HomeMy WebLinkAboutBuilding Permit #515-2011 - 50 EDGELAWN AVENUE 1/3/2011TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: — 2 0// Date Received
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION 1iG 1�1 � 4� Z-14 Wly 14(l '�_
Print
PROPERTY OWNER M iLL P0,6 -1t( L
Print
MAP NO: �d Pati PARCEL6 0 ZONING 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
tion
No. of units:
❑Commercialpair,
ae
replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
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DESCRIPTION ON WORK TO BE vbxv uxiviti):
OWNER: Name:
Address: n C.
CONTRACTOR Name:
Address:
Identificgjon
�L YL [<&i
Supervisor's Construction License:
Home Improvement License:
ARCHITECT/ENGINEE
orar4rAczQ-
W
e or Print CIearly)
11
Phone: � ? 5r7G o/
fV P iL--
e zA,*f-n-v Exp. Date:
<6 Exp. Date:
FEE SCHEDULE: BULDING PERMIT: $12.00 PER
Total Project Cost: $
Phon
Reg. No.
00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
FEE: $ �'6 —
�?" -
Check No.: �I , 7 t / Receipt No.: 2 3?2;
NOTE: Persons contracting with unregis`'ftered contractors do not have access to the
Sirinafii�r of
Whet, co
Signature of contractor
9
e.
Location
No. 2 o ii Date
NORTH
TOWN OF NORTH ANDOVER
F � s
9
i •
Certificate of Occupancy $
CMUS <�
Building/Frame Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
23829
Building Inspector
v
Plans Submitted ❑ - Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑
Well ❑
Private (septic tank, etc. ❑
Tanning/MassageBody Art ❑ Swimming Pools ❑
Tobacco Sales ❑ Food Packaging/Sales ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT11
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
DATE REJECTED
DATE APPROVED
Reviewed on Signature
Reviewed on Signature
7
A
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 on site yes no
Located at 124 Main Street
Fire Department signature/date
COMAMNTS
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
❑ 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
New Construction (Single and Two Family)
❑ 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
❑ Engineering Affidavits for Engineered products
DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
a all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
iat the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
Lust be submitted with the building application
Doc: Doc.Building Permit Revised 2008mi
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Page 7 of 9
Home Improvement Agreement
PLEASE READ THIS
No. 2685-179217
Important additional information regarding Customer's rights may be contained in an attached State Supplement.
Scope: This "Agreement' consists of this page, the following General Terms and Conditions, the Invoice, the State
Supplement if applicable, and any drawings or Change Orders expressly made a part of this Agreement. The Agreement is
between the Customer identified on the Invoice and Home Depot U.S.A., Inc. ('The Home Depot" or "Home Depot"). Any
installation services provided under this Agreement shall be performed by a licensed and insured third party Authorized
Service Provider. The Home Depot does not perform architectural or engineering services, nor does it make structural
changes to dwellings or other structures. The Home Depot and its Authorized Service Provider will perform installation
services in accordance with applicable law.
Payment Schedule: Payment is required in accordance with the below schedule.
Down Payment: $ 10131.51 Due in full immediately. Customer down payment
is NOT an installment payment under this
Agreement
Final Payment: $ 0.00 Due upon completion of installation.
Sales Tax: $ 153.21 If applicable.
Total Amount of Sale: $ 10131.51 Includes all applicable discounts, rebates, and
taxes. Excludes finance charges.*
*Any interest payments or other finance charges will be determined by Customer's separate cardholder or loan agreement, to which The
Home Depot is NOT a party, and will be in addition to Customer's payment under this Agreement. Customer is subject to the terms and
conditions of the cardholder or loan agreement, as applicable. No funds should be made payable to Authorized Service Provider;
however, Authorized Service Provider may collect Customer's payment(s) made payable to The Home Depot.
Anticipated Delivery/ Installation Schedule
Delivery Date: TBD Start Date: 11/07/2010 Finish Date: 12/07/2010
Acceptance and Authorization: Customer authorizes The Home Depot to order and arrange for the delivery of all goods
and services included on the Invoice. Customer further agrees and understands that this Agreement is the entire
agreement between Customer and The Home Depot with regard to said goods and services and supersedes all prior
discussions and agreements, either oral or written relating to said goods and services. This Agreement can not 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 is entitled to and has received a complete copy
of this Agreement at the time Customer signs the Agreement. Do not sign if blank or incomplete.
Electronic Signature: The parties to the Agreement agree that the digital signatures of the parties included in this
Agreement are intended to authenticate this writing and to have the same force and effect as the use of manual signatures.
Customer acknowledges that he or she is the person named on The Home Depot contract number identified on the point of
sale device.
CANCELLATION: CUSTOMER MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR
OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE
THIRD BUSINESS DAY AFTER SIGNING THIS AGREEMENT. Under such circumstances, Customer's
payment(s) will be returned within ten (10) business days after The Home Depot's receipt of Customer's notice.
Acce b
11 /117/9O10
Customer's Signat'u e—' Date
Authorized Service Provider's Full Business/Trade Name, Address and
X
License No. or No(s)., as applicable:
Associate's/Authorized Service Provider's Full Signature
--
Date
Associate: Please print your salesperson's license number, if applicable.
License No(s).
Authorized Service Provider's Tel. No.
Questions? If The Home Depot store and Authorized Service Provider are unable to answer Customer's questions,
Customer may contact The Home Depot Customer Care Department at 1-800-553-3199 or use the address below.
Home Depot U.S.A. Inc., 2455 Paces Ferry Road, N.W., Bldg B.3, Atlanta, Georgia 30339
1/2010
age 7 of 9 No. 2685-179217 Customer Copy
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All dimensions size designations
given are subject to verification on
job site and adjustment to fit job
conditions.
