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HomeMy WebLinkAboutBuilding Permit #1042-16 - 3 Fernview Avenue U-7 4/5/2016 1�11 D •'4� NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER: APPLICATION FOR PLAN EXAMINATION y T Z h T Permit No#• 0�� ^ � Date Received '1s9'°�Tnr¢° SSACHUS� Date Issued: IM 0RTANT: Applicant must complete all items on this page LOCATION P int --- PROPERTY OWNER. - Print 100 Year Structure yesrno MAP PARCEL:PARCEL: _ZONING DISTRICT:`Historic District yeMachine Shop Village ye TYPE OF IMPROVEMENT PROP SED USE Res' ential Non- Residential ❑ New Building One family ❑A ition [I Two or more family El Industrial ❑Aeration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ WatershedDistrict l ❑Water/Sewer PTI00f0,FW0ffT0BE ERFO MED: Id ntificati n- Please Type or Print Clearly OWNER: Name: Phone: Address: �J Contractor Name: Email Address: Supervisor's Construction License: Exp. Date: Horne Improvement License: Exp. Date: _- 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. Total Project Cost: $ FEE: $ � Check No.: 9Z _Receipt No.: -7� ©� NOTE: Persons contracting with unregistered contractors do not have access to g ra ty fund r gnature of Agent/Owner Signature of contractor Location No. ��Ed Date • - TOWN OF NORTH ANDOVER f Certificate of Occupancy $ Building/Frame Permit Fee $ rG Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1 Check# f i , Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/1\2assageBody 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 Signature COMMENTS HEALTH Reviewed on Signature COMMENTS 4 r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments V,'�ater& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: w- ,� Located 384 Osgood Street FIRE DEPARTMENT Temp Dempster on slter. Located-at 124 MainStreet ye n_o Fl;re Department signature/d_`ate 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 Pennit 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 o Building Permit Application L3 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 Doe:Building Permit Revised 2014 t% RTF ' ve, , ,o O :. No. - h , ver, Mass, z'/Y1,� o L^K. 1. COCKICKl WICK V RATED 0`p�`�,(5 U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT 0"� BUILDING INSPECTOR has permission to erect buildings on ... f '' !F.................................... Foundation .......................... ... ..... ..... ................. Rough tobe occupied as ..................... .................................................. Chimney 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 ' Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T TS Rough Service . . . . ................................. Final 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. a -ems ROME Itl2PROVEMENT CONTRACT PLEASE READ THIS 77 q _ Sold,Furnished and installed by: Branch Name: New England DatetJ / // tfo THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch.Number: 31 908.Boston Turnpike,Unit 1,Shrewsbury,MA 01.545 Toll Free 877-903-3768 Federal ID#75-2098460;ME Lie#C 02439;RI Cont Lie# 16427 CT Lie#HIC.0565522;MA Home Improvement Contractor Reg.#126893 Installation Address: ye Ue_/J.—. ap g 01,�Y5_ City State Zip Purchaser(s): Work Phone: home Phone: Cell Phone: f r i. Home Address: (If different from htstal.lation 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 Home Depot Prolect Information: Undersigned("Customer"),the owners of the property located at the above installation address,a�eefu ; and THD At-I-lonie 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 Sheet(s), all of which 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"): Job#: dulemal Reference) roducts' Spec Sheet(s)#: Project Amount Roofing ❑Siding Windows Insulation 07 ❑ ❑ 1Y Gutters/Covers Entry Doors L 1LJ 41 ❑Roofing Siding 0 Windows ❑ Insulation 4� ❑Gutters/Covers ❑Entry Doors ❑ ❑Roofing Siding 'Windows insulation ❑Gutters/Covers El Entry Doors❑ $ []Roofing Siding ❑Windo�t{s Insutation ❑Gutters/Covers ❑Entry Doors ❑ 1lbnimum 2.5%Deposit of Contract Amount due upon execution of this co ntract. Maine Purchasers may not deposit more than one-third of the Contract Amount Total Contract Amount $ Customer agrees that, immediately upon completion of the work for each Product, Customer will