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HomeMy WebLinkAboutBuilding Permit #297 - 80 EDGELAWN AVENUE 10/29/2008 BUILDING PERMIT Olt No RTH qti 2 46th, ., TOWN OF NORTH ANDOVER - - A APPLICATION FOR PLAN EXAMINATION • 1, Permit NO: Date Received �,ypoAnrfo�rP�g9 SSACHUS Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print: PROPERTY OWNER Print MAP NO: ARCEL: ZONING DISTRICT: His#oris District yes no Machine Shop Village ;yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands 'Watershed District Water/Sewer I DESCRIPTION OF WORK T EPRORMED• � e d tifiePlease Type or Print Clearly) OWNER: Name: tion Phone: Address: 5 CONTRACTOR Name: F � Phone- &1 honey Address: 2PVIri � I DI 7 Supervisor's Construction License: 71d ?` Exp. Date: Home Improvement License: L p '�,'r� ��� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSTT B/-A�SED ON$125.00 PER S.F. Total Project Cost: $ ( FEE: $ Check No.: C7- Receipt No.: NOTE: Persons contracting w' unreg' tered contractors do not have access to the guaranty fund signature of Agent/Owner c Signature of contractor Location No. Date NaRTh TOWN OF NORTH ANDOVER O 9 Z- + Certificate of Occupancy $ Building/Frame Permit Fee $ yy ncMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 21641 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 r , 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 Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp:Dumpster onsite yes Located at 124'Main`StMet Fire Department signaturefdate 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 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 N0RTH `._� Andover TO" of ._ _ O _,K..�. ,� to No. a 9 _ _ o dover, Mass. 4K O �= -L A � 1 1 COCHICHEWICK V ADRATED P-'o� -`C7 qS BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING.INSPECTOR THIS CERTIFIES THATAA ...... ... .. .... ......................... ....... ............... ...................................... Foundation has permission to orect........................................ buildings on Rough . ......... ►w.✓�................ tobe occupied as. ........ ..../.........AJ09.496.f).................................................................................................. Chimney provided that the personaccepting this permit shall in every respect 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 43b PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRf4uzaaw TS Rough . Seryice BUILDINGINSP 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. Ul.I-CC-CeIL'lo rl •<�or rnu HOME iMPRC)YEM'ENT CONTRACT PLEASE READ THiS Sold,Furnished and Installed by: THD At-Home Services,Inc. Branch Name: Boston Date:!_ i d/b/a The Home Depot At-Home Services 145A Greenwood Street,Unit 2,Worcester,MA 01607 Brap,ch Npmber: Toll Free,(.80)'(557-5182; Fax(508)756-8823 �orth 33 []South 31 Federal iD#75-269$4611 ME Lie#C 02439;Rl Coat,Lic#16427 CT Lie#565522;MA tomo Improvement Contractor R%#1.26843 04 Installation Addrttrs: 20 __ Ciry S to zip Purehaser(s): Work Phone: Home Phone: Cell Phone: _ ��]� a-•br�� [ � .,... Home Address: City State Zip (If different from installation Addr s) E-mail Address(to receive pro*t communications and i4ome Depot updates): ❑I DO NOT wish to receive any marketing emails from The Home Depot Pruieet Infortttatinn: Undersigned("Customer"),the owners of the property IoLated at the above installation address,agrees lb,,.)buof y, and materials-a gybed on the below andoDine n the3referenced Spec rees to Sheet(iqhs)aali of whiceliver and arrange re incorporated into this;Contracttbhis rall eference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, "Contract"): JobfF: ome•��•t P nets: S cc sheets #: Project Amount hoofing Siding - - indows Insulation $ i ❑falters/Covers ❑Entry Doors ❑ l�'0 L 1 _Roofing Siding Windows insulation $ ❑Gntwrs/Covm ❑EntryM-4 ©. . Ruoling Siding Windows insulation $ [3Ctutters/Covers Ountry Doors❑ — itoofmg Siding Windows Insulation $ [Gutters/Covers [:,Entry Doors Minimum 25%Deposit of Contrud Amount due Upon esowlion orthis contract notal Contract Amount Ma1nc Purchasers may nut deposit more tbsn one4bird of the ContradAmounR Completion f: stomer will cate he k for uct.Cu (one fuer a product s defined byiately paritt d vidua�Specn of tSheet)rand paycany balance due, As applicable,eea h C stomer under this (ono for each Contract agrees to be jointly and severally obligated and liable hereunder. ange Order or terminate this Contractor any individual Products(s)included herein,at The Home Depot reserves the right to issue a Ch is discretion,if The Home D.CPat.or its author zed sei*S provider asbestos or lea that it cannot perform its erns,prions due er bemuse problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing work required to complete the job was not included in the Contract, included as part of this Contract,sets forth the total �'l Pavmcrit�a!y= The Payment Summary#��.�5� Contract amount P� applicable)' and payments required for the depnsits and final payments by Product(as app NOTLCE IM CUSTOMER You are entitled to a completely tilled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certilleste for each Ilsted Product as defined by individual Spec Sheets)before work an that Product is Complete. expenses in the event of termination of this Contract, r Authorized Customer egrets vi Ray The Hume Depot the costs of materials,labor, p and services provided by The Home Depot or Authorized Service Provider through the date of termination,plus any other amounts set forth in this Agreement or allowed under apPC�>le law. THE HOME bE, - MAY yvlT�Iac�Ll1,AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT .PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING 1Tm HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. mer Acccatance and Authorization: Customer agrees and understands that this A grccment is trio snare agreement between CtlsL4-..__ and ThC home Repo[wttb regard lu the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products CustomeracknowledgesThcad ree mentagrees canwi Customessih ,u��ds,mended voluntarit by a ly accepts the t4 the by Customor and The home Depot• terms of and has received a copy of this Agreement. SubmiKed by: ♦��'rv �` Ac ted by: Y Date C Sales Consultant's Signantre �y T Telephone No.� -- t, s Signature Date Safes Consultant License No- ia9 oppiimblc) CANCELLATION: CUSTOMER MAY CANCEL THiS AGREEMENT W1TH..DUC PENALTY OR OBLIGATION BY DELIVERING WRITTEN PLOTiCE TO THE 1'I9Mg. DEPOT BY MIDNIGHT ON THE THiRD SUSViESS DAY AFTER SIGNING: 'PHLS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A FORM To USE IF ONE. IS SPECIFICALLY PRESCRIBED BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDITIONS ARE STATIM ON'1H1l 6EvrstiSR SIDE AND ARE PAIYf OF THIS Ct]NTIIA CT ;, n.e..41Inn VA1L%W-r'alatomer Pink-Sales consultant O63-A-379 43-43 DS Vin;i I .Viniio Ll 51013 pzOduct IIOutrla-Kung I Vyntana da d0ola ?ai114tina Argon/?r0.3olar I Arghn/?rOsolar NetlonelFinastrdan 3/32" Glass 1 2.38 ma Vidrio R W4 C unde No Laminatad Gla2s I Sin vidrio laainado ® No Grids I Sin rejillas ENERGIE PERFORMANCE RATINGS E%UUIIA=N OE RENDIMIff=EMEROETICO U-Factor Solar Heat Gain Coefficient FectorU Coefldarote Ganauia de Energia Solar /0 . 32 1 . 8 0 . 2 9 ADDITIONAL PERFORMANCE RATINGS WAWA=SUPL EMENTARiA DE RENOSGENTO Visible Transmittance Tran nWon de LutAAW 0 . 