HomeMy WebLinkAboutBuilding Permit #421 - 10 WOODCHUCK LANE 12/1/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0:01 Date Received
Date Issued: ' G
IMPORTANT:Applicant must complete all items on this page
LOCATION 11{�✓' 'f�/ `t _
Pant
PROPERTY OWNER A--0
Print -
MAP NO: PARCEL: ZONING DISTRICT: Historic District, yes o
Machine Shop Village 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
Repair, replacement Assessory Bldg Others-
Demolition Other
Septic Well Floodplain , Wetlands Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
dU d t
Identification Please Type or Print Clearly) -G�s- Sad
OWNER: Name: �d /C� �r�/ S�,nccJ-�- Phone:
Address:
CONTRACTOR Name:' % ^/t S d- Phone
Address: /- 1,16
, `-
Supervisor's Construction License: f 7 Exp. -Date,-
Olt
Date cz
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
c�
Total Project Cost: $ 7 �1 �� FEE: $ s3
r
Check No.: C) 3 SReceipt No.: 7.2 dr 7
NOTE: Persons contracting with unregistered contractors do not have access to the uaranty fund
ignature of Agent/OwnerSignature of contractors
Plans Submitted Plans Waived Certified Plot Plan Stamped Plans
TYPE OF SEWERAGE DISPOSAL
Public Sewer Tanning/Massage/Body Art Swimming Pools „
Q
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
sr
Planning Board Decision: Comments
Conservation Decision: Comments
Water & Sewer Connection/Signature& Date Driveway Permit
a.
DPW Town Engineer: Signat rlP:
Located 384 Osgood Street
FIRE DEPARTMENT=Temp Dumpster on site yes -no
Located at 124 Main Street
Fire Department signaturefdat
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 2008
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: Doc.Building Permit Revised 2008
Location/0
No. Date
TOWN OF NORTH ANDOVER
O
41
F w
9
° Certificate of Occupancy $ �.
Building/Frame Permit Fee $ s3
1ACMUSt
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check 4PS35"I
22667
Building Inspector
Sep 21 2009 10: 39PM MIKE SIDMAN 6039345514 p. 1
MA H1C license 4149601 ]expires 1/24/IC)
Renewal
i RENE`W'AL BY ANDERSEN �ederollaxlDtl83-040d201
Wyl ie. �► m, c,p, QF GREATER MASSACHUSETTS AND NEW HAMPSHIRE
t
104 Otis Street•Northborough,MA 01532
Phone 508.919.0900-Fax 508.919.0903
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Data cf A reement
Bu rlsl ome
Burs ls1 rot Address,Ci tote,and 2i!Code
D
ENail dress Home Tel fans Number Wo k Telephone Number
97 — —Sotm
s /or services of &L Windows,Inc.dba Renewal by Andersen of Greater
Buytir()hereby joint] d severa�y agrees to purchase the product and J
Massa usetts and Hamps ire("Contractor"),in accordance with the terms and conditions described on the front and the reverse of this
agreen ent and on the attached Specification sbeet(s)(col)ectively,this`Agreement").Buycr(s)hereby agrees to sign a completion certificate after
Conte ctor has comf I ted allwodk under this Agreement,
Method of Pymnt;O Cash u Cheek Q Mastercard O VISA
Total b Amount:l�71. Fatimare Sto 'ng Oale: Q Discover nanced,App#�O,�YI«.r a7o�r s�b8'
r o --
Deposit Rea i ed(33%): IV��._. �- — Name or Credit Card:
Balance at Start ojob(33%Gjr!#_. E59mulV Compl ton Date: Credit Card#;
Bolorcoof SubstantiolS -� �—.-- CCE Dole: CC Secv y Code:
Completion o Job(33%):;�rL__
By initialing here,you acimowledge that the Balance at Start of Job and the Balance on Substantial Completion
B er Imitdals i of Job cannot be shade by credit card and must be made by personal check,bank check,or cash.
