Loading...
HomeMy WebLinkAboutBuilding Permit #512 - 75 CROSSBOW LANE 12/30/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO : Date Received Date Issued: IMPORTANT: Applicant must complete all items on this Daae LOCATION ��C I,��Le-in-,L _ Print / , Print MAP NO: PARCEL:`20 �- ZONING DISTRICT: Historic District yes no Machine Shop Village yes no 100 year-old structure yes no TYPE OF IMPROVEMENT I PROPOSED USE Reside ial Non- Residential ❑ New Building pene, family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Ajt6ration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D peptic ® Wei --11 ;®F�loodplaini I® We lands f� �Watershed.Disfrict� ®Water%Sewers (Ide tification Please Type or Print Clearly) OWNER: Name: Phone: a_-2 Address: Andow p &6 CONTRACTOR Name: Phone: Address: bpi d X12` 01 " I Supervisor's Construction License: Exp. Date: Home Improvement License:Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT.• $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $_ ���[� FEE: $ Check No.-:_ (�� - Receipt No.: � `� Z .. . NOTE: Persons contracting with unregistered contractors do not have access "the�gupranty fund Location No, Date d NORTH TOWN OF NORTH ANDOVER OL , w 9 Certificate of Occupancy $ Ar,,,;st<�'' Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL` $ Check # n51- 2 4 9 L 1 Building Inspector 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED Q DATE APPROVED Reviewed on Signature Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments 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.$10041000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi J 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 duh ipster 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 2008mi ti z . W W cd x w w fsy a W °o w �' cn .8 � o w o w U Cdo w" G w o ui om I o 0 O C Cm.1 C.) cts : A mcFac m 1 o a L E = Z cn :.0 m c o 0 c I VJmcm \O :lea- . U y Jc H 3 C/) 0 �. C" m y L) .12 1 = C NJ z Wyly. co O -..L-. y .� W U m rm o m y o c :! y+ CM cl /W Ci dJ .O O .-:.c o cm CL m _ m ''m N a IN Wc mr=...�Z •.. - ti o c L3 .m v� Cas � O ..ca CL32 2 .` M 's O E L O ZQ. O h Q C I CD cm O■� y Q 'O a� y O O �E m m co O co CD �3 CL "O Qo C Q y 0 � C co co Z V y c C C CL C COD Q LU 0 19 W W 19 W U) I I I ��. "C/JOO?i/rIZ00� O�LftCOL[lJ2�t� &Business ffai s Re elation Office of Consume A r g OME IMPROVEMENT CONTRACTOR R.e istration: 93ti268.. T '. " Ex itremaiat�pplementl. t " �8..32Q9 it The Home:06061:X06 e;8ervUs t .x_iM, AR t` ,... FALL ' D ' FA RICHARD, 2690 CUM13ERLAKO PAIkKWAY S Undersccretar Y - will �.' . , National Fenestration - a RatingCounwl® i::::c ENERGY PERFORMANCE RATINGS EVALUACION DE AENDIMIENTO ENERGETICO r U-FactoSolar Heat Gain Coefficient Coef{ciente:Ganancia de anergia Solar Fa acto ` wsn•o► owetdco/sn ADDITIONAL PERFORMANCE RATINGS f%VALUACION SUPLEMENTARIA DE RENDIMIEMO • VisibleTransmittance ' Transmision de luzVisible .. i Ii Manufacturer stipulates that Nese ratings conform to applicable NFRC procedures for determining whole product perfertnance. NFRC ratings are determined for a Axed set at envtranmental condrdons and a specific product size. NFRC does not recommend any product ,y < and does not warrant the suitability of any product for any specmc use. eonsutt manufacturer s literature for other product peRamtanca Information. www.nfro.org Este fabrtcante esdpula que estes valares cutupten can los procedlmlentos apacabies de NFRC para deterninarel rendimi¢nto total del producto. Los valons usados par NFRC son deterninados par un can uc de caadidanes ambientales y p lama. de pro el especit(co. NFRC no recomienda ningun products y no garantiia que el products sea adecuado para un use especiltco Consults can el M folleto del labricante para et use Vn iado de este producto' w"u*c,org .3:i z ' qua I! Uas 'or E:Y7RdX STAR " canioatgl: Nactbern. North egFr4l, S,�trrh C9»trat, T.r ��ni,�w,1 rwl�f.irsi para I9fg1 aw• 29 i is z rygac:r;esi, V" 77 S T AR F.001i , :�1 HGt G+i Caaccal, aur C'iCa1 3•�z. Lc1u: Roin W/41aus lib." -;,C..S i ' •� Waited Size: • IND: Ratuer.o LOlJic:ric 3.13 ncu% eT-LC25 rl P TMJAO Pcobado : 1'L 1.9 cm x 2077.2 cat M1 - ,� - • ltpp:icaio.a Tas't y'tan•:ardisi : aNSt/AaHxihweo'uX1v1/I.9.2-�7,�i► llA;` Gar:LV i:Silt)ilY.o.2/ ly4t)-OSS a irtei w�lridr' C$�►i01 2. . V 1440 08, -Pav-1fZen t ' f � 7Ve aj , nVe5 .igft 1f)r75 boo W.fishingy0n S17201 BDvon, N14 02111 V orkers' Connpeusas o,n In-su.. ran4c a Affidavit: Builders/Con ractor°siT. i;�etri i nsi'i rra � s A, Micant Information Please Print LEgibiy Narne(Busin'ess/Organizationilndividual): Address: CiWState/ Phone #: Are an employer? Check. the appropriate box: 1. / I am a employer with _�_ 4. [] I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2111 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have k' working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t employees and have wor ers comp. insurance.+ 5. n We are a corporation and its officers have exercised their right of exemption per MGL c. 152, §1(4), and we have no employees. [No workers' comm insurance reQuired.1 `51 Type of project (required): 6. [].New construction 7. ❑ :Remodeling 8. E],Demolition 9. ❑ _Building addition 10.❑ Electrical repairs or additions 11.Q.Plumbing repairs or additions 12.[] of repairs 13. 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. tContractors 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 thepoliey and job site information. Insurance Company Name: Policy # or Self -,ins. Lic. #: /-� Expiration Date: Job Site Address: ��C obi t,�l�i City/State/Zip: 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 $250.06a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of I do hereby for insurance coverage verification. penalties of perjury that the information provided above is true and correct. Official use only. Do not write in this area, to be completed by city or town officiaL City or Town: Permit/License 4 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector T T -EP, -;FIC,'TE -,OLDER. TN THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGCCERTIFICATE OF LIABILITY IN U1 FZANCE . + i J L?Orl l = v� r, n I� THIS 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 BETINEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(lee must at endorsed. if SUI3ROGAdoes IS Uc confer ri subject to the terms and conditions of the policy, certain policies may require an endorsement• A statement On this certificate does not canter rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER 1-404-995-3000 yAME: `— ------ FAX Marsh USA, Inc. PHONE _ --__---^� AICyNal_,_..__....__..._........... AIC No �tL.-. — --- - -- E-MAIL homedepot.certrequest@marsh.com ADDRESS: Two Alliance Center, 3560 Lenox Road, Suite 2400 INSURERS) AFFORDING COVERAGE __ �_—NAIC X _ Atlanta, GA 30326 Steadfast Ins Co 26387 Fax (212) 948-0902 INSURER A: ------ INSURED INSURERS: Zurich American Ins Co 16535 The Home Depot, Inc. INSURER C: New Hampshire Ins Co _ 23841_ Home Depot U.S.A., Inc. 23817 - 2455 Paces Ferry'Road NW INSURER 13, Illinois Na:::s COBuilding C-20 INSURER E: NATIONAL UNIRE INS CO OF PITTS 19445 Atlanta, GA 30339 Illinois Union Ins Co 27960 INSURER F 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. _---.___.__.... _ ,NSR ADDL SUBR �03/01/1 F POLICY EXP LIMITS YYL LTR TYPE OF INSURANCE POLICY NUMBER MMIODIY / A GENERALLIABILITY' GL04887714-01 03/01/12 EACH OCCURRENCE $9,000,000 DAMAGETO RENTED 1,000,000 PR MISER (Ea occurrence $ _X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE a OCCUR X LIMITS OF POLICY XS X OF SIR: $1M PER OCC GEN'L AGGREGATE LIMIT POLICYF71 JECT PRO - AUTOMOBILE LIABILITY Xi ANY AUTO ALL OWNED AUTOS HIRED AUTOS X SIR AUTO P Y UMBRELLA LIAB EXCESS LIAB PER: SCHEDULED AUTOS NON -OWNED AUTOS OCCUR C WORKERS COMPENSATION AND EMPLOYERS' LIABILITY D ANY PROPRIETORIPARTNERIEXECUTIVE YIN NIA ❑ OFFICERIMEMBER EXCLUDED? N E IMandatory in NH) MED EXP Any one person $ EXCLUDED PERSONAL BADV INJURY $ 9,000,000 GENERAL AGGREGATE • $ 9,000,000 PRODUCTS - COMPIOPAGG $9,000,000_- - -08 03 01 1 03 01 12 COMBINED SINGLE LIMIT 1,000,000 Ea accident _._ ..._.. _._...__ ......... BODILY INJURY (Per person) $ BODILY INJURY (Per accident) S ~ PROPERTY DAMAGE $ (Per a cident _ ___.-._.....-•.-_ $ WC061967352 (AOS) 03/01/1 03/01/12 X ORVLIMITS — WC061967354 (FL) 03/01/1 03/01/12 E.L.EACHACCIDENT $1,000,000 WC061967353 (CA) 03/01/1 03/01/12 E.L.DISEASE-EAEMPLOYE $ 1,000,000 a. nISEASE-POLICY LIMIT I $ 1.000,000 DE54�ilr I �V ry t,r urc,w wwa ,.o..,.. C Workera Compensation lwcu61967355(KY,MO,NY,WI, Vp3/O1 1L03/01/12 F TX Employers[XS Indemnity TNSC46244151 (TX) 03/01/01/12 Occurrence/SIR 30M/1M E Workers Compensation WC1191378 (QSI) 03/01//01/12 SIR 1M DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORO 101, Additional Remarks Schedule, if more space Is required) RE: EVIDENCE OF COVERAGE 11 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. HOME DEPOT U.S—AL, INC. 2455 PACES FERRY, ROAD NW AUTHORIZED REPRESENTATIVE BUILDING C-20 �- ATLANTA, GA 30339 I USA ©1988-2111>0 ACORD, CORPORATION. All rights reserved. ACIDRD 25 (2010105) The ACORD name and logo are registered marks of ACORD jfiero hd 1 OCT -31-2011 13:17 From:KEN SANDEL.L RSW 603 782 8726 To:Home Depot AHS P.1/8 iTOME IMPROVEMENT CONTRACT PLEASE READ THiS Sold, Furnished and Installed by: Branch Name: Boston Date: THD At -Home Services, Inc. d/b/a The Home Depot At-liumc Services 345 A Greenwood Street, Unit 2, Worcester, MA 0160') Toll Free (800) 657-5182: Fax (508) 71("823 Branch Number: 31 Federal ID # 75-26984611; Mai Tu. # C 112439; Ri Cunt. Lie# 16427 ACT, Ucc' # HIC.tYi6.5522; MA Hume Imprrovenimt C ontrtra'cltor Reg. # 126893 irasfallatirtn Addrerar: 75 Ce0 K'1 - / V Qn'� �-wew<-pO f7 0 i a -{�]�—Ciy State 'Lip Work Intone: Borate Phone: Cell Phone: N,tt' -c r [ i _ RWI 691-rX6+tel S -32k( Nome Addin w: (if different from Installation Address) City_n State Zi N -mail Address (to receive pmjwt communications and IIow Depot updates): N ` 1 1 fit>F o. a ✓i/i_ NJDO NOT wish to receive any marketing entails from The Horne Depot Fmiect information: Undersigned ("Customer"), the owners of the property located at the above installation address, and THD Ai -Horn: Setviccs Inc.("The Home agrees n buy. , i)tput") agues [o furnish, deliver and arrange for the installation ("It�taAAl3on") of all nruterWs described on die below and un the nfcrcitced Spec Shetx(s), all of which ace iticurporatcd into this Contract by tWs reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders (collectively, "Contract"): Job # Re"°""�1Y°"'r P�edncts ha...wrahi. s :Y.. ��,// ' 7a�`' Aofmg OSiding a,drnv[Is inwhitiun OR❑Canoes/C0.m-- Entryflims ❑ $ I 601 Roofing idins windows ❑ 7malatio[i 1 Covers ❑Istrtry Drax n R iding ❑ Windows ❑ insulation 5 w 5?k $ I Q 1 L352 00umrs l Lavers ❑Ijntry Doors o^5 Roofing ElSiding [] Wimlows ❑ Trimlation OGullers I covers ❑Enuy L)oors L l $ �a Minimum 25% ))emelt of t7mdrod Aman doe i" cxacvdm edfhe Fr-talContractAnioun, Maim iyachaseps nay not tkptlEltmore thana0e6fidoftheCa traclArmuM. Custoinei agrees that, inuriediately upon completion of the work for each Product, Customer will execute a (bmpletiotl Certificate (one for each product as defined by aii individual Spec Sheet) and pay any balance due- As applicable, each Customer under this Contract agreg to be jointly and severally obligated and liable hereunder. The- Home Depot rmcrvcs the right to issue a Change (hder or terminate this Contract or any individual product(s) included herein, at its discretion, if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with tic (runic, 4nivirantnental ha/arits such as mold, asbestos or lead paint, other sat-cty concerns, lnicine efrots or ht:cause work requited to complete the job was not included in the Contract. Payment Summary: The Payment Sumina y 9 included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product (arc applicable). I N(TIFI 'E TO CUSTOMFA You are entitled to a completely filled-in copy of the Contract at tht nano you sign. 00 not sign a Completion Certificate (note: there is one Completion C'ertiflcete for each fisted Product as defined by individual Spec Sheets) before worst an that Product is complete. i In the event of termination of this Contract, Clislomer agrees to pay The Home Depot the costs or materials, labor, expenses and services provided by The Home Depot or Authorized Service Provider through the date of termination, plus any other anmutits set forth in this Agreement ter allowed under applicable law. THE HOME DEPOT MAY W IT HHOLD AMOUNTS OWED TO THE HOME DKPb'1' VROM THE DEPOSIT PAYMENT OR OTHER PAYIM1KN'1S MADE, WITHOUT LIMITING THE HOME DEPOT'S O"ITIER RKMEDIF$ FOR RECOVERY OF SUCH AMOUNT'S. AceeCOM and Authorization: Customer agrees and understands that. this Agreement is the entire agreenmit between Customer and The Home Depot with regard to the Products and installation services anti supersedes all prior digressions and agreements, either oral or written, relating to said Prtxtucts and installation- This Agreement cannot be msigned or amended except by a writing signed by Customer and The f come Depot- Customer acknowledges and agrex-s that Customer has read, understands, voluntarily accepts the terms of and has received a copy of this Agreement - Ace" by: X Customer's Solarm Date X _ Custnu>cr s Signature Date CANCELLATION: CUSTOMER MAY CANCEL THIS AGREEMENT'WITHOUT PENALTY OR OBLIGATION BY DEL1149MG WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THiS AGREEMENT. THF STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM TO USE IN ONE IS SPECH(ICALLY PRESCRIBED BY LAW 1N CUSTOMER'S STATE, N(rr it'K. M>nlTit)NAI. TKRMS AND CONDITIONS APJR STA 0,71-10 C -SC Subed by Sales Consultant's Signature ^� Date 3 r T'elcphone No. Gd `- S G� 1" ]�rlZ 1 Sales Consultant license No - (as applicable) taliV P-M,.SMEANDARF.PARTOPTimsCON17Wt`r Wrdle - 8rench Fee Yeltnxr -Customer b. aS-rc:{7.t-,•�pd�ii�eGs:Pr���cG::9_,�:tia`u4:t .. �:i� a �.t �• .'J, :•i:F tv Y ' .�' � 4. Y.' .r :•. � .`. i Se w ,�,f :fly; ♦ r .r . ' tj y N U! s a•�'rnr ' Zi Z C,- �. .rJ Q.o• sm ' n r VI In lu 9 7 f� r t • i;i :o L. 1•i .W :