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HomeMy WebLinkAboutBuilding Permit #409 - 75 SHERWOOD DRIVE 1/2/2009 TIy►OR BUILDING PERMIT c* r 4OR A TOWN OF NORTH ANDOVER �r`4 ''`- op APPLICATION FOR PLAN EXAMINATION Permit NO: Date ReceivedAraD �gSSACHUs Date Issued: IMPORTANT:Applicant must complete all items on this page ALUCATION '75-, Print PROPERTYROWNFR' �: u > C c ,�,� Pnnt ;MAI?:NIO! PARCEL; eZON'ING DISTRICT HistaricUstrict - yes:° °no � a_ as _ . w MaChine Shop Village ...yes n f� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial -A teratio No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic UIe11 Floodplain Wetlands WatersFied`Dstnct ia, � iter/Sewer _ DESCRIPTION OF WORK TO BE PREFORMED: &?2547-ff Y 5LA26 C/GtA� C_0x1J n.Y &25E dih'/—/n>Is/j>!U(r &99ft �ZL SQM""fl 2-X2- t�'_PP CCI Liti6 FIA-491 /fT :2 Z yU'►� `Ta j254,45a2) AS n- lzv i_y &o' l c Identification Please Type or Print Clearly) OWNER: Name: &&[ Y 614+ ?' Phone: a i Address: 7 C ,NTRACTOR Name. - fione. / . / - a - „ 4cltlress � rci Ii2�ru ° j � A Supervisot,,sConitruction.License , Exp_ Date ld 2, . ` °Horne.lmprovement'License :/ 7 �3 :Exp TJate.. . ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ b 6� FEE: $ Check No.: 4 Receipt No.:""2/ NOTE: Persons contrac `ng with unregistered contractors do not have acce to he uaranty fund 5i nature of A erit/Owrneii nature of;conttac r � 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 Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments II� Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FARE-DEPARTMENT - 1 ei�p umpster-onsite yes ~ ono° '~ s - •-Lgcat6dat'124'N1aimStreet = j Fire Departrrtfftat 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 2008 i 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 o 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:Building Permit Application Revised 2.2008 Location No. Date ' O NORTh TOWN OF NORTH ANDOVER f � S ' Certificate of Occupancy $ sA01USEt� Building/Frame Permit Fee $ ✓ 00— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #4�a 21778 Building Inspector =� Board o uiing egulat' ns r and tan ards One.Ashburton Place Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration Reqistration: 137943 Type: Supplement Card Expiration: 1129/2009 OWENS CORNING BASEMENT FINISHLNG -----. -- -- DANIEL WALSH 60 SHAWMUT PARK CANTON, MA 02021 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card 'S-CA1 of 50M-05/06-PC8490 i r 770 B a of u� erg�lati1 1- fan ar el Construction Supervisor License Lieftse: CS 79893 Birttitiat°e 10/5/1962 0/6/2009 Tr# 4794 WE' . DANIEL F WALSR 488 KENDALL TEWKSBURY,N1A 016 Commissioner r ACORD. CERTIFICATE OF LIABILITY INSURANCEDATE(MWDD"YYY) 10/7/2008 PRODUCER Phone: 781-659-2262 Fax: 781-659-4725 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Andrew G. Gordon, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 680 Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P. O. Box 299 Norwell MA 02061 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA:Peerless Insurance ,4198 Bay State Basement Systems, LLC INSURERB:Pilgrim Insurance Company 1750 60 Shawmut Road INSURERC:Renaissance Marketing Canton MA 02021 INSURER D: INSURER E: COVERAGES 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICY NUMBER POLICYEFFECTIVE POLICYEXPIRATION LIMITS LTR TYPE OF INSURANCEDATE(MM/DDIM DATE fMM/DD/YY1 A GENERAL LIABILITY CPB8512851 9/5/2008 9/5/2009 EACH OCCURRENCE $1,000,000 - DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurence $50,000 ' a CLAIMS MADE a OCCUR MEDEXP(Any one person) $10OOO - - PERSONAL&ADV INJURY $1.000,000 GENERALAGGREGATE $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X I POLICY PRO- LOC B AUTOMOBILE LIABILITY PGC10007161409 1/17/2008 1/17/2009 COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $1,000,000 ALLOWNED AUTOS BODILY INJURY X SCHEDULEDAUTOS (Perp_) b X HIREDAUTOS . BODILY INJURY b _ X NON-OWNEDAUTOS (Per�dent) PROPERTYDAMAGE b (Per aocident) GARAGE LIABILITY - AUTO ONLY-EAACCIDENT b ANYAUTO