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HomeMy WebLinkAboutBuilding Permit #488 - 1770 SALEM STREET 1/21/2010TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: yf Date Received i Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 1726 54L,!!�,vt 5% Print PROPERTY OWNER_, f.gftrCc�t�t Print MAP NOV_ /06 PARCEL:/—ZONING DISTRICT: Historic District, yes Machine ShoD Villaae ves .nog TYPE OF IMPROVEMENT PROPOSED USE Reside ' Non- Residential New Building _, One famil Addition ---Two or more family Industrial Alteration No. of units: Commercial epair, replacement Assessory Bldg Others: emo i io Other Septic Well Floodplain Wetlands Watershed District Water/Sewer oESCRiPTiON OF WORK TO BE PERFORMED: Please OWNER: Name: pe or Print Clearly) ivo Phone:,7'�-3 Address: , `-17.6 S 4LF� isf - CONTRACTOR Name: Y- R- .✓,,/Lt Phone: 2,f Address: 5 ti +20 h r1AW Ai.,+- cele 3 a2_ Supervisor's Construction License: 0,9 eS _3 -Exp. Date: - zfb- rz> Home Improvement License: t 0,J 7.2 ARCHITECT/ENGINEER Phone: f - Address: Reg. No. FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $6 6 -- FEE: $ 17�Z Check No.: ���� Receipt No.: ,22 `7�/ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ownerc ee.aSignature of contractor 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 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 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 Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Durnpster on site yes. Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street no 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 Location a No.Date2 /,) N TOWN OF NORTH ANDOVER n Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #�� 4 2275:1 1 Building Inspector O z 14P A G O w aai cn w P-4 z z Cd p w bp O r� C U co G X. w z G cz G w CL R. a w w V) C w x o a 0 w z w z W 90 ztm cn o v O cn t U C Co cm E C L O s Z CD CL O CO) Q C I cm CO) � Q 'C y O O g m m 43 C CD .G3 O.a CD Q L o a CL CMQ c ca � P) J .0 O. O +O+ CO2 Z V h cc C — C Oak C _cc �. CO2 Q Ck 19 W 19 W N c y- . o 02 o cs c ` O y O V V ea CD c t : CO O®c 0 `hoc CA E C O: o= \o.. :v0 s cm c E 'CO : X03 y ._. o zip !. y W O � y W Amoo, CLE --5m y O : woo :mor ca m L O `O ccZ rc ts i O CL. C CD i m C •O Q = o : : w:5CL ni CODCD3 W O 3 :5 Z •V! R r.. � •� d� = Or.+ ®•y v fl G7 Z 0 CW S cm y a 06 m t U C Co cm E C L O s Z CD CL O CO) Q C I cm CO) � Q 'C y O O g m m 43 C CD .G3 O.a CD Q L o a CL CMQ c ca � P) J .0 O. O +O+ CO2 Z V h cc C — C Oak C _cc �. CO2 Q Ck 19 W 19 W N -Name. Adams: q T F-pv%dl aA �ii�►/Stafiel7ip: i19 /�Ir �I��r°� 1d�t#.I_ •47��` �°`�� Are you an employa? Check the apprepriato.bons • . . 1.CaI maemployerwilh 4L ®I amagonerat contractor andII employees(fAand/orpumbne) havehiredt �ub�contr rs 7 rl T am a onlay umMatm nr aninar. listed onthei atiaohod dwat t ship and have no employees wotidag hr meinanycapaoity. (Nm o�wo�rha, rs' comp, insurance 3.® Iamahomeov wdoiogagwork myself [No warbers' ow. �ns�ance regni<ed.] �' workers' comp. insuacac®. ' 113 We are acorporationandib offim have =&d** d&afexemptionpwMM L 15% §1(41 Ind Wehaveno OM#kpm [No vqw Comm. insmgmce r04aiiAI hC a T ie off project (reguirso: 6. ®New condruction: 7. O R=deft 9. ® Building addition 1013 Blectdoal mep*s or additions 11.13Plumbiggmpairs oraddidons 12.0 Roof repairs 13.® Olwr OA,preppliaaat�►etahea�6ax imu9telsosilout asaattanirelowshowing .. compensa�onpolioym maaflon. tHamaownmswhosala�8�is effidavitindtcatiogtl�q andoiogaUwa�sadthmtldaaen�deaonticaoto�samnteabmitsnawo�nlevltin�iaatinpeaob. 