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HomeMy WebLinkAboutBuilding Permit #404 - 29 BUCKINGHAM ROAD 11/15/2006 TOWN OF NORTH ANDOVER NORrH APPLICATION FOR PLAN EXAMINATION O`<���° '",gti- O , 6 o Permit NO: Date Received 9006 7 /V�'✓ ��� 7 pDRAreD Date Issued: - 1 �� 9SSaC S�`� IMPORTANT: Applicant must complete all items on this page �y , LOCATION / ac e n f Print c y PROPERTY OWNER ,V, 1 ► " l G� w� G , J �t Print MAP NO.: PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building -e0ne family ❑ Addition ❑Two or more family ❑Industrial ❑ Alteration No. of units: ❑ Commercial ;?-kepair, replacement ❑Assessory Bldg ❑Demolition ❑Moving(relocation) ❑Other ❑ Others: ❑Foundation only DESCRIPTION 9F WORK TO )E PREFORME� L.. r► Yv� u)or k " Identification Please Type or Print Clearly) OWNER: Name: 1 d-I tvi -S vytc �� Phone: Address: CONTRACTOR Name: - v Phone: 3a Jci 7,50 Address: �? - �`� Or �e r Supervisor's Construction License: - Exp. Date: Home Improvement License: /49907 Exp. Date: // ,'2007 ARCHITECT/ENGINEER -- "-� Name: Phone: --� Address: �'- Reg. No. FEE SCHEDULE:BULDING PERMIT: 1 .00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ 101 f) FEES I4- Check No.: Receipt No.:l — Page W4 Location No. 6}" Date �a 40*TN TOWN OF NORTH ANDOVER Certificate of Occupancy $ �s'•••� E�� Building/Frame Permit Fee sACMUs Foundation Permit Fee $ 'e Other Permit Fee $ TOTAL $ Check # I - 19805 i r Building Inspector i . TYPE OF SEWERAGE DISPOSAL Swimming Pools 11F] Tanning/Massage/Body Art ❑ Public Sewer Well 1-1Tobacco Sales Food Packaging/Sales El❑ Permanent Dumpster on Site Private(septic tank,etc. ❑ Electric Meter_location to project NOTE: Persons contracting with unre 'stered contractors do not have access to the guaranty fund Signature of Agent/Ownerr Signature of contracto C -) Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 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 i HEALTH ❑ ❑ COMMENTS FIRE DEPARTMENT - Temp Dumpster on site yes n Y Fire Department signature/date 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 Building Setback(ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA— (For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.Jan2006 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 'w Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract o Floor Plan Or Proposed Interior Work Addition Or Decks ❑ Building Permit Application o Surveyed Plot Plan o 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) New Construction (Single and Two Family) Li Building Permit Application o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses r Affidavit ❑ Workers Comp, ❑ 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 In all cases if a variance or special permit was required the Town Clerks office must stamp-, tamp 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:BPFORM05 Page 4 of 4 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 n Ir LIF-R Polm �l Y"_t Roi ZTR .) j� Name(Business/Organization/Individual): s E ...L; 10 MVS VVt e-VI Z/— 7' (.G r,fI-1!