HomeMy WebLinkAboutBuilding Permit #298 - 412 MASSACHUSETTS AVENUE 10/28/2008 BUILDING PERMIT Ot OORTH q
TOWN OF NORTH ANDOVER o?
APPLICATION FOR PLAN EXAMINATION
V �
Permit NO: Date Received
Date Issued: -�
��SSACHIJ`''����
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IMPORTANT: Applicant must complete all items on this page
LOCATION
Print
PROPERTY OWNER
Print
MAP NO: Y� PARCEL: ZONING DISTRICT: Historic District yes no
Machine Shop Village yes no
-TYPE OF IMPROVEMENT PROPOSED USE
Re ' Non- Residential
New Building
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
DESCRIPTION OF TO PREFO MED:
7:02 4t,
\� 1JQCD6
4l
I entifica on lease Type or Print Clearly)
OWNER: Name: Phone: 62�V:51103
Address:
CONTRACTOR Name: t Phone: 3
Address:
Supervisor's Construction License: '� � Exp. Date:_
Home Improvement License: Exp. 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: $ FEE: $ q
Check No.: f)e-) Receipt No.: cr)1 1
NOTE: Persons contracting -t unreg' ered contractors do not have access o e g ar ty fund
i
�_ignature of Agent/Owner Signature of contractorA- IV-
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Swimming Pools
Tanning/Massage/Body Art _
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 Siqnature
COMMENTS
a
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 Dumpster 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.$100-$1000 fine
NOTES and DATA— For department use
❑ 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
❑ Building Permit Application
❑ Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
o 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
Li Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o 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
o 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
o 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
Location �/ mw 7f
eIN
No. a Date p�
NOR7h TOWN OF NORTH ANDOVER
?O:� . o :•1,x.0
O
F w
P
Y
+ ; : Certificate of Occupancy $
CHU <� Building/Frame Permit Fee $ �d
Foundation Permit Fee $
Other Permit Fee $
�( TOTAL $
Check # 1 U
2iG 'L. 2
Building Inspector
OCT-23-2008 02:24P FROM: TO:18665208390 P.7
ROME TMPROVEMENT CONTRACT
PLEASE READ THIS
Sold,Famished And installed by,
Branch Name; Boston Date:/0 / /_ THD A144ome%rviees,Tnc.
d/b!a The Home Depot Ai.home Services
branch Number: 345A Greenwood Street,Unit 2,Worcester,MA 01607
Pforth 33 []South 31 Toll Free(900)657-5182; Fax(508)756-9823
Federal ID#75-26911460;ME Lie#C 02439.RI Cont.Lie#16427
41 ('r Linc'#SM522;MA Homc improvement Contractor Reg.#126993 �r
[rMtailallonAddress: !� a _1aSGC -a�� t�1 �►a'1�0t1��, f-
City StateZip
Pnrafiaser{s): Work Phone: Home Phone: _. Call Phone:
Home Address• —
(Tf different from Installation Address) City State Zip
E-mail Address(to receive project communications and Homo Depot updates):
❑1 DO NOT wish to receive any marketing emails from'Ilhe Home Depot
Proleet 3n[ormation: tjndersigned("Customeel,the owncn of the property located at the above installation address,agrees to buy,
nail THD 1t-Homc 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 Shoet(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'):
.lob 9. arremoi Ro Pr oats: Sec Shed(s)S: Pro' t Amount
[]Roofing. Siding._ Windows. .Insulation -yt r/ 24-100utters/Covers ❑Eatty Doors C1 C+
Roofing tjSidinp C3 Windnws El insulation $
[]Gutters/Covcra []Entry Deers [ _ _„_
Roofing Siding El Windows LJ Insulation $
❑Gutters/Covets ❑EntryDoors❑_..
Roofing OSiding Windows ❑Insulation $
[]Gutters/Covers []EntryDoors 0__ .
Minimum 25%Deposit of Contract Amount dile upon caaxdien or this euohwL Total Contract Amount $ "7 LJ! 6z
Maine Purcnji r may flat depmk more than one4hbrl of the Contract Amount [-"6 b
Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Cortifu are
(une fur each Product as defined by an individual Spec Sheet)and pay any balance duo. 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 Products(s)included herein,at
is discretion,if The Hente 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 lend paint,other safety concerns,pricing errors or because
work required to complete the job was not included in the Contract.
Pnvment Summary: The Payment Summary#Cg33 'l !, included as part 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 of the Contract at the time you sign. Do not sign a Completion Certificate(note'
there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work out that Product
is complete.
