HomeMy WebLinkAboutBuilding Permit #751 - 5 BACON AVENUE 5/16/2007Permit NO: �—`
Date Issued: 6--/ p- U
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received r b
of
DESCRIPTION OF WORK TO BE PREFORMED:
�n5�a l l On x`S1,J
c I h
Idegtification Please )'ype or Print Clearly)
OWNER: Name: {tee!
Address: 5 2aCOY1
AVe—
,+)" L
ARCHITECT/ENGINEER Phone:
78.683-
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: $ 81 500 — I I FEE: $ r U
Check No.: Receipt No.: C
NOTE: Persons contracting wit/, uWegistegd contractors do not have access toffie,guaranty fynd
Location5 &16017 /4 --
No. 7 5 Date �� }
HCRTN TOWN OF NORTH ANDOVER
` A
Certificate of Occupancy $
s NUS EBuilding/Frame Permit Fee $
AC
Foundation Permit Fee $
>r
Other Permit Fee $
TOTAL $
Check #
202 *1 6
Building Inspector
Plans Submitted ❑
Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
emp vurMp5l:er
on:;site yesnu
Public Sewer .t ❑
Tanning/Massage/Body Art ❑
Swimming Pools i
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
HEALTH
COMMENTS
DATE APPROVED
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision
Water & Sewer Conn.ecti
Located at 384 Osgood Street
. !
_Comments - i
- Comments
i
Nrcc ueHrc� mcrn �.1
emp vurMp5l:er
on:;site yesnu
_ocated at' 24 Main Sfret
Fire Dejart�ieir~t srnatur/date.
�-
�R
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 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
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
o 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
L3 Workers Comp Affidavit
a 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)
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
o Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o 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
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Home I 6 N r 4 YFI
Seers HHome Improvement Products, Inc. Job No.:
1024 Ftonda Central Park" a Longwood, FL 3x750 flame lmproremem Products Phone #-
FEIN 25.1698591 WBBtirtabaerer Exterior Protection System A
License Numbers: AL 5461' FL CGC01253& to 64194- Location: k'D . i'>+
MA 148607• MS 50222 NC 47330• RI 27281 • SC 10583;
TN 2314; us, GA G170I7; CT HId.0607669 Siding
Name W (f - 7 l,9j�
(') kcm Phone: R d7r _ — !o ff
Address: �l' I RC :' Av'e city. ry?Y'" 0
UWe, the owners of the premises described below, hereinafter referred to as'Pumhaser offer to contract with Sears Home Improvement
Products hereinafter referred to as "Contractor", to furnish, deliver, and arrange for installation of all materials necessary to Improve the
premises located at:
t\*Uc
(Street) (City) (State) (Tp)
According to tihe following
specifications:
NOT
INCLUDED INCLUDED SPECIFICATIONS
PREPARATION: 1.
Z
LJ Obtain all necessary permits and insurances.
2.
❑ Inspect surfaces in work area - renail loose wood, replace rotten surface wood where necessary in work
3.
❑
area excluding root, decking or rafters, and structural members.
area
[� Existing siding: Type:
4.
5.
❑
[
�ir out walls on brick, block, metal or stucco areas: Location:
❑ Caulk and seal around all windows & doors In workarea necessary.
6.
�
E]Install approved non -corrosive starter strip. , 3
INSULATION: 7.
�
0 insulation on 8atwall areas to be sided with' ruded poly -styrene insulation. (circle one)
CUSTOM TRIM: a.
ElVyna-Kiad
/�Install
aluminum fascia system: Calor.
9.
Eli
emove and reattech/dispose of existing guttering.
10.
❑
Cover soffit areas of home with vinyl soffit "am, accept those araac noted below.
/�eatherbeater ❑ Max 0 Pius 0 Wea9rerbeatar 0 Other (check one) Color: _ Pattern:
1 I.
❑
(� Custom Vyrta-toad aluminum frieze boards: 1^�A i
12.
Location: 1 C c 6olor. Size:
uh trim: Location: Color:
13.
ell windowolsilWmulWheaders with Vyne-Klad aluminum:
/ Color:
14.
❑
,.�
L>�d'/Flemove and reinstall existing storm windowelawnings/atwttera
15.
