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Home My WebLink AboutBuilding Permit #138 - 44 BRUIN HILL ROAD 8/26/2008 BUILDING PERMIT O* NORT11 q �tq.lD • TOWN OF NORTH ANDOVER c? o� APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received !/ 2� ,I Date Issued: (� �SSACHUS�� IMPORTANT: Applicant mut complete all items on this page LOCATION 44 cR nA`t Y-) C'1 i �I RocAL PROPERTY OWNER, Print I- �S Print `I it MAP NO: ILA,I\ PARCEL:0097 ZONING DISTRICT: 'R I 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: Comm ial Re airplacemen Assessory Bldg Ot rs: Demolition Other Septic Well Floodplain Wetlands atershed District Water/Sewer nS-ha � C1 � e C IPTIONaxe- OFe vy� E ��F�Vti�: � Id ntificati n Please Type or Print Clearly) OWNER: Name: f e Phone: 7 • �gOS Address: 4'�' c� rut'l h I oA— I-C4 60s VCc— ,5-04 ` CONTRACTOR Name: e- Phone:g - 7S3 -0 -S-Z-- Address: Address: t 07,4-- o r I9(X ce ('GC(JZ'�i' Supervisor's Construction License: 9,n519 l Exp; Date: C) Home Improvement License: 148 Exp. Date: f l Poo 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: $ 'S, [ res�— FEE: $ 3?- Check No.: Receipt No.: a141 Z/6 NOTE: Persons contractinZwi 7rowstered ontractors do not have acc2to arantyf nd _ignature of en „caner igna#ure ofcorgi#racto Location Date 6� No. � NORTH TOWN OF NORTH ANDOVER f41 9 Certificate of Occupancy $ BuildinglFrame Permit Fee $ swcNus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ s i. Check # i 2144b -.� Building Inspector 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 CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 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 DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dumpster on site yes no Located=at 124!Main Street Fire Department signatureidate 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 2008 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 Calculationslicable If Applicable) P ) ❑ 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 2.2008 NORTH TO" of Andover 0 �W� - ... No. 13 1_= } _ o , * dover, Mass., O COCHIC EWICK �• S RATEO BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System BUILDING.INSPECTOR THISCERTIFIES THAT................................................................... .......................................................................................... Foundation -e/y Sr 0.,;v / has permission to erect........................................ buildings on ................................... /��..................................... Rough to be occupied as .S o�� 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 CONSTRU=ON STARTS Rough r.-+- ............................................ Service BUILDING INSPECTOR Final Occupancy Permit Required to Ocmpy 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. 1r The Commonwealth of Massachusetts Department of Industrial Accidents Office ice of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibly Name(Business/Chganizationtin(hvidual): Sears Home Improvement Products Incorporated Address: 1024 Florida Central Parkway City/State/Zip: Longwood, FL. 32750 Phone #: 407-551-5402 Are you an employer?Check the appropriate box: Type of project(required): 1.❑ I am a employer with 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 [No workers' comp. insurance 5. We are a corporation and its officers have exercised their 10.❑Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself [No workers'comp. c. 152, §1(4),and we have no 12.❑Roof---aii- insurance required.]t employees. [No workers' 13.