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HomeMy WebLinkAboutBuilding Permit #691-14 - 36 EVERGREEN DRIVE 4/9/2014TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received .TYPE OF IMPROVEMENT. PROP ED USE Res' ential Non- Residential ❑ New Building One family ❑ A dition El Two or more family 11 Industrial ❑ 4fteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 4 � Septic-❑xVllell ❑ Floodplarn~0°Wetlands_ ❑ Watersheds®istnct p. 01Nater/Sewer '_ __ — — DESCRIPTION OF VVOKK I u bt: rtK1-UK1v1tu; ipn $leasg Type or Print Clearly) OWNER: Name: Address: 'J - - �CON= �RACTORr L� Phone. Address _ T te: { Supervisor sConsfru.ction, Licen e , , spa - _ y� erl Ir ma Im'nmvcmon4=lrirar cP; 1 .�� 4:- -- � at2: %� _A `�4.�__ � , i 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.: Receipt No.: ` 2 NOTE: Persons contracting with unregistered contractors do not have access to the para,pty fund Plans Submitted 'Li Plans Waived ❑ Certified Plot Plan ❑ StapAped Plans ❑ III Location No. Check #.4. I 27423 Date `I ) TOWN OF NORTH ANDOVER Certificate of Occupancy $_� Building/Frame Permit Fee $( U7q Foundation Permit .Fee $ Other Permit Fee $ TOTAL $ Building Inspector f Plans Submitted ❑ -Plans Waived ❑ . '_Certified. Plot Plan ❑ Stamped Plans El f r- JW1E OP':-SEWERAGE"DiSP.OSAL .:._ Public Sewer ❑ Tanning/Massage/Body Art ❑ .. .Swimming Pools ❑ Well ❑ Tobacco Sales • - : Food Private (septi tank, etc._ - ❑ - Packaging/Sales ❑ Permanent D'' pster on,Site ❑ THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMEN°r COMMENTS DATE REJECTED DATE APPROVED ❑ ❑ CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_.. Planning Board Decision: Comm Conservation Decision: Comments Water & Sewer Connection/Signature � Date Driveway Permit DPW Tow -0 Engineer: Signature: Located 384 Osgood Street FFIAE DEPARTM� NT Temp Dumpster on site .:yes , -no catedat 124Mair,it3.,w..}.vb ,W,,,ire Departure,itsignature/da#e Y r , , ,; s_ -. �y A� ,, .{ {;x, COMMENTS_'�� E _Dimensicyn Number of Stories: Total square feet of floor area, based on Exterior dimensions._ -Total land area, sq. ft.: -ELECTRICAL: Movement of IVleter.locatdron, trust -or service drop requires approval of :Electrical Inspector Yes N® + _ DANGER -ZONE LITERATURE: Yes No MGL .Chapter -166. Section 21&zF and G min.$100=$1000 fine Doc.Building Permit Revised 2010 Building Department :-.-,The foE"'owinos"a list of -the required.forms to be filled outfor.:the appropriate. permit to: -be obtained. Roofirg, Siding, Interior Rehabilitation Permits o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or3 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 ❑ 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 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) o 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 cans if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals jthat the apo•,al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.tted with the building application I ' I Doc: Doc.Bui?ding Permit Revised 2012 J S LL O D O m v \ O U !n U Q In O� U N z z m C m 'O 7 LCL L W ? C U _ f0 LL OOU W N z C7 Z O t 7 2' _ LL d V1 z J u W t � U_ VI f0 LL oc O u W of Z CA Q C m O K N C LL z W Q W a W LL N ` = m z N y Q v O N 0 W a Cl) CD 0 M m V/ O E Z U N W 1.L 0. a Z _ x O co U) _c W J a, Z 0 a� _ .0 N d t O z O a � J O C, r., E G1 i O O Z CDCM AAi o •- �W�/� Q YI •M a� V 0 0 � O � a -Q CD Q O v_ J cc •CL O d Z V N Branch Name: Boston Branch Number: 31 Installation Address: >6 Purchaser(s): HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold, Furnished and Installed by: Date: THD At-liome Services, Inc. d/b/a The Home Depot At -Home Services 345A Greenwood Street, Unit 2, Worcester, MA 