In the event of termination of this Contract„Customer agrees to pay The Home Depot the costs of materials,labor,expenies
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 WiT11HOLD AMOUNTS
OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMtN OR OTHER PAYMENTS MADE, WITHOUT
LIMITING TILE ROME DE'POT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. i
Acceptance and Autharization: Customer agrees and understands that this Agreement is the entire agreement between Customer
and The Home Depot with regard to the Products and installation services and supersedes all prior discussions and agreements,either
oral or wriucn,relating to said Products and Installntion.This Agreement cannot be assigned or amended excopt by a writing signed
by Customer and The Homo Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the
terms of and has received a copy of' is Agreement
Aece ted by: Subm' cd by-
191 L$M . x 10LIU1,98
Cu er's Miniature Date Sales Consultant's Signature Date
X Telephone No. .SSD-R—Zero-Y4�I
Customer's Signature Date Salcs Cuosultant License No. _
CANCELL&T_ION: CUSTOMER MAY CANCEL THIS (u appticabml
AGREEMENT WrMOUT PENALTY OR OBLIGATION
BY DELIVERING WRITTEN NOTICE TO THE ROME
DEPOT BY MIDNIGHT ON THE THIRD BUSINi~SS
DAY AFTER SIGNING THIS AGREEMENT. TH.E
STATE SUPPLEMENT ATTACHJW HERETO
CONTAINS A FORM TO USE IF ONE IS
SPECIFICALLY PRESCRIBED BY LAW IN
C_f_i_ST_OMER'S STATE.
NOTICK:ADDITIONAT.TERMS AND CONDITIONS ARF,STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT
"liza CSC White-Branch File Yellow-Customer Pink-Sales Consultant
AORTH
Town of
C% o W �` dover, Mass., '
- A.
GOC ICEWICK y
7�AoRATE0
qS E� BOARD OF HEALTH
Food/Kitchen
PERMIT T D . Septic System
&r.
� � 410�
BUILDING INSPECTOR
THISCERTIFIES THAT..................... . ...................... ................................................I........................... Foundation
�' � *04.00................... Rough
has permission to erect.................... ................. buildings on ..... .. .. .. ......... ...... .. ... ...........
... ... !��...............................�........
to be occupied as........�1.3....... Chimney
provided that the person accepting t s 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
d• PES EXPIRES IN 6 MONTHS
ELECTRICAL INSPECTOR
UNLESS CONSN TATS - Rough
.......................................... Service
BUILDING CTOR
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 Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
SEE REVERSE SIDE Smoke Det.
063-1-379 43-43 DS Vin;i 1 .Vinila
l
51,311 Product
Do�tDla-{•ung 1 Vatltana de dobla 7u1110t1da
Argon/Prh3h/a_ I Argon!?=hsolar �_.
NedoralFenesbatlan 3/32" C1222 1 2.38 mm Vid=ia
No Lazinatad Class 1 stn v1dr10 laminado ,
® No Crids I SiA rajiLias
ENERGY PERFORMANCE RATINGS
EOU A=N DE RENDIMIEMO DMRGM=
U-Factor Solar Heat Gain Coefficient
Fkwr-U CoefiftuGarwWa de Energia Solar
/0 . 32 1 . 8 0 . 29
a ADDITIONAL PERFORMANCE RATINGS
EVAUJA=N SUPLEMEMARIA DE PENDMMENM
Visible Transmittance
hansmWon de LraVisible
0 . 52
MmMechaer stiprYsha Sat Saes radrge cadtxm to appacabb MitC ptocadrsee far detertnkdrrp while prochrct perfartnerrce rvfltc
• relfnpe are delernrirod tot a hoed set d errehonmerdai arrdSene and a spedec product sbe.M'i1C dose rot racortunend sry product .
W does not warrant the s llal ft of any product for any spa*uee.0orardhrreadxlur 7 alsebsa br off ar product pedarnmnce '
trdormdfon.www.rdroap
rste tebntearrte esSprda qua edoe wdaee canplen can me procedrroeninn ep0wft de MRtC para detenntar d renOnlenfa toad del
po&ift Lae vam rieedoe pw M'iIC son detemdrft por un canparto Sp ds oorrmc', ambWfta y rn bv,w o de produclo
eepxdlco M•itC no necanbrda ntpar prodreclo y no ell que d pmdubW seri edecwdo Pena un NO ea wAm Car vub can d ..
toaeoo del tebricante para d ueo apropledo de este pr�edrrcto.wwurrdro.arp
Unit Vaiitias for ENERGY STAR
=agion(a) : NortharA, North
Cant:al, Booth CoAt■aL, JorthnsA.
i
LA anidad naLLtioa pa:a "A(&) SKROf STAR
l y' ragien(p) ENBRCY STAR: Norte,
Norte CRAtral, sur Cantral, Sur.