execute a Completion Certificate (one for each Product 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 Depot reserves the right to issue a Change order or terminate this Contract or any individual h-oduct(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 moll, asbestos or lead paint, other safety concerns,icing errors or because work required to complete the job was not included in the Contract. pr Pavment. Suunmar. r: The Payment Summary #__fid 7 r(P2 -4? included Contract amount and payments required for the deposits and final payments by Product(assapplicablepart of l)t5 Contract, sets forth the total NOTICE TO CUSTOMER You are entitled to a completely filled-in copy 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 defi is complete. ned by individual Spec Sheets) before work-on that Product In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses and services provided 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 HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS,. Acce A,'4—pe—and Authorization: Customer agrees and understands that this A`reement 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. except breements, either oral or written,relatin<<to said Pr•culucts cid Installation. This Aereentent cannot be assigned or anicndcd y a ufriting Horne signed by Customer and The.Hoe Depot. Customer acknowledges and agrees that Customer has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement. Alce ted b Submitted by; 4� 1 0 WINDOW SPECIFICATION SHEET - Spec Sheet#: 9 4 >J Sheet: of.- Customer: f..Customer: Job x; Consultant: �'syCi' Date: 3 New Window Fisting Window Hinge Locations Measurements Grids Product Options Labor From outside, Options Lek to Ritjht Location Bays,Bows, Color Rough Opening N of bars #of bars Csmnts,i Pnf, use L,R or S m Glass Misc items L? Hardware Code v' c �. «° Screens For doors use _`0 9 r & W o o c — o "5 stationary or Style Wraps v c o N v ti Mull "X"—o g Room Float Code c ° v a o ut 10 C operating (YIN) St Ie Code Series Code x S r— u 8�67I 3 ZPtU L- c�o �/ r�1 70 ,�3 t t 3 P tn, A 2 L�Nf. LPN �0 t i 6 l a 9 10 11 11 73 wiapcolor SPECIAL CONSIDERATIONS: Inter or Casing type Bay or Bow wi ndow: Seatboarti Materialavinyl only-81rch or Oak) -y— Rry Projection Angle 1a °or mot) &hy Franker Type(DH,SH or CsmntJ Tap or window to wffit(inches) Ea��� If tied tnsuffit colorofaotfnmatetlai I have reviewed and agree with all the job specifications above and the Construct Roof lyes or NN 1 Special Terms and Conditions on the back of the yellow(Customer)copy. Garden Window: $eatboard MaterFaCtvinyl onlyW Nice Pionite,Birch or Oak) Aditional 1lelfinches) Customer Signature Additional Shelf(Yes nt Na, 1.rt Renr�gmrantrr[hr err,Nngles,nll mai,h rxls3nq,dcs, White-The Horne Depot Yeiiow-Custamer iHt)ibe i The C'oinntottwealth of Alassachusetts Department of Industf ial Accidents = 1 Congress Street, Suite 100 a Boston,NM 02114-2017 --% www.mass.gov/dia workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PER114ITTTNG AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: 12'1/� �'��� wfjlk� City/State/Zip: " G' Phone#: ` Are you no-employer?Check the appropriate box: Type of project(required): 1. I am a employer with employees(full and/or part-time).** 7. []New construction 2.F�I am a sole proprietor or partnership and have no employees working forme in8. Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.®1 am a homeowner doing all work myself.lido workers'comp.insurance required.)r 10 Q Building addition 4.❑1 am a homeowner and will be hiring contractors to conduct all work on my property. I will airs or additions re ensure that all contractor either have workers'compensation insurance or are sole I LM ElectricalP proprietors with no employees. 12.n Plumbing repairs or additions 5. I am a general contractor and redhub ttlid the attached sheet the sub-contractors listed on . ® d I hhili.❑Roo repairs These sub-contractors have employees and have workers'comp.insurance.t 14. er 11 6.Q we are a corporation and its officers have exercised their right of exemption per-, iGL c. 152,§1(4),and we have no employees.[;Io workers'comp.insurance required.) *Any applicant that checks box'"l must also 611 out the section below showing their workers'compensation policy information. 