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HomeMy WebLinkAboutBuilding Permit #565-12 - 7 WALKER ROAD 5/1/2018 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION /z Permit NO: 6 Date Received Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 71 TALI]LrQVi 4 L:LJ Print PROPERTY OWNER Unit# Print MAP N0: 99 PARCEL ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Resid tial Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial ❑AI ation No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other iT Se tic ® Well ._ r-.._.,, ®F,Iood in '❑W tlaricls � - --4p � (] Wafershed j istnct, _�❑t�Water/Sewers ___ • DESCRIPTION OF WO PERF RMED: C ( LAI VJ0z)!Si enti 'ca ' n PI se Type or Print Clearly) OWNER: Name: Phone: Address: / CONTRACTOR Name: r 'fi Phone: Address: Supervisor's Construction License: Ex . Date: p Home Improvement License: Exp. Date: 31)x ARCHITECT/ENGINEER Phone: Address: Reg. No. s• FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $_ �5?�C�t7s FEE: $_ D Check No.: -7 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access a gu my fund - �i ----�- �__ _-__�_._�-, in - :63•'a Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer Swimming Pools ❑ ❑� Tanning/Massage/Body Art ❑ g � Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ . I I I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS r Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wat6t& 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 servicedroprequires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 offrom 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/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) o Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic C y alculationslicable If Applicable) pp ) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products MOTE: 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 2008mi Location och6-, /c/ No, ���— 2 Date Ila 2 1401tT1y TOWN OF NORTH ANDOVER r 9 Certificate of Occupancy $ s�cMus<� Building/Frame Permit Fee $ R Foundation Permit Fee $ !` Other Permit Fee $ TOTAL $ [` Check # �6 7�F7 5 f 2497 uPfling Inspector P NORTH TO." Of _ - : . , r , 0% No. �Wri o , over, Mass.,LAKE COCMICME WICK RATED 7v BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT....... !. ...... � j ` . ................................................... ....................................... Foundation hasP 9 ,... � / /.1.�� permission to erect...........:.:........../,.�....../. ..... buildings on .. ... . ..:.. ... .................. ...................:.....:.:................ Rough to be occupied as..................... ............(_ ^ /�D. ............. 1 .�`` ��°�?,e.N.... ...�................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 MONTHSTARTS - ELECTRICAL INSPECTOR UNLESS LESS CONS 1 L��J CTIO l AR l S Rough :..._........... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Rough Display in a- Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burner'FIRE-DEPARTMENT Street No. SEE REVERSE SIDE Smoke Det. Fm:MyFax-Justin Bethune To:gllbert(18009863610) 15:34 01109112GMT-05 Pg 01-08 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and installed by: Branch Name: Boston Date: THD At-Home Services,Inc. IZ-/t-�' d/b/a The Home Depot At-Home.Services 345A Greenwood Street,Unit 21 Worcester,IIA 01607 Toll Free(800)657-5132:Fax(508)756-8823 Branch Number:31 Federal 11)4`75-26984K ME Lie#C 02439:Ri Cont.L.ie#16427 CT Lic•4 HIC.0565522;MA Home Improvement Contractor Rep.#126fs93 n Installation Address: �� jN?Litt"S2f{T __ City State ryZip Atrhaser(s)- Work Phone; Home Phone: Cell Phone: 1161�;� — I j E if I Home Address: �.'