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HomeMy WebLinkAboutBuilding Permit #557-2016 - Fernview Avenue 11/15/2015 NoRYH BUILDING PERMIT TOWN OF NORTH ANDOVER �� o APPLICATION FOR PLAN EXAMINATIONn ^ �o ,m 1 Permit No#: // Date Received AORA7eo 11" fy �ITSACHUS�( Date !Issued:- I I . INlpORT.ANT:Applicant must complete all items on this page LOCATION t Pri PROPERTY OWNER rint 100 Year Structure yes no MAP PARCEL: _ZONING DISTRICT:-Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ❑ e family El Addition Two or more family [I Industrial ❑AI ation No. of units:D,K ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ ---- _. - � 1 f twat re shedl�Distnct� Well, ( f _ O'Flo�odplain []Septic ❑;+ � - - - _ __ ❑�Wetlan s. i.. Wat2f/RSe ii DESCRIPTIO Jo KT _ ERFO ED: tifca ' - PI e Se Type or Print Clearly Phone: OWNER: Name: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Nome 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.: J? Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acces the g ranty fund M„, — — -- Location 2k -C N ti/1 P. ► /`NP, No. V) r —^ Date 1 `S . - TOWN OF NORTH ANDOVER Certificate of Occupancy $,i Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#/335- 7 i Building'Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ • ` Tanning/Massage%SodyAit ❑ S�'ilMnlUing Pools 1 Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. F] Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFFS - 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 Conned►on/S . Driveway Permit ]DPW Town Engineer: Signature: FIRE DEPA-(-,Tllfj ]��' Located 384 Osgood Street Located a a Ternp,Dumpster on site es cc.z at MainStreet y not } . '- FirelDepar'megnature/dale 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, wast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-woo fine NOTES and DATA-- (For department use) 03 Notified for pickup Call Email -Date -- _�- -V------- Time Contact Name Doc.Building Permit 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 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 OTE: 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 :6 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 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 a6 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 4. 2012 IECC Energy code � Engineering Affidavits for Engineered products OTE: 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 Doe:Building Permit Revised 2014 Auc .( ve. ... - 0 1M No. - _ �1 � 1 5 — * � Y - _ � y h ver, Mass, 2,61 coc HICHlwtc Are 0 r`P�,`�5 U BOARD OF HEALTH Food/Kitchen PERMI T LD 1► Septic System THIS CERTIFIES THAT ,e e .4 .................�Nr4�1e.2 BUILDING INSPECTOR has permission to erect ........................ buildings on ., .....be-"\.e- ...... `."Q:.. .�. Foundation �y� Rough to be occupied as ............................ .......P .. . .... .... .lti .a.?^.�r7........................................ 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT STARTS Rough Service .. `2��sZF�' .,.�...,............ . .. ...................... ...... BUILDING. . . INSPECTOR.. Final GAS INSPECTOR Occupancy Permit Required to Occupy Buildin-a 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. HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name:New England Date/k/�/ /S THD At-Home Services,Inc. d/b/a The Home Depot At-Home Services Branch Number:31 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free 877-903-3768 Federal ID#75-2698460;ME Lic#C 02439:RI Cont.Lic#16427 t V/ CT Lic#HIC.0565522:MA Home Improvement Contractor Reg.#126893 Installation Address: 2/ FMIA1 kZ4.I tft 07,&L / — Aldo c'li2."4 D/1,y5 City State Zip Purebaser(s): Work Phone: Home Phone: Cell Phone: [ 3 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 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 this1,1 reference, along with any applicable State Supplement and Payment Summary attached hereto and any Change Orders(collectively, (/�,i'1 "Contract"): .lob#: (We.1 References Products: See Sheet(s)#: Project Amount Rooting Siding P Windows Insulation �j[�7 ❑Gutters/Covers ❑ ntry Doors ❑ /( V!/� 32-2— S05300 Roofing ❑Sidin9E'ntryDoors Windowsinsulation ��7 � s❑Gutters/Covers ❑ 7 7 Roofing Siding Windows Insulation ❑Gutters/Covers ❑Entry Doors❑ Roofing ElSiding El Windows 0 Insulation ❑Gutters/Covers []Entry Doors ❑ Minimum 25%Deposit of Contract Amount due upon execution of this contract. Total Contract Amount $ 3 Maine Purrhasers may not deposit more than one-third of the Contract Amount. Customer agrees that, immediately upon completion of the wort: 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 #I 67 / included as part.of this Contract, sets forth the total Contract amount and payments required for the deposits and final aYents 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 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 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 aZhhasived a copy of this Agreement. A ed Submitted by: Xr�n.t�t -- ZO-Id�i x fD The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organiz on/Individual): Q r Address: �- City/State/Zip: CPhone#: Are you employer?Check the �aappropriate boa: Type of project(required): 1. I am a employer witl�L_employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 3. I am a homeowner doing all work myself t 9. El Demolition ❑ rig y [No workers'comp.insurance required.] 