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HomeMy WebLinkAboutBuilding Permit #612 - 295 MASSACHUSETTS AVENUE 3/27/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: �) Date Received `L Date Issued: TYPE OF IMPROVEMENT I0 _ A Residential Non- Residential ❑ New Building TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: k4y;5W 5/0.sCX Phone:9 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. f Total Project Cost: $ FEE: $ / Check No.: OT % Receipt No.: �o o S—r NOTE: Persons co acting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner 4PLe Signature of contractor�� : Z� 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 L3 Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work Li 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 ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses L3 Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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) o Building Permit Application a Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 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 HEALTH COMMENTS S DATE REJECTED DATE APPROVED 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 ❑ Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Comments Water & Sewer Connection/Signature $ Date Driveway Permit Located at 384 Osgood Street 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 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 No -- r Mlqsl� Ale, Location No. &Z Date TOWN OF NORTH ANDOVER i Certificate of Occupancy $ B CHU uilding/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 20059 -�,,2 Lj�,-� Building Inspector k ? 2. �: 2 7 3 g - . � = � O k - . k k � ■ ��a . �J cu � m � �� S2 m . InIt <-.c k °/a � \V. � `- k �0 E � _ » c k2S ± � _Z, 7 n» §§kk g �2��|'\ .� N m m ,,mww YI m y v m C � CACD C7 az y C O CO) O d= y CD O v �� O Q CD Er !D O CD I= w a. C� CD y CLO y CO C I �O I i� C 0 O 2 00. .-► m m O m CL c U2 m Cl. 0 CLCA H m 0-0 czr -4 cr �.�� 'coo SO m 10y co m • -4 m S -p to 40 O y 0100 o. n a Is CL 4c mr -� O CUR m3 H nom%' O1 y ' CpSj Q c m- a I m y IE N y O � m a� fG imb !i �: CDI qaco. m •Or. % F : y O z 0 in �3eH �] O O a� CDI qaco. m •Or. ',?7 �m: :rw �I: to r CL" 0 1 C O O � . % F : y O z 0 in CAW z o� �] "' 'T1 '�1 qaco. ',?7 :rw G 0CA to r O V3 0 c© CERTIFICATE OF LIABILITY INSURANCE csR ' DATE IMLUDD YYYY) „ PAW -12/16 06' robobucER Ame rican P;ret Ina Agency Inc AneQuincy Shore Drive - THIS CERTIFICATE IS ISSUED AS A MATTER OF,INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXMOOR ALTER THE COVERAGE AFFORDED $Y THE POLICIES SELOW. INSURERS AFFORDING COVERAGE NAIC0 North Quincy NA 02172 PhoneT617-7.70-4000 INSURED - - INSURER A,. Arbella-Proteotion'She.:CO.r. . O: -'.INSURER INSUAERC' Ne r0 Gpppliating LLC POoX 2696 - -:.Woburn MA 01BO1' �INBURERD: INSURER E: SPEC001 -0OVERAGES. -FTHEASOYEDEeCAIBEOPOLNBE90ECANCELLEDBEFORETIISE%PIRiLT10H GATE THEREDF THE ISSUING INSURER WILL ENDEAVOR TOMAIL 30, OAWS WRITTEN. IKE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED NOTWITHSTANDING -.. - : ANY REQUIREMENT. ; 7E111A OR CONDAHAVOF ANY CONTRACT OROTHER DOCUMENT WITH RESPECTTO WHICH THIS CERTIFICATE AIRY BE I6SUED OR - IMOOSE NO OBLIGATION OR LIABILITY OFANY KIND UPON IKE INSURER, ITS AGENTS -.. MAY PERTAIN, TILE INSURANCEAFFOROPO BY THE POLICIES OESCRIBEDVEREIN IS SUBJECT TO ALL THE TERMS; EXCLUSIONS AND CONDITIONS OF.SUCH �AEORESENTATIVES. POLICIES. AGOREOATE LIMITS SHOWNMAV HAVE BEEN REDUCED BY PAID CLAWS. - - :. ITR NBR TYPEOFINBIIRANCE POLICY NUMBER OATS ATE Dn „ LIMITS - .• ::. CENERALGARILITY `.. '. EACH OCCURRENCE S':1,000, 000 A X COMMERCIAL GENERAL LIABILITY 650000010609 01/01/07" 01/01/08. PREMISES EiaauroATe 3:50 000 ,. CLAIMS MADE $OCCUR :. MEO E%P (Airy da pe00nj 55,000 .:;PERSONALAAOYINJURY S1r000J 000 GENERALAGGREDATE .''62,000,00 .. OEN'L AOGPEOAtEUMR APPLIES PEA: PRODUCTS CDMP/OP A00 S2 000.,000 -71 POLICY .. P LOC: _ AUTOMOBILE LIABILITY : ._. COMBWEDSINGLE LIMIT ..8:1,000.000 A .