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HomeMy WebLinkAboutBuilding Permit #505 - 343 SALEM STREET 3/6/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: w Date Received OWNER: Name: DESCRIPTION OF WORK TO BE PREFORMED: .f) Z/,-, e C /l d Please Type or Print Clearly) S4Ye`SSer cY I 471 i . ne: � �/ ��U�Off ARCHITECT/ENGINEER Phone: Address: Reg. No FEE SCHEDULE: BOLDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED CO'STT� BASED ON $125.00 PER S.F. Total Project Cost: $ �QT�o? % FEE: $- Check No.:eceipt No.:.ai7 -4 ( NOTE: Persons contractingAvit� unregistered contrlqr do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanni.ng/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 El DATE REJECTED DATE APPROVED CONSERVATION ❑ . ❑ COMMENTS DATE REJECTED DATE APPROVED HEALTH ❑ ❑ COMMENTS r� 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 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 Pennit 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses Z3 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 o Workers Comp Affidavit o 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) o 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 o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o 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 3 V,-.7 No. S D,�— Date NaRT� TOWN OF NORTH ANDOVER f �,y O F ~ 'A } �e1 41 Certificate of Occupancy $ swcNust U 9 stn Buildin /Frame Permit .Fee $ s Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2097. Building Inspector ti 0O z 0 . W Cd p O LE N Cf)cisv y v cn ° w a g p w t O c� :2 u X,G ° w a n: w w w W �� cG r"r,� ch �a i�. x p U, X00 00 c� u. z w w c c� 6 cn Q O cn E IEN O i N cmC O m 12 cm C 32 m `o cm c N m L r O Z O 0 O w P-4 O O co O V Z co CL O CO) G C O Om CO2 O O .� O O .!A— E m m co 43 CL s 3� as O O _O O O' Q. C2 c Cc •o. O,; C Z V CD CL t/2 O C' Cs cc a H cm 0 y Y/ W W 19 W 0 c c m c •� -cam o = C ~ O N C 'JO _v V CL C R ;= O • r r Cc p ILOi:EQ o o a N ' C r 3 �mcm A N :mm o 4D 3 N 1 � � m m ' N W N m c a�oa p,Ct V -.2, O C '� Z c o Q ` H m C = m 3 W C ea j 'O Z LL O r Cr mea C F. ma CZ .L +"' •N .O LU V O O C N a a O� aia-m E IEN O i N cmC O m 12 cm C 32 m `o cm c N m L r O Z O 0 O w P-4 O O co O V Z co CL O CO) G C O Om CO2 O O .� O O .!A— E m m co 43 CL s 3� as O O _O O O' Q. C2 c Cc •o. O,; C Z V CD CL t/2 O C' Cs cc a H cm 0 y Y/ W W 19 W 0 Ir NFRC. re al ATANDPR3RN" . WoodNinyC Composite Frame r . . Clettcuae►rles►rativn FtatigCcrfci► Dual Argon Low E Glider ENERGY PERFORMANCE RATINGS U=Factor (U.S)/I-P Solar Heat Gain Coefficient Bill 0 130 .3 A001TIONAL PERFORMANCE RATINGS Visible Transmittance 0w49 Menufacturorstlputetes thel tMee mth+gs confdrm to epo"bN NFRC pro du.s for de:WMkikrp wholo product pofforrnance, NFRC.tetIngs afd dateaolnod fors Mod set of ehvltononental conditions ends spoobk product NFRC does not r*cornrnod any product and does not warrant Me ful4thAlty Of eny Product foreny spochk use. Consult manuraeturees ghrature for othorpmduet podohnanze Infomrotlon. . wWW.O M . ENERV STAR* Qualified In All 50 States DESIGN PRESSURE (PSF) H - L C 2 5 OfMeodrlen 100-00296313=006 enedm AfS A 71 S.-'-97or ufeeturtr sf' is aoofo ace to lh<a Iz standards_ Moats oroeceeds M.E.C., C,E.C, 61.E.C.C, Ah Inflshatlon raqukamants WOMA Naknafh Coftllleabon Prograne 9 r ACORDCERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY( 02!13/2008 PRODUCER Joseph MCKeone JP McKeone Insurance Agency, Inc. P.O. Box 333 Ann Arbor, MI 48106-0333 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. INSURERS AFFORDING COVERAGE NAIC # INSURED Renewal by Anderson JBL windows, Inc. 104 Otis St Northborough, MA 01532 INSURER A Hartford SU Company INSURER B: Hermitage INSURER C: INSURER D: INSURER E: LvIg1TJ a:7_[0 4:' 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. wsR LIM TYPE OF INSURANCE POLICY NUMBER POUCYEFFECTIVE PMJCYEXPIRAMON uMITB B GEMMMUML17Y HCP 507 404 09/07/2007 09/07/2008 EACH OCCURRENCE S 1 O 000 COMMERCIAL GENERAL LIABILITY CLAIMS MADE © OCCUR PREM! ES Eaoccurence $ 