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HomeMy WebLinkAboutBuilding Permit #420-15 - 858 JOHNSON STREET 11/3/2014 BUILDING PERMIT o� t%ORORT b E:, 'a TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: r Date Received �� �b 1 Sys RATEO SPP SACHU`�� Date Issued:1, IMPORTANT: Applicant must complete all items on this page 7 7, y. 'a"77 .` ALO."ATION .J 2>tfn�.SUn1TST r+—* F '1PR'OPERTY p. Yea S�tru Lureeyes anon _`� / I?ARC:E < J ` ZONINGDISTRIb �T : Histone+District "eyesno ' TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑Two or more family ❑ Industrial [Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other O Se<tic , ❑1lVell° _,�❑ Floodplain 1E Wetlands $��❑ °WatershedlDistnct = 0 Water/Sewer¢ ry DESCRIPTION OF WORK TO BE PERFORMED: FiN � 13,�s1✓�n syr us61 0w6 64dlmx t MWFJi-F�i SysrF12f/— Z X Z o P �FIuyG F>�vts k T' '3 Roam 7Z & 645_6 F-r R Identification- Please Type or Print Clearly OWNER: Name: J 4mEg rnJ.uotLy Phone: Ff/4/ Address: o'S Contractor�Name _' Ph_one :7�'� ?715 ��7r n ;. w � — mss" �,-.�� '".—"�. .„� a, '=�z.•�.„s,.,,�a.; � q ^5_:E6�OZ( Address : Su`pervisor's(Constructiori License `$ `-$ o:me�lmprovement.'{License n {` : ExptDate' �H �3Y7 3 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Z I/7Y. FEE: $ Check No.: Receipt No.: G l NOTE: Persons contacting wit unr ister d ontractors do not have access th gu ya fund __ a .e - Sg� natwre of Age Owner:: Signature of contract`r I 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 I 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: FIRE Located 384 Osgood Street ;DEPARTMENT t ,empDumpsteronsite es w 6t-1i 4 r - Y nog 44- F, 44- f Located iNlain�St`reet " F� � � � -� u a, y ;Firer ,_gpartment'signaturet"Ate 2. e t . COMMENTSti -- - - . : 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) i C i ❑ Notified for pickup Call Email 3 j Date _ Time Contact Name Doc.Building Permit Revised 2014 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 a 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 o 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) a ❑ Building Permit Application i ❑ 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 Revised 2014 i Location v T e--- Q"� No. Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check y 28210 Building Inspector Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost $ 2'9,,1'74.;00 m $ - $ 350.09 Plumbing Fee $ 43.76 Gas Fee 100 comm. $ IMAGO I Electrical Fee $ 43.76 Total fees collected $ 537.61 858 Johnson Street 420-15 on 11/3/2014 Finish Basement i NORTH Town of 1Andover o - - No. 4zi o 16 h ver, Mass, flj4 coc..""IWIcu 1• 7,A �J SATED PPP,�'�5 S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT ............ ►.:...... ....... !.!............ . ....................:..................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildin son .. •�.. Rough to be occupied as ..:...... .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 PERMIT LD VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR 3,;b • UNLESS CONSTRU ON RTS Rough Service ....... V ...... .... ............................ 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. CONTRACT TO INSTALL OWENS CORNING BASEMENT WALL FINISHING SYSTEM Jwens Corning Basement Finishing Division(the contractor)hereby submits this proposal to sell and install the Owens Corning Basement Nall finishing System and related items as described herein at the residential premises set forth below.This proposal shall not become a )inding commitment unless and until it has been signed by the Contractor and the Customer. Contractor: Owens Corning Basement Finishing Systems a division of.Road,Canton, M LLC. 60 Shawmut.Road,.Canton,MA 02021 Telephone#(781)821-0060 Facsimile#(781)1821-8552 Federal Tax ID#14-1855297 Mass.Home Improvement Contractor Reg.'#137943 Date 5 �?OIy Customer: Customer Name SA,e% �oron�o��g Street Address SlSSS J O�NctijN 5/ City,State,Zip (/or2�i iTelephone( �/y ) ��7 �g7T��) ��y 707. / 1S ��G? This is a contract between the Contractor and the above named Customer tosell 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 <a 0-C City,State,Zip Scope of Work: 2 dL� Ge^^'+t. ,��s�I>7�e w7" R9 Are Sketches and/or specrftca6onssfpeets attached��eOYe 1 07 N +it", t d t j I hT s t :'All attachments are Incorporated into'le,p andfWCeme art oflhls con{rect I art' rF'r`zp¢ 4,}t y✓�"1� __ `,�;�'�dl w�,����r��;4i`,�t',,�2�t�r'�"fifl''�I",tyl�z� Description of Work/SpeclflcaEAhons w4+o\� dDwe'✓S Cor S atC w. C+tee 5 k.d� 'Al D' 'ta.