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HomeMy WebLinkAboutBuilding Permit #432-13 - 5 MAGNOLIA DRIVE 11/29/2012 TOWN OF NORTH ANDOVER f APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received I&A v Date Issued: v IMPORTANT:Applicant must complete all items on this page ti #11 ONt ,,r.nt; , I?ROPER*Y,01NNERi - _ - _ .. ^� Print' - 1 OlStructure� yessn- _0iye',arjQ1d. . RC - y MAPNO: PARCEL: ZONING D_ISTRICT'. Histone District yes,'Machlne;ShopVillageF yes TYPE OF IMPROVEMENT PROPOSED Reside Non- Residential ❑ New Building ne family ❑Additio ❑Two or more family El Industrial ❑Alte ion No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .� - _ - -y ❑ $ ptiq; ❑W&M ❑ Floodplain} ❑Wetlands ❑ Waters hedDistrict" . 0 Water1S.Pwer,. DESCRIPTI?N_0-F-W,0R TO rE P WgD.-- Identi !SaUM Please yp or Print Clearly) OWNER: Name: ri.1.A Phone: Address: J x . T z_ . . CONTRACaTOR' Name - =Phone = Adtlress.. L - 'Supervisor=s�Constructon License:. _ ( _ Exp Date. -_ � . - i ;_Home Improvement License: Exp Qate; - 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: C7 Check No.: � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to u ran fund Signatureof{Agent/Owner¢ ;- Sgnatureof contractor c....._x... .... Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Sta ped P ans El .X Building Department The fdowing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application Li Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work Q 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 Li Workers Comp Affidavit o 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) o 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) o Building Permit Application o Certified Proposed Plot Plan Li Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations If Applicable) Li Copy of Contract u 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 submated with the building application Doc: Doc.Bui Ming Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools El 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 r 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 TowL Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at-124.MaWstrdet. Fire Departffi"isignatdreldate COMMENTS 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 El Notified for pickup - Date � I Doc.Building Permit Revised 2010 Location N �� �`' �Q►J Q No. Date 2-t r r? -a' e • TOWN OF NORTH ANDOVER Certificate of Occupancy $ �, Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ TOTAL $ Check# � w 25993 Building Inspector NORT#1 own of �. : a ndover No. h ver, Mass, o . COC MIC Nl WICK V �d p04ATED PPa,�'Ly S U BOARD OF HEALTH Food/Kitchen .PERMIT D Septic System •hdTHIS CERTIFIES THAT BUILDING INSPECTOR Foundation has permission to erect . buildings on ... l �I.�. ..... . ... � ......................... . ..... ... limb Rough to be occupied as ....S14uAlb....:■.*A....I&w . .•. • •� • •• • •..•••.•••• Chimney 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIATS— T Rough 17�s S i Service- ..................... • •• ................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. SEE REVERSE SIDE NDV-03-2012 21:27 From:KEN SANDELL RSW 603 782 8726 To:Home Depot AHS P.1/4 HOME l[MPROVEMENT CONTRACT PLEASE READ THiS Sold,Furnished and Installed by: Branch Name: Boston Date: THD At.-Home Services,Inc, �I 11 L d/h/a The Hnme Depot At-IIome Services 908 lioston Tumpike,I)nit 1,Shrewftry,MA 01545 Toll rrca(80))657-5182;Fax(508)845-6017 Branch Number:31 Fc dcral ID#75-2698460;ME lie#C 02439;RI Cont.Llc#16427 (T Tic#HIC.0565522;MA Home Improvement Contractor Reg.#126893 Installation Address: 5 ASS'�`10�..1�C t V� , �GfaC�1�'�pd t �. t�'}{� Q 1st15- �eiiry State Tip Purchaser(s): Work Phone: Hone Phone: C¢!1 Phone: I 1 _. Horne Address: _ (If different from installation Addrass) City5""t State,State, Zip E- it Address(to receive pmject communications and Hume Dcpot updatai):�W0 IF 5 1 Zf C"o k D()NO'f wish to receive any marketing emails from The Home Depot Oiect Information: Undcrsigned("Customer").the owners of the property])oaten at the above intiWlation address,agrees to buy, and THD At-IIome Scrviecs,Inc-('The Home Depot")agrees to furnish,deliver and arrange for the installation(•7nstallatiun")of all materials described on the below and nil the referenced Spec Sheet(s), all of which arc incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contruct"): lob*: Spec shows)#r Project Amount hoofing LISiding4wdows jkInsulation Ill(]Gutters/Covers rnlry Diwts El , Rtxrfutg Siding Windows LJ Insulation ,K) flu ❑Gailrn/C'oveas ❑Entry Doors El Roofing Siding Winduws Lj rnM,lxlian ❑Gu tcrs/(overs i-lEntry Dours❑_ $ Roofing Siding[I Windows U insulaticnl ❑Gutters/Covers ❑Eahy Daum: [I $ Minimum 2,5rY Depaavt ct C Usd Amw d due upon emwuliva of lho courses. Total Contract Amount $ ` Maine Pumiuuers my mt deposit more than otte bird of the Contract Annum Customer agrees that, immediately upon completion of 01C work fou each Product, Customer will execute a Completion Certificate (one for ead, Prtaluct as defined by an individual Slim Sheet)and pay any balance due. As applicable,each Customei under this Coatract agrees to he jointly and severally o bliguted trod liable hereunder_ the Home Depot rescrves the right to ix!,m a Change Order or terminate this Contract or any individual Product(s)included herein,at its discret.ionr,if llie Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,envirtmmental hazards such as mold,asbestus or lead paint,other safely cunccans,pricing mors or because work required to complete the job was not included in the Contract. r Payment Summa try: 'The Payment:Summary/k � � included is part of this Contrict, Sets fatal the [irial Cuntiact amount and payments required for the dcptx%ils and final payments by Ptoduct(as applicable). NOTICE TO CUSTOMER You are entitled to a completely Flied-in copy of the.Contract at the time you sign. IM not sign a Completion Certificate(note: there is rine Completion Certilicute 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 Home Depot the emits of materials,labor,expe.uses and. rviec5 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 THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING T'HE HOME DEI'O'r'ti(rmim KEMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Customer agrees and undermands,that this Agreemcmt is the entire al+Tccment hetween Customer and the home Deput with regard to the Proxlucts and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot he assigned or amended except by a writing signed by Customer and"Ilse Home Depot-CusLrmttr acknowledges and agrees that Curtnmer has read,understands,voluntat ily accepts the terms of and has receival a tx)py of this Agreement. A led h Sub •teed b . �- 6 J X � 1 /z_.._ x�'� ���1 Z Cut u en'sgn ature Date Sales Consultant's Signature Date X _ T'cicphtmc No. 603-51` —", I\ Customer's Signanlrc Date Salts Consultant l Jo rn%c Nn. CAN('NI.LAT'ION: CUSTOMER MAY CANCEL THIS ia.�appliuddc) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DNJdVFRING WRITTEN NOTICE TO THE IIOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. THE STATE SUPPLEMENT AI-1'ACHEI) HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PROSCRIBED BY LAW iN CUST'OMER'S STATE. NO't10E.ADPrrlONA1.1 KHMS AND CONDITIONS ARE STATED ON IHE REVERSE SIVE AND AKE MART OFTHIS CONTRACT 03-3D•12 C-SC White &am h Flle Yellow Customer I • Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen icor Specialty License: CSSL-100189 + . THEODORE J PIONA. 18 THAYER AVE: AUBURN MA 01301 I - Expiration 09/13/2014 Commissioner The Commonwealth of Massachusws `= Delrrrt°ttrterrt of Itrdrrstr ial Accitletr.ts IT- Office of Investigations 4 600 lI'ashing torr Street Boston,MA 02111 ><v minass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eicetricians/Plumbers Applicant Information Please Print Legibly Name if siraess/organization individual): Addre::-',s: City/ '...,, ne/ Are yo employer?Check the appropriate box: Type of project(required): 1. I am a employer with 4. [] I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling ship �,.and have no employees These sub-contractors have 8. E]Demolition working for me in any capacity. employees and have workers' insurance.$ 9• ❑Building addition comp.[No workers'comp.insurance p• required.] 5. E] We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself..[No workers'comp. right of exemption per MGL 12.[]Ro ep insurance required.]t c. 152,§1(4),and we have no ` employees. [No workers' 13. Other comp.insurance required.] *Any applicant that checks box#1 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. #Contractors that checkthis 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 providingworkers'con enation insurancejor my employees. Bel ow s the policy andjob siteinformation Insurance Company Name: Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address: an City/State/Zip: Attach a copy of the workers'compensation po cy 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 penaltiesin 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 for insurance coverage o age verification. I do hereby certi n r t pa' and pe Ities of perjury that the information provided abo a is tr 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): f 1. Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: IPA N. r ";I i�.. tai .. i.P=;3;-`1 ;I3J; ;-!, FIR,INIA11 1."1 +I a NS...:A,lit C:, , .^.�Jr`..: t..,, _..:Li`l?..) J iJ=.i,i .. J...._.. OF ],.N LFA,--iE 'OO'iE.S 4, - ^-r a IE C R ,YsO01,.1f ER AND TIHEER ) Cry rt r_1!'a 0rI _ n 111 ;hili. f.J.i)'-1 9°a riJ3 ,...�)J91)[J7h:#I_ ).. 1 ; . and . , ..i- " vl;1.,� ni.Ms C71 . tv,thP Policy,, b .o..aii1 pal a{ / i .t- ii .. r �i-ii 7 , -ht , �ai s w;I^,'cy.Y-)cj! -'+'.d i. i .,-)C i.I.. 1 is 4:J i i.. PHONE E-MAIL '-- ------ -=-- _aro Alliance center, 3560 Lenon R.oa:�, Suit-- 2,-00 _ ?'tlan'td, GA. 30320 IiJSU ER(S):A:PDRDII`.h Ls'`I'_5'AG,E NAIG4 1 ------ Fa s (212) 948-0902INSUR-cRA: Steadfast Ina Co ---- - 26387 INSURED IrasuR_R a: zu?ict. antericen Co The Home Depot; Inc. 23841 Nome Depot U.S.A., Inc. INSURER C: Na'ra Hzumps:ira Ins Cc — _—..-- 2455 Paces Ferry Roar? ?P8 INSURER D: Illinois Natl Ins Co 23817 - Building C-20 NATIONAL UNION FIRE INS CO Oil 'PITTS 19445 Atlanta, G-1 30338 INSURER E: _ _ INSUP,ERF: Illinois UnionInsCo --. -- _27960 COVERAGES t" CERTIFICATE NWBER: 25776028 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 l INDICATED. NOTWITHSTANDING ANY.REQUIREMENT, TERM OR CONDITION OF ANY CONTRACTOR 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 HPVE BEEN REDUCED BY PAID CLAIMS. — INSR ADDL SUBR POLICY EFF POLICY EXP LIP ITo LTR TYPE OF INSURANCE P VD POLICY_ _NUMBER MMIDDIYYYY .MMIDDNYYY - J - A GENERAL LIABILITY GLO4887714-02 03/01/1 03/01/13 EACHOCCURRENCE _ $ 9,000,000 XDAMAGE TO RENTED 1,000,000 COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence S CLAIMS-MADE a OCCUR MED EXP(Any one person) $EXCLUDED X LIMITS OF POLICY XS PERSONAL&ADV INJURY $ 9,000,000 X OF SIR: $1M.PER OCC GENERAL AGGREGATE $ 9,000,000 GEN'LAGGREGATELIMITAPPLIESPER: PRODUCTS-COMPIOPAGG $ 9,000,000 X POLICY PRO- Fj LOC $ B BAP 2938863-09 03/01/12 03101/13 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident 1,000,000 X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED [—'SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS - NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X SELF INSUR D PHY DMG $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ DED RETENTION$ r $ C WORKERS COMPENSATION WC019736915 (AOS) '03/01/1 03/01/13 X WT RYLj�L 0TH- ' ----- AND EMPLOYERS LIABILITY Y I N D ANY PROPRIETORIPARTNER/EXECUTIV&E NIA WC019736917 (FL) 03/01/1 03/01/13 E.L.EACH ACCIDENT_- $ 1,'000,000— OFFICER/MEMBEREXCLUDEO? N WC019736916 (CA) 03/01/1 03/01/13 E.L.DISEASE-EA EMPLOYE $ 1,000,000 E (Mandatory In NH) It yes,describe under1000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ , E Workers Compensation WC1192494' (QSI) 03/01/1 03/01/13 SIR (AOS)/SIR (GA) 1N/750,000 C Workers Compensation WC019736918 (WI) 03/01/1 03/01/13 F TX Employers XS Indemnity TNSC46566397 (TX) 03/01/1 03/01/13 Occurrence/SIR 30M/1M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOME DEPOT U.S.A., INC. ACCORDANCE WITH THE POLICY PROVISIONS. 2455 PACES FERRY ROAD NW AUTHORIZED REPRESENTATIVE BUILDING C-20 ATLANTA, GA 30339 USA ©198 22010 ACQRD CORPORATION: All rights reserved. ---- -- -••-•-•--• Tr... Ar^ran nama and Inon are reoistered marks of ACORD'}' ✓a .1 + � Fi '�app �pq ry/�y(�r19C <.S ,� 3 �,t�,Ob �I an am ill 7 3..Z'L • v''� c'U'bL�s.9 �1 l�+.AyC.L3� � ���` .. .. o Park Plaza - Suite 5.p 0. ;sachu t1en: 128833. <ype: upp;emant Carr) Nit --_ 813/2014 Me `iCii7iF � C; �1 a i=t•1 1--.1—�,I�3 7 fly l.:J`A 30,3139 h f �4v`yw Tj date jkc!&== rfrd return cs�d.t�ltairlt renson.ior clinngc: s ® �c?<dress ersctivQi Empiayftrcnt n Last Cnrd ;4, :1 ✓P.t.�e -f.0+tY7i/3Y9fY t.J�.2E •� G .J..L.3dYi".^02/:d2�.°! r 'asfr:h°idui sz 1onse r registration vilid, of k-crisuyner Arfri"t 6e,Burn. or Yy H � before tim expiratlora dnte. �E ilius d returnAm' iNll'f':Cs1/�(1rE1�iT�Je�t�'i�!'T71. Office of Consumer rsi leirs a:d lsiness cbnia:ior, I�r li,i k��J} -'c i�Istr4flr�rl; 24ti� ° ..Typ-, 10 ParkPisiza- uit4 5170 Supplement Card. Boston MA 02116 > h 5-o t;tl i]Ppl_ .i;]I...I;;,i-iD F!-�LL(Sf;lt= 't.:iCs�==✓� � �, � �. e 6'JiJ OU P,�r�L1 :y' net'witeof valid �,�i