—oc, Address: /0,24 FL D r i CI Ct L G-?I�I�j"a I Y� City/State/Zip:101051W Cal FL, 3�)7 SD Phone#: A07- 9S ) - S4 Oa Are you an employer?Check the appropriate byx: Type of project(required): 1.El am a employer with 4. I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. + 7• ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. F1Building addition [No workers' comp.insurance 5. r_1We are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their 3.❑ I am a homeowner doing all work right of exemption per MGL 11.E] Plumbing repairs or additions myself.[No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs( insurance required.]t employees. [No workers' 13n�Other Vinyl si r comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submit this affidavit indicating they are doing all work and then him 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: Ace- A m P r i C , —L r s u r-a til C�e t o kill t9cei1/1 Policy#or Self-ins.Lic.#: w L PC 4A 34 (j5?G 0Expiration Date: 6A Q/ 11�OD a /Vorf Job Site Address: City/State/Zip: r-//-,—- M4 01 5 Attach a copy of the workers'compensation 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. Ido hereby certify der a pains a penalties of perjury that the information provided above is true and correct. i Si ature: — _ e Date: )S �v0,e Phone#: 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#• f R" oo -W Andover .2, Twn 0 ....... as No. 4eoq over, Mass., �l �' LA WV COCHICHEW11 K Ids RATED PPG �5 WARD OF HEALTH Food/Kitchen PERMIT T D Septic System V BUILDING INSPECTOR THIS CERTIFIES THAT...... .............goo-w6..,PY4.... . ..... ........................................................ ............. ..... .. ............ ........... •. ........... ..... Foundation 40 has permission to erect........................................ buildings on 02.?.....if, ........................... Rough Chimney to be occupied as... ..L........ro( a . . ...... ......... ... ... . . . ....... . ... ..... .... . ..... .... . . . .. .. provided that the person acceIT ing 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 at PERMIT EXPIRES IN 6 MONTHS Final ELECTRICAL INSPECTOR UNLESS CONSTRI,_C S S Rough TjUft"Wft�.......... Service ......................... ............ BUILDING TOR Final Occupancy Permit Required to Occupy 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. �t^ ./1(.�: 1,�.'(,. /�'1/1�til.�� trZ1��{ !.�1 .. l�!7„1✓{s(.�r.�/.i�F�� =�= _ Board of Building Regulations and Standards NOME IMPROVEMENT CONTRACTOR Registration: 148607 10/11/2007 Type: Public Corporation SEARS HOME IMPROVEMENT PRODUCTS INC. ALFRED NYMAN JR. -- -- 11-024-F'L-ORBA CENTRAL - Y LONGWOOD, FL 32750 Administrator U) J/2006 15:02 467-767-8536 PERMITS LICENSE= DEPT PAGE 03 I ✓ � $ CERTIFICATE QF LI BILITY INSUR,.ANGE ioiri ono` oos LOWON COMPANEB CER r ATE O 1188UIR ASA TIER P tNFPORMATfDN 525 W.mmms,eub soD ONLY AND.Cq]NFEF NO RIGHTS UPON THE CEFlT1FICATE CHICAGO IL 60661 LR.TN I$ CER'-PICA DOES NOTANEND T&ND DR (312)88 aou Enm MDED M Mff 501h I h1SURE RS AFFORDING COVERAGE nMUM s WIT beerHddl 10621 B3 GCOI po►stlon 6 dN 6S M HMW Mal fOpFDYe M Pio kft,InC, a eRd1EJL D�N41<thAmaric� epvreM W177B 3338 9ew►ly Rd. nqn Fate K IL SD179 THE POLICIES OR INBU4IANCQ LISTED NLOW HAVE HEEN Il18UED TME INSURED NANIED ABOVE FOR T IE POuCY