- r V_ 9q-i (lf different from installation Address) `City State Zip E-mail Address(to receive project communications and Home Depot updates,: Q 1 DO NOT wish to receive any marketing emails from The Home Depot Project Information: Undersi-aned("Customer ).the owners of the property located at the above installation address,agrees to buy, and THD At-Home Sen ices,Inc-("Che Home Depot")agrees to furnish,deliver and arrange for the installation(`Installation* of all materials described on the below and on The referenced Spec Sheet(si,all of which are incorporated into this Contract by this rckrence,along.with any applicable State Supplement and Payment Summary attached hereto,,and any Change Orders(collectively. "Contract,.): ` 1015#: nn,—JRerrreur+ Products: Spec Sheet(s)_#: Project Amount �..� e t QRc>vlinQ ❑Siding. vindows ]nsulation i _ ')3 f -- 1S 77 52 -- 1 1 ;l4'fs46€ ' ❑Gc:ners 1 Covers ❑-Wiry©ttnr. ❑ ! I �� c j QRctyting QSidim Q!4`inda<ys ❑{nexdation If QC:toters 1 Cevcrs QFitn Doori Q1 r (�Raolinn QSidiate Q Nk-i nfouw El Insulation _......_.._.-_ --- � ' f,=utrerss f Coy.r, QEtnn•Doors[,� � S QRcxrfing QSidin —......._.... .-- 1 I QC'•to QEn.ry Doors hlirr.'mttm 25%Deposit of Contract Anuxtnt due upon execution of tbis contras! t Total Contract Amount i yitir,c Purdtxers ora}tun deptssit more titan fete-tlrind a:the Conrr.�t Anxount. 1 ��r t � `aj Customer agrees that,immediately upon completion;of the wort for each Product,Customer will execute a Completion certificate. (_one for each Prtcloct a.defined by an individual Spec Sbeetl and pay any balance due. As applicable,each Customer under!hitt Contract a_rec-s to be Jaintly and severally obligated and liable hereunder. The Home Depot reset ve,c the right to issue a Clrut c Cinder or terminate this Cimtr_rct or any inchcidua?Prc duct(.si included herein,al its disc:rction,if The Hontc Depot of its autitorizcd service provider detemlines that it cannot parform,its ohhl�a icrnS due.ton Structural pnrhlem .vita t!te home,emirn,unentsi hartres sitcit as mold.asbestos or lead paint.other sales conecrns,pricing errors or because work required to complete the Joh was not included in the Contract. ff ryf I_a-y-ment Summary: The Payment Summary 4_%11-4tJ�rincluded ::s par: of this Contract, sets Earth the rata! Contract aunount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You are entitled to a completely filled-in copy Of the Contract at the time you sign, Do not sign a Completion Certificate(note: there is one Completion Certificate 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 costs of materials,labor,expenses and services 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,acv. '1'I{E'HOME DEPOT MAY'AranIIOIA)AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYAIENTS MADE, WITHOUT LIMITING.THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and Authorization: Ctstomer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and installation services and supersedes all prior discussions ani agreements.either oral or:Witten,rehun_g to said Products and Installation-This Agreement cannot be assigned or amended except by a s+riling*sig.ned by Customer and The Home Depot.Customer ncknowled_es_and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Ac pted by: i Sub tt U. tier's Signal a Date! � I sultani's � aturc Date Telept no No. Customer's Signature Bate � Sales Consultant License No- CANCELLATION: CUSTOMER IM AY CANCEL THIS i las applicable) AGREEMENT WITHOUT T PEINALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE ROME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY .AFTER SIGNING THIS AGREEMENT. THE. STATE SUPPLFNIRNT ATTACHED HERETO CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S R'S STA'T`E. INOTICE::ADDITION At."i ERNIS AND C0\!)I't'It)N-S ARE S'CAi'ED ONUIP REV FRSE SIDE AVD ARE P4 WI OF THI S CONTRA,t' ' 07-13-11 C-SC Vt+t 2–3 arch rite Yellaw–Customer Ii Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR "' > •Registration ?126893 TYPE Expim 1.qn $/312012 r >.