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HomeMy WebLinkAboutBuilding Permit #788-11 - 267 MASSACHUSETTS AVENUE 5/23/2011Permit N0: 7 bo, Date Issued: 0/,-/` TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received IMPORTANT: Applicant must complete all items on this pate LOCATION 2� 7 l 1 e,s W✓e- _ Print Print MAP NO:016. 0 PARCELO 0 �f- ZONING DISTRICT: Historic District yes 4 Do Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition 0 Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �1Septi-f c ,� Well ®FFlo dplain� 0 Wetlands 3 � �WatershedtDistrict; � Cl Water/Sewers t DESCRIPTION OF WORK TO BE PERFORMED: C—Dn slCuc_-tI le cti Z i� _ (Identification Please Type or Print Clearly) OWNER: Name: &kA 6g;rnc-u Phone: Address: 1(67 / Ig -45 Avc /Umrkti yne)ovC-t-, f-4 l / CONTRACTOR Name: lm,,,,,Q„ ►t v Phone: Address: Supervisor's Construction License: C S 8;cJ S'4- Exp. Date: Home Improvement License: ] O 7 3 5 2 Exp. Date: 7/ 7/31 ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.000 PER S.F. Total Project Cost: $ Y, S-& .CSD FEE: $`OV Check No.: Receipt No.. NOTE: Persons contracting with unregistered contractors do not have access to the guars fund ,Signature�of.Agent/Owner�� � �� �'• .. -�.�S�gnature of,contractors_.;._.,..�,.,.�,.�,��-~P 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 o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Li Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses a Copy Of Contract a Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) a 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) o Building Permit Application o Certified Proposed Plot Plan • Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) a Copy of Contract o Mass check Energy Compliance Report a 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 2008mi 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 PLANNING & DEVELOPMENT ❑ COMMENTS CONSERVATION COMMENTS /,)CD HEALTH COMMENTS Reviewed o �A 140 0" DATE APPROVED Reviewed on Signature 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: k,_ Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 2008mi Location No. %� �� Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 'Sy Drs Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 24175 /Building Inspector 0) M M M M °m y C d CO) C7 n z coo CLO O d CO) loc o v CD CD o Cr =r CD CD CD IMM a C CD W CD CL.O y O I Co CD O CO) O CD O CD C CD C 0 0 z O CD 0 cc O 00 c Co CD to c O CLCA0 s Co m G ? � O d = 0 CA no5m cn Cc ® C Cl) C,* m . c �. = -� 5") � Mgt m N y T a. ?d W m CA o y �mm: a ZS O y p mo'm _ CL r..... CD CD rA: CL o�,� N 'Cr CD `� CD Co rh �Q 0 CD 0: G Cos "'• m CD CD c�.�- Cr =. C c o ~" O ��-y _ rt o M �' ; orn �' M r a? 05 r.?' �' '� n c o�c ro a a. w z y 'a F O r/�rr to d z omi 0 O C ►s Stan's General Contractor & Home Improvement, Inc. CARPENTRY -ROOFING COMBINATION WINDOWS & DOORS 89 School Street, Saugus, MA 01906 SIDINGS -GUTTERS VINYL REPLACEMENT WINDOWS 1781) 233-1858 CUSTOM TRIM COVERAGE Federal ID No. Contractor Registration No. 107352 Homeowner Information: 2C7 /Io5 Aut I 4C 41- A ,aver /1" 41,5It s �78— The Contractor agrees to do the following work for the Homeowner: �pvtC L%5c- k &1 � � 4 1 ?,at l6 �t�\k o� bxc � 7'rt�r o�te I A5 rbC ;'Ivor; nj M,,6cc� tc� rq� �ins5 Crovr.d PC,." �.�}e r' air �cc>�, Materials expected to be used: ?C.C5Sar_ • r ra�e� ped, v�ny� Pq•<<ngS1 '(teys ��kt^S The following building permits are required and will be secured by the contractor as the homeowner's agent (owners who secure their own construction -related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund): 1. Proposed Start and Completion Schedule - The following schedule will be adhered to unless circumstances beyond the contractor's control arise. r L N Date when contractor will begin contracted work. 5131 I� Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work, furnish the material and labor specified above for tVe total sum of: $ Payments will be made according to the following schedule: $ Z,p00- oo upon signing the contract. #VALUE! upon completion of the contract. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Two identical copies of the contract must be completed and signed. One copy should go to the homeowner. The other copy should be kept by the contractor. /,,, H4Qeo er's sig ature Contr or's signature �_ /I — S/ Date Date You may cancel this agreement if it has been signed at a place other than the contractor's normal place of business, provided you notify the contractor in writing at his/her main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Unless otherwise noted within this document, the contract shall not imply that any lien or other security interest has been placed on this residence. The law requires most home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. Any inquiries relating to registration should be directed to: Office of Consumer Affairs and Business Regulation Ten Park Plaza, Suite 5170 Boston, MA 02116 Phone: (617) 973-8700 Arbitration The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract, the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairsatid Busingss Regulation and theFonsumer shall be required to submit to such arbitration as provided In Massachusetts General Laws, re Contractor's Signature NOTICE: The signatures of the parties Sbov"k apply only to the agreement of the parties to alternative dispute resolution initiated by the contractor. The homeowner may initiate alternative dispute resolution even where this section is not separately signed by the parties. Execution of Contract The contract must be executed in duplicate and should not be signed until a copy of all exhibits and referenced documents have been attached. Parties are also advised not to sign the document until all blank sections have been filled in or marked as void, deleted, or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties. Contracted work may not begin until both parties have received a fully -executed copy of the contract, and the three day recission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However, in instances where a contractor deems him/herself to be financially insecure, the contractor may require that the balance of funds not yet due be placed in a joint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. 5/23/2011 1:29 PM FROM: Foster TO: 1-978-688-9592 PAGE: 002 OF 002 ACORbr CERTIFICATE O F LIABILITY INSURANCE `66� DATE (MM'DD/YYYY) 05/23/2011 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: NORTH ANDOVER INSURANCE AGENCY, INC. FOSTER INSURANCE SERVICES PHOE (A/CN No, EM): (978) 686-2266 (a/c, No): (978) 666-6410 E-MAM.J. ADDRESS: cfernandez@nafins.com i63 MAIN STREET PROUCER CUSTOMER ID #STAN'S ALUMINUM HOME NORTH ANDOVER MA 01845-2508 INSURER(S) AFFORDING COVERAGE NAIC S INSURED STAN'S ALUMINUM HOME INSURER A MERCHANTS INSURANCE GROUP 23329 INSURER B :GUARD INSURANCE GROUP IMPROVEMENT CENTER INC 89 SCHOOL STREET INSURER C INSURER D i INSURER E SAUGUS MA 01906-4362 IINSURER F %.VVCRAUl GtK IIFICA It NlUIVILihFC oCVICIANI Al11hAMM0. THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF (M IDD/YYYY) POLICY EXP (M /DDNYYY) LIMITS A GENERAL LIABILITY Y BOP1045104 1/12/2011 1/12/2012 EACH OCCURRENCE $ 1/000,000 X COM MERCIAL GENERAL LIABILITY CLAIMS -MADE I—XI OCCUR / / / / / / / / RENTED PREMISES Ea occurrence $ MED EXP (Any one person) $ 15,000 PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 / / / / X POLICY PRO LOC / / / / FLL $ 500,000 A AUTOMOBILE LIABILITY ANY AUTO Y CA7015307 1/01/2011 / / 1/01/2012 / / COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) BODILY INJURY (Per person) $ ALL OWNED AUTOS / / / / BODILY INJURY (Per accident) $ . X SCHEDULEDAUTOS PROPERTY DAMAGE (Peraccident) $ X HIRED AUTOS / / / / X NON -OWNED AUTOS / / / / $ $ UMBRELLA LIAR OCCUR / / / / EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE / / / / AGGREGATE $ DEDUCTIBLE $ / / / / RETENTION $ / / / / $ B WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR)PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? El (Mandatory in NH) It yes, describe under DESCRIPTION OF OPERATIONS below N/A TWC239309 1/26/2011 / / / / / / 1/26/2012 / / / / / / VJC STATU- OTH- X R I ITS E.L. EACH ACCIDENT $ 100,000 E.L. DISEASE - EA EMPLOYE $ 100,000 E.L. DISEASE - POLICY LIMIT $ 500,000 BOPPROPI045104 1/12/2011 EMPDH 25,000 [1/12/2012 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, r more space Is required) �.�r� nrwr� nVa_vcn I.ANI.GLLA I IVN ATTN • BUILDING DEPARTMENT SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER 120 MAIN STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01845- ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. INS025 (200909) The ACORD name and logo are registered marks of ACORD ..� 2 LEL ) !\m § `\ !$2 U) - $ / \ 77= / \ " 2 \ #� | � 2 Lu. t =D, � < §■5' 2 E $ �I ] .S / / / / » ~ ® / E �/ ƒ m f0\/ \ .° e co .�a \ s. / 72. §7 \� a �% � k'®` w.. — °§ \: (2 2 LEL ) !\m § `\ �mA � !§ �:w 77= | � 2 Lu. t =D, � < §■5' 2 E $ o ? 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Rr fNI+oRN ,= M YNRPARK STCMG 1CRN FROM dXtSrfNO RSL1aRDS ANDOMR, YdSSdCHUS8M 01810