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. 1 atn an employer that is pi-oviding workers'conlpetlsatiot111lsui-ance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lic.#: ) ) Expiration Date: Job Site Address: b� ( j� l � City/State/,Zip: Attach a copy of the workers' compensation policy declaration page(showing the pojcy number and expiration date). Failure to secure coverage as required under IvIGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify n er t e a' s at d penalties of pet jury that the information provided above 's true and correct Siertature Date: Phone#: Official use only. Do not write ill this area,to be completed by city or town off ciaL City or Town: Permit/License# Issuing Authority(circle one): 7 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: A��aj DATE(MMIDDIYf!!) CERTiFiCATE OF LIABILITY INSURANCE Dvlalzois 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 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). PRODUCER CONTACT NAME: MARSH USA,INC. PHONE FAX T7'10 ALLIANCE CENTER c o Ext): A1C No 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC# 100492-HomeD-GAW-16-17 INSURER A:Steadfast Insurance Company 126387 INSURED INSURER B:ZWCh American Insurance CO 16535 THD AT-HOME SERVICES,INC. DBA THE HOME DEPOT AT-HOME SERVICES INSURER C:New Hampshire Ins Co 123e41 2690 CUMBERLAND PARKWAY,SUITE 300 INSURER O:llrinais Nalional Insurance Company 123817 ATLANTA,GA 30339 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003746646-14 REVISION NUMBER:B 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 I TYPE OF INSURANCE ADOL SUBR • POLICY EFF POLICY ECP LIMITS LTR. 0 VYV POLICY NUMBER MR)D MIDDIYYYYI A X I COMMERCIAL GENERAL LIABILITY GLO4887714-06 0310112016 0310112017 1 EACH OCCURRENCE 5 9,000,000 j? DAMAGE TO RENTED ( I CLAIMS-MADE �OCCUR PREMISES Fa occurrence S 1,000,000 I I LIMITS OF POLICY XS MED EXP(Any one person) 5 EXCLUDED OF SIR:$1M PER OCC PERSONAL&ADV INJURY S 9,000,000 CEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 9,000,000 �` POLICY❑PRO- OTHER: PRODUCTS-COMP/OP AGG S 9,000,000 JECT I I OTHER: IA S B AUTOMOBILE LIABILITY IBAP 2938863-13 0310112016 0310112017 COMBINED SINGLE LIMIT I S 1,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) S PALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) 5 I AUTOS AUTOS I HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS Per acadent S H 1 UMBRELLA LIAR HOCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATEk I S DFS I I RETENTIONS S C WORKERS COMPENSATION WC015519215(AOS) 0310112016 0310112017 X sTATIJTE ER AND EMPLOYERS'LIABILITY C ANY PROPRIETORlPARTNERIEXECUTIVE YIN WC015519217(AK,KY,NH,NJ,VT) 0310112016 0310112017 El.EACH ACCIDENT S 1,000,000 D OFFICERIMEMBER EXCLUDED? EN N/A (Mandatary in NH) WC015519216(FL) 0310112016 03101/2817 E.L.DISEASE-E4 EMPLOYES 1,000,000 If yes,describe under Conitnued on Additional Pae 1,000,000 DESCRIPTION OF OPERATIONS below 9 E.L0ISEASE-POLICY 'MIT S DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORO 101,Additional Remarks Schedule,may be attached if more space 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 ->tMkA.9rO ©1988-2014 ACORD CORPORATION. All rights reserved. - - ---- .. __ AflnDr% =' Office of Consumer Affairs Zhd Business Regulation 1,mfff 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvemp Quntractor Registration Registration: 126893 ;r Type: Supplement Card } Expiration: 8/3/2016 THD AT HOME SERVICES, INC. RICHARD FALLONE 2690 CUMBERLAND PARKWAY SU1TE3d0 1 ATLANTA, GA 30339 Update Address and return card.Mark reason for change. Address ❑ Renewal [] Employment I_ Lost Card CAI 0 20M-05/11 �' fice of Consumer Affairs&Business Regulation License or registration valid for individul use only r' before the expiration date. If found return to: 1NE IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation egistration; _Tg6893`=: Type: 10 Park Plaza-Suite 5170 Expiration gj3�2p=I:.F= Supplement Card Boston,NIA 02116 rHD AT HOME SERVICES; rHE HOME DEPOT AT f{071tIE`SERVICES RICHARD FALL NE' 2690 CUMBERLAND PARKWAYS 4�LANa`A,GA 30339 undersecretary 14Notlidt signature l f . d .� CSSL-106006 BENJAMIN PARKER JR. � -13 (.I21'ENOUGI I ROAD a+'y � i�y`'wG33d . Plaktow Nil 03865 Its 021/1/2018