52 gut Ilmeee rallrpf mdlmn to appAcaele NFAC p,ocedtfeerademrmtntrto wtoale product per(amerxe.NFAc ratlnpe are deEmfmkmed for a tbaed eat ar errvhamnmenfal oatdtlaf<and a fpatiEc product fr:e Nt}1C does rot reratmrratd enY Dmdtret . addaefrtotwarrarttOmau9eblYtyor?nYproduct�rtr�dom�WmLftq 8seretrretorotfterpreductpationtmrmce -- . ----- --- E*fabrii"eftlptde qua efine veJaes crancan plen be probe apk*u de MC Pere deWft d rmftWnto bW dd prodt W6 Lm vabraf rtfadm pa me fon demrt*oft pargn fro de oon cb=arttbl nWa Y un tm.w de produft efpadit nc mm r cm*de rdnptat pmoducW Y m Canelo qua d P ad mumb.�untrpo etpecM Mm b con d _ t88elo dd 1ti+britanm para d use apropla0 de efoq pmducto.weAtrdro.ap Unit qualifies for ENERGY STAR ragion(4): Northern, North Contaal, South CantaaL, 90uthava. La uaidad CALL9104 pa.a iaW . SNER6f STAR rsgirsa(ka) 8WOROY STAR: NOrtt, Norte Cantral, Sur Ckntral, gar. •• IND: Rain OO/Glass 3/32"/K-R43 . } Tastkd Sisk: 36" x 63" r IND: Rafuarso OO/Vidrio 2.38 mm/K-R4S DP : 451 —`t/1 5 Taafano probado: 91.4 cn x ISO CA 1 4G7.73. Ks Koffaaa 2931120. IlseP 1ha bW hr PosAmorgystls ENERGY SW mWmTo loom mvWwww.oempv. ft vWle www.an Guards ama"para pos�les maem6ohos ENERGY STAR."pmtnnocer mos am do ft, . • I_.__,p__. ?/e TOoonmwnciieal4� or✓�aaaasc�//tuaetla �..\ Board of Build.in B Regulations ulations and Standards . HOME IMPROVEMENT CONTRACTOR RegistrgtiQkk 126893 m Exp Lt. tr= _ /2010 p"e=upPlement Card The Home Depoty:ffi e= voce RICHARD FALLONE - 3200 COBB GALLERtp, 1''#20 f DATE(MM/ODIYYYY) - .ACQRL?e CERTIFICATE Of LIABILITY INSURANCE 02/25/08 1-404-995-3000 THIS CERTIFICATE 13 ISSUED AS A MATTER OF INFORMATION ROOUCER _ ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE arch USA, Inc. HOLDER. THIS CERTIFICATE OCES NOT AMEND, EXTEND OR �medepct.eertrequestamarsh.cam ALTER.THE COVERAGE AFFORDED BY THE.POLICIES BELOW. +-5 piedmont Rd :r•, Suite .1200 Ga 30205 INSURERS AFFCRCING COVERAGE 1 NAIC S sz 72.2! 943-0402 1 -3- �NSURE�p;S."ddi33t i.^.] CJ 2g- :m3�0ecat U.S.A. inc. NSURE.49'.' ich Adler car I^a Co ie :Soma Decat, Inc. I1'_inaLa .Na: Lns�YRarw-- 53317 153 Picea Farm Road NSUR..RC: sildiag C-8 INSURERO:Ama-Loan Home Aasur Co Y93:A0 aaata, GA. 30339 n NSUAERScYew Hampshire Ins Ca 23341 OVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS THABOVE FOR THE POLICY PERIOD INDICATED.E INSURED NAMED 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. IR 0 POUCYEFFECTNE POUCYBXPIRATN7N LIMITS : PCUCYNUMBBR GENERALUABILM XPR 3757 608-02 03/O1/OB 03/01/09 EACx.000uaaENCE (4,00.0,000 . Ke X COMMERCIAL GENE ABILITY LIMITS OF POLICY ARE EXC SS PR I n a f 1,000;000 CLAIMS MADE OCCUR "OF SIR: 51,000,000 -PER CC" MED EXP M anepanonl fEXCLOOYD PFR30NAL&ACV INJURY $4,000,000 GENERAL AGGREGATE S4,000,000 i PROOUCTS-COMPIOPAGG $4,000,000 GENL AGGREGATE UMITAPPLIES PER:. X7POLI 70- LOC 03/01/09 l AUTOMOBILE LIABILITY SAP 2938863-05 0]/01/08 COMBINED SINGLE LIMIT $1,000,000 (Es accident) X ANY AUTO ALL OWNED AUTOS SOOR.YINJURY 3 (Par parson) SCHEDULEOAUTOS HIRED AUTOS• BODILY INJURY $ (Par aaydanl) NON-OWN EO A X Sur INS4RED AUTO PROPERTY DAMAGE 3 (Para Asm) PHYSICAL DAMAGE AUTO ONLY-EA ACCIDENT S GARAGE LIABILITY EAACC I OTHER THAN ANY AUTO AUTO ONLY: AGG f IPA 3757 608-02 03/01/08 03/01/09 EACH OCCURRENCE 15,000,000 EXCESSIVMBRELLA LIABILITY 5,000,000 AGGREGATE S. X OCCUR CLAIMS MADE , I • S DEDUCTIBLE 1 RETENTION 1. Q3/01/09 X WC 0TH• WORKERS COMPENSATION AND 1928757 (FL) 03/01/01 " EMPLOYERS'WBILITY 1928756 (CA) 03/01/01 03/01/09. E.L.EACH ACCIDENT $1;000,000 wPARTNERIEXECUTrvE O3 O1 09 E.L.0ISEASE•EAEMPLOYEE 81,000,000 oY CERImEETO 1 0 t / / FFIcEaMEMBERExauoeD7 1938755(009) 03/0 / . 