� OJher �OICG'M'1C'.n� comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. r— t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. $Contractors that Bieck 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 isproviting workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Aon Risk Services Central,Inc. / Phone:(866)283-7122 Policy#or Self-ins.Lic.n#: WLRC42847859 Expiration Date: 4 08/01/2009 Job Site Address: ` ncu( City/State/Zip: n Or' b I SL}S 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 cern n the pains and natties ofperjury that the information provide above is?,,eandcorreet. i Si tore: (Sears Auth.Agent) Date: �L/ Phone#: Home.80--79.. 06 Cell:860-753-0452 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#: S 08/06/2008 08:55 4077678536 SHIP PERMITS&LIGENSE PAGE 01/01 1 4��LJa $tli!•� i �=' 1 �j�"� a•.wc. GATE FM+1 Db 07/3 2008 PROVUCAon n Risk Services Central, Inc. THtS C`FiEtTl1+ICAT'E TS iS$DED AS A MATTER OF YiVFORMATiQty ONLa' fka Aon Risk Setvi ces, InL of Illinois ANb[(�]VFERS No RiGATS UPON TRE CERTIFTCATF;13(OLDztt,'I'fM 200 East Randolph CERT[F[CATEDOES NOT AAW%EXTENDORAUTER'THE Chicago IL 60601 USA CotfitiltAGEAF70RDEDBYIHEFOUCiESBEi.AW. rsaw. 66 283-7122 FAX- 4 S3-5390 WSURERR AFFORDW;COVERAGE WC N n MIM lNsuaERA: ACE Amtrican insurance companX 22667 a. sears Holdings Corporation ,, dba Sears Nome Improvement Products, Inc WSURERR, Indemnity ]insurance Co of North America 43S75 Attn: Risk Managgement E3-219A 3333 Beverly Road rlatrReRr Self-Insured Retention 0065AL Hoffman Estates it 60179 USA rib: National union Fire ins Co of Pittsburgh 119445 TNsvAER e � THE POUaESOFTNWRANCEUSED BELOW WAVEBEEX3 t=T0TH8"GURPDNAMEDABOVEFORTHEPOUCYFFRiObMTC.ATEDwN0TWTTHSTANDINO ANY REQUMEMENT.TFAN OR CONDITION OPA74Y CONTRACTOR MM DOCU-ME Tf'WITH$ESPEC:1'TO WHICHTHTS CER11FICATB MAY BE ISSUED OR MAY PERTAiN,THE TMU'RANCE AFFORDED BY TM POLICIES DWrRTBED HEMSTN IS SITWECT TO ALL TM TERMS,EXCLUSIONS AND r.ONDPTIONC OF SUCH POLICIES. AatiRP,6AT6 UMiTS SHOWN MAY DAVE BEE R6Dt1C�By pAjDCLA7W. LIM1TS SHOWN ARE AS REQUESTED OBRPq JAISW IMLTcy ITFRCTM"DCV F:XM UTI0 L'ra TYE[ttFArSUAANCC sO1aCYNUMbIR b"E(Mtalbm"). oATrnaM1DD{Yyt UMIT-A C XIIALLIAWL"T Off Insured 08/02/08 08/01/09 8Atmor,CURRENCE X COh1W%,(ALOHNERAL1.TA81LTFY OAMAOETOR£WYEO 4Alt45 MARE ff] OCCUR PREMIB6S(Ca a�me)tce) to PERAONAL R ABY INJURY N 06NTfAAL AGORP�ATtr M Oh`N'L AGGREGATE L1AOT APPUFg PBR: a ® rTR.tCv PRO-® LOC PRODUCTS•COWAA AOC o JECT sin/oPduttible x5,000,000 A AUTTOMODILt+IAAMLrN I5AR08247274 0$/01/08 08/01/09 COMBrNFO&iNGLELtMri A At+YAUTo IsnN08241316 08/07/08 08/01/09 (Fsnesao4 55,000.000 ALL AUrm �CMF..nO uui.p AU-COG AO nTLV IKAMY ( w person! tC T(TATDAUTOR )( NUN OWNRO AUTO& aor7n,Y 1TINRY V (Per nocidcvl PROPERTY DMIAn-. (Pa attidcnp GAttngr r lAb1LTTry AVrO ONLY-6A ACCtbEw MW AUTO OTRPATHAN 6A ACC At,IrOONLY: AtT D CXCIMIUMNIMAUAIRJTY 601822 08/01/09 PALM OCCURRENCE $2,000.000 ITrr--�OCCUR ❑ MAIM MAnF AGGREOAT6 $2.000,0001 �0EnUCTIDLE RF.TF2MON 6 wOariiRS COM►EmAT10NAN0 C / )( C ArnTU- OTH- ANYPEMYPROROER&•taATnr.m AOS LM= LUL— wLRC42847938 0801/08 08/01/09 E,I.EACH CFOIaNT sz,Dno,000 ANY PAI6'I'OAI�ARTNAR!BXBC(nTl'E - OP7tCE%,mrMn11R GXCI-ubFr3? CA ILL bIREASF•6A MOLOYEt; $1,000.0m, A SCRC42847975 03/01/08 08!01/09 . Ec'br56A6E-POurV I.IMrT S11000.000 tfyes,demnx)MAccSPECinLPROVt3tO;ts WI33 !ICON OTHEIt =NXI lTONOFOPP.RATION&A.00ATTONSNEMCLEA ICWSrONSADMWBNDOR9WMENr15 WALPAOyiav" Sears Nnml Improvement Products, Inc SHOULD ANY OrTHEADOVFPUM1320MUCMUnCANCELIAOBSPORSt"LFXP)RAr10N ' 1024 Fl ori da Central Parkway DATE TFMMP.,THE iSSUMO rNSURER WILL ENOP,AVORTO MAIL Longwood FL 92750 USA 30 DAYS WRMFVNOTIC6TOTRE CURT1Fi 7C HOLDER NAM6b76TME LEFT, Sur EAIGURE TO bO RO SHALLIMPOtF.PIOOBLICATION Olt LIABILITY OF AriY KrND UPON TIi=IN9Tfl:FR.ITS nOF.N i'S OR RBRREaWATryFS, ai`• AUTHORT MR9M099NTATTVFj .y.d�ifc was+iw i�wr�A+6sws lionsReceived on 8/6/2008 8:56:02 AM .1 FF Boarco uil �nlans an an ar s g � One Ashburton Place - Room 130 >, Boston, Massachusetts 42108 Home Improvement Contractor Registration Registration: 148607 Type: Supplement Card Expiration: 1011112009 SEARS HOME IMPROVEMENT PRODUCT Sears Authorized Agent LUBOS SVEC Home- 860-792-8106 1024 FLORIDA CENTRAL PKWY _ _Cell-860-753-0452 LONGWOOD, FL 32750 Update Address and return card.Mark reason for change. [ Address [] Renewal !" Employment Lost Card MIS CAI 0 50-"7*07-FC-0,190 j'@ "(Cf.'3N!)7G t2lt/N.[l'�I7rllfif.YlYtCl.1F.Ilci Board of building Regulations and Standards [Acense or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: t Registration: 1ggSg7 Board of Building Regulations and Standards Expiration: 10111/2009 One Ashburton Place Rm 1301 Type: Supplement Card Boston,Ala.02108 SEARS HOME IMPROVEMENT PR 1024 FLORIDA CENTRAL PKWY LONGWOOD.FL 32750 Administrator "ot Valid w thout SignaJ6;?4 ij 47 t"AW 3j7oY9ffmgjAaV5ti n��ar�4 One Ashburton Plate Raoin 1301 Boston.. Mass huse 02108 Home lmproveme . a aor R.eglstrafton: Roal itmm- 148607 - Type: Ptttrtie Corporalion "atio s SEARS HOME IMPROVEMENT - 11}t11l20t Tri' ?' ::ry ALFRED NYMAN JR. T '# 1024 FLORIDA CENTRAL PKWY LONGWOOD, FL 32750 UtXlat@ Address anti retain Cart).i1&O,rewma for c 1muge. --, Addr.;ts.9 0 Pen7, Al F, Employ mart r I LostCwd OFT.-CAI Q $(*& W6M4W Jit6 Iit4fltl +� �� 1lQxrd«f 8nlldttrg ti e8ar�rtt4 aaet tax ids Lies or rtgistrafiotl euTld for bdiriM me only HOMO IMPROVEIUIENT COAT' MOR Wam the tWrntt a daft- 0 farad rMim to: "`+ Mti of BoRdWS RegeMow mW St�uMQard_s Re9i%V6 i _N 14MO 04*Ashbne'ton Place Rw 13(a E119MQ9 T#* 239MBoston.Ma.02108�_. Corpiwittion SEhR$HOME 11, s- oDucrs INC, ` ALFRED NYAM4N 1024 FLORIDA CG)MEIQ! Dint valid tAtt _ - - - - LONGWOOD.Fl.32i'5Cf� "+ Adrninisiratur naftuYrc N _ Board of Building egulations and Standards ; - ,r Cine .shbur on Place �• Room l Boston. Massachusetts Construction upervisor License License y5: 97519 Restriction: Ota Sirthdate: 8/3111963 Expiration: 8/31/2010 Tr# 9:7519 LUBO'S S EC 827 THOMPSON ROAD THOMPSON, CT 06277 Update Address acrd return card. !'Marie reasovi for change_ DrIS-CAI Address Renewal Lost Card I d� t '�1Giar raev�tr,trrre��f �?'`. .ttrs trrrute'a ^ « s •a Board of Budin Rc g g ulati rm17.S and Stcura4ltrrrls CCrlDstrirction Supervisor(License License: CS 97519 T Birthdate:: 8131P19S3 Expiration 813112019 Tr# 97519 . S j Restriction: 90 87111 jRJ ' 'lt?ii1 3bCTOWW LUSOS SVEC 827 THOMPSON ROAD THOMPSON, CT 06277 Commissioner Job# ? !/ r� Sears Home Improvement Products,Inc. Location: License No.CGC 012538 .M Phone# 7 r►— yy— P.O.Box 522290♦Longwood,FL 32752-2290 Doors Name: a G Gll3Q le— Phone:Res: GFS Bus.: 7^j 716 Address: Yy /LPct(ry LL 4& City: A) ' (/C St.: TSG zip: Me,the owner of the premises described below,hereinafter referred to as"Purchaser offer to contract with Sears Home Improvement Products,Inc.hereinafter referred to as"Contractor",to furnish,deliver,and arrange for installation of all materials necessary to improve the premises located at: -T4T- /t° ee4-- (City) (State) Entry Door 1 Loc. JEW` Entry Door 2 Loc. Loc. Loc. tom Style: L G Style: SIDELITES: STORM DOORS: C. 7 I Jamb ❑L F e C Double ❑Full Jamb ❑L Frame O Double Model Number: Model Number: 770 ❑r�c�c SSt�ta'�inr�auble "OLMT Smooth DOC Stainable OCC Smooth CLMT Smooth ❑CC Slaina le O CC SM ❑One/Two ❑Deluxe^^ C"W ate' r Colors Exterior Colors Exterior Colors Colory�w r f U�ll Interior Colors Interior Colors Interior Colors &Tinted Glass Bronze❑Gray Grid/Blind dolor Grid/Blind Color Grid/Blind Color ❑Alum m Screen wire ❑ Glass Style C`� ❑ Glass Style ❑Glass Style oml Door Stands ardware ®,M� re Finish CAB ❑SN ❑ Hardware Finish OBB OAS ❑SN J Brass Threshold O Black e r ndard Hardware PKG CI Standard Hardware PKG O 3% C 2:5Colonial Casing Specialty Hardware ❑ Decorative Trim Handle ❑ Decorative Tdrr Handle ❑2%Modern Casing Color: ❑ Magazine Slot O Magazine Slot O Jamb Color ❑ Door Knocker and View ❑ Door Knocker and Vida ❑ Standard CI Extended Jamb Fat ❑BB OAS ❑SN O Door Knocker ❑ Door Knocker Additional Options ❑ Kick Plate ❑ Kick Plate TRANSOMS: SECURITY DOOR: Additional Options Additional Options Model Number: Model Number., ❑CO Stainable ❑CCSM ❑Single Door Double Door Exterior Colors O Sidelites ❑One ❑Two h Outowing Inswing Outswing Interior Colors Color _ ..._. ..._-_. Left HsM Marg 1`11,11 Hand Lea Hand R'ght Hared t>A1 H- RqM Hent ❑ Glass Style ❑Standard Hardware(Bright Brass) Iron� linid. 1 I'Mii ❑ 3% ❑Mi Colonial Casing Hardware Options O 2%Modern Casing Color:_ Brass Threshold ❑ areas Threshobi ❑Jamb Color ❑ 33 ❑2%Colonial Casing O 3%C 2%Colonial Casing O Standard C Extended Jamb U Magazine Slot Wit; ;i LF Modern Casing Color w ❑2%Modern Casing Color: Additional Options ❑Self Storing Glass ❑ Door Cutdown O Door Cutdown Jamb dding Color-S(XW Jamb Cladding Color tit tandard Jamb❑Extended Jamb —�Standard Jamb O Extended Jamb Patio Door Screen Color Patio Door Screen Color Do Not Do: Purchaser Initials: X Special Instructions: e4wrle ti !t v o(a, 40/4 rS� Contractor is not liable for condition or operation of rehung storm doors. A1' c1 t'ewOG0ll lcQ ""e Clean up job related debris and provide necessary permits and insurance. Allow approximately 3-6 weeks for installation.Warranty will be mailed upon satisfactory completion. NOTE:THE WARRANTY PROVISIONS AS STATED ON THE REVERSE HAVE BEEN EXPLAINED AND IIWE UNDERSTAND THEM FULLY. ADDITIONAL PROVISIONS AND WARRANTIES ARE STATED ON THE REVERSE SIDE AND AREA PART OF THIS CONTRACT. I)( Please read the following told type and initial corresponding line. r' Verbal understandings end agreements with representative shalt not be bidding.All understandings and agreements must beset forth in writing inth Contract. Due to climatic conditions,Interior condensation may occur. Purchaser Initials: X Icing on storm doors may occur. Total Items .00 Terms: Credit (Subject to the approval of the Credit Department) $ .00 Cash ❑ (Final Payment payable to installer upon completion) Initial visit Discount' $ .00 State Sales Tax(may) Funded by Bank Phone# (M applicable) City State Acct# Total Contract Price 3/D — Deposit $ _ Balance Due 1$ 3/O 10%Preferred Customer Discount(PCD)awarded for any future Sears Home improvement Products purchases.Current pricing available for one(1)year. If this is a credit transaction,the agreement for credit is contained in a separate document which is incorporated herein by reference and made a pan hereof.I/We the undersigned are hereby authorizing Sears Home Improvement Products,Inc.to verify and review my/our credit record with an independent credit reporting agency and release them from all fie[nlity incurred from inadvertent omissiors or errors. IN WITNESS WHEREOF Purchaser(s)have hereunto signed their name(s)this day ofand acknowledge receipt of a true copy of this Contract and unless otherwise specified,it Is understood that the owner is ready for work to begin. You the Purchaserl may cancel this transaction any time prior to midnight of the third business day after the date of this transaction.See accompanying notice of cancellation form for an explanation of this right. Signapue affixed below agW receipt ch )r separate cancellation forms. SUBMITTED BY:Representaave ate Purchaser X � 'f ACCEPTED SY:Sears Home Improvement Products,Inc. Date P ase Date x X G2-SO Rev-09/04