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HomeMy WebLinkAboutBuilding Permit #213-13 - 30 EAST PASTURE CIRCLE 9/18/2012 9UILDING PERMIT OF"O oT bqa TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received *�R"meq TE, �SSACHl1`'�( Date Issued: / /2 ORTANT:Applicant must complete all items on this page iS { f 1 4 _.� , F i #i:{Y t rr }t*r r T a:}` to y.,�i *. + t . - i,T. } ATI LOC .�Y• C• �.. ter, t °#','. .t PJ nnt �. .' 7 .�.. .• , 4 CS'fi>` ,;4.b'n.�r" `�Si;R7 ya: '�PRO.PERT#YfOOW NERC cl���'1_�i��y�S,4t� .F: .��K����. °` `� >����'�•'' ,:,,� � �.Jy -. s .-•"a't td�` .... ...W..y.�,....,.r+r"— -a-c- *",;r �s�-t`' .. ... ,.i ti,,,t,f A r �� p-a n [§T t`MAP NO 1 Q PARCEL �� ,0NING ©ISTRIQ.T iistoncib tact aShop a ti- r max. •"._+...r*5....4ta� .,a•. .k. "i-i _ - fi/ cHine: Village; es4,, no' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Welly oopain..,,,, r=.FldlWetlands . , t.Watershetl District r x �� .rxY,� -'r ,_� • � .i `� r �� 7�."�"s € f�:.� ; .,5� � r1^C �, r:� y 'Y -• �r Y, tL. _;' :Water/Sewerc���' �-�=#.r � _ -��_...r _,�' f •'� � ..' ._ r-4u�. ,.��:� � � �-� �._:r `:• � ,�r DESCRIPTION OF WORK TO BE PREFORMED: ` �/ D curd ar l- bei O�N Identification Please Type or Print Clearly) OWNER: Name: 717oVir% To-Lzbsa) Phone: 97k' 6�-73J,23 Address: �: s.� V#f:S r.:.�,..r,i _.Y-• sy sv r` r '; rr-��-+A ! 3� F- .:�+ L ..F -.7.., t.'�,... zCONTiR,&T®RLxNameN 1 - o 11t:S Phone -;e r , ♦ �f"-'t.a Supervisor'ts�GonstructionlLicense-n.. q a. • L I" f S T iHome.almprovementtLicense_ : .= b�6t#5 .u_ . _ 14Exp$: -Dafe ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.,$12.00 PER$9000.00 OF THE TOTAL ESTIMATEICOST BASED ON$125.00 PER S.F. Total Project Cost: $ D 63,9� FEE: Check No.: Receipt No NOTE: Persons contracting with un egis eyed contractors do not have access to the guaranty fund Signature of Agent/Owner. Signature of contra o " Location � G� f 1a5��✓F �i• c �i` No. 2 — Date�L. • - TOWN OF NORTH ANDOVER 46 • 4 M Certificate of Occupancy $ � Building/Frame Permit Fee $ Foundation Permit Fee $ . Other Permit Fee $ TOTAL $ Check22pyV� 25717 uildng Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes ' "finning 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 ono Loc' ,at Mam 124 Street ' Fire Depattment`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.s100-$1000 fine NOTES and DATA— (For department use) 4 i � 1 ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 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 1M ❑ Building Permit Application 1 ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work j o Engineering Affidavits for Engineered products, NOT1 : All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building'Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products N OT 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) o Copy of Contract ' ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products 40TI: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit I Ina I 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 mus be submitted with the building application Doc:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 �10RTH 4 E Tlo-wnof2Andover 0 -� 0% As- No. �� , ver, Mass, �q COCKIC"RWICK �R^TEO 0'Pp,`'�5 S V BOARD OF HEALTH Food/Kitchen _ T LD Septic System THIS CERTIFIES THAT dPERMIT BUILDING INSPECTOR ......................... . ................................................................................... has permission to erect ....... buildings on ay't � ��fi�'G Foundation .................... ..................................Y.............. ........ ............. Rough t� i''o�y(4 hhDO� tobe occupied as .............�...�:..............:f�:....................................................................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS 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. SEE REVERSE SIDE , The Commonwealth of Massaelausetts Print Form F i w Department of Industrial Accidents se'; l Office of Investigations ik t'P I Congress Street, Suite 100 .z' Boston, MA 02714-2017 T, www:mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Llformation Please Print Legibly Nanic (13usi»css/Organiralion/hxlividual); 1�T-'QC'tIl 0 �Ut�r'tA Address:_ $irch Lckne City/State/Zip: T e IMA D Phone#: a g 8 7 Are you an employer? Check the appropriate box: 'Type of project(required): 1.❑ 1 am a employer with 4. ❑ 1 am a general contractor anti I employees(full anti/or part-time>.'� have hired the suh-contractors t' E] Now construction 2 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees an([have workers' insurance. y• ❑ Building addition INo workers' comcump. insurance P• require([.