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HomeMy WebLinkAboutBuilding Permit #365 - 45 ROCK ROAD 12/1/2008 i yORTIy BUILDING PERMIT olt00 TOWN OF NORTH ANDOVER / APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ° SSACHUSE Date Issued: IMPORTANT: Applicant must complete all items on this page s LOCATION Print PROPERTY OWNER Print MAP NO '[I PARCEL: 1, 9 ZONING DISTRICT: Historic District yes no Machine Shop Tillage :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: I,::2 W(: ijboo X (LJO Identification Please Type or Print Clearly) OWNER: Name: a,) Phone: Address: CONTRACTOR Name: �rG t Phone: - °t y—uno Address log C t S . nr Supervisor's Construction License: Exp. Date: Home Improvement License;. r CJ ( Exp. Date: b, 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. - C�� I Total Project Cost: $ oUf3-U. FEE: $ ` Check No.: Receipt No.: c')- NOTE: Pern ratting with unre isteredl contractors do not have access to the guara ignature o then caner. gnature-of contractor. 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 o 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 o Building Permit Application o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses Li Copy Of Contract ❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) a 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) o Building Permit Application ❑ Certified Proposed Plot Plan o 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 i Revised 2.2008 I 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 COQAMENTS I 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;;Dumpsteron site -,yes = no .Located at 124 Main Street Fire-Department signatureldate COMMENTS . i 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 i ❑ Notified for pickup - Date Doc.Building Permit Revised 2008 F ' Location No. J6 Date NORTH TOWN OF NORTH ANDOVER Certificate of Occupancy $ r. Building/Frame Permit Fee $ rY Foundation Permit Fee $ F Other Permit Fee $ TOTAL $ - Check # 2121 Building Inspector IF FORTH"own of Anduver s 0 NO. - �,( i ' 0 W �` d®ver, Mass. T 0 LAKE COCHICHEWICK 0Rgreo BOARD OF HEALTH Food/Kitchen rElIMIT I Septic System • BUILDING INSPECTOR THIS CERTIFIES THAT........ ... .e. .......... .. ................,. Foundation L has permission to erect........................................ buildings on ...... .7........� ............ . _ Rough tobe 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 MONTH-- S UNLESS �� �+ �T ^-� T ELECTRICAL INSPECTOR. l J 1`J I✓�Ss7 �1�I J d� C ST r 1 S Rough ............. .............................................................................................. Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy .wilding 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. Window Agreement-Page 1 of 2 J&L Windows,Inc.,d/b/a 104 Otis St.,Northborough,MA 01532 Renewal ���. MA Home Improvement Contractor (508)919-0900•Fax:(508)919.0903 Bali License#149601(Expires 1/2412010) Customer Service:(800)573-7606 CbyAndersen. Federal Tax D#83.0404201 - WINDOW REPLACEMENT -Ad­-Co pnny Product Manager: L \`mac. Window Agreement Contract Date: S ZZ—O Homeowner("Owner")'s Name(s): Ail un) vI ._PvAi Street Address: YK, ?O . City/Town: JUS J9r1 OF State: ptjl9 Zip:gyf Home Phone: ' werk1n1bne: / ,qa ©p Job Site Address(if different): E-mail Address: Materials to be provided and work to be performed by Renewal by Andersen("Contractor"): Contractor will furnish and install Renewal by Andersen-approved materials to the following specifications: 1. Date on which Work is Scheduled to Begin: :571V V . Expected Date of Substantial Completion: 2. Contractor will Install a total of_windows in Owner'9 home,using the following individual quantities: 7 Double Hung(DB) OKIEqual..