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HomeMy WebLinkAboutBuilding Permit #702 - 35 EQUESTRIAN DRIVE 5/28/2008Permit NO: Date Issued: �.5 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received 57 -deb "0 IMPORTANT: Applicant must complete all items on this Daae LOCATION_ r I Print `✓ Print MAP NO: PARCEL:A� ZONING DISTRICT: Historic District yes no Machine Shop Villaqe ves no TYPE OF IMPROVEMENT PROPOSED USE Resi n ' Non- Residential New Building C One famil Addition Two or more family Industrial Alteqtipp No. of units: Commercial lacemen .. Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer Type of Print Clearly) OWNER: Name: Address: CONTRACTOR N Supervisor's Construction License: Exp. Date: 11 Home Improvement License: IQ/ -a9; Exa. Date: M/W 11 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: $ CO-- FEE: $ 0l0 - Check No.: 21 q % % Receipt No.:�1� q�' NOTE: Persons contracting with unregistered contractors do not have acce"eguay fund Signature of AgentlOwner ureof contrac I Location EA t4e!Sfrll gh Dri-Ve No. Date s--,149-09 NORTH TOWN OF NORTH ANDOVER • OL Certificate Occupancy $ of _ sAc ust`� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # P-�L (g -) 2 J ! 80, ►a►G Building 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Drivewav 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 imension umber of Stories: Total square feet of floor area, based on Exterior dimensions. otal land area, sq. ft.: LECTRICAL: Movement of Meter location, mast or service drop requires approval of lectrical Inspector Yes No JGER ZONE LITERATURE: Yes Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 No 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 All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ 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/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 TOTE: 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 TOTE: 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 M M X M M v, y .0 C � CIO Cl) CD MZ CA D.O �. r c 03 CZ S. H 70-1 C CD CD o CL C7 "d CD CD CD w a C O CO2 CD CZ O_ CO) CD I v CO) O Z CD V. CD CD O CCD O 0 `� J 1 0 r� cn cn n o� zo �z cn cn C 0 — N O cr N SL pO CA a® n m C7 m m an N ff' N ...�CK - a p CD T N O FM CA i m CD m: n = -00- : � -� 0 I O N C2: .40C', : H CD q -o W CD a C 01 N W- a CD m N N L• mm 97S , W ;A 4bi mom` .-. e9 o O CD � 3 N CD o m : = N C C=Dr d 03 a CL C.) Com: c O O �• M" z O V V Tj #** r v cn rD d cn r"p tD o a7 C Oil 37 � w.. jd '�zl w f 9 '� 0 �1 z ?1 7 ?� 7d 0 00 r ',z� � 0. (� �' '� a pip `17 G o z � cn d r* cn 'r1 O p„ x x 4 E W M v 1,-� 4 0•' y 0 9 May 19 08 08:15a Rick Odonnell 6036474457 p.4 ROME IMPROVEMENT CONTRACT As/&71 , j " Sold, Furnished and Installed by: Branch Name' fiAs-� Date' S�6�d� THD At -Home Services, Inc. d/b/a The Home Depot At -Home Services 345A Greenwood Sheet, Worcester, MA 01607 Branch Number. Job#: 3 % % ci6 $� Toll Free (800) 657-5182; Fax: 508-756-2859 Federal ID # 75-2698460 ME Lic # C 02439 RI Coat. Lic# 16427 / CT Lic # 56,55222; MA Home improvement Contractor Reg. #126893 r� Installation Address: 3 sl`v / a z!