•• � IND: EtaiA OOJGla92 3/32"!R-R43 .
Tastad sisa: 36" x 63"
IND: Ratuarso OG/Vidrio 2.38 mm/tf-R45
DP : +451-45 Tavuto prcbado: 91.4 = x I60 es►
E5909�f C� 407.73. Ns Hoffman 2951120
Keep ft W for p*Ab ENERGY S'UR're ft To Inn moa visit www.erreryysftp
Ikmr a este etiqueb pa poslk aemkim ENERGY SW No Garroter mils aama de 00,vWte wwr enerpystacpmt
• �----- �i e �oo�iynaui�eall� o�✓�aaeac�lu�aella
Board of Building Regulations and Standards .
HOME IMPROVEMENT CONTRACTOR
RegistC1IQA:N 126893
Ex� ..N.-MM/2010 _
� e��upplement Card
i.
ll
The Home Depot Acirrie� ia e
RICHARD FALLO(yE 'y
3200 COBB GA LLEFt1IEG� `'Ik20
--- RTI ANTG nA vn-A-1 �'w
The Commonwealth of Massachusetts
Department of Industrial Accidents
n. Office ofInvestigations
600 Washington Street
Boston,MA 02111
WWW.mass.,,oo/dia
'orkers' Compensation Insurance davit: Builders/Con tractors/Electricians/Plumbers
`y Please Print Legibly
A olicant Information
Name(Business/Organizatiowbdividual):
Address:
O�
City/State/Zip:
A'Tltn�i' �'��,�� Phone.#'
an employer?Check the appropriate bor. Type of project(required):
Are Y 4, I=a general contractor and I
Io ,r with 6. ❑New constiuction
1• I ant a emp .Y -- —,e have hired the sub-contractors
( `and/or part time). 7. Remodeling
•
employees �" , listed on tha'attached sheet
2.❑ I am a'sole Pi;opnetor or partner- These sub-coattactors have g, []Demolition
ship and hove no employees employees and have workers' 9. ❑Buildfng addition
working ifor me in any capacity. comp.iasnraaceJ.
o workers'comp.insurance 10.❑Electrical repairs or additions
[N 5. (� We a corporation and its
required] . officers have exercised their 11.Q Plumbing repairs or additions
3, I am a homeowner doing all work mp P 1211irs
right Of exemption Per MGL Roof re a
myself[No workers'comp. c.152;§1(4),and we have no 13.
insurance required•)t employees.[No workers'
comp.insurance requited.]
the section belowshowing their workers'compeaaation Po6cY information.
Any applicant that checks box#1 must
also fill out • a new a$dsvit indim g
t Homeowners who submit this affidavit indicating they are doing ail work and then the name of thhire eisub•eonftetors antside contractors must
stat4 whether or not those entitin haveshect .
=Conftch"that check this box must attached as additi must u �showing dicir � .Palley number.
employea. If the sub-contractors have employees,they
that is providing workers com ensatlon insurance for my employees Below Is the pocky and Job site.
I ilm an employer , P
information
Insurance Company Name:
Expiration Date: /
Policy#or Self-ins.Lic.#: h
City/Statc/Zip: (I�
Job Site Address: and
Attach a copy of the workers'compensation policy declaration page(showing the policy numbefcntirentialties of a•
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imp P
fine up to$1,500.00 and/or one-year imprisonment,as well is civil P � m the form of a STOP WORK ORDER and a fine
a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
of up to$250.00
Investi 'tions of the for insurance covers a verification.
Ido hereby cerci r p sand penalties of perjury that tl:e information provided abov is and correct
Si afore:
one#:
Offutal use only. Do not write in lis area,to be comp etc by c or town ofciaL
City or Town:
#
Issuin; ect
Authority(circle one): or
1.Board of Health 2.Building Department 3.CitylTown Clerk 4.Electrical Inspector 5.Plumbing Insp
6.Other
_Phone#:
Contact Person: I
OATEIMM/OO:YYYYI
AC0'RD. BRT �GATB OF.LIABILITY INSU�NC8 02/za/ae.
