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HomeMy WebLinkAboutBuilding Permit #76 - 369 SALEM STREET 7/31/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 6 Date Received Date Issued: � / ? I IMPORTANT: Applicant must complete all items on this page ••.:1IZ�6"b. 0 ai i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial v"Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic 1iVe11 Floodplain 1lUetlands : j US/atershed D strict -r '-. Waterf ewar DESCRIPTION OF WORK TO BE PREFORMED: �\d.3w S . Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: ARCHITECT/ENGINEER Phone: Address: -Reg. No FEE SCHEDULE. BULDING PER MIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ I.1 i Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty_fuud Plans Submitted Plans Waived Certified Plot Plan Stamped Plans TYPE OF SEWERAGE DISPOSAL Public SewerSwimming Tanning/MassageBody Art 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 AA! DATE REJECTED - DATE APPROVED PLANNING & DEVELOPMENT COMMENTS DATE REJECTED DATE APPROVED CONSERVATION COMMENTS DATE REJECTED DATE APPROVED HEALTH COMMENTS i' 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 FIRE DEPARTMENT Temp "Durnpster oWsite yes no, re 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 MGL Chapter 166 Section 2 1 A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup - Date Doc.Building Permit Revised 2007 No r 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 o 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 Location 3e-- -55 ( 64'1^ J -/— Nil). /— No. Date T,31-ok NORTq TOWN OF NORTH ANDOVER 41 ' Certificate of Occupancy $ �'�s''•°' E<t' Building/Frame Permit Fee $ J4CHUS Foundation Permit Fee $ Other Permit Fee $ . f TOTAL $ Check # 2 t 371 Building Inspector O z O A ora c u ci U) V) Ix OU z z r/�/� w° c2 v U w oG AA (� 1� a°' Cld w O w ow w a°' J) : r, O N W c g2 w w w W z cn Q cn c w- O CD C ;,C O C V p ` t C N2 p K... C ; R O C., V C R O � O .� R E a N 0 N C O 0 cm ID cr- Ql c S m 0 cm c N co L O Ne 0 0 T :C®a U) o,L :®or .o ;co22 a x ® CL 0 CL F_ r0+ N CD. y0„ ~ Uj us yr C O C x N �E O.L v v N C.3 ® ®®mac C* NO ®'o O � f- L � m.- m E a N 0 N C O 0 cm ID cr- Ql c S m 0 cm c N co L O Ne 0 0 T The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigadons 600 Washington Street Boston, MA 02111 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ►Dolicant Information _ Please Print Legibly Name Address: NV CJM 0 Phone #: �` On Are you an employer? Chick the appropriate box: Type of project (required): L LJ i am a employer with 1 4. ❑ I am a general contractor and I 6. ❑ New construction employees (full and(or�part-time).* have hired the sub -contractors 7. ❑Remodeling 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. = ship and have no employees These sub -contractors have 8. ❑ Demolition working capacity. w for me in any�c i workers' comp, insurance. . 5. ❑ We area corporation and its 9. ❑Building addition [No workers' comp.mstuuance ��] i officers have exercised their 10.[] Electrical repairs or additions 3. [1 I am a homeowner doing all work right of exemptibn per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, 41(4), and we have no 12.0 Roof repairs ince recluired,] t employees. [No workers' 13.❑ Other I comp. insurance required.] *Any applicant that checks box #1 must also fill out the section below showing their wori cro' compensation policy inf nmetion. t Homeowners who submit this affidavit indicating they are doing all work and then hive outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the now of the subcontractors and their workers' comp. policy information. I am an employer that is information. Insurance Company Nan Policy # or Self -ins. Lic. Job Site Addresk Jb`I - X Attach a copy of the workers' workers' compensation insurance for my employees. Below is the policy and job site nYVI� rc� r1c� cl��' ry j:n5 - C-0 Expiration Date: 15� I z n 9 City/state/Zip 'y Al dOVe(} MA (3MW5 policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL e. 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 $250.00 a day against tQviolator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido herebyncertift un er p ' " and penalties ofperjury that the information provided above is true and correct Signature: !bbl t>Date: 113,10-a 'hone #• Official use only. Do not write in this area, to be completed by city or town offlciaL City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: 1a SIDING - WINDOWS - DOORS Family Owned And Operated 254 North Broadway • Salem, NH 03079 • In the Breckenridge Mall www.bronk-ctswn._.f-n,,,_.9 (603) 894-4488 I/we the owner(s) of the premises r necessary materials, labor and workmanship, to install, construct and place the imp Amit, Sadhana Banedi 978-557-9154 on,, on premises below described: Owner's Name: 369 Salem St. Job Address: North Andover, MA 01845 _State: Zip: Quantty .M1g�tS /!' Double Hung Build Tie Into ATG/ Low -E Roof Overhang Foam Argon Screens Yes No Yes No Yes No Yes No Yes No Full L -Bend New Inside Grids Tdm Trim Azek Finish Yes No Yes No Yes No Yes No Yes NO Provide container on Site TOTAL$ I� SL� / �` 2WA Oepf>sit$Ot1i1°GG7 Picture'., Slider :Bo Ba 3 .. Cover Fascia & Soffit X 5D%start Oi Job $ 6a,S ©1 C;) corder Ca Awn - art Hopper '; X ac New Gutters Balance Upon / ^ Completions Patio Door Entry Door Provide Vinyl Accessories light blocks,dryer vent,gable vent, faucets. Lattice Ceiling NOTM, f(G;tt ' �-�e tu) t3Fry - IVL 4 itch Storm Door Nmuj - k R I Porch Enclosures Decks 1LGt y icort-5 All Wce ins ok') + cS fUo t- (SIDING) SPECIFICATIONS Apply over body area of house. Type of insulation Items not covered or installed: Yes No Yes No Yes No Strip off Existing Siding Override Window Casing Porch Column Provide container on Site Vinyl Shutters Rails Cover Fascia & Soffit Window Mantels Roof Door Casing Door Surrounds New Gutters Full Window Casing Dentil Mantels Gutter off & on Provide Vinyl Accessories light blocks,dryer vent,gable vent, faucets. Lattice Ceiling Fluted post Traditional post PVC Trim Inside Buttress Remove all debris fUo t- r --s pci,% g E t ( 1 ON START OF ALL.IOBS-ROMEOWNEAS Must REMOVE ALL ITEMS FROM WALLS & SNE IE,4 Construction related permits: If the homeormer obtains the overt construction -related pemdte for the work descdhed uceer this agreement, the hmncoemm Is hereby advised Nat In the event of dispute, judgment mid nonpayment of the contractor, the hone miner will not be annual to make a claim to a collect from the guaranty hod established by Chapter 142A, M.G.L. WARRANTY The Contra cfer warrants Mat the work tumished hereunder shag be free from defect in materials and workmanship for a period of 1 Year following completion and shall comply with the requirements of this Agreement. In the event any defect In wmkmanshlp or materials, or damage caused by the Contractor. hb subconlactos, employees or micros, is discovered within doe year after comptegoi of any job, Including cleanup, the Contractor shall, at his awn expense. forglwNh mmedy. repair, correct replace, or rouse to be remained, repaired, or replaced, such damages or such defect in materials or wo onanship. The foregoing wamanges shall survive any Inspection performed in connection with the agreed-upon work No guarantee on golfer back lap in roof, no guarantee on ice back up and no guarantee on failing of vinyl siding. BROOKS does not do arty painting or staining. BROOKS is not responsible for the conditions in cmumslences beyond its conbd resulting from or due to pre-existing conditions. BROOKS is not responsible for any inner wood from any existing work. If rotted wood is fond, an additimal charge will be incurred. MOMS win charge for replacement pard. BROOKS is rot responsible tar mood or mildew. All waramies or pumemeas slate back to the manufacturer. Ihder such manuf chorus' warranties, the Owner may be required to register or mall In a warranty card or other evidence of ownership and use of incl equipment in oder to activate such warranties. The Owners failure to mail in or register such documentation, which failure voids the manutactuar5 warranty shall not creme any responsibility for the Contractor to wamanry such equipment. MANUFACTURER OUNIANIEES LABOR AND MATERIALS, NOT BROOKS SIDING A service charge of i M of the kNpsid Calan er per monM wig be added to Wence d rot paid arxoN/rg to femis ofconaanon compkGan of comind TOTAL $ Payrrrent to be made as follows: 20 % ($ ) Upon signing Contract; 50 % ($ ) Start of job 50 % ($ ) 1 at week 50 % ($ ) 50% second week ($ ) Balance upon completion Note: If Cancelled After 3 Days, 50% Df Remaining Balance Is Non -Refundable. Notice: No agreement for home improvement contracting work shall require a down payment (advance depwitl of more than -50%- of the total contract price or the total amount of all deposits or payments which the contract or must make, in advance, to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is greater. Brooks Vinyl Siding • Windows • Doors Name or contractor / Designated Registrant 254 N. Broadway - Breckenridge Mall Street Addn�s Salem, NH 03079 (603) 894-4488 city / state Phone 101682 Registration No. �//� ,illl ' 4 r'f; 10,59 JUN? 14, 2008 ID: FRED C. CHURCH FAX N0: 978-454-1865 #110092 PAGE: 112 A OI\Drre CERTIFICATE OF LIABILITY INSURANCE CERTIFICATE07/, DATE MAY PERTAIN, THE INSURANCE AFFORDED BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 4/2008 10:57 PRODUCER (800) 225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C. Chinch, Inc. 40 Kenoza Avenue Haverhill, MAO 1830 ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. PeFnnPr1nnN 800-225-1865 AUTHORIZED REPRESENTATIVE P INSURERS AFFORDING COVERAGE NAIC # INSURED Brooke Construction Co., Inc. 254 North Broadway INSURERA: Corrmlerce & Industry Ins. Co. INSURER B: National Grange-NGM INSURER C: Salem, NH 03079 INSURER D: RENTED PREMISES Es occurence $ 50,000.00 INSURER E: COVERAGES THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TOTHE 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 BYTHE POLICIES DESCRIBED HEREIN IS SUBJECTTO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. AGGREGATE LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. INSR 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 AGENTS OR PeFnnPr1nnN REPRESENTATIVES. AUTHORIZED REPRESENTATIVE P ITn i Tunrnrulrnmtnrr Pf1tYMMRF ntrU�n nsrr111mnn IIM1111 . RENTED PREMISES Es occurence $ 50,000.00 X COMMERCIAL GENERAL LL4611-11 Y CLAIMSMADE O OCCUR MED EXP (Any one person) $ 5,000.00 PERSONAL &ADV INJURY $1,000,000.00 B MS002750 4/28/2008 4/28/2009 GENERAL AGGREGATE $ 2,000,000.00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -OOMP/OPAGG $ 2,000,000.00 POLICY PRO EJ LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Eo occidont) $ 80DILY INJJRY ALL OWNED AUTOS SCHEDULED AUTOS (Per person) $ BODILY INJURY $ HIREOAUTOS NON-OMEO AUTOS (Per accident) PROPERTYDAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANYAUTO AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR FICLAIMSMADE AGGREGATE $ $ $ ]DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND WC STATU- OTH- TORY 1l ER EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $ 500,000 A ANY PROPRIETORIPARTNERIEXECLMVE WC6413152 5/16/2008 5/16/2009 E.L.DISEASE -EAEMPLOYEE $ 500,000 OFFICERIMEMBEREXCLUDED? If yes, descn'be under SPECIAL PROVISIONS below E.L. DISEASE - POLICY LIMIT $ 500,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT! SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION It & Sadhana Baned 1 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 69 Salem Street DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL Orth Andover, MA 01 845 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE P ACORD 25 (20011091 05-16-08 to 04-28-09 r e, OO ACORD CORPORATION 1989 [\ }\\ \ /.@ � - w \ !§ i \\ = z \ §\wo q § . . R �=.z ) u .. b \ . . & ] §, CL, |��¥x—ap< _ 7 OCL ¥y : % 9 � CU j ? \ % o z o./ § . § n ± "- \ K y < § � � � \ \/e\ \ 0< % e . \ /.@ m \ -'w §, . . \�7 \ \ § . § n ± "- § � � � \ \ 2=�2<± Co I z w -i k % \ (. t ) �- ,