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HomeMy WebLinkAboutBuilding Permit # 11/21/2016 t ORTN BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR.PLAN EXAMINATION ', Permit No#: r� ° �_ 17 Date Received_ 4�ATED ACHUS Date Issued: 1WORTANT:Applicant must complete all items on this page l L 06-ATION ' Print° PROPERTY OWNER � � i "� . PARCEL: �, .�� ZC7NING DISTRIC°T: 1DDYearSt'r�rcture y MAPPrint es ` Historjc District yes no Machine Shop`✓illage yes _no TYPE OF IMPROVEMENT PROPOSED USE _ _ Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: - ❑ Commercial EXRepair, replacement ❑Assessory Bldg ❑ Others: 0 Demolition ❑ Other El Septic Q Well ❑ Floodplain 0 Wetlands 0 VVatersl ec District DE CRIPTION OF WORK TO DE PERFORMED: , Identification- Please Type or Print Clearly OWNER: Name: " � y, `6 "y F ��� . Phone: ✓ .. Address: , -------- _ . hone _ �4 Contactor Nar-ne: ���° �,���°,.�, _ � Address`. Supervisor's Construction License: � L C)17116. Exp: Date: JLHarare Irnproy�ment License � �-/ ?. �,�°` '". Epp. Date I i ,�°� ARCHITECT/ENGINEER Phone: Address: _ Reg. No. FEE SCHEDULE;BULDING PERMIT,$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Dotal Pr0]e t CSO t: $ 2 FEE: Check No. �._..__._._. Receipt No,: � � � NOTE. PeYyons contracting with unregistered contractors dna not have:access to the guaranty fund Sc nature of eritfC7wr� r ' Si n--tUre cif contractor= g __.9 -- - . ..9_- .._... tAORT Town of -W Andover ® S. 0 No. _ 3 h ver, Mass, ^C' O LAKE .� ➢' COC NIC KgwacK V ATED BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT54041.001 . ...... .. A. Af .. BUILDING INSPECTOR has permission to erect ... buildings on .. ... Foundation ®® Rough to be occupied as ....... .. ...... .�. .. .. .. .. ..... P. ...... .. .. ............... Chimney provided that the person accepti g 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 LES T 1 Rough Servce .................. ............................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Kermit Required to ®ccu BuRough 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. 'rhe HlPhert pualltrWlndoWa' - - 1-'800-693-1307 7 Rolling Hill Avenue Fed ID 20-0124453 Plaistow, NH 03865 MA License 140588. Name Phone# Work# Address City r State Zip I/we,the o ne f the premises described above,hereinafter referred to as"Purchaser"offer to contract Seacoast Replacement Windows,to deliver and arrange for installation of all materials to improve the premises. Not Included Includes Obtain all insurances and permits © ,' Re-measure all openings to ensure a custom fit pyy Remove existing windows and install vinyl windows. "Total new windows 0 Wrap outside jam O 1 Remove existing windows and install a new viny ba or bow with all new unpainted,unstained interior casing and app priate trim on the outside O - Install and shingle a custom made roof to 6t bay or bow if no overhang exists within 18" 'ii. I/+ s Remove existing windows and install a new vinyl garden window with the interior casing and exterior wood trim # p Cleanup of all job related debris D Issue manufacturers limited warranty ❑ Special work :b r6"JI-61 ', Contract price Deposit Balance ' ` _ If this is a credit transaction,the-agreemenCf'or\edit is contained on a separate document. (Due by or upon completion) All home improvement contractors and subcontractors shall be registered and that any inquires about a contractor or subcontractor relating to a registration should be directed to:Director,Home Improvement Contractor Registration,PO Box 871,Taunton,MA 02780-0871 508-821-9375 I/We the undersigning are hereby authorizing Seacoast Replacement Windows to verify and review my/our credit record with an independent credit reporting agency and release them from all liability incurred from inadvertent omissions or errors, Verbal understandings and agreements with representatives shall not be binding. All understandings and agreements must be set forth in writing in this contract or on an attached addendum. Work will begin in approximately to weeks. You the purchaser may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. All warranties on the owner's rights under the provisions of 780 CMR Rb and MGL c 142A Purchaser understands and agrees that if this arrangement is cancelled after measurements have been made and production cannot be cancelled,complete deposit is forfeited. if production'-can be halted,a$100.00 measurement fee will be withheld. DO NOT 51' J THIS CONTRACT 1F THERE ARE ANY BLANK SPACES Signed Date Signed � at'e Re r entative Signed �� ,WIG Purchaser{ Information and. Instructions Massachusetts General Laws chapter 152 requires all employers to provide worlt:ers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in tho service of another under any contract of we, express or implied,oral or written:' An employer is deffibd as"an individual partnership,association,corporation or other legal entity,or any ttivo or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receivbi'ox trusted o1 art individual,partnership,association or other legal entity,employing employees..Ho-,vever the owner of a dwalliug house having not more than three apartments and who resides therein,or tho occupant of fEe dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer" MGL chapter 152,§25C(6)also states that"every stato or local licensing agency shall withhold the ismartce or renewal of a license or permit to operate a business or to constrict buildings in the commoxrwealth for any applicaztt wh6 Ras not produced acceptable evidence of compliance with the iusur ance coverage xequi)red." Additionally,MGL chapter 152, §25CM states`Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority," Applicants Pleasb fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub contractor(s)name(s),addresses)and phone number(s) along with their certificate(s) of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the rtr emb ers or partners,are not required to carry workers'compensation insurance. If an LLC or LLP dohs have employees,a policy is required. B e advised-that this affidavit may be submitted to the Department of Industrial Accidents for confa atiou of insurance coverage. Also be sure to sign and date the a:ffidawit. The affidavit should be returned to the city or town drat#fie application fox the permit or license is being requested,not the Dopar-tment of Industrial=Accidents. Should you have ani questions regarding the law or if you are required to obtain a workers' compensation%policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license,number onthe appropriate line. City or Town Officials Please be suze that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to.jM out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permithieenso number which will be used as a reference number. ht addition,an applicant that must submit multiple permit/license applications in any given year,meed only submit one affidavit indicating current policy information(if ncoessary)and under"lob Site Address"the applicant should write%111 o cations in (city or town)."A copy of tho affidavit that has b eon officially stamped or marked by the city ortown may be provided to the applicant as proof that a valid affidavit is on file for Unro permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog heezrse or permit to burro leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The, Commo:awealth of Massachusetts Department of Industrial Accidents Z Congress Street, Suite 1.00 :Boston,MA 02114-2017 Tel. #61.7-727-4900 ext.7406 or 1-877-MASSAFE Fax#61.7-727-7749 Revised 02--23-15 wwwmass.gov/dia ja'j0j5SjuJW00 -83.LS3143 9£0£0 14N 'di-S -a-a NVAj-jjnS;:INHOr ,,�AjadnS Uc)qonj1su00 ftietoads946660-ISSO r)u!pjjng 10 P,209 Pula SU0111Clnbeadba swupLYS -�10 u �!jqnd 10;UaLu Office of Consumer Affairs and Buslness Regulation 10 Park Plaza Suite 5170 Boston, Massachusetts 02116 Home Improvement C69tractor Registration Registration: 140588 Type: Partnership Expiration: 11/3/2017 Tr# 273002 SEACOAST REPLACEMENT WINDOWS: JOHN SULLIVAN 7 ROLLING HILL AVE PLAISTOW, NH 03865 Update Address and return card.Mark reason for change. Employment Lost Card n Address F] Renewal License or registration valid for individul use only piner Affairs&Business Regulation Office orcons n date. If found return to: before the expiration HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 140588 Type- 10 Park Plaza-Suite 5170 Expiration- 1113120.1.7 Partnership Boston,MA 02116 'ST REPLACEMENTWINDOWS ULLIVAN IG HILL AVE )W,NH 03865 Undersecretary Not valid without signature