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HomeMy WebLinkAboutBuilding Permit #139 - 1149 OSGOOD STREET 8/26/2008 BUILDING PERMITo�"°oT 6'�ti TOWN OF NORTH ANDOVER oma ''- *° APPLICATION FOR PLAN EXAMINATION Permit NO: 5 Date Received ADg4rED �SSAC04l1`+�t Date Issued: L9-t IMPORTANT: Applicant mut complete all items on this page Al LOCATION � � '�' PRtPERTY OWNER,,- Print"" APNO; PARCEL:LLDU.3 . ZONING [3ISTRICT: _ F Histaric Distract Ali` _ yes,- -no Machine Shop VMage .yes neo TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial No. of units: Comm Industrial , -placement Assessory Bldg Ot rs: Demolition Other Septic Well Floodplain Wetlands' , atershe Diszi, tract ;s 4��_ /atar/Swere. _ - ' � DES RIPTIOY �OF ORK TO BE PREFORMED:Y7 11'1 1 entification Pl ase Type or Print Clearly) OWNER: Name: Phone:978 �' Z� 0/SO-z– Address: Address: 1 (�c=,/CMCLC' 4— CONTRACName. Rho T.' .amu TOR Z- r - . Address- � -43 �7 duper visor's Construcfion Licensea �'� � C�© �� p date:C��3 1Horne Improvement ice nse `Exp mate, I01l i . > ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12..010 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �r G 'T'7FEE: $ Check No.: ®�FC es 0 Receipt No.: O? NOTE: Persons contracting wit unregistere ontractors do not have access to the guaranty rad wo V,7�7= - � � Signature o A ent/ ner _ Si6hature.of con bctor 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH - - Reviewed on -Signature-• 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 384 Osgood Street :FIRE IEPARTM Temp Dutpsterra slty�s no Locatedt"12411net _ Y Fire D6artment"IS1 natu"refda#e ,., t P . � i i h 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) i 1 . ❑ Notified for pickup - Date I 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 i ❑ Building Permit Application ❑ Certified Surveyed Plot Plan i ❑ 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 2.2008 Location Y orve Ols3w-- f e--eltNo. Date G N°RTM TOWN OF NORTH ANDOVER �41 s Certificate of Occupancy $ s'•^°'Eta' Building/Frame Permit Fee $ 4 e►cNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # L 2 Jj i 4 4 5 Building Inspector The Commonwealth of Massachusetts -Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 , www.mass.govvdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Busim...ss/Orgmimtion/individual): Sears Home Improvement Products Incorporated Address:. 1024 Florida Central Parkway City/State/Zip: Longwood,FL. 32750 Phone #: 407-551-5402 Are'you�an employer?Check the-appropriate box: Type of project(required): 1.❑ I am a employer with - 4..❑ I am a general,contractor and I 6. ❑New constriction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. t 7- ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition -working for mein any capacity. workers' comp. insurance. 9. ❑Building addition [No workers'comp. insurance 5. We are a corporation and its . ._ officers have exercised their 10.❑Electrical repairs or additions required.] - 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions ,1521 ,and we have no myself. [No workers'comp. c. § 4. ( ) 12.❑Roof rcpairs insurance required.]t employees.