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HomeMy WebLinkAboutBuilding Permit #183-14 - 1160 GREAT POND ROAD 8/27/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIO Permit NO: / Date Received v� l Date Issued: I IMPORTANT:Applicant must complete all items on this page LOCATION / 4� �ot7 1— .__ PROPERTY OWNER IC..--- SC H00 Print 100 Year Old Structure T yes Ano, MAP NO: PARCEL- ZONING.DISTRICT: .. Historic District yes Machine,S,hop Village. yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: Wommercial ,Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: eg- Identification Please Type or Print Clearly) OWNER: Name: 'cA.-57XyCT�oitJ Phone: Address: CONTRACTOR Name: _.0 /o77M Address: SECK?N , /-1A 6 277 Supervisor's Construction License: (fS -/00 8 Exp. Date:__ Z2_S2c�/ Home Improvement License: ____ __ __w Exp. Date; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COSI T BASED ON$125.00 PER S.F. Total Project Cost: $ 1409� �s8- FEE: $ I I Check No.: a Receipt No.: NOTE: Persons contractind with unregistered contractors do not have access to the guaranty fund Signature_of Agent/Ovvner gnature,of contractor Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ tamped Plans ❑ Building Department The fol%owing is-a list of the required forms to be filled out for the appropriate.permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o : Building Permit Application o Workers Comp Affidavit Li Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) o Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 apw-al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submAed with the building application Doc: Doc.Bui ding Permit Revised 2012 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE.OF-:SEW-ERAGE-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 i COMMENTS HEALTH Reviewed on Signature COMMENTS A 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 To-ty . Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Mair Street - Fire Depailiffd it siginatu`re/date 1R ... - 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 7- 6NN Vk"5 EJ Notified for pickup - Date Doe.Building Permit Revised 2010 ii //.' Location t �((ao ts4 on / L P h nS d n 1 No. - Date ', -/,3 . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ t v° Other Permit Fee $ TOTAL $ I Check f� 26780 Building Inspector r , V NORT1-� w1. . : : : � � � E : 0. .c . : ver O i � h ver, Mass g a� • T O LANE COC NIC Nl WICK V AERATE V "kf' aS V BOARD OF HEALTH Food/Kitchen PERMIT T-, LD Septic System L THIS CERTIFIES THAT `, ..Aa.. .....! !�d ............U..N.K.... .149 rao BUILDING INSPECTOR .............. 11 has permission to erect buildings on ! 1(0Q........�.!..f d. ..�............ Foundation . .......................... .... . . .... .... .... Rough to be occupied as ....�. ........ .......ts�a V. ............................................. Chimney provided that the person accepting this perll 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 UNLESS CONSTRUCTIST RTS Rough Service .................. ....................... ......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. SEE REVERSE SIDE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA. 02111 Uf www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information \ Please Print Lezibly Name(Business/Organization/Individual): �d�Q J sA i tO, Address:3 ` ` PC, V\-R, I City/State/Zip:4z r, I I��O�v Mk d27(,0 Phone#: 53)Y 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 construction employees(full and/or part-time).* have hired the sub-contractors am a sole proprietor or partner- listed on the attached sheet.I-9remodeling 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 required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am 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' 11dother comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I 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. Insurance Company Name:. Policy#or Self-ins.Lic.#: Expiration Date: Job Site Address �.