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HomeMy WebLinkAboutBuilding Permit #410 - 92 FRENCH FARM ROAD 11/15/2010 NORTH BUILDING PERMIT TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Date Received �Q°°R.,Eo r`¢ -4 Permit NO: l �SSACHUS�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION —1 [ Valejn Pnnt :. PROPERTY OWNER.: Print _ MAP 210 _PARCEL-: .K . . ZONING DISTRICT: ..Histofic:District. yes.• no . Machine Shop.Village yes -n TYPE OF IMPROVEMENT PROPOS USE Resid ial Non- Residential [I New Buil ng ne family ❑Addi ' El Two or more family ❑ Industrial El Al ration No, of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other b.Septic p Well. D Floodplain ` Wetlands 0..Waters' ed District. ❑mater/Sewer. . DESCRIPTIONME MOR T BE FORMED: n o� r Z% G� denti cation P ease Type or Print Clearly) OWNER: Name: Phone: Address: 9 CONTRACTOR Name: [.-Address: ori,, 1� , -e� d1 .7 ;— Supervisor's.Construction License: ( Exp: Date:... -� Home Impro'vernent License: Exp. Date:: ARCHITECT/ENGINEER _ Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT. $92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ FEE: $ 36 / J Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the u anty f nd Signature of Agent/OwnerSignature of contra Location 9g Ln e,0,1 No. �v Date L/J�— MaRTM TOWN OF NORTH ANDOVER O 0 w A }�e Certificate of Occupancy $ Nust Building/Frame Permit Fee $ �y Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 3 a'3 1 236Lof Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 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 on site yes no Located at 124 Mairi 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 Motor looceation, mast or service drop requires approval of Electrical Inspector DANGER s No ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use ® Notified for pickup - Date Doc.Building Permit Revised 2010/0ct0ber Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers .Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products INI OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products ®TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Xn all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:$uildingPermitRevised2008 3RTH 0Tvm of 6Andover No. dover, Mass., U• < < O COCHICHEWICK AORATED P' 0::," 5 S V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT � .... .. SAA.. . ...... . .................... Foundation has permission to erect...............:...... ............. buildings on ...gq........ ... ............. ... ................... Rough to be occupied as....... ! ......... ........... ................ ! ......... \ V. ................................ Chimney provided that the person accepting this pe mit 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-taws 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 CONSTRUC OST TS Rough Service BUILDING INSPECTOR 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. _ ani-:►•-,1�3 13—a3 ^.H t7:a:' i •�7_aLio V—e:tG OWN- ENERGY PERFORMANCE RATINGS . • ' ' C11J.L11LLCN OE RE}�It,QE+(jt7 _ . ' U-FactarSolar Heat Gain Coefficient ' . . .�� • ��,,,ocGun+a�+daErxcyia5a�r •' /Q . 32 4 . e ,ADE) ZONAL PERFORMANCE RATINGS ', 111A1,U�GtON SUPLt7fE7(1•J�RIA DC FlE?(OrhRENTO ' YlsibleTransmihwce nom,4 Lu%Vtsbit .• . •• 0 : 52 . • - . .. •�. -.. . . .. - . . - , • . • .• '••��.a�rr,>�a�r:�d std.,�,yr�o�,�r,�,��,��s�.,��.,..��,�rt�r�.��:. fir dwbriyras h 4a rt3>r t�a+rr Mttt*do bra proca**lr� b lF C pn drtin+tttr dnndtrtlrtdo tW bra proddt tct talent tiadot par FERC ion dartr+tvd�a par to asV++b Ido b aatdlbr srblrtAIN Y t i IstrIM de prosily' Asn �o nttattfrttdra nirQn ptostto y ro o�ci aw r pvd<t� atcacb pra un up te�tcfrri t�nu�om - t ati t4ocl�rtY pn d m Wm01m do A#Fii1th»nrvuiraap UnLt cquallfLis for LNERCY STIR cagloa(a) : uortlthrn, North C�AC+xl, •fo�tlt C�Atra1, J...thOYA. 5 K A9 r STAR Li uniGxa niLLilaa p�+x lx 00 r+•TL6n(au J trwaltay•JTAA: worts, .• Norte Cantcxl, 9uc Caetcal, 9,4c.