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Home My WebLink AboutBuilding Permit #812 - 30 WINDKIST FARM ROAD 6/20/2007BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: (/ Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ?'One family ❑ Addition El Two or more family ❑Industrial Iteration No. of units: El Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other OF WORK TO BE PREFORMED: '0_1._1i iz r.._, x,,..cm.r_ c.c_ 4133 S6wr 2X 2' �- sAI /�'T �� Poc>� 7at'- /ilG`� /4y r9a Q! 2 2 OWNER: Name: Identification Please Type or Print Clearly) Phone: 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. Total Project Cost: $ Z5'2 FEE: $ � 3 Check No.: I 2—' Receipt No.: Ow 3z- I NOTE: Persons contracting with unregistered contractors do not have access to guaranty fund Plans Submitted L7 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 DATE APPROVED 11 DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS A Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Water & Sewer Connecti Located at 384 Osgood Street Comments 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 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 ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract - L, 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 a 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 o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit a Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o 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 Location,56 (^)/'qqv/J /1 No. ` Date O:NORTH TOWN OF NORTH ANDOVER 9 Certificate of Occupancy $ Building/Frame /Frame Permit Fee $ s�►cNust 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2G5�`i Building Inspector �l w O 0 rA O m `,4cl0 V w 0 z :C E N O i H C cm m m •. O CO C �C N m t 0 Z 0 5 0 F. r sYl 0 u s v �7 l 0 I c C C.— CA p •o h O ' m m CL +�+ �3 .O O O � i O, d ca o � C O v O c Z CD 0 CL C.3 y O C C h W 0 Y/ W W LLI ix W C4 w° y cgi Cd O w° a U w o°4 w W tw a�' w rA cn cn O m `,4cl0 V w 0 z :C E N O i H C cm m m •. O CO C �C N m t 0 Z 0 5 0 F. r sYl 0 u s v �7 l 0 I c C C.— CA p •o h O ' m m CL +�+ �3 .O O O � i O, d ca o � C O v O c Z CD 0 CL C.3 y O C C h W 0 Y/ W W LLI ix W C4 5 0 •m /: C O � � C O y C v C3 •CL CLC O A m C ;= O ® USI E V c �� ms L� C. a c E O m `,4cl0 V w 0 z :C E N O i H C cm m m •. O CO C �C N m t 0 Z 0 5 0 F. r sYl 0 u s v �7 l 0 I c C C.— CA p •o h O ' m m CL +�+ �3 .O O O � i O, d ca o � C O v O c Z CD 0 CL C.3 y O C C h W 0 Y/ W W LLI ix W C4 Z 00 �- cn Dw w U) Z ZO D 7 ca U) I 0 0 Cl m � 1 v 0 C-4 rn v m d C o = N N_ f" t co CO � (` O v U rn r o C-4 o UD' t co Z W _ Q) J Q L=- m Z W YY 0 � v Fw- rM >m0 Z OOM x=a Z I oil M� D r. >m0 Z OOM x=a Z I oil M� D z 0 q m rn 1 VWi >Xn M Z X=a M n z 00 0 tCn 7 N 0 3 3 0 w c N p o m 3 CD m m c0 w SU C NO 1,1 I OP ID S Acom- CERTIFICATE OF LIABILITY INSURANCE BAYST DATE (MMVDDmw) 05/24/07 PRODUCER Andrew G. Gordon, Inc. 680 Main Street PO Box 299 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. POLICY NUS Norwell MA 02061 Phone:781-659-2262 Fax:781-659-4725 INSURERS AFFORDING COVERAGE NAIC# r+SUF&D Bay State Basement Systems , LLC dba Owens Corning Finished Basement System INSURERA Renaissance Group INSURER B: INSURER c INSURER D: 60 Shawmut Road Canton MA 02021 INSURER E: PREMISES (Ea occuence) $ rnVCRAPFS THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REOUIREIaENT. 