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10❑Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet These sub-contractors have employees and have workers'comp.insurance.t 13.❑❑Ro repairs 6.❑We are a corporation and its officers have exercised their right of exemption per MGL a 14.�ther 152,§1(4),and we have no employees.[No workers'comp.insurance required] *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'co enation insurance for my employees. Below is the policy and job site information. �----- Insurance Company Name: Policy#or Self ins.Lic.#: 77 D Expiration Date: f Job Site Address: City/State/Zip:_N Attach a copy of the workers'compensation policy declaration page(showing the policy number an expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pai and en ties f perjury that the information provided above is ue and correct Si ature: 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 6.Other Contact Person: Phone#• CERTIFICATE OF LIABILITY I SU k"E I o7/15rze15 j 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 BEPNEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER j IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poticy(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 MARSH USA,INC. NAME: TWO ALLIANCE CENTER PHOC.N o F No): 3560 LENOX ROAD,SUITE 2400 E-MAIL ATLANTA,GA 30326 ADDRESS: INSURERS AFFORDING COVERAGE NAIC A 100492-HomeD-GAW-15.16 INSURER A:Steadfast Insurance Company 26387 INSURED THD AT-HOME SERVICES,INC. INSURER B:Zudch American Insurance Co 116535 DBA THE HOME DEPOT AT-HOME SERVICES INSURER d:New Hampshire Ins Co 23841 2690 CUMBERLAND PARKWAY,SUITE 300 ATLANTA,GA 30339 INSURER D:Illinois National Insurance Company 23817 INSURER E: INSURER 0: COVERAGES CERTIFICATE NUMBER: ATL-003746646.13 REVISION NUMBER:8 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. 'LTR TYPE OF INSURANCE AD UB POLICY NUMBER POLICYlYEFF M�DD EXP LIMITS A I X I COMMERCIAL GENERAL LIABILITY GLO48BT714-05 T1 03101!2015 0310112016 EACH OCCURRENCE $ 9,000,000 I CLAIMS-MADE OCCUR DAMAGE TO PREMISES(Ea occu RENTED nce) s 1,000,000 LIMITS OF POLICY XS MED EXP(Anyone person) s EXCLUDED OF SIR:$1 M PER OCC PERSONAL&ADV INJURY s 9,0m,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE s 9,00,000 X POLICYI PRO- `�JECT LOC PRODUCTS-COMPIOPAGG s 9,000,000 OTHER: s B AUTOMOBILE UABILITY BAP 2936863-12 03/01/2015 03/01/2016 COEa aMcciINBdentED SINGLE LIMIT s 1,000,000 X ANY AUTO BODILY INJURY(Per person) s AALLOOIWNEO i 1 SCHEDULED SELF INSURED AUTO PHY DMG AUTOSiV0S PROPERTY DAMAGE s BODILY INJURY(oar axident),S N000) I HIRED AUTOS AUTOS Per accident s UMBRELLA UAB I I OCCUR EACH OCCURRENCE s � EXCESS LIAB CLAIMS-MADE AGGREGATE s DED 1 1 RETENTIONS $ C WORKERS COMPENSATION WC017731493 (AOS) 03/0112015 03/01/2016X PER oTH- C AND EMPLOYERS'UABIUTY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE ❑ WC01T731495(AK,KY,NH,NJ,VT) 03/01/2015 03/01/2016 E.L.EACH ACCIDENT s 1,000,000 D OFFICERIMEr4BER EXCLUDE07 N N I A (Mandatory In NH) WCOIT731494(FL) 03/01/2015 03!0112016 E.L.DISEASE-EA EMPLOYE S 1,00,000 If yes,describe under Conitnued on Additional Page 9e E.LDISEASE-POLICY LIMIT S 1,000,0 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached it more space Is required) EVIDENCE OF INSURANCE t: CERTIFICATE HOLDER CANCELLATION THD AT-HOME SERVICES,INC. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE DBA THE HOME DEPOT AT-TOME SERVICES THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 2455 PACES FERRY ROAD ACCORDANCE WITH THE POLICY PROVISIONS. ATLANTA,GA 30339 AUTHORIZED REPRESENTATIVE of Marsh USA Inc. Manashi Mukherjee �la..wr�►.: ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD •f1�� y,i'ys:i(�'YSY:.t` �-'�;:'�.'J.✓.�l. :''y' -qq mf tom...J - p- ip _ 4j sem 10. THD AT,HOM5 SE IDES, 1NO 9MAY OITe 3.00 aJpatadr�ns Add �� Addr �. 72Jp3L� a� • `-�'�'�� C�ftlrLJft�7l!Y:l�f1 t�����+�1/CIA.:.t'!�' • .ASEoSCOnSi;ric9-PAiss:Rs?3n5t �•�u3a D3 Lli�� Dr?, r ,ioa�a3i iD in�i s� s.or Oy phiai?ex�ra'ti -mmc ,T*esl lira �t� �PI' .� •'.�� 5J,%P7 r�r•{S,)L.rF����S uD•t9� � _ • ;R fflt a�'Dot 10 .. ripe. 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