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HomeMy WebLinkAboutBuilding Permit #148-13 - Heritage Green 8/23/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ' Date Received Date Issued: IYIPORTANILApplicant must complete all items on this page LOCATION Print PROPERTY OWNER Print MAP NO: �� PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no llf TYPE OF IMPROVEMENT PROPOSED USE Resid ial Non- Residential ❑ New Building ne family ❑Ad ition ❑Two or more family ❑ Industrial ❑P/eration No. of units: ❑Commercial $KRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑Other r (] S ptic ®well 791- �odpla npWetl'ands ❑`}7�T,atPr'/Sewer _ DES CRP i ION OF W0 TO ELP 1i0 ne dentificati P ease e o Print Clearly) OWNER: Name: Phone: 7 Address: •— CONTRACTOR Name: tL- Phone: Address: -- Supervisor's Construction License: _Exp. Date: f Home Improvement License: 1�a �1 Exp. Date: ARCHITECT/ENGINEER Phone: t 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: $ �a --3— FEE: $ Check No.: o� eipt No.- �. . NOTE: Persons co ;ractin it unregistered contractor d 0t ac s to t ze guaranty fund ofton factor n, Location No._Aq 0 �/ Date • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ � ' Foundation Permit Fee $ Other Permit Fee $ u TOTAL $ Check#���L L G I 25639 Building Inspector J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body 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's i nature& Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT -Temp Dumpster on site yes Locatedno384 Osgood Street 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 or 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 - t ® Notified for pickup - Date i Doc:.Building Permit Revised 2008mi r 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 MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Perm Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Con ra-tL ❑ Flo o r/Crossection/E levation 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 Perm 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Perm; 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: Doc.Building Permit Revised 2008mi r 1 NORTH ' �� NA . .c . Y ve" **0%- y ah ver, Mass, IA 42'2 Z 6 0 T O diANf COC NIC MIWICK A14� x,45 RA TE O I�Pp�,(5 7 V BOARD OF HEALTH Food/Kitchen PE Septic System *A^ , 4 s ak BUILDING INSPECTOR THIS CERTIFIES THAT ....MITIP ................. !khmit............. ... ................ '"...21... has permission to erect .......................... buildings on Feln Foundation p g ... a.. .. ....t.w... .. . ..!. ... . . Rough to be occupiedas .Z.. �..51� ....�.... .... ... .*.................. 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 CONS TRUCTI, A T Rough Service ............... ..... .......... ........................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SEE REVERSE SIDE AUG-17-2012 10:23 From:KEN SANDELL RSW 603 782 8726 To:Home Depot AHS P.1/8 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Solei,Faun ribbed ars)Installed by: Branch Name: Boston Date: THD At-Home Set vices,Inc. d/b/a The Home Depot At-Hume Service.,, 345A Greenwood Sweet,Unit_>,Worcester,MA 01607 Toll Free(SM)65/-5182;Fax(508)756.8823 Branch Number:31 Federal ID ft 75 2698460MF.Lic It C:024.39;Ri Cuni.i k-4 164).'/ Ar, C1 Lac d I11C.0565522,MA Huuc hupnrveniml.Contractor Reg.#126991 Installation Address: S Fy rr►y►ew Ave. N OC_W%-0VV0We a/ MA a t t 4 G, J city statE Zip Pumhaser(s): Work Phone: Hume:Phone: Cell Phone: �97�J,66'-Z3oo [ j [ 1 I 1 [ ] Home Address: (11'different from Installation Ackhrss) City StatQ� Zip it Addrmta to receive project communications and Hone Depot updates): r E,eA/A P V ,� O�yF��DD,/O i NUT wish to rewteive any marketing Horne i emails from The Horspot ! Yroieet Informs iur: UndersigeeA("Customer'),the owners of the property located at the above installation adnlress,agrees to buy and THD At-Hume Services_inc.