OTHERTHAN EAACC b AUTOONLY: AGG b A EXCESS/UMBRELLALIABILITY CU8511953 9/5/2008 9/5/2009 EACH OCCURRENCE $1,000,000 X I OCCUR FICLAIMS MADE _ AGGREGATE $1.000.000 b DEDUCTIBLE b RETENTION $10.000 b VCSTC WORKERS COMPENSATION AND C 0371527 5/24/:_2008 5/24/2009 TORY. U-EMPLOYERS LIABILITY - E.L EACH ACCIDENT $1000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L DISEASE-EA EMPLOYEE b l 0 0 O 0 0 0 If yes desrnbe under SPECIAL PROVISIONS below - E.L.DISEASE-POLICY LIMIT I$1 O 0 O O 0 0 OTHER DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED Ba State Basements, LLC BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER Y WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE 60 Shawmut Rd CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO Canton MA 02021 SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001/08) 6ACORD CORPORATION 1988 The Commonwealth of Massachusetts -' Department of Industrial Accidents It %� Office of Investigations 600 Washington Street ~n ^' Boston,MA 02111 www.mass.gov/dia Workers.'XgMpensafion Insurance Affidavit: Builders/Contract©rs/Electricians/Plumbers Applicant Information Please Print Legibly Name [3usiness/Or ani7atiott/Individual • �({f�J j (ac'),Vc Sy I .:. t; )• Address: imu F/PUj9-0 --- City/State/Zip: eR,A,� 0 t� G _)_ Phone #: 912/-6�zQ Are vdu an employer?Check the appropriate box: Type of project(required): 1. lam a employer with .` 4. ❑ I am a general contractor and 1 - b: New .,.. colistttict o employees(full and/or part-time).* have hired the sub-contractors _❑ I h 2.❑ Iam a sole proprietor or partner- listed on the attached sheet. 7. emodelirg ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' comp. * 9• ❑ Building addition [No workers' comp. insurance P• insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 4m a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL . 12.0 Roof repairs insurance required.]+ c. 152, §1(4),and we have no employees. [No workers' 13-❑.Otlii'r_ — —`---- ...-- comp. insurance required:] - - *Any applicant that checks box#I must also till out the section below showing their workers'compensation policy information. t Homeowners who submit this atlidavit 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 state whether or not those entities have employees; If the sub-contractors have emp[oyces,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 informafrort. Insurance Company Name: Policy#or Self-ins. Lic.#: W(' D3 ? Expiration Date: s zy Job Site Address: 75" SMM11Q4p 0-9 City/State/Zip: Attach I 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 ORDERartd a brie of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the biticc of Investigations of the D r insurance coverage verification. do hereby c if ndert e �e. of perjury that the information provided dbope U true and cbrrecl. Si natu Phone Official use only. Do not write in this area,to be completed by city or town official. City ter Town: Permit/License# Issuing Authority(circle one): 1. Boar<l,of Health 2.i3uilJing Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#• n <IY\fnc CONTRACT Customer Name 4 9 It 16?-r -' customer Signature SKETCH Contract Date Be c. S O Sates Representative Signature A 1A ATTACHMENT Customer Phone VX•U�y -373 9 ,�$'S�• `71/� �V Contract Price �. (0sw 1 2 3• 2 4 B 9 7 9 9 10 11 , 13 14 15 19 17 15 1s 20 21 22 23 24 25 29 27 29 29 30 31 32 33 34 35 35 37 39 39 40 41 42 43 44 45 46/ 47 49 49 50 51 52 53 54 55 59 57 59 59 90 J I I G D i _ f i I 14 I _I^ illic 19 72 I I r � 21 ;rte za23 oe_ NAI 24 (, 2, �, -- I � za - i 21 29 .. .�__.I.... 'a.. I I 30 , O - - 32 34 39 NOTES: C_R_ S $ ttc e.,^ 0 t Cd L 'Each box equals one fool unless otherwise noted.This sketch Is a good faith eC J C representation of the work to be done,it is understood that all dimensions IL I I k derived from this sketch are approximate,and that all locations of outlets,light S n tVI {P '4j, r-, � tr k T 4 s fixtures,plugs,Jacks and/or switches are subject to change if necessary. — ��� ` NORT►y '9 TOMM of . _ Andover , No. o i-' LA over, Mass., ,p O COCHICHEWICK 7� y ADRATED P' � 1 S E BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING.INSPECTOR THIS CERTIFIES THAT:.... ...... 