Boys (s) agrees a understands that this Agreement constitutes the entire understanding be
the parties,and that
the are stover understoodings changing or modifying any of the terms of this Agreement.No alteration to or deviatior
from this Agree nt will b¢valid without the signed,written consent of both Buyer(s) and Contractor.Buyer(s) herebl
aekn wledges th Buyer(s},1)has read this Agreement,understands the terms of this Agreement, and has received s
eom leted,Signe ,and dateld copy of this Agreement,including the two attached Notices of Cancellation,on the date first
wri above an 2)was o y informed of Buyer's right to cancel this Agreement.DO NOT SIGN THIS CONTRACT 13
THE ARE BLANK SACES.
i
Rene wall by Ander sen of Greater MA cad NH Buyer(s) Buyer(s)
Bv:
Signature o roduet ka i ager Sigh urs Signature
,lie
Print Name of Product Manager Print Name Print Name
YOU, THE BUY (S), AN
MA+ CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRE
BUS SS DAY ER THIO DATE OF THIS TRANSACTION,SEE THE ATTACHED NOTICE OF CANCELLATION FORM:
FO AN TION US THIS RIGHT.
x- - - - - - - - - - - - - - -�-c- - - - - - - -K - - - - - -
- - - - - - - - - - - - - - -s.
F N 1 NOTICE OF rANCE [ON
Da of Tronsa e .You miry camel l Date of Transaction V .You may tante
thio section ithout a pena ty or obligation,within this transaction without a peva or obligation,wNhir
th business s from fl above date.If you cancel,any three business i from the above ars.If.ydw cancel,an
ppra traded ,any pa nts made by you under theI roperty traded in,any payments made by you under the
Co ct of Sale, nd any tiable instrument executed Contract of Sale,and any rk *,able instrument exec, c
by ou will be mod w n 10 days following receipt l by You will be returned whNn 10 days following receipt
by a Seller.of. urcan on.notice,and any secunty I by the Seller of your cancellation notice,and any socuriq
ince t arisng ut of the;transaction will be canceled. I interest arising out of the transaction vast] be canceled.
If y u cancel, must ke available to the Seller at t IF you cancel,you must make available to the Seller al
you residence, 'n subs Helly as good condition as your residence, In substantially as good condition m
w n received, y good delivered to you under this l when received, any goods delivered to you under thit
C .net or Sale, r.yR
m y tf u wish,comps with the i Contractor Sale'or you may,If u wish,comply with the
ins 11Ychons of 5etrd � �c',h►m sh�pmsnt of X instructions of ffie Sellergd ret:sbtp�m+ent�4
this i�dtltcil tEthtttIf�rolb'tndlkb the aodt'atfhe�elt8r i�3ea" �r1yoirsiiiFke
the cods avail to thel]SeI er acid'he Seller does not the goods available to the Seller and the Seller dopa not
pie them up in'20 dtiys of the date of your Notice i pick them up within 20 days of the date of your Notia
of
11 on, u ma in or dispose of the;.goods of Cancellation,you may retain or dispose of the good.
w' out arry fu er 6b 11 n. N you fail to make the I without an further obligation. If you fail to matte the
s available the S r,or if you agree to return the goods avairable to the Seer,or if you algree to return tht
g s to the 5e11 and fail do so,them you remain liable Igoods to the Seller and fail to do so,then you remain liable
for performon of all obligations under the Contract. I for performance of all obligations under the Contract.
To once] this t nsactian,[mall-or deliver a signed and To cancel this transaction, mail or.deliver a signed anc
do d copy of th concellancin notice or any other written dated copy of this oncellation notice or any other wrkw
no e, or send a telegrdim to Renewal by Andersen 1 notice, or send a telegram to Renewal by Anderser
of 3reatter Mos ehusetts and New Hamppsshiro, 104 i of Greater Massachusetts and New Hampshire, 104
Ott Street, No ,MA 01S32, NOME THAN t Otis Street,Northbo u. , 01532, NOT LATER THAN
MI NIGHT OF / .(Date) MIDNIO T OF
X 1 HEREBY CANCEL IS RANSACTION.