11p,.doL,;rundar E.L.DISEASE-POLICY LIMIT $1,000,000 SCIAL PROVISIONS below OTHER TN'_C' (TX) 03/01/08 03/01/09 ccurrencs/SIR 25X/2N TX Emplaysrs XXCGSB 03/01/06 03/01/09 workers Compensation :[1926759 (GSI)workers Compensation28758 (XY; N0, NY, NI) 03/01/01 03/01/09 SCRIPTION OF OPERATIONS I LOCATIONS IV.EHICLESI EXCLUSIONS ADDED BY ENDORSEMENTI SPECIAL PROVISIONS OR'SVIDENCE ONLY :RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN B HOME DEPOT, INC. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT.BUT FAILURE 10 00 SO SHAH IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER ITS AGENTS OR. SS PACES FERRY RD:r N.W. BUILDING C-8 REPRESENTATIVES. AUTHORIZED REPRESENTATIVE LANTA, GA 30339 *07 91,4404klisk USA 0 ACORD CORPORATION 1988 1 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations •; 600 Washington Street ,i Boston,MA 02111 www.mass:gov1d1a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers PIease Print Legibly A DUcant Information r Name(Business/orgmnizadowbdividual): Address: a � • �•�'i.��n�i. �".� Phone.#• �i t'�`Zl�� City/State/Zip: Are as employer?Check the appropriate bor. Type of project(required): Y 4. I am a general contractor and I to er with 6. ❑New construction 1, I am a emp .Y have hired the sub-contractors to ees( 'and/or part time). listed on the-attached sheet 7• Remodeling 2.❑ I am a'sole proprietor or partner- These sub-contractors have g, ❑Demolition ship and halve no employees employees and have workers' g, ❑Building addition working ifor me is any capacity comp.insurance.t' [No workers'comp.insurance 5. ❑ We are a corporation and its 10•❑'Electrical repairs or additions requirrd•] officers have exercised their 11.❑Plumbing repairs or additions 3,❑ I am a homeowner doing all work right of exemption per MGL 12.❑Roo pairs myself[No workers'comp. c.152,§1(4),and we have no insurance required.]t employees.[No workers' 13. then comp.insurance required•] •Any applicant that checks box#1 must also M out the section below showing their workers'compensation Policy information. t.Hemeovuners who submit this affidavit indicating they are doing an work and then hire outside contractors must submit a new affidavit iadiadng such. the nava of the sub-ea mmtors and Ado whether or not those entities have =Contractors that c�this box must attached as additional sheetg .4ogcY number. employee: If the sub-contractors have employem,they must . to er that is provlding workers'compensation utsurance far my employees Below is rte poucy and job sue I am an emp Y lnformattorr: Insurance company Nape. Expirationl)ate�, / Policy#or Self-ins.Lic.#• City/Staftaip Job Site Address: Attach a copy of the workers'comp tion policy declaration page(showing the policy number and expiration date). to secure coverage as required under Section 25A of MGL a 152 can lead to die imposition of criminal penalties of a Failure ear risonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine fine up to$1,500.00 and/or one-y imp Be advised that a copy of this statement may be forwarded to the Office of of up to$250.00 Investi •tions of a day against the violator.the for insurance c vera a verifi my Penalties of perjury that the information provided abov is I do hereby cern and correct . Date• f� Si afore: Phone#• 0ffuial use only. Do not write in cis area,fo be comp to by city or town officiaL Permit/License# City or Town: Issuing Authority(circle one): artment 3.CitylTown Clerk 4.Electrical Inspector S.Plumbing Inspector 1.Board of Sealth 2.Building Dep 6.other Phone M Contact Person: I ;trr:,rd uC tir,ildrn tle2likilinns And 4lsandNrds ConstructionSupervisor License Liceiise: CS 75139 Birthdate: 1113119G8 Expiration: 21131200D It# 957,4 Restriction. 00 KENNETH F NARDONi D c i � 10 GAIL ST CHELMSFORD.IVA 01824 l:C,lrsnris,irine r. r✓ ti e A ' f } r0 r N' d' Ct7 i �7 00 O : L � r0 F: