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HomeMy WebLinkAboutBuilding Permit #554-13 - 80 Kingston Street 2/5/2013 BUILDING PERMIT NosrN '� Ot�t�eo TOWN OF NORTH ANDOVER o � APPLICATION FOR PLAN EXAMINATION _ e L/ 'V Permit N0: Date Received �,y °gArea►pa�q`� 2 SSACHISE Date Issued: -5 -t3 IMPORTANT:Applicant must complete all items on this page y } PRQPL-RJTjY/(D.WI NER1. - Fant{ MAP�2i10i. _, PAR'CEL� ZONINGS®IS�TR_ICT '_- HistoncDistnct yesAn� ucture yes" TYPE OF IMPROVEMENT PR POCial D USE Resi Non- Residential ❑ New Building ne family ❑Ad ition ❑Two or more family ❑ Industrial ❑PAeration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic 0 Well1 UaFloodplai17, hi 11W.etlands_3 I 0 WatershediDist ct ❑Water/S.ewer - - DESCRIPTIO! O=T 71RFQI,�IVIED. Identifi tion PI e pe or riot Clearly) OWNER: Name: Phone: 7 S \o- Address: s 4 Phone:; _ CQNTRAC.TOR Name:: _ Address: f6A Supervisor!s�Construction Licenser pi, Date•. G Ek Ho me lmprovemenf License;: _ EXp, 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: $ �zo FEE: $ Check No.: �/� 7� Receipt No.: A NOTE: Persons contracting with unregistered contractors do not have cess ua vfund G' i I Signature)ofA_�_gent%ewn-e oriti _ Signafure�of�cactoc_ 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 I I j CONSERVATION Reviewed on Signature I COMMENTS HEALTH Reviewed on Siqnature i 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 at 384 Osgood Street—978-685-0950 FIRE DEPARTMENT Temp��DumpsterPon'rsit0) yesnos,- }_ Loc`atedlattl,4jMainaStreet 978?688 9590 Fii•e Deparfra�ent)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 ❑ Notified for pickup - Date Doc.Building Permit Revised 2012 i 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 o 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 i Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan Li Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ 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 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 Li 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 VOTE: 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 2012 i ..p; R I C Hf D I 16 L,AVVIDZENICIE RD 7 0 SALE Oil 1/2013 3870 NORTNI .own of � ndover o No. r5 h ver, Mass, • A- coc«ic«ewrcw y1' 7d p�R^TED HPa,��y - S V BOARD OF HEALTH Food/Kitchen PERMIT T Septic System THIS CERTIFIES THAT .....16�M41.. � BUILDING INSPECTOR ........................... ... . ..... ............ ........ ........ has permission to erect .......... buildings on ....b.4 . ' ........ Foundation. Rough to be occupied as ..........5.!.........V........ ......... ..r........ ........................ 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 OPERMIT EXPIRES IN 6 NTHS - ELECTRICAL INSPECTOR • UNLESS CONSTRUC 0 TA Rough Service ............ .... ........... .......... ............... .. Final BUILDING INSPECTOR GASINSPECTOR 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 The Co oaswetzttdt r�f Massachusef!s Department of Industriad Accidents 0 ce cif rnvesi g4tions 600 Washington Street Boston' ,MA 02111 www.mass.govldia Workers' Compensation Insurance Affidavit: ]Builders/ContractorsfElectricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizatiorlindi+ndual); f464I Address: -- City/State/Zip lrhone. Are y An employer?Check the Appropriate box: Type of project(required): 1. I am a employer with 4, [] I am a general contractor and:1 employees(full and/or part-time). have hired the sub-contractors 6. []New construction listed on thea 7 lin 2.❑ I am a sole proprietor or partner- � . leached sheet. .. [❑Remodeling ship and have no employees These sub-contractors have g, Demolition working for me in;any capacity, employees and have workers' 9 Buildiaddition (No workers'comp,insurance cow. insurance.¢ n B required.] S. ® We are a corporation and its 14.[]Electrical repairs or additions 3.[❑ 1 am a homeowner doing all work. officers have exercised their 1 i.[]Plumbing repairs or additions myself.[No workers' comp. right of exemption per MGL t2.[]R frepairs ittsttrance required.]t c. 152,§1(4),and we have no. employees.[No workers' 13: Other comp. insurance required.] *Any applicant that checks box#l 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 anew affidavit indicating such. Cant actors that check this box must attached on additional sheet showing the name ofthe sub-contractors and state whether or not those entities have employees, ff the sub-contractors have catptoyces,they must prcrvide their workers'comp,policy number. I am an employer that is prop1ding workers'.cornpensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:_ Policy#or Self-ins.Lie.#: L431F! ��j Expiration Date: Job Site Address: City/State/Zip:' Attach a copy of the workers' compens2on i4cy declaration page(showing the policy number and expiration date), Failure to secure coverage as required under Section 25A of MGL c, 152 can lead to the imposition of criminal penalties of a fine tipto$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$250.40 a day,gg.Rinst the violator. Be advised that a copy of this statement may be forwarded to the Office of Investi ations of th IA or insurance coves e verification, I do hereby cerci urs r tie and enalties ofperjury that the information provided above is true and correct Si at urm Dat hon #: 1 Official use ors y. .Do not write In this area,to be completed by city or town official. City or Town: Pernlit/License# Issuing Authority(circle one): . 1.hoard of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S. Plumbing Inspector 6.Other i Contact Person: Phone#: l -1C . � � iglati:oli anc �usiriess g 11r� e 0 .Consumes Affair r. C. „ FIJI .. 10"parlfPlaza - SuA6 5170 oton9 ssachuse-ts:02 6' onlxacto�c• egis i �:0 f • -_ �-_� �: prose � . . . . .. _;. . • • • . ' `� Repistrtfort: 12109.3- T 12189.3 = Type;.-`Supplement Card .• w F;cPlraUon: 8/3!201�6 ' . . . 7 1 1-ivrle ' i��® � i-ic�rle �rvi `� - J 1 LA "'.TLANTA.; GA 30339 �civ�A y•.�� Update Address en'd rctu:rn card.Mtirk rcnsoti for chnngc. r 10 rtrcnt l Lost Cnrd �-A6dress [] Rcnctivel' .(�'.�mp y. : me `��L:3 lUfYl)L1PSf.VJiLU�2Ll . Alice of'onsumcr Afrnirs&Business Rev afOn.'; ���or�41te eXpirattoC or in d te.!if foundlreturn to only «;Ulil(;IMt'FicrV firl�iT t�30i�l�lRADT�i;a. Il r kli r ®thee aiConsumer Affairs and Business Rc�ulntiors i r'J F;ecitstratio� p'.�788�J3 ` ..Typo. 30 ParkPlaza-suite. 517.0 : ;� rT / piraf(bh......... ' a supplement Gard bRQ9tori,MA 02116 1 10�71E7 Dcpt'J{ri/X{ �1fIGi ` E�rViGUS ' ', J l U :_�AeCt1(v1LLRLAIVD�'`btfl7V r+5 �► of vntld}vith u fst nature ' n a Gr''.3CJ335`r ' iindersecrefar� .' ACC>RaCERTIFICATE ®F LIABILITY INSUR NCE DATE22/2/Y2 10/22/2012 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 BETWEEN 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,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 1-866-966-4664 CONTACT Marsh USA Inc. -NAME: PHONE FAX AIC No.Ext): A1C No), homedepot.certrequest@marsh.com E-MAIL Two Alliance Center, 3560 Lenox Road, Suite 2400 ADDRESS: �— Atlanta, GA 30326 _INSURERJ§ AFFORDING COVERAGE NAIC_#___ Fax (212) 948-0902 INSURER A: Steadfast Ins Co 26387 INSURED INSURER B: Zurich American Ins Co 16535 The Home Depot, Inc. Home Depot U.S.A., Inc. -INSURER C: New Hampshire Ins Co 23841 - ------- ---- 2455 Paces Ferry Road NW INSURER O: Illinois Nati Ins Co 23817 Building GA GA 3 NATIONAL UNION FIRE INS CO OF PITTS 19445 Atlanta, 30339 INSURERS: _ INSURER F: Illinois Union Ins Co 27960 COVERAGES CERTIFICATE NUMBER: 29786745 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LIMITS LTR POLICY NUMBER MM/DDIYYYY MMIDDIYYYY A GENERAL LIABILITY GL04887714-02 03/01/1 03/01/13 EACH OCCURRENCE $ 9,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED - 1,000,000 PREMISES Ea occurrence $ CLAIMS-MADE �OCCUR MED EXP(Any one person) $EXCLUDED X LIMITS OF POLICY XS 9,000,000 PERSONAL&ADV INJURY $ X OF SIR: $1M PER OCC GENERAL AGGREGATE $ 9,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ 9,000,000 X POLICY PRO LOC $ B AUTOMOBILE LIABILITY BAP 2938863-09 03/01/1 03/01/13 COMBINED SINGLE LIMIT Ea accident 1,000_,0_00 _ - ___ X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X SELF INSUR D PRY DMG $ UMBRELLA LIAB HOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WC STAT U- OTH- C � YIN AND EMPLOYERS'LIABILITY WC019736915 (AOS) 03/01/1 03/01/13 X RYLIMITS._ _,R_-_— . D ANY PROPRIETOR/PARTNER/EXFCUTIVE 1WC019736917 (FL) 03/01/1 03/01/13 E.L.EACH ACCIDENT_ $ 1,000,000 OFFICER/MEMBER EXCLUDED? L-• J NIA - - - -"--- E (Mandatory in NH) WC019736916 (CA) 03/01/1 03/01/13 E.L.DISEASE-EA EMPLOYEE $ 1,000,000__ If yes,describe under 1,0 0 0,0 0 0 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ E Workers Compensation WC1192494 (QSI) 03/01/1 03/01/13 SIR (AOS)/SIR (GA) 1M/750,000 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/1M DESCRIPTION OF OPERATIONS I LOCATIONS/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 ATLANTA, GA 30339 � Qti Cts IniL<L ht.}Ct USA U ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD fallen 29786745 JAN-24-2013 11:04 From:KEN SANDELL RSW 603 782 8726 To:Home Depot AHS P.1/6 HOME IMPROVEMENT CONTRACT PLEASE READ THIS Sold,Furnished and Installed by: Branch Name: Boston Date: THD At-Home Services,Inc. J2J,�3, d/b/a The Home Depot At-Home Services 908 Boston Turnpike,Unit 1,Shrewsbury,MA 01545 Toll Free(800)657-5182;Fax(508)$45.6017 Branch Number:31 Federal ID#75-2698460;ME i.ie 4 C 02439;RI Cont.Lien 16427 CT Lie iI HIC-0565522;MA Hume Impmvcmcnt Contractor keg.#126893 installation Address: LJ K - Altmx ,A104166AIDJAf MA 018`I,� Cdy State Zip Purchasor(s), Work Phone: Home Phone: Cell Phone: KSeNto\ e [ ] [ ] [a7Fr�g2og-67 Home Address: (If differert from Installation Addrrss) City y� Spate Zip nail Address(to receive project communications and Home Depot updates): /V 1 Ch 13?uGY�@r VAkdoaam �J I TSO NOT wish to receive any marketing emails from The Home Dcpot If Proice 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("instsdlation')of all matcnals described on the below and on the referenced Spec Slteet(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#1 if---tad...1 Cee % # Project Amount f"I overt vers� iDom �t1tSUlat10R 4-796-71 $ ' LI arir+s/CAvetB Doors (� t1 UR,00ft OSxhng Windows U Insolation ❑Gutues/covers aentrylkwes Q, $ L]RoofwUSuling 0 Windows El Insulation QsOuteer /Corns©Entry t)nnrs r_1 $ Roofing ElSiding El W-aJuws lrisulation QGutters/Covcrs OlEntryDoors EL_ V� Q KInfir®25%Dwadt otContrad Amoautdut upua cxmdinn otttes,contract. Total Contract Amount S 1 Maine Pardmets nuy riot deposit more than*r*4bW 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 Conttraact. `''/� Payment Summary: The Payment Summary#�S- included as part of this Contract,sets forth the total Contact 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, Du not sign a Completion Cerdfleate(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 net 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.DEPO'T'S OTHER REMEDIES FOR RECOVERY OF SUCH AMOUNTS. Acceptance and_Authorization: Customer agrees and understands that this Agreement is the entire ugrecmcnt between Customer and The Homc 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. 1 Suba=&:&A x %� C /l 3f/3 X t 17,2.113 Customer's signawre Date Sales Consultant's/S�iPah— 1 Date xTelephone No. OV?" SZ 1- Scil , Customer's Signature Date Sales Consultant License No. CANCELLATION: CUSTOMER MAY CANCEL THIS fsswplicable) 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 19 SPECIFICALLY PRESCRiBFD BY LAW IN CUSTOMER'S STATE. NOTICE:ADDITIONAL TERMS AND CONDr17DNS ARE STATED ON THE REVERSE SIDE AND ARE TART OF TRIS CONTRACT OS-1042 Whirs-SranchFao Yalow-Customer Jan. 24. 2013 8:58AM FA)c cd OD- p,�s 82�030 AT-HOME Job # � � To whom it may concern, Re: address= Concerning the above location, We give the-Home Depot approval to install Number of winds Style ( Double Hun asement,'name type) Uv C4 V/V Color. Manufacturer l r'r.)p A/ Exterior finish as agreed to be PVC (wrap trim)? color VyI A We agree to the grid or lack of grid configuration Are grids between the panes of glass? Le 4 As stated these proposed windows do meet with the Condo Management approval.- Signed- pproval._Signed Print name 6MA4- -Title e/'ZC!/P Phone Date-- { Location / No. ate - /3 o ��a,C�Cccn.�mg6. TOWN OF NORTH ANDOVER • o o Certificate of Occupancy $ Building/Frame Permit Fee $ ?, = Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check 26138 Buil ing Inspector