HomeMy WebLinkAboutBuilding Permit #475-14 - 94 PETERS STREET 12/3/2013TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
TYPE OF IMPROVEMENT
PROPOSED USE
Reside I
Non- Residential
❑ New Building
ne family
r_
❑ Addition
❑ Two or more family
❑ Industrial
❑ AI tion
No. of units:
❑ Commercial
epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
x
Address'.�� _
❑Septier Dwell �.h�
i �FloodplamrWetlari s
0 iVllatersletlFDistnct$. a
❑�V11ater/Sewers-. �., � � �:�
� � _ � ..� � _ � ,.._ ��
_ zF.�_�g' �-
DESCRIPTION OF
OWNER: Name:
TO BE PERFORMED:
or Print Clearly)
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: $ r �_
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have acceft� the gamy fund
!9natuof►A`gent/:Owner'L"�T�/ Y`__ _ Sig��atureot'cont_r.c�,
Plans Submitted L� Plans Waived ❑ Certified Plot Plan ❑ tamped w �y Plans ❑
r_
'
�CONTRAC�T®R
x
Address'.�� _
.v
B �Y IJ [/ !
76h ti License 't
�'-Expo sD-_�4q
,Supervisor's _
r
a
y
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: $ r �_
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have acceft� the gamy fund
!9natuof►A`gent/:Owner'L"�T�/ Y`__ _ Sig��atureot'cont_r.c�,
Plans Submitted L� Plans Waived ❑ Certified Plot Plan ❑ tamped w �y Plans ❑
Plans Submitted❑ Plans Waived❑ Certified Plot Plan ❑ Stamped Plans ❑
-: T-YPE'_OF°:.SEW-ERAGE:DISPO.SAL'
Public Sewer ❑
Tanning/MassageBody Art ❑ ..
Swimming Pools ❑
Well ❑..
Tobacco.Sales ❑
Food Packaging/Sales 11
Private (septic tank, etc._ ❑
Permanent Dumpster on Site ❑
THE. FOLLOWING SECTIONS FOR -OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
- DATE REJECTED -
- ❑
DATE:APPROVED
El
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Commen
Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Tow;: Engineer: Signature:
Located 384 Osgood Street
'FIREDEPARTOIr NT -Temp Dumpster on site .yes no
Located at -124 Mair, Strdet
Fire Departure►)t`signature/date
C011fIM.ENTS
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
D Notified for pickup - Date
Doc.Building Permit Revised 2010
Building Department
- ~The fol'owing is -=a -list of the required_forms to be filled out for the appropriate. permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
o Building Permit Application
❑ Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L.Licenses
❑ Copy of Contract
o Floor Plan Or Proposed Interior Work
o 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
o Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
L3 Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
a 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)
o Copy of Contract
Li 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 cask if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apw-al 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
Location 14�
No. Date
• - TOWN OF NORTH ANDOVER
•
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee $
Other Permit Feeelf
TOTAL $
Check #
190,12
27152 Building Inspector
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92/11 -61111.1111 2CUP68l.11b O
Office of ConsutiaerAffairs Business Regulation License or registration valid for individai� use only
-1 t IOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to:
Office of Consumer Affairs and Business Regulation
Registration �2F,gg3 T e
�= YP 10 Park Plaza - Suite 5170
Expiration g/3/2014 Supplement yard Boston, MA 02116
'The Home Depot At 9arne eruicbs
RICHARD
2690 CUMBERLAND PARKWAY S
A'frAN, GA 30339 Undersecretary Iot valid 4ithout signature
s
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TS � TAI a. `'' " t d *,� i"� O '`O1 R
—HIS CE )1 CA,TE IS ISSUED AS A MATTEIR 'CF 11INFORINIAT ON 0141 y �a°l� �V°1F� � Neo �
IIFi't;1T DOES NOT 'r' i �;9s�Tj'pt`I� CR ,ECAT1�1Pl.Y AM.
t� �jEND OR roti I R Ts Gil t � L ixlt E ' i
EL I'; , 7§3i CERTIFICATE (3F 113!i +10E DOES NOT CONSTITUME A COiNTR 1''"5 �<T drs''. ,.HE issu°:fix..;. I;ISiII•,ER,ale iaLJTi'i'a +? t
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�Z ~3E_N IATiVE OR FiRODUCate AND TIME CERT Fli* ICATB HO EI ; 3 `TM I t.
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tU e is 3i s. laid t;0„dd;ior, � 0� 1 � q (3CI1C�r CS^,'38En policies „,aa� i ;:gt;1i B use � 3?�iC:.� .i7 z i�E ri x
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fy p'10 y IS P7, 1.
i . ZSH USA INC PHONE
t•YVOAUJANCECENTER
3 ID LENOX ROAD, SUITE 2400 ADITR
ATLANTA, GA 3032661NNJREI
26387
100492-HoineD-GAIAI-13-14
;Pd_V1jRED _ —
THE HOME DEPOT, INC.
HOME DEPOT U.S.A., INC.
2455 PACES FERRY ROAD, NW
BUILDING C-20
ATLANTA GA 30339
A: Sioadiast Insurance Go"IP llj
B : Zudch A: lerican MSurance Co
C: NewHampshife ins Ce _-- ---- j23841
D : IIIirois National Ins Go -- 23817
INSURER F'
'OVERAGES CERTOFIivATE NUMBER
. ATL.003159545.04
E;ET1I5iON �IUi>ti0ER.7
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOVV 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 TI. WHlCI-1 THIS
CERTIFICATE MAY BE ISSUED OR MRY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AL1- THE TERMS,
EXCLUSIONS AND CONDITINS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
O--
1�OLICYEFF POLICYEXP{ LIMITS _
ISR TYPE OFlNSURANGE DD 5 B PgLiCYNUMpirR _— I`fA8Wi1DtYYYYYmj! MMIDDrYYYY I 1� 4000,1
A .i GENERAL LIABILITY �i (E048877'1403 !03!01!2013 (0310112014 ACHoccURRENCE _ __)
pAMA E TO RENTED ^rgti Is 1,000,1
MERC1ALGENERAL LIABILITY -- _ LAGLUUru
CLAIMS-PAADE 0 OCCUR LIMITS OF POLICY XS MED EAP {Any one person) S
u9,000,Q00
OF SIR: $1M PER OCC , PERSONAL ADV INJURY S 9,000,000
t GENERAL AGGREGATE S
I e 9,000,00G
LIMIT APPLIES PER:
B I AUTOMOBILE LIABILITY
ANY AUTO
AUTOS IED H AUTOS LED SELF INSURED AUTO PHY DMG
NON -OWNED
HIRED AUTOS AUTOS
UMBRELLA ILIA
EXCESS AS 8 H OCAIMS-MADEI I I '
S
013 10310112014 CC'M IVED SINGLE LIMIT s J 1,000,000
Ea ace dent
BODILY INJURY (Per person) 5
BODILY INJURY (Per accident) S
PROPERTY DAMAGE S
Per accident
S
EACH OCC __ 5
(s WORKUPS COMPEN5KHOIV
AND EMI"LOYERS' LIABILITYYIN VVC,033575315 (AIC, AZ) 0310112013 03!01!2014
U ANY PROPRIETORIPARTNERJEXECU"flVE
D ` O FICE RIMEr�ISER EXCLUDED, N N l a ' VC03357531n (FL) 03101!2013 103101!2014
(Mandatory In NH)
if ves, describe under
C 111ORKIRICOMPENSATION
C,
11
WC033575317 (KY, NC, NH, VT) 10310112013 11111112014 I (EL) LIMIT
WC033575318(NJ) 03101!2013 103.'01!2014
IN SCRIPTION OF 0PERATIONR I LOCATIONS I VEE-11CLES (Aitaclt ACOPP 101, Additional Rernaaks Schedule, if nlore spce Is required)
EVIDENCE OF COVERAGE
CERTIFICATE HOLDER
THE HOME DEPOT INC.
HOME DEPOT USA, INC.
2455 PACES FERRY ROAD, NW
BUILDING C•20
ATLANTA, GA 30339
ACORD 25 (2010M)
s
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
of Marsh USA Inc.
ManashiMukherjee 1Vtar^'"ti';
01988-2010 ACORD CORPORATION. All rights reserved.
The ACORD name and logo are registered marks of ACORD
Nov 12 13 09:02p
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Branch Name: Boston North
Branch No: 33
Installation Address: 27 Lafayette st
HOME IMPRO%7EMENT CONTRACT Sold, Furnished and Installed by:
PLEASE READ THIS CONTRACT
Date: 11/9/2013
THD At -Home Services, Inc.
d/b/a The Home Depot At -Home Services
908 Boston Turnpike Unit 1,Shrewsbury,MA 1545
Toll Free 8779033768;Fax 8009863610
ME Lic # C 02439 RI Cont. Lic# 16427
CT Lic # HIC.0565522 MA Home Improvement
Contractor Reg. # 126893 Federal ID #
75-2698460
Haverhill MA
01832
City State Gip
Purchaser(s): Work Phone: Home Phone: Cell Phone:
Mrs. Sue Ouellette (978) 521-7101
Home Address: 27 Lafayette st Haverhill MA 01832
(If different from Installation Address) City State Zip
E-mail Address (to receive project communications and Home Depot updates): sueotnelet32Pyahoo corn
Marketing emails will not be sent from The Home Depot. / W
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 ("Installati
on") 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"):
Job #: (internal Reference) Products: Spec Sheet(s): Project Amount
7222852
Windows
7222852
$3,940.37
Minimum 25% Deposit of Contract Amount
I
Total Contract Amount
$3,940.37
I
due upon execution of this contract
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.
Payment Summary: The Payment Summary # 7222852 , 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).
GENERAL TERMS AND CONDITIONS
Responsibilities:
The Home Depot: will provide the Products identified above, make arrangements to have the Authorized Service Provider perform
the Installation services in a professional and workmanlike manner, and arrange proper insurances. Unless otherwise expressly
provided for herein, Authorized Service Provider will obtain required pen -nits and provide permit numbers.
Customer: will identify any property lines, easements, covenants, underground or overhead utility lines, pre-existing physical or
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