3C4Nraataca�etala�k�taormnetet�tedsnaddii�onalaheatshawingil►enamao�fhesa��aanl[aolursandthdcwad�s' aomp.po8asrinfom�on. 1 aaean eAV?oyerdbatispn Wft worlQaoes' cvm pmdoa b mermce, jbrnrarloyaea; Below kthepoft asrdfob Me bomdfim 1'nsumnescomp wmam Policy # or Sains. uc.: Oil W G%V& SWI Rc mdonD: Job Site Address• Ciq+/StatalZ: Mach a copy off the woftme connpenaahion policy declaratlonn page @bmn-mg tine policy number and expimilon dmte� pito secure coverage as requiredunder 3ecdon25AofMM o. 152 can lead to the imposidonofcrio"penaldes of a tine up to $1,500.00 and/or one yearas well as dvRpenaldes inthe formofaSTOP WORK ORDER and aline ofupto $250.00 a dgagdostthe violator. Be advlsedthat a copy; �is st*mentmeybeforwardedto*e Office of Imresiigadous of*eDIA for insurance coverage veridoadon, a[lo leeeeby eee�r �hepa�se eared peraaltlee gfpey Aha�;the ii�oe�aB�'oaapemva'dedabmve is lane asedsaav¢c� - Date-SMON Lhmlk. '77 - 2 A. 26s- "721 - - Cpdd = 0910. lSoaeot'ladBe fee go as'ea, ao be comylead by d*► ®rto= ®ffleleII Cly or7bwne NrFiquwse IIsn*g Alntbo* (drale oneN. I. Board eff leall 2. Zdab1ng Department a. Ol%rMwm plyX.ZeMad IImpselor S. PI=blmS ](aspnc�r . — ORD . CERTFOCATE OF L-ABOL O U oNaW11A11 CE PRODUCER (800) 225.1865 THIS CERTIFICATE IS ISSUED AS ONLY AND CONFERS NO RIGH Fred C. Church, Inc. HOLDER. THIS CERTIFICATE DOI 41 Wellman Street ALTER THE COVERAGE AFFORDI Lowell, MA 01851 800-225-1865 INSURERS AFFORDING COVERAGE INSURED INSURERA. Citizens tasurance Company of 1 New England Window & Door LLC INBURERe; Hanover Insurance ComPSOE 45 Fond( Road INSURERc: Massachusetts Bay Insurance HavetbM, NA 01832-1302 _ -Wansda'YJndetwtiters Insaranee THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJ POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. __ wwnwV CGGGR GENERALUABILITY X COMMERCIALGENERALLIABILITY CLAIMS MAOE a OCCUR A JL ANYAUTO ALL OWNED AUTOS C SCHEDULED AUTOS HIRED AUTOS NON -OWNED AUTOS GARAGELIABILITY ANYAUTO E(CESSNMBRELLALIABILITY X OCCUR CLAIMS MAOE B DEDUCTIBLE X RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY D N CERIPMREMBEREAXCLUEDED7 ECWIVE 11pes desmiba under SPR W. PROVISIONS below DESCRIPTION OFOPERATIONSI LOCATIONS IVEH w England Window & Door LLC Fondi Road verhill. MA 01830 ZBM161407 1 7/1/2009 ADN8162169 1 711/2009 UHNS167305 1 7/1/2009 DATE(MMIDII)M tJ 06130/260916:20 NAIL # ABOVE FORTHE POLICY PERIOD INDICATED. NOTWITHSTANDING EC TO ALL THE TERMIS, EXCLUSIONS AND COMAY D TIONS OF UCH rn� Pau D OTION LIMITS en.1unmr11Q rsmiM &I,000,000 BINDWC 1 7/1/2009 7/1/2010 0IMEDGINGLELIMIT $1,000,000 (Ea acoldent) BODn.Y INJURY $ 7/112010 PPRoPI d DAMAGE $ ar AUTO ONLY-EAACCIOENT $ OTHERTHAN EAACC $ AUTOONLY: AGO S 7/1/2010 7/1/2010 I SPECIAL PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURETO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. NUTHORMEDREPRESENTATIME P © ACORD CORPORATION 1981 \ > -4 k / \/ \_\D I� m X k _ m 2 /"n E §. 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If you cancel, any property traded in, any payments made by you under the agreement, and any negotiable instrument executed by you will be returned within ten business days following receipt by the seller of your cancellation notice, and any security interest arising out of the transaction will be cancelled. If you cancel, you must make available to the seller at your residence, in substantially as good condition as when received, any goods delivered to you under this agreement; or you may if you wish, comply with the instructions of the seller regarding the return shipment of the goods at the seller's expense and risk. If you do make the goods available to the seller and the seller does not pick them up within twenty days of the date of your notice of cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the seller, or if you agree to return the goods to the seller and fail to do so, then you remain liable for performance of all obligations under the contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Pella Windows and Doors, at 45 Fondi Rd., Haverhill, MA 01832 4Y/noy (4VP ) not later than midnight •f (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) DISPUTES Job Name =';y��r� Date 12-116/09 THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS CONTRACT, PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A AllAte, _ Contractor l ill r,� L�-Ll 14ot IeOW 7 NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT SEPARATELY SIGNED BY THE PARTIES.