�� �onCity/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. Ido hereby certify under the pains d e alties of perjury that the information provided above is true and correct. Si ature: _�- Date: Phone#• ',v n r r1 2-C- 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the 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 state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced-acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)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 Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)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 members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any 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 on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future 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 license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealtla of Massachusetts Department of Industrial Accidents office ofInvestigatlons 6.00 Washington Street Boston,MA.02111 Tel.#617-727-4900 at 406 or 1-877-MASSAFI�, Revised 5-26-05 Fax#617-727;7749 wWW-mass,8ov1dia Massachusetts -Department of Public Safey . � Board of Building Regulations and Standards Construction Supervisor License: CS-1008l54 . til t I CORY S POTTERS`•'; 3 ' 24 MAYNARD AVENUE SEF,kONK MA 62771 )1,W ExpiratiQ i 0412512014 commcssioner _ b Customer Brooks School �)f'1 I STERGIS Aluminum and Vinyl Products Inc JOB Links/Johnson Buildings z— L� 79 Walton St ATTN Brian Palm FJ Attleboro, Ma 02703 (508)455-0661 fax (508)455 06,c' www.sterais.com Date/Rev 6/27/2013 i gSrFRvWINDOWSo o/ORS'S Quote Prep By TR ver 2012 Vinyl Commercial MO WS Widt MO WS Heigh Jamb Unit Windows QTY h Height Description Rating QTY Width t Color Grids Glass U-Value Screen Depth Cost TOTAL Links A 16 601/4 x 72 5000 SH CW 16 593/4 x 71 1/2 White GBG Contour IG Low E .30 or Less Yes 31/4 $ $ Links B 28 601/4 x 86 5000 SH CW 28 593/4 x 851/2 White GBG Contour IG Low E .30 or Less Yes 3 1/4 $ $ Links C 2 601/4 x 66 5000 SH CW 2 593/4 x 651/2 White GBG Contour IG Low E .30 or Less Yes 31/4 $ $ Johnson A 21 42 x 82 5000 SH CW 21 411/2 x 81 1/2 White GBG Contour IG Low E .30 or Less Yes 31/4 $ $ Johnson B 18 38 x 62 5000 SH CW 18 371/2 x 61 1/2 White GBG ContourIG Low E .30 or Less Yes 31/4 $ $ Johnson C 16 31 x 54 5000 SH CW 16 301/2 x 531/2 White GBG Contour IG Low E .30 or Less Yes 31/4 $ $ Total Windows Only General Notes Windows SEE OPTIONS BELOW FOR ADDERS Tax Add if Applicable Frame Retrofit/Replacement Frame - CW Rated Vinyl OPTIONS Sashes Welded - Reinforced - Double Locks/Impact Latches Add Exterior Square Panning and Trim Links Building Included in Scope Glass Insulated - LowE/Argon Gas .30 U-Value or Less Add Building Permit per Town of North Andover By Customer Screen Aluminum Screen - Wire Installation Timelines to be mutually agreed upon by Brooks School and Ster i_ Grids GBG Contoured Grids Matching Existing Installation Links Building Included In Scop Hardware Block and Tackle Balances Custom per Sash Weight Installation Per Typical Links Opening Approx. Not Applicable Installation Johnson Building Included In Scope Lift Provided by Brooks IDIsposal by Brooks School Installation Per Typical Johnson Opening Approx. Not Applicable NOTES------MO=Masonry Opening---WS=Window Size---IG=Insulated Glass---Prices Valid for 30 days Total Windows with Complete Installation $ 109,958.56 Confidential Quote Page 1 �U WINDOWS DOORS 79 Walton St. Attleboro, MA 02703 Ph 508.445.0661 Fax 508.445.0622 www.STERGIS.COM Replacement Window Installation Contract August 26,2013 Contractor: 3D Construction 311 Paine Road North Attleboro,MA 02760 Attn: David Potter Customer: The Brooks School 180 West Pond Road North Andover,MA Attn: Brian Palm Total Contract Value: $109,958.56 Windows and Installation This contract is in place between Stergis Windows and Doors of Attleboro,MA and 3D Construction of North Attleboro,MA to install all required replacement windows into the Links and Johnson Buildings for the Brooks School in North Andover,MA per the contract with Stergis Windows and The Brooks School. This is to include the removal and disposal of existing aluminum windows into proper dumpsters for aluminum and scrap glass and wood provided by the Brooks School. The installation of Brand New Replacement Commercial Vinyl windows into the existing openings,fastened,trimmed,and sealed. Thomas4RIndows fort David Potter Stergis W and Doors 3D Construction 40-, , 45 Years of Quality Aluminum and Vinyl Windows and Doors www.alliancewindows.com We are the First and the Last www.ster�),is.com Ly. ' S { Aid ir1NCE v 1�GP]1 ;