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HomeMy WebLinkAboutBuilding Permit #383-15 - 99 MARIAN DRIVE 10/22/2014 BUILDING PERMIT 0.1NORT bgti StLeo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �4q j gSSACH�15�� Date Issued: I RTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER 0 ; � ,� - Print 100 Year Structure yes n MAP PARCEL _ ZONING DISTRICT. _ - Historic District yes n_ 7 Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑ Aeration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain, 11 Wetlands. ❑ Watershed District El Water/Sewer ESCR - NOF WORK TO.BE PE RMED: Identification- Please Type or Print Clearly OWNER: Name: �/ Phone: Address: �6 f //C3' i� s 9 Contractor Name: �. P�one: . Address:_ j/ r� _ Ae Supervisor's Construction License _ _ Exp. Date _ . Home Improvement License ,-_. : - �.Exp. Dater ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$1//2.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASE ON$125.00 PER S.F. Total Project Cost: $ �,�1�'op FEE: $ r _ Check No. *5 � �'`� Receipt No.: 0 NOTE: Persons cont�•aith unregistered contractors do not have access o h gu a fund Signa nature of Agent/Owner _ Signature of contractor 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 o Building Permit Application Li Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract Li 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 o Certified Surveyed Plot Plan a Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/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 NOTE: All dumpster permits require sign of from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit Li 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 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ i 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 x COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments ,pConservation 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 124Main Street Fire iDepartrhent 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) I II I I ❑ Notified for pickup Call Email Date Time Contact Name I Doc.Building Permit Revised 2014 5Location 1 No. .] Date ! 22 �� � I '11 i . • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ :r, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ J, Check# �� 1 Building Inspector Location No. Date o NpRTM TOWN OF NORTH ANDOVER � w . Certificate of Occupancy $ ^� s4� 5 Building/Frame Permit Fee $ Foundation Permit Fee $ . Other Permit Fee $ TOTAL $ Check # 24223 rng Inspector vermitbervices i aui 'too[trots P i /��/� /�/�yrs yy��/� //��/ �7 //�///t/�/�,•/y�+�J� �f,,GJ�� �/ J'VV ��V//��J'1 W'/�VT/..C�� V C':%' " ✓K...JL(•L/VW �/�✓� Office of Consumer Affairsand Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement*Contractor'Registration Registration: 126893 Type: Supplement Card Expiration: M=16 THD AT HOME SERVICES, INC. _ RICHARD TROIA -_----- 2690 CUMBERLAND PARKWAY SUITE 300 . . -- ' ATLANTA, GA 30339 -- - - --- Update Address and return card.Mark reason for changes Address (J Renewal Employment J Lost Card ..a r�%:'�(J/N lrltlrrt/:C(/��J/•� ��irC:rrr,�rr:ri;' - -`. OtTicc of Cuasuner ptfairs&Bnsinas Rcgufation License or registration valid for indiridul use only before the expiration date. If found return if`{ f�OME Il11PROVEMENT CONTRACTOR Office of Consumer Affairs and Business Re_ ..ion "� 's Re istratiort .126693 Type: 10 Park Ptazs-Suite5170 "�� Expiratiorc. SM2016 . Supplement Card Boston,MA 02116 THD AT HOME SERVICES,INC. THE HONE DEPOT AT•HOtd1E SERv10ES / RICHARD TROIA 2690 CUMBERLAND PARKWAY S GA 30339 Undcrsccretary ",alsis ature r f MORTFI Town o n over o No. h ver, Mass, d COC NIC Ml WICK It. VArr, P'Pa�,�S S U BOARD OF HEALTH Food/Kitchen . PER I D Septic System ".. BUILDING INSPECTOR THIS CERTIFIES THAT ........ .. .�J........... .. . . .............................................................................. has permission to erect .... buildings on ....D.V Foundation .�)cel;�i . .... .... ..�. . .... .� ................. Rough C to be occupied as ...... . .. . .. ...............� _� Chimney provided that the personang t is 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 T S Rough Service ................. .... ..... .... ....... .._._......-.........I.............. Final ING INS TOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. I ..„c; vurucurt�r't:ctu�[ vd ��1c1SJ'UCIIllS'L'IIS. / Department ofliidustrzalAccidey.