(The Home Depot")agrees to furnish,deliver and arrange for the installation("Installation")of all materials described on the bcluw and on the referenced Spec Sheet(0-all ol"which are incorporated into this Contract by this reference,along with any applicable Stare Supplement and Payment Summary attached hereto and any Change Orders(collectively. Contract"): job#: (IN—M Mdrresrl Products: Swt Sbeetits)0: Pro ccl Amount p4t (,� [ Roofing OSiding induws ❑Inmlation ( l {� ' b"ra"n!C'ovens f.n Doors ❑ 5�O V ,4 ,�� y 4 Roufurg❑.Siding indows n Insulation �+ 'w I F 643 31 v� ❑Goners!Covers naryrhe+,x ❑ "l O�� $ 6�3 _ ❑Rcxrfing ❑Siding ❑Windows ❑ima'Iblion -- �� ❑(ititwm/Covers❑Entry Doors U__ $ ❑Roxrfung []Siding Windows Ll Insulation ❑Clutters/Covers []Entry Doors E $ Mirdniu ,2S%DepositofConrrariAmouitdueuponammitionoftlrsaint wow. Total Contract Amount $ 6 �3 Maine tltrehamm may not dcptrA nwac than one-tlnrd of the ConlrrartAmuunt- Customer agrees that,immediately upon completion of the work for each Prixluct,('ustnmer will a 401te.a Completion Certificate (one kir each Product as defined by an individual Spec Sheet)and pay any Nalance due As applicable,each Customer under this Contract agrees to be,lointly and severally obligated and liable hereunder. The home Depot reserves the right to issue a Change Order or terminate this Contract or any individual PfO&Ci(b)iiicludcd herein,al its discretion,if The Huhu lhpol or its authorized service provider determines that it cannot perform its obligations duc to it structural prohlem with the home,environmental hazards such as mold,asbestos or lead paint,other safety Luncerus,pricing errors or because work required to complete the job was riot included int adieContractt Payment Summar-y: The payment Summary# 60 t b- \ 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 sten. Do not sign a Clrmpletion Certificate(note: there ba one Completion Certificate for each listed Product or,defined by individual Spec Sheets)before work on that Product is complete. In rbc event of termination of this Contract,Customer agrees to pay Tire Home Depot the.costs of materials,labor,expenses and services provided by The Home Depot or AuthoriyeA Service Provider thrmrgh the date of termination,plow any other amounts set firth in this Agreement or allowed under applicable law. THE HOME DEPOT MAY WITHHOLD AMOUNTS OWFD TO THE HOME DEPOT FROM THE DEPOSIT PAYMENT OR OTHER PAYMENTS MADE, WI-111,1011- I JMITING I7H011- i:IM177NG 7IIK HOME DEPOIXUTHKR REMEDIES FOR RECOVERY OF SUCH AMOUNTS. t m and Authorir on- Cu omer agccs and understath nds at this Agreement is the entire agreement betwLen Cusiomer and' he Homc Depot wi regard to)tic I'rWtwtr and Installation so vices and supersedes all prior dtxusm ons and agreements,either oral or written,relatiu o said products and Installation. Ihis Agreement cannot be assigned or amended except by a writing signed by Customer and The tome _C",totip, ackn ledges and al7ee%chat Cnstnmer has read,understands,voluntarily accepts the term;of and has rec ved py of this A moil Accepted b �j c� Sublgitted by�AK#' �GF^b /tr �l 51'7, Customers Signature a ate`•' SaIcss`J+Coon%ulunt1%J Signature Dale h _ Telcphunc No. DD 3- a 1— custunler's Signature Date Sates Consultant License No. CANCELLATION: CUSTOMER MAV CANCEL THIS ACRFFMENT WITHOUT PENALTY OR OR1.il;ATiON BY DELIVERING WRITTEN NOTICE TO THE