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HomeMy WebLinkAboutBuilding Permit #82 - Exception 8/1/2007_ BUILDING PERMIT ,TOWN:OF,;NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received TYPE OF IMPROVEMENT PROPOSED USE - - Residential Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family, ❑ Industrial C<Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg Others: ❑ Demolition ❑ Other t`t g � � � t c al Wit a Ids ". � ate�stae� t astnc TV UtSGKIF 11UN ur vvum v o� rn�wr�■��• MSM) & 1106Us ISG -&, C& &- -r Z 'X-2 ' T�ieoP C /UN�a 1CinIi.SN /f'T % �S IPG TD L G1SC') 4s W )-5M L Y A5W7 Please .Type or Print Clearly) OWNER: Na 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: $ 7.3/. FEE:) -f $� Check No.: yc� Receipt No.: v e NOTE: Persons coWtractin ith nregj;ypred contractors do not have accesspt e uara�Ofund 4 Plans Submitted Q� Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer K Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ 4.. THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED. HEALTH ❑ ❑ COMMENTS Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature Date Driveway Permit Located at 384 Osgood Street 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.s100-s1000 fine Doc -Building Permit Revised 2007 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 NOTE: 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 ❑ Copy Of Contract ❑ Floor/Crossection/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 ❑ 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 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location / Svrn ell f - No. 0 Date ! O MORTh TOWN OF NORTH ANDOVER C�r�ao ,a'�ti � 9 t ♦ i Certificate of Occupancy $ i J�CMUs Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 901. 204SI Building Inspector � ff S i I - i Qi y I - "i_ F y - _, i y I + • c L J CD ca O V X N 2,0 CL o ^ --1: - - -- ---; - - \ A 7 N v� i0 iLM 6 le - i -— - X m ° O a rnE co Cr Qo U, ak - —i- - - — ;• 3 0 w v i v i �- 00 r `/® \ (np �" Jt Ir 77 z m a m t E^.J in c in d LL �• ~ C e � __hl � � J ✓y V" Z . fS - L UJ .L a o Y F_ � D" U cn J� �VL x�l W _bo�. Z t w O O FM4 e WD V) rl S. VA JV Q W3 � H Yi 0 FW - T 1 10 o Q I'�r G0� �N o' 7ML C O O. Q m C = m x +O, CL 0 F- ee = m uiV� •N O C LU oc E dZ +-� v v y 92Mh O. O� O.fl = W H O =sa m a no °cc u� v ►� w b Lm a a .� W .a, c ,� $ LE cM o w o w U w" o rx w" c rx w o rx is", CE cn cn JV Q W3 � H Yi 0 FW - T 1 10 o Q I'�r G0� �N o' 7ML E Z C* 0 a N cm C S m O co C C N m 0 Z 0 cm O w w P-4 W Paw.;IM 0 U v iJ tl, Ccm C O•� CA Q-0 ' . m m Z O� �3 m m Q LM 0 CL CMa Cc v C .Z CD 0 CL V y O C C CA Q W ��o vI W W C9 W U) C O O. Q m C = m +O, CL 0 F- ee = m uiV� •N O C LU oc E dZ +-� v v y 92Mh O. O� O.fl = W H O =sa m E Z C* 0 a N cm C S m O co C C N m 0 Z 0 cm O w w P-4 W Paw.;IM 0 U v iJ tl, Ccm C O•� CA Q-0 ' . m m Z O� �3 m m Q LM 0 CL CMa Cc v C .Z CD 0 CL V y O C C CA Q W ��o vI W W C9 W U) OP ID E AMR -D. CERTIFICATE OF LIABILITY INSURANCE BAOPID DATE (MMIDDlYYW) 03/02/07 PRODUCER Kaplansky Insurance Brookline 114 Harvard Street Brookline MA 02446 Phone: 617-738-5400 Fax:617-738-8214 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED B ystate Basement System LLC D60 T Owens Corning Finishing 960 Turnpi02021 Canton jNvII��, INSURER A. Norfolk & Dedham Group 13,943 INSURER B: INSURER C. INSURER D. INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED REAMED 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR NSR TYPE OF INSURANCE POLICY NUMBER DATE (MM/DD/YY) DATE (MMIDDIYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1000000 COMMERCIAL GENERAL LIABILITY PREMISES (Ea occurence) $ 100000 CLAIMS MADE a OCCUR MED EXP (Any one person) $S000 A X Business Owners R0309626 02/06/07 02/06/08 PERSONAL&ADVINJURY $1000000 GENERAL AGGREGATE $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ Excluded 7X POLICY jELOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ BODILY INJURY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY HIRED AUTOS NON -OWNED AUTOS (Per accident) $ PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESSARVIBRELLA LIABILITY EACH OCCURRENCE $ OCCUR F] CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND IA TORY LIMITS ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ ANY PROPMETOR/PARTNER/EXECUTIVE E.L. DISEASE - EA EMPLOYEE $ OFFICERI AMBER EXCLUDED? It yes, describe under E.L. DISEASE - POLICY LIMIT $ SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES / EXCLUSIONS ADDED BY ENDORSEMENT/ SPECIAL PROVISIONS Job Loc: 195 Lynn Fells Parkway Melrose MA CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL City of Melrose IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR Building Department 562 Main SL REPRESENTATIVES. Melrose MA 02176 A II.E TIVE ACORD 25 (2001/08) ©ACORD CORPORA s MAR 02,2007 12:40 ., page 1 3 Board of Building Regulati6ns and Stan ards One Ashburton Place - Room 1301 Boston. Massachusetts 02108 Home Improvement Contractor Registration OWENS CORNING BASEMENT FINISHING DANIEL WALSH 60 SHAWMUT PARK CANTON, MA 02021 'S-CA1 0 SOM-05/06-PC8490 Reqistration: 137943 Type: Supplement Card Expiration: 1/29/2009 Update Address and return card, Mark reason for change. Address Renewal Employment Lost Card U BOARD OF BUILDING REGULATIONS License: CONSTRUCTION SUPERVISOR Numbet: t$ 079893 Birthdate 1010521962 Expires 10/05/2007 Tr. no: 6491.0 Restricted Ot) DANIEL F 488 KENDALL LL RD RD TEWKSBURY, MA 018.7.6" Commissioner QCow. CERTIFICATE OF LIABILITY INSURANCE OP ID S BAYST-1 DATE(MWDDIYYYY) 05/24/07 Andrew G. Gordon, Inc. 680 Main Street PO Box 299 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY NUMBER Norwell MA 02061 phone: 781-659-2262 Fax:781-659-4725 INSURERS AFFORDING COVERAGE MAIC# INS<IRED Bay te Basement systems , LLC dba !Sta us Corning Finished Basement System 60 Shawmut Road Canton MA 02021 A- INSURERRenaissance Group rSUIIRER B: INSURER C: IRSURERDr. NSJRER E: 0 Arca v THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED RAND ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIRENENr. TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY pERTAK THE INSURANCE AFFORDED BY THE POLICES DESCRIBED HEREIN IS SUB.ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. NSK LTRTYPE OF INSURANCE POLICY NUMBER DATE 0"UMM DATE (MMtDDIYY) LJMTS GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE D OCCUR EACH OCCURRENCE = i PREMISES (Ea ocarmw) i MED EW (Any ane prion) i PERSONAL a ADV NJURY . i GENERAL AGGREGATE i GENL AGGREGATE L94T APPLIES PER: pgxY PPRRO- LOC PRODUCTS - COI+P/OP AGG i AUlTOMOBLE LTABLITY ANY AJTO ALL a NNED AUTOS SCHEDULED AUTOS HIRED AUTOS NON-0WNED AUTOS COMBINED SINGLE LIMIT i (Es sodden) BODILY KLI RY (Per person) i BODILY LU RY i (Per accident} PROPERTY DAMAGE ; (Peracow") GARAGEUABLIN ANY AUTO AUTO ONLY -EA ACCIDENT i OTHER THAN EA ACC i AUTO ONLY: AGG i EXCESSIPUMBRELL►LIABILITY Occm F-1 CLAIMS MADE DEDUCTIBLE RETENTION i EACH OCCURRENCE i AGGREGATE i i i i A WORKERS COMPENSATION AND EMMOVERS'LIAIMM � amvE If yes.descsibeunder SPECIAL PROVISIONS beloM WC 0371527 05/24/07 05/24/08 TORY LIMfiS ER E.L.EACHAOCIOENT $1000000 E-L•DISEASE -EA EW LOWE $1000000 E.LDISEASE-POLICYUMR i 1000000 POTHER DESCFWTM OF 6PERATIONS I LOCA7KM 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Pe.YTim-ATF HOLDER CANCELLATION MISCII+L SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLM BEFORE THE EXPIRATION DATE nE tE0F. THE ISSUING INSU m WLL aDEAVOR TO MAL 10 DAYS WRITTEN Bay State Basements NOTICE TO THE CERTIFICATE HOLDER NAM TO TME LEFT. BUT FAILURE TO DO SO SHALL for record purposes MOOSE NO OBLIGATION OR LMU Y OF ANY 1QO UPON 7:E ITS AGENTS OR fMPRESMATNES. D 25 (2M/08) 0 ACORD CORPORATION 1988 The Commonwealth of Massachusetts Department ofIndustrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers _Applicant Information Please Print Lezibly Name (Business/Organization/Individual): ,1,dews C effwai &5noyezeT' SYsme Address: %D SAA1/Y UT R0" City/State/Zip:�i�•&YM1J MA 02OZ1 Phone.#: VLY21-0060 Are an employer? Check the appropriate box: 2-V 4• ❑ 1 am a general contractor and I 1. rJ I am a employer with employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet ship and have no employees "Mese sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance COQ # 5. ❑ We area corporation and its required.] . 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t c. 152, §1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): - 6. ❑ New construction 7. Q<emodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions I I.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *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. tContractoms that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have employees. If the subcontractors have employees, they must. provide their workers' comp. policy number. I am an employer that isproviding workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: " 1_59AAA66 640 UP Policy #. or Self -ins, Lic. #: 4& 037497 Expiration Date: Job Site. Address: q u?mm / T S77wo - City/State/Zip: A) A&W W Attach a copy of the workers' compensation policy 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 tip 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 apinst the violator. Be advised that a copy of this statement may be forwarded to the Office of I do hereby use City or Town: of perjury that the information provided above is true and correct. not write in this area, to be completed by city or town official 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 #: CONTRACT TO INSTALL OWENS CORNING BASEMENT WALL FINISHING SYSTEM Owens Corning Basement Finishing Division (the contractor) hereby submits this proposal to sell and install the Owens Corning Basement Wall Finishing System and related items as described herein at the residential premises set forth below. This proposal shall not become a binding commitment unless and until it has been signed by the Contractor and the Customer. t �'i Contractor: Owens Corning Basement Finishing Systems a division of Bay State Basement Systems, LLC. 60 Shawmut Road, Canton, MA 02021 Telephone # (781) 821-0060 , r"OWENS ® Facsimile # (781) 821-8552 Federal Tax ID # 14-1855297 Mass Home Improvement Contractor Reg. # 137943 Date _7116170 Customer: / Customer Name Ria /" f C Iwn a'1-./ 5 U/qq 1114 Street Address `U'' //'�f'LAS CNN- State. Zin Als ✓ AT 1711C Z' -p ,r- "AL Telephone ( � / 0 ) i� S)> 5_ �a 6 This is a contract between the Contractor and the above named Customer to sell and install the Owens Corning Basement Wall Finishing System and related items specified herein at the Customer's residential premises identified below: Installation Premises: Street Address ( 5' 9M H'1 // City, State, Zip rAl, A z,- o w t_ 11-r 0/'PV 5— Scope •of Work: Are Sketches and/or specification sheets attached? IlPf-e's- . ❑ No *All attachments are incorporated into and become a part of this contract Description of Work/Specifications: (9—PI,,/Ij 13,.- RfAII ►7`' - 2 'S��l� C/ a�f G/C 1 pe Me �" S i l�'uyr <.'t ft iO�.r tsl!�llt f0/rr �/�/S f��%r✓ L9'•'�1 f f'� r kclezj/r[� el stn ,`ti`s " -4- (��� � �w,`TC` I , "Tri-�. �t� o �,�,�� 'Er�a'bi�- �ef ek�--r, �� t-'-�'�i��t�77i��- �if c?%�Grnlv�G'�n�i�-.'T�-Ccl_a'E_,:L.�G�.fC/PS• �e✓r-if��S � 4eGs^%�/c��•`'%�?� a�i� C ke'l 1-1,00 pion 'Ae r- Cash J��E : �� �'C� tJ7C �w �f cif i�cs�r orf fro <j� A F/,,�4— Work Schedule": Approximate Commencement Date: 7A_ I l? . Approximate Completion Date: /VATXI "*The proposed work schedule is approximate and subject to change Contract Price: Total Contract Price: $ Deposit with order: s 3) f� d - ❑ Cash 121�'6heck # LIP 62 Balance Due: � $ , Terms: � Cash Ofinance (Cash terms are 10% deposit, 50% on commencement, 40% on completion) / 7 4 - rli in nn 1 eimmnnncmnnt DO NOT SIGN THIS CONTRACT UNTIL ALL APPLICABLE BLANKS ARE COMPLETELY FILLED IN AND UNTIL YOU FIRST READ AND UNDERSTAND THE ENTIRE CONTRACT, INCLUDING ANY ADDENDUM ATTACHED HERETO, AS WELL AS ANY ATTACHED SKETCHES, MATERIAL LISTS OR THE LIKE, AND THE TERMS AND CONDITIONS ON THE BACK OF THIS CONTRACT DOCUMENT. YOU ARE ENTITLED TO A COMPLETE, FULLY EXECUTED COPY OF THIS CONTRACT AT THE TIME OF EXECUTION. Witness dur hand(s) and seal(s) below on this 7�4A day of Vel Bay State Basement Signatde and Title k Print Name DO NOT SIGN THIS CONTF1,ACT IF THERE ARE ANY BLANK SPACES PA ( i ku1 Print 7me Cus6w.-6r'Signature Print Name d - Nrur,S P f Contractor may have certain lien rights in the premises until the price is paid in full. You have the right to cancel this contract, without any penalty or obligation, at any time prior to midnight of the third business day after the date you signed this contract. See the notice of cancellation below for an explanation of this right. —Customer acknowledges receipt of a true copy of this contract which was completely filled in prior to customer's execution hereof. NOTICE OF CANCELLATION Date You may cancel this transaction, without any penalty or obligation, within three (3) business days from the above date. If you cancel, you will not be liable for any finance or other charges, and any security interest given by you, including any such interest arising by operation of law, becomes void upon such cancellation. In addition, any property traded in, any payments made by you under the contract of sale, and any negotiable instrument executed by you will be returned within twenty (20) business days following receipt by the Contractor of your cancellation notice. If you cancel, you must make available to the Contractor at your residence, in substantially as good condition as when you received, any goods delivered to you under this contract or sale or you may, if you wish, comply with the instructions of the Contractor regarding the return shipment of the goods at the Contractor's expense and risk. If you do make the goods available to the Contractor and the Contractor does not pick them up within twenty (20) days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice to: Owens Corning Basement Finishing Division 60 Shawmut Road, Canton, MA 02021 Phone: 781-821-0060 Fax: 781-821-8552 I hereby cancel this transaction. Date Customer's Signature n hereby acknowled a receipt of two copies of this Notice of Cancellation advising me of my to cancel. Date Custom is Sign re Date Co -Customer's Signature