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 Replacement: 4. ❑Yes is No #of sills to be replaced by Contractor: 5. ❑Yes 9CNo #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: C*Iigh Performance ❑Other If other,please specify: 7. Exterior color to be:`0 White ❑Sand ❑Canvas ❑Terratone 8. Interior color to be: 7.White ❑Sand ❑Canvas ❑Terratone ❑Wood / Note:Interior color can only be white,wood or same color as exterior. Wood interiors need to be finished by Jp}ner, 1 9. Hardware: X White ❑Stone ❑Canvas❑Brass Double Hung: Install lifts? ❑Yes ❑No F/fgl, 10. ❑Yes 4NNo Contractor will remove metal frames or grilles. #of Units: 11. ❑Yes ft No Contractor will install new paint-ready or stain-ready casings. Inside or outside stops#of openings:_ Interior casing#of openings: Exterior casings#of o ❑Pine ❑Maintenance free material Owner is aware that Contractor does not do any pain Ow r initials 12. ❑Yes ❑No Contractor will wrap exterior casings w col sock of color. Note:Required with storm window removal;removal of storm windows will leave screw holes in casing. 13. New windows to have: alf or ❑Full screens Screens to be: jF%Fiberglass ❑Aluminum 14. Windows to have grille�Yes ❑No If Yes: ❑Grille Between Glass(GBG) Removable Interior Wood(INTW) ❑Full Divided Light(FDL Grille patterns: #JX #: #: #: #: #: #: FP F1 B P F-1 M DH DH DH DH CW/Picture Gli r� W or GPW .use additional sheet if needed Owner approved(i tials): C 15. Yes ❑No Contractor will insulate,caulk and seal windows with 3-point system to and air infiltration. 16. Yes ❑No A limited warranty shall issue to Owner uponcompletion of the job and payment in full(see reverse side). 17. es ❑No Building Permit—Contractor will secure any and all necessary permits.The fee for the permit(s)is not included in the Contract Price and a separate check is r(i ulred at the time of sale fort is fee. 18. Additional job details: on q r �`�g 10 Iq LSAd ftr=h � L& -bow-,;- 19. WYes ❑No Owner has reviewed the Additional Terms and Conditions governing this Contract on the reverse side, including Owner's Three-Day Cancellation&�hts pursuant to MGL c.93.§48 4 D&V or c.255D§14(See Section 25). 20. Total Contract Pri e:$ V0 Regular Retail Price:$ RUN -711 x_"711 available discounts applied:A(es ❑No 21. Deposit(1/3):$ G 7 aid by❑Cash ❑Finance (Account#: ) Second(1/3)$ t to be paid by Cash at start of job on (Estimated start date). Final(1/3)$ �o be paid by Cash at completion of job on (Estimated completion date). 22. ❑Yes ❑No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment. No 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 agree in advance that should a dispute arise regarding this contract,Contractor may submit such dispute to a private a bitration service that has been approved by the ffice of th onsumer Affairs &Business Regulatio and O n shall be required to submit to such arbitration rov d GL 2A. Contractor Signature: Owner Signature: NOTICE:The signatures parties above apply only to their agreement to alternate dis to resolution in by Contractor.Owner may initiate alternate dispute resolution even where this section is not signed separately by the parties. DO NOT SIGN THIS CONTRACT IF THERE ARE NY BLAN C J&L V indows,I c.d/b/a Renewal by Andersen q , By: Product ager O r Signature Product Manager(Print Name) Owner Signature White—Renewal by Andersen Yellow—Installation Pink-Homeowner The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston;MA 02111 wwwWorkers'Compensation Insurance Affidavit: r it Buildetris/Contractors/Elec ' A Lcant Information cians/Plumbers " -Please•Print le ibl Name(Business/Organiza6on/Individual): Address: •S L JJ t T City/State/Zip: �r � Phone f: USD Fe employer?Check the appropriate box: employer with p 4• Type of project(required): ❑ I am a general contractor and Iees(full and/or parttime)'� have hired the sub-contractors 6• ❑New construction sole proprietor or paroer- listed on the attached sheet.t �• ]Remodeling d have no employees These sub-contractors haveg for me in any capacity, workers'comp,insurance, g' ❑Demolition rkers'comp,insurance 5. ❑ We are a corporation and its9 ❑Building addition d.] officers have exercised their 10.❑Electrical repairs or additions . 3.❑ I am a homeowner doing all work right of exemption per MGL 11.[]Plumbing repairs or myself.[No workers'comp, c.152, §1(4),and we have no additions insurance required.]t employees.[No workers' 12•❑Roof repairs comp,insurance required.] 