Loading...
HomeMy WebLinkAboutBuilding Permit #440-2017 - 59 FARRWOOD AVENUE 10/25/2016 NORTf-r 61 BUILDING PERMIT o`�t`E° 'bq�'o I/r TOWN OF NORTH ANDOVER < - APPLICATION FOR PLAN EXAMINATION _ Permit No#: V� Date Received 9SsArED Date Issued&C) y. P4PORTANT: Applicant must complete all items on this page -rr W 0Uj l�✓'L LOCATIONS �� PROPERT WNER p_ - Pnnt 96 Year structure yes no MAP PARCEL: Z®N1NG DISTRICT:`Historic District yes+ no Machine Shop Village yes? no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New ilding ❑ One family ❑Ad ion ❑Two or more family ❑ Industrial ❑ eration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Septic 11 Well ❑ Floodplain ElWetlands ❑ Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ,UG s -rlt ut- rt 4C- C �� jeS� Identification- Please Type or Print Clearly 7� Phone: 1G2 OWNER: Name: k 3 10 Address: S -r'rc..)vo� Avg ' d !C /' � i��n� ( G 3g- moo Contractor Name: tG tiE..r ' . �,°L ' I*b v,r Phone:- Pill Ernail: Address: y3 r2R� o��, 1 t'a r'Suta. /V R- � � s License: <� � Exp: Date: Supervisor's Construction - _ Ex Date:. Horne Improvement License: _ p. r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. C� Total Project Cost: $ 7r C" FEE: $ Check No.: 1 Receipt No.: l �© NOTE: Persons contracting with unregistered contractors do not have, ccess tote guaranty fund Signature of Agent/Owner -L(- Signature_of contractor Location No. Date • - TOWN OF NORTH ANDOVER .r y Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i � Check#�� Building Inspector J / Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swim,ring pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS 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 Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes---..no.. Located at 124 Main Street - - Fire Department signature/date COMMENTS 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 Call Email Date Time Contact Name = Doc.Building Permit Revised 2014 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/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 ❑ 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 t%O R Tly Town of 6 ndover O No. h ver, Mass, 10 �p O LAK@ ,�, C OC KIC C"V K!WICK .44 sATIED U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .. ..... ,• ................. BUILDING INSPECTOR U-R.15 has permission to erect .......................... buildings on . . ... wtoa..Ns-.Arr.. Foundation Rough to be occupied as A.sjovae...6...1te.PLLM.K)T... 't .................... 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 CONS Rough Service .. .. ........ .... Final LDING INSPE OR 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. A r Home Depot Contractor License Numbers: MA Home Improvement Contractor Reg. # 126893 Salesperson Name and Registration Number: Leonard Racite : R-1-073-14-00023 Home Improvement Agreement THD AT- HOME SERVICES, INC ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: Chris Hansberry 9586431 First Name Last Name Branch Name Lead# 59 Farrwood Ave, North Andover, MA NORTH ANDOVER MA Zip p 845 Customer Address City tate (978) 943-1612 Home Phone# Work Phone# Cell Phone# Ehristopherhansberry@gmaii.com Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED, ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES THAT THE CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL. PLEASE SIGN BELOW TO ACKNOWLEDGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITTEN NONCE OF YOUR,RIGHT TO CANCEL. Acknowledged by: �— X --- = 10/01/2016 CustomerRy�qn aturee Date 1 Distribution: White-Home Depot Yellow-Customer Copy Simonton Windows _5-u `v'antage?a!:to - ;!.,,! 1;',Glass Argon Lv,-;�. ;o Lamnated Glass U14CL'cubio_..�,r, n ` 'a t/.rr. Grills FrsF�r dentar.a e Boole gt illotina V ni!o 3 18 mm Vidrio Argbr. Lo !-t Si: ! rCCu�rn7 vidr.o lar-inado Con rejillas t CPD.SSP-A-44-21042-00002 07-75 OH ENERGY PERFORMANCE RATINGS EVALUACION DE RENDIMIENTO ENERGETICO U=actor Solar Heat Gain Coefficient f :`�af3LCl3 Ga Cf?(�13 G2. 