-i. Office of Ir;vestiga j%�, - f 1 Con;r•ess stree -Suite 100 ``: Boston 211 -2017 -- - - W ruass gov/dia Workers' Compensation•InsuranceAffidavit: Builders/Contractors/Electricians/Plumbers ADDlicant Information Please Print Le 'blv .r A-� plc S Names :ss/Organizaiionllndividual ): � Address: Ci&state/Zip: �L �� 44q-•'fnhoneiu: � �7 Are you an'employer? Check the appropriate bo . • Type of project(required}: - I.❑ I am a employer with 4 E21 am a general contracior and I * Have hired the'sub-contracto employees (full and/or part-time). 6� ❑New construction 2.❑ I am a sole'proprieitir or partner- listed on the attached sheet. rs 7. ❑ Remodeling ship and have no employees emP These sub-contractors haveg• Demolition ❑ working for me Tiiany capacity. employees and have workers' t 9. ❑ Biiilding addition [No workers' comp:insurance comp. insuranc . •. We are a co oration and its . 10.0 Electri:'ll repairs or additions 3.❑ I am a homeowner doing all work omcers have'exercised their 11:❑ PluinH.;repairs or additions m self. o workers'.com righi of exemption per MGL 12.[] Ro "repairs' q ] t p c. 152, §1(4)';and we have no ' insurance re wired. 13 Other "employees. [No workers'' com• �._ P. insurance..required.] : `�ny applicant u:.:�lucls box=?;c 5t air, fill out the section beloww showing ihcir workers''compensation policy information. t Homeowners who submit tars affidavit indicating they are doing all work and then hire outride contractors must submit a new affidavit indicating such. tContractors that chick this box must attached an adaitional sheet showing the tiame of the sub-contreetois and-stat:whether or not those entities have c nployem If the sub-contractors have employees;they must provide their workers'comp.policy number. , I ani a;i employer that isproviding workers' conipensation insurance for my employees. 'Below is thepolicy and job site' • "iitforntation. ���J _ �. . ' '• Insurance Company Name: Policy#or Self-ins. Lic. T: �`'IM)*j: Expiration Date:• ^/ � �— Job SiteAddrtss:_ �� y ,J U .• h—If �'`�`��`✓!� �/ ' City/StateJZip: ' �'" Attach a copy of the workers' compensation policy declaration age showing the ' olic number and expiration date). page(showing P Y P ) 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 S1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of.a STOP WORK ORDER and a fin: Of up to 5250.00 a day against•the violator. Be advised that a copy of this statement may be forwarded to the Omcc of Investi•gatiors-of the DL4 for insurance.coverage.verincation : . . . .. — I do hereby cerci pa and e� alri� erju that the in provided above is true acid correct Signature: . i Dat P • IP o n n i, Ofj-=Ial use only. Do not write in Utir arca, to be completed by city or town official. City or Town: Perr it/License T Issuing Authority (circle one): s 1.Board of Health 2.Building Department 3. City/roNvn Clerk '4.EIectrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone 4: C'Ca • � z' enelgYlar.nrcan—tncan.g . n • ��. � .r. •.}fit . Q,duled p allot final In;peclioh; SAVE for lulure reference p ove lab�l. , _m Weather ShWd Fi CPD6 050=A-17z NFRC }A0del B1DB Double Hung DPeralinp Plum clad Thermal Frame 314 Inch Glazing 022 LOW— on ow— c �attra t,, :• � Argon Fill Grille in Alt Space ' ENERGY PERFORMANCE RAS C�GII_:nl U—Fr-:Itt • � 0.30 � � N.i1l_P (htiltifil ADDITIDNAL FERFORMAN��pRt�RII�IGS C • Ylllhlslr:I�I�IIq::: D ' �I.Zn.rxueTrvalc.cvinnq i•sFt,�put lrPerct lthc+l l n6it,sc r npeinM1gtsn}ff°� brnIt Pmw ndot,tdxrnrc pWi enC d1°ceut r� xF6C Joel 101 ndrClct tv+llpnf ud Lsd el scri=m I nil rtnnl ht nkrmrtM. podanLeen:nuIet 11, UUaunI%tr=.vw� rsosb*,= ^ ^Q d .avlrrmrnls C. rru' I.E.C.C. >Jr In11uuXKWD tVls.2—S7 trlf or escecdf t1._C•, C._. IteeltdlleSL'+1 . uL'I:t Irsre u u I ' 1 N-L:IS 111 r::2FOl U.1n, r.e.......,lu 4mv I=e EIQISCG2111Y•SiD .. DATE(MM/D0NYYY) ACCORD . CERTIFICATE OF LIABILITY INSURANCE 02119/2014 ie�' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES OT 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 requlre'an endorsement. A statement'on this certificate does not confer rights to the ceitificate holder In lieu of such endorsement(s). CONTACT 'PRODUCER NAME: MARSH USA,INC. PHONE FAX TWO ALLIANCE CENTER A/c Not: 3560 LENOX ROAD,SUITE 2400 EMAIL ADDRESl: ATLANTA,GA 30326 INSURERS AFFORDING COVERAGE NAIC I 1VA92-1-16onneD-GAW14-15 INSURER A, Steadfast Insurance Company 26387 INSURED INSURER 8:Zurich American Insurance Co 1E535 THD AT-HOME SERVICES,INC. 