This is an original design and must
not be released or copied unless
applicable fee has been paid or job
order placed.
Designed: 11/7/2010
Printed: 11/7/2010
A230866D.KIT El 1 Drawing #: 1
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All dimensions size designations This is an original design and must Designed: 11/7/2010
given are subject to verification on not be released or copied unless Printed: 11/7/2010
job site and adjustment to fit job applicable fee has been paid or job
conditions. order placed.
A230866D.KIT JE12 IDrawing #: 1
120'
08"
window
Legend baseboard heat
1: UF3
2: DB15 4DWR
3: B24 2FWT BUTT
4: BWBT18-2
5: BLB39/42R {P}
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8: W1 830L
9: W3012
10: W1 530R
11: UF3
12: CW2430R
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All dimensions _size designations
given are subject to verification on
job site and adjustment to fit job
conditions.
A230866D.KIT
This is an original design and must Designed: 11/7/2010
not be released or copied unless Printed: 11/7/2010
applicable fee has been paid or job
order placed.
All Drawing #: 1
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16
All dimensions _size designations
given are subject to verification on
job site and adjustment to fit job
conditions.
A230866D.KIT
This is an original design and must Designed: 11/7/2010
not be released or copied unless Printed: 11/7/2010
applicable fee has been paid or job
order placed.
All Drawing #: 1
®
A� o CERTIFICATE OF LIABILITY INSURANCE
DATE(MM/DD/YYYY)
1/3/11
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 endorsement(s).
PRODUCER
A & K Fowler Insurance LLC
200 Park Street
North Reading, MA 01864
CONTACT
NAME:
PHONE FAX
(AIC No, ExM AI No:
E-MAIL
ADDRESS:
PRODUCER
1261
INSURE S AFFORDING COVERAGE NAIC #
INSURED
Richard J. Madison d/b/a
R J Construction
3 Madison Ave.
Groveland, MA 01834
INSURERA:Hartford Insurance Company
INSURER B:Pilcrrim Insurance Company
INSURER C:
INSURER D:
INSURER E:
INSURER F :
warn i+E OTI CIP ATC K1 lnnuCo. F rvlllKm mtinfammm-
vTHIS 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.
INSR
LTR
TYPE OF INSURANCE JAF
I
SUBR
POLICY EFF T
POLICY NUMBER MM/DDNYW
MM DD/YYYY LICY EXP
LIMITS
GENERALLIABILITY
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTEDnence $ 300 000
E aoccu
5/28/10
5/28/11
MED EXP (Anyone person) $ 10 000
CLAIMS MADE I—XI OCCUR
PERSONAL &ADV INJURY $ 1 000 000
GENERAL AGGREGATE $ 2,000,000
GEN' LAGGREGATE LIMIT APPLIES PER
PRODUCTS - COMP/OPAGG $ 2000000
$
POLICY PROT LOC
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT $ 1,000,000
B
PGC10009624593
8/28/10
8/28/11
(Eaaccidert)
ANYAUTO
BODILY INJURY (Per person) $
ALL OWNED AUTOS
BODILY INJURY (Per accident) $
SCHEDULED AUTOS
PROPERTYDAMAGE $
HIRED AUTOS
(Per accident)
NON -OWNED AUTOS
UMBRELLA LIAR
OCCUR
EACH OCCURRENCE $
AGGREGATE $
EXCESS IAB
CLAIMS -MADE
DEDUCTIBLE
$
RETENTION $
$
A
WORKERS COMPENSATION
OSWECGQ0I60
5/30/10
5/30/11
TH-
- OFIR
WC STATUTS
E.L. EACH ACCIDENT $ 100,000
AND EMPLOYERS' LIABILITY Y / N
ANY PROPRIETOR/PARTNER/EXECUTIVE
E.L DISEASE -EA EMPLOYEE $ 100,000
OFFICE RMIEMBER EXCLUDED?
(Mandatory in NH)
N / A
E.L. DISEASE -POLICY LIMIT $ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is regli red)
Insurance verification
n Co'r1Ea!`ATC unl MCD CON CFI 1 O I IUN
Town of North Andover
North Andover, Ma 01845
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Lisa A. Dabrieo, CISR
U TVtW-ZUUV Ali UKU L VKrVM1A I IVIY. Au n911w Icacl vuu.
ACORD 25 (2009/09) The ACORD name and logo are registered marks of ACORD
Ak -Clow
Board of Building Regulatio sand Standards ` .
HOME IMPROVEMENT CONTRACTOR
Registration: 118509 I
Expiration: 3/29/2011 Tr# 281414
Type: DBA
R.J: CONSTRUCTION j
RICHARD MADISON
3 MADISON AVE
GROVE LAND, MA 0.1834 Administrator
Massachusetts - Department of Public Safety
UV Board of Buildin!-, Relgulations and`Standards
Construction Supervisor License
License: CS 30000
Restricted to: 00
RICHARD J MADISON
3 MADISON AVE
GROVELAND, MA 01834
��- Expiration: 7/21/2011
f'ununisioncr Tr#: 17764
Q
xw&�w
39 Farrwood Avenue, Unit 1 Telephone (978) 685-4434
North Andover, Massachusetts 01845 Fax (978) 685-0521
January 3, 2011
To Whom It May Concern:
Re: William Farewell
50 Edgelawn Avenue Unit # 2
North Andover, Massachusetts 01845
Mr. Farewell informed Heritage Green Management Office that on Tuesday, January 4,
2011, and continuing until completion RJ Construction will be renovating his kitchen.
The -unit owner will provide the office with contractor's license and certificate of
insurance.
Sincerely,
L;)G�
osann Ciofolo
Heritage Green Condominium Trust
Assistant Property Manager