The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #406-2016 - 92 FRENCH FARM ROAD 9/30/2015 f NORTH � ' t�a�BUILDING PERMIT3`�O�? 6'0'��G TOWN OF NORTH ANDOVER ° ; APPLICATION FOR PLAN EXAMINATION Permit NO: !J" Date Received y 1 Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION ) �Ct `irN1 Arin PROPERTY OWNER Lit, ,17 Print MAP NO: V 1� PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Villa a yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building Rodne family ❑Addition ❑Two or more family ❑ Industrial ❑Al!pration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition I ❑ Other Septic �--, Well U, Floodplain -J Wetlands Watershed District J Water/Sewer PN film# tbln&r, %--v ", , Kze';+ze-Lat IdentificationP�Plea�seType or Print Clearly) OWNER: Name: ��tl/ c �eL Phone:M 497 3 Address: CONTRACTOR Name: Phone: 141>1r� Address: Oh PJ l�[ Supervisor's Construction License: � Exp. Date:—tlj,'b Home Improvement License: Exp. Date: �i ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ q4 Check No.: 1 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access IaWguarmy f nd Signature of Agent/Owner Signature of contrac r � - 1 BUILDING PERMIT u�No°T b TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received . sAc►+us�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition [I Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition _ [I Other LI Septic t]Well [I Floodplain ElWetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: ' Contractor Name: 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$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with,unregistered contractors do not have access tothe guaranty fund Signature of Agent/Owner Signature of contractor Location No. �-r�7 Dat =y1two �w tv • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee ;A Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# (2 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody Art ❑ Swming 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& Date Driveway Permit DPW Town Engineer: Signature: Located 3.84 Osgood Street [FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department 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 Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 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 ❑ 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 a Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract a 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) ❑ Building Permit Application ❑ Certified Proposed Plot Plan o 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 t%ORTH Town of t EAndover 0 52" *3 2 y C, h ver, Mass, (' T O LAKE %MOP, A- COC NIC Nl WI[/t � 7,e ADR�t7ED hPa��S S V BOARD OF HEALTH Food/Kitchen PERM- IT T LD Septic System THIS CERTIFIES THAT L��r� .....Ski. ..' #4.......................................... BUILDING INSPECTOR ... Foundation has permission to erect ........ QW ldings on ... . . ... .. T .... • j Rough . C)rwl to be occupied as ............... .�...... ............................................................................ 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 UNLESS CONSTRUCTIO S RT Rough Service .................... ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. Sep 15 15 10:34p Rick Odonnell 6033780151 p. l HOME IMPROVEMENT CONTRACT PLEASE READ THIS e� Sold,Furnished and Installed by: Branch Name:Boston North&South Date: THD At-Home Services.Inc. d/b/a The Home Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal ID#75-2698460;ME Lic#C 02439;RI Cont.Lic#16427 q q / CT Uc##HIC.0565522;MA Home Home Improvement Contractor Reg.#126893 Installation Address: 1 / Fr�iit/E r►Z /l d /f/• Tt�"�QG �! /7g Clper City State Zip Purchaser(s): Work Phone: Home Phone: Cell Phone: �0-t/14_ Sty / [ ] [97f] 6:i-7-regi 31.2 [ l t l [ l Home Address: (If different from Installation Address) City State Zip E-mail Address(to receive project communications and Home Depot updates): ❑I DO NOT wish to receive any marketing entails from The Home Depot Proiect Information: Undersigned("Customer"),the owners of the property located at the above installation address,agrees to buy. and THD At-Home Services,Inc.