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HomeMy WebLinkAboutBuilding Permit #309-14 - 81 LISA LANE 10/2/2013 TOWN OF NORTH ANDOVER ^ APPLICATION FOR PLAN EXAMINATION vl Permit NO: O� - �� Date Received Date Issued--- IMPORTANT: ssued: I PORTANT:Applicant must complete all items on this page I IPR�OCA�TIONF �� LISGt Lcfn°� ®PERTY;OWNER �ToG�n Go�la� _ = r .; ,Print ' '. X100 Year'®Itl St�'ru�tucre .,Y - no ��.•`_}� 1111AN® __o.�,PARCr � .,Z®NING ®ISTRIC � Histo �c D strict yes Machine,ShoV�llage� yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential I ❑ New Building One family El Addition El Two or more family [I Industrial ❑A teration No. of units: ❑ Commercial - epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑fSeptic Well ���Flp� ®Wetl nd 4 ®I Wate fieri®istrict r Y 11Nater . DESCRIPTION OF WORK TO BE PERFORMED: Jit Sir` oneyr`n f ✓ f a c2�y,z4 f bo v✓ w� do -- A/,, s �G7V„d ( c- ►,o y U Identification Please Type or Print Clearly) OWNER: Name: J`vl^� C 61a” Phone: 978�68�—s�77 Address: co A-& �r2 ,�►va(,c%� _ 6__. �I �- -. _ .Ad`des_sz,.. "i —,71-7-7 I g'7Ex �IDate -SL = Su Qenr�iso jConstr�uc�ionLicense� / l� __ - p a Hom Imp �� nLicense _.� __ ��r__ f r dE�xp Date ��j / __J ARCHITECT/ENGINEER Phone: Re No. Address: g FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ $-3/3--- FEE: $ �� Check No.: Receipt No.: p NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund .�,� � Signaturee of Agent/Owner ._ .e :.`: t ' �ignaturf0ffcontracfor, Plans Submitted ❑ Plans WaI4 ❑ Certified Plot Plan ❑ Stamped 6/ans ❑ 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products (VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If,Applicable) " Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New C i and Two Family)* N Construction (Single a w y) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products VOTE: 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 submAted with the building application Doc: Doc.Building Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ElSwimming 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 Siqnature COMMENTS HEALTH Reviewed on Signature i COMMENTS -s 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 f DPW Boum]Engineer: Signature: Located 384 Os d Street FIRE DEPARTM_NT =Temp Dumpster onsite yeas no Located at'124{Mair Street t' Fire Department signatureldate 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, roast 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 i NOTES and DATA— For department use f I I I� I B Notified for pickup - Date l Doc.Building Permit Revised 2010 Location i No. ! U r` 1 Date �1Z y. o - TOWN OF NORTH ANDOVER ,r Certificate of Occupancy $ �\ Building/Frame Permit Fee $ Foundation Permittee $ Af ^� Other Permit Fee $ TOTAL $ Check#A 26943 Building Inspector i NORTH Town of s : I., Andover 0Z LT. q h , ver, Mass, Z � COC NICHT WICK S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT Coack r* BUILDING INSPECTOR ............... �, ...................... ............. .......................................... . ..... ..... ............ buildin s on , ��� �* Foundation has permission to erect .............. .... .. ......... ............. ........................................... - Rough i to be occupied as ......7R414... bo W............ ....V1.N: . ... ....� ....w.......................... Chimney provided that the person accepting this permit shall in every respect conform to the terms 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 aft UNLESS CONSTRUCT S RT Rough Service ............... ................................................................ Final BUILDING INSPECTOR 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. SEE REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial,Accidents Office of Investigations 604 Washington Street Boston,MA 02111 www.massgovldia Workers' Compensadoin Insurance affidavit: Builders/Contractors/Electrieians/Plumbers Applicant Information Please Print Lem Name(8„sinue rOrgmu�tionlInalvldual): �t�l Et2 C!G+�I i�'1 C 1� �lIV4 RD V19 � •;� r� Address: MI/ ✓tf}PjL2T f/tl• J � gilt) . City/Sta1e1zip: Phone#: S It'`e7q-'.-t,'t U A da.n employer?Check the appropriate boi: Type of project(required): 1.( 1 am a employer with , 4. 0 1 am a general contractor and 1 6. []New construction employees(full and/or part-time).' have hired the sub-contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet.2 ?• C]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑ Building addition [No workers'comp.insurance 5. 