^ ANY AUTO 81037400001 12/31/06 :12/31/07 (EP moldenU ' ALLOWNEOAUTOS BODILY UONRV. '.- X SCHEOULEDAUT09 ; - IPerOermA) '- X MIREDAUTOS r BODILY INJURY $-. -- :. X NON.OWNEDAUTOS , (PeleWdanQ :.. - PROPERTY DAMAGE } '.:. IPArecNaenu GARAGE LIABILITY'' :.. ,"•° ,.., ,-. AUTO ONLY '• EAACCIDENT S ANYAUTO: OTHER THAN 'EAACC.. $..-, AUTO ONLY: --. .ADO: S'.„ E)(6fSS'UMBAELLALIA8ILRY �- - EADH OCCURRENCE $57000,000 A , X .00CUR f cIaMSMADE, A660010709 01/01/07 ',01/01/00 AGGREGATE : " 46,000,000 s; OECIUCTRILE 5.. „ WOR%ERBCOMPENSATION ANI) ' - X TORY LIMITS ER -- --.- ' - A EMPLOYERS'UABILRY ANY.PROPAIETOBtPARTNEIUEXECUTIVE ;: 90967005 '05/01/06 05/01J07,. E.L. EACH ACCIDENT :S 506OOO OFFICEPJMEMBEB EXCLUBE07 ,'. :- E.L OUiEASE'•EA EMP LOVE 5500,000"- :: - Il ppeess�doceACaE.L. SPECIALPAOVISXINShelew- DL4EASE•P.OLICYLIMIT 5500 000 .. _ .. OTHER . _ OE6CFBPTION OPOPERATIONSf I.00ATIONSI RHICLESJ GREW ADDED 0Y0NDORSEMENt/RPEC1Al PROWSKINS CERTIFICATE HOLDER '- CANCELLATION SPEC001 SHOULD ANY -FTHEASOYEDEeCAIBEOPOLNBE90ECANCELLEDBEFORETIISE%PIRiLT10H GATE THEREDF THE ISSUING INSURER WILL ENDEAVOR TOMAIL 30, OAWS WRITTEN. NOTICETO THE CERTIFICATE HOLDER NAMED YO TNELEFT. 9UTFAILURE TO CO SO SHALL' 'BPBCItON IMOOSE NO OBLIGATION OR LIABILITY OFANY KIND UPON IKE INSURER, ITS AGENTS -.. �AEORESENTATIVES. AUTHORREDREPRESENTATIVE ' ::... Zama d. , Farren Department of Industrial Accidents Office of Investigations 600 Washington Street UT, Boston, MA 02111 www.mass.og v/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): NEWPRO Address: 26 CEDAR STREET City/State/Zip: WOBURN, MA 01801 Phone #: 781-932-8300 Ext. 251 Are you an employer? Check the appropriate box: 1. X I am a employer with 50+ 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. $ 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 myself. [No workers' comp. insurance required.] + right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. X Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs 13. ❑ Other *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. + 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: ARBELLA PROTECTION INSURANCE Policy # or Self -ins. Lic. #- 90967005 Expiration Date: 05/01/2007 Job Site Address: �9, "ASS LIE City/State/Zip: Af, , A/ D6 L) HI Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). 8�`j 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. FOR NEWPRO Date: Phone #: 781-953-8146 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 . Building De artmen 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 517-7-7,1 MA Reg. #146589 CT Reg. #0605216 RI Reg. #26463 =7 r' .� TV Federal ID #20-2625129 Corporate Headquarters: 26 Cedar St., P. . Box 2696 Wobum, MA 01888 (781)933.4100 1-800-342.2211 THIS CONTRACT MADE E ..... ,�o .... day of ..... . . , ... 200' . between ............ OmeOwners) (Ho fe Phone (Bus. kll one) Mr./ r of (Address) / (State) (Zip Code) the "Owner" and NEWPRO Operating, LLC, "NEWPRO". NEWPRO hereby agrees that it will for the consideration hereinafter mentioned, furnish all labor and material necessary to install the following described work at the premises located at :sem. (Job address) rr=_nn�;i naa. TOTAL Windows Purchased /�-� NEWPRO Additional S ty tyle Q Work TOTAL CASH PRICE Window Color S eci s Slidin Glass Door DEPOSIT WITH ORDER 4/2% Capping Color Sped Q Steel Security Door Double Hun BALANCE DUE AT INSTALLATION Picture Window _ Obscure Glass T BOTTOM Stationary Casement Screens HA .. FULL Casement - Model #,4�S % NEWPRO® does not do any paintin Staining. NEWPRO® is not responsible for conditions or circumstances beyond its control including condensation resulting from or due to pre - existing conditions. 