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HomeMy WebLinkAboutBuilding Permit #578 - 43 UPLAND STREET 3/29/2010 1 BUILDING PERMIT "O oT"�ti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 4q °RAreo gsSACHUs�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION _ .,not I�ROPLRTY OWNER ' �� Print . MAP NO: PARCEL: ZONING DISTRICT:Historic District , : ayesr,n E _. MachinShop Village yeS._. TYPE OF IMPROVEMENT PROPOSED USE Residenf Non- Residential New Building �ne famil Addition <----Two or more family Industrial Alteration No. of units: Commercial VI\Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain - Wetlands Watershed, District'' Water/Sewer - ro .DESCRIPTION OF V�4$F TO BE -"M% Ide ti ication Pr Print Clearly) OWNER: Name: Phone: DF Address: CONTRACTOR, Name: . ' a Phone:. g � ee Address: - r Supervisor's Construction License: l� Exp.. date: II Home Improvement icense: - :Exp. iDate : a 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.: NOTE: Persons contracting with unregistered contractors do not have access to he guar my fund i�gnature of.AgentlQwner° gnaturefof�contracto 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 I I Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I� Conservation Decision: Comments Water & Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT_ y-�ernp Dumpster-on site yes, z no ' F 'Located.at 9.24 Main Street ° ,Fire D6partment`signatu,reltiate � t. COM' Mt' TS 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 ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses i ❑ 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 i New Construction (Single and Two Family) i ❑ Building Permit Application ❑ Certified Proposed Plot Plan u 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 A licable Y ( Applicable) ❑ Copy of Contract it ❑ 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:INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location No. ���_ Date ./ �aRTM TOWN OF NORTH ANDOVER f � 3? • • OL r F 9 }�• ay Certificate of Occupancyo $ Building/Frame Permit Fee $ �'"' � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 22686 Building Inspector 19-MAR-2010 16:30 FROM-HOME DEPOT 3462 +603-626-3445 T-327 P.001/005 F-998 PLEASE READ THIS Sold,Furnished and Installed by: Branch Name: Boston Date: _,y-,5 10 THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street•,Unit 2,Worcester,MA 01607 Branch Number:31 Toll Free(800)657-5182; Fax(508)756-8823 Federal ID#75-2698460;ME Lic#C 02439;RI Cont.Lic#16427 t CT Lic#565522:MA Homc Improvement Contractor Rcg.#126893 Installation Address: ~-ice�l� �j - /�} ALC a City State Zip Purcbaser(s)e Work phone: Home Phone: Cell Phone: Home Address; (If different from InstaIla on Address) City State Zip l E-mail Address(to receive project communications and Home Depot updates): (V/vJl ❑I DO NOT wish to receive any marketing cmails from The Home Depot Project 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 Shert(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#: (L.1—M tw-r-w* CW. Snec Sheets #: Project Amount Roofing ❑Siding Windows El Insulation ❑Guttcts/Covcis QEatry Doors ❑ �� r Roofing ❑Siding LJ Windows El lnsulanon ❑Gutter';/Coycrs ❑Entry Doors n $ ©Roofing ❑Siding Windows ❑Insulation ❑Gutters/Covers ❑Entry Doors❑ Roofing ❑Siding ❑Windows El Insulation ❑Guncrs/Covcrs ❑Entry Doors El- Minimum Minimum 25`7a Deposit of Contras Anrormt due upon execution of this contram Total Contract Amount $ ) Maitre Pravhasers may not deposit more than ore-tinrd of the Conant Amount. t Customer agrees that,immediately upon cornp.letion 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(%)included herein,at its discretion,if The Home 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 #2�p I 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 ynu sign. Do not sign a Completion Certificate(note: there is one Completion Certificate fur 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 amounts set forth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THF, DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPO'T'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceotance and Authorization: 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 written,relating to said Products and Installation.This 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. Aeee ted bye Snb Y: Custorhor's Signature Date Sales Consultant's Signature Date X Telephone No. cz- Customer's Signature Daze Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (as sppricahlC) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE 'THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL.TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 11-3"9 C-SC Waite--Branch File Yellow-Customer Pink-Sales Consultant XAORTH Town 0 ....v w:. �.. 