HomeMy WebLinkAboutBuilding Permit #278 - 120 WINTER STREET 10/6/2009 TOWN OF NORTH ANDOVER
APPLICATION FOR.PLAN EXAMINATION
Permit NO: v Date Received
Date Issued:
MP RTANT:Applicant must complete all items on this page
LOCATION :
— Print ,
�„ e
PROPERTY OWNER` ,1\ '
Print
MAP NO: PARCEL: ZONING DISTRICT: Historic District �. yes no
Machine Shop Village` r yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building On fa
mity
Addition Two or more family Industrial
Alteration No. of units: Commercial
Repair, replacement ►✓ Assessory Bldg Others:
Demolition Other
septic,'.,i Well y G Floodplain Wetlands Watershed'District"
Water/Suer
W
DESCRIPTION OF WORK TO BE PERFORMED:
VSO tY� "��_-'s m
Identification Please Type or Print Clearly)
OWNER: Name:_ Q4 �M,Cct..�- Phone:
Address:
ty
as
.CONTRACTOR Name: �` ���� �
� r5 Phone; Ot t -ocl t)
Address: ( , C�' 'c.b -� � o
; � A,
Supervisor's Constrd ion-License: ' _ Exp. Date: _,t 0
Hone Improvement License: * ' c (51 'Exp. Date-
ARCH ITECT/ENG IN EER
ate 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.
oU GCS
Total Project Cost: $ 12 . (o—)L - FEE: $
Check No.: 2 2 �O 3
0�5�(7 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
gnature of Aent/OwR ,'
�-_ (dCx. Signature of contract 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 a
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-DEPARTMENT Temp Dufinpst`erari site yes 4 no vT - a b
Located at 1,24�Maan Street s -;
Fire Department°signature/date
F '
COMMENTSa #'
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 i.
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
j
Location
No. Date 1016 6
MORTM TOWN OF NORTH ANDOVER
0
F A
' Certificate of Occupancy $
• i �
� c �
Building/Frame Permit Fee $ /tib
sACHUs
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
22503
Building Inspector
r1ORTH
® of
41
o == A K E dover, Mass., za G 6�'
COC HIC HE WICK y�.
ADRATED C7
S BOARD OF HEALTH
PERMIT T D Food/Kitchen
Septic System
• BUILDING INSPECTOR
THIS CERTIFIES THAT..........����.e.7...... e..l1...�'+�...............
Foundation
has permission to erect........................................ buildings on.lez..�..........�'V*�• f�
.................................................... ..... Rough
to be occupied as...................................... ,0?. i.�!rwg ........:....................................... 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
UNLESS CONSTRUCTIONS ARTS ELECTRICAL INSPECTOR
Rough
............................................. Service
BUILDING INSPECTOR
Final
Occupancy Permit Required to Ocmpy 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.
Renewal
17:13 9782785010 JOHN BEAVER PAGE 06/07
Renewal RENEWAL BY ANDERSEN MA Lironse Federal Ta9601 x 10#83-04042011 }
byAndemen.
WINDOW ., ,a.,r.., OF GREATER MASSACHUSETTS AND NEW HAMPSHIRE
1.04 Otis Street•Northborough,MA 0153'2
Phone 5013.919.0900 a Fax 508.919.0903
CUSTOM WINDOW AND DOOR REMODELING AGREEMENT
Buyar(Al ViaDotrpF�Agresment
Air �Al
Buyerlel dreeP Address,City,State,and Zip Code
E-Mail Addvmz Home Telephone Number Work Telephone Number
9��-9 7S•560� ��~-� �-�/�7 Z•2�
Ruyr_r(s)hcreby.joindy and severally agreras to purchase the products and/or services of jik L Windows,Inc.dba Renewal by Andersen of Greater ,
1v.Amach.usctts and New Hampslvre("Contractor'),in accordance with the.terms and conditions described on the front and the reverse of this
agrr.,,=cnt and on the attached specification sbcct(s)(collectively,this"Agreement").Buyer(s)hereby agrees to sign a completion certifirate after
Contractor has completed all work under this Agrcbmcnt.