'R-R New Hampshlre Ins CO 23841 DBA'THE HOME DEPOT AT-HOME SERVICES. INSURER c 2455 PACES FERRY ROAD INSURER D:111hols National Insurance Company 23817 ATLANTA,GA 30339 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: ' ATL-003242685-01 REVISION NUMSER:3 THIS IS TO CERTIFY THAT THE POLICIES ORINSURANCE LISTED BELOW HAVE BEENASSUED 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. ADDL SUBRIPOLICY EBEFF POLICY EXP LIMITS ITR TYPE-OF INSURANCE • ' POLICY NUMBER. - MMIDD/YYYY MM1DO YY ' GL04887714-04 - 03101/2014 03/01/2015 EACH OCCURRENCE S 9,000,000 A GENERAL LIABILITY DAMA X S 1,000,000 COMMERCIAL GENERAL LIABILITY PREMIS S E rrence CLAIMS•MADE ❑X OCCUR LIMITS OF POLICY XS MED EXP(Any one person) s EXCLUDED OF SIR:S1M PER OCC PERSONAL is .`.V INJURY S 9,000,000 GENER11' 3ATE , 9,000,000 GENL AGGREGATE LIMIT APPLIES PER PRODUCTS_COMP/OP AGG S II X POLICY Pc O- F LOC $ J BAP 2938863-11 03/01/2014 03101/2015 COMBINED SINGLE LIMIT B AUTOMOBILE LIABILITY Ea accldenl - BODILY INJURY(Per person) S X ANY AUTO ALL OWNED SCHEDULED SELF INSURED AUTO PHY DMG BODILY INJURY(Per accident) S AUTOS AUTOS PROPERTY DAMAGE NON-OWNED P r accident) S HIRED AUTOS' AUTOS S UMBRELLA LIAB. OCCUR EACH OCCURRENCE S EJCC�UABCLAIMS.MADE AGGREGATE S DEDS C WORKERS COMPENSATION 188 3/ 12014 TH­ 031011 X WC S"MIJ CER C AND EMPLOYERS'LIABILITY Y/N WC049101884 AK,A2,VA 031012014 031012015 1,OOQDOD ANY.PROPRIETOR/PARTNERIEXECUTIVE ( ) E.L.EACH ACCIDENT S . D OFFICERIMEMBER EXCLUDED? N/A WCD491018B3(FL) 03/012014 031012015 1,000,000 (Mandatory In NH) EL DISEASE•EA EMPLOY S H yyees,describe under 1,000,000 DESCRIPTION OF OPERATIONS below E.L DISEASE•POLICY LIMB S C WORKERS COMPENSATION W 04910188(KY,NC,NH,VT) 031012014 03101/2015 (EL)LIMIT 1,000,000 C WC049101886(NJ) 031012014 031012015 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Addlllonal Remarks Schedule,If mon space is required) EVIDENCE OF INSURANCE CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-HOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZEO REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee ©1988-2010 ACORD CORPORATION. All rights reserved. Permit Services 401 246 2868 P.1 ass ac.' --c;etts - e a Lj g . iat:a., ,.sa aStajr)cl-I.# CS-0887561 S� _ SCOTT A MACMtLLAN ,w 10 PARK AVE SALEM NH 03079 03/2912016 o World area will be container! . ' Pre-Renovation Form Date: Z— i NAT-19276-1 - This form is used to document compliance with the requirements of the Federal Lead-Based Paint Renovation,Repair,and Painting Program after April 2010. Customer Address Job Number(s) a Jit i OCCUPANT CONFIRMATION j ' Dust will be munimizeCi Pamphlet Receipt ri" I have received a copy of the lead hazard information pamphlet informing me of the potential risk of the lead hazard exposure from renovation activity to be f performed in my dwelling unit. I received this pamphlet before work began. ,.; Home Year Built Enter the year my home was built, rg CQ[! m _ If my Home Year Built is Pee-1978,my home requires lead paint testing to determine ©. rr*,c� ,�+ , n whether Lead-Safe Work Practices are necessary,per EPA or State regulations. Work o rk a r +tea will be cleaned u p If my Home Year Built is 1978 or after,Lead-Safe Warts Practices are not required. thoroughly r A)a" Printed Name of Owner-occupant �r S' natu Ow er- pant Signature of Pe on Gerti t,_ad Pamphlet Delivery SEE STATE SPECIFIC FORMS ON REVERSE SIDE HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name:Boston North South Dater THD At Services,Inc. d/b/a The Home Depot At-Home Services Branch Number:31 and 33 908 Boston Turnpike,Unit I,Shrewsbury,MA 01545 Toll.Free 877-903-3768 Federal ID#75-2698460;ME Lic#C 02439;RI Cont.Lic#16427 CT Lic#HIC.0565522;MA Home Improvement Contractor Reg.#1.26893 Installation Address: `Y6 i/rr N' ►'""� Gl�-- AAA— City State Zip Purchasers): Work Phone: Horne Phone: Cell Phone: 71 V3 I I 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 emails from The Home Depot Project 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"): Job#: (Internal Reference) fioaucts: Sec Sheet(s)#: Project Amount Roofing Siding indows El Insulation []Gutters/Covers ffiEntry Doors ❑ � � Roofing QSiding El Windows Insulation $ ElGutters/Covers ❑Entry Doors ❑ Roofing ElSiding 0 Windows El Insulation ❑Gutters/Covers FlEntryDoors❑ Roofing Siding El Windows El Insulation ❑Gutters!Covers ElEntry'Doors El Minimum 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 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 0 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 Home Depot the costs of materials,labor, expenses and services provided by The Horne 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 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, urt erstanndds, voluntarily accepts the teens ofna�►nd has received a copy of this Agreement. A�/ ����_"�f A %,+/f//�1.1. . .�/"l ! 1 1 Cnhmitfnr7 tti�i•