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HomeMy WebLinkAboutBuilding Permit #657 - 120 OLD FARM ROAD 4/10/2007 p►ORTH BUILDING PERMIT o�t,�o TOWN OF NORTH ANDOVER 3� �''`'` °� APPLICATION FOR PLAN EXAMINATION '' n �!J S Permit NO: Date Received SSAC NU`�� Date Issued: L,--(O O —a IMPORTANT: Applicant must complete all items on this page '. wT �'r x x LOCATION w 4 r ,' ZI PROPP- TY OUVNER .5 ►^� 46, MAf N "H TO RICTL CO P, RCyes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building &One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ,KRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other -0 Sepfip M ill e �� � � Cl Fly Ldp`""i -A �t-Watlar�i, '� �lVater�� ed O l�tnct Water/SjveF q. z.,..: DESCRIPTION OF WORK TO BE PREFORMED: C,c c Dua r. Identification Please Type or Print Clearly) OWNER: Name: CJlkaPhone: 57Y- Loi 11757 Address: f 20 0(4 Fa.,- CONT dame : �. s w� Pttoh ' . d1 WSS:,� xk .� m; Supervtsc�r's Ct�nstructidt� .rcense ` exp 'Da e. i � ! 4,44 A Horrne Improvement License = ryy E�tp, pate` "" ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3 1 ! 7. ~ FEE: $— '3),-,— Check '3)"-,—Check No.: e�2 o Receipt No.: aU /la— NOTE: Persons contracting with unregistered contractors do not have access to the gua fund Signature of AgentlOwner: ;Signature of corttac r. ' 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 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ , . ❑ COMMENTS A Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments j Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street • . FIRE DEPARTMENT "Temp Qpster Y Located at ir24 Mairi`Street ; Fera©epartment:signature/date` 49 <W COMM'NTS a , . 461 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 2007 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 Li 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 Doe: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 omoglio,Christian Project: Comoglio,North Andover-WME Order No.: On aide View Item Nn- OIL, Unit Price Rxtended Price Item#10 Qty: 1 7282 Fixed/Vent OX Sliding Contemporary Door,Frame:71-1/4 X Location:Proline slider 81-1/2:ProLine,Clad,Model I ,White,3/4"InsulShld Temp IG w/ R.O:6'0" X 6' 10" Argon Glazing,PreFinished White,Sliding Screen Whitt AlumWun, ° WallCond:4-9/16" White Int Hdwr w/Champ Footbolt,Match Cladding Color-Ext Hdwr, �O Fins(single unit per design) Value Added Items:2-Wide Sliding Door-Qty 1 Disposal per Unit-Qty 1 Notes: Thank Yo r Purchasing Pella Products Taxable Subtotal $2,968.98 Custmer Signature Pella Sales R resentative Signature Sales Tax at 5.0000% . 148.45 Non-taxable Subtotal 0.00 , A"� Q Total $3,117.43 Da $ Date 0.00 sit Received i WARRANTY: Pella products are covered by Pella's limited warranties in effect at the time of sale. All applicable product warranties are incorporated into and become a part of this contract. Please see the warranties for complete details,taking special note of the two important notice p sections regarding installation of Pella products and proper management of moisture within the wall system.Neither Pella Corporation nor Pella 3 Windows&Doors,Inc.will be bound by any other warranty unless specifically set out in this contract. However, Pella Corporation will not be liable ' for branch warranties which create obligations in addition to or obligations which are inconsistent with Pella written warranties. Clear opening(egress)information does not take into consideration the addition of a Rolscreen for any other accessory] to the product. You should consult your local building code to ensure your Pella products meet local egress requirements. i For information regarding the finishing, maintenance, service,and warranty for all Pella products,visit the Pella Website at www.aella.com. Contract-Page 2 of 3 NORTIy Town of 4Andover VO No. S7 - - o dower, Mass., �� } o LA COCHICHEWICIc y 7�S RATED BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System 0 0 • BUILDING INSPECTOR THIS CERTIFIES THAT........6.4...a.�.�.. Ate............. ..a. `.. ��J......................................... Foundation has permission to erect..... ................................. buildings on ./It.40..........d/1W..... .