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HomeMy WebLinkAboutBuilding Permit #248 - 10 CABOT ROAD 10/3/2007 TOWN OF NORTH ANDOVER �10RTM APPLICATION FOR PLAN EXAMINATION o* 0 i O Permit NO: Date Received /0-3—U 7 1# Date Issued: b' gCHl1SEt�� IMPORTANT: Applicant must complete all items on this page + LOCATION Print PROPERTY OWNER_7(`A?6-AJ G/}Is y F Pri nt MAP NO.: � ,O PARCEL: 003 ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Fj New Building One family 0 Addition 0 Two or more family ❑ Industrial 0 Alteration No.of units: Repair, replacement 0 Assessory Bldg 0 Commercial Demolition ❑ Moving(relocation) 0 Other 0 Others: ` 0 Foundation only DESCRIPTION OF WORK TO BE PREFORMED 1e6;:?06.q cE- 9 &11AJv0&j s No S�zu c�ci,e�9� Cry.4�✓E'F.� Identification Please Type or Print Clearly) OWNER: Name: .C'/L��L/G(,� Phone: 9'7r•680/• //66 Address: /O (,,,qa 6—T CONTRACTOR Name:AEVA/, ,qe Phone s0� 9/ O X90 Address: /d D"T/ s 1-X = /10,,e-A//3o.s? Supervisor's Construction License: 7 S/ Exp. Date: _ 9— O 9 _ Home Improvement License: / 4/9'(p d Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL EST/MATED COST BASED ON$125.00 PER S.F. Total Project Cost :$__ rF.3 7�, oo FEE:$ 96. °_ Check No.: 7/j Receipt No.: v�— / Page lof4 Location No. Date r �oRTM TOWN OF NORTH ANDOVER ; Certificate of Occupancy $ }�/7S'„•°E�� Building/Frame Permit Fee $ 96 '� 5 s�CMus Foundation Permit Fee $ Other Permit Fee $ i TOTAL $ Check # 20651r ``Building lnsOector TYPE OF SEWERAGE DISPOSAL Swimming Pools C Tanning/Massage/Body Art Public Sewer Tobacco Sales ❑ Food Packaging/Sales Well Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contracting with unregistered contractors do not have access to th guaranty fund Signature of Agent/Owner Signature of contract Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ' ❑ S amped Plan ❑ 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 V -i FIRE DEPARTMENT Temp Dumpster on site yes no Fire Department signature/date - COMMENTS Zoning Board of Appeals: Variance, Petition No: "Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Sinature& Date Driveway Permit III Building Setback ( Front Yard Side Yard Rear Yard Re wired Provided Require Provides Required Provided I / / Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use ' I I Page 3 ufd I Doc:INSPECTIONAL SERVICES DEPARTMENTBPFORM05 Created AMC.Jan._006 I r i Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. l Roofing, Siding, Interior Rehabilitation Permits i ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses t ❑ Copy of Contract ' ❑ Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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 I Doc:INSPECTIONAL SERVICES DEPARTNIEN'rMFORN105 I' +I 1 Page 4 of 4 NORTH ovm Of Andover No. 'Z o. , dover, Mass., Ad• 3•d I�O� COC MIC EwICK DRATED BOARD OF HEALTH PERM . D Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT............... ...•............................................ ............................................... "' """"""" Foundation has permission to erect..........................%............ buildings on .... ....... ........................................................ Rough to be occupied as..........� ..................................................................................................... Chimney . . . ... ... . . ... ..... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUCTIO_ STARTS Rough f Service B ', ING INS% ECTOR Final Occupancy Permit Required .to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 111 'u 600 Washington Street n � i ��iii ))4 Boston, MA 02111 " www.mass.gov/din Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): �jif�—� L ,�>✓ f�y(//��p ��—� Address:/!SL/ OT/'s s i�EGT City/State/Zip:d6l12 T•V&Uleo i�- 0/.f.32hone #: SZ,f_ 9/9• y�:9j Are you an employer?Check the appropriate box: Type of project(required): employees am a employer with 3y 4. F1I ama general contractor and 1 6. E] New construction (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. * 7./WRemodeling ship and-have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL I LEI Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance d.uire re t employees. [No workers' required.] 13.0 Other comp. insurance required.] *Any applicant that checks box#I 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 their workers'comp.policy information. 1 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site in formation. Insurance Company Name: Policy#or Self-ins. Lie.#:�- �-7�� �'��� Expiration Date: Job Site Address: 0,4-6 E-T "eO/¢s' City/State/Zip-NAZ/Qe),& e_ `y214 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date)O/g-y5 Failure to secure coverage as required-under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a tine 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. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do Ire eby certify nder the pains and penalties of perjury that the information provided above is true and correct. Si>na e: Date: 9- 2L• D Phone#: / .(> 9 9 v Official u e only. Do not write in this area,to be completed by city or town official. City or own: 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#: C-Nf4 Vst,d 10,IUD renewal BY ANDERSEN,wi*w.„pltiml,nt ., .. Customer Service 800-573-7606 10406, St.-Northborough,MA 01532•Main:(508)919.0900•Fax:(508)919.0903 - J&L Windows,Inc.dba Renewal by Andersen•Contractor License 0149801•Expiration Date 09/23/2008 W DOW AGR MENT / SOLD T0: DATE: (D -n /�f ADDRIE : PHONE-Home ft) CITY: C� STATE:�41P:QALr NE-Work: (_) JOB SITE ADDRESS(if different): E-mail: Approximate Start Date: Approximate Completion Date: -O-C' 1 SPECIFICATIONS Renewal by Andersa9pproved materials will be furnished and installed to these specifications: 1. Install total of. d s. 2. uantity of windows: ;qul Double Hung(DB) sash ❑Cottage sash(1/3 top,2/3 bottom) ❑Oriel sash(2/3 top,1/3 bottom) _Casement(CW) O Hinge right ❑Hinge left(as viewed from exterior):❑Standard handle ❑Metro handle _Double Casement(CDW) ❑Standard handle ❑Metro handle _Casement/Picture/Casement (CPW) ❑1:1:1 or ❑12:1❑Standard handle ❑Metro handle _2 Lite Gliding Window(GW) _Glider/Picture/Glider(GPW) ❑1:1_1 or ❑1:2:1 : _Awning Window(AW) Picture Window(PW) --�Bor Bow Window: 3. I�Yes ❑0 NSP #Windows to be Custom Fit Replacement: 4. ❑Yes ae pcA of sills to be replaced: 5. ❑Yes aKo #Windows to be New Construction Full frame(includes new interior&exterior casings): Exterior casings:7n^PIne ❑Maintenance-free material ❑Factory applied 908 Fibrex brickmold 6. Glazing to be: lSHigh P rformance ❑Other If other,please specify: 7. Exterior color to be: ,�,',,�8„r'ite ❑Sand ❑Canvas ❑Terratone . 8. Interior color to be: LVfVVttite ❑Sand ❑Canvas ❑Terratone ❑Wood Note:Interior color can only be white,wood or same color as exterior. Wood interiors need to be finished by cust. 9. Hardware: VAite ❑Stone ❑Canvas❑Brass Double Hung: Install lifts? ❑Yes J15'fG'b 10. ❑Yes. Removal of metal frames or grilles #of Units: 11. ❑Yeso Install new paint-ready or stain-ready casings. Inside or outside stops#of openings: Interior casing#of openings: Exterior casings# f o ngs: 11 Pine 13 Maintenance free material 12.Custome,,r,,a��, re that RbA does not do any painting. St.initials 13. O Yes �No Wrap exterior casings with aluminum col stock: calor. Note:Required with storm w!,palow removal.Removal of storm windows will leave screw holes in casing. 