Loading...
HomeMy WebLinkAboutBuilding Permit #566 - 406 CHESTNUT STREET 3/23/2010 i I BUILDING PERMIT OF NOeDTH '9ti TOWN OF NORTH ANDOVER 0�4'`,''` APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received gDwTED•�'`4`� gsSACHUSE� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER, MAP 210 PARCEL:- ZONING DISTRICT: Historic District yes o _ Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Res' Non- Residential New Building O e Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed'District Water/Sewer DESCRIPTIO OF WO BEP EFORMED' Awl, Id n 'ficati Please Type or Print Clearly) OWNER: Name: r Phone: I Address: ` 0 CONTRACTOR Name; _�r Address: Supervisor's Construction,License: Exp. Dater Home Im rovement License: I' ExN. date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ q� FEE: $ Check No.: 2Erl a Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access t t e gl#zraptyfund Signature of AgentlOwner Signature of contractor Locationtio/ `rr O No. ok-1 of! Date � ) 140RT4 TOWN OF NORTH ANDOVER , O 9 Certificate of Occupancy $ +s ESQ' Building/Frame Permit Fee $ sACMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 0 22671 1 -- QBuilding 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 Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp Durnpster on site yes. no Located at 124 Main Street Fire Department 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.$10041000 fine NOTES and DATA— (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2010 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 o 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 a 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 o Two Sets of BuildingTo Be Re Plans (One turned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) E3 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 Doc:Building Permit Revised 2008 03-16-2010 09:57 FROi1-HUEDEPOT2685 +919789466421 T-935 P 001/006 F-515 PLEASE KE tr'cull;, " Sold,Furnished and Installed by: Branch Scr ac: Boston Date: _/LI'�._ THD At-Home Services,Inc. d/b/a The Horne Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number-31 Toll Free($00)657-5182; Fax(508)756-8823 Fcdcrui ID#75-2698460;ME Uc#C 02439;RJ Con-Uc#16427 CT Lic#565522;N4A Home Improvement Contractor Reg#126893 Installation Address: City State Zip Purthaser(s): Work Phone: dome Phone: Cell Phone: Ju O y c Home Address: l (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 nwkt:ting emails from The Home Depot Ziect 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#: nam+ n�rl Procts; Socc Sheet(s)#: Pro'ect Amount Roofing ❑Siding indows []Insulation $ _ CGuaers/Covers []Entry Doors ❑ t[ Roofing ❑Siding ❑Windows]Insulation $ ❑Gutters/Coven ❑EntryDoon Q Rooting ❑Siding Windows D Insulation $ CGutters/Covcrs DEauy Doors❑ Roofing ❑Siding M Windows ©Insulation S ❑Gutters/Covers DEnuy Doors ❑ t� 1lirtinturn 25 A Dtpa®t of Contract Amount doe upon ea:ewtioo of this eattrttct Total Contract Amount $ MainC Po rchasers may not dVosit more than one-third of the CunlzaM Customer agree that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for caeh Product w 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 Homs;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 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 pan of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product.