1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ROoucER ONLY AND CONFERS NO RIGHTS UPONTHE CERTIFICATE
a-sh USA- Inc. HOLDER. THIS CERTIFICATE ODES NOT AMEND, EXTEND OR
ALTcR.THE COVERAGE AFFFCROEO BY THE.POLICIES BELOW.
tmede?at.eert-equast(9ma-ah.eam
+-y 74edmont Rd :r•. Suits 1200
:.arta, GA 30305 ` INSURERS AFFCRCINGCOVERAGE INAICX
yx (;11; 943-0901 '
;NSI:aEAA;S:aad:33t .r1 Ca. 1 1577
.,aL]ecat U.S.A. inc• NSCAE39:3ur:ch Alta: cui i^s Co 15:31
is acme Oe?at., Lrc. - +naia t}At: Lea —
V,3 P.acas Par_[ Raad NSIRERC:=•--
uld:nq C-e INSURERO:Ame-ican Home Aasur Co 193:00
aarca, GA. 30339
..: NSUREi::New Hampshire Ins Cc 23841
OVERAGES
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEdrTO 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 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.
POUCY6FFECTNE POLICY EXPIRATION UNITS
5-1 DOIL POUCY14UMBOR
t' GENERALUAaIUTY. . ;
SPA 3751 601-02 03/01/09 03/01/09 EACH OCCURRENCE $4.000,000 .
X . . DAMAGE 70 KINTEr—
COMMERCIALGENE LOBILITY LIMITS OF POLICY ARE EXC SS .13REMISES18 11,000,000
CLA)MSMAOE OCCUR "OF SIR: =1,000,000 'PSR CC" MEOEXP(Anyone panon) $lXCLUDED
PERSONAL A ACV INJURY $4,000,000
GENERAL AGGREGATE 34,000,000
F
PRODUCTS-COMPIOPAGG 14,000,000
GENt AGGREGATE UMITAPPLIE3 PER:.
PR
x POLICY AT LOC 03/01/09
1 AUTOMOBILE LIABILITY HAP 2930963-OS 0]/41/08 COMBINEDSINGLENGLELIMR $1,000,000
(Ea accident)
X ANY AUTO
ALL OWNED AUTOS BODILY INJURY 3
(Par Panora)
SCHEOULEOAUTOS
HBODILY INJURY
IRED AUTOS. 1
(Par accident)
NON-OWNEDAUTO3
X SELF INSURED AUTO PROPERTY DAMAGE S
(Par accident)
PHYSICAL DAMAGE
AUTO ONLY.EA ACCIDENT 1
GARAGE LIABILITY EA ACC 1
ANY AUTO OTHER THAN
AUTO ONLY: AGG 1
SPR 3757 608-03 03/01/08 03/01/09 EACHOCCURRENCE 15,000,000
EXCESSNM8RELLALIABILRY 1,000,000 '
AGGREGATE t
x OCCUR CLAIMS MADE
S
S
DEDUCTIBLE
S
RETENTION S. 03/01/09 X WCSTATU• 0TH-
WORKER'SCOMPENSATION AND 1928757 (FL) 03/01/08
EMPLOYERS'L1ASIUTY 1921756 (CA) 03/01/01 03/0.1/09 E.L.EACH ACCIDENT 11;000,000
ANY PROPRIETORIPARTNERIExECUTNE0]/01/01 03/01/0! E.L.OISEASE•EAEMPLOYEE $1,000,000
OFFICERIMEMBEREXCLUDE01 1929755(AOS)
II ysa.datolbeunder E.L.OISEASE-POLICYLIMIT $1,000,000
SPECIAL PROVISIONS Oalaw
OTHER TNS-1245197967 (TX) 03/01/08 03/01/09 ccurrence/SIR 25x/2M
Tx Employers ZXCGSB 1938759 (ASI) 03/01/00 0]/01/09
workers Compensation
workers Coslpensation 1920738 Me MO, NY, WI) 03/01/08 03/01/09
SCRIPTION OF OPERATIONS f LOCATIONS IV.EHICLE3I EXCLUSIONS AOOEO BY ENDORSEMENT f SPECIAL PROVISIONS
OR EVIDENCE ONLY
cRTiFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF,THE ISSUING INSURER MLL ENDEAVOR TO MAIL 30 OAY1 WRITTEN
E HONE DEPOT, INC.
NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO 00$0 SHALL
IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR.
SS PACES FERRY RD.* N.W. BUILDING C-8 REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE
LANTA, GA 30339 USA •
0 ACORD CORPORATION 1998
i
>:Y loard of lwildrna lit:�n►ulkwn and Standard,
Construction Supervisor License
' .. Licr�ttse: CS iS i n9
elrthdate: 2113/19of1
Expiration: 2/131!00:1 Crit 9573
wt Restriction: 00
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