100.000 MED EXP (Any one person) S 5j QQQ _ PERSONAL & ADV INJURY S 1,000,000 GENERAL AGGREGATE $ 2,000,000 [GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG S 2,000,000 POLICY PRO• LOC A AUTOMOBILE WASILITY ANYAUTO 35 MCC XD 6390 10/01/2007 10/01.2008 COMBINED SINGLE LIMIT s 1,000,000 (Ea accideq X ALL OWNED AUTOS SCHEDULEDAUTOS BODILY INJURY S (Per person) HIRED AUTOS NON -OWNED AUTOS BODILY INJURY S (Per accident) - PROPERTY DAMAGE S (Per accident) — GARAGE LIABILITY AUTO ONLY• EA ACCIDENT S OTHER THAN EA ACC S ANY AUTO AUTOONLY: Ate, S EXCESSIUMBRELLA LABILITY OCCUR CLAIMS MADE EACH OCCURRENCE S AGGREGATE S S i S DEDUCTIBLE I RETENTION S S A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY 35 WEC PP 1444 02/17/2008 02/17/2009 WC STATU- OTH- E.L. EACH ACCIDENT S 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFF'ICERIMEMBER EXCLUDED? W0describe under SPECIAL PROVISIONS below E.L. DISEASE -EA EMPLOYEE S 500,000 E.L. DISEASE • POLICY LIMIT S OTHER DESCRIPTION OF OPERATIONS !LOCATIONS 1 VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION INSURED COPY DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO AWL 10 DAYS WRITTEN NOTICE TO TKE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LL► MM OF ANY KIND UPON THE INSURER, ITS AGENTS OR I AUTHORIZED REPRESENTATIVE C`7/� / l /' �Vv � `"�• I ' ACORD 25 (2001106) © ACORD CORPORATION 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 Name (Business/Organization/Individual): Address: 6Y), S r -C C City/State/Zip:j-� G r� r „I �1'�� Phone #: Ct�J a J %l Are you an employer? Check the appropriate box: 1. al am a employer with 30_ 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 right of exemption per MGL myself. [No workers' comp. c. 152, § 1(4), and we have no insurance required.] t employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. 4 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. 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 subcontractors 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. h),3q1,61)Ce— ­oe Insurance Company Name: �✓' /CP�!!7C'- Policy # or Self -ins. Lic. Expiration Date: oZ Job Site Address: 13y 3 1 lc /�kn `fit City/State/Zip: f %",'1 -015 - 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 rtify under thl a pains and penalties o rjury that the information provided above is true and correct. -0y0® 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 #: 1 ✓%e '(Opy�covwfea�Ji ��cc�iude�b Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registrai ann.,149601 E*ptr ttvTr V_ 4/2010 .0lement Card RENEWAL BY A ! Q1 . - '? 1 Q KATHLEEN BLAN „ 104 OTIS STREET .v NORTHBOROUGH, MA 32 Administrator y Board of Building Regulations and Stand"aids i ConsEructi Supervisor t.icerise . ' Llr,"il;'ICS 74251 r- =1963 _. n.5 ;. 191 9 Tr 11065 JOHN K ESLER 104 OTIS ST NORTHBORO, MA 01:532 Commissioner E 03/02/2008 19:15 FAX. 9784105478 SULLY Q001 CJ JR;e- V'S'�� l�s�fr l�'iN G - renewal BY MaIRMSEN', wlndgr,rep4opnmr /Y So �}- q, wo Customer Service 800-573-7606 104 Otis SI., Nodhbomvgh, MA 01532 • Main: me) 91 e•ogo0 • Fax: (509)919+0903 J&L Windows, Inc, dba Renewal by Andersen • Contractor License #149901 • Expirellon Date 09123/2008 r WINDOWAGREEMENT SOLD TO: C, A V, 0 S / IZ f. Ss',- L DATE: a ADDRESS: �A /1') S Tj� PHONE- Home: S) �gS- 7 CITY: iJ DOEEO— STATE:IZIP: �v yr PHONE -Work: (_) JOB SITE ADDRESS (if dfffererl0: �✓ Email: Approximate Stan Date: Approximate Completion Date: SPECIFICATIONS Renewal byAndepproved materials will be furnished and installed to these specifications: 1. Install total of:windows. 2. Openthyofwiddows: &5 Double Hurl® (DS) 39 Equal sash ❑ Cottage sash (1/3 top, 213 bottom) ❑ Oriel sash (2l3 top, 113 bottom) Casement (ICW) ❑ Hinge right ❑ Hinge left (as viewed from exterior): ❑Standard handle ❑Metro handle Double Casement (CDVV) ❑Standard handle ❑Metro handle (1 Casement 11 Picture / Casement (CPW) ❑ 1:1:1 o54 1:2:1 ❑Standard handle L9Metro handle 2 Lite Glldhjg Window (GW) J Glider 1 Pic re /Glider (GPW) ❑ 1:1:1 or ❑ 1:2:1 Awning Window (AW) Picture Wirtdow (PW) _ Say or Bow Window; 3. )a Yes ❑ N # Windows to be Custom Fit Replacement: 4. ❑ Yes -& N # of aills to be replaced: ' 8. 13Yes)2N # Windows to be New Construction Full frame (includes new Interior & exterior casings): Exterior caslnps: ❑ Pine ❑ Maintenance -free material ❑ Factory applied 908 Flbrex brfekmold 8. Glazing to be High Performance ❑ Other If other, please specify; 7. Exterior Color to be; j�Whito ❑ Sand 11 Canvas ❑ Terratone 8, Interior color o ba: J� White C3 Sand 11 Canvas ❑ Tertatone ❑Wood Nota; Interio color can only be white, wood or same color as exterior. Wood interlo need o finished by oust, 9. Hardware: its ❑ Stone ❑ Canvas ❑ Brass Double Hung; Install lifts? N 10- Yes ❑ N Removal of metal frames or grilles # of Units: S' rd R i 4 i 11. Yes J$[ N Install now point -ready or stain -ready casings. Inside or outside stops # of openings: - Intsdor casin # of openings: Exterior casin=#pnings: ❑ Pine ❑ Maintenance free material 12. Customer ere that RbA does not do any paintini;ust initials 13. ❑ Yes N Wrap exterior casings with sluminum color, Note:equl d with storm window removal, Removal of storm wind wa will leave screw holes In casing. 14. New wind to have; 0 alf o Full screen Screens to be: Fie Aluminum 15. Windows to ave grilles: WYSS o I ea: Grille Between Glass (GBO) ❑ Removable Interior Wood (INTW) ❑ Full Divid d Light {FDL) Grille partems: H -EE= DH DH OH DH t3W/Plcture Glider r GPW rI'JAA!/ us dltional s at ff needed Customer approved (Initial& 16'r&Yes © o Insulate, caLlk and seal Windows with three-point system to prevent water and airIn tratlon. 17 You ❑ t o Remove and dispose of existing windows and storm 18. Yea ❑ to Clean Up. All job related debris removed. Vacuum nightly. 11 Yes ❑ to insurance. All workers compensation and liability Insurance maintained. 20. Yes ❑ 1, o Warranty. Given to customer upon Completion and receipt of full payment. 21, A dltiohal in ormatlon: 22, Regular Ret II Price: $ 9 7 23. Total Prole Amount $ All available discounts have been applied: ❑ Yee ❑ No 24. Is Project to 68 paid In ❑ Cash KFinanoed ❑ Combination of Cash and Finance 25. Cash Deposit (1/3): $ 113 of balance due at start of Job and final 113 due at completion of Job. If remaining 2/3 payment Is made by credit card an additional fee or w 11 be added to er lee chdrgad by Credd 28. ea ❑ No Flnanoed. If Yee, Amount Financed -70 S (Account #: , - - 6a- - -- �- /4 y 1�j 27 Yes ❑ No Customer agrees to be present on the Mel y of Installation for final inspection and to deliver final payment.. 28. Yes ❑ No Homeowner gives RISA appro4 to place a yard sign on their lawn at the time of measure, 29Yea ❑ No Suildina Permit -As a Convenience the company will secure the building permit. The fee for the -5nnit is not Included In the agreement price and a separate check is required at the time of sale for this fee. 'RENEWAL BY ANDFRSFW IS NOT RESPONSIBLE FOR ANY EXISTING SECURITY SYSTEMS OR CONDITIONS THAT COULD NOT HAVE BEEN SEEN PRIOR TO OPENING THE WALLS, PLEASE REMOVE ALL SHADES, VERTICALS, BLINDS, CURTAINS. DRAPES OR WINDOW MOUNTED AIR CONDITIONERS, AND ANY FURNITURE AT LEAST SIX FEET AWAY FROM WINDOWS AND DOORS PRIOR TO THE INSTALLATION OF YOUR NEW WINDOWS, INSTALLERS ARE NOT RESPONSIBLE FOR THE REMOVAL OR INSTALLATION OF THESE TYPES OF ITEMS. 'SALESMAN HAS NO AUTHORIZATION TO CHANGE ANY ITEMS OR MAKE ANY REPRESENTATIONS OTHER THAN CONTAINED IN THIS AGREEMENT AND'OWNER' REPRESENTS THAT NONE NAVE BEEN MADE TO, OR RELIED UPON BY -OWNER.- YOU ARE ENTITLED To A COMPLETELY FILLED IN DUPLICATE OF THIS AGREEMENT. 'CONTRACT SUBJECT TO FINAL INSPECTION BY RENEWAL BY ANDERSEN CONSTRUCTION DEPARTMENT 'TERMS AND CONDITIONS THAT GOVERN THIS CONTRACT ARE PRINTED ON THE REVERSE SIDE, This "ritrabt io a leas) document. Yow Renawal by Andersen nroduct will ba esoedally made-to-order ter vee. LN40ER NO CIR(:IIMSTAIJGFB WILL RbA Rep, W/ 11 � / Customer Slgnaturs:A v Customer Signature; "Re,- Renewal by Andersen Yellow -Installation Pink - Homeowner 02.02.07