(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy or the Contract at the time you siert. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work 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 amomtts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE ROME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LLNIMNG THE HOME DEPOT'S OTHER REMEDIF,S FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and understands that this Agreement is the entire agreemenr between Customer and The Hame 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 Insudlation.Thio Agreement cannot be 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. Accept Submitted byt Customer%,Signalitife Date Sales Consultant's Signature Date X Telephone Nlo. t Customer':;Signature Date Sales Consultant License No. _CANCELLATION: CUSTOWR MAY CANCEL THIS les applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE TBM BUSLPTESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE Xi' ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TEFWS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART Oi;TIIIS CONTRACT 11-30.09 CSG White—BranchFle Yellow—Customer Pink—SalesCorsultani I UL.p;lrtincfit nl Oki 11Jlk' \;ilCl1 WI (3u:n'(I til t3uil(lin� K�_ul:tlinn: ;111(1 �.T Construction Super7isor Spec(i1lty L1ceri5c L cense: CS SL 100696 ReS(ftC(cd to: WS ALAN PAIN'"tN 11 16TH AVENUE HA.VERHILL, IMIA01B30 Expiration: 8!21!2012 l ��nm�i.:o•nrr 7r» iG0696 "1 •ter ,1 ZJ SolarHea,Clain Co&i cion" - F�r1J . �M' (1ytrldx7'�Gxvt+6d¢Erargia Alar •'. '0 . 32 1 . 6 ..0 : 29 A.DDi GI GAL PERFORMANCE RAnNGS VIsibleTrans•iimnce 7ru%m to am dt(ja vwD4 0 : 52 uru*vv lr�dara,;x m-ftmmQvcItb 4,--padj-ftrvp�a �r resp va�Crt�wi ks t�ret d rrnA0rvirri0l m40Qa and r�a��a�.}fPL dor nOQ r�t'�'d.8:Y psi ' and daw nit w%n (,v ..ft h d nr F-xw,tr rrf vek AL cn n am—A cur gal-4 mrkb r • - • . - ►acrtr�rn 4..rocrtrcap ,tote m� 4m m aka a amdo t� �v .MSC pia de�m}® d m ls�bd ad' podlffi L[s` &IR urub oa�fflC ry do�*Ti�axru ►1Tb�O �ee°1 Y.un�rroro d�o®tm'-. sq cdca,MRL re r8anyr�4v.n,�fu w ?s J smib - ' "UnLC gilLLLiu fob. C>6ftCC .911EC Ca�.7.�1_ •9u...c.nrj'nt��l_ fo..tR4.n. . Li—Ld-ld oaLf.fLca p--' 1�(•)_ ccl LOn(��I Q1rGl�CL ]L.1.A: Nock. . Nock CanCcaL,'s c Cantcal, 9..c_ ' • I4G: fteln. 00/CL1aa J/�1"/K-(LIQ- ' pIHO. Uf..t,,z Q0/VLd.cLo 2.31 Tan/H-.Rt) +!1 C / Q,5 1:LAAfo pcobtdo: IL.1 C.n�'1Ga UIQ- --- �a77J _ HS Kcrcun 2]JLIIQ. E�9�C9S/Q' __..w_.. SUr fibex To Inca rtvn'A1t ww.mr�trtzQor Cued.arta rr�v nn para 90 -�rrt rbo6nr QiEtbT SUC rom m ocu rtm ao m .0 tk1i r r rvl an I Qrrtol�l _ _�_wTr_m_a Balt/ o f'.�faeeac�tr � Board o(Buildiog Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration:, 126893 Expiration:_B(312010 T.ype`.•Suppternent Card The Home Depot At•Home Service C).,_u 6,Q n Fal I nNF DAT'(MMiCD,YY^/) ACORD CERTIFICATEF UABil-� INSURANCE f PRODUCER 2-4e4044-;95-3000 T}iiS %E :liF'CRTE fS iSSU=D AS A NTA-, rER OF ! C'r+ Y \ ) RIGHTS U, O`i G F C ;cars: US'-_, Inc. :load In, c-c l _. ...NZ8 CO ... .__...