4ofAndover . No. - - 0 LA E dover, Mass., ' COCMICMEWICK y1. ADRATED PPS\ �� S BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR , THISCERTIFIES THAT................ ......................... ............ ........ ........... . ............................................................. Foundation p V 41... has permission to erect................ ..................... buildings ... .. �,►.�..... t�................. Rough � P Chimney to be occupied as...........:.:.... ... :............ . Ii ..Ml�►. . 'M�, ..........,..:............. y C e provided that the person accepting is per shall in every resp ct conform to the terms of the application on file in 00 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 CONSTR C S TS Rough Service BUILDING R Final Occupancy Permit Required t0 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. Licensee Details Page 1 of 1 The Official Website of the Executive Office of Public Safety and Security(EOPS) Mass.Gov Home Public Safety Department of Public Safety Licensee Complaints License Type Construction Supervisor License# 88756 Restriction 00 Name Scott A Macmillan City,State,Zip Salem,NH,03079 Expiration Date 3/29/2012 Status Current No complaints found for this Licensee. Back To Search http://db.state.ma.us/dps/licdetails.asp?txtSearchLN=CSL88756 3/26/2010 r I ✓�1se ?citp:�.oavr-+ea.�i� r%' 8 wrd of Building Rrgalatioaa and Standards Cunsbwlian Supervisor License Deet : cs aa�ss Office of Consumer Affairs and Llsine;s R lation Expiration: 3,/2912910 TrX 20262 � E � ! egu - 10 Park Plaza.- Sure 5170 �. Restrecbon_ oo Boston, MassayLbusetts 02116 Scow A MACMILLAN I come Improvement.�Dn Ctor Registration 10 PARK AVE SALEM,PSN 03079 _- Registration: i58 Com�iasoaeer � Endi MACMILLAN CONTRACTING SCOTT MACMILLAN - 10 PARK AVE_ - SALEM, NH 03079 1 = _ Update Address mod. M u OP31(Ar d srnr.oaos 3ioAddress J dRrue�vai Ofdicx r Of(osaorner AlTaira&Basiacrs Rees teoeosek�or reg tbaa valid for individal use of t- WE MP ENT CONTRACTOR berme expimtioa date, (f famW return to: R OMM o (ensamer Afi�•s and Busim"s BegA x•..:158306 s 10 INA(Plsaa-Saite;I71) 3t?1 �2 Tr9 291290 Boston,AM 82116 Roklaw > lLLliPJ COTS`._ SCOTT MACAAIL£A�J 10 PARK AVE. SALEM,PW 03079 � -- -.-.- - _ Not vvaJid wsthoart signaftre r The Coin»ronwealth of Massachusetts Department of Industrial Accidents W Office of Investigations 600 Washington Street Boston, MA 02111 www.rnass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): — y Address: �1rti tY/�,6-4�1 rt City/State/Zip: ' ��JiA ��7 t Phone#: r Are y an employer.'Check the appropriate box: Type of project(regnired): 1. I am 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 7. Remodeling 2.❑ I am a sole proprietor or partner- listed on the attached sheet. _ ship and have no employees These sub-contractors have g. ❑ Demolition ' working for me in any capacity: employees and have workers9 ❑ Building addition [No workers' comp. insurance comp. insurance.$ 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions tion per MGL of exemption myself. [No workers' comp. rig12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no 13.®"Other employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. _ Insurance Company Name: 1c Policy#or Self-ins. Lic. #: Expiration Date: Job Site Address: 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 fine 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 and r t e p 'ng ties of perjury that the information provided above i true a d correct Signature: Date: _ Phone# L �� Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License ff Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other Contact Person: Phone#: ---. SO(V r,c)ainCoe f dent FaCcc Gxn (w ,6 da Er ergia Alar ' • - - fru ' %o . 32 1 . 