1 H RESP t:ANC THIS SACTtON. i
t
Cone xvwrls Signature nate I tem aw-'s Signature Gal.
JL
Sep 21 2009 10: 39PM MIKE SIDMRN 6039345514 p. 2
1 1Nd HIC Lkvnse#148601(expires 1124/10)
Ren al W RENEWAL BY ANE)EMEN Fcdaral Tax IV# 83.0+04201
bYp111d C58t1. OF GREATER MAs$ACHUSEPT3 AND NEW HAMPSHIRE
.,w•ar KIPLAMENUT .•M I04 Olis Street,•Northborough.Massachusetts 01532
Phone 508.919.0900•Fax 508.919.0903
SPECIFICATION S'HFM
Date of Agreement
Buyer(s)Name
wit
The B yens)fisted ve herebX jointly and severally agree to purchase the goods and/or services listed be w,i accordance with the prices
and v rms describe i on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WNDOW AND DOOR
FEmC DWG AG f of ivhich this specification Sheet is a part.
WINWW DETAILS \
ticv-
tall a totali of�windows in Owner's home,using the following individual quantities: Xel
tDB) Fqual sash(1/S top.2/3 bottom) ❑ Oriel sash(2/3 top.l!3 botto
_,54
I Casemert CV ❑ urge right 0 Hinge left(as viewed from exterior), ❑ standard handle ❑ Metro kDouble entent(CIM ❑ Standard handle ❑Metro handle /
CASCCMcMn Picture/;Casement(CFW) ❑ 1:1:1 or ❑ 1:2:1 ❑ Standard handle❑Metro handle
2 Lite Gli Eng Win[10v(GW)
Glider/ I cture/Glitter(GFW) ❑ 1:1:1 or ❑ 1:2:1
Awning Vindow WO)
Picture ndow(FM
Bay orBAN Window
Patio Do (see separate Door Specification Sheet) /D
2. Yes ❑ No ty of Wittiiows to be Custom fit Replacement:
g, yes No y of Sills1lo be replaced by Contractor:
4. Yes No Qty of Wirkows to be New Construction Full frame(includes new interior&exterior casings)
Exterior ings: ❑ e❑Maintenance-free material EJ Factory applied 908 Fibrex brickmold
5. Glazing to be: J. HP Low- SmsrtSunym (Tax f7rr&Mft) ❑Other If other,please specify:
G. terior color : ❑ to❑ Sand Canvas ❑Terratonc ❑ Cocoa Dean
7. It iterlor color to = ❑ White❑ Sand Canvas ❑Terratone❑ Ane❑Maple❑ Oak
Nota; Intmiorcclor Jn only be white,wood or same color as exterior. Wood interiors need to finished by Owner,
9. hardware:❑ 11hite ❑ Sion ZCnnvas ❑ Brass Double Hung:
9. Yes❑ No stall Lifts Vvith ble Hung Windows
10. peens: wind to have:!E] Half or °Full screens Screens to be: Filxrglass C] Aluminum ❑TntScene
GRIT lDECAIIS
11, Windows have Iles: es ❑ No If yes Grille Between Glass free)E] R rnmbk interior Wood omwl E] Full Divided light(ret
Qty. 1 Qty, Qty Qh': Qty:
I
on ooa cwmkvn. CPWar
Dra6v grille pafta above 'Use additional sheet if needed Owxer approved(irtitials):
ADDrMNAL WORK DETAQS
12. Yes Contractor twill remove metal frames of windows. Qty of Units:
13. Yea17. Contractor'"'li install new paint ready or stain-ready casings.
interior c4 sin$qty of ripenings: Exterior casings qty of openings: [] fine ❑Maintenance-free material
14. Yes U�No Contractor iwill install new paint-ready or stain-ready inside(;�outside stops qty of openings:
Interiors ps qty of oijeri fts: Exterior stops qty of openings ❑ Fine ❑Maintenance-free material
.f weer 13&was 0 that Cmtr}actor does not do arty painting- L-4,", owe=WbAle
16. Yes Wo tractori tl wrap exterior casings with aluminum coil stock of_�_�_�__color.
Note: W may required with storm window removal;removal of storm windows will leave screw holes in casing.