("The Home Depot")agrees to furnish.deliver and arrange for the installation("Installation")of all materials described on the below and on the referenced Spec Sheet(s), ail of which are incorporated into this Contract by this reference,along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively. "Contract"): /S�Xv 014P Job#: (InWmW Re—n) products: S Sheet(s)#: Project Amount Roofing Siding Windows Insulation ❑Gutters/Covers []Entry Doors ❑ $ �SD Roofing Siding Windows Insulation $ O 7 [3Gutters/Covers ❑Entry Doors ❑ Rooting Siding L3 Windows Ll Insulation ❑Gutters/Covers ❑Entry Doors❑ $ Rooting Siding LJ Windows Insulation ❑Gutten/Covers ❑Envy Doors E] $ Witimum 25%Deposit of Contract Amount due upon execution of this contract. Total Contract Amount $ $�� Maine Purchasers may not deposit more than one-third of the Contract Amount.Customer agrees that,immediately upon completion of the work for each Product,Customer will execute a Completion Certificate(one Por each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable, each Customer under this CA Contract agrees to be jointly and severally obligated and liable hereunder. The Home Depot reserves the right to issue a Change Order or terminate this Contract or any individual Product(s)included herein,at its discretion,if The Home Depot or its authorized service provider determines that it cannot perform its obligations due to a structural problem with the home,environmental hazards such as mold,asbestos or lead paint,other safety concerns,pricing errors or because work required to complete the job was not included in the Contract. Payment Summary, The Payment Summary# //V y 8'6/ included as part of this Contract, sets forth the total Contract amount and payments required for the deposits and final payments by Product(as applicable). NOTICE TO CUSTOMER You arc entitled to a completely filled-in copy of the Contract at the time you sign. Do not sign a Completion Certificate(note: there is one Completion Certificate for each listed Product as defined by individual Spec Sheets)before work on that Product is complete. In the event of termination of this Contract,Customer agrees to pay The Home Depot the costs of materials,labor,expenses 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 applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LLMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acce t mce and Authorization: Customer agrees and understands that this Agreement is the entire agreement between Customer and The Home Depot with regard to the Products and Installation services and supersedes all prior discussions and agreements,either oral or written,relating to said Products and Installation.This Agreement cannot be assigned or amended except by a writing signed by Customer and The Home Depot.Customer acknowledges and agrees that Customer has read,understands,voluntarily accepts the terms of and has received a copy of this Agreement. Acce //� Submitted b X �- usto er's Signature Date Sales Consultant's Signature Date X Telephone No. Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS (as applicable) AGREEMENT WITHOUT PENALTY OR OBLIGATION BY DELIVERING WRITTEN NOTICE TO THE HOME DEPOT BY MIDNIGHT ON THE THIRD BUSINESS DAY AFTER SIGNING THIS 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 STATED ON THE REVERSE SIDE AND ARE PART OF THIS CONTRACT 03-17.15 White—Branch File Yellow—Customer The Commonwealth of Massaciu e s _ Department of Industrial Accidents Office of Invesdgations I Congress Strreet, Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers,Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Please Print Legibly Name (Business/Organization/Individual): Address: City/State/Zip: fl cl Phone#: Are an employer?Check the appropriate box: 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.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. Demolition working for me in any capacity. employees and have workers' 9 Building addition [No workers' comp.insurance comp.insuraneeJ required.] 5..❑ We a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11:❑Plumbing repairs or additions myself. [No workers' comp. right of exemption-per MGL - I2.[T of repairs urane�eq • c. 152;§1(4),and we have no employees. tNo workers comp.insurance required.] _A *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit.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 employees,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 andjob site information. oo Insurance Company Name: Policy#or Self-ins.Lie..