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. I No workers' comp. right of exemption per MCL insurance rcyuired.l r c. 152, §1(4),and we have no 12.0 Roof repairs employees. INo workers' 13•❑ Other comp. insurance required.] *Anv ai. pplicant that checks pox#I nutst also fill nut the section helow showing their workers'compensation policy information. IioMeow CIS who suhtnit this affidavit indicating they are doing all work and then hire outside comiaclors must submit it ncw•affidavit indicating such. ':Contractors that check this hox nlusl attached an additional sheet showing the name of the sub-collraCU rS and stale whether or not those entities have employees. 11'01C suh-contractors have employees.they must provide their workers'comp.Policy numher. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and.job site information. M insurance Company Nam /�e: L,OmQQhy Policy#or Self-ins. Lic.#:_ M p K Ssi�'3� Expiration Date: /0 10 101; Job Site Address: 3oc Td54W if. City/State/Zip: (10. (TC 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$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 clay against the violator. Be advised that a copy of this statement may he forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby c•ertif' er the pa' . nd penalties of perjur that the information provided above is true and correct. Signature: - Date:'. Phone#: 978-86��q Y 7 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. Roard of Health 2. Building Department 3.City/Town Clerk 4. Electrical inspector .5. Plumbing Inspector 6. Other Contact.Person: Phone#: Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Super%isor License:CS-095306 GERARDO CASIRTA 5 BIRCH LANE s TOPSFI IAMA 019&3 r Sru--� ►4��� Expiration Commissioner 03/0412014 0 a. ons � Q ice 4 10 park plaza Suite 5170 Boston,Massachusetts 02116 nt Contractor Regisegist1`80on: ton Home Improvement 161645 Type: IndivIdual 206441 Expiration: 11/12J2012 Tr# GiERARDO CASERTA IGERARDO CASERTA 5 BIRCH LANE TOPSFIELD, MA 01983 Update Address and return card.Mart reason f*r change' i-.1 Addiren Renewal Employment Ll Lost Cordl DMOki 0 50VW-OW44101216 License or registe ASO:'-'=o'd r.r iTidividul use 0U1Y before the es9kration dEft- If found return to: HO (HrIce of Consumer AiW"rs avid Business Reguwlon WIE japRoVEMENT CONTRACTOR Reqlstmii0n: 161645 lndMdual Boston,MA 02116 iratiow. 1'4112(2012 CASERTA GERARDO CASERTA W� 5 BIRCH LANE out 6119mat"Te 70PSHELD,MA 01963 UadersecretArY A+C GERAD-i OP ID:Jl' �...----" CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.!THIS CERTIFICATE (TOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE= AFFORDED 13Y THE POLICIES BELOW. T141S 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(les)must be endorsed. 1f 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 Chas.F.Hartshorne 781-245-4300 rcin°uE cr 3 Chestnut St. 781-246-5810 SHe° Wakefield,MA 0188() 1.(AIC,No)! MICHAEL A LAURANO ADD $g: INSURER(S)AFFORDING COVERAGE MAIC it INSURER A:NGM Insurance Co INSURED m an 14788 Gerado Caserta 5 Birch Lane INSURER B Topslield,MA 41983 INSURER C: INSURER INSURER E: --� COVERAGESINSURER F= CERTIFICATE NUMBER: REVISION NUMBER: THIS 1S TO CERTIFY THAT THE t'OLICIES OF INSUR/1NCE 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 dE 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. WSR TYPE OF INSURANCE ADD - lhall POLICY NUMBER Y EFF POL EXP 'T GENERAL UA61L1TY MMfDD MM/DDlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MFK5183X EACH OCCURRENCE 5 1,000,00 10!18!11 10/18/92 PR'MG- $ 500,00 CLA(MS�L4DE J OCCUR occurrernn MED EXP(Any one person) $ 10,00 PERSONAL&ADV IMIURY $ _ 11000,00 GENIL AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 2,000,0 POLICY f X PRO- LOC PRODUCI'S-COMPJOP AGG S _ 2,000,0 AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT A ANYAuro rM91054816 EeeccldoM .- 300,00 04!24!12 04/24113 BODILY INJURY Per ALL OWNED SCHEDULED ( Person) $ AUTOS X NON-OWNED BODILY INJURY(Per acciderA) $ X HIRED AUTOS X AUTOS P- OPER Per ccidentt __ $ UMBRELLALIAM OCCUR $ EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ AGGREGATE DED RETErrnoN $ WORKERS COMPENSA71ON g AND EMPLOYERS UABIUTT WC STATU- QTR_ ANY PROPRIETORIPARTNER/E✓�CECUTNE YIN -' JMJTS OFFKZRIMEMBEREXCLUDED? NIA E.L.EACkACCIDENT $ (Mandatory In NHI KYes describe O E.L.DISEASE-EA E $ DESCRIPTION OF OF OPERATIONS below � �- EMPLOYE E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS 1 LOCATIONS I VE141CLFZ (Attach ACORD 101,Additionat Remarks S�hcdute,tf rrlo-sppce K required) LOWE'S COMPANIES, INC. AND ANY AND ALL SUBSIDIARIES ARE NAMED