pEloW INDICATED.NOTYY M&TAND*4 ANY R6auntEMENr,TSWt OR OF ANY CONTRACT OTHER DOCUMW WRH ROVECr .0 VMICM THIS CERTIFLIATE MAY Be mum OR MAY P6RIYUN,THE INSURANCE AFFQl BY THE Po 04 IGREW 18 SULIEOT T)ALL n I TEW&DGWSIG NS AND CONOMON5 OF SUCH 10 /len ID e u w—_ 08tl6RA1,uAelrm A X CML Goo"AL LUMILM HDO 021729383 CW ON0lfltg6 1X►/O1P1(07 Mmw s Excluded CAAAMSNuu7s XC�OCOUR AAeDEVI ampmml Plud AM MMUMANNIMM a 5.000 000 LAC=EQ&LEuwrAppt PER GEWWLAQ4RF0A7'E f S M1249MEMNA = 190,000 000 AAIfOMOAIIA!LWI!!7Y A X AWrAWO ISAR08219953Oa/01lZ006 tuI/Ol/'�017 =eeate�°enry MEUmrr a S,OD0.000 ALL O Wmo AUTes SOMEDUM AVMS BOOLLY INAIRY IralEOAvros (Perpanon) = 7DCItaC7p(x NON•OwNepAtITo9 pec re�o�„r��r a X3CXXXXX I, oArAAae�IAeIAm 1p=*TTYnq�m f XKXXXXx A ANY AUro0 oWly_ AC 5.1.R$5,000,000 04/0)/2006 01101/2017 I MtW UADLLrry .�—y AUtFi Olilr622 �r ` OCCUR ❑—�IQAIMS I� NOT A,PPUCAB.LE enclf CccuRR r XXXXXXX LOTHM 0T0' � PRM )Ot)t�00Ctr10N°N'o"$A'roNArmwLRC44340860(CA)(D .) 04/01/x006 (k-M/2001 X WCs�tWIAJ7Y BSCFC44340872(WX)(RE p) 04/01/x006 NAlrm r WLRC4434085 @° s000 904/01/2006 t0 101/200 EL msEAse- 1000000 9_IR.>;5,000,000 .poticrurerr e I Annrscaa6lrATttrWetLocATloNeruefeetEgy .usroles AoMn ANtaa w.Nyman,Jr.,Liana oc=1253S tocemd a 1014 Pitlrida cm p"� KM Ioca�d®1 WA RlorldA Central lmX,pe d Fl 32?30 4'-10T--K FI321St Md Alf,d W.Nymon,Jr.,License 6CMCI 24951 a 226=2 AWL— asm Home ImprOvemeel Produale L Nt mw"' OEse no Pot+atie e5 CAMC66LM 9EF0Ra TWQ MrnRA7" 1UMRwoud 024 F lWde Gw"Pa&,q NI gA AIMp AVS WA IMt1 euDFiANOR TQ NAIL � GAY!yyprTTFA ��� 6R4UarEDT9"OLIPT,AllrFALUMmoO SOMALL I"+Mt uAM fry OP AW 00 VOM yn eteIl. UN&%Ib ApENTy oR Aurwam kwp1l�E/i1 ATIv6 �, CORD 25S(7/ATX Forww,.,q.wny,o,,�s�....,�re. eMnwaw Mnr �n�0oww,I���ttrrrnn�ANOAf oACORD CORPORATION 1988 I I Sears Home Improvement products,Inc. J 0 b No.: 10— y 7OSa License NO.COC 0125M Phone 1f: P•0.Btxk$22290+Longwood,FL 32752.2290 4: aaae� Location: 1 01'1 Name M I r I rw M Siding 1F 18"I Phone:Rea q]�(p 3- Sus. Address: 1)cE1h-jftCd0%Cr St.: MA zip: o--L��_ UWe,the owners�th. bedbelow,hereinafter referred 10 as'Purchaser offer to contract with Seam Home ses improvement Products hereinafter referred to as"Contractor,to furnish,deliver,and arrange 1 )rttrtaUatbtt of all materials necessary Home!o improve the Premilocated at ( ) (city) Acoorcing to ire toRoxlf ) (rip)n9 ePettiications: NOT INCLUDED INCLUDED SPECRCATIONS PBEaummu: I. 0 ❑ Otualn e9 necessary permits aro insurances. 2. 0 ❑ inspect surfaces in work area-'one"base wood,replace roles surface wood where necessary in work area Nldud no roof,ded3ng or ratters,and strutiturai wbers. 3. ❑ Remove E,denrtg a": Type: �trn+ 11 4. ❑ Ft out walb on trick,block,metal or stuaco areas;Location: C,rte arm r-- s• ❑ Caulk arta a"around all windows&doors In work ares as 8- 7. ElInstal approved non-corrosive garter strip '3l 9INSULATION: ❑ Install insulation on 11etwat areas to be sided with-N4'/"4M'•01ruded poiy'stYrene OtetAalicrt.(chola ate) : S. L? Custom Vyna-Klad alum :Is System: Color. 9 ❑ Remove arm res mdstin9 guttering. 10. Q Cover t afth areas of tit v*ho sofit system,oxoapt those areas noted below. ,( 11. WeRbitbMter 0 Max 0 Plus 0 Waftrbealsr 0 Other (chumki Pagem: ❑ ( Custom Vy11840ad atummurn frieae boards: AV Location: Cao ; 1 s O J�ow trim: Location:U%—fckLo4 Da�w wapwindgMffNrmdlalfeades with Vya-KW alaninulw—�—fQ lac:r e urn st R' 14. ❑ Remove and reinstallCobr: 15. ❑ 9 storm wirtdowra/awnirhgs/sinmers CLW—wrap door bdnp with VMI-load alu r inI 18. ❑ cK L ocatlon: Color lOI Custom wrap garage door fps singleAtoubla with VynedOad aluminum. 17. ❑ Remme and reinstall storm dotes Color: 18. Deluxe comer posts: Col. r C 19. ® ❑ COP Iaddng system: Location: ;ANG 20. install 0 Max 13 0Wtieaellus er SWM vi Sidi rn' ft0o-Aivc n9•(checkone) PORCH 21. ❑ P0mh rfkal COLOR: Cn 1 G _\Cry( IE9�: 22. ❑ P�Ptd: Location: Color. 23: EJ 24. Porch beams: Color SLEBtI!!P: ® Color: ❑ Clean up and removal of related debris: 2$. ® ❑ Each Job b overstappad to avoid delays.Remove taooess materials and restock. WAaSAHM: 28• © ❑ Mamrbgtuefe warranty sent upon completion. Work not to be done: O D IPEDGECo lame O PAI I � C�• w//s�rwa-v— . !K/ OU i S cr' dF Jaw,v iF "><I vW t lwt[.,O(,a7 kurC soc�Ay Ai of the above Check tmmms and the tiwoA not to be done'section Crave been nW wW and explained to me. NOTE:THE WARRANTY PROVISIONS AS STATED ON THE REVERSE HAVE BEEN EXPLAINED AND IIWE UNDERST ADDITIONAL PROVISIONS AND WARRANTIES ARE STATED ON REVERSE AND ARE PART OF THIS CONTRACT Verbal underatandl Pfea�" the following bold type and initial corresponding line. nga and agreements with represemaltve shall not be binding.All understandings and agreeme s f e set forth In writing In this Contract Purchaser hrnlels: The TOTAL PRICE for all Labor&Materials(including any appiCable discount)'s Down Payment $ I Contract Price $1 0.109 Q.sP Balance Payable$ t O,bG .00 State Sales rax(_%)$ O ! (If applicable) ob Tema: Credit IF (SulrJect to the approval of the Credit Deparbnemt) Total Contract Price $AQ,is go, Cash ❑ (Final payment payable to htstaler upon complation)Funded by.. Bank: city St- 1076 Prafened Customer Diseaud(PCD)awarded for Aoct 9 any Futuro Ssera Ibnra mhprovenront Prod Purcheeea.Cwrent prldng ev Wit fw one(1)year. If leo.I a credit undemitransaction,the agreement for credit Is contained In a separate document which is incorporated herein by reference and made a part hereof.UWa the undersigned are hereby authorizing Sears Home Improvement Products to verity and raView my/our credit retard with an independent credit reporting agency and release them from all liability Incurred from inadvertent Ongltxhs or errors. IN WITNESS WHEREOF Purchasers)thane hereunto signed their names)this day of�—20 Qb and acknowledge receipt Of a true Copy Of this Contract and unless Otherwise Specified,it is urMerstood that the owner is ready for this work to begin. THIS MESSAGE APPLIES TO DOOR-TO-DOOR SALES ONLY.You the Purchaser(s)may canal this transaction any time prior to midnight of the third day after the date of this transaction. See accompanying notice of cancellation form for an explanation of this right. signature elated below acts as rewph vett wan rata omcftCm forms. AA .D BV:rh�Waeentetivo tate Purcn��yy -06 /I�AZCy ACCERfED aY: Sw�tue So2ra Metre Imre PrurDras.Irk. Dara � Date 02•SO •Rev.og"