� Supplement The Home Depb�,At-HomeSer��ces RICHARD FALLOta1E ' t' 2690 CUMBERLAND R RKWAYS A'fCAt3�A,.GA 3033" y — Undersecretary NadanalFenesi[ada �:,'a,:;Lt::;,,i:... ENERGY PERFORMANCEA SING' EVALUACICN OE AEN 1 ` U-Factor Solar Heat Gain Coefficient Coeficlente:Ganancia de cnergia Solar Factar-U 1 l 1 4 f 1I ' „ •• , s1U5/1•DI pNeatcolSn ADDITIONAL PERFORMANCE RATINGS VALUACION SUPIFMENiAR1A aE RENOIMiEWO Vis ibleTransmittance Transmisicn de LuzVisible } . 44 .i ManutacDrrer stipulates that these l cf enu►aro�menlal conditions and a sped is product si a rm to ap plIcable NFRC procedures for determining does otdrecommend any product I ratings are determined tar a Axed s huntfor any specific use.ran mam tacDiref's ilteralure for.other product pedarmarce and does nctwarantthe suitaDlfty of any Information.www.nfrc.org _____ ———--———— - t ables de NERC para determiner el rendimiento tatat dei sa c can rocedlmlenta p , I ca ducto' tares Gump en P n tamano de ro � Este fabrkante estlpula que eslas vajunto fila do CoAdIdOnes producla.los valares usados per NFRC son deterninaada Par un antiza quo el praducto sea adecuada para)un u�lso espeCillc(.Cansufie Can el - especilico.NFRC no recomienda ningun producto y g� talleto del fabdcante para ei use aproplado de este producto.wuvKnA"M _ y;►::. c)vatilies :ur regica(sl: NortheCra. NOCth O� gnsr harr...'F enrral, Strath Cgnts31, ^..,, T,r unictwr) rwti4irR vara 19rg1 w µ p LLjJFVW 29 Crt Cs•}.E%-7*Z .i a� x P.oln (Ali lamed il�" [r:a5olarl>1-;.C25 I:Iu: Tates: Sipa: pi's" x Lv"' • � %3Is: R3�LLDt�O VG/1]s.r>rc 3.1$ Ireu/R-i.i;2� • .;-r/h /—•1 Taaoatlu Pcobado: 1'L 1.9 cm x 20 .2 cos Dp y _ dPP�l:.diJaa► TO" y-tdntaedis) yHSI/ArllLi%NWiBtA'li{3/I.$:%-J7r� {14'i►ru4UC5Aa0i/I.e.2/ta4t)-05�� .• ,lildlwu@(A/C:i�1C'1i2.�•Z��a1G-Oa. I I ri 2 j13 __ f ' ^ VLII .,W Xi s / Y,,, ,�^ s off`--;�,'�` •�'•- r� tty Are y an employer? Chec��the approp�taa box, Type of pb ode A(rPq rad: �•, 1 'LTi M V?na 9 r"Ont nrtar and sa �ds.'r1`d�7f7 s d tGtiU I• DA tura IILMPIoyer�r-ith� have hind the sab-eontr� tors employees(fall and/orpmt ) 7, ®Remodeling listed on the tbehed shed.I g< ®Demol�tior <® I tma sole proprietor or partner °These actors have . slop rmd bare no empIo ye� workm' coffip,ansutMlc. 9. D BZ&d g addifiOn . working for me sa my capacity. [No Workers' coffip,gt�surance g• ale Ma corporation and its Blectri�l repah�or addditlom ofn-=have used their �', right of��ptia�per MGL I I.[]Plumbing.repairs aadditiq� 3.® Y mn a homeowner doing ell work ®d we have no l2•®Roof repah rnyscLfi[Ido workers, comp. c, 152,§1(4), . q employee.