AS ADDITIONAL. INSURED AS RESPECTS TO GENERAL LIABILITY AND AUTOMOBILE LIABILITY. HInD AND NON-OWNED AUTO ENDORSED ON THE GXNERAL LIABILITY POLICY. CERTIFICATE HOLDER CANCELLATION LOWESCO SHOULD ANY OF THE ABOVE!DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lowe's Companies,Ino„ ACCORDANCE WITH THE POLICY PROVISIONS- Attn: IS Insurance PO BOX 1111 AUTHORIZED REPRESEN - F- North Wilkesboro,NC 2$656 _ �^+ ACORD 25(2070105) The ACORD name and togo are registered marks of1ACORD D CORPOF2ATION. All rights reserved. TIT :fid BS:£T ZT—TT-90 STORE COPY 8 INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK- INT/EXT/PATIO DOOR LOWE'S OF DANVERS, MA., STORE# 1094 STORE PHONE: (978)646-9099 153 ANDOVER STREET SALESPERSON: DENNIS GLENNON - DANVERS, MA 01923 SALESPERSON ID: 1227928 Document Print Date: 09/16/2012 This is only a Quote for the merchandise and services printed below.This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree- ment, including the specifically completed pages of this document, the Terms and Conditions included with this document,the applicable portion(s) of Lowe's receipt, and any other addenda or attachments hereto, shall be referred to herein as this "Contract." PLEASE READ THIS ENTIRE DOCUMENT INCLUDING THE "TERMS AND CONDITIONS," BEFORE SIGNING. Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, Inc.'s MA HIC NO.: 148688 Lowe's Home Centers, Inc.'s FEIN: 56-0748358 Customer Name Home Phone S JOHN JACOBSON 978-687-3823 ® Customer Address Other Phone 30 E PASTURE CIR L City State/Province Zip/Postal Code ® NORTH ANDOVER MA 01845 Installation Address T 30 E PASTURE CIR Installation City Installation State/Province Installation Zip/Postal Code ® INORTH ANDOVER MA 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 84616 : CCM803-S2S : SOS : SOS THERMATRU CLASSICCRAFT PREFIN : CCM803 SINGLE DOOR W 2 SIDELITES : REEB MILLWORK OF NEW ENG- LAND - QTY 1 1054 : 87568 : STK : 1 X6X8 RED OAK BOARD : 1 X6X8 RED OAK BOARD : BABCOCK LUMBER - QTY 1 1098 : 87728 : STK : 1 X8X8 POPLAR BOARD : 1X8X8 POPLAR BOARD : BABCOCK LUMBER - QTY 1 193569 : 35170FJPMD : STK : PFJ CASE 351 2-1/2X11/16X7 : PFJ CASE 351 2-1/2X11/16X7 : EMPIRE COMPANY, INC. (THE) - QTY 3 238348 : 2828-8 : STK : 3/4.X7.2.5X8 RF EMBOSD PVC TRM BRI : 3/4X7.25X8 RF EMBOSD PVC TRM BRD : ROYAL MOULDINGS LIMITED- QTY 1 materials Price $3959.94 Store 1094 Project No. 363041637 for JOHN JACOBSON Page 1 of 7 i STORE COPY r 4 INSTALLATION DESCRIPTION Stock or SOS : SOS Door Type : Exterior Select Location : Front Door Select New Door : Single Pre-hung Number of Doors to Install : 1 Side Lights or Transoms : Yes Total Number of Side Lights and Transoms : 2 Hardwood (Mahogany or Oak) Door : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Install Storm Door : No Lead Safe Practices : No Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door : Yes Customer Understands Scope of the Project:Yes Permit Required : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : new trim [int./ext.] ext.jambs;th-hold Other Work Charge : Yes Comments : No Comment Labor Charges $ 1139-OC Detail Deduction -$ 35.0( Additional Specifications: Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop- erty is governed by Historic District Regulations. Additi®nab Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right:Important Lead Hazard Information for Families, ract, Customer acknowledges having received a copy of this pamphlet before work began informing Child Care Providers and Schools. By signing this Cont Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES where applicable SUB-TOTAL $5063.9, *TAX $ 0.01 DELIVERY $ 0.01 ORDER TOTAL $5063,9 • Page 2 of Store 1094 Project. No. 36304.1637 for JOHN JACOBSON 7 STORE COPY /IIT SUC KBIT ATI S ROVIDED IN M.G.L. c.142A B Date: Lowe's Home Centers I c. By. --7 Date: Y O n r By: Date: Spouse THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE RESOLUTION INITIATED BY LOWE'S PURSUANT TO M.G.L. c.142A. THE OWNER MAY BE PERMITTED TO INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THE SECTION ABOVE IS NOT SEPERATELY SIGNED BY THE PARTI WITNESS OUR HAND(S) AN SEAL(S) BELOW THIS DAY OF- Lo Lo e's Home Centers, Inc. By- = (Seal) Print Name: (Seal Address ne, City State/Province Zip/Postal Code Print Name (Seal Co-Owner or Witness Print Name Customer acknowledges receipt of a true copy which was completely filled in prior to Customer's execution hereof. You the customer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. See the attached Notice of Right to Cancel for an explanation of this right. Store 1094 Project No. 363041637 for JOHN JACOBSON Page 4 of