Total Job Amount_I 4>-7qf Method of Pymnt:LJ Cash ❑Check ❑Mastercard ❑VISA
_! Estimated 5tarlin Do �
A Discover 4 lnanced,App#,04P3'�6453o6J/']O$
Deposit Received(33%): .. ._......— �l�'"ev's
Name on Credit Card: }� 1�I
Balance at Start of Job(33%):—()—.- Estimated Completion Dote; Credit Card#:
Balance on 5ubstonlial IM
�� �.. CC Exp. CC Securi Code:
Completion of Job. %):._�
—._. P N
By initialing here,you acknowledge that the Balance at Start of fob and the Balance on Substantial Completion
Buyer Ini als � /' of Job cannot be made by credit card and must be made by personal check,bank check,or cash.
Buyer(s) agr an derstands that this Agreement constitutes the entire understanding between the parties,and that
there are no verbal understandings changing or modifying any of the terms of this Agreement.No alteration to or deviation
from this Agreement will be valid without the signed,written consent of both Buyer(s) and Contractor. Buyer(s) hereby
acknowledges that Boyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a
completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,an the date first
written above and 2)was orally informed of Buyer's right to cancel this Agreement,DO NOT SIGN THIS CONTRACT 117
THERE ARE ANY BLANK SPACES.
Renewal by Andersep of Greater MA and NH Buyers) 13uycr(s)
By:
Sigma .f Pmdt ager i c Signature
va
Print Name of I?roduct Manager Print Name Print Name
YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD
BUSINESS DAY AFTER THE DATE OF TIIIS TRANSACTION.SEE THE ATTACHED N'O'TICE OF CANCELLATION FORMS
FOR AN EXPLANATION OF THIS RIGHT.
-- — — - — — — — — — — — -- - —�-<- — — — — — — —x— — — — — — �- - — - — - - - - - - - — - —�
C C OI F CANCELLATION
-CLIIO IO
Date of Transaction . You may cancel I Date of Transaction You may cancel
this transaction without any pens ty or obligation,within this transaction without any penalty or,obligation,within
three business days from the above date.If you cancel,any three businessc6ys from the above late.If you cancel,any
property traded in,any payments made by you under the I property traded in,any payments made by you under the
contract of Sale,and any , otiable instrument executed I ontract of Sale,and any otiable instrumentexecuted
by you will be returned vn ]Ode days following receipt by you will be returned vn 10 days following receipt
by be Seller of your cancellation notice,and any security by the Seller of your cancellation notice,and any security
interest arising out of the transaction will be canceled 1 interest arising out of the transaction will be canceled.
If you cancel, you must make available to the Seller at If you cancel, you must make available to the Seller at
your residence, in substantially as good condition as your residence, in substantially as good condition as
when received, any goods delivered to you under this 1 when received, any goods clelnrered to you under this
Contract or Sale-or you may,ifyou wish,oomph►with the I Contract or Sale-or you may,if u wish,complly with the
instructions of tl(te Seller regrading the return shipment of instructions of the Seller regarding the return shipment of
the goods at the Seller's expense and risk.ffyou do Intake x the goods at the Seller's expense andrisk.If�rad do make
the g6ads t 0isilable'b>fherldler-:and the Seller does not goo
1 the ds b available fht:Seder:anld the Seller does not
pick them up within 20 days of the date of your Notice pick them up within 20 days of the date of your Notice
of Cancellation,you may retain or dispose of theoods of Cancellation,you maay�►retain or dispose of the goods
without any further obligation. If you fail to make the I without any further obligation.,If you fail to make the
goods availablego
to the Seller,or it you agree to return the I ods available to the Seller,or if you agree to return the
goods to the Seller and fail to do so,then you remain liable goods to the Seller and fail to da so,then you remain liable
for rfarntalnee of all obligations unser the Contract. for performance of all obligations under the Contract.
1 I ,
To cancel this transaction; mail or deliver a signed and To cancel this transaction, mail or deliver a signed and
dated copy of this cancellation notice or any other written I
dared copy of this cancellation notice or any other.written
notice, or send a telegram to Renewal by Andersen t notice, or send a telegram to Renewal by Andersen
vis Greater noithbgmgh ISI OIX1,Hampshire,
OT 1ATFR THAN 11 Oil Greater
U1 Al HA ,FthamF,,,.
104
03/23/2'006 17:13 9782785010 JOHN BEAVER PAGE 07/07
Renewal RENEWAL BY ANDEnEN MA License#149601(expires 1/24/10)
.Andersen. federal Tax 117# 83.0404201
+rraoow hOLAeerewr a� „,c. p OF GREATER MASSACHUSETTS AND NEW HAMPSHIRE
104 Otis Street•Northborough,Massachusetts 01532
Phone 508.919.0900•Fax 508.919.0903
SMCMCATION S=
Buyer(s) ame Date of Agreement
Q
42 i ries _. I
The 13 r(s)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices
and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR
REMODELING AGREEMENT of which this S ification Sheet is a art.
WINDOW DIUAILS
1. Contractor will Install a total of windows in Owner's home,using the following individual quantities;
J Pn Double Hung(DB) [Equal sash ❑ Cottage sash(1/3 top,2/3 bottom) ❑ Oriel sash(2/3 tap.113 bottom)
Casement(CW) ❑ 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❑ 1:2:1 ❑ Standard handle❑Metro handle
2 Lite Gliding Window(GW)
Glider/Picture/Glidcr(GFW) ❑ 1:1:1 or ❑ 1:2:1
Awning Window(AW)
Picture Window(°W)
Bay or Baw Window
atio Doors(sec separate Door Specification Sheet) J
2. Fr Yes❑ Qty of Windows to be Custom Fit Replacement: l
9. ❑ Yes Q'3o-Qty of Sills to be replaced by Contractor:
4. ❑ Yes 4XN0 Qty of Windows to be New Construction Full frame(includes new interior&exterior casings)
Exterior casi : ❑ Pine ❑ Maintenance-free material ❑ Factory applied 908 fibrex Mckmeld
$. Glaring to be: NPLo EQ31 SmattSun- (Trac Cnslfiti571g' 113 ❑Other If other,please specify;
6. Exterior color lobe: White ❑ Sand ❑ Canvas ❑ Terratonc ❑ Cocoa.Bean
7. Interior calor to be: VWbite ❑Sand ❑ Canvas ❑Terratonc ❑ Fine ❑ Maple❑ Oak
Nous: Inte '0r color can only be white,wood or same color as exterior. Wood interiors need to finished by Owner.
S. Hardware: White ❑ Stone E) Canvas E] Brass Double Hung:
9. 0 Yes No instal)Lifts with Double Hung Windows
10. Screens: windows to have: Rr Half or ❑ Full screens Screens to bc: 5/viberglass ❑Aluminum ❑TnruSeene
GRILLE MAILS
11.Wi ows have grilles: Yes❑No If yes:[❑ Grille Between Class(mo)❑ Removable Interior Wood amw)❑ Pull Divided Light(rmj
Q Qty:_L� Qtr. Qtr Qty., Qty: Qtr.
ME.,-
DH DH CWIPlcturn alder CPW or G
Draw grille p tterns above "Use additional sheet if needed Owner approved(in
ADDITIONAL WORK DETAILS
12.❑ YcsContractor will remove metal frames of windows. Qty of units:
13.❑ Yes� Contractor will install new paint-ready or stain-ready casings. _
interior sing qly of openings: Exterior casings qty of openings: EJPine CJ Maintenance-free material
14.❑ Yes Ivo Contractor will install new paint-rcaady or st ' side or outside stops qty of openings:
Interior stops qty of openings: Exterior ps qty of openin�, ❑ Pine❑ Maintenance-free material
15. Owner is a that Contractor does not do eta pa* ' . ( ..lam) er Initials
16.❑ Yes No Contractor will wrap exterior casings with k of color.
Note: Wrapping may be required with storm window removal.;removal of storm windows will leave screw holes in casing.
17.ErYcs [❑ No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration.
is, s❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in.full.
19. Yes ❑ No Iitrild(ttg Permit--Contractor will secure any and 411 accessary permits. The fee for the per,mit(s)is not
included in the Contract Price aAd a separate check is requipcd at k.l f tic of sale fo this fee. I
20. Additionaljobdetails; q 6/fx C!
a �
21. [ Ls ❑ No Owner agrees to be present on the final day of installation;or final inspection and to deliver final payment.
No flnol pvWnent,0411 Lv demanded unlit the contract is ccmplefed to flit sagsfaetion of e11 parries.