[No workers' 13.M Other lin ' comp. insurance required.] ( 5J 1 *My 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. lContractors 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 isproviding workers..'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Aon Risk Services Central,Inc. / Phone:(866)283-7122 Policy.#or Self-ins.Lic. #: WLRC42847859 Expiration Date 08/01/2009 Job Site Address: l e City/State/Zip: 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 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 maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cern r er the pain, d penalties of perjury that the information provided ove is true and correct. Sign atur {Sears Auth.Agent) Date: Z ?-oZJ'P Phone#: Home:860-792-8106 / Cell:860-753-0452 Official use only. Do not write in this area,to be completed by city or town official. City or Town: 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#: 08/06/2008 08:55 4077678536 SHIP PERMITS&LICENSE PNCE 01/01 .I <' x. DATE dMMACOR 7y 008 + PRODUCER Ron Risk Services Central 2rtc. TStS CRRTiB?CATE 13 iSSUED AS A MATTER OF INFORMATION ONLY , flea Aon Risk Services, In;.k of 1l l i not s AND CONFERSNO RIGHTS UPON TRF,CERiWBICATE 19OLDUM TATS ; 200 East Randolph CEKrIFtCATEDGELSKOTAWN%WENDORAi,TERTHE ChiCago IL 60601 OSA COVERAGE AFFORDED BY THE POLICIES BELOW. oms. 866 ,283-7122 O FAX. S4 953 5'39 17REP-9 AFFORDING CPVRRAGE NAFC IxsTneRn WSUZRA: Aeii American insurance COIR any 22667; _ sears Holdings Corporation WS11RERa: indemnity insurance to of North America 43575 dba sears mome improvement Products, Inc Attn: Risk Mane ement E3-219A ry aC: -self-Insured Retention 0065AL 3333 Beverly Roa� i Hoffman Estates IL 60179 USA Irmumbt. National union Fire ins Co of Pittsburgh 11191445 ITNStURC _. gr-. ^rv,d° t_a '9 I I, ' . m SB'�.•N !' ,lr u.•.,.. THE POIICrESOFilu'SURANCEUSTBOBELBW'WAVFBEETISSURDTOTHErNSURRONANMABOVEFOR.TIM VOUCYPERIOD MMICATED.N70PSUCH 1ANDINO ANY RE4UIREMEN7,TM OR C ONDPITON OF ANY CONTRACTOR OTHER DOCUMENT WrM IMPErr TO V HECiTHrS CERTIFICATE MAY BOR MAY PBRTAPv,THr 1N5L RANGE AFFORDED HY THE P4LE DESt RT4Eo}ISRSTN t5 SI)I3lEC i 70 AI.t THE P&RM5 137CG1,USION3 AND CCINOiTIONPOLtCiEs, AOtiRPOATE umr[`5 Si#OWN MAY HAVE OM REDUCM 9Y PAtDcLAiMB, LIMfTS SHOWN ARE AS REQUESTEO tIR LTRTYPE PiwmAmcs ralacrNUMDBra T01dtYEFFF bOlatYfiXPIMYIDN umin DA4RiMm1uMYYI cA'e>{MMWD1ltYi , Gis VAALLiABILITY SM Insured 08/01/08 08/01/09 EACHOrCUMUNCG X COMMPRUALCENSRAL1JASiLITY GAMAGETOUNTEO PREnnSt 5(Co t�merte} , 0ATh1S MHDP OCCUR . �Y OIIO pR5P,1 PEMWAL&ADV INJURY N V, to GuNRRALAGOREDATG FM m a O5Pr1.ACGREGATF L1POT AF9uF_4 P6A �' PRODUCTS•CONVIOP AGG ry PALICI' 0 Pan.� we • o tErr sza/oeductible , $5,000.0 A AtMOMORRALIARILPI'Y ISAN08247274 08/01/08 08/01/09 , A AT7VAUTO LSAMOS241316 08/01/08 08/07L/09 COMtImFi}SndOLELIMrt. a } {E♦Aascdmti 55,000.000 `�—' ALL OWYF,D AVPOS 710DiLY IKJURY srHEMULEDAUT05 EPare J 7IIRT,DAUTOF - ROMLYINAURV . }( NUIYOWNWAUTDS - fPanoadctt) . PROPERTY DAMArM,, CASACCR VAbILtW AUTO GKV-6A ACCIbSNT � &VY AVID { ! OTHER THAN FA ACC AUTOONLY: Alm d EXCF 1UAM3tW.AUA 1L1TV 6081622. /01/08 HACHOCCURRL'ACE Sz.000.000 OCCUR 0 CLMIM MAW AGGREOATrj 42,OODr000 RETENTION 9 WORKERS COMPFJYVAT101S AND W4R C ETATU- 