8 C� a 24 A.DOi" OVAL FERFO€-MANCE RATINGS oe a£r+c(14rENTQ VfsibleTnW nit>ancz • ihntrnhlan dellu`/titmta . 0 : 52 xv mcg T•d coo r"a> m etc m o tit r >n +Q i cat rirhavrsrtal ana erd a a>f a��- dnm rot r®[rrrvr�d.art� sAtt o d dam rvt a�rrvrt c,+n('BtY d r*r •a mr �c5"r=�nra ka o8��nici n '.r NV�4A arrnow cn to gv:3d � b FAL 9" mhof r ry 6bnls�bad d Rcd r�to uu�as SPC.m a .F mw C j+, arblar ta{w YEA 0—ft "'fM?FFG M r:mnlydc amu+ > m'f o yerr�a a s 1 snag,�.lsasao,fon um CIA SL cs a gsra d ab po�tL wwtca� Unit q�_�LLLLu :oc C1t£ftCY .9C1R -- caAy i7:r'�i�.: L7o-:c cR.i cn, No<Cn Ci.�.n LdAd oaLCl Lca ,pa.a Lam(•) - ' cc?-Len l•a1 Q?!pllOT 9i.a-A: uoct�_ . Noctt Ca•�Cci1,'3.c ceatcIA, 3-c_ IVG: fteLn. 00/CLIsl 3/�I�JH—ftl� —� INO: H1f acro OOfYLdrLo 2.31 7erafH,Ra) �n S / '_ /1 LLn1Ao pcoDado: ]L.1 C-n .'IGQ. C-A De Y T 10113 - K3 KofCun 293L1I0. ,,�•.,-,•_...._._- Lrpfialnbalforpaab}+QICeGt Jw n6ata-Tolrommon'Ahwrr.mr'rgrrtcrcgm_ Cued.arta �hiv Aa yea gas>bla na rbo&at f}IEt6Y St1l'�o a 0)ACu rill ao m ba ah, ll�'r++L�n r 7�troLQo c Boicd of Building Regulations and Standards ' HOME IMPROVEMENT CONTRgCTOR } Registration:, 126893 Expiration:._8(312010 _.-Type. Supplernent Card . The Home Depot-Al Home Service- ,aco CERTIFICATE OF LIABILITY INSURANCE D02/19/10 PRODUCER oz/19/10 PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND: EXTEND OR homedepot.certrequest@marsh.com ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Two Alliance Center, 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 Fax (2 12) 948-0902 INSURED INSURERS AFFORDING COVERAGE i NAIC# -- - .- ..__._......_ The Home Depot, Inc. INSURER A:Steadfast Ins Co i 26_387 Home Depot U.S.A., Inc. INSURER B:Zurich American Ins Co 16535 2455 Paces. Ferry Road NW ------ Building C-20 INSURER C:New Hampshire Ins Cc 23841 Atlanta, GA 30339 INSURER D:NATIONAL UNION FIRE INS CO.OF-PITS 19445 INSURER E:Illinois Union Ins Co 27960 COVERAGES 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 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. INSRD ----- T D'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION DAT M / /YYY T / YY LIMITS A GENERAL LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES(Ea occurrenceL $ 1,000,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ EXCLUDED PERSONAL 8 ADV INJURY $ 4,000,000 GENERAL AGGREGATE _ $ 4,0_00_,_000 GEN'L AGGREGATE LIMIT APPLIES PER:POLICY PRO- PRODUCTS-COMP/OP AGG $ 4,000,000 -- JEC ----"..---- T LOC - B AUTOMOBILE LIABILITY BAP 2938863-07 03/01/10 03/01/11 COMBINED SINGLE LIMIT X ANY AUTO - (Ea accident) $ 1,000,000 ALL OWNED AUTOS ----'- ----------._..._.... SCHEDULED AUTOS BODILY INJURY $ - __. (Per person) _ HIRED AUTOS ----- NON-OWNED AUTOS BODILY INJURY $ (Per accident) X SELF INSIIRED AUTO PROPERTY DAMAGE PHY $SICAL DAMAGE (Per accident) GARAGE LIABILITY. AUTO ONLY•EA ,CCIDENT $ ANY AUTO ------"---'- - OTHER THAN EA ACC $ AUTO ONLY: AGG $ A EXCESS/UMBRELLA LIABILITY GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE $ 5,000,000 X OCCUR CLAIMS MADE AGGREGATE $ 51000,C00 DEDUCTIBLE RETENTION $ --""— C WORKERS COTION ❑ _$ 03/01/10 TH-AND EMPLOYERS'LIABILITY WCO20342355 (AOS) 03/01/11 WC STATU- O D ANY PROPRIETORMARTNER/EXECUTIVE YIN I ORy_L OFFICER/MEMBER EXCLUDED? WCO20342356 (CA) 03/01/10 03/01/11 - E.L.EACH ACCIDENT $ 1,000,000 E (Mandatory in NH) WCO20342357 (FL) 03/01/10 03/01/11 E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under _ SPECIAL PROVISIONS below OTHER E.L.DISEASE-POLICY LIMIT $ 1,000,000 E TX Employers Excess TNSC46242373 (TX) 03/01/10 03/01/11 Occurrence/SIR 30M/2M D Workers Compensation WC0910566 (QSI) 0.3/01/10 03/01/11 C Workers Compensation WCO20342358(KY,MO,NY,WI, ) 03/01/10 03/01/11 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OFTHEABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE HOME DEPOT, INC. DATE THEREOF,THE ISSUING.INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN HOME DEPOT U.S.A., INC. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 2455 PACES FERRY ROAD NW IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR BUILDING C-20 REPRESENTATIVES. ATLANTA, GA 30339 - AUTHORIZED REPRESENTATIVE USA ACORD 25(2009/01)Jthornton_hd ©1988-2009 ACORD CORPORATION. All rights reserved. 14481889 The ACORD name and logo are registered marks of ACORD