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 HEREM IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF NSURIWCE POLICY NUS DATE (M M1DWYY) DATE (MMUDDNY) LIMITS REPRESENTATIVES GENERAL LIABILITY COMMERCIAL GENERAL LIABILITY CLAIMS MADE OCCUR AUIHOfMED REPRESENTATIVE House Account EACH OCCURRENCE ; PREMISES (Ea occuence) $ MED EXP (Any one person) $ PERSONAL & ADV INJURY ; GENERAL AGGREGATE ; GENL AGGREGATE LIMIT APPLIES PER: RO- POLICY LOC PRODUCTS - CONrPIOP AGG ; AUTOMOBILE LIABILITY ANY AUTO ALL OWNED AUTOS SCIEDULEDAUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED SINGLE LIMB (Ea accidert) ; BODILY INJURY (Per person) ; BODILY INJURY (Per accidert) f PROPERTY DAMAGE _ (Peracddert) *GE LIABILITY AUTO AUTO ONLY - EA ACCIDENT S OTHER THAN EA ACC ; AUTO ONLY: AGG $ EXCESSAIMBRELLA LABI.mf OCCUR El CLAIMS MADE DEDUCTIBLE RETENTION ; EACH OCCURRENCE ; AGGREGATE $ i $ ; A WORKERS COMPENSATION AND EMPLOYOWLueILmr MY PROPRIETOR/PARTNER/EXECUTIVE OFFIEOCLUDED9 SPECIAL PRovISIONs I�elow S ECALPR PROVISIONS WC 0371527 05/24/07 05/24/08 TORY LIMITS ER E.L.EACIACCIDENT ;1000000 E.L. DISEASE -EA EMPLOYEE $1000000 E.L. DISEASE -POLICY LIMIT $ 1000000 OTHER DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CFRTIFICATE HOLDER CANCELLATION -- mscm L SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EVIRATION DATE THEREOF. THE ISSUING Iomm WILL ENDEAvOR TO MAIL 10 DAYS WRITTEN Bay State Basements NOTICE TO THE CE RTMATE HOLDER NAMED TO THE LEFT, BLIT FAILURE TO DO SO SHALL for record purposes RI POSE NO OBLIGATION OR LIABLITY OF ANY KIND UPON THE INSURER ITS AGENTS OR REPRESENTATIVES AUIHOfMED REPRESENTATIVE House Account ACORD 25 (2001/08) 40A(:VKV WKN'VKAIIVN IV NThe Commonwealth of Massachusetts In Department of Industrial Accidents Office of Invesdgations 600 Washington Street klip Boston, MA 02111 rWorkers' Compensation Insurance Affidavit: Bu des/Contr actors/Electripnlicant Information cians/Plumbers Name (Business/Organization/Individual): City/State/Zip: Phone #: Are you an employer? Check the - appropriate box: • LJ t am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time) 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t "Any applicant that checks bo mi have hued the sub -contractors listed on the attached sheet, t These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its Officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. C] New construction 7. []Remodeling ii. ❑ Demolition 9. E] Building addition 10.[] Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.[] Roof repairs 13.❑ Other t must also fill out the section below showing their workers, compensation policy information. Homeowners who submit this affidavit indicating they am doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must attached an additional sheet showing the name of the sub.contmemm ..A z am - - _� .115 sump. policy information. information. an emp oyer t at is providing workers' compensation insurance for my employees Below is the policy and job site Insurance Company Name: �61X),¢IS9,*7Jre / .r,0.,.D Policy # or Self -ins. Lie. #:'7/S Z 7 Expiration Date:--s'-1�►''� , Job Site Address: Attach a copy of the workers' compensation policy declaration page (showing the policy number /l% /i -U Failure to secure coverage as required under Section 25A of MGL . 52 can lead to the imposition of expiration date). 