•• IxD: EiaLe, 44/Cl;2a 7/31'/H-RAS•.. TRttkd 3ist: 3C' x 63' � � - � • IUD: Bn:Snacxo 04/Yldrlo 2.3i Xr's/K-Rt3 , 45(-45 TLxu6a pzobado: 91.4 CA x 190 C.W: 14173. H4. Hof Durk T9S112a. • Cap dtia>a6�f for pass$Is EHEt6Y.Swt°mbataz Ta Iprnenn•bd•rut:iuryYstacQo+r• ` . it 4#4?ara'iz16 mmnbiz ENERSY SUV hAl mroix mcs Ma iio;*1 wxiniqMcQK a i. Txe Vr rrn�na�uoeall� a�,/Lfcraeacf ueel�a Office of Consumer Affairs&Business Regulation i OME IMPROVEMENT CONTRACTOR i Registration-'426893 TYpd EttI Supplement:: The Horne Depat ome.Setvices RICHARD FALLdfVE-r 2690 CUMBERLAN ,RARKWAY S X?[JA ` ,GA 30339," `' !' rrn,1ar..,ro-rary S + Ojyke ofInvestigations 644 Washington Street .Boston,MA 02111 r www mass govldia Workers, Compensation Insurance Af i davit: 3Bm"tders/ContractorslE3�-icia�l�6e� A in Workers, Please Print ieiy Name GhtsinesslorzmAzati - — � ' r. Address- �;i#y/StatelZip: �; . Phone#• c Ar�e-,po en emlr°opei'!Checkttie appropriate box: Type of-project(requiredD; 1.ld 1 am a employer >�- 4. El r wn a general contractor and I 6. 0 New construction employees(faanwor,part-time)s f have - •_�]yRtttadThese dung_ _•- 2.O-I asal6 opactEn-or•parmcr:-- =-. ---•sab-conumtomhave 8. 0 Dcmdrdion. ship and have no employees workers'comp.insaranca 9. 0 gm-Ming addition worlang-for mem any capacity= _ (N0 VD&�•comp_insurance y 5_ E] Weare a corporation and its 10-0 Electrical repairs or additions officers ban exercised their , .required.] rightorexcmptionperMGL 110 Pbrmbing-repahs or additions 3:❑ I am a homeowner doing aIl work C.I52,§1(4�and are haveno 12.[] f rcpans " myself[No workers comp.. to em- o workers' insarance ro4aired-]t �P y once icquhvd-] 13. Odrer_ 'Any inot a=Ut=aimonabosnooc ftbaow g,a z r r Homoowaeis abo snbaaR�is a�idavit$x1ic tt�Y air VM&and tWnI&C aotside amemcommnstsabmot anew aif`da�t ouch LCvatraci m mat chock Wsbm most afM&ed m'aa 600at shoat sbowms�e as otme mb-aoahadoes aodIIaea�osioW Damp:PoTx9IDfo oa f mrn aR employer that ispro Waw"WAM,CvffTVnsaiion i rsw =for my employees. Blow is&epoliey sndjob sift informa&M �- Ins nwc a Company Name: LI `3 Policy#or self-ins.Lir.#• ; --"_ Expiration Datc: Job Site Andress: °1 TJ,P�+� ( iry/3tatd7ap: Q -r `- Attach a copy orthe.worlcns'compensation policy declaration Page(showing the policy number and esphufton date). Dov =qua,od under Section 25A ofMGL c:152 can lead-to t'hc imposition of c 6m.n penalties of a . FaRmc to secure CMSe_as _ _ _ _ _ b0'bdt'an�ecrtiauye�r ' ::�:::..:�- -�s `YI�civr�'�� =ro��rbc fo��do�dE1RIC ORi�II�-am�d-afmc-- 6kup to S *&e Office of of up to$250.00 a day against ft-violdw- Be advised that a copyofthis staummi Imresdgjons of&c DIA cx coverage-veriSc lou. I do hereby ccrlif9 under ofpapwy tWthe iinfonn&*x pr*rI&d RboNa h trove and corm phone#: FB:darrd oniy. Do not wrnte in&h arta,to be eoa{�l W bY'd&_ortown o, &*L Z n:hority(circle one): Death.Z Bmlding Department 3.(Stprrown Qerk 4.Electrical Inspector 5.P►annbing Inspector P6nne#_ I ® DAfE(MM/DD/YYYY) ACC?�RO CERTIFICATE OF LIABILITY INSURANCE _ _ 02/19/10 PRODUCER 1-404-995-3000 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Marsh USA, Inc. ONLY AND CONFERS NO RIGHTS UPON T':-1E CERTIFICATE HOLDER. THIS CERT!FICA.'_ DOES NOT A.;VIEND, EXTEND OR homedepot.centre- est ma::sh.com AlL -TE Ti E COVERAGE AF-ORDED3 7,j POLICIES 3'_'_'D'/;h Two Alliance Center, 3550 Lenox Road, Suite 2400 Atlanta, GA 30326 i Fax (212) 943-09.)2NSURERS,-,=F0PDfNG �O`1EP`Gt_._._... iN3URED - 3�,�_ Ins Co _ 253i' ...... The Home Depot, Inc. —-- —--- -----—- Home Depot U.S.A., Inc, iiNSUR7_P3:Zurich A:aerican Ins Co 15535 2455 Paces Ferry Road NW NSURER C:New Hampshire Ins Co23841_ Building GA 3 Atlanta, GA 30339 INSURER D:NATIONAL UNION FIRE INS CO OF PITTS 19445 - - - --- -- ---- " - - INSURERE:Illinois Union Ins Co 27960 COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION T M/ /Y V T M / /YY Y LIMITS A GENERAL LIABILITY GLO4887'714-00 03/01/10 03/01/11 EACH OCCURRENCE $ 4,000,000 i DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 1,0_00,000 - CLAIMS MADE a OCCUR MED EXP(Any one person) $EXCLUDED PERSONAL BADV INJURY - $ 4,000,000 GENE RALAGGREGATE $ 