17. Yes❑ No Contractoe will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.
Is. Yes❑ No A limited%�arranty shall be issued to Owner upon completion of the job and payment in full.
19. ❑No Contractor will secure any and all necessary permits. The fee for the permits)is rat
included iL the Cont t Price and a separate check is required at the time of sale ff this fee.
20. Additional job atolls• N� 0 r t s e1Ld#L,, lLlt1 flw,1 S45
i
its r•
e-
tip r ?� Si
21, Yes ❑N Owner airees to present on the Final day of installation for final inspection and to deliver final payment,
No final payor wt shall be demanded una!the oaO tinct is ownpletrd to the satisfaction ofall parries.
It b agreed and undmitood by and bdween tho parties that this Spoclffcation Sheet, Along with the CUSMM WMDOW AND DOOR
Re DEMG AIG ,�tulm tho entire understanding between the parties,and there are no verbal u�changms or
T110 any of ternta Spociacation Sheet may not be charted or its terms madiSed or varied in my way tusbaa a colt cbangw aero
in •ting and " by both the Buye(s)aril Contractor. Buyer(s)hereby acknowledge fltat Buyrr(a)has read this 9pecitication Shed.
Ra at by Anile of reaitfr MA and NK Buyer(s) Buycr(s)
-�
Dy:
Sr(f Prod,tct aser
Print Name f Product Print Name print Nauu
f The C'omnionwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
F
600 Washington.Street
Boston,MA 02111
Y www.ntass gov/dia
Workers' Compensation Insurance Affidavit: Builders/Coiitractors/Electricians/Plumbers
Applicant A Please Print Legibly
�p Information � v
o ) E}^S e
Name(Business/'Organization/Individual): e
Address: /0 q
City/State/Zip: tr 1.. J.14_ Phone
Are you an employer?Check the appropriate box: Type of project (required):
L l am a employer with J0 4• ❑ I am a general contractor and I 6. ❑New construction
'
employees(full and/or part-time).* have hired the sub-contractors 7., emodelin
2.E3 am a sole proprietor or partner- listed on the attached sheet.# g
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
requ
3.❑ I a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions
myself.[No workers' comp. c.152,§1(4),and we have no 12.❑Roof repairs
insurance required.]t employees. [No workers' 13.❑Other
comp.insurance required.]
*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,
$Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information.
I am an employer that is providing workers'compensation insurance for my employees. Below.is the policy and job site
information. nn�� J�
Insurance Company Name: � ' 1 rl C f)e—o n-2- /f1 Cl4 r-(,-n C e
Policy#or.Self-ins.Lic..#: &y la)�c � /`�q ,(__ Expiration Date:
Job Site Address: I �►� � City/State/Zip:
Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration elate).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a
sonment as well as civil penalties in the form of a STOP WORK ORDER and a fine
foe up to$1,500.00 and/or one-year impn
of up_to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
Ido hereby cer der the pains and penalties,of perjury that the information provided above * ue and correct
Signature: / GS
74
Phone#• Z
U�J % o CYJ
Official use only. Do not write in this area,to be completed by city or town official
City or Town: Perrnet/License#
Issuing_kuthority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plurr2birtg Inspector
6.Other
Contact Person: Phone#:
,
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BRIAN DERNISON3:-
85CR�a?CIi'.CL'
VVORC S I c?.,MA 0100"05 Cor�missianer,
RE AL EY ANIOE�SON
BRIAN..DENIN!ISON
104.O TIS S►REE
O ►,Li`BOROUGH, MA-01532 .
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