0TH- r: EMPLOYERS'LJARtt.rrV ADS Fi.PACIIACCIDFl�,T S110901000 A WLRC42847938 08/01/08 08/01/06 ANV PROPRiFTOR I PARTNER?'FXECUnIVE --��• OFFrcER,'NrL!ftMQ=UDM? CA ILL bIREASFrBAGMPLOYEE S110001000 A SCFC4284797S OB/01/08 08/02/09 byes,aewafrlmetrsPECmALPR0V1310:t5 wI _ t.L,DISSASe410tjrYTJMIT $1.,000,000 blow GTM. Iwo, bt%X1PTIW OF 0PRRA'nONSILCCAt1ONS1VEHICLEA/FXCLUStONS ADDM V 10WASBMENrtSPECIAL PROVISJONS .. ,i`11 yaler �. S Sears Nom improvement Products, Inc. SHOULD ANY OF THEAROCR182D UMSDUCANCELIAOBEFORE THE MMIRATiON 3024 Florivs:D6S da Central Parkway I ATe nrE ,T>m rssurnmrNsvRiDewnLEnaEAvorsTOMAH Longwood FL 327S0 USA BvrDF IILURE70DO90SHAL1MPOSF.O�QQBWGAHTTIONORLIADiLITOLDER NAMED T*V HE LEFT, OT ANY MIND UPON THF.INSUIM MAO FNrS OR RGPRE;"TATiVFS. AUTHORMFMR@PRt M'tATTVF n,4F f 1x ,C�3 eS3 j Received on 8/6/2008 8:56:02 AM x 011ie Boar� �mgolaons n an ar ee& One Ashburton Place - Room 1301 ` Boston, Massachusetts 021088 Horne Improvement Contractor Registration Registration: 1618607 Type: Supplement Card Expiration: 10111/2009 SEARS HOME IMPROVEMENT PRODUCT _.Sears Author°iz Agent LUBOS SVEC Haeme 860-792-8106 1024 'FLORIDA CENTRAL PKWY 611-8 60-753-0452 LOIVGUVOQD, FL 32750 - ._,. _ _ Update Address and return card.Mark reason fur change. UPS Qk1 0 .5 f JI Address F-1 Renewal [—I Employment Lost Card �, '+:/fee 'trr��nrucrt�rsfvz�fo�s.,GltztSr�J�G . ¢. tinard of R;eli;fing Reg,lations ansa Stanatar;ls License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: Registration: 148607 _ Board of Building Regulations and Standards Expiration: 10/11/2009 One Ashburton Place Rm 1301 Type; Supplement Card Boston,Ala.02108 a SEARS HOME IMPROVEMENT PR 1024 FLORIDA CENTRAL PKWY � LONGWOOD.FL 32750 a dminlste Bator~ 'ot valid trithout signs i Ao to I� One-Ashburwn Place M Rown 1301 1 ostom Massachusetts 02108 Home hnpmveme tramr Registration Reamtmflain 140807 Type: Pumic Corooratioll SEARS HOME 'IMPROVEMENT � 6 .; ALFRED NYMAN J.R. 1024 FLORIDA CENTRAL. PKIAMY LONGWOOD, FL 32750 � ®r `; f•`, RPrl e AddrM and rolartn carol.ihbAc re-wan foi-+:har t-. �' tildtls ltta�:itlIngtta�yu�at f La4tt?s Fsgaxt�y orf�tasitdirr Re ata{tit+ dLlkmeor m istradon valid for ii iMidul Vse only Home-1MPROVEMEW CORMCTOR ttfoursd reftEm tet: i � BoArdDEaR. nadiRgP.Ag 1497 s bltZ A f 3iiE_q 10 T#* 3lBKdt3�rcffi 109 sskns HOME 11 O T8 INC. AiV + 1 ALFRED NYN! 1624 PLORl C -. . LON 40I),'FL 32' 750�"�� Alinir tntar I�vt�eYul t sFgs�ats�ey �__ Beard of:wilding Regulations and Standards f One Ashburton lace,- Room 1301 Boston. Massachusetts 02,108 A 1i Construction Supervisor cense License GS: 9761119 Restriction: 90 Sirthdate: 8131/1963 Expiration: 8/31/2010 T 9751 LUOS SVEC 82 THOMPS N ROADTHOMPSO __.._..._._. _.._ N 06277 Update Address and, return cera. Pylark reason for change, 17YS-CA! 0 50M-M--YGc-FC'•E I" Address Rsi`.nl:wal j Lost Card m _ � '`. %1 61irr. Board of Building Regulations and Sl and Ards _ _� _ . _ g ConstrU tion Supervisor License q ,.�, ,r License: CS 97519 C Rcstr 8tsscs C:1 ��'' Birthdate:, 913.111 96,3 1EC ' .� F ' Expiration, 8131/2010 `i~r# 97519. 