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HomeMy WebLinkAboutBuilding Permit #011-12 - 7 WALKER ROAD 7/6/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: all I / -2, / Date Received Date Issued:-2-4 `f/ EUPORTANT:Applicant must com lete all items on this PLge LOCATION n , Print r i PROPERTY OWNER kAQ-Tcan Prinf. MAP NO:�PARC EL:�Z NING DISTRICT: Historic District yes mit Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential 0 New Building Non- Residential g ❑ One family 0 Addition 0 Two or more family 0 Industrial 0 Alteration No. of units: Repair, replacement 0 Assessory Bldg 0 Commercial 0 Demolition 0 Other 0 Others: ®IS ptic O1Pit �W. i 11:1, p Wetlands ® teished� i0`�JiTaxei/Sevaei" _ M-1- DE . n� o-. DESC! P_I^^ION 0 F 1`FdORIS TO BE.PLitrO'RME,D.- A� i -fit (Identification Please Type or Print Clearly) OWNER: Name: N Address: Phone: UJ � J ``Os i CONTRACTOR Name: (�(�! y1a Phone: (003-c3c_ 1�oq d � Address: Q I 30 Supervisor's Construction License: 3$Cj��q Exp. Date: � 0 Home Improvement License: �'•�$ -$ Q Exp. Date: as�' 11 ARCHITECT/ENGINEER - Phone: `- t Address: Reg No �---- ' FEE SCHEDULE.BULDING PERMIT.$12.00 PFR$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cyst: $-- 1$aL.S—q FEE: $ Check No.: 0 �_ 6 �-1 q �(OLf e I Receipt No.: NOTE: Persons contract' wi u egistered contractors do not have access to the guaran s—.-..-L.�_ _�.- _ ty fund li t Slgnafure of:contractor y - r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taaning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ ElPermanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVA T ION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS t Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes a 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 I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. i.: i ELECTRICAL: Movement of Meter location, creast 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 i 1 NOTES and DATA-- For department use I i 1 I ® Notified for pickup - Date Doc:.Building Permit Revised 2008mi 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 ❑/ Iding Permit Application �!orkers Com Affidavit ! p a �it hoto 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 MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Pe! 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 Contrad ❑ Flo o r/Crossection/E levation 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 Perri 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 o 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 .Perm In all cases if a variance or special permit was required the Town CIerks 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 -T — - Location -21V414 A/ -;q1T No. Date —� NORTh TOWN OF NORTH ANDOVER 3?O��t�•o I•,�� O F � R P Certificate of Occupancy $ wuBuilding/Frame Permit Fee ¢ � J,+csE Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #26J d 24 .5 ;; Building Inspector NORTH TO" Of O No. o - �� - �i� =-_ - - -- y o , dover, Mass., �- • T O LAKE I� COCHICHEWICK %�DRATED PP���� % BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............... . .....rr ....................................................................... .......... •"""""""' Foundation has permission to erect..A_.*.*i_i,.,i_.___........ buildings on ...4.iJq.L ..Q.• �............... Rough tobe occupied as............. .. ..... ....04mi I...... ................................ ..... ............ ... .. Chimney r vi that the erson acce this ermit s II m eve res ect conform to theterms of thea Iication on file inp 0 d8d p pp every P Pp Final- this inalthis 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 b MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TAR S Rough ................ .......... .... ................ Service BUILDING INSPECTOR r 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 FIRE-DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. SEE REVERSE SIDE Smoke Det. INSTALLER COPY INSTALLATION SERVICES CUSTOMER CONTRACT- MWORK - INT/EXT/PATIO DOOR LOWE'S OF SALEM, NH, STORE#2382 STORE PHONE: (603)681-4218 541 SOUTH BROADWAY SALESPERSON: FRANK SIMONE SALEM, NH 03079-0000 SALESPERSON ID: 1502071 Document Print Date : 06/06/2011 This is only a Quote for the merchandise and services printed below. This becomes an agreement upon payment and issuance of a Lowe's receipt, upon which the entire agree- ment, including the specifically completed pages of this document, the Terms and Conditions included with this document, the applicable portion(s) of Lowe's receipt, and any other addenda or attachments hereto, shall be referred to herein as this "Contract." PLEASE READ THIS ENTIRE DOCUMENT, INCLUDING THE "TERMS AND CONDITIONS." BEFORE SIGNING. Lowe's Registration or Contractor License Number/Lowe's Contractor Name Lowe's Home Centers, Inc.'s MA HIC NO.: 148688 Lowe's Home Centers, Inc.'s FEIN: 56-0748358 Customer Name Home Phone S NHU TRAIN 978-273-7240 O Customer Address Other Phone 7 WALKER RD, UNIT 9 L City State/Province Zip/Postal Code D NORTH ANDOVER MA 01845 Installation Address T 7 WALKER RD UNIT 9 O Installation City Installation State/Province Installation Zip/Postal Code NORTH ANDOVER MA 01845 MERCHANDISE AND INSTALLATION SUMMARY MERCHANDISE SUMMARY 18302 : STK : PNE CASE 351 2-1/2X11/16X8' : PNE CASE 351 2-1/2X11/16X8' - QTY 3 130224 : 45873OAKSL : STK : OAK SDLE 458 4-5/8"X5/8"X73" : OAK SIDLE 458 4-5/8"X5/8"X73" : EMPIRE COMPANY, INC. (THE) - QTY 1 131203 : 131203 : STK : 1X4X16 PRIMED FINGER JOINT : 1X4X16 PRIMED FINGER JOINT : IRVING FOREST PRODUCTS (MAINE) - QTY 2 238345 : 2827-8 : STK : 3/4X5.5X8 RF EMBOSD PVC TRM BOARD : 3/4X5.5X8 RF EMBOSD PVC TRM BOARD : ROYAL MOULDINGS LIMITED - QTY 1 238353 : 2866 : STK : 1X3.5X10 RF EMBOSD PVC TRIM BOARD : 1X3.5X10 RF EMBOSD PVC TRIM BOARD : ROYAL MOULDINGS LIMITED - QTY 3 231061 : NA : SOS : SOS ATRIUM VINYL PATIO DOORS : 312 2 LITE PATIO (71" W X 80" H) : ATRIUM WINDOWS - QTY 1 Materials Price $ 927.35 Store 2382 Project No. 326408688 for NHU TRAN Page 1 of 4 INSTALLER COPY INSTALLATION DESCRIPTION Stock or SOS : SOS Door Type : Patio Select Location : Front Door Select New Door : Sliding Number of Doors to Install : 1 Side Lights or Transoms : No Hidden Damage Description : None Number of additional holes bored for accessories : None Install Specialized Mortise Hardware : No Lead Safe Practices : No Total Linear Feet of Custom Trim to be Installed : 0 Deliver Door : Yes Customer Understands Scope of the Project : Yes Permit Required : Yes Who Will Obtain Permit : Lowe's Permit Fee : No Additional Miles Traveled over 20 : 0 Bring Up To Code Description : None Local Disposal Fee : Yes Describe Other Work Needed : Exterior toe kick, cut out existing flange, exten- sion jamb, 3rd floor Other Work Charge : Yes Comments : No Comment Labor Charges $ 894.25 Detail Deduction -$ 0.01 Additional Specifications: Notation: Lowe's will not make structural modifications, paint or stain or remove/reinstall security system equipment. Customer is responsible to advise if prop- erty is governed by Historic District Regulations. Additional Specifications:Federal law requires Lowe's to provide you with the pamphlet Renovate Right: Important Lead Hazard Information for Families, Child Care Providers and Schools. By signing this Contract, Customer acknowledges having received a copy of this pamphlet before work began informing Customer of the potential risk of the lead hazard exposure from renovation activity to be performed in Customer's dwelling unit. TOTAL CHARGES OF ALL MERCHANDISE AND SERVICES 'where applicable SUB-TOTAL $ 1821.5 *TAX $ 0.0 DELIVERY $ 0.0 ORDER TOTAL $ 1821.5 Store 2382 Project No. 326408688 for NHU TRAN Page 2 of 4 INSTALLER COPY BALANCE DUE I I 1 i Store 2382 Project No. 326408688 for NHU TRAN Page 3 of 4 INSTALLER COPY WAIVER OF LIEN and ONE YEAR WARRANTY(TO BE SIGNED BY CONTRACTOR) I,the undersigned