}' N' "�' �"�a /tto DJ &'y - ' r 1 City State Zip I�At J! Last 4 Digits of Driver's Purchaser(s): Lic. # & Exp. McNr: Work Phone: dome Phone: (978) e'q - 93Z ( ) ( ) Home Address: S� (If different from Installation Address) City State Zip E-mail Address (to receive updates and promotions from The Home Depot): Project Information: I/We/You ("Pur+chasei'), the owners of the property located at the above installation address, offer to contract with THD At -Home Services, nc.(vb jio}ne D ) to famish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet # �b 6 , incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if, upon re -inspection of the job, Home Depot determines that it cannot perform its obligations due to a structural problem with the home, pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract CONTRACT AMOUNT $ tLESS DEPOSIT $ s7 BALANCE DUE ON COMPLETION $ tbilaimum 25% of Contract Amount due upon execution of this contract. Indicate Payment Method For BALANCE DUE ON COMPLETION: /L(O-S/r Ca,d *When you provide a check as payment, you authorize us either to we information from your check to make a one-time electronic fund transfer t%m your account or to process the payment as a chock transaction. When we use infommtion fi+om your check to make an decnome fimd mar fa, funds may be withdrawn from your acooant as soon as the payment is received, and you will not receive your check back. DEPOSIT PAYMENT OPTIONS (Subject to fund verification and/or credit apvmaL) 1. Check', Cashiers Cheek or US Postal Service Money Order (Made payable to The Home Depot). 2. Credit Card" and/or other payment options - Cirde One Below Visa <IiterCatd iscover American Expmw The Home Depot Home improvement Loan The Home Depot Credit Cant ❑ New Account 0 Existing Account (MM & ADCC ONLY) AvnBabk Credit: S (AIL & ADCC ONLY) Awl#: 53b g 90133 63.20 " p Date: //O 9 Name as it appearson card: Zed 2'. ' e_J' **By my/our signature below, I/We agree to allow Home Depot to charge tJie above referenced credit card for the deposit indicated. Cardholder's grguabtrc ✓ Date HIL or HDCC Authorization Codes it Final Payment # # Purchaser agrees that, immediately upon completion of the work, Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement This agreement and its attachments, including any financing agreement, contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement sighed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract. You may cancel this transaction any time prior to midnight of the third business day after the date of this contract Sex Notice of Cancellation for an explanation of tills right. There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser AFTER the third business day, but BEFORE materials are ordered. There will be a service charge equal to 25% of the contract amount if job is cancelled by Purchaser AFtER materials are ordered. BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATURE BELOW, I/WE AGREE TO BE BOUND BY THE TERMS OF THUS CONTRACT. I/WE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. g� SUBMITTED BY: _7 —a= -ac t� Date: _ t �ales Consul ACCEPTED BY: 77 2 - — Date: Purchaser Date: Purchaser NOTICE: ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 9.21-07 rev 4-2-07 C -SC White - Brench Fie Yellow - Customer Pink- Sales Consuttartt PER �f�j'A,-A IC_r��l�,a� L1 iJA:.1CN ;s ri' i IDlrtdlEtiTJ .0 iGiG! iCO U-F2ctar Sclar 4eat Gain Coeffidert Facmr-U Coeficente:sananda A Energia i&v t ., 0.24 c; 1 . �. n,.sn•or rereaicalSa ADOMONAL PERFORFAMcE RATIN MALUACtON a P.EWENTAF A DE,FVMWEMT0 Visible Transmittance Tmn=Wan de U uVtstbk x,45 that thew Mew mftm to MPWa* NFAC a 'xh°le Product P NfAC redngs are determined for a tiled set d dMmn WW =Mm and aspok p lAd sim. NFRC doe rot recommend airy product end doe not wmrdat the suite ft of any pwd fW OL Moi =mftbut Mer&n for oW Pnoduct P bmm wwA M Este dd fatxicarde edp* qw etm vabre aanP�rr mrt be p aD de pffRC P� dat�y - mldrndo total o pmdnem. Las vdora usadow porMW son ddv..tandm Por to mgudo fro de cmndlr m aerbbale yut �nmro de produeto gmeclb NERC no re,,d,,ft*pW&ftynD graram 9m d ppm tae AOM Para m mo epedlm Ctxmib ten d Wo dd hbtbft Pere d mo epr OWD de ate Pmdmh wwwn(m mg pnit gnalifla for 13=Rt:Y STAR Le- vogLid 1Jorth7rn, C.-ntral, Sooty Caat=al. 90othera.rim UA La wad califica para la (10 t 3TC: Y! rtgidin (sa) ER�EQGY STa3: Hosts, TaOrta Central, gas Central, 9ua. IND: lisle C0/Clad 'i/8"/K-LC23 reetad Sise: 48" x 10" 1� IND: Rafoae:o 0(I/VLdrio 3.18 ua/K-LC23 DP : +2 5 / — 2 5 raMaao psObadO: 121.9 CM x 2(13.1 an q0120 Kaarra 1 29 6929849/02 Keep the lwbd for pm u ENOW S1'1Re nota. To lemn =N.i tTw+ gvdmpv Guatde este wfiqueta pme Fwz rmn6oha OW SM Pom rim mis mm de oto, trite www ew qi to P .tanens(nituprr ' . ajivag` pie0 )uawalddn 900ZI 7J ;*i : E699ZL �� �AIUfa BCf06 VJ'd1N'dll� ` . VI1d ME). 8800 OOZE = 3NO1'1H.4 �dHOW . swoH-)V #plop awoH 3Hl uof* di3' l101OVHlN001N3W3AOV' dW13WOH _ f% I -, � c�rclMlwrwr�„� 1.ar,.-9) 13C ?;i1S C RT1FiCAT-- IS ISSULi. AS A 10-A 1 Z OF INFORMATION 1 :c�uc I ONt'( AND CONFERS AI4 RIGHTS IJPQ`( ?'r!TIFICATc DOES �iGTHECERTIF!CAT= ;rsh TJSA, Inc. HOLDER. THIS CE. AMEN -10: EXTEND OR G� I ALTER THE COVERAGE :a,7 OORDED BY T l�::_ruL.ICIES ,mede7oc.,rsrtrequest-'emarsn.cum ,75 Piedmont Rd Na, Suite 1200 :!ant=, G=. 30305 Ix (31_2) 948-0902 SUR50 ,ma Deoot Q.S.A., Inc- a Some Depot, Inc. ,35 Paces Fern Road d lding C-8 :lanta, GA 30339 IN3U'r.ERS ArF�7Au!TiG I: J/E.A�3:: ,NSURERA steadfast Ins Co iNSURER8:Zurich Ams-ican Ins Co INSURERC Illinois Natl Ins Co - INSURER O:American Home Assur Co _wjiacac•Naw Hampshire Ins Co NAIC 126397 I -__ 16535 --- _- __ 23817 I - 19380 - —^ 123041 OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CNDITION OF AN'CONTRACT OR OTHERTH ECT WHICH THIS MAY BE ISSUED OR FICATE MAY PERTAIN THE INSURANCE AFFORDED BY THE. POLICIES DESCRIBED HEREIN NT SEI SUB ECT TO ALL THEOTERMS. EXCLUS ONSI AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS- EFFECTIVE POLICY EXPIRATIONRPREMISES(Ea2Mgenc@j_ LIMITS iR 00' POUCY NUMBER AT MM ryY A M I N RD FI R 03/01/08 03/01/09CE 54,000,000 IPR 3757 608-02 TO GENERALLIABR.ITY 5 1, 000, 000 LIMITS OP POLICY ARE EAC SS Y Ct1MMERCIALGENERALLIABIUTY E7CCLOOED g "OF SIR: $1,000,000 PER CC” Person( $ CLAIMSMAOE � OCCUR 4,000,000 PERSONALBADVtNJURY S ISE HOME DEPOT, INC. 2455 PACES FERRY RD., N.W. BUILDING C-8 ATLANTA, GA 3Q339 ,....,.