01607 Toll Free (800) 657-5182; Fax (508) 756-8823 Federal ID # 75-2698460; ML Lie # C 02439; RI Cont. Lie# 16427 CT Lie # HIC.05655522; A�A Home Improvement Contractor Reg. # 1261193 City State Zip IU)me Address: (If different from Installation 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 Prniecl Information: Undersigned ("Customer"), the owners of the property located at the above installation address, agrees to buy, and THD At -Home 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 #: (1-t i Reference) �y 7 y3� .rurrc rnone: dome Phone: Cell Phone: b []Gutters / Covers []Entry Doors ❑ �C 2 J o $3p0 IU)me Address: (If different from Installation 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 Prniecl Information: Undersigned ("Customer"), the owners of the property located at the above installation address, agrees to buy, and THD At -Home 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 #: (1-t i Reference) �y 7 y3� ❑Roofing ❑Siding Windows ❑Insulation ec sneetts) 0: Prnject Amount b []Gutters / Covers []Entry Doors ❑ �C 2 J o $3p0 ❑Roofing LJSiding ❑ Windows 0 Insulation []Gutters /Covers ❑Entry Doors ❑_ $ Roofing ❑Siding ❑ Windows ❑ Insulation ❑Gutters! Covers ❑Entry Doors ❑ $ Roofing ❑Siding ❑ Windows ❑ Insulation ❑Gutters/Covers ❑EntryDoors ❑ $ Minimmn 25% Deposit of Contract Amount due upon execution of this contr acL Maine Purchasers may not deposit more than one-third of the Contract Amount. Total Contract Amount $ � �usaomcr agrees mat, tmmeatately 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 Product(s) included herein, at its discretion, if The Home Depot or its authorized service provider detennines that it cannot perform its obligations due to a structural problem with the home, environmental hazards such as mold, asbestos or lead paint, other safety concerns, pricing errors or because work required to complete the job was not included in the Contract. Payment Summary: The Payment Summary included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product (us applicable). NOTICE TO CUSTOMER You are ficate (note: there is onertled to a C Completion Certificate or each listed Product s defined of the Contract at the by indiviou dua Spec'lot Sheet.) before Completion wor on that Product is complete. 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 DEPO'T'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agr and e cement is the entire agreement between Customer ThHome Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements, either oral or written. relating to said Products and Installation. This Agreement cannot he assigned or amended except by a writing signed by Customer and The Home Depot. Customer acknowledges and agrees that Customer has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement. Accep by: X t �. , Customer's ignature D to Customer's Signature Date CANCELLATION: CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUTPENALTY OR OBLIGATION BY -DELIVERING WRITTEN NOTICE TO THE HOME r... DEPOT, BY MIDNIGHT ON THE THIRD BUSINESS ?, DAY, AFTER SIGNING THIS AGREEMENT, THE '.� STATESUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS 5)ECiFICALLY PRESCRIBED BY LAW IN �+1ST011fER'S STATF pt([Cr+ (; �JYti7'IL'E ADDPMONALTEIdAfs AND CONDITIONS ARF: STAT N'Y�t.