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HomeMy WebLinkAboutBuilding Permit #60 - 333 RALEIGH TAVERN LANE 7/23/2008 BUILDING PERMIT Ot r10RT1y t,�o qti TOWN OF NORTH ANDOVER or _, o° APPLICATION FOR PLAN EXAMINATION # Permit NO: TT Date Received 7 w�gwrEo PPyq`� �SSACHU5�t Date Issued: G IMPORTANT: Applicant must complete all items on this page LOCATION 1 (4 thy - (.cam Print PROPERTY OWNERR.+�1i1 i - ►L JhaWnQ:� d \t Print MAP NO: PARCEL: ZONING DISTRICT: __Historic District yes no Machine Shop Village yes no 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 Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: EEM 6 C� `'I �1 1" 1N�G 's -- Identification Please Type or Print Clearly) OWNER: Name: ��r�rti1�`F c o1� Phone: 99F-Do - OWNER: Address: CONTRACTOR Name: G it i Phone: CSS q� Address Supervisor's Construction License: Exp. Date: Col,-7111 Home Improvement License: I' Exp. 'Date: /Dul I 10 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: $ [O(,3q3 ,C-0 FEE: $ Check No.: Receipt No.: r�i J S:-4 NOTE: Persons contracting with unr gistered contractors do not have access to the guaranty fund i nature g Age '/Owner Signature of contractor11174 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 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 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 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 ❑ 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 NORTH Town of Andover dover, Mass., O O COCMICNE WICK ORATED PP�,��� 7 V BOARD OF HEALTH Food/Kitchen PERMIT T _ Septic System BUILDING.INSPECTOR THIS CERTIFIES THAT...............J..�! .!'�.t ........................... ...a............................................. .......................... .... Foundation q T has permission to erect........................................ buildings on .3..I?3........R4.c,,,qL.......1... !"��...... .... Rough Ch to be occupied as.....1 ............ ........... ... �..........�� ................ ... '............................__................ Chimney provided that the person accepting 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 Final PERMIT EXPIRES IN 6 .MONTHS ELECTRICAL INSPECTOR UNLESS OONSTRLI N STARTS Rough Service BUILDING INSPECTOR 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. _. J, ,• .. a •: • • re al . P4�orylt talon WooWpylCottipo'ite•frime Ring CanAtD DUAL Argon low E Picture -ENERGY-PERFORMANCE.'RATINGS 1 U4actor(.U.S)h P, Solar Heat Gain Coefficient -0-- 3.2 . 8-32' ' 8 ADDITIONAL PERFORMANCE*RATINGS Visible Transmittance • • • 'M+n.e►olunr♦t►ib1.,M�Nu•n++r»NMn'MMik�w!1N11oNis♦I.wrMb'lyllMn�w�.�/wh:i Y ' ' ' f1►e1MM• • - - N M C ♦ I b ♦1 M.�♦.I •1 N •� V '�Mwa .•♦ . rreewrn. ' «.t M. • NMCey.n.lr�♦pw'n♦TeyMIwtA11«♦..Iwiw�lMe.AM►wll�•i/rVNdY•rM•n�'►.rbi.vi..' . ..' . •o•n•MKT•nve•.a„•nw•r•wehr:M•rjDlyrlr.�enr.:•,�«�.1►je .. � � DESIGN PRESSURE'(PSF) ' 29 .1 u Art ' M♦♦ur{ly.•♦�•M,6e,,0Eo,fact:e.o_�tInN4.rnwii�.�kWOMAM♦MroAc.�.1•.►e•Mm •. .. :. •. . xrkc r .l_ WoodNinyl Composite Frame i tiigCtxlA « N.af. . Argon'% Low E , — 'Double Hung . ,.. ENERGYPERFORMANCE RATINGS U-Factor U,S /I-P Solar . I Heat Gain Coefficient Oe32. -ADDITIONAL-PERFORMANCE RATINGS . '.Visible Tran.vhittanC.e� -; 54' • ' M.nrTlelupf.Yf.A.h!Urt M•ri;afbnp.e.,Mf.m.b.gplk�el./dFPC pw•Mw..Lr.