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 cnminal penalties of a 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 of Investigations of the DIA for insurance coverage verification. !do hereby 0,ti.a, a , e that the information provided above is true and correct - Y7./ - Official use only. Do not write in this area, to be completed bycity or town gfficiai: City or Town: Permit/License # Issuing Authority (circle one): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: CONTRACT TO INSTALL RESIDENTIAL PRODUCTS/SERVICES Owens Corning Residential Products Division of Boston (the contractor) hereby submits this proposal to sell and install the Home Improvement Products/Services as described herein at the residential premises set forth below. This proposal shall not become a binding commitment unless and until it has been signed by the Contractor and the Customer. Contractor: Owens Coming Residential Products Division a division of Bay State Basement Systems, LLC. 60 Shawmut Road, Canton, MA 02021 Telephone # (781) 821-0060 Facsimile # (781) 821.8552 Federal Tax ID # 14-1855297 Mass. Home Improvement Contractor Reg. # 137943 Date Customer: Customer Name { u G I e e d o� V fft Z[ l,e l k C� So � a r, r4 t Street Address 3 o i A tl K i S -E Far rn ra City, State, Zip 6 r -F ti f` d Q u P(, t Cfia Telephone ( q7 2- ) (o R 1- Z '74 S' (AJ 7- Klo - 33 Z 7 <t*(( Products purchased under this contract are not necessarily manufactured by Owens Coming. This is a contract between the Contractor and the above named Customer to sell and install the Home Improvement Products/Servioes specified herein at the Customers residential premises identified below: Installation Premises: £ Street Address a the City, State, Zip 'zG MN,e Scope of Work: Are Sketches and/or specification sheets attached? CI(YeS' 0 No 'An attachments are incorporated Into and become a part of this contract Description of Work/Specifications: Ztn STA( I V 1 3 et\ C O ALAj b 4 Seme. Fee" ayec,ed. E..,0e erotNt 6dWarr do 4fiers Work Schedule": p ` Approximate Commencement Date: O �t9 / % 6 7 O Approximate Completion Date: O 1-2n, 6 "The proposed work schedule is approximate and subject to change Contract Price: Representative: // q f Signaturend Title �^ q 2 2 � Total Contract Price: $ i / I DO NOT SIGN THI CO RAC Z o O Deposit with order: $ 1� Print Name r 2 2 17 Balance Due: $ j Terms: (Cash ❑ Finance (Cash terms are 1/3rd deposit, 1/3rd on commencement, 1/3rd on completion) $ 1z, l it n 9 Due on Commencement $ 16 1 `3 10 Due on Completion 0 Cash Check # 023 Z 3 DO NOT SIGN THIS CONTRACT UNTIL ALL APPLICABLE BLANKS ARE COMPLETELY FILLED IN AND UNTIL YOU FIRST READ AND UNDERSTAND THE ENTIRE CONTRACT, INCLUDING ANY ADDENDUM ATTACHED HERETO, AS WELL AS ANY ATTACHED SKETCHES, MATERIAL LISTS OR THE LIKE, AND THE TERMS AND CONDITIONS ON THE BACK OF THIS CONTRACT DOCUMENT. YOU ARE ENTITLED TO A COMPLETE, FULLY EXECUTED COPY OF THIS CONTRACT AT THE TIME OF EXECUTION. Witness our hand(s) and seal(s) below on this 0 day of To Ne , Z00 -T Bay State Ba ant Systems, LLAuthori Representative: // q f Signaturend Title �LoSeP� SCLM& Print Name DO NOT SIGN THI CO RAC ARE ANX BLANK SPACES Customer"^. /Cl%gomeog,iina Print Name r chistomer Si tura L cel Print Name Contractor may have certain lien rights in the premises until the price is paid in full. You have the light to cancel this contract, without any penalty or obligation, at any time prior to midnight of the third business day after the date you signed this contract. See the notice of cancellation below for an explanation of this right. "'Customer aclnowledges receipt of a true copy of this contract which was completely filled in prior to customer's execution hereof. / .i ^=T y eg Board of Building Rulations and Standards One Ashburton Place - Room 1301 Boston, Massachusetts 02108 Home Improvement Contractor Registration Registration: 137943 Type: Supplement Card Expiration: 1/29/2009 OWENS CORNING BASEMENT FINISHING DANIEL WALSH 60 SHAWMUT PARK CANTON, MA 02021 'S-CA1 0 50M-05/06-PC8490 Update Address and return card. Mark reason for change. Address Renewal Employment Lost Card s