The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #17 - 474 WAVERLY ROAD 7/9/2007 _ L TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION O�t<<eo -6;�tio 0 z Permit NO: Date Received *mow qq cecwc c Date Issued: P ® SACHl1`''��y IMPORTANT: Applicant must com Tete all items on this page LOCATION Print PROPERTY OWNER l 2.DLE �!A D% g r1 Print MAP NO.: � d� PARCEL: ZONING DISTRICT: i TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building One family ❑ Addition ❑Two or more family ❑Industrial ❑Alteratio No. of units: )(Repai replacement ElAssessory Bldg ❑ Commercial 11Demolitio ❑ Moving(relocation) ❑ Other ❑ Others: ❑ Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: DLG �DUi Phone: Address: CONTRACTOR Name: NAohl ,� Phone: Address:,J5Lt6 C', E1y � , ��1c�2Cr-��ETZ a-1 Ls`=g:�fi (�t� Supervisor's Construction License: Exp. Date: Home Improvement License: \al�$Ct� Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. ;I FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost S FEE:$ o i Check No.: I g�� Receipt No.: 90,31 Page I of 4 1 _ r TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming Pools ❑ ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales [I Private(septic tank,etc. Permanent Dumpster on Site ❑ ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner �� Signature of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stam p ed Plans F1 THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF:U FORM DATE REJECTED DATE APPROVED PLANNING& DEVELOPMENT ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS IIS _ FIRE DEPARTMENT -Temp Dumpster on site yes no. Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments I Water&Sewer connection/Sisnature&Date Driveway Permit L Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area,based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPEORM05 Created JMC.Jan.2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) f New ConstructionSin le and Two Family) Y) � g ❑ 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) ❑ Copy of Contract ❑ Mass check Energy Compliance Report 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:BPFORM05 i Page 4 of 4 Location No. , Date -7' ' 7 MORTq TOWN OF NORTH ANDOVER ♦ ' Certificate of Occupancy $ 9 'IS CHUS Building/Frame/Frame Permit Fee $ d s�cNusa Foundation Permit Fee $ ' Other Permit Fee $ TOTAL $ Check # 20314 Building Inspector NORTH To" of No. 17 y �( z _oto over, Mass. • T O — LAKE 1 coC MIC-E C.EwIC. y �A0p? ppm` �y �S BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D 0BUILDING INSPECTOR THIS CERTIFIES THAT.........C;4..a#Lf ........... ............... ............................................................ Foundation has permission to erect........................................ buildings on .... .. ........W..4# ............ 12> ..•........... Rough tobe occupied as...... 3............. .�.M1R. .j............ ....... ..................... ........a..................................................... Chimney provided that the person accepting this permit shall in every resp ct 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 �0.WWW PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS COl eJ S 1 R IJ CTIOZR'l., Rough Service BUILDING INSP 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 Nm SEE REVERSE SIDE Smoke Det. Sunday,July 01,200711:41 PM Craig Smith 603594-5973 p.04 HOME IMPROVEMENT CONTRACT Sold,Fumished and Installed by: Branch Name:� [j Date: � t� d 7 THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services ( 345A Greenwood Street,Worcester,MA 01607 Branch Number:S� Job# l ��Q/ Toll Free(800)657-5182; Fax:508-756-2859 Federal]DR 75-2696460 ME Lie#C 02439 RI Cont Lie#16427 o Cf Lic#565522; MA Home improve ineeat Contractor Reg.#126893 Installation Address: q /.yq ��V 'L'e i t 1 RLA1. AdLn n u c,�`/ MW 1� Q 1 X G— c City State Zip Purchaser(s): Last 4 Digits of Driver's Lie.R&Exp.Mo/Yr: Work Phone: home Phone: ( ) 110 Home Address: (N different from Installation Address) City State Zip E-mail Address(to receive updates and promotions from The Home Depot): Project Information: I/We(You("Purchaser's,the owners of the property located at the above installation address,offer to contract with THD At-Home Services,Inc. 'Home Depot')to Purnish,deliver and arrange for the installation of all materials as described on the attached Spec Sheet# incorporated herein by reference and made a part hereof. Home Depot reserves tate right to cancel this contract if,upon re-inspection of the job,Home Depot determines that it cannot perform its obligations due to a structural problem with the home,pricing errors or because work required to complete the job was not included in the Spec Sheet or Contract. DEPOSIT PAYMENT OPTIONS H (Subject to nmd verifleation and/or credit approval.) CONTRACT AMOUNT $ �i"i3L• 1. Check,Cashiers Check or US Postal Service Money Order (Made payable to The Home Depot). j LESS DEPOSIT $; .Q 2. Credit Cerci*"and/or other payment options-Circle One Below BALANCE DUE Visa)vox MasterCard Discover American Express ON COMPLETION $�[�Fl .n The Home Home Improvement Loan The Home Depot Credit Card j'Miniotum 25%of Contract Amount due upon 0 New Account ❑Existing Account (ML&HDCC ONLY) execution of this contract. A ailable Credit:S (HIL&HDCC ONLY) Indicate Payment Method For y3A &: 7�j y ;'41/rg �0� cp.oate:ac I _ BALANCE DUE ON COMPLETION: as it appears an card MAPA L A 1;q w . my/our signature below,I/We agree to allow Home Depot to e the above referenced credit card for the derposit indicated. 'When you provide a check as payment,you authorize us either _ l94� 0 to use inf rmtation ffom your check to make a one-time electronic folder's Signature Date fund transfer from your account or to process the payment as a check transaction.When we use information from your check to make an electronic fund transfer,funds may be withdrawn from HIL or HDCC Authorization Codes your account as soon as the payment is received,and you will not Deposit Final Payment receive your check back. # # Purchaser agrees that,immediately upon completion of the work,Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder. Entire Agreement:This agreement and its attachments,including any financing agreement,contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you read it. You are entitled to a completely filled-in copy of the contract at the time you sign. Keep it to protect your rights. Do not sign a Completion Certificate before this project is complete. Law prohibits home repair contractors from requesting or accepting a Completion Certificate signed by the owner prior to the actual completion of the work to be performed under the contract You may cancel this transaction any time prior to midnight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this rlghL There will be a service charge equal to 10%of the contract amount if job is cancelled by Purchaser AFTER the third business day,but BEFORE materials are ordered.There will be a service charge equal to 25%of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW 1/WE UNDERSTAND THAT THE AGREEMENTT T REVIEW MAY BF.SUBJECT 0 CEW E OF MY/OUR CREDIT HISTORY AND UWE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATURE BELOW,UWE AGREE TO BE BOUND BY THE TERMS OF THIS CONTRACT. VWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. SUBMITTED BY: Date: ACCEPTED BY: Date: Purchaser Data: Purchaser NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 6-1-07 rev 4-2-07 C-SC White—Branch Flo Yellow—Customer Pink—SalosConsultant R AT-HOME Installed :SERVICES Siding and Windows SM s� . o Proudly sold,furnished and installed by RMA Home Services,Inc.,a Home Depot authorized contractor. 345 Greenwood St. Unit 2 •Worcester, MA 01607•508-756-6686•Fax 508-756-2859•Toll Free 800-657-5182 MARSH CERTIFICATE OF INSURANCE CERTIFICATE NUMBER ATL-001234410-01 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS MARSH USA,INC. NO RIGHTS UPON THE CERTIFICATE HOLDER OTHER THAN THOSE PROVIDED IN THE homedepot.certrequest@marsh.com POLICY.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR ALTER THE COVERAGE FAX(212)948-0902 AFFORDED BY THE POLICIES DESCRIBED HEREIN. 3475 PIEDMONT ROAD,SUITE 1200 COMPANIES AFFORDING COVERAGE ATLANTA,GA 30305 —"— COMPANY 100492-THD-IPUSA-07-08 IPUSA A STEADFAST INSURANCE COMPANY INSURED COMPANY HOME DEPOT USA,INC. B ZURICH AMERICAN INSURANCE COMPANY 2455 PACES FERRY ROAD NW COMPANY BUILDING C-8 ATLANTA,GA 30339 C AMERICAN HOME ASSURANCE COMPANY COMPANY D NEW HAMPSHIRE INS COMPANY COVERAGES ,This Certificate supersedes And replaces any.previously issued certificate for the policy.period noted below. 