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HomeMy WebLinkAboutBuilding Permit #260-13 - 5 MAGNOLIA DRIVE 10/2/2012 1� �I•� - NORTh BUILDING PERMIT o� r.D6 6 o TOWN OF NORTH ANDOVER 3? ham•, :', , °� o m ur V 0�JeA APPLICATIOP, FOR PLAN XA iNATION 7° Permit NO:� Date eceived �qS RATED IPPt.(5 SAS�CHU Date Issued: 1 IMPORTANT:Applican must complete all items on this page `LOCATION 5 l�ll�tzl� f6i.a l Print - PROPERTY OWNER An#yU rte.kA•11k14 Print - � MAP NO . PARCEL ZONING:DISTRICT.lHistoric Distract yes: no Machine Shop Village es. no. _ :.. y. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building <T ne famiI Addition Two or more family Industrial Alteration IA c LAT1 No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well FI'oodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: �L SULPM MkSS ubul I f-X t a Identification Please Type or Print Clearly) OWNER: Name: aW,&tA,*ol Phone: Address: S MAA KOL1 A '6< CONTRACTOR ;Name: ((aLS'L1Q�iict7el )�. Phone Address: Ro CIOt;iA_ &L_ 1 &_& Lnckw 4 Supervisors Construction License.: 0S�-�S4 . Exp. Date:. 3 �. �l y. Home-Improvement License Ol_ Exp. Date: _ 2 2.p 1 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: $ 3020 • 3 FEE: $_ .OD Check No.: ;27 y� Receipt No.: a,5'_-7 7 S—_ NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund Signature of Agent/Owner _. Signature_of contractor.__ 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ 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 o Building Permit Application o Certified Surveyed Plot Plan o 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) o Mass check Energy Compliance Report (If Applicable) u 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 o Certified Proposed Plot Plan L3 Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o 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 DEPARTMENTMFORM07 Revised 2.2008 J - 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 R HEALTH Reviewed on Signature COMMENTS Zoning.Board of Appeals: Variance, Petition No: r Zoning Decision/receipt submitted yes ann ng 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 iteyes no Located at•1`24'Main Street - Fire Department signature/date COMMENTS`_ T i 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) I I i I I i I ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 r Location � f Date ' TOWN OF NORTH ANDOVER • ��C�r.rJti�;;r��� - su s - Certificate of Occupancy $ Building/Frame Permit Fee $ j a Foundation Permit Fee $ Other Permit Fee $ `� 4t1`v I TOTAL $ Check# 7yy 25775 Building Inspector November 6, 2012 Dear Jennifer, Attached is the information for the refund of the fee for Building Permit 260-13 issued on 10/2/2012. The receipt number is 25775, check number 2748 in the amount of$37.00. The homeowner has decided not to go forward with the project. The refund check can be sent to: Dave Hope/HRH Construction 80 Campbell Road N.Andover, MA 01845 Thank you for your help in this matter. If more information is needed please let me know. Maura Deems Building Department Assistant NORTH T E own o Andover O Z b h ver, Mass, CONIC Nl WICK y�. ����R�TEO �•P�,��y `S °U BOARD OF HEALTH PE. RMIT T Food/Kitchen L.D Septic System THIS CERTIFIES THATS? nI• �' c 441 •.•.•.• BUILDING INSPECTOR ............................. • kk Foundation ....................... buildings on ..: 00'�cp .... has permission to erect ... ••••••• � G Rough to be occupied as ......v.: lr ..... su/�T F' Chimney ..................................................................:.......................... e provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough J� Service .................. ..... ........................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. IF SEE REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plutnbers A Iicant Information Please Print Le ibl NaII18(Business/Organization/Individual): . �� Address: City/State/Zip: , Phone.#: q 11 Are y an employer?Check'the appropriate bog: 1. T am a employer with 2 4. I am a general contractor and I Type of project(required):, employees(full and/or pazt time).* have hired the sub-contractors 6- [3 New construction 2- I atn a'sole proprietor or pa--tner- attached listed on the sheet 7. []Remodeling ship and have no employees These sub-contractors have working forme in any capacity. employees and have workers' 8. F1Demolition [No workers'comp.insurance comp.insurance.# 9- ❑Building addition iequued j 5. [3 We are a corporation and its i0. 3.