Loading...
HomeMy WebLinkAboutBuilding Permit #916 - 308 CAMPBELL ROAD 6/20/2012 WILDING PERMIT Y_'^.',6 0 TOWN OF NORTH ANDOVER 10 APPLICATION FOR PLAN EXAMINATIO Permit NO: Date Received ATAT ED c5 �SSA C U Date Issued:��k IMPORTANT:Applicant must complete all items on this page 77 1ION -LWL A 'J: 'OWNER, 1:1 2 ,,PROPERTY MAPfNO�`c. � �-�' P�ARCEL-�Z� ZONING DISTRICT F Histone Distract,r�t ,+eyes no TYPE OF IMPROVEMENT -PROPOSED-USE Residential Non- Residential New Building Addition Two or more family Industrial Alteration No. of units: Commercial ,W.epzx,cep4Geffrer1L Assessory Bldg Others: Demolition Other _,_%aters et a"", --he 1,is n ap ain tw e tic, a a DESCRIPTION OF WORK TO BE PREFORMED: entification Please Type or Print Clihrly) OWNER: Name: Phone: Address: hdnd:� iGNTiRAO�TORName 77777777777,,..�� drbss:l R_ 7 ch:�,b �Mk A License 4 Isoo n Exp date = Mr6cti6n Home entUid' h ARCHITECT/ENGINEER-0— Phone: Reg.eg. No. FEE SCHEDULE.BULDING PERMIT-'$I 00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: - Check No.: �0 3 Sci 12 T--J, c� Receipt No.: NOTE: Persons contracting with registered contractors do not have access to the guaranty nd 7! 1nn tirenf,c ontra i i Location .Q Date No. —qy— TOWN OF NORTH ANDOVER a t t Certificate of Occupancy Building/Frame Permit Fee ; $� Foundation Permit Fee $— Other Permit Fee $ TOTAL Check Building Inspector 25436 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 ONLY H FOLLOWING SECTIONS FOR OFFICE USE INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMONTS 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 :=::Tem Diam ster-on site':` es-: no. p p Y 'Located,at124 Mam'Street �' - '.Fire Departmentsignatureld;to i 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) ' i I I I ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 - -------- -- ---- ------ - � ` it 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 ' ❑ Buildin Permit . g Application ❑ Certified 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) ❑ Engineering Affidavits for Engineered products N 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products V®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 Doc:INSPECTIONAL SERVICES DEPARTMENTMFORM07 Revised 2.2008 NORTH Town o _ ndover O 1. 1 No. soh ver, Mass, %w coC C.'wlcll ' 1 �.A p'DRATEO S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .............. .. ......... ..................C4 ... ...................................... BUILDING INSPECTOR (� I Foundation has permission to erect .......................... buildings on .... 01.....1 .I ..l.... ............................... 000 Rough WI ....... to be 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES INNTHS ELECTRICAL INSPECTOR UNLESS CONSTR TI ST Rough Service ......... .................... ............................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 Massachusetts Print Farm Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 ` Boston MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electric�ans/Plumbers I Applicant Liformation Please Print Legibly Name (Business/()rganiialion/lnclivichlal): Address: E P irc,h Lckne City/State/Zip: 0*14 D/qY 3 Phone#: g17Y' g , a Q 8 7 Are you an employer'' Check the appropriate box: Type of project(required): 1.❑ 1 am a employer with 4. ❑ I am a general contractor and 1 employees(full arci/or part-time).* have hired the sub-contractors 6. E] New construction 2 I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand have no em to ces These sub-contractors have � P Y' 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp. insurance comp. insurance. required.] .5. ❑ We are a corporation and its 10.[:1 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their i 1.❑ Plumbing repairs or additions myself. (No workers' comp' right of exemption per MGL 12.❑ Roof repairs insurance require([.] + c. 152, §1(4),and we have no employees. INo workers' 13.❑ Other comp. insurance required.] ny applicant that checks box#1 In also fill out the section he low showing their workers'compensation policy information. ' i Inmeowners 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-contactors and state whether or not those entities have employees. il'the soh-contractors have employees.they must provide their workers'comp.Policy numlM. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: gnC�Q t/n�,on1Qa►hy Policy#or Self-ins. Lic.