•M�M•i.FwM6�Ldwr •. , (rMlafnHK•-KFACn'U.g..n4.f.n*Adandpnd..r.t...hnrn.nrlrlMlt:.M101di.►K•I(arr.dwlAIX. -• - hfnc ds.l Mtnr•^ww.nd..rP"40.ndd... �e�.edmld(y.f.nt�ndU.l tr.q.lrclRc�n.: .. . .C•n.ury h�.Mf�el.rn`r AFnlw•Nf.MI.rwedwI MR.Tfrne•i.IeMw.Nu.,' .. - . . DESIGN PRESSORE'(PSF) H -. L C 2 . . TOO-0.0270289-61 L • .. -1 jl,.A*t' 1.L\. ` ), tufty Ww,pfmIs•di rdr.41.... 6r. 4,r.—AWdo • , • M/.d 0,6Tw.d.,tMC.'C.EC,6L6C.Q.1p If111M4m N-(%"T*-".k"WA4 4r.lk C-Awd..►nyf•M, • - _ ,. .' .. . . 1 . ISI ACORD. CERTIFICATE OF LIABILITY INSURANCE02/1312008 DATE(MMMDrYYYY) PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Joseph MCKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE JP McKeone Insurance A enc , InC. HOLDER. THIS CERTIFICATE DOES NOT AMEND; EXTEND OR g Y ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING COVERAGE NAIC# INsuREO Renewal b Anderson Y INSURER a Hartford Insurance Comp an J&L Windows,Inc. INSURER e: Hermitage 104 Otis St INSURER C: Northborough,MA 01532 INSURER D: COVERAGES INSURER E: 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, IN. D'L POLICY NUMBER• POLICY EFFECTIVE POUCY EXPIRATION mfoorm LIMITS B cENERALUABILm HCP 507 404 09107/2007 09/07/2008 I EACH OCCURRENCE s 1 OQQ 000 COMMERCIAL GENERAL LIABILITY =S=&Z TO S 1 OO 0 0 CLAIMS MADE ©OCCUR MED EXP(Any arra person) S 5,000 PERSONAL 3 ADV INJURY s 1 O QOO GENERAL AGGREGATE S 2,000.000 GENT AGGREGATE OMIT APPLIES PER: PRODUCTS COMP/OP AGO S 2000,000 POLICY PCT n LOC A AUTOMOBfLE LIABILITY I: 35 MCC XD-6390 10/01/2007 10101.2008 COMBINED SINGLE LIMIT ANYAUTO (Ea accident) I s 11000,000 X ALL OWNED AUTOS SCHEOULEDAUTOS (ODILYIK) S (Parperson) HIRED AUTOS NON.OWNED AUTOS BODILY INJURY S(Par acsdeny PROPERTY DAMAGE (Pera=ident) S GARAGELU161LITY AUTO ONLY•EAACCIDENT S ANYAUTO OTHER THAN EA ACC S. AUTOONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR CLAIMS MADE AGGREGATE S I s DEDUCTIBLE S RETENTION S A WORKERS COMPENSATION AND 35 WEC PP 1444 S 02/17/2008 02/17/2009 we sTATu_ DTH. EMPLOYERS'LIABIL1T1r ANY PROPRIETOWARTNERMXECUTIVE E.L.EACH ACCIDENT S 5OO OOO OFFICER/MEMBER EXCLUDED? If es,describe uncler E. DISEASE-EA EMPLOYEE S 500 OOO >R SPECIAL PROVISIONS below E.L DISEASE•POLICY LIMIT S 500,000 onl DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL.PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES BE CANOE-LED BEFORE THE EXPIRATION INSURED COPY DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENT'S OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE ACORD 25(2001108) . ©ACORD CORPORATION 1988 Massachusetts- Department of public Safety Board of Building Regulations and Standards - Construction Supervisor License License: CS 99256 Restricted to: 00 SCOTT PHILLIPPI 58 D STREET WHITINSVILLE, MA 01588 . Expiration: 6!712011 Commissioner Tr#: 99256 Restricted to: 00 00 Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license Refer to: WWW.Mass-Gov/DPS . _ �/re,��,,ayuvea�o�✓�iraaachuaelta •. - . Boardof Building Regulations and Standards lugHOME IMPROVEMENT CONTRACTOR Registrtad:� 149601 ice— .42010 r_! �ement Card RENEWAL BY ANN TRACI TRUDELL 104 0TIS STREET✓f .