Loading...
HomeMy WebLinkAboutBuilding Permit #36 - 47 ELMCREST ROAD 7/14/2009 BUILDING PERMIT Olt"°oT 6 qti TOWN OF NORTH ANDOVER �2t':" - * *` °°� APPLICATION FOR PLAN EXAMINATION (/74L ?, `.(' � Opp Permit N0: Date Received ��Ssgc►+us Date Issued: IMPORTANT: Applicant must,complete all items on this page LOCATION L � P ' PROPERTY OWNER ' Print a MAP NO .6? PARCEI �? KING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family 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 WORK TO BE PREFORMED' Identifi ation Pika,,T e or Print Clearly) OWNER: Name: Phone: Address: QJ Elm CONTRACTOR Name: H814�7�111e one: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: L Exp. Date: / ARCH ITECT%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.:Aac),D 1 NOTE: Persons contracting with unregistered contractors do not have access the gua anty fund Sgnature_of Agent/Owner P Signature of con ror act Location / EEL'f No. Date 1 " �aRT►, TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ Building/Frame Permit Fee $ �Q AC NUS Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # t 22LU9 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerTanning/MassageBody 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 Dumpster yin site yes no Located at 124 Main Street Fire Department signatureldate 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 Doe.Building Permit Revised 2009 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) o 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 Li Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o 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 Li 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 �1ORTFi F Town of : s gAndover 0 No.3 (, C% ;= LAKE dover, Mass., - d COCMICMEWICK 7d A0RAT E O F"*Vp `s BOARD OF HEALTH Food/Kitchen PERMIT T D. Septic System 1 BUILDING INSPECTOR THIS CERTIFIES THAT h .1 ► .aA............................... ................................................................. Foundation . 1 .. .r.....�............has permission to er .. ................................. buildin s on ...q.70 .. ................ �1 • Rough 3Aj.V.. 1 S ..... .4..�. ............................................7fiiio�i�j=6tion Chimney to be occupied a ......................fir.. provided that the person accepting this permit shall in every respect conform to the terms on 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 30 ELECTRICAL INSPECTOR UNLESS CONSTRSTARTS Rough ..............:.. Service BUILDING INSPE R 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. The Commonwealth of Massachusetts Department of Industrial Accidents u Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance.Affldavit: Builders/Contractors/Electricians/Plumbers ApOicant Information Please Print Lejjbly Name (Business/Organizatiordlndividual): Address: �t71YiG ( ¢r)1/ City/State/Zip: Phone.#: � Are yoy an employer?Check the appropriate bog: Type of project(required): 1.kL In am a employer with 100 4. E] I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, D Demolition workingfor me in.an capacity. employees and have workers' Y P tY• 9. ❑Building addition [No workers' comp. insurance. comp. insurance. required.] 5. We are a corporation and`its. 10.0 Electrical repairs or additions officers have exercised their 11.[]Plumbing repairs or additions 3.0 I"ain a homeowner doing all work myself. [No workers'comp. right of exemption per MGL 12 ❑RKf r airs insurance required.]t c. 152, §1(4), and we have no employees. [No workers' 13. Other comp.insurance required.] *Any applicant that checks box#I 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 anew affidavit indicating such. IContractors 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: C� Policy#or Self-ins. Lie.