#:_ M�K S �'3 Expiration Date: I I (ot Job Site Address: U &DKr V I I City/State/Zip: DU 6rt 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 ol'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 insurance coverage verification. I do hereby certify er the pa' , nd penalties of perjury that the information provided above is true and correct. Sitrnature: Dat�:i Phone#: 971-8 a�l—�R 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. Board of Health 2. Building Department 3.Cityfhown Clerk 4. Electrical Inspector 5.Plumbing Inspector (. Other Contact Person: Phone#: I 4t Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Super isor License:CS-095306 �� A-FIS rs GERARDO CA ARTA 5 BIRCH LAE TOPSFIELDVIA 01M..`a Expiration _ Commissioner 03/04/2014 F, d { s 2 -x'=,- i .,. „ ., ': .,�SI' (' 4.< 3 ttuhr,6 It, max- f, � -. ; t r rx x � �y � - -- r 'iri.;,r` imm i 91 L i ,. t, UU Res i' vOo1 Gi C 'I RT IF LANA ` SIE ,:,KiA 64,68,31-, T yr*, Y ' 11-01-11 ; 16: 12 ;patrick-j-woods-insurence 19788800023 ;9785318617 # 2/ 3 CERTIFICATE OF LIABILITY MURANUE 10/03j2oii PRODUCER 978,531.2777 FAX 978.531,.86 .7 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION P.J. Woods Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 40 Main St. HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 3S3 Peabody, MA 01960 INSURERS AFFORDING COVERAGE NAIC III INSURED Ronco Construction, Ronald Wac in D/b/a INSURER A: COMMERCE INSURANCE COMPANY 34754 12 Tuckers Ct. INSURER D: Peabody, MA 01960 INSURER C: INSURER D; INSURER E: COV 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 WHIGH 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I ISR D' TYpE PP INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY NV7121 11/03/2011 11/03/2012 EACH OCCURRENCE S 500,0001 X COMMERCIAL GENERAL L',ABILITY DAMAGE TO RENTED $ 50.000 CLAIMS MADE FX7 OCCUR MED EXP(Arty mw parson) g 51000 A PERSONAL&ADV INJURY $ GENERAL AGGREGATE g 11000,000 GEITL AWAF-43ATE LIMIT APPLIES PER: PRODUCTS-COMF'IOP AGG ffi 1.000.000 X POLICY JECT LOC Au7FoMOBIL6 LIABILITY VK0743 02/14/2011 02/14/2012 COMBINED SINGLE LIMIT S ANY AUTO (Ea acadanl) ALL OWNED AUTOS A X 8CHEDULED AUTOS Par pemn)ILY INJURY $ 10000 0 X HIREOAUTO6 BODILY INJURY g X NON•OWNEDAUTOS (Pet3— eAl) 300 ,00 PROPERTY DAMAGE ffi (Per ecoldern) 100,0()0 GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO EA ACC g OTHER THAN AUTO ONLY; AGO g EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE ffi OCCUR CLAIMS MADE AGGREGATE g g DEUUCTIDLE RETENTION It $ WORKERS COMPENSATION AND I MIT WC STATU- I 0TH- EMPl.0YERV LIABILITY FR '^ ANY PROPRIETOWPARTNERIMCUTIVE E.L.EACH ACCIDENT S OFFICERIMQMER EXCLUDED7 E.L.DISEA6E-EA EMPLOYEE g Ify as.6OKdbe under SPECIAL PROVISIONS below EL DISEASE-POLICY LIMIT S OYHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROv QN$ owes Companies,Inc & any and all subsidiaries are named as add 1 insured as respects to general iability and auto 'liability. OOS Ford FSSO Super Cab, 1FDAX57YISESS44S 2005 CARMATE TRAILER SA3C816D45LO104538 000 CARMATE TRAILERS, SA3C610SXL0004012 2002 DODGE DURANGO, 1R4HS78X62F118138 CERTIFICATE HOLUER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL LOWS COMPANIES, INC, 10 DAYS wRrTTEN NOTICE TO THE CERTIFlCATE HOLDER NAMED TO THE LEFT, IS INSURANCE BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LWBY.RY P Q BDX 1111 OF ANY KIND UPON THE INSURER,ITS AOENT6 OR REPRESaITATIVES. WILKEBORO, NC 28656 A44PI&ED REPRESENTATIVE ACORn 25(2001!08) FAX: 336.658.2308 @ACORD CORPORATION 1988 , 80102901169 62011,RR Donneilev.All riohts reserved.-0221 _I90�M:Nwl CONTRACT# MASSACHUSETTS EXTERIOR SOLUTIONS INSTALLED SALES CONTRACT' INSTALLED SAES S:ECIALIST NUMBER CUSTOMER. _ 11.2 47i 9 76 r STREET ADDRESS ; STORE NO. STREET ADDRESS f ,,3 f1;F 4.-��rY7 ZIP CITY, STATE ZIP CITY S f, TATE TELEPHONE jj TELEPHONE �]..�g� DATE LOW: 358 E'S HOME CENTERS,INC.'s MA HIC NO.: 148688 CASH BANK LC99C REG CARO CHrARGE FEIN56-0748 � .�..� This.is only a:quote for the merchandise and services printed below.This becomes an agreement upon payment. Upon payment,the entire agreement,_inGudmg thespeclfically completed,pages of this' ,. document,the Terns and Conditions.induded with this document and any other addenda and attachments hereto,shah be referred to herein as this'Contract." PLEASE READ.All TERMS AND CONDITIONS ON THE REVERSE SIDE OF THIS PAGE AND FOLLOWING PAGES BEFORE SIGNING. . . t CITY STATE ZIP INSTALLATION STREET ADDRESS jj z r f jr rte± f 1 J I. i.'JL.._•�! e ,,' ' k*i 4f' — lots a': eF3s"a + �f ' g,i✓7 -t,'^i r' P �, -�.-,`a`� � is^','a Y; ; r.. t! . ... t �?(�q,n•�4 .%tel`40 Contract Total Are permits required for this installation?: [K]Yes [ ] No *applicable tax included 1 NOTICE TO CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity. I Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including,but not limited to,marketing, advertising, publicity, illustration, training and Web content. By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. i Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be [fille in date].Estimated completion date is o t [fill in date]. Said estimated substantial completion date is not of the essence: A statement of any contingencies that would materially change said estimated substantial completion date is as follows: (if applicable,inserta statment of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: t,4 Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: (1)Deposit $ to be paid upon siging contract.Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142A r,iAt�'c AMr)r,tA!Mr-P I-IFRFRY MUTT IAULY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS CONTRACT,- T1 i •l Contract Total Are permits required for this installation?: [ ]Yes [ ] No *applicable tax included - Yrs�► NOTICE—10 CUSTOMER: Federal law requires Lowe's to provide you with the pamplet Renovate Right.By signing this Contract,Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activi to be performed in Customer's dwelling unit. PHOTO RELEASE:Customer grants to Lowe's and Lowe's employees the right to take photographs of all work performed at the Premises related to this Contract,and irrevocably grants to Lowe's all right,title and interest in and to the photographs for use in all markets and media,worldwide,in perpetuity. Customer authorizes Lowe's to copyright, use and publish the photographs in print and/or electronically, and agrees that Lowe's may use such photographs for any lawful purpose, including,but not limited to,marketing, advertising, publicity, illustration, training and Web content. By initialing here,Customer agrees to the foregoing. [Customer to initial to the left]. ' Work is to commence upon reasonable availability of Contractor and/or any special order or customer made Good(s)which is anticipated to be 3 [fille in date].Estimated completion date is_ 5,,h�/,,z [fill in date]. Said estimated substantial completion date is not of the essence. A statement of any contingencies that would materially change said estimated substantial completion date is as follows: �;f j; r (if applicable,insert-a statment of such contingencies). IF THE CONTRACT TOTAL IS$1,000.00 OR LESS Customer must pay in full. COMPLETE THIS SECTION ONLY WHEN THE CONTRACT TOTAL EXCEEDS$1,000.00: [i],Customer to Pay in Full; OR [ ]Customer to use the following payment schedule: (1)Deposit $ to be paid upon siging contract.Deposit should be 1/3 the total contract price;and (2)Payment of$ to be paid anytime after this Contract is signed and before commencement of installation, I/We authorize Lowe's to do one of the following(check appropriate box below): [ ]Charge my/our credit card for the amount of the payment indicated above anytime after the date this Contract is signed; or [ ]Deposit my/our check for the amount of the payment indicated above anytime after the date this Contract is signed;and (3)Final payment of$100.00 to be paid upon completion of the installation and both parties'satisfaction. NOTICE REGARDING ARBITRATION AGREEMENT FOR CLAIMS COVERED BY M.G.L.c.142A LOWE'S AND OWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT LOWE'S HAS A DISPUTE CONCERNING THIS-CONTRACT THAT LOWE'S MAY SUBMIT SUCH.DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUT- IVE OFFICE OF CONSUMER AFFAIR&AND BUISNESS REGULATIONS AND THE OWNER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS P.ROVIRED IN M.G.-/c 1,42A' i f By: —_ *� �< :-r -.�2, Date: Lowe's Home Centers Inc Date: Owner Signature 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 PARTIES. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AND UNTIL YOU HAVE READ THE TERMS AND CONDITIONS CONTAINED ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT. BY SIGNING BELOW,YOU ARE ACKNOWLEDGING THAT YOU HAVE READ, UNDERSTAND AND AGREE TO THE TERMS AND CONDITIONS SET FORTH ON THE REVERSE SIDE OF THIS PAGE AND THE FOLLOWING PAGES OF THIS CONTRACT.YOU ARE ENTITLED TO A COPY OF THIS CONTRACT AT THE TIME OF SIGNATURE. WITNESS OUR HAND(S)AND SEAL(S.p,BELOW THIS DAY OFZ L.o.we's 1st®me CentersInco/I Specialist or Above Owner Co-owner or Witness Customer acknowledges receipt of a true copy of this contract which was completely filled inrior to Customer's execution hereof. cancel this transaction at any time prior to midnight of the third business day after the date o t his transaction.See the attached not ce of cant buyer, mayy form for an explanation of this right. #90981 (Rev. 12/1 J) 1 ©2004 by Lowe's.®Lowe's and the gable design. are registered trademarks of LF Corporation.