Installer/Independent Contractor, having been employed by the Customer who signed the Certificate of Completion below do hereby certify that the work for this project will be or has been completed in a workman like manner and to the Customer's satisfaction. In consideration of the receipt of one dollar and other good and valuable consideration,and to the extent permitted by ap- plicable law, I hereby waive and relinquish all liens and all rights and claims of liens which I,the undersigned,now have or may hereafter have for labor or materials furnished,and Further certify that all work performed and materials furnished, if any, by any other party or parties upon the order of the undersigned, have been fully paid for. Further, I the undersigned, agree to cause the prompt release of any mechanic's lien(s) which may be filed against the Customer's premises by any subcontractor, laborer, mechanic or material supplier claiming the right to file such a lien through work related to Customer's Contract with Lowe's. In addition to any warranties provided by law or specified elsewhere,including the Customer's Contract with Lowe's,the undersigned further warrants that all work fur- nished for this project shall be free from defects either in material or workmanship. If any defects in material or workmanship shall be discovered in the work furnished or material used during the course of the work or within one year from the date of the Certificate of Completion,the undersigned agrees to replace or correct such deffective work or material,free from all expense to Lowe's and the Cus- tomer in a manner satisfactory to the Customer. I further represent that I have given Customer the option of retaining some or all of the surplus materials or having some or all of such surplus materials removed from the Customer's premises. If applicable to the performance of the work required for this project, I,the undersigned installer/Independent Contractor,do hereby certify that I have complied with all requirements of the Lead Renov- ation, Repair,and Painting Program Rule("LRRPP RULE"),40 C.F.R.sec 745.80et seq., or any applicable state laws or program regulating lead-based paint safe work practices, including compliance with all information distribution, notice requirements and work practice standards in performing the work required for this project. 1 certify that I have provided the Customer with all documentation re- quired to be supplied under the LRRPP Rule or state program, shall retain all records required by law, and have attached to this document copies of all the records required to be retained by the LRRPP Rule or applicable state program. Signed and delivered this day of (Seal) SubContractor Print Name CERTIFICATE OF COMPLETION 1. I, the Customer, certify that the Installers/Independent Contractors or their sub-contractors, have furnished all Goods and/or services, that installation, repairs and alterations or improvements ("the installation services") have been completed as set forth in my/our contract with Lowe's, and that I have been offered the oppor- tunity to request that Lowe's allow me to retain some or all of any unused, receipted surplus materials rather than have such surplus materials remain the property of Lowe's. 2. Buyer's initials (Buyer INITIAL ONE only) There were no such surplus materials. I accepted all surplus materials I wanted. I declined to receive any surplus materials. Date: Owner's Signature Owner's Printed Name Store 2382 Project No. 326408688 for NHU TRAN Page 4 of 4 '=, �lax,:icl�t,}t:t[.ti - Uc e�rtnticrtt iri•P i[ ' •�: '• 9 &t;tr ., t!09' � BwltSin„ }2e„ul.ltinrts.itjt7,ji,lntt:3ttd. '�- Construction Supervisor Licerise License: WS 86039 Restricted to: 00 ....... MICHAEL F MURPHY �r 26 STONEPOST CIR RAYMOND, N-i 03077 Expiration- 121512011 r'uauui'�h trcr Tr=: 13728 le-cmvuaweweah- cy ;?'l-udJtt��zrcJc'lIJ ::tea•-\ Office of Consumer Affairs&$usiness Regulation HOME IMPROVEMENT CONTRACTOR + s Registration: 148780 Expiration: 1012512011 Tr# 289914 Type: Ltd Liability Corpor MURPHY BROTHERS CONTRACTING,LLC MICHAEL I URPHY 26 STONEPOST CIRCLE RAYMOND,NH 03077 Undersecretary. �.d L 6ti8968809 Agd.inw eN!N p9£:90 0 L 90 oea From:Julie Dortona FaxID:Santo Insurance Page 2 of 2 Date:6/29/2011 11:17 AM Page:2 of 2 OP ID: JD A�C0-R0° CERTIFICATE OF LIABILITY INSURANCE DAT06129DNYYY) 06!29!