4,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS COMPIOPAGG $ 4,000,000_-____ X__1 POLICY PRO- 7LOC jrrT B AUTOMOBILE LIABILITY - BAP 2938863-07 03/01/10 03/01/11 COMBINED SINGLE LIMIT (Ea accident) $ 1,000,000 X ANY AUTO ALL OWNED AUTOS , BODILY INJURY SCHEDULED AUTOS (Per person) $ —_— HIRED AUTOS BODILY INJURY (Per accident) $ NON-OWNED AUTOS X SELF INSURED AUTO PROPERTY DAMAGE $ PHYSICAL DAMAGE: (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC _$_ AUTO ONLY: AGG $ - A EXCESS I UMBRELLA LIABILITY - GL04887714-00 03/01/10 03/01/11 EACH OCCURRENCE $ 5,000,000___ X OCCUR EICLAIMSMADE AGGREGATE $ 5,000,000-- . $ DEDUCTIBLE $ RETENTION $ $ C WORKERS COMPENSATIONWCO20342355 (AOS) 03/01/10 03/01/11 X WCSTATU 0TH- —_ — AND EMPLOYERS'LIABILITY YIN -- - --- .- '---- D ANY PROPRIETOR/PARTNER/EXECUTIVE WCO20342356 (CA) 03/01/10 03/01/11 E.L.EACH ACCIDENT _ $ 1,000,000 R/ OFFICEMEMBER EXCLUDED? a E (Mandatory in NH) WCO20342357 (FL) 03/01/10 03/01/11 E.L.DISEASE-EA EMPLOYEE $ 1,000,000 — If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 OTHER E TX Employers Excess TNSC46242373 (TX) 03/01/10 03/01/11 Occurrence/SIR 30M/2M D Workers Compensation WC0910566 (QSI) 0.3/01/10 03/01/11 C lWorkers Compensation WCO20342358(XY,M0,NY,WI, ) 03/01/10 1 03/01/11 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION THE HOME DEPOT, INC. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN HOME DEPOT U.S.A., INC. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR 2455 PACES FERRY ROAD NW BUILDING C-20 REPRESENTATIVES. ATLANTA, GA 30339 AUTHORIZEDREPRESENTATIVE USA ACORD 25(2009/01)Jthornton_hd ©1988-2009 ACORD CORPORATION. All rights reserved. 14481889 The ACORD name and logo are registered marks of ACORD Oct 24 10 08:32p Rick Odonnell 6036474457 p. l HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name: Boston Date: 1619_ t0 THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services 345A Greenwood Street,Unit 2,Worcester,MA 01607 Branch Number:31 Toll Free(800)657-5182; Fax(508)756-8823 Federal ID#75-2698460;ME Lic#C 02439;RI Cont.Lic#16427 £ CT Lic#565522;MA Home Improvement Contractor Reg.#126893 Installation Address: // ��'�t/� / G-'^` AZ y City State Zip Purchaser(s): cff S //Y( .� Work Phone: Home Phone: Cell Phone: [ ] [ 1 [ 1 Home Address: - (If different from Installation Address) City State Zip } ✓ E-mail Address(to receive project communications and Home Depot updates): t ❑I DO NOT wish to receive any marketing emails 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), all 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"): Q/7S/t, Job#: lim—e R,*,—tc�, S Sheet(s)#: Project Amount Roofing ❑Siding indows ❑Insulation .2 9 sa 9 i 7;Z0 ❑Gutters I Covers ❑Entry Doors ❑ /6as39 ❑Roofing []Siding ❑Windows ❑Insulation $ ❑Gutters l Covers ❑Entry Doors ❑ Roofing OSiding ❑Windows Insulation $ ❑Gutters/Covers ❑Entry Doors❑ oofing ❑Siding El Windows 0 Insulation $ ❑Gutters/Covers ❑Entry Doom n Minimum 25%Deposit of Contract A'noi'nt due upon execution of this contract' Total Contract Amount Mame Purchaws rimy not deposit more dean onedurd of the ContractAmount Customer agrees that, immediately upon completion of the work for each Product,Customer will execute a Completion Certificate (one for each Product as defined by an individual Spec Sheet)and pay any balance due. As applicable,each Customer under this 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# C/yy 5�f Gl 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 are 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 Horne 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 MAX WITHHOLD AMOUNTS OWED TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WITHOUT LIMITING THE HOME DEPOT'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance 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. Accepted by: Submitted b X /y/aP.10 X Z 2 3-tom C stomer's Signature ' Date Sales Consultant's Signature Date X Telephone No. ZD 3 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 AAn r;_g(; White-Branch File Yellow-Customer