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HomeMy WebLinkAboutBuilding Permit #651 - 19 BLUEBERRY HILL LANE 4/9/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Issued: Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other d Septic ❑ V1ell ❑Floodplain�WetlandsVll�tershed D�strc C� Water/Seuu c ap DESCRIPTION OF WORK TO BE PREFORMED: O -/l/2 ©C7 • o� ( F Identification Please Type or Print Clearly) OWNER: Name: _[Zo�erf' tAAIS,Ptif Phone: ARCHITECT/ENGINEER Phone: 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: $ 1,5IOT/ZJ • FEE: $ Check No.:/ Receipt No.: C:P U l e e;oe NOTE: Persons contracting with unregistered contractors do not have access to the g aranty fund Signature 6f Agent%Owner Signature of contractor *! k; 1 &4, A�e / Locaiion U 'Ile nate No. TOWN OF NORTH ANDOVER 4, Certificate of Occupancy $ Building/Frame Permit Fee $ C" Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 007�1-- 20'1 U6 Building Inspector 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 .t 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 Located at 384 Osgood Street r�rc uGrAK i Mt:N I 1 emp vt r Aster on site''yd po Lcicated..at 124 Main-5treet _ . Fire Ciepartment signature/date= 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 o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Est. 1984 Hughes Expert Exteriors Lic.#116786 10 Greenough Rd. Windows & Siding Fully Insured Billerica, Ma. 01862 Doors, Gutters, Sunrooms & More 978-663-8714 Customer: Mr. and Mrs. Robert Hansen Phone: 978-208-8198 Address: 19 Blueberry Hill Lane North Andover, Ma. 01845 Date: 2/21/2007 Contract for Work(Revised) Remove 5 existing double -hung windows in the first floor. Insulate and seal openings properly. Install 5 Thermal Industries DH530 double -hung welded windows with superpeak triple glass. Windows to be white with internal grids (12/12) and half screens. Remove 4 existing triple casement window units. Inspect framing as needed. Insulate and seal as needed. Install 4 Thermal Industries triple casement window units with superpeak triple glass. The left and right units will crank out and the middle will be fixed. There will be internal grids in the front two windows. (grid style 1 V -4H) These windows will have foldable window handles. These windows will require new interior trim and exterior trim. We will install all trim and you will paint it as needed. Upstairs, we will remove 8 existing oriel style windows. Insulate and seal opening. Install 8 Thermal Industries oriel style DH 530 series windows with half screens and internal grids (8/12). On the exterior window stops, we will install trim and sealant. This area will require no work on your part. We will do all the expert installation with our crews. As mentioned, we will be very cautious and neat during the install process with dropcloths and mats. We will vacuum completely. s This work is guaranteed for 25 years. All above mentioned windows come with foam filled insulation in the frames and sashes. , All above mentioned windows to come with Thermal Industries lifetime warranty on all moving parts and frame materials. The glass is warranted for full for 25 years. The warranty is transferable. We will remove and dispose of all debris. The following page contains pricing and payment information. Pricing: Total Price Discount from Home Show for Superpeak Glass Price for internal grids on the front casements Deposit received 2/16/07 14827.00 -1700.00 120.00 -200.00 Agreement: We agree to the terms of this agreement and to the work described as such. Payment to be made as follows. Initial deposit of $200. A second payment of $3500 upon window measure and order. Remaining balance due upon window installation. I look forward to servicing you and thank you for hiring Hughes Expert Exteriors. "A customer at Hughes is a customer for life." Jeffrey Hughes President, owner Hughes Expert Exteriors Customer: Date: Date: 2 Z 3/O 7 Deposit Received:y -� v (/ S Date: d Boardof _—~~~~g Regulations uuuumuuu,d§�� / MOM E|MPROVEMENT CONTRACTOR Registration: 116,786 E'Xplration: 7/20/2008 |zYpm: Ltd Liability Corporation JEFF HUGHES EXPERT EXTERIORS_-� ' JEFFREY HUGHES' ' 10GREsNOUGMRD. / 0LLER|Cx MA O18U2 Deputy Administrator -' 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): Address: Q Cit /State/Zi tom' Y P� f�/� ICCZ ,�%%Q. 0/e6 Phone Are you an employer? Check the appropriate box: 1. I am a employer with �— 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees These sub -contractors have working for me in any capacity. workers' comp. insurance. [No workers' comp. insurance 5• ❑ We are a corporation and its required.] officers have exercised their 3. ❑ I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other *Any applicant that checks box #1 must also till 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. *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. #: /�jli �Q �a Expiration Date: 3 Q Job Site Address: (U City/State/Zip: xl(l. Attach a copy of the workers' com nsation 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Phone #: , l L�GW "-F%I% 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 M z g cm I eW ►'V a CD Z O O CIO CD c O CD C3 cc M COD 0 o. 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