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Home My WebLink AboutBuilding Permit #685 - 72 PADDOCK LANE 5/21/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: i S� Date Received Date Issued: 21 - 0 IMPORTANT: Applicant must complete all items on this nage L>I10I N • � PROPERT Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villaqe yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New BuildingOne fami Addition wo or more family Industrial Alteration No. of units: Commercial Repair, replacemen Assessory Bldg Others: Demo i ion Other Septic Well Floodplain Wetlands Watershed District Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: 1-1 v)1A.L., 4�;Avr,e, Address: CONTRACTOR Name: Address: Supervisor's Construction License: Home Improvement License: ARCHITECT/ENGINEER Exp. Date: Date: Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ lga4 FEE: $ Check No.: a G2'{ Receipt No.: C7�. NOTE: Persons contracting with unregistered contractors do not have access t the guranty fund Signature of Agent/Owner p, Signature_of contract Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools Well Tobacco Sales Food Packaging/Sales Private (septic tank, etc. Permanent Dumpster on Site 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 Siqnature COMMENTS �y Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comm Comm Water & Sewer Connection/Siqnature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS t_ocatea X364 Usgooa street yes no 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 - Date Doc.Building Permit Revised 2008 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 Location �2 �� `s,( r., 54 - No. Date (� d NORTq TOWN OF NORTH ANDOVER Certificate of Occupancy $ J�CHus Building/Frame Permit Fee $ ?��! Foundation Permit Fee $,` Other Permit Fee $ TOTAL $ Check # 2►�6;; Building Inspector CO)0 m m m m CO) m CO) -O CD C Z CD O CLto CD r a� .0 O � CL Q CCD O CD to CD CD H -0 CD a O Lei COP) d O O CO) C7� C O CO) CD O �M CD D a, y CO)CD O CD O CD IL 0 0 7 I F al� V rO -�M O Q N n 0 m 'fl y �- o m c, C H C2 a� m Z o ma �� H _I Qr, .y O ...f O T CL 0 m CL O y N O -Co. o S > >� o C o ZS.c� '+ O y, !'! m ; C 3 y t S' a ca o =rm o w m7 c» am . sm m� ON pm ad ; Q N C 6c R 10 -- m N CD f� ^. o 0 � 3 . CD o m CD N : d CDm m a y O O O CD CD C, i. �I � O ^ o Cj :; 1�. /r Z O z ; O x r~ `-7 O n z n PooO o tz r z� r r) ^0 E3 I =T - 0 d tg- y 0 O C MAY -15-2008 01:11P FROM:THD LONDONDERRY WARE (603)623-5311 TO:1B665208390 P.6 HOME IMPROVEMENT CONTRACT Sold, Furnished and Installed by: Branch Name: AP" Date: S -If -P8' THD At -Home Services, Inc. d/b/a The Home Depot At -Home Services 345A Greenwood Street, Worcester, MA 01607 Branch Number: 133 Job #: 375,CgZ3 Toll Free (800) 657-5182; Fax: 508-756-2859 Federal ID # 75-2698460 ME Lie # C 02439 Ri Cont Lic# 16427 CT Uc # 565522; MA Hua Improvement Contractor Rea. #126893 Instatletlon Address: 37— /1 9,- N40 ANbd W . /1A O Vf S'- 3&r City ' State zip Last 4 Digits of Driver's Purehaser(s): Lic. # & E:n Mo/Vr: Work Phones Rome Phone: Home Address: t i Is t; (If different from Installation Address) City State Zip E -mall Address (to receive updates and promotions from The Home Depot); Project Information: I/We/You ("Purchaser"), the owners of the property located at the above installation address, offer to contract with THD At -Home Services, Inc. "Home Depot to furnish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet # ffSfl , incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if, upon re-hispection of the job, Home Depot determines that It cannot perform its obligations due to a structural problem with the home, pricing errors or because work required to complete the job was not Included In the Spec Sheet or Contract. CONTRACT AMOUNT s Z ¢- tLESS DEPOSIT $ I, 'V S6 "- BALANCE DUE 56-61r— ON COMPLETION $ tMialmum 25% of Contract Amount due upon execution of this contract, indicate Payment Method For BALANCE DUEONON COMPLETION: t Yr' *When you provide a check as payment, you authorme us either muse information from your check in mato a onedimo electronic Rad transfer from your account or to process the payment as a check transaction. When we use in(brmntion from your check to make an electronic fund trunsfa, Rinds may be withdrawn from your account as soon as the payment is received, and you will not receive your check back_ DEPOSIT PAYMENT OPTIONS (Subject to fund verineadon andior crodit approved.) 1. Ch=k'. Cashiers Chcck or US Postal So Mea Muncy Order (Made payable to The Hong Depot1 2. Credit Card" andtot other payment options - Circle One salon Visa MasterCard Discover ArnvicenExpreas The Home Depot Homo Improvement Loan The Homo Depot Chdit Card 0 New Account 0 Existing Account (HiL & HDCC ONLY) Available Credit: $ (H[L & HDCC ONLV) Acct#: 40-W Ile: Name as It appears on card: --By my/our signature below, I/We agree to allow Home Depot to charge the above referenc .d credit card for th-e�-depppossiittiindicated. Cardia ces S' taro D� HIL or HDCC Authorization Codes 150f79#033 fi10116> - ( 3s75*21 - Home Address: t i Is t; (If different from Installation Address) City State Zip E -mall Address (to receive updates and promotions from The Home Depot); Project Information: I/We/You ("Purchaser"), the owners of the property located at the above installation address, offer to contract with THD At -Home Services, Inc. "Home Depot to furnish, deliver and arrange for the installation of all materials as described on the attached Spec Sheet # ffSfl , incorporated herein by reference and made a part hereof. Home Depot reserves the right to cancel this contract if, upon re-hispection of the job, Home Depot determines that It cannot perform its obligations due to a structural problem with the home, pricing errors or because work required to complete the job was not Included In the Spec Sheet or Contract. CONTRACT AMOUNT s Z ¢- tLESS DEPOSIT $ I, 'V S6 "- BALANCE DUE 56-61r— ON COMPLETION $ tMialmum 25% of Contract Amount due upon execution of this contract, indicate Payment Method For BALANCE DUEONON COMPLETION: t Yr' *When you provide a check as payment, you authorme us either muse information from your check in mato a onedimo electronic Rad transfer from your account or to process the payment as a check transaction. When we use in(brmntion from your check to make an electronic fund trunsfa, Rinds may be withdrawn from your account as soon as the payment is received, and you will not receive your check back_ DEPOSIT PAYMENT OPTIONS (Subject to fund verineadon andior crodit approved.) 1. Ch=k'. Cashiers Chcck or US Postal So Mea Muncy Order (Made payable to The Hong Depot1 2. Credit Card" andtot other payment options - Circle One salon Visa MasterCard Discover ArnvicenExpreas The Home Depot Homo Improvement Loan The Homo Depot Chdit Card 0 New Account 0 Existing Account (HiL & HDCC ONLY) Available Credit: $ (H[L & HDCC ONLV) Acct#: 40-W Ile: Name as It appears on card: --By my/our signature below, I/We agree to allow Home Depot to charge the above referenc .d credit card for th-e�-depppossiittiindicated. Cardia ces S' taro D� HIL or HDCC Authorization Codes De sk Pinar Payment I # 01 + Purchaser agrees that, immediately upon completion of the work, Purchaser will execute a Completion Certificate and pay any balance due. Purchaser also agrees to be jointly and severally obligated and liable hereunder_ Entire Aereement: This agreement and its attachments, including any financing agreement, contain the complete agreement between the parties and can not be amended or modified unless in writing in a separate agreement signed by both parties. NOTICE TO PURCHASER Do not sign this contract before you rend it. You are entitled to a comple" Mlcd-in copy of the contract at the time you sign. Keep It to protect your rights.Do not sign a Completion Certificate before this project is complete. Law prohibits tion of thew k to be performedc uor nder the Completion Certificate signed by the owner prior to he actual completion You may cancel this transaction any time prior to miduight of the third business day after the date of this contract. See Notice of Cancellation for an explanation of this right. There will be a service charge equal to 10% of the contract amount if job is cancelled by Purchaser Ali CER the third business day, but BEFORE materials are ordered. There will be a service charge equal to 25% of the contract amount if job is cancelled by Purchaser AFTER materials are ordered. BY MY/OUR SIGNATURE BELOW, I/WE UNDERSTAND THAT THE AGREEMENT MAY BE SUBJECT TO REVIEW OF MY/OUR CREDIT HISTORY AND I/WE AUTHORIZE HOME DEPOT TO VERIFY AND REVIEW MY/OUR CREDIT RECORD WITH AN INDEPENDENT CREDIT REPORTING AGENCY AND RELEASE THEM FROM ALL LIABILITY INCURRED FROM INADVERTENT OMISSIONS OR ERRORS. BY MY/OUR SIGNATURE BELOW, I/WB AGREE TO BB BOUND BY THE TERMS OF THiS CONTRACT. VWE ACKNOWLEDGE RECEIPT OF A COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION. nw� SUBMITTED BY:Art/ytant� `' rJ `„ asat ACCEPTED BY: Date: t4 Pu-m-Futser Date: Purchaser NOTICE: ADDITIONAL TERMS AND CONDITION$ ARE STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 0.21-07 rev 4-2-07 GSC White—Branch Re Yeltow—Customer Prink—SetesConsuttard v HOME IRPROVEMENT CONTRACTOR Repistratiom 126893 Eipira_Elon:=r-�3%2p08 supplement Card THE Home Depot, At -Home Senile RICHARD FALLONI= 3200 COBS GALLERIA P.ICIIVa' #20 AtIANTA, GA 30339 Adm(aistntor soe,ot =WAWA W.* '4P Ip � Rw MM NNa m 1,�ts m Fqm omd atonbNo a� OF", �t3 Mo pal s.,p CJI �6zL909i ' TTaued 6H DLTQb �4J6b86�69 vo rin x m 6'TLT Iopsgoad ope+stt 4tOZ—ttJ 8T'E, oT�T1VOD osaaaSaS '02ii 4 x.08 ' .8► a=T6 Da3as �'• fsaz->zl.aJ� sser�toc W :OKI -sn6 •TEaiOa, tng "Sall -343014 :1=6 7Cmf4m (so) v.47bs= i E ' 0Z5 (F) TT esed TaTZTTTO PT7 " eZ _ til65 J�9tliA* . gsap;Aof 'Tes�'�� RTeQS 'Te==ua0 ,opt 'vsay�soK s(s]u4TIIas 8[i5 soS eaT:TTeeb 3Tv[1 doaganu+N+ pt uo� �'�� aso un eRd ap qMp ud ep 0uaosJ to ANFU M sroope NPI�OWugq=p> PwwNIaP sP° au6ata�po�dte�R�ouI � uas Tod sopeso �^ so'1'�P� sq um wlduao onb aFdRsa opR�ugW e99 ------------ GzMwvwpvw>aF�Ul➢ s1P J4I�!nseiAwPueMlour+aPP� e I1 to Pn41 a roJ PsupwalaP eye s6ugei 3anp� lfue pcnuoauP MN sRs Wool OH�I'1� lu0�d � AJ S�lIIP0.70d o9 o►AUoD� �+ BCiW IEUI wlQl►� W GD90 algiRh2rn ap U0.MWU e L eWLLISUe11 alq!SIA Oti3IWtQ�' 30 Mtl��1hF�N3idt1F Not SDNLLYd 30�W�U -aLIJ :aha_ BlE au, ap moved �a�E, �1 1uaDWa0 ; u!LD 10H RIDS Au 1..gI;4-9•)5 JOCU 1 7-113 C RTiP:CATE IS 1•S5Ucu A,) A PLAI i.Jr- Uvr.mm.-.II+JI'I :C -U:�R ONLY AND CONFERS NO RIGHTS UPOiN THE CERTIFICATE .sh USA, Inc • s ,HOLDER. TI -IIS CERTIFICATE DOES NOT AMEN,10, EXTEND OR ALT=R T`lE CO`J=R1.Gc .a:=FIDRJ I� I- ---------- 8Y 'I -E: NOUCIES 8`L0Tj. ------ Imedepot.r-ertrequestamarsiZ.cam -- ,75 Piedmont Rd NZ, Suit= 1200 aanta Gi. 30305 RS AFFOulM.,r. IN31J'r.=-►i {MAIC tx ix ('211) 949-0902 --- -- INSURER A: - �teadPast IaCOs 26387 ,ma Oeoot U.S.A., Inc. INSURER 8• Zurich AmariCan Ins Co _.