�.aL..lai.9 s"'.ez �'^'.'k��. ns1.. •,G .., t Submitted Sales Consultant's Signature Date Telephone No. C� 7 — ]y- -- Sales Sales Consultant License No. (as applicable) BD ON 7'DR REVERSE: SIDE AND ARF. PART Oh TRIS CONTRACT 4 4 DATE (MMIDDIYYYY) !" ® URANCE 02/1912014 OF LIABILITY INS. A ATE_ IFIC PON THE TE IS THI TIfICATE IS ISSUED ASA MATTER OF IN AT VELY AMEND, EXTEND AND OR ALTER.FERS NO TfIiE COVERAGE AFFORDEDABY THE DPOLICIES CEIt.T1FICATE DOES IN AFFIRMATIVELY.:OR NEG AUTHORIZED BELOW T}l5 CERTIFICATE OF INSURANCE pOES ,NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING lNSIJRER(S), REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. les must be endorsed. If SUBROGATION 15 WAIVED, subject #o m IMPORTANT: If the:certlflcate hoider,is an ADDITIONAL INSURED, the policy(` ) the`.terms.artd conditions of tti� poticy, certain policies may resguire an endorsemen#• A statement on this certincatr does not confer rights to tilt ce Tk i- ats holder :in lie u of such endorseme.n s). CONTACT PRODUCER r f NAME: MARSH USA, IC IC TWO. PHONE FAX No t: ALLIANCE 'ENTER EMAIL. 3560'LENOX ROAD SUITE 2400. AoDRESs: NAIf p ATLANTA, GA `30326 INSURER S AFFORDING COVERAGE 26357 INSURER A: Steadfast Insurance Company 100492-H6imb-dAW 14-15 Zurich American Insurance Co 16535 INSURED INSURER B: 23841 New Hampshire Ins Co THD`AT HOME SERVICES; INC. INSURER C : 23817 DBA THE HQME ME DEPOT AT HOSERVICES Illinois National Insurance Company 2455 PACES FERRY ROAD INSURER D ATLANTA GA 30339 INSURER E INSURER F COVERAGY PERIOD ES CERTIFICATE NUMBER ATL -003242685-01 REVISION NUMSER:3 THIS IS TO CERTIFY THAT THE POLICIES OF IN MEMN TERM OR CONDITHE Il,4SURED NA ELOTION OF ANY CONTRALTHAV.O OR OTHER DOCUMENT WITH RESPECT TO E ABOVE FOR THE WHICH THIS wit -;-.A. ANY REQUIR INSURANCE..OLICIES DESCRIBED CERTIFICATE MAY BE ISSUES OR MAY PE� CI S. L MI SHOWN MAY HOVE BEEN REDUCED BY PAID CLAIMS. HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH P0.. , :, po-ICY EFF POLICY EXP LIMITS INSR ADDL SUBR pni ICY NUMBER MMIDDIYYYY MM MY 9,000,000 LTR TYPE OF INSURANCE 0310112014 0310112015 EACH OCCURRENCE $ A GENE RAL LIABILITY GL048877i4-04 DAMAGE 10 RENTED 1,000,000' REMISES Ea occurre ce $ EXCLUDED X COMMERCIAL GENERAL LIABILITY :: MED EXP (An one person) $ LIMITS OF POLICY XS 9,000,000 CLAIMS -MADE a' OCCUR. OF SIR: $1 M PER OCC PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ 9,000,000 PRODUCTS -COMP/OP AGG $ 9A00,000 GEN'L AGGREGATE LIMIT APPLIES PER $ X POLICY, PRO - X LOC COMBINED SINGLE LIMIT 1,000,000 BAP 293886311 0310112014 0310112015 Ea acadent B AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ X .ANY AUTO BODILY INJURY (Per accident) $ _ ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG PROPERTY DAMAGE $ a AUTOS P racclden NONAWNED; . HIRED AUTOS , AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAR OCCUR.AGGREGATE $ EXCESS LIA6 CLAIMS -MADE : $ DED RETENTION - W0049101862(AOS) 0310112014 0310112015 X-WGSTATU-OTN- C WORKERS COMPENSATION 0310112014 0310112015 1,000,000 AND EMPLOYERS' LIABILITY. Y 1 N WGO49101884,(AK, AZ, VA): E.L. EACH ACCIDENT $ 1,000,000 C _ ANY PROPRIETORIPARTNERIEXECUTIVE . N N.1 A 0310112014 0310112015 E.L. DISEASE'- EA EMPLOYE $ OFFICERIMEMBER EXCLUDED? WC049101883 (FL) 1000,000 d (Mandatory In NH) : E.L. DISEASE -POLICY LIMIT $ if,yes describe under 1,000,000 DESCRIPTION OF OPERATIONS below WC049101885 (KY, NC, NH, VT) > 03101/2014 0310112015 (EL) LIMIT C. WORKERS COMPENSATION 0310112014 0310112015. C WCO49101866 (NJ) DESCRIPTION OF OPERATIONS.I LOCATIONS (VEHICLES. (Attach ACORD 1ol,:Additional Remarks Schedule, It more space Is.required) _ EVIDENCE OF INSURANCE CANCELLATION .CERTIFICATE HOLDER HOME SERVICES, INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THD AT- DBATHACCORDANCE WITH THE P .HON1E DEPOT THE EXPIRATION DATE THEREOF, NOTICE' WILL BE DELIVERED IN 2455QACE6 FERRY'ROAD _ OLICY PROVISIONS. ATLANTA, GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. ManashiMukherjee ©1988-2010. ACORD CORPORATION. All rights reserved:_, ACORD 25 (2010/05)- The ACORD name and logo are registered marks of ACORD -SI JO'sy vat NM" i ......... .=n