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 CONTACT 603-890-6439 NAME: Planright Insurance-Salem PHONE 603-8906521 FAx 224 Main Street Suite 3C Arc No Ext): Salem,NH 03079 E-MAIL James A Santo ADDRESS: PRODUCER MURPH4 CUSTOMERID# INSURER(S)AFFORDING COVERAGE NAIC# INSURED Murphy Brothers Contracting INSURER A:Peerless Insurance Company 24198 Mike Murphy INSURER B: 26 Stone Post Circle Raymond, NH 03077 INSURER C: INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFYTHAT 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 I TYPE OF INSURANCE A DL S B POLICY EFF POLICY EXP LTR INSR N/VD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A X COMMERCIAL GENERAL LIABILITY X CBP5715446 03/01111 03101/12ANIA 0 ENT PREMISES Ea occurrence $ 100,000 CLAIMS-MADE FX1 OCCUR MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJJRY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMIT APPLIES PEP,, PRODUCTS-COMPIOPAGG $ 2,000,000 X POLICY JECT LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY ALIT(D (Ea accident) BODILY INJJRY(Per person) $ ALL OWNED ALITOS BODILY INJURY(Per accident) $ SCHEDULED AUTOS PROPERTY DAMAGE $ HIR ED AUTOS (Per accident) NON-OWNED A.IJTOS $ $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- I OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER .ANY PROPRIETORIPARTNEP.fEXECUTIVE E.L.EACH ACCIDENT OFFICERIMEMBER EXCLUDED? ❑ NIA (Mandatory in NH) E .DISEASE-EA EMPLOYEE $ If ves,describe under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) GL: Lowe's Companies, Inc and any and all subsitiaries are named as an additional insured with respect to the Commercial General Liability Policy by writen contract only.A waiver of subrogation shall be provided to Lowe's and any subsidiary with respects to the Commercial General Liability Policy b writen contract onl . CERTIFICATE HOLDER CANCELLATION LOWESC1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN LOWES COMPANIES INCORPORATED ACCORDANCE WITH THE POLICY PROVISIONS. ATTN: IS INSURANCE PO BOX 1111 AUTHORIZED REPRESENTATIVE NORTH WILKESBORO,NC 28656 �� . ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents ;;, Office of Investigations 600 Washington Street Boston, MA 02111 �"t r www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Oreanization/Indi\idual): Address: amity/State/Zip: Phone #: �� Q�,('�---�- Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 4. El am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. El New construction 2. I am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.+ 9. ❑ Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.111 am a homeowner doing all work officers have exercised their ILEI Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing T their workers'compensation policy information. Homeowners who submit this affidavit indicating thev are doing all work and then hire outside contractors must submit a new affidavit indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: P 1a f i�. - ` �1Isa rCj Y\C Policy#or Self-ins. Lic. #; C�P 4:1"S L4 L4 Expiration Date: C)1 _ Job Site Address:—i O kp City/State/Zip:R 4oicko—rjf M A (je gqs, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer ' ender the ins and penalties of perjury that the information provider/above is true and correct. Signature: Date: ' Phone#: COGS- 50S- I(0q 0 � Official use only. Do not write in this area,to be completed bh ciff,or town official. City or Town: j Permit/License# Issuing Authority (circle one): I 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: