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HomeMy WebLinkAboutBuilding Permit #324-2017 - 8 WALKER ROAD 9/26/2016 poRTH BUILDING PERMIT TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION '- OO ^" Permit No#: a a f Date Received d �qs RATEo CH►15 Date Issued: ORTANT: Applicant must complete all items on this page LOCATION • Print PROPERTY OWNER F22 Print 100 Year Structure yes no MAP PARCEL: 604 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid al Non- Residential 0 New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic ❑Welly ❑ Floodplain ❑Wetlands ❑ Watershed"District ❑Water/Sewer DESCRIPTIO.-QJ; WO K BE P -RFORME Id-eptification- Please Type or Print Clearly OWNER: Name: Phone: Address: ' Contractor Name: 01 Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address-. Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ �(?!Y�? FEE: $ --x-- Check No.: VIS 2771--2 Receipt No.: �3 0 C/ L NOTE: Persons contracting with unregistered contractors do not have access19 the guaranty fund 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 Reviewed On Signature_ 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 Conservation Decision: Comments Water & Sewer Connection/Signature ®ate Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIREIDEPAR;TMENT - Temp_,Du_mpster on site yes.. .. no, Located at.,12411VIainiStreet Fire D'epartM-ent signature/date COMMENTS t — — 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 LI Notified for pickup - Date E t t Doc.Building Permit Revised 2010 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 OTE: 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/Cross Section/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 OTE: 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 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 Revised 2014 Location �-/, y" ; V"E No. -?d V- c' t Date `"f - d (o -0 0/f 3; 5 t • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $-3L Foundation Permit Fee $ 3-7 Other Permit Fee $ TOTAL $ Check# t r 41 Building Inspector r 1 - NORTH q . :. .c . : ve: p No. ay_ ,1 7 - �o h ver, Mass, COC NIC Nl wKK 1' xO �ARATEO �P �(5 U BOARD OF HEALTH P T T D Food/Kitchen ER Septic System THIS CERTIFIES THAT �..,aI ,, *, BUILDING INSPECTOR has permission to erect buildings on W 4 k 4 Foundation to be occupied as .............................. Rough u h ..�......�'���........... �.terms ..��� Chimney provided that the person accepting this permit shall in eve res ect conform to teI'y p of the application Final on file in 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TARTSRough Service .. ................ BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. ACIOR Dli® CERTIFICATE OF LIABILITY INSURANCE F °02/2420016 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 MARSH USA,INC. NAME: ONE TWO ALLIANCE CENTER HCC. ext): xt FAX No: -IAI3560 LENOX ROAD,SUITE 2400 E-MAIL s: ATLANTA,GA 30326 INSURERS AFFORDING COVERAGE NAIC 100492-HomeD-GAW'-16-17 INSURER A:Sleadrasl Insurance Company 26387 INSURED THE HOME DEPOT,INC. INSURER 13-.ZUnCh American Insurance CO 16535 HOME DEPOT U.S.A.,INC. INSURER C:NEW Hampshire Ins Co 23841 2455 PACES FERRY ROAD,NW BUILDING G20 INSURER D:Illinois National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: ATL-003741310-08 REVISION NUMBER:O 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMlDDIYYYY MMIDONYYY LIMITS A X COMMERCIAL GENERAL LIABILITY GL048977%06 03101/2016 03101/2017 EACH OCCURRENCE 5 9,000,000 7 CLAIMS-MADE M OCCUR DAMAGE TO RENTED PREMISES Ea occurrence S 1,000,000 LIMITS OF POLICY XS MED EXP(Anyone person) $ EXCLUCED OF SIR-SIM PER OCC PERSONAL&ADV INJURY S 9.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 9,000,000 X POLICY ECTCT LOC PRODUCTS-COMPIOPAGG S 9,000,000 OTHER: S B AUTOMOBILE LIABILITY BAP 2938863-13 03/01/2016 03/01/2017 CEa MaOccidentBINED SINGLE LIMIT 5 1,000,000 X ANY AUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident AUTOS AUTOS ) S HIRED AUTOS NON-OWNED PROPERTY DAMAGE s AUTOS IPer accident S UMBRELLA LIAB OCCUR EACH OCCURRENCE s EXCESS LIAB HCLAIMS-MADE AGGREGATE S DED I I RETENTIONS S C WORKERS COMPENSATION WC015519215(AOS) 03!01/2016 03/01/2017 X PER OTH- C AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE WC015519217(AK,KY,I4H,NJ,VT) 03101/2016 03!01!2017 1,000,000 D OFFICERIMEMBEREXCLUDED? a NIA E.L.EACH ACCIDENT S (Mandatory In NH) WC015519216(FL) 03/01/2016 03101/2017 E.L.DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under Con6nueti on Additional DESCRIPTION OF OPERATIONS below Page E.L.DISEASE-POLICY LIMIT S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION OF NORTH ANDOVER 1600 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 16000SGOODST. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH ANDOVER,NIA 01845 ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE of Marsh USA Inc. ManashiMukherieea9 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Bepartment`of indvistrial,d ccidenis C ` Offece of Investigations 600 Washington ,Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectricia-ts/Plumbers Applicant Information Please Print Lea5l y Name (Business/OrganizatiorJlndividual): _.. __._.. City/State/Zip: Are you an employer?Check the appropriate bp Type of project(required): 1.❑ I am a employer with 4. I am a general contractor and I 6. ❑New.construction employees (full and/or part-time).* have hired the sub-contractors 2.f-1 I am a sole proprietor or partner- listed on the attached sheet.x �• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. g, ❑Building addition [No workers' comp.insurance 5. ❑ We are a corporation and its re4uired.1 officers have exercised their 10.❑Electrical repairs or additions ;.F-1I am a homeowner doing all work right of exemption per MGL 1 l.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑R f repairs insurance required.]t employees.[No workers' 13. Otherl"7frj i comp.insurance required.) 1ny applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must subrrdt anew affidavit indicating such. .. :ontractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. am an employer that isproviding workers'compensation insurance for my employees. Below is the policy and job site formation. /17 surance Company Name: 'n ,Iicy#or Self-ins.Lic.#: -/�( ,) Q jl-, ExpirationDate: . I b Site Address: ( City/State/Zip: :tach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date), ilure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a e 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 up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of iestigations of the DIA for insurance coverage verification. o hereby ce�i nd r th pains and penalties of perjury that the information provided above is true and correct r nature: t.. Date: me#: Official use only. Do not write in this area, to be completed by city or town offaciaL City or ToWii: Permit/License# [ssuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.EIectrical Inspector S.Plumbing Inspector i. Other -ontact Person: Phone#: C4, Affairs an Business Regulation _ Office of Consumers 10 Park Plaza - Suite 17 -= Massachusetts 02116 Boston, -�.... - :. Home Improve�.t�ontractor Registration Registration; 126893 Type: Supplement Card Expiration: 813/2018 THD AT HOME SERVICES, INC. RICHARD FALLONE HSC 2455 PACES FERRY ROAD, - TA GA 30339 dark reason for change• ATLANTA, y'= Update Address and return��•` Lost Card Renewal _ Employment -- — :address — — ;; aoti�-cs l Use only License or registration valid for individual Sc Business Regulation expiration date. If found return to: •�"`- fi3ce of Consumer fairs before the esp' and Business Regulation Office of Consumer Affairs a —�4iOME IMPROVEMENT CONTRACTOR Type: LO Park Plazan'S'!Lute 5170 -�- - Supplemenf.Card- gusto THD AT HOME SEFIufEz��' �NICES THE HOME DEP0f'A RICHARD FAU.ONi :. — RRY dffP�rHSC �- of valid with t si t 2455 PACES FE L`nderseccetary ATVANTA,GA 30339 Jis o Details l,jQDe Details Information Full Name: SHAWN M LEMAY Owner Name: icense Address information City: Danville State: NH Zipcode: 03819 o ntr : U 'ted tates icanse inTormation License No: CS-069270 License Type: Construction Supervisor Profession: Building Licenses Date of Last Renewal: 7/7/2016 Issue Date: Expiration Date: 8/17/2018 License Status: Active Today's Date: 8/31/2016 Secondary License Type: Doing Business As: atus Change R as n: License Rgoewal rarequisie inTormation No Prerequisite Information Close.Window O 20,11 Commonweaitn of iMassachusetts Site Polices 1ontact Us http://el i cense.chs state.m a.us/Verification/Detai I s.aspx?agency_id=1&Ii cense_id=258220& 1/1 P . 4 l� Home Depot Contractor License Numbers: MA Home Improvement Contractor Reg. # 126894 Salesperson Name and Registration Number: Leonard Racite : R-1-073-14-00023 Home Improvement Agreement THD AT- HOME SERVICES, INC ("Home Depot") or Service Provider named below will furnish, install and/or service the equipment listed below at the price, terms and conditions as outlined on this form. Customer Information: Ramon Suero 9529671 First Name Last Name Branch Name Lead# 8 Walker Rd Bldg 8 Unit 6 1 NORTH ANDOVER 1 01845 Customer Address City State Zip [(978) 975-1619 [(978) 360-3026 Home Phone# Work Phone# Cell Phone# santoramon65@gmail.com Customer E-mail Address NOTICE OF RIGHT TO CANCEL: YOU MAY CANCEL THIS AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO HOME DEPOT AT: 908 Boston Turnpike Unit 1 Shrewsbury MA 01545 Address City State Zip or Email CustomerCancellationNorthEast@homedepot.com BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING, UNLESS THE STATE SUPPLEMENT PROVIDES A different CANCELLATION PERIOD. THE STATE SUPPLEMENT CONTAINS A FORM TO USE IF ONE IS SPECIFICALLY PRESCRIBED BY LAW IN YOUR STATE. YOUR PAYMENT(S) WILL BE RETURNED WITHIN TEN (10) BUSINESS DAYS AFTER HOME DEPOT'S RECEIPT OF YOUR NOTICE. YOU MUST MAKE AVAILABLE FOR PICKUP BY HOME DEPOT OR PROFESSIONAL, AT YOUR SERVICE ADDRESS, AND IN SUBSTANTIALLY THE SAME CONDITION AS WHEN DELIVERED ANY MERCHANDISE OR MATERIALS DELIVERED TO YOU. OR YOU MAY CONTACT HOME DEPOT FOR INSTRUCTIONS REGARDING RETURN SHIPMENT AT HOME DEPOT'S EXPENSE. THE LAW REQUIRES -T r ME-CONTRACTOR GIVE YOU A NOTICE EXPLAINING YOUR RIGHT TO CANCEL.,jP� ASE SGN BELOW TO ACKI '13 DGE THAT YOU HAVE BEEN GIVEN ORAL AND WRITT/�_/NNOTICCE",5F YOUR RIGHT TO CAN "EL. Acknowledged ??;.`-- ., } 7� a, 09/01/2016 Customer's Signature's '� � �!' Date 1 Distribution: White- Home Depot Yellow- Customer Copy WINDOW SPECIFICATION SHEET - Spec.Sheet#: 9529671 Sheet: 1 of 1 ro Customer: Ramon Suero Job#: 9529671 Consultant: Leonard Racite Date: 09/01/2016 New Window Hinge Locations Existing Window Measurements Grids Product Options Labor Options From outside, Left to Right Bays,Bowls Location Color Rough Opening #of bars #of bars Csmnts,1 Pnl, use L,R or S Glass Misc Items Hardware Code Screens For doors use !� Mull "S"=stationary or at 5 0 5 _. m o �`�, N .� N "X"=operating Style Wraps .� (7 r r W X Qt T O i0 O N O p a) O Room Floor Code (Y/N) Style Code Series Code = w x ai U a > x > x STD,TMP:Full, WRAP,F, 1 BATH 1st DH Y DH 6100 WH WH 35.00 34.00 69 _ F,GBG WHT,W c ALL 2 1 ALL 2 1 GlassPack:Standard LSR HT GlassPack:Standard LSR 2 BED1 1st DH Y DH 6100 WH WH 39.00 50.00 89 F,GBG WHT,W c ALL 2 1 ALL 2 1 HT GlassPack:Standard LSR 3 BED2 1st DH Y DH 6100 WH WH 39.00 50.00 89 F,GBG WHT,W C ALL 2 1 ALL 2 1 HT GlassPack:Standard LSR 4 BED3 1s1, DH Y DH 6100 WH WH 35.00 34.00 69 F,GBG WHT,W c ALL 2 1 ALL 2 1 HT GlassPack:Standard LSR 5 BED4 1st DH Y DH 6100 WH WH 35.00 34.00 69 F,GBG WHT,W C ALL 2 1 ALL 2 1 HT SPECIAL CONSIDERATIONS: rap Color WHITE MISC1:..,Line Level Notesl:.. interior Casing Type Bay or Bow window: eatboard material(vinyl only-Birch or Oak) ay Project Angle(30 or 45) ay Flanker Type(DH,SH,or Csmnt) op of window to soffit(inches) f tied to soffit,color of soffit material I have reviewed and agree with all the job specifications above and the onstruct Roof(Yes or No)` Special Terms and Conditions on the following page Garden Window: eatboard Material(vinyl only-White Pionite,Birch or Oak) Nall Thickness(inches) Customer Signature dditional Shelf(Yes or No) `There is no guarantee that new shingles will match existing color.