4 ........4.1inw.7mm"� ........................... ............................................ Foundation has permission to erect.. buildings on ..... ......� .. . .... �r .. Rough Chim n to be occupied as........1,7o'.0.4.4........ ...... .. . ........................................................................................ ey provided that the person accepting this permit shall in everyrespect 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 .10% -depPERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTR CTI AR S Rough' ...................... ................................................... - Service BUILDING INSPECTO Final Occupancy Permit Required t0 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. CONTRACT TO INSTALL OWENS CORNING BASEMENT WALL FINISHING SYSTEM Owens Corning Basement Finishing Division(the contractor)hereby submits this proposal to sell and install the Owens Corning Basement Wall Finishing System and related items as described herein at the residential premises set forth below.This proposal shall not become a binding commitment unless and until it has been signed by the Contractor and the Customer. Contractor: Owens Coming Basement Finishing Systems A m a division of Bay State Basement Systems,LLC. 60 Shawmut Road,Canton,MA 02021 Telephone#(781)821.0060 s Facsimile#(781)821-8552 , Federal Tax ID#14-1855297 'Y Mass.Home Improvement Contractor Reg.#137943 Date ` i 0 C S U Customer: Customer Name Street Address ^ City,State,Zip___ 1 Y J. Q J e / (� a Telephone( ) �OS� ,� / This is a contract between the Contractor and the above named Customer to sell and install the Owens Corning Basement Wall Finishing System and related items specified herein at the Customer's residential premises identified below: Installation Premises: Street Address LS 1442 City,State,Zip Scope of Work: Are Sketches and/or specification sheets attached? fWes` ❑No - 'All attachments are incorporated into and become a perlQff�tthia contract / Description of Work/Specifications: l U�1 C-. l/1 til C.l(1�S ! I �(�l e to M dl 4�e /U ee !l 1 l� lC�l e t f d/) SJ t n / ne t)61 �e CU�u a Ong wi'\clu 7�izW 771h1, Fu.�. .Si Oc/n e� UJt)%LS 1l�2eo 4 t fl IXcIC f �LUU �Sf e�r, ttJc euAC�/�. Work Schedule": d/[t+C6r/11)n CleCL3`bA3 c, Sw I e.� ru ' c;tre`e�lg lL fii QCK.s0 elec• owtl ci . /, t° Approximate Commencement Date: — or�1_ Approximate Completion Date: 2-9, "The proposed work schedule is approximate and subject to change Contract Price: Total Contract Price: $ tvtt O Deposit with order: $ �-1 ( D ❑ Cash d heck# Balance Due: $ a !9 D Terms: CLCash ❑Finance (Cash terms are 10%deposit,50%loin commencement,40%on completion) $ 0,b r � I 0 0 dt Due on Commencement — $ (0 r 1 V Due on Completion DO NOT SIGN THIS CONTRACT UNTIL ALL APPLICABLE BLANKS ARE COMPLETELY FILLED IN AND UNTIL YOU FIRST READ AND UNDERSTAND THE ENTIRE CONTRACT,INCLUDING ANY ADDENDUM ATTACHED HERETO,AS WELL AS ANY ATTACHED SKETCHES,MATERIAL LISTS OR THE LIKE,AND THE TERMS AND CONDITIONS ON THE BACK OF THIS CONTRACT DOCUMENT. YOU ARE ENTITLED TO A COMPLETE,FULLY EXECUTED COPY OF THIS CONTRACT AT THE TIME OF EXECUTION. Witness our hand(s)and seal(s)below on this —day of Bay State Base nt Systems,,LLCJthorize Representative: Signature a6dTlflfe L\5 CL �'l Print Name e DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Cu tome" i V C; iii ustomer Si nature L e Print Name Customer Signature Print Name Contractor may have certain lien rights in the premises until the price is paid in full.You have the right to cancel this contract,without any penalty or obligation,at any time prior to midnight of the third business day after the date you signed this contract.See the notice of cancellation below for an explanation of this right. "'Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to customer's execution hereof. NOTICE OF CANCELLATION