�1 1......... ...:. Rough to be occupied as.......... Achimney provided that the person accelking 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 3�. PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRU ARTS ELECTRICAL INSPECTOR Rough Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocayy 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. Bumer Street No. SEE REVERSE SIDE Smoke Det. ACORDCERTIFICATE OF LIABILITY INSURANCE DAT20061D/YYYY) 07/05/2006 13:54 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C.Church ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 41 Wellman Street Connector Park HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. Lowell,MA 01851 INSURERS AFFORDING COVERAGE NAIC>Y INSURED INSURER A: Hartford Insurance Company New England Window&Door Inc, INSURER B: Hanover Insurance Company 45 Fondi Road Haverhill,MA 01830 INSURER C: Mass Bay Insurance INSURER D: INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING. ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH-THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DO'L POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION UMrTS GENERAL LIABILITY EACH OCCURRENCE 51,000,E DAMAGX COMMERCIAL GENERAL LIABILITY PREMISE $500,000 CLAIMS MADE FKOCCUR MED EXP(Any oneperson) $10,000 g ZBN8161407 7/1/2006 7/1/2007 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG S 200,000 POLICY PRO LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s1,000,000.00 ANY AUTO (Ea accident) - X ALL OWNED AUTOS BODILY INJURY (Par person) $ C SCHEDULEDAUTOS ADN8162169 7/1/2006 7/1/2007 X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per fici y PROPERTYDAMAGE $ (Par accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN FAACC $ AUTO ONLY: AGO $ EXCESSNMBRELLALIABILITY EACH OCCURRENCE =.9,000,000 X OCCUR a CLAIMS MADE AGGREGATE S 9,x,000 B UHNS167305 7/1/2006 7/1/2007 $ HDEDUCTIBLE $ x RETENTION t $ WC STATU• 0TH- WORKERS COMPENSATION ANDIAS I ER EMPLOYERS'LIABILrTY E.L.EACH ACCIDENT s 500,000.00 A ANY E EFEXCLUDED?ECUTIVE 08WBNL5742 7/1/2006 7/l/2007 OFFICER/MEMBER E.L..DISEASE•EA EMPLOYEE S 500,000.00 Ir yes:describe under SPECIAL PROVISIONS below E.L.DISEASE•POLICY LIMIT $ 500,000.00 OTHER Blanket Building&Contents BP ZBN8161407 7/1/2006 7/1/2007 $5,540,000Deductible S1,000BIanket Business Income S4,500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION 3110ULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION New England Window 8t:Door;Inc. DATE THEREOF,THE t33U1NG INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN dba Pella Windows&Doors,Inc. NOTICE TO THE CERTIFICATE Hi NAMED TO THE LEFT,BUT FAILURE TO 00 SO SHALL 45 Fondi Road, Haverhill,MA 01830 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE r ACORD 25(2001/08) Client# 2960 Mst# 0607 all lines Cert# Evidence of INsurance 0 ACORD CORPORATION 1955 � � �/xe -Pgm�.nwouuea.� o�..✓�aaaa�l�e/ BOARD OF.BUILDINO REGULpTiOfiS L.iWOW�CONSTRUCTIQN SUPERVISOR , NumhecX35. 089839 f9] 008 Tr no 89839 I �r-.., t SCOTT P HOUSE, Commissioner �1'ie�oHaona�uae� oo�✓j�ac�uCaetta Bpard:nf Bu►ldrng Regulations and Standards HOME;IMPROM 9NT.GONTRACT012 Registration 129774. � gxpiration:11/2(2007 . Tom,=DBA PELLA WINDOWS YND QOORS l... SCCSTT HOUSE - Admpistratot� The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly . Name (Business/organization/Individual): �� �`� �/�/ t✓1G1 1S a .t C� Deo rS Address: ys Fvrl City/State/Zip: VeA"i t Phone#: Are you an employer? Check the appropriate box: Type of project(required): 1.X I am a employer with Z. S 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet 1 7. Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for mein any capacity. workers' comp. insurance. 9. E] Building addition [No workers' comp- insurance 5. ❑ We are a corporation and its 10.[1 Electrical repairs or additions required.] officers have exercised their 3.El I am a homeowner doing all work � exemption right of per MGL 11.❑ Plumbing repairs or additions pon ,152 ,and we have no myself. [No workers' comp. c. §14( ) 12. Roof repairs insurance required.] t employees. [No workers' 13.El 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 TContractors that check this box must attached an additional sheet showing the name of the subcontractors and their workers'comp.policy information. I am an employer that is providing workerscompensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: +144(rJ (hsyr`A AGet 6>mpan►y Policy#or Self-ins. Lic. #: OT V ANI,S"N I Expiration Date::!AD Q . Job Site Address: OU U 4raK I�s'I City/State/Zip: Attach a copy of th 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 ce r the pat and penalties of perjury that the information provided above is true and correct Siena e: Date: Phone#: 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#• Location 04 Y5,f� No. l/S Date ! NORTH TOWN OF NORTH ANDOVER Of " O '•,�O + ; ; Certificate of Occupancy $ �'s''•'° Eta' Building/Frame Permit Fee $ � AC MUS Foundation Permit Fee $ w! Other Permit Fee $ it TOTAL $ Check # S 20 .1 i 2 Building Inspector