•,nod Aatkinson USA :ANCELLAIIVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER ITS AGENTS OR . AUTHORIZED REPRESENTATIVE " ©ACORD CORPORATION 1988 GENERAL AGGREGATE S 4,000,000 PROOUCTS-COMPIOPAGG 541000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRO LOC X POLICY F HAP 2938863-05 03/01/08 03(01/09 COMBINEOSINGLEUMIT, ,� $1,000,000 B AUTOMOBILE LIABILITY (Ea accident) X ANY AUTO.. BODILY INJURY 5 ALL OWNEO AUTOS (Per Pawn) SCHEOULEO AUTOS BODILY INJURY S HIREOAUTOS (Per accident) NON -OWNED AUTOS PROPERTY DAMAGE 5 X SELF INSURED AUTO (Per accident) PHYSICAL DAMAGE AUTO ONLY. EAACCIDENT S GARAGE LIABILITY ' ' • OTHER EA ACC' "S THAN ANY AUTO AUTO ONLY: AGG S IPR 3757 608-02 03/01/08 03/01/09 EACHOCCURRENCE 55,000,000 A EXCESSNMBRELLAUABILITY AGGREGATE' 35,000,000 CLAIMS MADE 5 X OCCUR DEDUCTIBLE S RETENTION S03/01/08 (FL) 03/01/09 X WCSTATU OTH- C WORKERS COMPENSATION AND 1928757 03/01/08 03/01/09 ELEACH ACCIDENT 31,000 D EMPLOYERSLIABILITY 1928756 IA) 03/01/08 03/01/09 . E.LOISEASE-EA EMPLOYEE $1-000'000 ANY PROPRIETORIPARTNERMIECUTIVE E OFFICERIMEMEERE=LUDEDT 1918755 (AOS) E.L. DIS EASE - POLICY LIMIT S1, 000, 000 S es. deem'be under SPECIAL PROVISIONS below 03/01/08 03/Ol/D9 occurrence/SIR 2 SM/2N OTHER F TX Employers Excess TNS -C45197967 (TX) (QSI) 03/01/08 03/01/09 D Workers Compensation 1928759 1928759 MY, MO, NY, WI) 03/01/08 .03/01/09 E Workers Compensation LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORg£MENT/SPECIAL PROVISIONS IESCRIPTION Of OPERATIONS 1 ,FOR EVIDENCE ONLY t ISE HOME DEPOT, INC. 2455 PACES FERRY RD., N.W. BUILDING C-8 ATLANTA, GA 3Q339 ,....,.•,nod Aatkinson USA :ANCELLAIIVN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CAN BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY HIND UPON THE INSURER ITS AGENTS OR . AUTHORIZED REPRESENTATIVE " ©ACORD CORPORATION 1988 41N. The Commonwealth of Massachusetts. 1 Department ofIndustrial Accidents ! Office of Invesdgations 1. { 600 Washington Street �l lj Boston, MA 02111 t~ �i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: Phone M Are n employer? Check the appropriate box: Type of project (required): ,yo 1. LyKam 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 listed on the attached sheet. t 7• ❑Remodeling 2. ❑ I am a sole proprietor or partner- ship and have no employees These sub -contractors have ' 8. ❑ Demolition working for me in any capacity.. workers' comp. insurance. 5. ❑ We are a corporation and its g, ❑ Building addition [No workers' comp. insurance officers have exercised their 10.❑ Electrical repairs or additions required.] require 3. ❑ I a homeowner doing all work right of exemption per MGL 11.[] Plumbing repairs or additions myself. [No workers' comp. c. 152, § 1(4), and we have no epairs' 12.❑ Zerr insurance required.] t employees. [No workers' 13. comp. insurance required.]04LD *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 their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below. is the policy and job site information. Insurance Company Policy # or Self -ins. Lic. #: �,? S`7 Expiration Date:��( Job Site Address: -j-- d. 1p'i'7 �� �I�i��i6�C'`G Y�ti�l City/State/Zip- 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 rine 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 insurance coverage verification. I do hereby certify a d�f?fie pyjns ind penalties ofperjury that the information provided e is tr�e and correct: 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