#: Expiration Date: Job Site Address: City/State/Zip: 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/or one-year imprisonment,as well as civil penalties in the fortis 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 of the DIA for.insurance coverage verification. I do hereby per ify un er he ai and penalties of perjury that the information provided abov is true and correct Signature: Date: 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 b.Other ' Contact Person: Phone#: CERTIFICATE OF L �] 1J'��„� +� INSURANCE i7� l��E j DA7E;MHvcirrf!Y,zi � THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HO DOER THIS l CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES I I BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE-VIVEEN THE ISSUING i REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER INSURER(S), AUTHORIZED I IMPORTANT: if the certificate holder is an AIIDITI'll MAL INSURED,the policypes) 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 , MARSH USA,INC. CONTACT TWO ALLIANCE CENTER NAME 3560 LENOX ROAD,SUITE 2400 PHONE FAx ATLANTA GA 30326 E MAa Alc No ADDRESS: 100492-HomeD-GAW'-15-16 INSURERS AFFORDING COVERAGE NAIC R INSURED INSURER A:Steadfast Insurance Company 26387 THD AT-HOME SERVICES,INC. INSURER B:Zurich American Insurance Co DBA THE HOME DEPOT AT-HOME SERVICES 16535 2680 CUMBERLAND PARKWAY.SUITE 300 INSURER C:New Hampshire Ins Co 23841 ATLANTA,GA 30339 INSURER D:Illinois National Insurance Company 23817 INSURER E: COVERAGES CERTIFICATE NUMBER: ATLINSURER F. THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEENISSUEDTHE INSUREDEVISION 1VAb1 D NUMBFEOR THEISHE PERIOD INDICATED. 410TWITFISTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECTH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ATEft1HIS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR I TYPE OF INSURANCE q POLICY NUMBER POLICY EFF POLICY EXP A X COMMERCIAL GENERAL LIABILITY GLQ4�7714�5 MM10D MMIOD LIMITS i 03/01/2015 03/01/2016 BCH OCCURRENCE S ! CL41MS-MADE a OCCUR 9,000,000 LIMITS OF POUCY XS PREMISES(Ea ocai encel S 1,000,000 OF SIR:STM PER OCC MED EXP(An one person) s EXCLUDED GEN'L AGGREGATE LIMIT APPLIES PER: PERSONAL 8 ADV INJURY 5 9,000,000 XPOOLICY !zCT r-1 LOC GENERAL AGGREGATE S 9,000,000 I OTHER: PRODUCTS-COMPIOPAGG S 9,000,000 9 AUTOMOBILE LIABILITY IBAP 293886312 S X 03/01/2015 03/0112016 COMBINED SINGLE LIMIT ANY AUTO Ea ccident S 1,0(10,000 ALL OWNED —1 SCHEDULED BODILY INJURY(Per person) 5 - AUTOS AUTOS SELF INSURED AUTO PHY DMG HIRED AUTOS NOR-OWNED BODILY INJURY-'c"N axident),S ,AUTOS PROPERTY DAMAGE-- Pe acridem S UMBRELLA UAB ' I OCCUR S EXCESS UAH CLAIMS-MADE EACH OCCURRENCE $r DED RETENTIONS AGGREGATE S C WORKERS COMPENSATION wco11731493 S C AN EMPLOYERS'LIABILITY (ADS) 03/01/2015 0310112 16 X PER OTH- ANY PROPRIETOR/PARTNER/EXECUTNE Y/N =: WC017731495(AK,KY,NH,NJ, STATUTE ER D OFFICER/MEMBER EXCLUDED? a NIA V)) 03/0112015 03/01/2016 (Mandatory In NH) WCA17731494(FL) 03!01!2015 03/01/2016 E.L.EACH ACCIDENT S 1,000 000 If yes,RIPTIOe under E.L.DISEASE-EA EMPLOYE $ 1,000,000 DESCRIPTION OF OPERATIONS below Conitrroed OD Additional Page E.L. PER LIMIT S IE7 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,gddlUonal Remarks Schedule,may be attached N more space!s required) EVIDENCE OF INSURANCE t• CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. DBA THE HOME DEPOT AT-HOME SERVICES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 2455 PACES FERRY ROAD THE EXPIRATION DATE THEREOF, NOTICE WILL ATLANTA,GA 30339 ACCORDANCE WITH THE POLICY PROVISIONS. BE DELIVERED IN AUTHORIZED REPRESENTATIVE Of Marsh USA Inc. Manashi Mukherjee .MA�n Doti: ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD ORD CORPORATION. Ali rights reserved. s =��tr'f� � .7�s1,^1 .i. s-�i-3 r'•�^..":�i:. ;��'� •n y '•.��.i�.tT,.;.•:1.7„ + •j-;� :,+.yl';~ ' _ ,�',I'lx=ice-''i f :r;i?F�r'�,1'�_,":•..'r L!e- :j.T ✓.-5/ a :a ,:i '•-I;�"/•;::-�L-..'_ • - ,� ,�j��Jyi3i Heid THD 1 , lM . SUITE 3DO ATOdel"]13 I y'�daT"i RI ?a: •� ,• '.•_---�-- Updfltz Addrwws gad Til ter& r�sao�ftr cita�g�. = Addr . r :�I ipiav LJ dos?C�,d �: ��"i%r•.�.y�u�+merrl{�r�^�(r•:tir�:�hrr.;+v1- 1 - ' nstnsNi Fwgu32602 x,12 rr 4 son i�a3i is i�Id1s�rash ok]� b9ore the ANA te. a MOM r P of orC +lis"er tai*$a 17w k?i'7m �� . _ ��ff��11?1Matflcn: 4� � .. i��: tl�lui�C�l' -,�°si��°f� •' - ' upplomant•Cw -'THD A;[ Nt Em"C S 1]d - 'SQ.FlPJIGI-D C$0 GLiMBEFiLA1VL1 PARI4 kAY S . — A'�[ + �GA9033A i,n�ersaueti;vjr : .. tva• w �a • �° CSSL-099823 D7MTRY BROVEq 70 NORTON AVE' Manchester NH 0109 0612612016