❑
Ind' Custom wrap door facing with Vyna-Klad aluminum:
16.
❑
Locatlon: Color:
01- Custom wrap garage door facings singleldouble with Vyna-Klad aluminum:
Color:
17.❑emove
and reinstall storm doors
1s.
❑^� //
Deluxe corner posts: Color:
19.
L1d�
❑ Clip locking system: Location: 7-dli i4eiz Q
SIDING: 20.
L4�
❑ Install Weatherbeater ❑ Maxus (IWealierboater ❑ Other Solid vinyl 'di one,,)4// �(
,(_TY
PE: Horizontal /Vertical COLOR: & &,-e d, Ag 1 AP !�
PORCH 21.
❑
Porch ceilings: location: Color:
SYSTEMS: 22.
❑
&-'-Jvm' h posts: Color:
23.
❑
[R-' Porch beams: Color:
CLEAN UP: 24.
®
❑ Clean up and removal of all job related debris:
25.
AI
❑ Each job is over -shipped to avoid delays. Remove excess materials and r shx k.
WARRANTIES; 26.
SPECIAL ITEMS:
(x]
❑ Manufacturer's warranty sem upon completion.
Wodk not tobe done: NO DRIP EDGE COVERED -NO PAINT APPLIED
All of the above check boxes and the'wo—rrk not to be done' section have been reviewed and explained to me.
TIME FOR COMPLETION OF WORK. Contra c shall commence work within approximately twenty (20) days from the date own he sin and will be
substantially completed within forty. () d after unless a different estimated completion date is shown herein.
� .,H., t2tw I.- % 1 f 1 ADbroxlmate comoletlon date Is:
HE
VERSE HAVE BEEN
INED AND I/WE
ADDITIONAL PROM IOS NS AND WARRANTIES ARE STTHE WARRANTY PRSIONS AS STATED ON ATED EDEON REVERSE AND ARE PART OF THIS CONTRACT. UNDERSTAND
t: : 11
Please read the following bold type and initial corresponding line.
Verbal understandings and agreements with representative shall not be binding. All understandings and agreements must be set forth In
writing In this Contract. '�:� I�� Purchaser initials: X
The TOTAL PRICF for all Labor A Materials (including any applicable discount) is $ ��_ Contract Price $ C
Down Payment $_
Balance Payable $ State Sales Tax (_%)$
/ (If applicable)
Terms: Credit M11 (Subject to the approval of the Credit Department) Total Contract Price $
Cash l I (Final payment payable to Installer upon completion) Funded by: Bank:
City St.
Acct
10% Preferred Customer Discount (PCD) awarded for any future Sears Homs 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 part
hereof. IANe the undersigned are hereby authorizing Sears Home Improvement P a to verify and review my/our credit record with an independent
credit reporting agency and release them from all liability Incurred from Inadvenent ons or e
IN WITNESS WHEREOF Purchaser(s) have hereunto signed their name(s) this day of 20 and acknowledge receipt
of a true copy of this Contract and unless otherwise specified, h is understood that the owner is r for work to begin.
ready
THIS MESSAGE APPLIES TO (DOOR-TO-DOOR SALES ONLY. You the Purc er(s) may cancel this transaction
any time prior to midnight of the third day after the date of this transaction. See accompanying notice of
cancellation form for an explanation of this right.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
lure affixed below acts as raosipt that P s ranked separeffir wnce6ationrma
fo
SUBMITTED BY: Reprenemetl" to Pu Meer Det.
3' LIU U4_412-4 « J
ACUPTED eY: AuMoAmd 8knahne 4x Sews ebme Impmyemm�t Pmduct. Ito. Dile Pudiaeer Dab
D2 -SO - Rev. 02!06
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02.111
UIP www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information a Please Print Legibly
Improvement Products Inc. I
Home ni
Name (Business/Organization/individual): Sears h
Address:
1024 Florida Central Pkwy
----
�__
Home: 860-792-8106
City/State/Zip:
Longwood, FL. 32750 Phone #: Cell: 860-753-0452
Are you an employer? Check the appropriate box:
1. ❑ I am a employer with
4. ❑ I am a general contractor and T
empioyees (full and/or pant -time).`
have hired the sub -contractors
2. ❑ 1 am a sole proprietor or partner-
listed on the attached sheet. t
ship and have no employees
These sub -contractors have
working for the in any capacity.
workers' comp. insurance.