-I 71R7 ( L-.ta, G? 3033) ---------= ---' -T COVERAGES THE POLICIES OF WSUP.ANCE LISTED BELOW NAVE BEEN ISSUED TO THE INSURED`TAMED ABOVE.FOR THE POLICY PERIOD iNDICATED.NCTMNITHSTAN DING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE lNSUP.ANCE AFFORDED EY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCK POLICIES,AGGREGATE LP PITS SI-ICVVM MAY HAVE BEEN REDUCED BY PAID CLAIMS, !NSR� DO'!T—_ POLICY_F.EGTIVE i_id.itTS LTR N TYPE F il^J^,A C- i POLICY NU°ri3�R i CST- '�diCD,Y1''•""''' A i L�iEwtiUABitkTY fCLQ4387714-00 03/01/10 03/01/11 iEACHOCCURRFNC'c., 4,000_000 '-DANIAGE TO RENTED --- _. --� ( X OMfidERGTAL vEN=P.AL LiA61!'C'�` PREMISES!Ea occurrenca)_-, 3 1,000,v 0: - = ` t y } --- ' 1 CLAIMS MAGE (X !OCCUR! 1 IVIED EXP r a e pe J� $T'Y(2tTDED -+-� I �PERSONr\C8 pub INJURY- s$-9,000 000 I •.I ( --- GENERALAGGREGATE i S 4,000,000 I �RODUCT.GEv'L AGGREGATE Lti+fiT APPLIES PER:! I S-CONIP!OPAGG S 4,000,000------ --•- i X i POLICY 1 ��PR�_7 w 2q^ I ! 03/0'-/:11 b AUTOFdCBRELIABILiTY 18=-- �31?53-07 03/C1/I0I COMBINED SINGLELINiIT i i S 1, Cv^^,000 I X i ANY AUTO I !(Ea accideeL; - j 1 ; ! I t—I ALL G!'V<`•iE0 AUTOS , {I I i BCOtLY ItJ!URY i S (Per person) I 1 SCHEDULED AUTOS I --'------�------------ 1 I{ H!RF_u^AUTOS � i � 130CiLY INJURY S (Per accident) _ NON-CAWED AUTOS I - ------- ------ '--' X t SEL? INST3II AUTO I ( _�..._._.....-.-----....---._._ _----__ _ P PEROPERTY DAMAGE {S (Peracc!dent),- 1 I ( PHYSICAL DARrAGS ... . I �AUTO ONLY�EAAC_CIOENT. _ ...------.--.-----_ GARAGE LIABILITY _I I ,� ;+ ' I ANY AUTO I OT'riER TH,';_N EA ACC F AUTO ONLY: AGG'3 A {_EXCESSIUld6nE!.LALiAA.BiLITY GL04337714-00 03/_ 02%20 .03/01/11 EACiiOCGLIRREiiCE I n:,00^•,000 X OCCUR I CL.AIMSMAOE ' {r.GGKEGATE,--_-_--_,..._,_....i 3 5,000:000 DEDUCTIBLE r RETENTION S I 1 i V✓C STA7J= i '0TH-� I C WORI<ERSCOMPENSATION I,yrCO20342355 (AOS) T-03/01/101 03_!01/17. i TC' n, AND WORKER EMN COMD LIABILITY L=2QRY-L103.,._._...�3 L____.._._._a.__._-.------- AND i oa 03 01 I.L. 00G,000 111111 D 'ANY PROPRIETOR/PARTNERJEXEOUTIVE . IIWCO20342356 (CA) 03/01,,10 / /11 _-_EACHACCIDENI __" OFFICERfMEMBER EXCLUDED': �� + I ' _ E '(MandatnryinNH) IWCO20342357 (EL) I 03/01%10 D3/O1/11 LELDISEA5:-EAEMPLOYE�'S 1,000,000 10 yes,describe under L_ !E.L DISEASE-POLICY LIMIT I S 1,000,000_— I .SPECIAL PROVISIONS be!ov: OTHER - I TNSC45242373 (^X) I 0.3/01/10 ! 03/01/11 Occurrencs/5IR 30M/2I2,,,,,_ E �Telorker$ TX'Employers EKc¢ss - I C3/01/IO 03 DI/11D Compensation iWC09205&0 (QST} / WCO20342356(RY,MO,NY,WI,+IV} 03/01/101 .03/01/11. C (Workers Compensation —1_ I _ -- ---•-- — DESCRIPTION OF OPERA(IONS!LOCATIONS:VEHICLES I EXCLUSION5 ADDED BY ENDORSEMENT!SPECIAL PROVISIONS _ "RE.,EVIDENCE Os COVERACE - CERT:F,CAIEHOLDER -- CANCELLATION - SHOUL0.4":Y OFTHE ABOVE DESCRIB FD POLICIES BE CANCELL'cD 3EFDRE THE EXPIRATICN DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAk. 30 DAYS'✓✓F;ITTEN THE HOME DEPOT, INC. � " NOTICE TO THE CERTIFICATE HOLDER NAMEDTOTHE LEFT,OUT FA!L L`RF T6 00 SC SFr,LL'_ HOME DEPOT U.S.A., INC. IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE;NSU P,ER,IT"AGENfS OR 2455 PACES PERP.Y ROAD NW REPRESENTATIVES, —_— —� EUILDING C-20- _ AUTHORIRDREPRESENTATIVE ATLANTA, .GA 30339 USA t ACORD 25,200910-1)- .. .. . Q 1988 '2009 ACORD CORPORAT-ON A--right"rlriS ea Tie U,"; c�;^N�ea th o�,�ii�isac%r�s��s \, ��r.re';'�",'��•;�•p�'��1�rts�Piarr'��C�?ll2s 1"�---"--1j-----��� ',,,iii ^i. J��IY G.1.s�.�• •� ,_ � Y3 (.�._.._�.�_.. L_�_. 7 rl._ i� l ti'l c iii_O� ii '�c_ c_ -- iron � P-rL-.t Linz. _ I l; Iicarlt hform a rin (BtsiaesslOro3�>zatiov -r ividual): Address: ' 3-) Phone#: i•��, ` City/State/Zip: 14.1 Type of project re uirO): Are you an: ployer? Check the appropriate box. p 1 ( q 4 ❑ I am a general contractor and I �New construction 1•❑ a employer wi _ - , -- - •- have hired the sut-contractors e 7. ❑Remodeling employees(full and/or part-tiln ) W listed on the attached sheet_ 2_❑ I am a sole proprietor or-pa?