(No workers' 13.0 Other comp.insurance re*C,11 H . °Any applicant that checks box#1 must also 511 out the se tion below showing thou w. cb eampeasadan polies j�rmatian. t Ham==="ho snbmIt this afgdavii adicvt ag they are dola�all work and the hire outside eaniracina must anbrtrit a new affida l' motion. lCoatia Lora that check this box must attach�as jad=d sh=t sbav6g the==of the sub-contrae=and they erorket�'comp.Policy site I=an !oyer thai fspravfding workers'coe�ensati n�arance for qty employees. Below u f the policy and o6 �-- Informatform Insurance Company Name: Policy#or Self-ins.Lie.9:_ �n F�cpindionDate• CitylStatelZip: 'Job Sitc Address: Attach a copy of the workers' compensation policy declaration page(showing the policy number and eipintion date)- Failure to secure coverage a3 required under Section 25A of MGL f IL c,I52 cin lead to the tmpositioWORKOpPenalties s Ine fine up to$1,500.00 andlor one-year imprisotltneat,es well as civil penalties in the form of a STOP of up to 5250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DLA.for insurance coverage verification. 7dre-by certitify u er a ins p�ofp�ry that Ilse Wormrrtron provld>d above true d eorred Def e:: official use only, Do nol write in this area;to be corTLfed by city or town o udaC City or Town. FermitlLlcense# Issuing Authority(circle one):' 1.Board afHealth 2.BuildMcr Department 3.CityrFown Clcrk 4.Electric&l Inspector 5.PlnmbingInspector 6.other br...•, i ERTi ICA � IA11-1W� INSURANCE i- a02/21/201y1 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). 1-404-995-3000 CONTACT PRODUCER NAME: ----------------------------------r FAX------------ - Marsh USA, Inc. PHONE _ AIC No . homede otcertre uestOmarsh.com E-MAIL p Q ADDRESS:_. Two Alliance Center, 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 INSURER(S)AFFORDING COVERAGE _ NAIC# Fax (212) 948-0902 INSURER A: Steadfast Ins Co 26387 INSURED INSURER B: Zurich American Ins Co 16535 The Home Depot, Inc. New Ham shire Ins Co 23841 Home Depot U.S.A., Inc. INSURERC: P 2455 Paces Ferry Road NW INSURER 0: Illinois Natl Ins Co 23817 - Building C-20 INSURER E: NATIONAL UNION FIRE INS CO OF PITTS 19445 Atlanta, GA 30339 --INSURER F: Illinois Union Ins Co 27960 COVERAGES CERTIFICATE NUMBER: 19834682 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 ADDL SUBR - POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY A GENERAL LIABILITY GL04887714-01 03/01/1 03/01/12 EACH OCCURRENCE $ 9,000,000 - ERENTER X PREMISES DAMAGE _ 1,000,000 _ COMMERCIAL GENERAL LIABILITY PREMISESS(Ea occurrence_L $ _ CLAIMS-MADE a OCCUR M_E2 EXP(Any one person) $EXCLUDED X LIMITS OF POLICY XS PERSONAL 8 ADV INJURY $ 9,000,000 X OF SIR: $1M PER OCC GENERAL AGGREGATE $ 9,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 9,000,000 X. POLICY PRO- LOC $ JECT BAUTOMOBILE LIABILITY BAP 2938863-08 03/01/1303/01/12 COMBINED SINGLE LIMIT 1,000,000 Ea accident $__ ..._._..._._ ..._.. 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 SIR AUTO P Y $ UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ C WORKERS COMPENSATION WC061967352 (AOS) 03/01/1 03/01/12 X WCSTATU- 0FR TH- -- '-AND EMPLOYERS'LIABILITY D ANY PROPRIETORIPARTNERIEXECUTIVE Y/❑N NIA WC061967354 (FL) 03/01/1 03/01/12 E.L.EACH ACCIDENT $ 1,000,000 - OFFICEtoryin EREXCLUDED7 N WC061967353 (CA) 03/01/1 E (Mandatory in NH) 03/01/12 E.L.DISEASE-EA EMPLOYEE $ 1,000,000—.--- If yes,descr be under 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Workers Compensation WC061967355(KY,MO,NY,WI,I qV)O3/01/1 03/01/12 F TX Employers XS Indemnity TNSC462441SI (TX) 03/01/1 03/01/12 Occurrence/SIR 30M/lM E Workers Compensation WC1192378 (QSI) 03/01/1 03/01/12 SIR 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 ATLANTA, GA 3 ATLANTA, GA 30339 (.. USA ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD,-_ jfiero_hd 11 19834682 h All assach usetts Sm!£d A of Buildiny Realations alid Star"laills License: CS 29328 RICHARD L KEYES 11 16 LAWRENCE RD SALEM, NH 03079 Expiration: 9/11/2013 TR: 3870 ...............................