�G►� . NORTHBOROUGH,MA 532 Administrator L The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,AM 02111 kvi www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organizarion/Individual): n J611 hndCr22En Address: e T City/State/Zip:L/n Cil?p 6 r6 Phone M (Uja Are you an employer?Check the appropriate box: Type of project(required): 1.&I am a employer with �_30 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. ❑Building addition workers'comp.insurance 5. ❑ We are a corporation and its �o w° cop 10. Electrical repairs or additions .1 required.] officers have exercised their ❑ p 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions o s myself. [No workers'comp. c. 152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees. [No workers' 13.0 Other comp.insurance required.] *Any applicant that checks box#1 must also fill 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: �� /'/C�LC/7'L k'sufemce_ Policy #or Self-ins:Lic.#: .�J � Expiration Date: T0 Job Site Address: City/State/Zip: [U0WCA= *7,r Z 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. I do hereby c rtrfy under th pain .and penalties o rjury that the information provided above is true and correct. Signature: Date: 43 � p f Phone#: a / 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#: 3 Window Agreement-Page 1 of 2 J&L Windows,Inc.,d/b/a 104 Otis St.,Northborough,MA 01532 Renewal ���i MA Home Improvement Contractor (508)919-0900•Fax:(508)919.0903 ���i License#149601(Expires 1/2412010) Customer Service:(8001573-7606 1)3A dersen. Federal Tax ID#83-0404201 WINDOW REPLACEMENT nnA de -Company ProductManager-/&,DAG Window Agreement Contract Date: Homeowner("Owner")'s Name(s): /►/r" �/L /�G ?f� Street Address: 3 City/Town ,&Z (rf tate: Zipo Home Phone: — (p QGLL Work Phone: 7 � �vriv[ Job Site Address(if different): /Yf E-mail Address: Materials to be provided and work to be performed by Renewal by Andersen("Contractor"): Contractor will furnish and install Renewal by Anders n- proved materials to the following specifications: 1. Date on which Work is Schedule to Begin: frl 46 Expected Date of Substantial Completion: 2. C tractor will Install a total oVgwindows in Owner's home,using the following individual quantities: 45 Double Hung(DB) KEqual sash ❑Cottage sash(1/3 top,2/3 bottom) ❑Oriel sash(2/3 top,1/3 bottom) Casement(CW) ❑Hinge right ❑Hinge left(as viewed from exterior):❑Standard handle ❑Metro handle _Double Casement(CDW) ❑Standard handle ❑Metro handle Casement/Picture/Casement(CPW) ❑1:1:1 or ❑1:2:1 ❑Standard handle ❑Metro handle 2 Lite Gliding Window(GW) Glider/Picture/Glider(GPW) ❑1:1:1 or ❑1:2:1 Awning Window(AW) Picture Window(PW) Bay or Bow Window: 3. Yes ❑No #Windows to be Custom Fit Replacem nt: 4. ❑Yes X No #of sills to be replaced by Contractor: 5. ❑Yes RINo #Windows to be New Construction Full frame(includes new Interior&exterior casings):_ Exterior casings: ❑Pine ❑Maintenance-free material ❑Factory applied 908 Fibrex brickmold 6. Glazing to be: ❑High Performance ❑Other If other,please specify: 7. Exterior color to be: I t%hite ❑Sand ❑Canvas ❑Terratone 8. Interior color to be: KWhite ❑Sand ❑Canvas ❑Terratone ❑Wood Note:Interior c for can only be white,wood or same color as exterior. Wood interiors need to be finished by Owner. 