-- _- 16535 ~_ .a Home Depot, Inc. LNSURERC:I11irtois Natl Ins Cc 23817_ 35 Paces Perry Road -^Yr19380 -_ Iilding C-8 Co--- INSURERD:American &oma Assur o :lanta, GA 30339 wsURERE.NsW Hampshire Ins Co 23041 UVhKAiL tJ THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE WHICH ANY REQUIREMENT, TERM OR NTRACT OR MAY PERTAIIN, THE INSURANCE AFFORDED BY THE PONDITION OF ANY LICIES C ES DESCR BED HEREIN SOTHER ESUB SNT UBJECT TO ALL THE TH RESPECT OTERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFFECnVE POLICY EXPIRATIONSPREMIS*SfEa0C=en LIMIrs iR 00' F I R POUCV NUMBER AM !YY A M 0 IYY R 03/01/08 03/01/09RENCE 54,000,000 IPR 3157 608-02 k GENERALUABIUTY1,000,000 X LIMITS OF POLICY ARE LrAC SS rce fCbMMERCIAL GENERALLIABRITV Ona Peron► f EXCLUDED CIAIMSMADE � OCCUR "OF SIR: $1,000,000 PER CC" 4,000,000 PERSONAL3ADVINJURY' $ GENERAL AGGREGATE f 4,000,000 PRODUCTS -COMPIOPAGG 54.000,009 . ., ..,-r_ncr_sTF LIMIT APPLIES PER. 8 AUTOMOBILELIABIUTY X ANY AUTO,. ALL OWNED AUTOS SCHEDULED AUTOS HIREOAUTOS NON-OWNEO AUTOS X SELF INSURED AUTO PHYSICAL DAMAGE GARAGE LIABILITY ANY AUTO A EXCESSIUMBRELLALIABILITY X OCCUR M CLAIMS MADE DEDUCTIBLE C I WORKERS COMPENSATION AND D EMPLOYERS' UABIIJrY ANY OFF CERIMEM EREXCLUDEOT EC�VE E HAP 2938863-05 IPR 3757 608-02 1928757 (FL) 1928756 (CA) 192875S(AOS) 03/01/08I 03/01/09 I COMBINED SINGLE UMIT, ,I $1, 000, 000 (Faacddent) BODILYINJURY $ (Prpersan) BO00.Y INJURY $ (Par accident) PROPERTYDAMAGE $ (Pr accident) OTHER THAN '"ACC' 's AUTO ONLY: AGG f 03/01/08 03/01/09 EACH OCCURRENCE $5,000,000 AGGREGATE 55,000,000 f S r 03/01/08 03/01/09 X 03/01/08 03/01/09 ELEACHACCIDE 03/01/08 03/01/09 E.LDISEASE-EA arcwrw r OTHER TNS -C45197967 (TX) 03/01/08 03/01/09 F TX Employers Excess 1928759 (4SI) 03/01/08 03/01/09 D Workers Compensation 1928758 (KY, NO, NY, WI) 03/01/08 03/01/09 E Workers Compensation )ESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENOORSEMENTI SPECIAL PROV1910NS ,FOR EVIDENCE ONLY rHE HOME DEPOT, INC. 2455 PACES FERRY RD., N.W. BUILDING C-8 ILTLANTA, GA 3Q339 USA ..� ,..nn�Inct datkinson e/SIR $1.000,000 $1,000,000 $1,000,000 25M/2M I 'ANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOnCE TO THE CERTIFICATE HOLDER NAMED TO T.HE LEFT, BUT FAILURE TO 00 SO SHALL IMPOSE NO 08UGATION OR LIABILITY OF ANY HIND UPON THE INSURER, ITS AGENTS OR . AUTHORIZED REPRESENTATIVE ;MM-FORATION 1988 P The Commonwealth of Massachusetts. Department of Industrial Accidents ! Office of Investigations t i 1 600 Washington Street Boston, MA 02111 t Zs www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print _Le ibl Name (Business/Organization/Individual): �tnw-mv -jai --- - = Are yo n employer? Check the appropriate box: 1. EVarn a employer with V _ 4• ❑ I am a general contractor and I employees (full and/or part-time).* .. have hired the sub -contractors listed on the attached sheet. t 2. ElI am a sole proprietor or partner- These sub -contractors have ship and have no employees working for me in any capacity.. workers' comp. insurance. [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers comp. C. 152, , and we have no § 14 () employees. [No workers' insurance required.] t comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. [❑ Building addition 10.❑ Electrical repairs or additions 11,❑ Plumbing repairs or additions 12. Roof repairs 13.0 Other •Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t Homeowners who submit this affidavit indicating they 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 their workers' comp. policy information. lam an employer that is providing workers' compensation insurance for my employees. Below. is thepolicy and job site information. „ t n 1 ( _ _I '"" i i - Insurance Company Policy # or Self -ins. Lic. #: ? 55 Expiration Job Site Address: r City/State/Zip:�1d�� Attach a copy of the workers' co m nation 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 Investigation of the DIA for insurance coverage verification. Ido hereby cert und�f?l�e pgfns end penalties ofperjury that the information provided abs is t ue and correct. Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other