14. New windows to have: UKalf or ❑Full screens Screens to be: "iberglass ❑Aluminum 15.Windows to have grilles: Co'es ❑No If Yes: 9115Ile Between Glass(GBG) ❑Removable,Interior Wood(INTW) - ❑Fyl{Divided Light(FDL) Grille patterns: - T I DH DH DH DH CW/Picture Glider �tra GPW 'use ad 'tional sheet if needed �� Customer approved(initis 16. gr3jps ❑No Insulate,caulk and seal windows with three-point system to prevent water and air 17. VYes ❑No Remove and dispose of existing windows and storm 18. As ❑No Clean Up. All job related debris removed.Vacuum nightly. 19. Y,, s ❑No Insurance. All workers compensation and liability insurance maintained. 20. lid'Yes ❑No Warranty.Given to customer upon completion and receipt of full payment. 21.Additional information: 22. Regular Retail Price:$ dA ,�� � 23.Total Project Amount:$ All available discounts have been applied:1b 11es ❑No _ 24.Is Project to be paid in❑ sh ce13Inand Combination of Cash and Finance 25.Cash Deposit(1/3):$ C _ 1/3 of balance due at start of job and final 113 due at completion of job. - e., �fining 2/J payment is made by credit card an addition a /3%will be added to cover f e charged by_C(@d'Car 26. ❑NoFinanced. If Yes,fvnount Financed: (Account#:4f r(7�,�`i s/ )27. _ �, ❑No Customer agrees to be present on the final day of installation for final inspection and to deliver final payment. -- �- 28.; es ❑No Homeowner gives RBA approval to place a yard sign on their lawn at the time of measure. 29.%Wes ❑No Building Permit-As a convenience the company will secure the building permit.The fee for the- permit is not included in the agreement price and a separate check is required at the time of sale for this fee.Cit Q dfC� RENEWAL BY ANDERSEN'IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS OR CONDITIONS THAT COULD NOT HAVE v BEEN SEEN PRIOR TO OPENING THE WALLS. PLEASE REMOVE ALL SHADES.VERTICALS,BLINDS,CURTAINS,DRAPES OR WINDOW MOUNTED AIR CONDITIONERS,AND ANY FURNITURE AT LEAST SIX FEET AWAY FROM WINDOWS AND DOORS PRIOR TO THE INSTALLATION OF YOUR NEW WINDOWS. INSTALLERS ARE NOT RESPONSIBLE FOR THE REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS.•SALESMAN HAS NO AUTHORIZATION T 0 O CHANGE ANY ITEMS OR MAKE ANY REPRESENTATIONS OTHER THAN CONTAINED IN THIS AGREEMENT AND`OWNER'REPRESENTS THAT NONE HAVE BEEN MADE T0,OR RELIED UPON BY-OWNER.-YOU ARE ENTITLED T A COMPLETELY FILLED IN DUPLICATE OF THIS AGREEMENT.'CONTRACT SUBJECT TO FINAL INSPECTION BY RENEWAL B O BY CONSTRUCTION DEPARTMENT.'TERMS AND CONDITIONS THAT GOVERN THIS CONTRACT ARE PRINTED ON THE REVERSE SIDE. This contract is a legal document Your Renewal by Andersen products will be especially made-lo-order for you.UNDER NO CIRCuNSTANCE t^ LL BEIIIISIONS OR 1,614chmio BE 1 Y AFTER THE SIGNED AND- 1ABOff. RREIPRODUCTS YOU ARE \ CIRDERING ARE CORREn RbA Rep.Signature: rr44 1, � Customer i natu �1 'Customer Signature: While-Renewal by arson Yellow-Installation Pink•Homeowner ��ie ����.zurealt/ a�✓�aaoac�u�oe� Board of Building Regulations and Standards 'G Construction,.Supervisor License Liceits'e '=CS 74251 Birthdate 3/x%1963 Expiration 3/g/2009 Tr# 11065 _. _ Restricilon� 00��t JOHN K ESLER 104 OTIS ST NORTHBORO, MA 015324 4 Com ' mission er ✓�cP C000nmzoozraealC�t ��i'ixaaczc/zuQ Board of Building Regulations and Standards i=' HOME IMPROVEMENT CONTRACTOR Registrafgr ; i49601 Expiration 2008 Type Supplement Card RENEWAL BY ANpERSONt " f KATHLEEN BLANCHAf�Q, 104 OTIS STREET' NORTHBOROUGH, MA 0132 Administrator I i AC"OR CERTIFICATE OF. LIABILITY INSURANCE. . .0910712007 PsaoutfEtt THIS' CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION JOSCph.MI;KEaone ONLY AND :CONPERB NO RIGHTS UPON THE CERTIFICATE J.P.MCKeone Insurance Agency, II1C: HOLDER THIS CERTIFICATE DOES' NOT AMEND, EXTEND OR ALTER THE:COVERAGE AFFORDED 13Y THE POLICIES.SELOW, R;t7 Boz 333 Aran arbor,.MI 48106-0333; 1WRERS AFFORDING GOVERA0E �c IH3uic a. Roncwal.by Ant owty INSULA It A. "Bard it ?r, ��n7L.W:_ J&:L Windows Inosir�a 104 Oft.St i IusuREE�c NoElhbtzroudh,MA 01532: INsupok I INSURERS .COVERAGES ... —�: THE POLICIES:OF INSURANCE.LISTED SELOW HAVE SEEN ISWE6 TO THE INSURED NAMED ASOVE FOR THE.POLICY PERIOD.IN©CATEO NO.TWETHSTANDING. _ ANY':EII;fJEJIRERMEz.NT,.TERM 0R. CONDITION-OF ANY:OONTI ACT OR OTHER.00CUMENT WITH:RESPECT.;TO•W ICH THIS:GERT1FiCATE MAY-DEa issUED OR -- MAY'P>rE� MN,:THE INSiIRANO :AFft?RDEL1 BY FHE P.OLtCIES QESI RIBEO HEREIN IS.SUBJECT.:TO ALL THE TEwRW,EXCLUSIONS:AND CONDITIONS UE`$K1 i POLICIES AGCzItEGATE:LIMITS SHOV*MkY HAVE:BEEN kEI7UCE0 BY.PAID:CLAEMS. t S L PaUCYFFEGTNE POUCY EXPIRATION w T PO�IC:Y.NUMf1HR. .. UtAtTS: l. 8 OEtiERAt.WABtIITY HER8868850 817/07 917/08 EACN.aCCURRENCE a S 1 000�r}00 COt4MERGtALf tEt2lLLIA tLtTY tY 't .100, 50} Gt A1M5 a�AOE 1!V N#6¢{ ! EXE g !.. PERSdatdAd3A0VtNJUR( S: �{� nn GEt4t AGGREGATE Limtr APPL"PEW t PRIJOi1�TS:C4}Ar��3lyAGG 5 � ��},00,Q9 RUTot oauuAstUtY` A 35 SCG XI3 6388 1011/06; 10!1/08 cat rtEasx s: 1.000100 ANY AUTO (Es'aaxaaaztt; A.lLp1NNEDrtUdAS DtLY!NMRY Ba SG}!El}UtEI)kUT {Aer pnrsonJ; m m ^ 't1 ET)AUTpS: - :f3pPL.YWJURY r i z tON�,..r..nOA?,TC3S,. - - .:. I,P4rnoradei.. .. . I ._ PROPERTY RPtt btri} WAGE mow. S aARAOELiABiIITY AUTt?t1ttLX t A ACGaGENT t5 ANY AUTO p7tiGR Tt1AN i AA RCC 15.. .. AUTOLStit�X' Ex�E55ftttdt�NEGI.:Ai.tAtttuTir: F.RCMOL`CUttREEd;�, j s.;� G?" CLAMS MADE: RGGA£GArf S: ' i9E�UCTISI£ ' S. RETIlNTEON ..: ..... ....::. ..... ... ... .. .. .... ..::..... ... ..... ....... ... : • V,�sTA u araj- q WEt,1ftERSCONtPEKSATIONANa 351IVBGNC8881 1.11107 01101108 a x EAN'L.$YER4:unlu74!. i €c sRs r cEtt rri _ :V ARYPROPMEi°csx�Atan�at >au ivE: s t r sERSE EA E<arEs. s E O{311Cf: gFFt £RAt£FdBERESLUFaEt} i I J!'yas,desefee:undar E L OISEA$,. POLIOYt,IMIT. SPEGtAtPAt1VIS10NSbe;�w ... .... _....... . .. Tor t OESCiiiPT#OtY 01:6P4gA71bNS t 46011.�iiNS/irftlfCtE5 I EXQLUSiOtl6;AtfbEb 6Y ENRCRSEJdENT{SpEGIAL:PA0Y13N8: CERTIPICATS'HOLDER. CANCELI:ATION::: $06UW At Y OF'THE ABOVE tt1WAISEO POUC ES BE CANCWX0 BEFORE THS WMATtaN DATE THERWi THE ISSL%"INSWRErt Wltu EtdffAVOR 7D.:�MAtl.. 1 E'SAY5 Y(RITTM ona TQ THE GE:ttTiFl a HOwot NAMEP Y4 TMf i EFT,BUT,FA1LUl; TO:Dq$O:$HAtt.. 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R'fi,tt`:w re al k NFRC 4 renal .�' S Nat.0ml Ferrnt aborr WoodNinyl Composite IF Rating Ci mide Dual Argon Low E — Double Hung fi ENERGY PERFORMANCE RATINua U-Factor(U.S)/I-P Solar Heat Gain Coefficient . 33030 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance (' = OA8 Manufacturer.stipulates that these ratings confomt to eppkeble NFRC procedures hrdeterfnlning whole product performance.NFRC ratings ere determined for a fixed sell of envtronmenlel conditions and a specific product size. - NFRC does not roeommend any product and does not warrant the suhabllity of any produet Mr any�pocific use. Consult manufacturer's literature torother product perfomtance Infornatlon. ' z e; DESIGN PRESSURE(PSF) f - H L C100-0 2 5 M Assotladm a.com 0336847-047_ 1 Tested to ANS 'WDA 101.4.S.2-97 or NAFS-02. Maoufeoturer sti ulatesoonformnnce to thea licablc staudar&'. jMeets or exceeds M.E.C.,C.E.C,It I.E.C.C.All,Infiiftmtlon requirements WDMA hallmark Certification Program. - y