2 I. S I `. Restriction 90 A.. LUSOS SVEC . k }s - - 827 THomPS®N ROAD THOMPSON, CT 06277 Commissioner i i I�II�III�i�l1 SwrsJob No.: d 7� Sears Home Improvement Products,Inc. Products covenant 1024 Florida Central Parkway♦Longwood,FL 32750 Home Improvement Phone#: FEIN 251696591 License Numbers: AL 5481;FL CGC012538;LA 84194; Loeationr. MA 148607"MS 50222;NC 47330;RI 27281;SC 105836; TN 231�;Columbus,GA G17017;CT HIC.0607569 Siding Name TWIX eA-TIPhone:Res. F-(a12-?o'"auS. Address +� Qny , !r City: N. St.: Zip:�1 � 1/We,the owners of the premises described below,hereinafter referred to as"Purchaser'offer to contract with Se is Home Improvement Products hereinafter referred to as"Contractor",to furnish,deliver,and arrange for Installation of all materials scary to improve the premises located at: (Street) (City) (State) (zip) According to the following specifications: NOT INCLUDED INCLUDED SPECIFICATIONS PREPARATION: 1. W ❑ Obtain all necessary permits and insurances. 2. Q ❑ Inspect surfaces in work area-renail loose wood,replace rotten surface wood where necessary in work area excluding roof,decking or rafters,and structural members. 3. ❑ Remove Existing siding: Type: 4" Fir out walls on brick,block,metal or 16!clolar.Location: 5. Caulk and seal around all windows&doors in work area as necessary. 6. ❑ Install approved non-corrosive starter strip. INSULATION: 7. ❑ install insulation on flatwall areas to be sided with'7f4C 1/4" coded poly-styrene insulation.(circle one) CUSTOM TRIM: 8" ❑ Custom Vyna-Klad aluminum fascia system: Color: G u 9. Remove and reattach/dispose of existing guttering. 10. Cover soffit areas of home with vinyl soffit system,except those areas noted below. Weatherbeater❑Max It Plus❑Weatherbeater❑Other (check one)Color.CW Pattern:Jfi 11. ❑ Custom Vyna-Klad aluminum frieze boards: Location: Color: Size: 12. ® ❑ A- 3g -ndow trim: Location: L( Color:_ 13. ❑ Custom wrap Wndows/sills/mulls/headers w th'jyrta-Klad aluminum: Color: Cs.W 14. ❑ Remove and reinstall existing storm windowslawnings/shutters. 15. ❑ Custom wrap door facings with Vyna-Klad aluminum: Location: Al,!L, Color: 16. ❑ ® Custom wrap garage door facings single/double with Vyna-Klad aluminum: Color. 17. ❑ Remove and reinstall storm door; 18. Deluxe corner posts: Color: -11"' 19. El Clip looking system: Location: S.IDING: 20. ❑ Install W ter❑Max Pius❑ eafherbeater ❑Other solid virryI "ding (check one) TYPE: rizonta COLOR: PORCH 21_ ElPorch cel Location: Color: SYSTEMS: 22. ❑ Porch posts: Color: 23. ❑ Porch beams: Color: CLEAN UP: 24" ❑ Clean up and removal of all job related debris: 25. ❑ Each job is over-shipped to avoid delays.Remove excess materials and re-stock. WARRANTIES: 26. ❑Q ❑ Manutacturer's warranty sent upon completion. SPECIAL ITEMS: a 1. lottatly-P IrdL / Work not to be done: NO OF31C EDQEC VERED--NQ PAINT APPL ED / .4A&T 111117 Alai. a 9—d itmo All of the above check boxes and the"work not to be done section have been reviewed and explained to me. TIME FOR COMPLETION OF WORK.Contractor shall commence work within approximately twenty(20)days from the date shown herein and will be substantially completed within forty-five 5)Mrsafter unless a different estimated completion date is shown herein. Approximate starting date is: Approximate completion