0.29 1 .65 _; 0.24 ADDITIONAL PERFORMANCE RATINGS EVALUACION SUPLEMENTARIA DE RENDIMIENTO m Visible Transmittance i 0.45 mwuw(L?f Silpu3las ral fS malty.. J Jm acr'n,3D ]e!tiiT!I.fG Mr'GI5 Jf�i7.n:l pd"f f•9fCd_ Jf�c:auf}:ifd U .L.:i 3Z�_'.Ir9G IC colt cr:T' nm ary ProvLc:3rd Jos-io!4 a rwt T a sum'!:'f of if:�p'GCLCI`ii 3'-y 3PK C.A'-'% .^..wt T.3 CtUfa.>:!iara!;:i 6 for.,.. 'oJ:.�:p5r%rma...e.rfx maton.ww)4.�L,.afy __ Da-a Jet5r:1!(.5f.'SrGm�:S� :�G�31Jal:,f)CLC!3._i3/aiGf:3 :'ar:d a�tpu%3I:8-do- C.iin,e._i,..os�f�.:.C.m.:erW�.r.?.I>?:9 e... ''� _ ,,a'2 1 .,C iGi':5'ar•. 2 u-.. .,-� �.. -r o S. f fa 7r L S. .':`�:nt-_yCf0 .v.)ff 5rda �;.GLU y(!G JafarluZ3:8 n!.fG7U:38a 3G-,u- D�.a�r�3G as, ..�� ,).,:.Ia.on ii'r.etu Ja!3�.Cc".a ii '="I.:Se 3u�DR:,G'_e ?;Ie prod ct nrf rl carp Unit qualifies for ENERGY STAROregion(s):Northern, �f North Central,South Central, Southern. { STC:29 IND: Rein 00/Glass ProSolar/H-LC25 Q P.+.2 5/'2 5 Tested Size:48"x 80" Fonda Product Approval:FL5167 Applicable Test Standards): ANSI/AAMA/NWWDA 101/I.S.2-97,AAMA/VVDMA/CSA 101/I.S.2/A440-05,AAMA/VVDMA,'CSA 10111.S.2/A440-08, f A440S1-09 Canadian Suppl r 8358790/01 80333 HS Howard 6400094A !`eeo -.s aGdl`Sr•oSS u..G gra 7 u Guafa es:a ib'�Pte vS'i":Arvv w 'aSI'a(gcv �i : l �:. :a�.. r��1,1 ?�' 'd.•e' ,+�r°�����r.r�,t,!,r.' ��1 't-Z�; ,d,��YG'v'��t�(e��; S �i�f ��° Office of Consumer Affairs land Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 126893 Type: Supplement Card THD AT HOME SERVICES, INC. Expiration: 8/3/2018 MARK NIADNA `--� ---- -- — 2455 PACES FERRY ROAD, HSC C-11 --- — — ATLANTA, GA 30339 —-- Update Address and return card.Mark reason for change, �i(,AI l� aom-0S/1I ❑ Address Renewal LJ Employment Ej Lost Card "= Office of Consumer Affairs&Business Regulation License or registration valid for individual use only before the expiration date. If found return to: IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 126893 Type 10 Park Plaza-Suite 5170 Expiration: 8/3/2018 Supplement Card Boston,MA 02116 THD AT HOME SERVICES,INC, THE HOME DEPOT AT HOME SERVICES MARK NIADNA 2455 PACES FERRY ROAD,HSC ...-r-•=�t ;; —— (1n �` ATLANTA,GA 30339 Undersecretary Not Vali without signt�ture v The Coinn►-onwealth of_ylassachusetts \ Department of Industrial Accidents office of Investigations J, I Congress Street, Suite 100 Boston,IbL4 02114 201 www mass.gov/dia ' Workers'Compensation Insurance Affidavit: Builders/Coatractors/Ele et age Pn� n�e errs PleApplicant Ynformation T�,M , Iev Name (Business/Orgsnizatioo/Indi Adua": VOL Ir Address: City/State/Zi : {,' Phone#: Are you an employer? Check the ap ropriate box: Type of project(required): 4. I am a general contractor and I 6 New construction 1.❑ I am a employer with have lured the sub-contractors employees(full and/or part-time)•* listed on the attached sheet. 7. ❑Remodeling 2_❑ I am a sole proprietor or partner- These sub-contractors have g. Demolition i ship and have no employees employees and have workers' 9 Building addition worltmg for me in any capacity. comp.msttrance.# I (No workers' comp. ne 5 We are a corporation and its 10.0 Electrical repairs or additions in=a required.] officers have exercised their 11L12. []PI mg repairs or additions 3.❑ I am a homeowner doing all woL1 right of exemption per MGL ] of repairs lM � myself (No workers' comp. c. 152,91(4),and we have no insurance required.] t Other .mployees. [i`io workers' , n µ.1S comp.insurance required] "�'/applicant hat checks box 1 must also fiat out the section.below work and then hire outside compensation Showing(heir work=, utractors must submit new affidavit indicating such. t Homeowners who submit this affidant mdicatingthey g aL sheaf showing the name of the snbt`ca�ac be®d staff whether or not base entities have tContractors that check this box must attached an addition rovide their workers'comp.p employees. If the sub-contractors have employees,they must pY insurance for my employees. Below is the policy and job site Jam an employer that-is providing workers'compensation information. ,5 - �D insurance Company Name: �/ r j Al ©� Expiration Date: / Policy!#or Self-ins.Lic.