9. Hardware - IWhite ❑Stone ❑Canvas❑Brass Double Hung: Install ' s? ❑Yes XNo 10. ❑Yes Contractor will remove metal frames or grilles. #of Units:11. ❑Yeso Contractor will qstall new paint-ready or stain- 'n s.Inside or outside stops#of openings:_ Interior casing#of openings: Exterior casings#of enings: ❑Pine ❑Maintenance free material Owner tsware that Contractor es not do any paintings wner initial12. ❑Yes oContractor will wrap exterior casings with I inum c stock of � col r x-6Note:Red with storm window remo al;removal of storm wl i I le ve screw oles in casing. 13. New windows to have: ❑Half or Full screens Screens to be: Fiberglass ❑Aluminum 14. Windows to have grilles:XYes ❑No If Yes: Grille Between Glass(GBG) ❑Removable Interior Wood(INTW) ❑Full Divided Light DL)� rifle patterns: #: #: #: #: #: #: #:� DH DH DH DH CW/Picture Glider GRXI-cf.6PW .use acjditional sheet if needed Owner approved(initials): 15. Yes ❑No Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air infiltration. 16. es ❑No A limited warranty shall issue to Owner upon completion of the job and payment in full(see reverse side). 17. Yes 11 No Building Permit—Contractor will secure any and all necessary permits.The fee for the permit(s)is not in luded in the Contract Pri a and a se�te hgck is re�uir ��� r is fee. 18. Ad ��onal job etai : 1, �! l z 19. ❑Ye6 ❑No Owner has reviewed the Additional Terms and Conditions governing this Contract on the reverse side, including Owner's Three-Day c Ilation Rights pursuant to MGL c.913,§4J3,c. 40D§10 or c.255D§14(See Section 25). 20. Total Contract Pri e:$� Regular tail Price: 7�' All available discounts applied:❑Yes ❑No 21. Deposit(1/3):$ paid by❑Cash Finance (Acc unt#: ) Second(1/3)$ to be paid by Cash Itt start of job on (Estimated start date). Final(1/3)$ to be paid by Cash at completion of job on (Estimated completion date). % Owner grees to be 22. Yes ❑No Opresent on the final day of installation for final inspection and to deliver final payment. /ft final payment shall be demanded until the contract is completed to the satisfaction of all parties. NOTICE: All home improvement contractors and subcontractors must be registered. Any inquiries about a contractor or subcontractor relating to a registration should be directed to: Registration Division,Program Coordinator,One Ashburton Place, Room 1301,Boston,MA 02108,Tel: 617 727-3200,Website:http://www.mass.gov/dps The parties hereby mutually ree in advance that should a dispute arise regarding this contract,Contractor may submit such dispute to a Iv a arbitration ervice that has been approved by the Office of the Consumer Affairs &Business Regul i wner sha re fired to submit to such arbitration as provided in MGL c.142A. Contractor Signature: Owner Signature NOTICE:The signatures of the parties a e apply only to their agreement to alternate dispute resolution initiated by Contractor.Owner may initiate alternate dispute resolution even where this section is not signed separately by the parties. O NOT SIGN THIS CONTRACT IF THERE A4 ANY BLANK SPACES J&L indows,In /b/a Renewal by Andersen PrZanager wner ignature r-S OJ6' 64 Product Manager(Print Name) Owner Signature White—Renewal by Andersen Yellow—Installation Pink-Homeowner Location t l k 70 V6'� No. U Date --2-03 NORTH TOWN OF NORTH ANDOVER � 9 Certificate of Occupancy $ �ssncMusE� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ (1 TOTAL $ Check # 2 ; 354 Building Inspector