(No workers' comp. insurance
5.19 We are a corporation and its
required.]
officers have exercised their.
3. ❑ 1 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.] Remodeling
$. ❑ Demolition
9. ❑ Building addition
10.0 Electrical repairs or additions
I .I .❑ Plumbing repairs or additions
12. ❑ Roof repairs 1
13.® Other Y 1 by Si � t ✓1
4'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.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp, policy information.
lam an employer that is providing workers' compensation insurance for my employees. Below is the policy acrd job site
information.
Ace American Insurance Company
Insurance Company Name:
WLRC44460798 Expiration Date: 04/01/2008
Policy # or Self -ins. Lie. #: P
It�or1�' O l8�
Job Site Address: 5 INVe h u _ City/State/Zip: A t ,r,M - 6 . , s
Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration elate).
Failure to secure coverage as required under Section 25A of MCL 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 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.
Ido hereby cerciandf� the pains a d penalties pf perjury that the information provided above is true and correct.
H� :�,r' Sears Auth. Agent } nAr� /1�%7, ;ICO%
Phone #:
Home: 860-792-8106 / 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 #:
Board of Building Regulations and Standards
' One Ashburton Place - Roon1 1.301
Boston. Massachusetts 02108
Horne Improvement Contractor Registration
SEARS DOME IMPROVEMENT PRODUCT
LUBOS SVEC
1024 FLORIDA CENTRAL PKWY
LONGWOOD, FL 32750
Registration: 148607
Type: Supulement Card
Expiration: 101'1112007
Updatc Address and return card. 51;11'1c rcas0n for- chsulF;e.
j Address i 1 Renewal EmplaN meut ; Lost Card
' f%�ii t, rhe?ttr,Itltall'f'.�1, t j, (t ttt�rttY(tNet(.i
*� Board of Building Itcgulntious and StRudards
"-i `t HOME IMPROVEMENT CONTRACTOR
'X ;�� 1 Registration: 148607
Expiration: 101,1112007
Type: Supplement Card
SEARS HOME IMPROVEMENT PR
License or mpista•atio0 valid for iudiVittttl use 0111t
before the expiration dale. If found ra;tttrtt to:
Board of"B tilding Regulmious .raid S&midards
One Ashburton Place: Rau 131101
Boston, Ma. 02108
LOBOS SVEC
10?_4 FLORIDA CEIJTRAt. PICiNY
� l/�,�
I"C�IVGWOOD, FL 32750 Administrator +�K Admiuistrator Nut ,t id vvithu it sif;
`1 04/02/2007 11:20 407-767-8536 LICENCE PERMITS SUBS PAGE 01
ACORD. CERTIFICATE OF LIABILITY INSURANCE os/ol./2007 7
DATE(MIUDDPM
03/10/2006
PRODuCtR
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
LOCKTON GOMPANII;S,L�C K CHICAGO
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
525 W. Monroe, Suite 600
HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR
CHICAGO IL M1ALIER
V G. AEF—ORDER BY THE POLj_CIES�EILQ
(312) 669-8900
INSURERS AFFORDING COVERAGE
INSURED
Sears Holdings Corporation
INSURER A i Ace American. st &w an
10629 83
d/b/a Sears Home Improvement Products, Inc,
INSUgEBsd ni Ins. Ca. ofNorth Ameri,,,
FIRE RAMLG ELAn one nre S Excluded
MEO EXP A_rn e c pmxanj s Exatudcd
Attn: Risk Management 85-1776
I INSURER D:
3333 Beverly Rd.
Hqftan States, IL 60179
09/01/2007
nnV9DAC9rd S'1CATJnnd r7
I t1t:! IilJallt'14AiY VF IHSVKAr1[rC YUCS MV 144VM311 I U t c A c.v11 r r[R1+ r 661 WCLry 1 nc rim,
tuc, fE0�1C� AnT tnn- DvebM ENTAT1Ue An ennro tree AUA TLeo reoTror%ATE LM ARD
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO TME 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 SY THE POLICES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH
POLICIES. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
L
TYPE OF INSURANCE
POLICY NUMBER
POLICY EFFECTIVE
T
POLICY EXPIRATION
DATE MMIDDIYY
LIMITS
rINSR
GENERAL LIAR LI Y
EACH OCCURRENCE S 5,000.000
FIRE RAMLG ELAn one nre S Excluded
MEO EXP A_rn e c pmxanj s Exatudcd
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS MADE x❑ OCCUR
1IDO G21729383
04/01/2007
09/01/2007
PERSONAL & ADV INJURY $ 5,000,000
GENERAL AGGREGATE $ 5.000 000
GERI- AGGREGATE LIMIT APPLIES PER!
PRODUCTS - COMPIOP AGG S 5.000 000
POLICYJERCT LOC
A
AUTOMOBILE
X
LIAOILITf
ANY AUTO
ISAH08219953
04/01/2007
08/01/2007
ceaddentSINGCE LIMIT $ 5 000,000
BODILY INJURY ¢ XXX7CxxX
(Por Psrnon)
ALL OWNED AUTOS
SCHEDULED AUTOS
BODILY INJURY $ XxXXxxX
(Per secldemt)
HIRED AUTOS
NON -OWNED AUTOS
PROPERTY DAMAGE S XXXxxxx
(Par accident)
GARAGELIA19MM
AUTO ONLY-EAACCIDENT $ XXXXXXX
OTHER THAN _E ACc- $ XXXXXXX
AUTO ONLY: AGG S XXXX.XXX
A.
ANY AUTO
S.I.R. $5,000,000
04/01/2007
08/01/2007
A
EXCESS uAsRm
X OCCUR ❑ CLAIMS MADE
XOO G23573830
04101/2007
08/01/2007
EACH OCCURRENCE S 10,000,000
AGGREGATE_ $ 10,000,000
xxx�fx
® UI�J1
xxxyXxx
DEDUCTIBLE FORM
$ xXXXXXx
RETENTION ¢
A
WORKERS COMPENSATION AND
Wi.RC44460737(CA.) (DED,)
04101./2007
04/01/2008
DTH
X TO ST IMU ER
A
EMPLOYERS' LIABILITY
SCFC44460749 T:TRO
04/01/2007
04/01/2008
E.L. EACH ACCIDENT $ 1,000.000
E,L, DISEASE - r=A EMPLOYEE $ 1.000,000
B
WLRC44460798
04101/2(K)7
04/01/2008
E.L. DISEASE - POLICY LIMIT $ 1000 000
B
ALL OTHER STATES
A
QTH
t3ar.Igekecl,crs [rabilRy
S.T.R. $5,000,0110
04/01/2007
09/01/2007
S,1.11, $S,ODO,OOO
DESCRIPTION OF OPERATIONSn=&TMNS/MICLESWCLUSIONS ADDED BY ENQORSEMENTISPECIAL PROPISIONS
Alfred W. Nyman, Jr.. License 4CGC012538 lncatcd ® 1024 Florida Central Parkway, Ltm"ood, Fr, 32750 and Alfred W. Nyman, ,fr., License MCMC i 24951,0
located CI 1024 Florida Central ParkwAy, Longwood, FL 32750
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
Sears Houle Improvement Products DATE ;HEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
1024 Florida Central Parkway
Longwood FL 32750 NOTICE TO THE CERTIFICATE MOLDER NAMED TO THE LEFr,6UT FAILURE TO Do SO SNA"
IMPOSE NO OBLIGATION OR LIABILITY OF ANY IOND UPON THE INSURER, ITS AGENT$ OR.
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE ..�
ACORD 25-S (7197) pnranac Ionc mpardhM this asrMesM, aemut IN mlmew name In Mo TfIN ucar Aftdlen elw,M,nd epom Ifio errant code ISEutr K. OD ACORD CORPORAT ON 1988
Received on 4/2/2007 9:22:20 AM
i
Board of Buildi,ng Regulations and Standards
Registration: 148607
A et Ition: 10/1112407
Type FPubl c Corporation
SEARS HOME IMPROVEMENT PRODUCTS INC.
ALFRED NYMAN JR.
LO G OO , FL 32750
Administrator