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HomeMy WebLinkAboutBuilding Permit #911-14 - 58 BEVERLY STREET 6/13/2014Permit No#: q I I Date Issued: BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this pate LOCATION 5 X l'�PVCDr T o ' Print PROPERTY OWNER wcw MA t0y Print 100 Year Structure yes no / PARCELi03Z- ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building eOne family ❑ Addition ❑ Two or more family ❑ Industrial 0 Alteration No. of units: ❑ Commercial KRepair, replacement 0 Assessory Bldg 0 Others: 0 Demolition ❑ Other ❑ Septic []Well 0 Floodplain 0 Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: T.14L,r [114rd Phone:g17� Address: ,r5Y 6 -everiv S� Contractor Name: Phone: 77,j 3699 3gz Address: 753 F -a---5 � 5 /4-( �6p-U Supervisor's Construction License: Exp. Date: / /�11G Home Improvement License: 1 % Exp. Date: 3 `l?/1S" 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: $ X26 FEE: $ J�U L/ Check No.: Ytafl- Receipt No.: a 7 77 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund -- - - _ n. -- - - - - Signature of Agent/Owner Signature of contractor Location IV (9-1 No. Date &IWJ�L Z/ e I I, - Check # -11 #4 TOWN OF NORTH ANDOVER, Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $— TOTAL $ ""Bui(ding Inspector v 1• C � 0 O Z CL cc 0 0 O vCD r� c 2) =r — cD CD O CD ou 0 v C• cQ CD � v O Z CD 0 � O CD a C CD Q C: m cn O cn W c cn V/ C v z --I O m -v cn z O cn yo=�°MU = °<. CD U) in CL O CD o 00 � = n � m o = = � N. rtCD -„ r•n OOm h ::tN 0 c -i CD CD = 2- A C D =� = O 0 � to CL :I O a) r CO) rt D O S O M o0,to9 cn Oz CD o o° a- A _ 7� CD cn 0 o CL O � 09 N - (D rD zrD CD :3 � CDjo AT O C S :3 �� N V) rD < w O C S W T DJ rCn a� � co CA S 3 °Z O C 0- O (D "O rt r) V) N cc :A o O :f. S rt CD C CD CO CD G1 O CD m n m 0 O 0+ C m 0 DCD C G o m z CD -0 3 W °y 0 T m = O � _rt 01 O Q , N B O 77 (D o (D N - (D rD zrD W C 3 (D T 3' N AT O C S N V) rD < w O C S T DJ O C S N S 3 O C S O C 0- O (D "O rt r) V) N O O n mW D m --iO G1 O m n m 0 C m 0 C G o m z 3 3 W °y 0 T m = O The Commonwealth of Massarhusens Department of Industria! Accidents dffwe of Investigations 640 Washington Street Boston, JNA 42111 www.mass.gov/d1a Workers' Compensation Insurance Affidavit: Buflders/Cuntractorsll iectricigm/Plumbers Adri rEs- �5-0 TCAPPPrl, liF 8110 _ 4CS F Z Pf i 1701 City/State/Lip: Phone #:_L t - EW — RVO Are rf an employer? Check the appropriate box: 1. I am a employer with .i1 4. n 1 am a general contractor and 1 employees (full and/or part -brise).' have hired the sub -contractors 2.0 1 am a sole proprietor or partner- listed on the attached shut, 2. ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. (No workers' comp. insurance 5. C] We are a corporation and its required.] officers have exercised their 3.0 1 am a homeowner doing all wont right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. f No workers' comp. insurance required,], Type of project (required): 6. ❑ New construction 7. 0 Remodeling 8. [] DemoIition 9. E] Building addition 10.01 lecuical repairs or.additions 11.0 Plumbing repairs of additions 12.[J Roof :repairs 13.0 other 'Any applicant that checks box 91 awn also fill out the section blow showing their workers' compansitoci policy tat=atioa. t Howwwarxr talo submit this at5davu lndicstiog they are doing all work and thea him outride coaftctm maast subroit a ww affiidavU initiating writ. tContmctorr that check this boat most atseched an additional sheet showing the name of the sub-contsaam aril t1u4i wobecs' comp. policy information. I ain an employer that is providing workers' eampensasion. Insumnce for bey employers. Below is the policy and Job site inforaudon. Insurance Company We,- 0,oa i6Ci'Vg7q 1® Policy !i or Self --enc. Lic. U� F.xpiratitTn i152e:---� Job Site Add= City/State/Zip. Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Fai lure to secure coverage as required tender Section 25A of MGL c.15.2 can lead to the imposition of cdMinal penalties of a fine tip to $1,500.00 and/or one- ear imprisonment, as well as civil penalties in the forms of a STOP WORK ORDER and a fine Of up to 5250.00 a y c . Be advised that a copy of this statement may be forwarded to the Office of Investigations o the D for cc oovemgc vw'i> ication. Ido hereby cerY# uqerlhepkk,andpenaffies ofperjury that the Informadon provided above is true and sand. Phone #: ? 7 z 3 Orial use only. DO not Write in this area, to be completed by Cry or town ogciai City or Town: Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. 6. Other Contact Person: PerrnitfUeense Clerk 4. Electricai Inspector 5. Plumbing Inspector Phone POWER -1 OP Iia: AW A4C"1? ®° CERTIFICATE OF LIABILITY INSURANCE DATDD1YYYY) TYPE 09il 09/11/13 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(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the poilcy, 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). PRODUCER215-723.4378 Lacher & Associates Ins Agency Lacher Insurance Group 215-723-8604.(CNN 632E Broad St P O Box 64398 Souderton, PA 1B964 NAMEACT — --- Ext, vc Nob o ;632 -MAIL - ADDRESS: INSURERS AFFORDING COVERAGE NAIC# Chad Lacher INSURERA: Harleysville Worcester Ins Co 26182 EACH OCCURRENCE S 1,000;000 INSURED Power Home Remodeling Group, LLC. Power Home Remodeling Group, Inc' 2501 Seaport Drive Ste 13110 INSURERB;,Harle sville Preferred Ins. Co 35696 INSURER c: Nationwide Mutual Ins Company 23787 INSURER D: INSURER E: Chester, PA 19013 _ INSURER F: $ THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE 13EE14 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 ADD B POLICY NUMBER 'POLICYEFF IMMIDDlYYYY1 POLICY EXP IIAMIDDNYYYILIMITS B GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY CLAIMS MADE a OCCUR MPA00000089793N-1 10101113 ' 10101114 EACH OCCURRENCE S 1,000;000 DAtTvA A TO RENTED PREM SEEa occurrence $ 100,000 MED EXP An • one rson $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; POLICY X Irr.T F1 PRO - 1 LOC PRODUCTS - COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS AUTOS BA00000089796N 10/01/13 10/01/14 COMBINE ,SINGLE LIMITMa 11000,000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S PROPERTY DAMAGE Per. er accident $ $ C X UMBRELLA LIAB EXCESS LIAB X OCCUR I CLAIMS -MADE CMBOOD00089794N 10101113 10/01114 EACH OCCURRENCE $ 10,000,000 AGGREGATE $ 10,000,000 DED RETENTION$ S A WORKERS COMPENSATION AND EMPLOYERS' LIASIDTY ANY05FPR PRAETOR ARTNERI ECUfIVE Y© (Mandatory In NH) If yes, desa�be under DESCRIPTION OF OPERATIONS below NIA WCDOOOOD89795 10/01113 10/01/14 X WC STATU- OTH- ITORYLIMI E.L. EACH ACCIDENT $ 1,000,000 EL. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT S 1,000,000 A A Mass Auto Policy NY Auto Policy BA00000018227P BAOD000074649R 10101/13 10101/13 10/01114 10/01/14 6.abllity 1,000,000 Limit DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES (Attach ACORD 101, Additional Remarks Schodule, if more space is requlred) --. _ ...._........----• • �.nrv�.c��n I tun NANDOVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover, MA 01845 4��� ' V 1968-ZUI0 ACORD CORPORATION. All rights reserved. ACORD 26 (2010106) The ACORD name and logo are registered marks of ACORD 11 Office of Consumer Affairs and Business Regulation 10 Park Plaza -Suite 5170 Boston, Massachusetts 02116 . Home Improvers ent�.-Contractor Registration -- - Registration: 168616 Type: Supplement Card 'OWER HO - Expiration: 3/18/2015 ME REMODELING GROUJ' LLC .JUSTIN SMITH = _ 2501 SEAPORT DRIVE STE 8110 CHESTER, PA 19013 SCA 1 ro 20M-05/11 c�/yoe �rrrv�ri9,asuu� a�C%UGaaaac�u, of Consumer Affairs & Business Regulation IMPROVEMENT CONTRACTOR POWER HOME JUSTIN SMITH 2501 SEAPORT ORN CHESTER, PA 19013 Type: Supplement Card LLC. Update Address and return card. Mark reason for change. Address ❑ Renewal n Employment ❑ Lost Card License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 ' - Undersecretary Not valid without signature Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS -093980 c JUSTIN S I .F SMI 399 E Hartford A:4nu'6 f Uxbridge MA 01-569 1 f �i12-- Expiration Commissioner 01/05/2016 about:blatilc NAHONAL HEADOUARTERS "� Judy 0 2sor seavw Dive. PA 19013 �011/ER • 31 osaso ,......, ..a... May 06, 2014 888 -REMODEL • �i.r� � " M .,- } t$1s�`1 max. , ru Htca teaata CUSTOM REMODELING AND IMPROVEMENT AGREEMENT &ryer(sY InfortnationAnd DeserOftn of the Ptoparty: project Nwiber 31-06880 May 06, tot4 Judy Huardwrawa.