HOME. DEPOT BY MIDNICHT ON THE THIRD BUSINESS DAV AVVER INIGNING TITFS AGREEMENT. THE STATE SUPPLEMENT ATTACHED HERETO CONTAINS A DORM 10 USE iF ONE iS SPECIFICALLY PRLSCRIBED BY LAW IN CU•S40MFR':4 STATE. NUTICF!A DDI I IONAI.t LRMS AND CONDITIONS ARE STAT FT)ON'1 NF:RFVF'RSY SIRE AND ARE PART OF TMS t ON I RAVI 10-04.11 GSC, White-Brdrwh File Yellow-Customer Ak Th(� D ep of 1hd.wfrW A MUM;13, offlof of hVesfigations 6019 Fr7ashinvoij siree" BvVony MU 02111 W4w.nwSS.g,9V1e1a Workers' Compensation Insurance Affidavit, Build ers/Con tracti)rs[Electriciam/T luraber._� Applicant InformationPrint Le My J zefl'si, Nsme i zad o rAndiv Idual): 'Address: City/state/zip: A,re P3, an er�ployer? Check illic.appropriate box: Type of project (required). 11 I' 1.[;? I um E employer with 4. El I am a general contractor and 1 6. E] New construction employees (full and/or part-time).4 have hire(.,the sub-contractors 2.El I am a sole proprietor or partner- listed an the attached sheet. 1 7. E] Remodeling ship and have no employees These sub-contractors have 8. E] Demolition working for me in any capacity. workers' comp. insurance. 9, E]Building addition (No workers'comp. insurance 5. El We are a corporation and its I O.E]Electrical repairs or additions require4.] officers have exercised their 3.0 9 am a homeowner doing all work right of exemption per MGL H.E] Plumbing repairs or additions myself [No workers' comp. c. 152,§1(4),and we have no 12-(l 59driepairs Insure=required.)t employees,[lo workers' 13 Other comp. insurance required.] QAny qVilicam that checks bolt I I must also rill out she section below showing"r workM'compensq(jgn policy inionnaiion. 11 HOMWWRM who svbml(this affidaylt indicating they ire doing all work and theb hire outside contractors must submit a new affidavit indic-sting such. 3coaftecson Out check this Wx mus(attached in additional sheet showing the um of the sub-coninic(ors and their workers'comp.policy Information. am till emloy-er Ghat_ pro VU111t workers Co tqenjado H-Insurance for aV etTloyees. Below is(h e policy and Job site - URPMUM Company Ne:__ zi PORCY 0 or SA ll-his. Uc. N: Expkation Daite: ' Job S5- Site Addrm*'--- CRYISMCIZO: ie AL4� AflachecWoUhtworkers1compeawt R polky decUra(ion page(showing the policy&umber and expiraglon dage). Fallum to omm coverage as requhd under Section 25A of MUL c. 152 can 6d to the lffiposfdon of criminal penalties oft On 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 dq against the violator, Be WOW that A COPY Of this statement may be forwarded to the Office of 101MUSAOM GHW DIA for imumnoo coverage verification. I*heft*coo made the ad an pendda ofX#uFy that the bVermaoi piv4dedeb 1$11 eand coerce k r 4 nate: 04W we only. Do not WHIC In this area,to be comide'by eta or town Odd a#or Towiai heft AMMrIty(ciMh one): 9.001rd or""Uh 2.8011ming MpafteM 3,Myrrown Ckt 4,F&UrkAl 1pqmlor 5.Phimblal W'N-C9]!9F C 00M .0 From:Dzinitr� rDuan _ ,Fax:(603)505-4508 __. ,To:+14014531367 Fax: +14014531367 Page 2 of 2 8/1412012 11:02 t..�......+..»�. -.... ...) Board of Building Regulations and Standards Construction Sapen icor Specialty _. License: CSSL-099823 DZMYTRY BROVIN 70 NORTON AVV <` Manchester NH 03109. `_ � � 4 Xpiration 06/26/2014 omrn!ss!aner DATE�MMIDDNeY0 CERTIFICATE OF LIABILITY INSURANCE1-- UPON THE CERT�FICATi THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RiGHTS, TIMIS 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 BETIJI]EEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, su;Tect 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). NAME: PRODUCER 1-866-966-4664 CONTACT Marsh USA Inc. PHONE FAX (AIC,No,.Ex I: I (A/C,No): ----------- homedepot.certrequest@marsh.com AE-MAIL DDRESS: ,Two Alliance Center, 3560 Lenox Road, Suite 2400 Atlanta, GA 30326 INSURER(S)AFFORDING COVERAGE NAIC# Fax (212) 948-0902 INSURERA: Steadfast Ins Co 26387 INSURED INSURER B: Zurich American Ins Co 16535 The Home Depot, Inc. INSURER C: New Hampshire Ins Co 23841 Home Depot U.S.A., Inc. 2455 Paces Ferry Road NW -INSURERD: Illinois Nati Ins Cc 23817 Building C-20 INSURER E: NATIONAL UNION FIRE INS CO OF PITTS 19445 Atlanta, GA. 30339 I INSURER F: Illinois Union Ins Co 127960 COVERAGES CERTIFICATE NUMBER: 25776028 REVISION NUMBER: 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. INSR LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER (MMIDDIYYYY) (MMI DD[YYYY)_ LIMITS A GENERAL LIABILITY GL04887714-02 03/01/1, 03/01/13 EACH OCCURRENCE $ 9,000,000 --i- DAMAGE TO RENTED COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence) $ 1,000,000 CLAIMS-MADE FYI OCCUR MED EXP(Any one person) $EXCLUDED • LIMITS OF POLICY XS PERSONAL&ADV INJURY $ 9,000,000 • OF SIR: $lM PER OCC GENERAL AGGREGATE $ 9,000,000 GENI AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 9,000,000 JECT _j POLICYF_j PRO- [ LOC I I $ BBkP 2938863-05 037OT7I� 03/01/13 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY (Ea accident) $ 1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident) Hx SELF INSURED PHY DMG $ UMBRELLA Ll B OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS MADE AGGREGATE $ DIED RETENTION$ $ Y LIMIT kWC019736917 WORKERS COMPENSATION WC019736915 (ADS) 03/01/1, 03/01/13 X I TWOCSTATUT 0TH- AND S ER AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEACCU.WC (FL) 03/01/1, 03/01/13 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED' [NJ N/A E (Mandatory In NH) WC019736916 (CA) 03/01/1', 03/01/13 E.L.DISEASE-EA EMPLOYE q$ 1,000,000 If yes,describe under I DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 E WorkersCompensation WC1192494 (QSI) 03/01/1 03/01/13 SIR (AOS)/SIR (GA) IM/750,100 C Workers Compensation WC019736918 (WI) 03/01/1 03/01/13 F TX Employers XS Indemnity TNSC46566397 (TX) 03/01/1 03/01/13 Occurrence/SIR 30M/lM DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) RE: EVIDENCE OF COVERAGE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE HOME DEPOT, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN HOME DEPOT U.S.A., INC. ACCORDANCE WITH THE POLICY PROVISIONS. 2455 PACES FERRY ROAD NW AUTHORIZED REPRESENTATIVE BUILDING C-20 21 ATLANTA, GA 30339 USA (12 ©198 J.1201 0 AC, RD CORPORATION. All rights reserved. I ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD,.'.' Jthornton—hd i gxle /. . 0 fixe of Consumer Affair and Business Re u.lat' i� _ o g � 10 Park Plaza - Suite 5.1.70 Bos . n., ssachu.setts. 02116- H 211.6 Home Zimprove. '. ontracto'-Registrytion Registration: 12889.3 Type; Supplement Catd f �, w=` W W Expiration: 8/3/2011 The Home Depot M-Home SeN ' w RICHAF�D FALLQNE m >. 2690 CUMBERLAND PARKWAY ATLANTA; GA 30339 w G�Af ;y4 Update Address and return card.Mark renson.for change: oPs-c,ai �;� �arn•oa�o,t•��o�270 F� Address (� Renewal .(� Employment f� Lost Cnrd order of Consumer Affnirs 8c Business Regulation Licanse or registration valid for Individul use only OME IMPROVEMENT CONTRACTOR before the expiration date. If found return:.to: r;%y. 1 Office of Consumer Affairs and Business Regulntion Reglstration:-;x.26993 _Typo: 10 Park Plaza-Suite 5170 Expiraf(tin .4 r Supplement Card Boston,MA 02116 ' r The Home Dep01%�EY{H4tneeNl es ' Js RICHARD FALLOMN -,.;;Tir,..rT�? 1 2.690 CUMBERLA D r.;r �•. A"fTAht`FA, CA 30339-''x- ?.�.y •,• Undersecretary. of valid with ut sl nature