It is agreed and understood by and between the parties that this Specification Sheet,along with,the CUSTOM WINDOW AND DOOR
REMODELING AGREEMENT,co;tw,s(U#w the entire undmitartding between the parties,and there am no verbal tmdexslandingi;charig;t g or
moditying any of the terms. This Specification Sheet may not be.ebanged or its terms modified or varied in any way unless such changes are
m writing and MIMO by both the Buyer(s)and Contrnclor. Buyers)hereby acknowledge that Buyer(s)has read this Spcct"i.CAtion Sheet.
Rene by of MA and NH Buyer(s) Buyer(s)
lure of ct Manager rgnature Signature
dl�h ,a Y e(Mire/
Print Name of Product Manager Print Name Print Name
RbA Copy- White CustOmcr Cori-W.Ilnw
1'lie Coinino;'twealth of Massachusetts
1 Department of lndustr•lal Accidents
14 '
Office of Im'—'siigations ,
600 �,ashiz gton Street ,
Boston,IiL4 02111 k
ww y massaav/did
Workers' Compensation insl?rance�4.fi,- -it: Builders/Con:fractors/Electricia�s/FFtimbers
poiicarlt Ilzfor?nat a:7 PTease Print Ledibiv
-� /� I
Name(Business/Organization/Individual): Aen"ItJ 1,� �'��
Address: lD•� i S L� Yz�i
Cit /State/ 1 lel/ C�Q�1
'y Zip:. � ���,�ba,� , ,��� ii J.�.3-? Phone- ��U
�ze'you an encpIoyer?Check the appropriate box- Type of f o ect re :tired
Lal—am a employer with OC) 4. ❑ I am.a general contractor and I
employees(full and/orpari-time).* ' hai,e hired the sub-contactors o. Q New construction2.El am a sole proprietor or partner- listed on the attached sheet
ship and have no employees Tu-se sub-contractors haus B. Demolition
worlang for me in any capacity. workers' comp.insurance:'";
"No workers coma.insurance 5. 9 ❑Building addition
L ire are a conooration and its
required.] o%kers hazre exercised their 10.❑Electrical repairs or additions
3.0 I am am
hosowner doin,till work right of exemption per l\fGL 11.0 Plimbiilg repairs or additions
myself. [No workers' comp: c, i52,§,1(4),and we have no 12.7 Roof repairs i
insurance required.]t employ=s. -No workers'
oonp,insurance required.] 13.❑Other
°Any?nnlicant that ch.cls box TI must also fill out the section below showing their worlwrs'compensation policy informatio'
n.
Homeowners who submit this affidavit indicating they are doing all wort and then hire outside contactors must submit a yew affidavit indicating such
;Contractor that ched:this box must attached an ad aiiional sheet shov,•iag the mane of the sub.-onuactors and their work=:.'comp.Policy information.
.Tam an—employer that:s pratridine guar hers'catrTer sadar insurance far r;iy etr play==s. =law:s the poIar1r ar d jqb site
njor r,°tazazt. �j J ) -
Il-isurance Company Name'-
Policy T or Selly ins.Lic. j
Etipira ion Late:_ J7/J!)
Job Site Address: J�b /k) .0
l CI y�State�Z?p. 4 `✓1� q / '
Aet$Cii a copy of the F'Orl4er5° OT. policy 'anF `
5 C pen sat)on .declzratian:=e(sho- '�'g °DDHCy ram,ber end e- it tion date).
Failure to S61Cure CDVeraaeF�
as.required under Section 23.k of MGL c. 152 can lead to the imposition of-
criminal penalties of a.
fine up to$.1;500.00 and/or one-year im-onsonment,as Tvellas civil penalties in the form of a STOP WORK ORDER and a fine
ofup to$250.00 a day against the violator. Be advised uat a copy.of his statement nay be forwarded to e OfEce of
Investigations of the DLk for insurance coverage venficaon
�1
Ido hereblr certthe pairs and pen lties,of perjury that tie crforriaiion provided.agave i Z711.1-0 wed correct
t
Silmatcre:
Date:' Lz__z_9
Phone
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WORCHSTF?'-"JAiA01o'D '. Commissions L
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BRIAN..
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