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 #Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,polica�� I am an employer that is providing workers'compensation insurance for my employees Below is the pati andjob o•L information. cy ,lob site Insurance Company Name: �� �� �-, C Ce__ Policy#or Self-ins,Lic.#:_ ,? Expiration Date: Job Site Address. City/State/Zip: J�> tFur Attach a copy of the workers' (compensation policy declaration page(showing the policy number and ' Failure to secure coverage expiration as required under Section 25A of MGL c. 152 can lead.to the im osition of c rimi' ahon date). fine up to$1,500.00 and/or one-yeas imprisonment,as well as civil penalties in the form of a STOP W nal penalties of a of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded o the �EeRof a fine Investigations of the DIA for insurance coverage verification. Ido hereby c rtzfy under th pain and penalties o rjury that the information provided above is true and rrect; Si ature: q�j Date:............_IaLIL - Phone#: Official use only. Do not write in this area,to be completed by city or town official City or Town; Permit/License# i Issuing Authority(circle one): 1.Board of Health 2.Building II Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing inspector 6.Other p or Ii Contact Person: I Phone#: ' i Massachusetts- Department of Public SafetN' Board of Building Re-ulations and Standards_ - Construction Supervisor License s - License: CS 99255 Restricted to: 00 SCOTT PHILLIPPI 58 0 STREET a WH171NS.VILLE,MA 01588 Expiration: 6/72011 ('u mmiti siuoec Tr#: 99256 Restricted to: 00 00..Unrestricted 1G-1 2 Family Homes Failure to possess a current edition of the Massachusetts State Buildiing Code is cause for revocation of this license. Refer to: WVVW-142ss-G0v/DPS G ze 't7po�mzaruuea�o�./1���� QN Board of Building Regalations and Standards HOME IMPROVEMENT CONTRACTOR Registratio :, 149601 Elf►tatuPM4/2010 � ypepplement Card RENEWAL BY ANDt5E3 'r= SCOTT PHILLIPPI =� r '; f 104 OTIS STREET`°: NORTHBOROUGH,MA OT532 Administrator DATE(MINDDIYYYY) ACORD-. CERTIFICATE OF LIABILITY INSURANCE PRODUCER THIS CERTIFICATE IS ISSUED AS,A MATTER OF INFORMATION Joseph McKeone ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. DOES NOTOR JP McKeone Insurance Agency, Inc. ALTER THEHIS COVERAGECATE AFFORDED BY T EMENDPOLLICIESTBEDLOW. P.O. Box 333 Ann Arbor, MI 48106-0333 INSURERS AFFORDING Hartford COVERAGE MAIC# INsuRFD Renewal by Anderson INSURER A: ord Insur nce Company JBL Windows,Inc. INSURER e: Hermitage 104 Otis St INSURER C: Northborough,MA 01532 INSURER D: I (INSURER E: COVERAGES 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 ADOLl POLICY EFFECTIVE POLICY EXPIRATION LTR IN-qRQ POLICY HUMBER LIMITS B GENERAL LIABILITY HCP 507 404 0910712008 09/07/2009EACH=URRRRFNCE S 1000 000 COMMERCIAL GENERAL LIABILITYPREMISES Ea U S 100,000 _17M=h TOED CLAIMS MADE ® CC OUR MED EXP(An one person) S 5.000 PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGO S 2,000,000 POLICY PRO. L� A AmomDs i.E LJ mury 35 MCC XD 6390 10/01/2007 10101.2005 COMBINED SINGLE LIMIT S 1,000,000 ANY AUTO (Ea aoaaenq X ALLOWNEDAUTOS BODILY INJURY ' S If:: SCHEDULED ALTOS , (Per person) HIRED AUTOS BODILY INJURY NON-OWNEDAUTOS (ParaceiCoal) S. PROPERTY DAMAGE S (Por ooaoent) GARA0EUAI3CtTY AUTO ONLY-EA ACCIDENT f ANY AUTO OTHER THEA ACC S ' AN AUTO ONLY: AGG S EXCESSJUMBRELLA LIABILITY EACH OCCURRENCE S OCCUR FiCLAIMS MADE AGGREGATE S ' S DEDUCTIBLE S RETENTION S S A WORKERS COMPENSATION AND 35 WEC PP 1444 02/17/2008 02/17/2009 we sfATu. O14.A EMPLOYERS LIABILITY E.L.EACH ACCIDENT S 500 000 ANY PROPRGTORiPARTNER/EXECUTNE OFFtCEWMEMSER EXCLUDED? E.L DISEASE-EA EMPLOYEE S 500 000 N as daaulbe under. SPECIAL PROVISIONS belay E.L.DISEASE-POLICY LIMIT S 500,000 OTHER DESCWT90N OF OPERATIONS ILOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED 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 RISURER.ITS AGENTS OR REPRESENTATIVES, AUTHORIZED REPRESENTATIVE �I_ „ �VV� ACORD 25(2001/06) t �.(,4/0 ACORD CORPORATION 1988 AhFb{ielF sirs Wood/V yl Composite Frame' coa�f,L� Dual.. -Argon' -Double Rung .M.m-_ �• EXERGY'PERFogmAm'dE RATINGS U.Factor(U.S)/1-P. 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