2 THIS IS TO CERTIFY THAT POLICIES OF INSURANCE DESCRIBED HEREIN HAVE BEEN ISSUED TO THE INSURED NAMED HEREIN FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THE CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,CONDITIONS AND EXCLUSIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. T TYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS LTR DATE(MMIDDIYY) DATE(MMIDDIYY) A GENERAL LIABILITY IPR 3757 608-02 03/01/07 03/01/08 GENERAL AGGREGATE $ 4,000,000 X COMMERCIAL GENERAL LIABILITY 'LIMITS OF POLICY ARE EXCESS' PRODUCTS-COMP/OP AGG $ 4,000,000 CLAIMS MADE a OCCUR 'OF SIR:$1,000,000 PER OCC' PERSONAL&ADV INJURY $ 4,000,000 OWNER'S&CONTRACTOR'S PROT EACH OCCURRENCE $ 4,000,000 FIRE DAMAGE(Any one fire) $ 1,000,000 MED EXP(Any oneperson) $ EXCLUDED B AUTOMOBILE LIABILITY BAP 2938863-04 03/01/07 03101/08 COMBINED SINGLE LIMIT $ 1,000,000 X ANY AUTO ALL OWNED AUTOS BODILY INJURY $ (Per person) SCHEDULED AUTOS ---- HIRED AUTOS BODILY INJURY I $ (Per accident) NON-OWNED AUTOS --- X ELF-INSURED AUTO PROPERTY DAMAGE $ HYSICAL DAMAGE GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN AUTO ONLY: EACH ACCIDENT $ AGGREGATE $ A EXCESS LIABILITY IPR 3757 608-02 03/01/07 03/01/08 EACH OCCURRENCE $ 5,000,000 X UMBRELLA FORM AGGREGATE $ 5,000,000 OTHER THAN UMBRELLA FORM $ C WORKERS COMPENSATION AND 2921209(CA) 03/01107 03101/08 X I TORY IMITS OE EMPLOYERS'LIABILITY E 2921210(FL) 03/01/07 03/01/08 EL EACH ACCIDENT $ 1,000,000 F THE PROPRIETOR/ X INCL 2921211 (AZ,ID,MD,VA) 03/01/07 03/01/08 EL DISEASE-POLICY LIMIT $_ 1,000,000 PARTNERS/EXECUTIVE $ 1,000,000 2821208(AOS) 03/01/07 03/01108 OFFICERS ARE: EXCL ( EL DISEASE-EACH EMPLOYEE D C OTHER 2921213(QSI) 03/01/07 03/01/08 E WORKERS'COMPENSATION 2921212(KY,MO,NY,WI) 03/01/07 03/01/08 G TEXAS EMPLOYERS TNS-C44642086(TX) 03/01/07 03/01/08 EACH OCCURENCE 25,000,000 EXCESS LIABILITY ISIR 2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSIVEHICLES/SPECIAL ITEMS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE POLICIES DESCRIBED HEREIN BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF THE INSURER AFFORDING COVERAGE WILL ENDEAVOR TO MAIL -In DAYS WRITTEN NOTICE TO THE FOR EVIDENCE ONLY CERTIFICATE HOLDER NAMED HEREIN,BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER AFFORDING COVERAGE.ITS AGENTS OR REPRESENTATIVES,OR THE ISSUER OF THIS CERTIFICATE. MARSH USA INC. 7 BY: MaryRadaszewski :.�y+ .,.3 `_y�Fl Lio ?),c...•. .k: MM1(3102) VALID AS OF: 02/28/07 \ I ne t,ommonwealth of Massachusetts _ Departrnent•of Industrial Accidents OJfice of Investigations 600 Washington Street Boston,AM 02111- Workers' Compensation InsM yr•`� www.mass.gov/dia Tobin Df Arlington Applicant Information urance Affidavit: Builders/Contractors/Electricians/Plumbers Please Print Le ibl Name (Business/organization/Individual):-7µ Address: /bLAI'D — 5�,2.2�11�00L 5�— City/State/Zip:_ �,� ']r,r r Phone #: — Are you an employer? Check th Y e appropriate box: I.[� 1 am a employer with- �C` 4. ❑ I am a general contractor and I Type of project (required): employees (full and/or part-time).* have hired the sub-contractors 6 ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet } 2• ❑ Remodeling ship and have no employees These sub-contractors have working for me in any capacity. work 8. ❑ Demolition ty ers co . insurance. ce. [No workers'comp. insurance 5. ❑ We are a corporation and its 9. ❑ Building addition 3.❑ required.] officers have exercised their 10•❑ Electrical repairs or additions I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c.152,§1(4),and we have no insurance r aired- t. 12.E] Roof repairs }eq ) employees. [No workers' ❑ COMP. insurance required.] 13 Other 'Any applicant that checks box 111 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 a new affidavit indicating such iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site informayion. Insurance Company Name: 1 0 Policy#or Self-ins. Lic. Expiration Date: - - J 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 maybe forwarded to the Office of urance coverage Investigations of the DIA for ins erage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sigpature7 _ Date: Phone#.- ---1 Ehe only. Do not write in this area,to be completed by city or town official n: Permit/License# 11 ority(circle one): I. Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector son• Phone#: