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HomeMy WebLinkAboutBuilding Permit #491 - 68 JEFFERSON STREET 1/2/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: / Date Received Date Issued: ( JJ� IMPORTANT: Applicant must complete all items on this p; - LOCATIONI Pri PROPERTY OWN -W, 0& Print;1 oo'Year Old,Structure, MAP'NO.': _PARCEL: ZONINDISJTrRlC,T; Historic District' Machine $hop,Villa! MI. no: no TYPE OF IMPROVEMENT PROPOSEULISE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other O. Septic, ❑ 1Nelh Floodplaint ' ❑ 1Netlands t ❑ Watershed+Districts , '. 11,Water/SewerF DESCRIPTION OF WORK TO BE F'tK1-uK1V1tU: Identification Please Type or Print Clearly) OWNER: Name: Phone: CONTRAC= �O.R Name.: /1 cc. l' -1/a r r> `i 1b �S o� �Pfone Address:kq11010S6ry A -U& 1LA614Q -- = a - p e: Supervisor's:'7- X1.Construction, License; G 3 a Ex Dat70'3. Home li�nprovement' License:: E°zp Date; 3 - 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: $ J:6' FEE: $ t No.: Receipt Check No.: P NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 45ignature�of Agent Plans Submitted ❑ Plans Waived ❑ O`/ A Certified Plot Plan ❑ Stamped Plans ❑ g 1 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 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: Doc.Building Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools El, Well ❑ Tobacco Sales ❑j Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM - PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED El DATE APPROVED El Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition N Planning Board Decision: f Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit DPW Towp- Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes - - no = _. Located at'124 MainStreet ` Fire Depart merit-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 - Date Doc.Building Permit Revised 2010 Location (o G� D n No. L -% Check #` 26060 Date" d " TOWN OF NORTH ANDOVER Certificate of Occupancy $----- Building/Frame Permit Fee $�s4 Foundation Permit Fee $ Other Permit Fee $ TOTAL G�� Building Inspector � 00-0— C v N om, < :) F— N� CD m Z T 0 z C v; � �._ . y O mrn � F O CD cD N O N = �o m CD O Q, 0 -� �. No N co � m mc r z 0 � 0 O :.._ CD 0--Z O rn - (D, -0. LA < 3 O ^ X Qi -C• Z y. cm 0 r— m Q tCD 0 � co N 70 � O Cl)rn m_ CD U) 3 Q O 2. m < vCD O o CD =CD -a� y,?I C = m Cr V+ o C1 CD CD o (D c So ou CD CD .• CL vOD rF _ cD =r • +L 0 U' cn cn(D� CO CD0 cn _= DCD 0 o o 0 CD � rt m: � O O O O CL O CD � 00-0— C N om, < :) F— m .� cD CD m Z T 0 z 0 .C-•. o � �•a v; O �._ . y O mrn � F O CD cD N O N = �o m CD O Q, 0 -� �. No CD co to `�C m mc r z 0 o 0 C �_ z M ^ 0 :.._ rt S M= CD O rn �1 (D, -0. LA < 3 CL X Z -0 cm •� T. � cn a tCD 0 � 7° • = Crt Cl)rn fq= CD U) 3 Q O 2. o 7 CL0 cm Z o =CD -a� O V+ o C1 CD cn So �o .• G 0 c rF _ cD =r • +L CD cn cn(D� CD �y Z _= DCD Z CD -°'a ca 0 � rt m: � O O O CL O < 00-0— co N om, < :) F— m .� cD CD m CD 0 = T 0 z 0 .C-•. o � �•a v; O O N .-P• cD O O ,� Q y O rt � F O CD cD N O N = �o m CD O Q, 0 -� �. No CD co to `�C m mc r z 0 o , o m O C �_ z M ^ 0 0 0 rt S M= CD O QC C .rt (D, -0. LA < 3 CL O D v O m i s � :E< �_ cm •� T. � O N tCD 0 0 = Crt fq= CD U) 3 Q O 2. o 7 CL0 cm �N: =CD 3 CD C1 CD cn So �o G 0 rF _ cD =r • +L CD cn cn(D� CD �y _= DCD CD -°'a 0 � rt � O O O CL x y 0 m 'n m ca m O • l y Deo VI Ln co T :) T Ny m T A T (� .Z7 T N T 3 O ;r N o c 3 m m D{^ Z z -i =5O d0 D M j (D O O Oq m mc r z 0 O DO C �_ z M ^ 0 _S O QC O 7 Qj p p z m Q 0 (D, -0. LA < 3 O d n O D v O m i s MAIN 6s A ^ 7 ® DATE (MM/DdYYYY) /JR" CERTIFICATE OF LIABILITY INSURANCE 12/4/12 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. INIr^ORTANT: If the certificate holder is an ADDITIONAL INSURED, the otic les 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 CONTACT , A & K Fowler Insurance LLC NAME: PHONE (978) 664-0366 FAX FAX (978) 664-2209 ,200 Park Street EMIL ADDRESS: .North Reading, MA 01864 INSUREFMSJAFFORDING COVERAGE NAIC # INSURER A:HartfOrd Insurance Com any INSURED INSURER B Richard J. Madison d/b/a INSURER C: R J Construction INSURER D: 3 Madison Ave. INSURER E: Groveland, MA 01834 INSURER F: rnVFRA(1.rQ f+MO IrrrAVC rnreecoo. 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. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POUCY EFF MM/DD/Y POUCY EXP MMIDD/YYYY LIMITS A GENERAL LIABILITY08SBANF7078 •• 5/28/12 5/28/13 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED $ 300,000 X COMMERCIAL GENERAL LIABILITY �< MED EXP (Anyone person) $ 10,000 CLAIMS -MADE FxI OCCUR c ; PERSONAL& ADV INJURY $ 1,000,000 Jf a GENERAL AGGREGATE $ 2,000,000 GENT AGGREGATE LIMITAPP LIES' PE R PRODUCTS - COMP/OPAGG $ 2,000,000 $ POLICY PRO-' jECT A AUTOMOBILE LIABIUTY_ — 08SBANF7078 5/28/12 5/28/13 EOMBIcd ntSINGLELIMIT $ 1,000,000 BODILY INJURY (Per person) $ ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS HIREDAUTOS X NON -OWNED X _ AUTOS BODILY INJURY (Per accident) $ PReOPP.E YDAMAGE $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE _-- DED RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE YINN OFFICE RIMEMBER EXCLUDED? (Mandatory in NH) Ifyyes describe under DES�RIPTIONOFOPERATIONSbelow / A 08WECGQ0160 5/30/12 5/30/13 WC STATU- OTH- E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE -EA EMPLOYEE $ 100,000 rE.L. DISEASE -POLICY LIMIT $ '5500,000 DESCRIPTION OF OPERATIONS/ LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space isreguired) With respect to insured operations and subject to signed contract, Barkan Management Co. and it's agents and 416 Marlborough Street Condo, -Trust are named as additional` insured -. 416marlborough@gmail.com - - CERTIFICATE HOLDER CANCELLATION ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. - --t n AUTHORIZED REPRESENTATIVE. , 4 t. Kerri A. Boutin, CIC CRM CISR ©1988 2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E -Mail: t=c, '�'•a 1 . f. i Page 9 of 14 No. 2685-200353 Home Improvement Agreement PLEASE READ THIS Important additional information regarding Customer's rights may be contained in an attached State Supplement Scone: 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 as indicated below. Please initial here to opt to pay the total amount of the sale now; Customer has the option of paying less as further specified in the State Supplement. Payment: $_ 1 5S7O.44 Due in full immediately. Sales Tax: $ 9AA 97 If applicable. Total Amount of Sale: $ 1 SMA 71 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 Horne 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 Deliver Date: TBD Start Date: 12/20/2012 Finish Date: 01/09/2013 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, Accepted b • ' 11/24/2012 stomer's Signature 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. 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