��.e (979)882.8645 Moa+sl rue fiabobom tia%and 1230p 58 oft" St (97a) 761-0860 (ROW111 COO) Estimated Project Start 6 to 7 weeks Naar Andover; MA. 01645 EBtl n ited Pmoct Completion: 1 to 2 days County: Essex Fisk! Sabs Repntowntve: Mdege Flerrng &aerp) aan%,bege #W a dd, start sm omni m Aaw am Not' 0nha aararoe. Dek" Townartlp: e Gorarecerrs oorod uta treta4ao rn Wa+levv trine ertea sea DerayltXkrwwr+Condr7ors. Buyer(s) listed above hereby jointly and severally agrees to purchase We goons angor serwc ea m rower rwrtm rce-r�-rj —w and Its vendors (�Contmeton in accordance with the prices and terrru described in Ws 5 page docunerit and the Product SpetaScations, vMch are incorporated as part of the Agreement (cotlecavely, tis �ABreernenl). Tru Agreement represents a cash sale of goods and services. Btyer(s) agrees to pay the coat of the goods and services purchased as described herein, regardless of timing or approval of any financing Buyar(s) may seek for their pur hale. Purchase Price. ;5,488.99 Pm Instsliatlon hfapection Dates: Doom Payment $0.00 rue fiabobom tia%and 1230p Balance Due on 66,488,39 Estimated Project Start 6 to 7 weeks Stbstan bat Completion: EBtl n ited Pmoct Completion: 1 to 2 days Method of Payment: Check &aerp) aan%,bege #W a dd, start sm omni m Aaw am Not' 0nha aararoe. Dek" e Gorarecerrs oorod uta treta4ao rn Wa+levv trine ertea sea DerayltXkrwwr+Condr7ors. Buyers) hereby adwoNledges MOW ole copy of the pampnhet, " ane t eae-oahe L enc >,xaotf w �neaw+w —W , ,• •• , ., sr Buyers) of the potential risk of lead hazard wposure from renovation actiivtty to be performed in or at "r(sY ProPeft at the addfaas kitten above. Buyer(s) received this pamphlet on the date of this Agreement. before commenw"nt of work. of Buyer(s), initials, Ttis Agreement constitutes the entire agreement and uderstanding between the parties, and rtes Agneemem repleoes any and all prior nege5atom, mprowntetons, or agreements. either w"en or omi. No amendment, mo Swtion or waiver ofihis Agreement shall be valid oreffeclhro unless In writing and signed by both parties. Buyer(s) hmWsdnwA9d9es that Buyer(s)1) has read the erfire Agreement and has received a completed, signed, and dated copy of this Agreemenk inckrdirp the two accomparvArV Notice of Cancellation forms, on the date first writen above and 2) was oratty irdorrned of td&t r right to cancel this transaction. Buyers) also agrees and understands that if Buyer(s) finances the work with a third -party, the farms of that financing will be contained on separate doounents. Including any fimnee charge. Future promotions not applicable. DO N77T SIGN THIS AGREEMiENT iF THERE ARE ANY BLANK SPACES. I have rad and received each papa of" 5 papa apresment uyer(s) 4,gPoafRernInX Nome Reode Group 5JW14 d;� 105106114 ngConsutant ignaitre Jamas Dingfeldsr Judy Huard YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANYTIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. May Ota, 201418:38 Page 1 of 5 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 MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup Call Ema Date Time Contact Name Doc.Building Permit Revised 2014 No 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 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 ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/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 o 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 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 2014