#: Vv / Job Site Address: 5 q A.r'r wvo 1 �"`` f City/State/Zip: A I Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration ti date required under Section 25A of a Failure to secure coverage as of a 1 MGL e. 152 can lead to the imposition of criminal p i fine up to$1,500.00 and/or one-year tmpzisoB�ed that a copy of thiss civil hstatement s in the may be forwarded o the Office of d a fine , of up to$250.00 a day against the violator. Investigations of the DIA for insurance coverage verification. I do hereby c nder the pat nd penalties of perjury that the information provided above is true and correct. i Date: Si atme: Q (� Phony [6.Other al use only. Do not write in this area,to be completed by city or town ofj'iciaL Cityr Town: Permit/License# g Authority(circle one): ector ard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Lisp ; act Person: Phone#: DA r°IMMIoorr t-n ACORD° CERTIFICATE OF LIABILITY INSURANCE )z'iIr THIS CERTIFICA T- IS ISSUED A3 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATc. DOES NOT ,AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED SY THE POLICIES BELOW. THIS CERTIFICATE" OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETlIIEEN THE ISSUING INSURER(S), AUTHORIZED j REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. I IMPORTANT; if the certificate holder is an ADDITIONAL INSURED, the policy(ies) must,be endorsed. If SUBROGATION IS WAIVED, subject to i the terms and conditions of the policy, certain policies may require an endorsement. A statement an this•:art icato does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: M,+PSH;SA,'NC PHONE FAR ,NO A !A ICE E`IT_° (AIC, Ext): lac.No L c0_cPIG`X 30AD 3"1 =241,0 E-MAIL ADDRESS: 30326NAIC k INSURER S)AFFORDING COVERAGE 1'iC492-eomeD-i3AW'-16-17 INSURER A:Steadfast nsurance Company 26387 INSURED INSURER B:Zurich AmefiCan Insurance:o 16535 THD AT-r10ME 3ER'/ICE3.!NC. .BA.T'�E HOME DEPOT AT-KNIE 3ERIr!CE3 INSURER c:1`)eW Hampshire!ns�0 23841 2590'UMBERLAND?.API,'Na 31JITE 3C0 INSURER D:Illinois National Insurance Company 23817 A7.1N A,GA 30339 INSURER E INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003736646-14 REVISION NUMBER:8 THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOPPATHSTANDING 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 ADDL UBW I POLICY EFF i POLICY EXP LIMITS LrR TYPE OF INSURANCE D POLICY NUMBER MMIDD MMIDD C COMMERCIAL GENERAL LIABILITY GL 488714-L6 0310112016 0310112017 BCH OCCURRENCE i 9,C00,000 DAMAGE TO RENTED i tOCo,oco �L�1.LIS-}+INCEDCCUR ?REMISES Eaaccurrence LF+il-3'.FP;UCVX3 MED EXP(Any E3ne?erson) E:<CUJDED OF SIP,:31M PER DCC PERSONAL&ADV'NJURY i 9,CC0,01C0 ` 3E>I'L AGGP.c7?.`_L IMI?;PALES>`=R: HGEER?.L AGGREGATEEAGG i .DUCTS-COMPIOP . i 9:J00,9Co JE;- C :)THER: ' 3 . AUTOMOBILE LIABILITY BAP 2938863-13 0101i2013 03101,2017 COMBINED SINGLE'_;MIT ; I,1000.000 E3 accident) >,I!AUTO BODILY INJURY(Per person) i ALL OlPrNED 3CHEDULED :SELF INSURED.AUTO?HY DMG BODILY INJURY(Per accident) 3 _ AUTOS _ AUTOS PROPERTY DAMAGE ICN-OlPn`IED : 5 ,HIRED AUT:S _.AUTOS Per accident — i UMBRELLA LIAB OCCUR EACH OCCURRENCE i EXCESS LIAB CLAIMS.AADE 'AGGREGATE I I DED RETENTION i ' 3 C WORKERS COMPENSATION WC015519215(AOS) !03101(2016 ;0310112017 X I STATUTE I !ERH I C AND EMPLOYERS'LIABILITY YIN WC (015519217 AK,iCf,NH.1J,VT) 0310112016 !0310112011 ;^ 1,000,000 .ANY PROPRIETORIPARTNERiEXECUTIVE E.L.EACH ACCIDENT a G OFFICERIMEMBER EXCLUDED' N INIA•. WC015519216(FL) '03101 016 i03101i2017 E.L.DISEASE-EA EMPLOYEE i 1,000,000 (Mandatory in NH) If yes,descnbe under ',Conitnued on Additional Page I E.L DISEASE-POLICY LIMIT s 1.000,000 DESCRIPTION OF OPERATIONS aelow I DESCRIPTION OF OPERATIONS!LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) =MDENCE OF!NSURAINCE CERTIFICATE HOLDER CANCELLATION THD.AT-HOME SERVICES.INC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA T'?E i+OME DEPOT AT-HCME 3ER%i!CES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. NTL*ITA,ITA,3A 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee _3"LnLUQo'� ©1988-2014 ACORD CORPORATION. All rights reserved. it tI.ti4. 811111 11ilvr� Iin10r Is. . CSSL-106006 BENJAMIN PARKER JIL 43 GREENOUGHRO�W­.. Plaistow N.H 0386.5 �'' r E r ' '44vo.wxp