0 We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.0 I am a homeowner doing all work right of exemption per MGL 1 i.[]Plum,Bing repairs or additions myself.[No workers'comp. c.152,11(4),and we have iso 12 Q Roof repaL/A/ insurance required.]t employees.[No workers' Bather0� comp,insurance required,] •Any applicant that checks box a!mast also fill out the section below showing their workers'tau policy luf nation. t Hotneowners who submit this affidavit indicating they axe doing all work and then him outside coausewn;artist submit a new at$davh Indicating ands. lContmctoca that check this box must attached an additional died showing the name of the sub-coutracwts and their workers'cvosp.policy'mformation. f ant an employer that>s providing workers'compensation Insurance for my employees. Belorw is the policy and Job site informadon. Insurance Company Name- Policy �� ySif!LL(: t.1/c,�2e:£ Trn15 GO -1--- p Policy#or Self-ink.Lic.#- -•O, 0'0y®e d V-/e�7p 6 Expiration Dare: Job Site Addrm 431 I-ts-ot L-Ane City/State/Zip. Nor-hn A-,oloa,,04A4A all?tf5 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/o*on=e- tar� p isonrtaeat,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a ytrxBe advised dw a copy of this statement may be forwarded to the Office of Investigations o the D coverage verification. I do hereby c un p and penalties of perjury drat the informadon provided above Ls trace and correct lyre W30 /3 Phonc OJJ<cki use only. Do not write in this area,to be conipleted by city or toren offl-ciaL City or Town: PermitMeense it Issuing Authority(circle one): L Board of Health 2.Building Department 3.City own Cleric 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone€f: POWER-1 OP ID:AW �..- CERTIFICATE OF LIABILITY INSURANCE tMMFDDIYYM 09/11/133 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(les)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 215-723.4378 CONTACT Lacher S Associates Ins Agency Lacher Insurance Group 215-723-8604 McN o Ext• A"fc No): 632 E Broad St P 0 Box 64398 ADDRESS: ILO Souderton,PA 18964 Chad Lacher INSURERS AFFORDING COVERAGE MAIC d INSURER A:Harleysville Worcester Ins Co 26182 INSURED Power Home Remodeling Group, LLC. INSURERB:.Harle sville Preferred Ins.Co 35696 Power Home Remodeling Group, +INSURER C:Nationwide Mutual Ins Company 23787 Inc. INSURER D: .2501 Seaport Drive Ste B110 Chester,PA 19013 -INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. ILS R TYPE OFINSURANCE DD POLICY NUMBER POLICY EFF OPMIOD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 B X COMMERCIAL GENERAL LIABILITY MPA00000089793N-1 10/01113 10/01114 °RENTED _EREMISE Eaoccurranee $ 100,000 CLAIMS-MADE �OCCUR MED EXP An one arson $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2,000,00 GEN'L AflGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG 3 2,000,00 POLICY X PlFrT El RO LOC $ AUTOMOS14E LIABILITY COMBINED ISINGLE LIMIT(FaaccIden1,000 00 A X ANY AUTO BA00000089796N 10/01/13 10/01/14 BODILY INJURY(Per person) $ r ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS AUTOS PROPER DAMAGE $ Pa! cdc $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 10,000,000 C X EXCESS LIAB CLAIMS-MADECMBOOOO0030794N 10101113 10/01/14 AGGREGATE $ 10,000,OD0 DED RETENTION$ $ WORKERS COMPENSATION WC STATU- 0TH- AND EMPLOYERS'LIABILITY X A ANY PROPRIETORIPARTNER/EXECUTIVE YIN WCOODOOO89796 10/01113 10/01/14 E.L.EACH ACCIDENT $ 1,000 OFFICERIMEMBER EXCLUDED? © NIA ,DOD (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,00( If yes,describe under R DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 A Mass Auto Policy BAOOO00018227P 10/01/13 10/01/14 L,labflity 1,000,000 A NY Auto Policy BAOD000074649R 10/01/13 10/01/14 Limit DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remerke Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION NANDOVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 1600 Osgood St AUTHORIZED REPRESENTATIVE North Andover,MA 01645 �yA�E/ /�14V� . ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26(2010106) The ACORD name and logo are registered marks of ACORD• 4nd Ofllce of Consumer Affairs .Bu 'Bus" Regulation g tion f 10 Park Plaza - Suite 5170 Boston, Massachusetts 021 1 G '-Horne Improvement Contractor- Registration Registration: 168616 POWER HOME REMODELING GROUP LLC Type: Supplement Card Expiration: 3/18/2015 ALLAN COLPITTS 2501 SEAPORT DRIVE STE B110 CHESTER, PA 19013 SCA a Aipdate Address and return card.n9ark reason for change. znta-os s .Address Renewal Employment Lost Card frce of Consumer Affairs 8usines Regulation License or registration vatid for indiv dul use only K - flME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: r1' t 2egistration: 168616 Office of Consumer Affairs and Business Regulation r Expiration: Type' 10 Park plaza-Suite 5170 P 3!18/2015 POWER HOME REMODELING GROUP LLC. Supplement t.ardBoston,MA 02116 ALLAN) COLPITTS 2501 SEAPORT DRIVE STE 6110 CHESTER.PA 19013 Undcrsccretxr` \'ot valid ii 1 ut signature AM ! ass<achuse"s -Depar`ment of Public Suety Board of Building Regulations and Standards t �,n,irLlknon 4upvr%s.-,r License. CS-001979 f� ALLAN K COLPI71S r 3 CHRISTIAN DR It NASHUA KH 03063 ' 05107/2014 about:blank ?4411 S;aport t.me Ca;"ter pyti t4013 John arid Jane Cadaran 3(3-8+1J06 Ctl�r 1C}M REM�}1 EL1 G A111}1MC Ri U MENT AGREEMENT WAIgic;;,tMift JohCaefarelfe stntam,nllan f'ria�eGt Number; f1-84506 August 29,2013 � Johtl�q:athr�,a2m�a t Jame Caderette i (976)68M 6-5 91 Wa Ln ,tBoc h Antimer,Mk.111:3 Colinty:Essex Township': t _ Buyer(s)listed above hereby jointly and severally agrees to purchase the goods alnd/or services of Power Horne Remodeling Group("Contractor")in accordance with the prices and arms described on the front and the following four Mas of this agreement and gny spec#ication sheets,WP icit are incorporated as part of the Agreement(collectively,this "Agreement").This Agreement represents a cash sale of.goods and services.Buyers)agneas to pay the:cost of the goods and service's purchases a's.desceibed herein,regardless of Hitting orapproval ref-any financing B vers)may soak for their purchase:Problems and inquiries regardirrg'ftiis Agreement should bre directs o4*o-0wdractar 4 S 6335, Purchase Price: S�S,3i2.¢2 1 Pre installation Inspection Data: Down Payment. t - tL6f1 Our Prz w1 tmnm an t r=° tl�bchrs i+SOis an 3 °p Balance Dale og5,3i .62= . lrstiinad Pro)tt Start:S tit 7 Ova Substantial Completion, t Est d e Proles p. p e�2 days Methcd'of Paymenh 1 (Che*: 00111* )cam,,101ku dais Is not 61 fh"essw]DiL Rulu},%Wyo t nntrsaksft cadtrot nni tn,tijdb J in `� �y4 +;aifcr},:;ivip.Unrs.frottt�z.EweC},�aylUnkr,pwi,Co;idrliiwrrun!'e'm�5a. ... II Buyers)horoby acknowledges recelpi of a copy of the pamphiat,"The lead-Safe Certified Guide to Renovate Flight" I informing Buyers)of the potential risk of lead hazard exposure from renovation activity to be performed in Buyer's home, of fie g ss tan sleeve:Buyers}received this parnphtet on:Ehe date of this Agreement before commencement of work, - (Buyer's initials). Itis c# understood by,and between the parties that,this Agreement constitutes the entire understanding between the partles,and there are no verbal understandings changing or modifying any of the terms of,thisAgreement.Buyer(s) hereby acknowledges that 13uyer(s)1)has read the entire Agrem. Ent and has received a complated,sighed,and dated copy of thts Agreement,including.the two accompanying Notice of Cancellation forms,on the date first written above and 2}was orally informed of histher right to cancel Oils transaction.OO NOT SIGN THIS AGREEMENT IP THERE ARE ANY BLANK SPACES. Future promotidns''not applicable. I have read and received each page of this fi page agreement. Parer tntne Remodeling Group Buyer(a) Buyers) '� u�,,,,,,,,_;tDB/29178 9/i3 � !I?t3728i`13 ur er»odeling Corisu nt Signature A95Q Alexander Sayre John Cadarette. Jane Cadarette YOU.THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANYTIME PRIOR TO MIDNIGHT-OF THE THIRD BusINESs DAY AFTER THE OATt:OF'THIS TRANSACTION. SEETHE NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. August 29,201.3 15,,52, Page i of S 1 of 1 9/13/2013 2:02 PM NATIONAL HEADQUARTERS John and Jane Cadarette 2SOI Seaport Drive,Chester, PA 19013CaWER 30-84506 Home A-defl y Gmup-.' $$B-REMODEL August 29, 2013 MA HIC#168616 Project Specifications Windows: Living Room 1 124.5"x56.75" Tao Vt#W — WINDOWS: Models SL 2700 Styles Bow Types 5-Lite Contigs Even Lite Casements OPTIONS: Color White/White: Grid Pattern: All Lites: Colonial: Contour I Removal Egg Crate Additional Details None j August 29, 2013 15:52 1' Ell 4 gnomon"- I �Cient VI51b�'� tr�it�i�p, ...� iirOtlQ@fl�t4{i1�Ri: iilCit:� # i �.n3""`S`l �R •;,. ,"a .3^ a. .�,,. -��"'Rd=ri: �.�,.C�3 7,�", wwl4�.,`�.�1, :- � 4 .��' Ty74( R I �,,, ��*..�.. wEW yuw 91 «x Mr,r`.I'� x P f + a a 7 #c N/� -d•hv's�w''�"'�F� � � Y I YaY 4 4 M y VIM tit r 6•.� .$IWf���f�'"�7" a-. ..4e �d�� �i4r'^f' yr'�"L6�t � '7�! MIW.