2 Lite / 3 Lite Slider Ba / Bow Frame CASH Balance Paid to Installer at Installation Garden Window Awning Other / FINANCE Bank Completion Form Signed at Installation GRIDS Colonial Diam DES IBE WORK: J _ L All steel security doors wiU416ve a 3/4" alumiptfm threshold installed over existing thre old. Customer initials Est. Stara Date: -- °Z_ � Est. Comp. Date: 010r, uiC vuuyauUri yr tv1=vYrr1U TO ODLaln any ano all permits necessary under this agreement, as the Owner's Agent. The Owners who secure their own construction -related permits, or deal with unregistered Contractors will be excluded from the guaranty fund provisions of MGLC, 142A. All Home Improvement Contractors and Subcontractors shall be registered by the Director and any inquiries about a Contractor or Subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton Place, Room 1301, Boston, MA 02108, (617) 727-8598. If the Owner is obtaining financing by way of a Retail Installment Sales Agreement, such Agreement shall include a time schedule of payments to be made under said contract and the amount of each payment stated in dollars, including all finance charges. The Retail Installment Sales Agreement shall be incorporated herein by reference. If the Owner is obtaining a revolving credit line to pay, in whole or in part, for the contract amount herein, the terms of the revolving line of credit including interest rate and payment terms, shall be clearly set out on the credit application. The portion of the credit application referencing a time schedule of payment, to be made under this contract, and the amount of each payment stated in dollars, including all finance charges, shall be incorporated herein by reference. NEWPRO represents that it carries Workmen's Compensation and Public Liability Insurance in the amount of $100,0004300,000. If the Owner refuses to permit NEWPRO to proceed with the work herein, or in the event of any breach of the Owner of this agreement, for any reason whatsoever shall cause the owner to pay NEWPRO a sum of money equal to tqrty-three and one-third percent of the price agreed to be paid, as fixed, liquidated and ascertained damages, and not as a penalty, without further proofbf loss or damage. NEWPRO shall not be held liable in damages for delays in the performance of this contract due to causes beyond its reasonable control. Owner warrants that he is the owner of the property on which the work is to bg performed or that he is otherwise authorized on behalf of the owners to enter into this agreement. This contract represents that entire agreement between the Owner and NEWPRO and cannot be changed except by a writing signed by both the Owner and NEWPRO. You are entitled to a copy of the Contract at the time you sign. Keep it to protect your legal rights. We, the aforesaid owners, certify that immediately after the signing of the aforesaid agreement, a copy was furnished to us. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office, or branch thereof, provided you notify seller in writing at his main office or branch 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. (Saturday is a legal business day). See the attached notice of cancellation form for an explanation of this right. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. The w s seen "s " warranties that will be provided by NEWPRO upon installation. pie wary ties pr vided to Owner. IN WI S W EO , the parties have hereunto signed their names this day of 2001 EIN# Signed Marketing ' pr entative Prin d Name Owner Accepte � �IZ��0r inLLC_ By Representative WOBURN BRANCH OFFICE 26 Cedar Street Woburn, MA 01801 TEL: 781-932-8300/EXT: 330 800-242-9974 (FROM NE) FAX: 781-933-0717 WHITE: Branch Copy US -15 100/PKG. 11/05 Signed Owner SHREWSBURY BRANCH OFFICE 151-153 Memorial Drive BusinessPark Suite B -C Shrewsbury, MA 01545 TEL: 508-842-6876 800-456-0555 (FROM NE) FAX: 508-842-9248 WARWICK BRANCH OFFICE 45 Gilbane Street Warwick, RI 02886 TEL: 401-732-2407 800-356-3312 (FROM NE) FAX: 401-732-1371 YELLOW: Customer's Copy PINK: File Copy GOLD: Finance Copy