#: 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 tip to$1,5.00.00 and/or one-year imprisonment, Well as GiVil Penalties in tlwfe of a STOP WQPJ�-� of up to$250.00 a day against the violator. Be advised that a copy of this statement may be foiwarded to the Office of Investigations of the DIA for insurance coverage verification I do hereby cern un r e p s an penalties of perjury that the information provided above is true and correct. Si ature: Date: _ Phone#: 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 Contact Person: Phone#: r &I - Board 6(Buitdtng Regulations and Standards r - HOME IMPROVEMENT CQNTRA�TOR License or registration valid for indtvtdul use/only 4 before the. expiration date. If found return to: Registration: 126893:. x Board of Building Regulations and Standards Expiration g/3/2010 One Ashburton.Place Rm 1101 _ Type Supplement Card Boston,iVla:02188 The Home Depot A7 HomezServi RICHARD FALLONE -� 3200 COBE GALLERIA PKVVI�#t20 C.-ATLANTA GA 30339 1, _ Administrator —= - Y Not vali without satu . ACORD,M CERTIFICATE OF LIABILITY INSURANCE DATE02/2020 /DDIYYYY) /09 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. 3475 Piedmont Rd NE, Suite 1200 Atlanta, GA 30305 Fax (212) 948-0902 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Steadfast Ins Cc 26387 THD At-Home Services, Inc. INSURERB:Zurich American Ins Cc 16535 2690 Cumberland Parkway INSURER C:NATIONAL UNION FIRE INS CO OF PITTS 19445 Suite 300 Atlanta , GA 30339 INSURERD:New Hampshire Ins Cc 23841 INSURER E:Illinois Nati Ins Cc 23817 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. INSR ADDI POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR N RD DAT MMD DATE M DD A GENERAL LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $4;000,000 X COMMERCIAL GENERAL LIABILITY LIMITS OF POLICY ARE EXCESS DAMAGETORENTED 1;000,000 PREMISES Eaoccurence $ CLAIMSMADE OCCUR "OF SIR: $1,000,000 PER CC" MED EXP(Any one person) $EXCLUDED PERSONAL BADV INJURY $4,000,000 GENERAL AGGREGATE $4,000,000 GEN'LAGGREGATE LIMITAPPLIESPER: PRODUCTS-COMP/OPAGG $4,000,000 X POLICY JEOT LOC B AUTOMOBILE LIABILITY BAP 2938863-06 03/01/09 03/01/10 COMBINED SINGLE LIMIT $1,000,000 X ANY AUTO (Ea accident) ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per person)- $ HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) X SELF INSURED AUTO PROPERTYDAMAGE $ PHYSICAL DAMAGE (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANYAUTO OTHERTHAN EA ACC $ AUTO ONLY: AGG $ A EXCESSIUMBRELLA LIABILITY IPR 3757 608-02 03/01/09 03/01/10 EACH OCCURRENCE $5,000,000 X OCCUR F—I CLAIMSMADE AGGREGATE $5,000,000 DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATION AND 3566916 (CA) 03/01/09 03/01/10 X WCSTATIU DTH- TORY LIMITS ER EMPLOYERS'LIABILITY D 3566915(A05) 03/01/09 03/01/10 E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE --- E OFFICER/MEMBEREXCLUDED? 3566917 (FL) 03/01/09 03/01/10 E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 OTHER D Workers Compensation 3566918 (KY, MO, NY, WI,F) 03/01/09 03/01/10 F TX Employers Excess TNSC45694422 (TX) 03/01/09 03/01/10 ccurrence/SIR 25M/2M C Workers Compensation 4801323(QSI) 03/01/09 03/01/10 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS RE: EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THD AT-HOME SERVICES, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 2690 CUMBERLAND PARKWAY IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR SUITE 300 REPRESENTATIVES. ATLANTA, GA 30339 AUTHORIZED REPRESENTATIVE USA ACORD 25(2001/08)ckomraus hd ©ACORD CORPORATION 1988 11172180 FROM : KIMBLY FAX NO. : 6033629675 Jun. 24 2009 12:54AM P4 ROME IMPROVEMENT CONTRACT PLEASN READTHIS /' Sold,Furnished and Installed by: Branch Name: Boston Date: Lo/ Y THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch Number: 345A(lreenwood Street,Unit 2,Worcester,MA 01607 'M Toll Free(800)657-5182; Fax(508)756-8823 ❑North 33 []South 31 Federal ID A 75.2698460;ME Liu 4 C 02439;RI Cont.Lic,B 16427 CT Lic#565522;MA I tome Improvement Contractor Reg.9126893 installation Address: J d 0 am 1 ' m r 7/�� / city tate Zip Parcbaser(s): Work Phare: Home Phone: i Cell Phone: -ftTrf ED Home 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 entails from The Home Depot P o'txt info bio : Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy, and T1ID At- one 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(%),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# minor a,*—) Products: Spec Shee s d: 1'ro'ect Amount []Roo 4jSiding Wdadows uhdion $ Y67, []Gutters/covers ❑Entry Doors ❑ []Rooting []Siding❑Windows LJ Insulation $ ❑Gutters/Covers ❑Entry Doors 1771 .._ Roofing ❑Siding Windows Insulation $ ❑Gutters/Covers ❑rintry Doors❑, ❑ ding Windows Insulation $ ❑Gotten/Coves ❑EntryDoors ❑_ Allntinnm25%DepositofC:ontractAmountdueuponexecutionofthiseontract. Total Contract Amount SS Maine Purchasers may not deposit more than ono-thW of the.Contract Amount Customer agr ut that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Shat)and pay any balance due. As applicable,each Customer under this Cont-det agrees to bejointlyand%Lve rally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Products)included herein,at its discretion,if The I Iome Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such a-,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 SummaryN /9y1 „I included ac 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 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 on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Rome 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 TEE HOME DEPOT FROM TIW. DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LINHTING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. W!nce and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer Homc IkTmt 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 carmot be assigned or amended except by a writing signed by Customer and The.Home Depot,Customer acknowledges and agrees that Customer bas read,understands,voluntarily accepts the terns of and has received a copy of this Agreement. - ,A:: .... _. . Sub ted o x dtJ stomer's Signature Date Sal . onsultant's 'gra Datf X Te hone No. ? > Oc7o�5 Customer's Signature Date -91 Sales Consultant License No_ CANCELLATION: CUSTOMER MAY CANCEL THIS' (as applicable) 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 CUSTOW,R'S STATE, NOTrCP:ADnITrONAX.nRMS AND CONDITIONS ARE STATED ON TELE REVERSE SIDES AND ARE PART OF THIS CONTRACT 11r.1-0R nw AAROR l:-Ar: .' illlAiM_R�annh Fila Yallnw–r�ii4}nmpr' Pink'-Calm r:nnm�ann+ 1lax.:,chia+ctt� - I)i IaI-IIIWnt nl'(IIf1) afi h 1 �� BnarYl itr tiuildin� ur ,ul:,tit,r,.o;tett SLt++tlanl. --' Construction Supervisor Specialty License Lir-etaSe: CS SL 102622 Restricted to: IC �r KEVIN LEGER � 3 1311 COUNTY STFcEET SOMERSET, MA 02726 r y —_-_ Expiration: 8/19!2012 (' Utntixi,iitrr T rtr: 102622 � c Board of Building Regulat ons and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement:Untractor Registration Registration: 152091 Type: Supplement Card Expiration: 7/28/2010 INSTALLED BUILDING PRODUCTS, KEVIN LEGER - 495 SOUTH HIGH ST SUITE 50 COLUMBUS, OH 43215 Update Address and return card.Mark reason for change. OPS-CAI ii 40h1-08/08-DBSLIFORMCAtOB272008 Address �J Renewal 17 Employment LJ Lost Card. �>ie �nnvianza-�uueall� of;✓GCa.la�uaefrtd –� Board of Building Regulations and standards u )'Ttia License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR ��.✓{.I I <. before the expiration date. If found return to: r Registration:..152091 Board of Building Regulations and Standards Expiration;.7/28!2010 One Ashburton Place Rin 1301 Type: Supplement Card Boston,NIP.02108 INSTALLED BUILDING, PROOUCT REVI,Y LEGER 495 SOUTH HIGH ST:SUITE 50 COLUMBUS,OH 43215 -- -------_._..—------ AdministratorN valid without v�i of wit signature 1 I