❑ I am a homeowner doing all work $Iectrtcal repairs or additions officers have exercised their _ 11_[]p 'ng repairs or additions myself.[No workers'comp. — ' right of exemption per MGL insurance required.]t c. 152,§1(4),and we have no 12❑ of repairs employees,[Nb workers' 13. Other l comp.insurance required.] T Ho 'Any applicant that checks bbx#1 must also fill out the section below showing their workers•co meowners who submit this affidavit indicating they mpensation policy information. g eY are doing all work and then hire outside contractors must submit a new affidavit indicating such. rContractors that check this box must attached an additional sheet showing the narne of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their work='comp.policy number. lam an employer that is providing workers' � compensation insura ncefor my employees. Belo rs tle o 'c y at—td— information. job site Insurance.Co an mp Y Name-,. Policy#or Self-ins, Expiration Date:—�•� — tTt t� Sob Site Address: 5 1�/�TI.OQV t � �� • CitylState/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 ) fine tito$150 MGL c. 152 can lead to the imposition P 0.00 of and/or one-year' criminal penalties Y 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. De advised that a copy of this.statement amay be forwarded to the Office of Investirations of the DIA for insurance cove a verification. Ido hereby certYY u der the ridenalties o P OfPerjury that the Information provided above is true acid correct- Date: orrectDate: ©C�. Oficial use only. �o not wrue in this area,to be completed by city or town offrciaL City or Town: Permit/License# Issuing Authority(circle one): Y.Board of Health 2.Building Department 3.Ci ty/Town Clerk k 4.Electrical Inspector 5.plumbing Inspector Contact Person: Phone#• . Massachusetts -Department of Public Safety ' Board of BuildingRegulations gulations and Standards Cumtructifin Superi,i.+a• License:C"57754 WILLIAM D UO'OE 80 CAMPBEM_ RD — N ANDOVE#MA 01845 ,f Commissioner zxp;raticr. 03/04/2014 ............._ Vfie�ay�znaaruvea�l�o�'�iaca�uc�tate� _._ .._ _-.----- UlxOffice of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: legistration: 101730 Type: Office of Consumer Affairs and Business Regulation piration: -,6/29/20_:14; Private Corporatic t 10 Park Plaza-Suite 5170 HRH CONSTRUCTIC)11 d:. Boston,MA 02116 William Hope Ats 80 CAMPBELL RD NORTH ANDOVER,MA 01845 Undersecretary Not valid wiature A�Rp® CERTIFICATE OF LIABILITY INSURANCE12/13/2011 DATE(MMIDON YYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF.INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the certificate holder in lieu of such endomement(s). PRODUCER NGUNTACTE. Michael Emond Emond&ASSOCIateS PHONE FAX 857 Tumpike Street E realL Ejdk 978-2n8!4713 N° Suite 133 ADORES&: mike— North Andover MA 01845 INsu s AFFORD►NG COVERAGE NAIL I INSURED INSURERA: Farm Family Casualty Insurance Com an HRH Construction INSURER B: 80 Campbell Road INSURER C: INSURER D: North Andover MA 01845 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TN_LTRTYPE OF INSURANCE B POLICY NUMBER MPMOLICY EFF FUL EXP YYY) LIMITS GENERAL LIABILITY X EACH OCCURRENCE 11,000,000 COMMERCIAL GENERAL LIABILITY PREMISE occurrence) S 50 000 A CLAIMS-MADE Ii OCCUR �: MED EXP(Ary one Person) $ 5,000 2001X0726 11120!2011 11/20/2012 PERSONAL&ADV INJURY s Included GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE OMIT APPLIES PER: X POLICYO LOC PRODUCTS-COMP/OPAGG $2000000 AUTOMOBILE LIABILITY $ I� =MSI SI GLE LIMIT ANY AUTO i aaident 1 000.000 _ ALLOWN A AUTO ED X AUTOS FOULED BODILY INJURY(Per person) $ BODILY INJURY eraca NON-OWNED 200104287-4A 03116/2011 03!16/2012dent) $ X HIRED AUTOS X AUTOS PROPERT—DAMAGE $ Peraccident $ 2ERETENTION B OCCUR EACH OCCURRENCE $1,000,000 A GJUMS MADE 20OIE1169 12/14/2011 1211412012 AGGREGATE $1,Oaa,aaa S SATION $ AND EMPLOYERS UABILRY A ANY PROPRIETOR!PARTNER/EJ(ECUTIVE.YIN A EN OFFICEIMEMBER EXCLUDED? F N I A F_ 2005W6827 12/07/2011 12/07/2012 E.L.EACH ACCIDENT $500.000 (Mandatory In NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $500,000 (�IF E.LDISEASE-POLICY LIMIT $500,000 1 DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Operations by named insured CERTIFICATE HOLDER CANCELLATION HRH Construction SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 80 Cam bel Road THE EXPIRATION DATE 1;HEREOF, NOTICE WILL BE DELIVERED IN p ACCORDANCE WITH THE [[(ICY P OVISIONS. i AUTHORIZED REP North Andover MA 01845 ©1988-201 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD L ,�. naionaigna THE POWER OF ACTION Conser alon Services Group