date is: NOTE:THE WARRANTY PROVISIONS AS STATED ON THE REVERSE HAVE BEEN EXPLAINED AND VWE UNDERSTAINTMEM FULLY. ApDITiONAL PROVISIONS AND WARRANTIES ARE STATED ON REVERSE AND ARE PART OF THIS CONTRACT. Please read the following bold type and initial corresponding line. Verbal understandings and agreements with representative shall not be binding.All understandings and agreements my st be set forth In writing in this Contract p Purchaser initials The TOTAL PRICE for all Labor&Materials(including any applicable discount)is $ I � ,00 Contract Price 3 X V7 Down Payment $ 6 Do Balance Payable $ AD State Sales Tax (If applicable) p Terms: Crotlft I-; (Subject to the approval of the Credit Department) Total Contract Price $ 9— Cash )k(Final payment payable to installer upon completion)Funded by: Bank: City St. Acct# 10%Preferred Customer Discount(PCD)awarded for any future Sears Home Improvement Products purchases.Current pricing available for one(1)year. It this is a credit transaction,the agreement for credit is contained in a separate document which is incorporated herein by reference and made a part hereof.I/We the undersigned are hereby authorizing Sears Home Improvement Products to verity and reviRw my/our cruet record with an independent credit reporting agency and release them from all liability incurred from inadvertent omissions or nors. IN WITNESS WHEREOF Purchaser(s)have hereunto signed their name(s)this 11 day of 20-OP-and acknowledge receipt res of a true copy of this Contract and unless otherwise specified,it is understood that the owner is this work to begin. THIS MESSAGE APPLIES TO DOOR-TO-DOOR SALES ONLY.You the Pu serfs) may cancel this transaction any time prior to midnight of the third day after the date of this transaction. See accompanying notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Signature affixed below acts as receipt that Pumhaserts separate canceltatlon lams. FS1111111T1FD eV:Representative ate Pa1eh w�Jk.vV O e D aY: 9 sue M Sears Nome Improwmem Inc. Date Puldawr Data D2-SO -Rev.OW cover �6 ® of - _ No. dover, Mass., LA A- COC MICMEWICK\� ORATED PP�,�'�y BOARD OF HEALTH Food/Kitchen Septic System RMI .. I PE BUILDING INSPECTOR l F' � .....�.... ............. Foundationanon THIS CERTIFIES THAT ?�d r Rough ��...... .. has permission to erect........�:.................••...•........ buildings on h e Chimney ^' ............ .......... to be occupied as........................... . eEt conform to the terms of the application on file in Final provided that the person accepting this perm" shall in every resp PLUMBING uvspECTOR d to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of this office, an Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final � PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service BUILD................. ...... ...................................:� ;� - .......... SPECTOR Final i GAS INSPECTOR qc�c�upa�ncyPermit Required to Occc,cpyy Euilding I Rough Conspicuous Place on the Premises — Do Not Remove Final Display In a FIRE DEPARTMENT No Lathing or Dry Wall To Be Done • ` and A roved by the Building Inspector. Burner Until inspected pp Street No. Smoke Det. SEE REVERSE SIDE