�e1- These sub-contractuis have 8. ❑Demolition ship andhave no employees employees and have workers' 9. ❑Building addition working for me in any capacity. comp.insurance t [No workers' comp.insurance We are a corporation and its 10.0 Electrical repairs or additions S. ❑ required.] officers have exercised their 11.❑Plumbing repairs or additions 3.❑ I am-ahomeowner doing allwork. right of exemption per MGL 12.❑R repairs myself.[No workers' comp. c 152, §1(4),and we have no 13. Other insurance required]t employees.[No workers' comp.insurance required.] +Any pp all work and then hire outside contractors must submit a new affidavit indicating such. applicant that chocks box#I must also fill out the sxtion below showing their workers'compensation policy information_ t Homeowners who submit this affidavit indicat ng�cY ere doingthe $Contractors that check this box must attached an additiona�sheet,�wthrcv werkcri ocompspolicy numbcr�d state whether or not those entities have cnployccs If the sub contractors have employees,they nl P nc X am do employer that is providing workers'compensatlon insurance for my employees Below is the policy anu�ruShe in orrrwtiorL — —Lnsurance Comp_ am•e;_---- Expiration Date: Policy#or Self-ins.Lic.4: ! 1 rpt _ ��n�+�",n4 City/State/Zip: Job Site Address:— Attach a copy of the workers' compensation Policy at decof MGL laration cog 2 can lead to the impos do of cnriminal peaalti e of a e p u. ed under Section 25A Failure to secure coverage as req ' fine up to$1,500.00 and/or one-year imprisonment,as well a civil penalties in the form of a STOP WORK ORDER ana of u to�2So.00 a day against the`isolator. Be advised thatoa copy of this statement may be forwarded to the Office of p e vertficatl Investigations of the DLkfor insurance cVtr-ag I do hereby certify u der h �7ja in nd eQtfes of perjury thal the information provided above is rue nd correct. 1/ Date: S;Ignaturt7 phone 4: Off cia(ztse only. Do not write in this area, to be completed by city or town ofTcial :..._..____.�.._.__. permit(License f, City or Town: Issuing Authority(circle one): 1,Board of Health 2.BuildingDepartment 3. City Clerk 4.Electrical Inspector S.plumbing Inspector 6. Other phone#: r FORTH TON*NM of __ 4Andover - LAKE o dover, Mass.,rn � -a3• rc- COC MICM..C. ORATED `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT........ .. ...1. -. .. .......�.... .. 2.L..C.�t�. ................................................................................... Foundation has permission to erect........................................ buildings on......'T'� ........e--f!I; 7� sT ................. hough �- i-� Chimney to be occupied as........... . ......w�...... N .......................................................:...................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUCTI. - STARTS Rough Ser ................ ...... _— vice BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a Conspicuous Place on .the Premises — Do Not Remove Final No Lathing or Dry the To Be Done Until Inspected .and Approved by the Building Inspector. FIRE DEPARTMENT Burner Street No. IFSEE REVERSE SIDE Smoke Det.