This service is brought to you through support from your local utility This Agreement is made by and among and Conservation Services Group(CSG) Attu: RCS i Jolm Graham ;i U i 50 Washington Street,Suite 3000 S Magnolia Dr T lVestborough,MA 01581 j North Andover,MA 01845-2633 Reg.No.,120837 {. Customer ID:C00000072152 Contract Ib:20120522 ASEAL Federal ID No. 222467170 ® site w:sooaaxo62>i3a ` Olail completed contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the follo%ving work on these"Premises"in a professional manner and in accordance Asith the terms of this Contract,including the attached reconunendations/work order describing the work in detail(the"Work")which are incorporated herein by reference: Description Quantity Location Perform Air Sealing at Estimated 62,5 CFM50 Per Hour8 Livin Space 0 0 9_P 562.0 __ _------- Therma•Oome(R10)with carpentry(Attic) 1 Living Spaog Sub Total: $811,63 Energy Efficiency Incentive $811.63 Net Sales Tax After Incentive $0.00 Total $0.00 • 4 v Printed:6120/2012 Page 2 of 2 11. PAYMENT Customer agrees to pay-Contractor for the Work,the Customer Share of the Contract.Price as follows: ® Payment#l:S ' as a Deposit payable to CSG upon signing the Contract(not to exceed 1/3 of the total retail costs or actual costs of-special ooi s,whichever is greater).Alail check&contract to CSG,Attn:RCS,50 Washington St.,Ste.3000,Westborough,MA 01581. Mnat Payment:$ as the final payment for the Work shall be due and payable to the Independent Installation Contractor ("I1C")upon satisfactory completion of the Work. Customer understands that he/she will not,be required to pay the Utility Incentive Share of the Contract price in the amount of$-18 ,1 The Utility Incentive Share is dependent upon the package purchased and/or prior incentive utilization.Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. You may cancel this agreement if it has been signed by a party there to at a place other than an address of the seller, which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. MT I N THIS NTRACT IF THERE ARE AN BLANK SPACES.Custo r na r reate Xlrating te your selected IIC here,if applicable htinl here if you want. th rogram to assign a P icipContractor I 99. n ti n r°a o alb flyConser atlon Services Group This service is brought to you through support from your local utility This Agreement is made by and among a-nd t Conseliiat.ion Seii ces Group(CSG) Attli:RCS John Graham �� 50 Washington Street, Suite 3000 5 Magnolia Dr ��/ �`' ^` Westborough, MA 01581 North Andover,NIA 01845-2633 Reg. No. 120837 a Customer ID:000000072152 Contract ID.20120522_WORK Feder,-d ID No. 222457170 Site I®:500002062134 (Mail completed contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract,including the attached recommiendationstwork order describing the work in detail(the"Work")which are incorporated herein by reference Description Quantity Location a Attic Floor Open Blow Cellulose 10° _ _1,080 Living Space $1,533.60� Attic Floor Enclosed Cellulose Dense Pack 5° 152 _ Living Space _ $276.64 Vent bath fan to roof flapper_ _ _ I. Attic $116.10 Damming__ __. __._.. _. ._ _--_—___74 NIA $130.98_— Propavent 44 Attic _._ .__ __.—�...$151.36 _ ---._ _.. Sub Total: $2,208.68 Energy Efflclency Incentive $1,656.51 Net Sates Tau After incentive $0.00 ® Total $552.17 ® I r I � i I ® I Printed:612912012 Page 1 of 2 iI. PAYMENT Customer agrees to av Contractor for the Rork,the Cnrstmner Share of the Contract Price as follows: ® Payment#1:S Z'.�n as a Deposit payable to CSG upon signing the Contract(not to exceed W of the total retail costs or actual casts of special orders,whichever is greater).Mail check&contract to CSG,Attu:RCS,50 Washington St.,Ste.3000,Westborough,MA 01581. i Final Payment:$ 3 5"i , as the final payment for the Work shall be due and payable to the Independent Installation Contractor ("IIC")upon satisfactory completion of the Work. Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of S The Utility Incentive Share.is dependent upon the package purchased andlor prior incentive utilization.Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility incentive Share. You may cancel this agreement if it has been signed by a party there to at a place other than an address of the seller, which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. d,NOT SiG THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Al" 7 6 72, coa> Custoutiure ate hu icate your selected IIC here,if applicable hnitia rere if you want ( the g r m rato assign a Participating Contractor