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HomeMy WebLinkAboutBuilding Permit #763 - 14 SALTONSTALL ROAD 5/18/2007 OORTty BUILDING PERMIT 0 .0"0 16q~o TOWN OF NORTH ANDOVER c� °�, APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received •0� 9SSAC HU`��,( Date Issued: �• IMPORTANT: Applicant must complete all items on this page �i1 1k I_C}CC4TI0 % 6141 � "^al ,r'fir'/�A s- 10 { ) C)PE T ga OiFVR3Id f a 4 � AP 1 IAtOl _ � IJNG .� TRi HiORiC ISRiC TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ Addition I wo or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other S'e J A IAF c�o�p�ain W�etCarids y !f o r F 'r Wate%/S PESC IPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: Wpk 14 ' r fC?R A " r01 Lmss" .rim s:' � A.d�lres -: y- sax 6 /r n.,» " sr -.� s sf„Q, w � Nit �' HbImpraver�ie�nf �Lrce 'AL ngo 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: $ A0 FEE: $ 17 Check No.: / `/69 Receipt No.: t?Z NOTE: Persons contracting with unregistered contractors do not have access to fund Signature afAgent/Owner 9LL� ... ` Si nature of contractor aAI Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ ti TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ` Q' Well ❑ Tobacco Sales ❑ Food Packaging78a1'es.% 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 i DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS i Zoning Board,6f Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments l 1 Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street - , FIRE DEPAi7�IT� T p Dumpsterbn SOC ted a "i81�tttal eet iTMTM �r �3epartrnent 'r�F r 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 ❑ 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 I 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 o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit a 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 orspecial 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 2.2007 Location r / � !4� Sv ' No. 7�-� Date r TOWN OF NORTH ANDOVER � 9 ' Certificate of Occupancy $ ��S' •'<�' 9 Buildin /Frame Permit Fee $ e "us OtherFoundation Permit Fee $ Other Permit Fee $ s TOTAL $ check # ! w 202 Building inspector F �ORTIy Town of � _ - 4 L Over 0 . , - dover, Mass., ' I • a - T O �- LAKE COCMICHEWICK V ADRATED PPS` 5 BOARD OF HEALTH PERMIT T Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT......i)-A.wew........� vJ..1�.�!!�1�e'............................................... . ...... . .. .... Foundation has permission to erect........................................ buildings on ...�.IV........,S",..1..A.11......51.......RrlRough D� Chimney to be occupied as.......c.3......... .... .. .. L✓ ....................."'r. ........................................................................................ y 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 —r PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRU S TS Rough ....................... ............ ..................... Service . ... . . ...... .. . ....... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RoughFinal 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. The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 dra Workers' Compensation Insurance Affidavit: Bu 1 . A llcant Information ders/Contractors/Electric>!ans/Plumbers Please Print Legibly Name(Business/Organization/individual): I Address: C City/State/Zip• _ A 04� Phone#: 9?_j Are you an employer?Check the ropriate box:am a employer with 4. ❑ I am a general contractor and I Type of project(required): 2.❑ employees(full and/or part-time).* have hired the sub-contractors 6• ❑New construction I am a sole proprietor or partner- listed on the attached sheet.i ship and have no employees 7. E] mi These sub-contractors have 8. E]Demolition working for me in any capacity. workers'comp,insurance. [No workers'comp.insurance :5. ❑ We are a corporation and its 9. ❑Building addition required.] officers have exercised their 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemptibii per MGL 11.❑Plumbing repairs or additions myself.[No workers'comp. c. 152,41(4),and we have no insurance required]t employees. [No workers' 12.0 Roof repairs comp,insurance requ ued. ] 13 OtherAnY applicant that checks box#I must also fill out the section below showing their workers'compensation 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-coutside contractors policy information. rs and their workers'comp.policy information. I am an employer that is providing workers'com ensati information. ' an insurance for my employees- Below is the policy and job site Insurance Company Name: —,L Policy#or Self-ins. Lic.#: 0Q, Expiration Date: 2 d Job Site Address: / Attach a copy of the workers'compensation ofage Cit'/State/Zip: 01 policy de P Y claration Failure to secure coverage as required under Section 25A of MGL o 152canlead twing o theoimposition licy bof aminal pener and ton datea fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties of a of up to$250.00 a day against the violator. Be advised that a copy�his statement may be forwarded to of a STOP he office and a fine Investigations of the DIA for insurance coverage verification, ce of r'r"''ere y reriri._ "nder the pain and penalties o er u ry that the information provided above is true and orrect ./•P J Si na e: Date• � '� Phone#: �� _ Oficial use only. Do not write in this area,to be completed by city or town ofj9ciaL 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#: )ate: 4/27/07 Time : 12 : 03 PM To : NATtN-nrys -a,l LCUvcua Page: 002-003 ® Client#: 79872 - NATIEN _ Oy/��DTM CERT'IFICAT'E OF LIABILITY INSURANCE M/DDIYYVY) /27/0 AC 4127!07 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION RC Knox 8 Company, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR One Goodwin Square ALTER THE COVERAGE:AFFORDED BY THE POLICIES BELOW, Hartford, CT 06103-4305 860 524-7600 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A. The Employers Fire Insurance Company National Energy Systems Inc INSURER B: 1331 Grafton Street INSURER C. �- Worcester, NIA 01604-2256 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 CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAYBE 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. NSR AOD'L POLICY EFFECTIVE POLICY EXPIR/1TION LIMITS LTR INSIR rTYPE OF INSURANCE POLICY NUMBER DAT 1 YY TF_( ADD/YY) _- A GENERAL LIABILRY 7100095110001 10/11/06 10/11/07 EACH OCCURRENCE $1.,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO a RENTED n e $500,000 CLAIMS MADE ®O('C UR MED EXP(Any one person) $10,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE s2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2 OOO 000 7. POLICY JECT PRO LOC --- A AUTOMOBILE LIABILITY FBIE03830 10111/06 10/11/07 COMBINED SINGLE LIMA $11000,000 (Ea accident) ANY AU 10 ----- ALL OWNED ALI OS BODILY INJURY 4 (Par person) $ IC SCHEDULED AUTOS — HIRED AU1OS BODILY INJURY $ (Per accident) X NON-OWNED AUTOS --^— PROPERTYDAMAGE (Per accident) GARAGE LWBILI'I Y AUTOONLY EA ACCIDEN I $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY. AGG $ A EXCESS/UMBRELLA LIABILITY 7100095110001 10/11/06 10111/07 �• EACH OCCURRENCE $5.000.000 X1 OCCUR ❑CLAIMS MADE AGGREGATE _ $5,000,000 $ DEDUCTIBLE '�— RETENTION $ $ WC S7ATU� OTH- A WORKERS COMPENSATION AND 4060172910000 04/29/07' 04/29/08 aC T Y u IT EMPLOYERS'LIABILITY CT MA PA NY E.L.EACH ACCIDENT 5100,000 ANY FROPRIETORIPARTNE RIEXE CUT IVE OFF, CERIMEMBER EXCLUDED? E.L.DISEASE EA EMPLOYEE $100,000 If yes,deacribe Under E.L.DISEASE•POLICY LIMIT $500,000 _ SPECIAL PROVISIONS below ---- "' OTHER UE SCHIPTION OF OPERATIONS I LOCATIONS!VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AS OVr_DESCRIBED POLICIES 8E CANCELLED BEFORE THE EXPIF(A TION Sample DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL _ 30 DAYS WRIT-EN NOTICE TO THE CERTIFICATE HOLDIER NAMED TO THE LEFT,BUT FAILURE TO DO SO SIMALL IMPOSE NO OBLIGATION OR LUIBILFTV OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. ___�•__ �._ AUTHORIZED REPRESENTATIVE ACORD 25(2001108)1 of 2 4S3862951M386293 PJM �O ACORD CORPORATION 1988 l 5'i Fr .I Ir. 1 Je _ RC d r' n USA' n J7I; VERiTICAL SLIDER, Mnlinn@l I erlcmailnw VINYL FRAME":TRIPLE GLAZE RauiGouncli KRYPTON FILLS® LOW E2 I TISCRNA 4000 Y. f �WY7�6n!t. d7F1d —N KKK pp• Y'4 - PE R . 0 MANCE• F a , I NG HeatCoefficient 0.21 U.30 j �a l�fT[67N� PERFORMANCE PERFORANCE RATINGS ': J� V(siblr, 1'r�7ri�rn itQa►�ce p rrII I _ ! I I G�Rn Ien�aYia�n;Resrstarice - i I l .l mess+c�nrrrawenaarewmmn�mxmxa�m�aaa�y� ` l (Jianula Uirer stipulates ihatihcse ratings conform to applicable NFRC procedures ror dai-armining whole speriflI' I r b ct pe�prm,nce,NEFC:ratings a e detarmmed for a fixed set of ur••( enulronmental conddions and a c ro ) size,Cansl l manuiaciurer's lit era@ure far other product performance i rformafion. www.ptrc.org I , I i , I 1 Board or Building Iicoutatinn_an Standards:;., ;r -Acease or refit NT,�ACTOi5.st3','all alid for individul use on HOME IMPROVEMENT COy before the expiratio❑ date. Iffound return to: \- ;il;_: 10409u Board of Suilding Regulations and Standards 1, Registration: <Cf Expiration: 711312008 One Ashburton Place RM. 130? Type: Private Boston,Iirla.02108 NEW ENGLAND SASH. 11,1,— Kevin rvcKevin Wells 1331 Grafton St-set Wt_�it !/f Worcester, MA 01604 � �Dtput3'Acl ninisrrscor Not valldz signature r Board of Building Regulations and Standards License or registration valid for in use only 41 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: � r Registration: 145941 Board of Building Regulations and Standards `'- Expiration: 3/14/2009 One Ashburton Place Rm 1301 Type: Supplement Card Boston,/Ma.02108 NATIONAL ENERGY SYSTEM,IN 'FRACI LANE 1331 GRAFTON ST WORCESTER,MA 01604thout Administrator Not valid wisignature �?:- i.�'�J�•r/.'iYt.'o6��:j- J•t:J�i;;3P1C-�S.:r3r3Gt.• Board of Building Regulations and Standards License or registration valid for individul use only HOME IMPRflVEM NT.t;©NTRAGTOR before the expiration date. if found return ds Banrd of Building Regulations and Standards Registration- 104098 One Ashburton Place Rm 1201 Expiration: 7/13/2008 Boston,Ma.02108 Type: Supplement Gard NEW ENGLAND SASH. INC RUSSELL WOOD 31 Gratton Street Sr f"' _ =orcesier, MA 01604 1dministracor` Noi valid without signature MA Rag.#104098 RI Reg,#26375 It New England Sash Inc. Federal ID#04-2889905 CT Reg.#547271 E -{ ' Main Office: Branch Office t 1331 Grafton Street Worcester,MA 01804 508-7 L6 � [92-918f•800-300-7274 1Fr� .1I]�d THIS CONTRACT made the I day of. Oti/� --In the year J�11 7 between New England Sash,IDC.and X357 (OWNERS) HOME PHONE) L 1 ,t n (BUSINESS PHONE)OF (STREET) (TOWN) (STATE) (ZIP) As used in this contract,the words we,us or our refer to New England Sash,Inc.and the wads you and your refer to the customer. We agree to furnish all labor and material necessaryto install the following described windows at: Sb>y�k AJfl?At!�- Triple Glass with Double Low E with Krypton Gas ❑Argon Gas ❑Other(See Addendum) Total Units: #of Units: Grids:Y /Nw_11111 Color, wk t , Material: 7Cf ,SC do not do any palnting or sta Double Hun Units: Installation; 6 f Via aro not responsible for conditions or clrcurmrances Picture Unita: beyond our control Inc ud ng condensation resullN g Total Contract; �5�3 hconea on or due to preAxiseng bna.Our ArMed Ho er Units: veer- ranty Is herein Incorporated by reference. -� Sales Tax: Slidin Units: 2-lite: 3-lite Awnin links: 1-lite: 2-lite r Casement Units: 1-I4e: 2-lite: 3•I1te: 4-lite Total as Bow Unit .D /CS: 3 "�f y J lite: 4-lite: 5-lite: Price: Garden Windows: q Deposit EMedor Finish; Roof Soffit Total Projeetion`J d 4,Z#4 Knee Brackets: Y With Order Entry Doors: St I F S"to ,1 Storm Doors: AluBalance Due Alum Core cod Style: Upon Deliv v Sliding Glass Doors; # InsiIng Out Right Active a Balance Due Capping N # 3 Capping Color: Upon Final Install: Additional Notes: ad r r 1 di 1 tt w 4^-11 e,,6- r LJI J Ocl-cli s3't � . fit f DEPOSIT WITH ORDER ❑CASH CHECK # 10K, BALANCE DU5,)&ASH ❑ FINANCE You agree to pay cash according to the terms shown above or,If your credit Is approved,to sign a note provided by us for payment of the amount due. The Installation will begin on or about !?-II�and will be substantially completed on or about 3' L4'1 J .II is understood by you that the following contingencies could materially change the estimated completion date stated above:customer's inability to obtai r quality for financing;Inclement weather; strikes or other labor disruption;non-availability of materials;acts of God. - We represent that we carry Workers'Compensation and Public liability Insurance in the amount of$100,000-1,000,000. I BY SIGNING BELOW,YOU ACKNOWLEDGE THAT YOU OWN THE ABOVE PROPERTY AND THAT YOU AGREE TO ALL OF THE TERMS OF THIS CONTRACT,INCLUD- ING THE ADDITIONAL TERMS LOCATED ON THE REVERSE SIDE OF THIS PAGE.YOU ALSO ACKNOWLEDGE THAT YOU HAVE RECEIVED A FULLY COMPLETED COPY OF THIS CONTRACT AND TWO COMPLETED COPIES OF THE NOTICE OF CANCELLATION,AND THAT YOU HAVE BEEN ORALLY INFORMED OF YOUR RIGHT TO CANCEL. DO NOT SIGN THIS CONTRACT IF TH/ERIE.ARE ANY BLANK SPACES.. �//� IN WITNESS WHERE F,the anies have hereunto signed their names this I!o r qday of r rl�v" in the year of J Signed _ Signed MARKETING REPRESENTATIVE v OWNER Y By _ — ---- -Signed- ------ --------�_...�.�--.- NOTICE OF CANCELLATION NOTICE OF CANCELLATION DATE OF TRANSACTION DATE OF TRANSACTION YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY YOU MAY CANCEL THIS TRANSACTION,WITHOUT ANY PENALTY OR OBLIGATION,WITHIN THREE BUSINESS PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE ABOVE DATE. DAYS FROM THE ABOVE DATE: IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAY- IF YOU CANCEL,ANY PROPERTY TRADED IN,ANY PAY- MENTS MADE BY YOU UNDER THE CONTRACT OR MENTS MADE BY YOU UNDER THE CONTRACT OR : SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED SALE,AND ANY NEGOTIABLE INSTRUMENT EXECUTED