuRderd fig° �n a yB�.�a.=�a» �°G c •n n_ N8a"�iD(3usiaessiorganizationadividual): V/ Yhone #: Jro g- 914 Are yoo'an employer? Check the appropriate boy: Type of project (required): 1. ❑ 1 am a employer with r 4. 1 am a general contractor and 1 6. [1 Rr construction employees (full and/or part-time).-- have hired the sub -contractors 7 Remodelin 2. ❑ 1 am a sole proprietor or partner -listed on the attached sheat. Z g ship andhave no employees These sub-conftwbm have g_ ❑ Demolition worldng for me in any capacity. workers' comp. inswance_ 5. ❑ Building addition o workers' comp. irfstaraiice 5. ❑ We are a coTporation and its til 10.[] electrical repairs or additions required.] officers have exercises their Q right of exemption per MGL 11.❑ Plumbing repairs or additions i am a homeovmer doing ail work; mysei_. [Na workars' coyp. c. 152, §1(4), and we have iso 12.[]R eR insuz-nce required./ t employees. ENO worker' I3, tomer comp. insurance required.] °An, applicant the checks box 9 i must also rill out the section below showing their waiters' comnensatiOna policy information. t Homeowners who subinit this affidavit indicating+Jy am doing all From and thea him outside wntraamrs must submit a new af-davit imlacating such. �conuactors treat check this box mast attached an additional sia- showing the acme of the snlrconyacbm and dick wortem, tromp. policy information. a eiarer �fFte��r�g loots' iaizeeos' a, e°o�e Be.$€at� teF@'� jFr $rte irz�ct�.a�es�. s f l insurance Company 1PZ5 17rr- 5 i'ciicy # or Self -ins- l,ic. c, Expiration Date: sob Site Address:�/��' t/ I.1�y1r_a City/State/Zig: Attach a copy of �he workers' compemm a&fl< poky deeiaMtio>a pgge (showing the pommy number and expiration dat: } FaiHure to secure coverage as wired under Section 25A o: MGL c. 152 can lead toAhe imposition of criminal penalties of a fine up to $1,500.00 an6lor one-year immlprisonment, 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 Duce of nvestigations of the DU for insurance coverage verification. I dr. AMby cmgy pmamey of'� Matt ittae saortFioaa prav&W esotle t>e and Phone #��-- iia@ use v*. Do not wrke in Fars arms, to be compk'ed by city or town officM City or Town: PerammiVLieense # Issuing Authority (circle one): i. Board of Health 2. wilding Deg&rtment 3. CitYNOW2 Clerk 4. Electrical bsWtor 5. P11MMbioirig IRSPeet®r 6. Mer Contact. Penon: Phone 4: ®®CERTIFICATE OF LIABILITY W, °02/E24I10NUDDMl15 INSURANCE EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. THIS CERTIFICATE IS ISSUED AS A 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 WANED, 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). PRODUCER MARSH USA, INC. TWO ALLIANCE CENTER 3560 LENOX ROAD, SUITE 2400 ATLANTA, GA 30326 CONTACT NAME: PHONE FAX MP (AIC,No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC 9 LIMITS INSURER A: Steadiest Insurance Conwy 26387 100492-HomeD-GAW-15.16 INSURED THD AT-HOME SERVICES, INC. INSURER B. Zurich American Insurance Co 16535 INSURER C: New Hampshire Ins Co 23841 DBA THE HOME DEPOT AT-HOME SERVICES 2690 CUMBERLAND PARKWAY, SUITE 300 ATLANTA, GA 30339 IN -SURER D: Illinois National Insurance Company 23817 INSURER E: X COMMERCIAL GENERAL LIABILITY INSURER F: L.VVI:KAUr_b CF_ RYIFICATE NUMRFR' AT1_0T2 060.E_0 oclncrnar e1111100en.7 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 LTR TYPE OF INSURANCEPOLICY ADDIL SUBR NUMBER FOLIC EFF CM MPOLIID EXP LIMITS A GENERAL LIABIUTY GLO4887714-05 03/012015 03/012016 EACH OCCURRENCE S 9,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGETO RED PREMISES occurrenceS 1'000.000 CLAIMS -MADE � OCCUR LIMITS OF POLICY XS MED EXP{Any one person) $ EXCLUDED OF SIR $1 M PER OCC PERSONAL 8 ADV INJURY $ 9,000,000 GENERAL AGGREGATE $ 9;000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS- COMP/OP AGG $ 9,000,000 X POLICY JE° LOC $ B AUTOMOBILE LIABILITY BAP 293886312 03/01/2015 03/01/1016 COMBINED SINGLE LIMIT 1000 000 Ea accident $ X ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS SELF INSURED AUTO PHY DMG BODILY INJURY (Per accident) S HIRED AUTOS NON -OWNED AUTOS PROPERTY DAMAGE Peracclde S $ UMBRELLA LIAR OCCUR HCLAIMS-MADE EACH OCCURRENCE S EXCESS LIAR AGGREGATE $ DED RETENTIONS $ C NroRxERSLOMPENSATION WC017731493 (AOS) 03/01/2015 03/012016 X wcsrATu- oTl+ C AND EMPLOYERS' LIABWTY Y l N -ANY PROPRIETOR/PARTNER/EXECUTNE WC017731495 (AK, KY, NH, NJ, VT) 03/012015 031012016 TO UMRSER 1,000,000 D OFFICER/MEMBER EXCLUDED? a N / A EL EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEE S 1,000.000 (Mandatory In NH) WC017731494 (FL) 03/012015 03/01/2016 If yes, describe under DESCRIPTION OF OPERATIONS below Conitnued On Additional Page 9 EL DISEASE -POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, H more space Is required) EVIDENCE OF INSURANCE .+rnr.ra.w rr ........... THD AT-HOME SERVICES, INC. DBA THE HOME DEPOT AT-HOME SERVICES 2455 PACES FERRY ROAD ATLANTA, GA 30339 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi MuldlerjeeoLaaodt.� IS) 19tRS-ZU1U ACURD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD i1c office of Consumer Affairs and Business Regulation -170 Suite 10 Park Plaza Su Boston, Massachus s 02116 T4c)me Improvement Contractor R-aistr ation THD AT HOME SERVICES, INC. RICHARDFALLONE 2690 CUMBERLAND PARKWAY SUITE_ L0. ATLANTA, GA 30339 )"A.0-5111 kddress and rtlur-" ca -,d. -.Nf ark resson var cna S - - E:MpjO,m,nt Card address F,=newal Jul 2815 09:40a Richard Madison 9782770685 P.1 Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -030000 Consiruction Supervisor RICHARD MADISON 3 MADISON AVE GROVELAND MA 01834 r-jz0K- Expiration: Commissioner 07f29/2017 -Office or Consumer Affairs& BkLsiness Regulation 1MPROVEIV1ENT CONTRACTOR 118509 Type., Expiration:- 312912017 DBA R.J- CONSTRUCTION - RICHARD MADISON - 3 MADISON AVE GROVELAND,.MA 01834 . Undersecretary k N I