+ WZ4�'� ��..,�.�c-s/�e r rC'n;s•>,r t'+I' C a rbc+r Vie.cr nse J �c,..�r ci�� �,�1 tiios-t� 'q-- l� r 4� 'iti� 8`14-`; .+.�o.ssa.�r�r�T r 5- Work 7 _WorkSchedyl cuy 4r`r'St a 'e, s is Approximate Commencement ate{ s' � .�` �f P: tr Approximate Completion Date r, {I k ' ° a 3/I//SV70Y5/' -The proposed work schedule is�opproximate andrsubfe t to change r r' " \ a Y a "i{If I Contract Price: �� „ w i�r3,7r� a t n �t"5t} u�k �3 �s ea rp� r AAATotal Contract Price: $� v. 1r2 y�'rl e v i r r-y r ri 3 Deposit with order: $ i W7xS N zff 91/x-7 ars x s a1 X11 p Cashy 4yheck�i �/ZI s s :n clnp^° rrt m h Ns i i'.f §u}3 t•k 1n;.E"is'�'s 3 Irgl.. Balance Due:., _ �'tTt��. ,,, t e' yy Terms: ash f o Finance� (Cash terms ar�/_deposd 50-/,on commenic t"46'".on completwn) ,firIs ,+ 4 r a a fir e i $ yi, -g7 Oue on,Commencement ...w.$.... $ /14 (el 70 Due on Completion DO NOT SIGN THIS CONTRACT UNTIL ALL APPLICABLE BLANKS ARE COMPLETELY FILLED IN'AND,UNTIL YOU FIRST READ AND UNDERSTANDTHE 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 seals)below on this day of st0-f zo/y —� LUX Renova' / ed Representative: fA Sign re and Itle �. Print Name -- DO NOT SIGN THIS CONTRACT IF7HERE.AREANY,BLANK SPACES . Customer***.- "Customer S' une � AN CM I'D NOII IIA .. Print Name 0 __.. _. ... Customer Signature - - - Print Name Contractor may,have certain1len rights indhepremises until the price is paid in full.You have the'rightto cancel this-contract,without any a penalty or obligation,at anytime prior to midnight of the.third.pus ness day after the date you signed this contract.Seethe 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: Connolly,James I 858 Johnson St N Andover,MA 01.845 814-397-0987 904-707-1895 rCONTRACT Customer Name Customer Signature SKETCH Contract Date 2s X14 Sales Representative Signature ATTACHMENT Customer Phone C)9$ Contract Price /74 1 2 3. 4 6 B 7 8 '8=f0=i1=12=13=14-+-15-..i8.e.17--�8 iB 20+21 22-�-23r2--- --2 7;28 28 30 / 32 73 34 36 37 38 39 40 41 42 43 44 46 48 47 49 49 50 91 52 63 54 65 56 67 68 59 60 I 3 --- I i III 7 )74 14 V 4A is _ _ '.;# `-� 18 17 IS jy - - - - — -- 20 a 21 v. 23 LA s ,_... ._. —i..,._.�28 _ 27 29 — --C� �►. �tnl- f — - - — - — 31 32 33 34 36 I _ I ..I.—�_ ...144 _— NOTES: Tach box equals one foot unless otherwise noted.This sketch isa good faith representation of the work to be done,it is understood that all dimensions derived from this sketch are approximate,and that all locations of outlets,light fixtures,plugs,jacks and/or switches are subject to change if necessary. Connolly,James 858 Johnson St N Andover,MA 01845 814-397-0987 904-707-1895 CONTRACT Customer Name (-�NNO��`� Customer Signature SKETCH Contract Date 25 20VE4 Sales Representative Signature ATTACHMENT Customer Phone -114 3q-2 [79$'7 Contract Price 1 2 4 5 8 7 8 —9-10-11-12-13-14-15-16~-17 t-le- 20--21--22-2a-2!I� - t 36 91_3L 39 00 of 42 13 60 l5 46 0 U 49 50 51 52 53 sa ss ss 67 se 59 50 . .. _.71 3 12 'j�e IIII- 6 l t d 13 14 15 'i to �I •�-'� l + a » _1 Ic -- - 20 21 za N l 24 -- - -- -- - - - -29 - 26 Z- 27 � 30 31 32 — T- 34 NOTES• Each box equals one foot unless otherwise noted.This sketch is a good faith representation of the work to be done,it is understood that all dimensions derived from this sketch are approximate,and that all locations of outlets,light fixtures,plugs,jacks and/or switches are subject to change if necessary. The Commonwealth of Massachusetts - Department of Industrigl Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians[Plumbers Applicant Information gb R Please Print Leily Name (Business/Organization/Individual): /,� � ws / /t�( 13Fs Address:_ 6iQ ,i&uT &Pus - City/State/Zip: �/�/A✓ A) Mit 0&,/ Phone#: -7 9/ ?Z/ 0 17 Are you an employer?Check tbee appropriate box: Type of project(required): 1.Ell am a employer with 1 S 4. F1 am a general contractor and I 6. F1 New construction employees(full and/orpart-time).* have Hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. [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. ❑ We are a corporation and its officers have exercised their 10.El Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.F1 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roofrepairs insurance required.]i employees.[No workers' comp.insurance required.] 13.❑Other 'Any applicant that checks box#1 must also fill out the section bel6w showing their workers'compensation policy information. 'Homeowners who submit this affidavit indicating they tie 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 their workers'comp.policy information. X am an employer that isproviding workers'compensation insurance formy employees. Below is the policy and job site information. Insurance Company Name.. r cC �nJS, II � Policy#or Self-ins.Lie.#: NCO t4zg715� Expiration Date: S Job Site Address: O,-,? .T sJ�1 City/State/ZipN./fA)&V�X 4h' 61 eV Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations o IA for insurance coverage verification. I do hereby ert�u er tl in nil penalties ofperjury that the information provided above is true and correct. Si atur Date: S- Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other - - - Contact Person: Phone#: ,�► Rb CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDn'Y" 9/11/2014 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 - Andrew G. Gordon, Inc. NAME: PHONE306 Washington Street AIC N - - FA No: - - Norwell MA 02061 ADDRRESS: info@acrordon.com ODUCER CUSTOMER D 4440 INSURED INSURERS AFFORDING COVERAGE NAIC# Lux Renovations, LLC INSURER A:Peerless Insurance 24198 Owens Corning of New England. INSURER B:Pil rim Insurance 60 Shawmut Road INSURERC:Star Insurance Company 18023 Canton MA 02021 INSURER D: INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER:639296000 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. INSR POUCY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER fMMIDDfYYYY1 (MMIDDNYYY) LIMITS A GENERAL LIABILITY CBP8512851 9/5/2014 9/5/2015 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTff PREMISES. occurrence $100,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $5,000 PERSONALS ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATELIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2,000,000 X POLICY PRO- LOC $ B AUTOMOBILE LIABILITY PGC10007161409 1/17/2014 1/17/2015 COMBINED SINGLE LIMIT $1,000,000 ANY AUTO (Ea accident) X ALL OWNED AUTOS BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ SCHEDULED AUTOS d PROPERTY DAMAGE X HIREDAUTOS (Per accident) $ X NON-OWNED AUTOS $ $ A X UMBRELLALIAB X OCCUR CU811953 9/5/2014 9/5/2015 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS-MADE AGGREGATE $1,000,000 DEDUCTIBLE 10,000 X RETENTION $ $ C WORKERS COMPENSATION WC0428715 5/24/2014 5/24/2015 X WCSTATU- OTH AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E L EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? [7N/A (Mandatory in If under E.L.DISEASE-EA EMPLOYE $1,000,000 yes,descriti'e aund DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000_ DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD.ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WRH THE POLICY PROVISIONS. Lux Renovations, LLC 60 Shawmut Rd Canton MA 02021 AUTHORIZED REPRESENTATIVE d#lr - ©1988-2009 ACORD CORPORATION. Ail rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD } LaMonsumer A airs ilnAusines4se gulat16n 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improven%ent;;-_Contractor Registration — - Registration: 137943 Type: Supplement Card Expiration: 1/29/2015 OWENS CORNING BASEMENT FLN`ISHING_ DANIEL WALSH 60 SHAWMUT RD ................ CANTON, MA 02021 Update Address and return card.Mark reason for change. - Address [] Renewal F] Employment f-1 Lost Card SCA 1 0 20M•05111 Cgze�Gamvr�ra�acaealG/r•o�C�/jlar�acicr�aeGGs Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 3 Office of Consumer Affairs and Business Regulation egistratio :=7379.43:: Type- 10 Park Plaza-Suite 5170 Expiratio r 1729/2015..; Supplement ::ard Boston,MA 02116 OWENS CORN ING�BAS:EMENT=_FINISHING SYS DANIEL WALSH 60 SHAWMUT RD � -7 �- CANTON,MA 02021 Undersecretary Not valid without signature 'f low Massachusetts -Department of Public Safety Board of Building Regulations acid Standards Construction Supen°isor ,, It License: CS-079893 DANIEL F WALSH - 488 KENDALL RD TEWKSBURY WA 0����` Expiration Commissioner 10105/2015