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HomeMy WebLinkAboutBuilding Permit #846 - 684 MASSACHUSETTS AVENUE 5/30/2012TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: gq(O ( Date Received Date Issued: IMPORTANT: Apikicant mum complete all items on this nage SS G\ cl oCA�� H 0 C_ n� P nt PROPERTY OWNER �V `a, �,�,J e,er S a ,n Unit # Print MAP NO: C6_1 PARCEL: 0b,2q ZONING DISTRICT: 3 Historic District yes no Machine Shop Village yes no 100 year-old structure 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 0i P v ®tF .d. Dsh 1Jr,6l fur I WN UP" wUKK TU BE FEKI Type or Print Clearly) OWNER: UK 'G�6�n_44 C CONTRACTOR Name: b r e &n O yN /} 1 S o n Phone: Address: e o r4l% 6"-b, 1M e, 6 f Supervisor's Construction License: q S -4- G -} Exp. Date: Cj- ?- I Home Improvement License: I --�-0 31(3 Exp. Date: 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: o FEE: $_ l Check No.: Receipt No.:- NOTE: o.:_NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED El DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water lac 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 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 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 2011 June/mi 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 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: Doc.Building Permit Revised 2008mi Location No. Date Check #c9 5 —4 ---� —:�- TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ALL --- Foundation Permit Fee $ Other Permit Fee $-- TOTAL $ 25338 Building Inspector 0 3-i Q o04 C u o O w v co a C1 cn 0 W � z Q o O cb. :1 O w U wC W Z a w O WO a w :3 cn . cd iz, d ca C on w m ia: F W W x N co o z cn v p o cn c y— o CD c C h O C cO CO LD p, C tp O m C := e ' � L CD N Ea o s � o c c `O m O O ea m c C n :.. mcmm O �3 e co N O co E� a.C.a y m V _i= Cm w � C OQ N ' V •y O, cc z c � o o a m to - 0 y co) CO w fl CDy.. C ++ .y dMD t O C '� � 0 cm COD M. mP o:o = eyp cm •J F� a d 4- m MA CD E C L O O v Z CL °o O y ® C I O C ca p 'C y O .O 'E 0 ow t O� y+ O G O � v�Q c oc t9 O V ®. I C CD C.1 CIO O C Cs C. y W 0 U) 19 W W 19 W 0 Renewal � MA Home Improvement Contractor Andersen® , License # 1708 10 (Expires 12/23/2013) ®_ Renewal by Andersen Corporation Federal Tax 1D #41-1918413 W!NDUW REPLACEMENT an Andersen Company 104 Otis St., Northborough, M/IA 01532 (508) 351-2200 • Fax: (65'1) 351-4810 CUSTOM WINDOW AND DOOR REMODELING AGREEMENT t -Mail Address Home Telephone Number Work Telephone Number Buyer(s) hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen Corporation ("Contractor"), in accordance with the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s) (collectively, this "Agreement'). Buyer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: Deposit Received (33%): 0 D ' Balance at Start of job (33%): 7) 060 Balance on Substantial[�O i Completion of Job (33%):3 cX Estimated Starting Date �/E -S Estimated Completion Date: /-2 CJ,�,A- Method of Payment ❑C�heck ❑Cash ❑Financed fiaVisa/MC ❑Discover ❑AMEX If credit card is selected, please see Credit Card Payment Form. t ;I A-V y'q Buyer(s), agrees and understands that this Agreement constitutes the entire understanding between the parties, and that there are no verbal understandings changing or modifying any of the terms of this Agreement. No alteration to or deviation :Iom this Agreement will be valid without the signed, written consent of both Buyer(s) and Contractor. Buyer(s) hereby acknowledges that Buyer(s) 1) has read this Agreement, understands the terms of this Agreement, and has received a completed, signed, and dated copy of this Agreement, including the two attached Notices of Cancellation, on the date first written above and 2) was orally informed of Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Renewal Man ager Joh 14 Print Name of Product Manager Bu er( , Signature Print Name Buyer(s) Signature Print Name YOU, THE BUYER(S), MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION. SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT. — — NOTICE OF CANCELLATION Date of Transaction /"c- . You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the Contract of Sale, and any negotiable insirumenf executed by you will be returned within 10 days following receipt I by the Contractor ("Seller") of your cancellation notice, avid any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the Seller at your residence; in substantially as good condition as when received, any goods delivered to you under this Contract or Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk. I Ifyou do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods without an further obligation. If you fail to irnake the goads avoilable to the Seller, or ifou agree to return the goods to the Seller and fail to do so, then you remain liable for performance of all obligations under the Contract. To cancel this transaction, mail or deliver a I signed and dated copy of this cancellation notice or any I other written notice, or send a telegram to Contractor: Renewal by Andersen Corporation, 104 Otis Street, Northboroagh, MA 01532, BY NOT LATER THAN MIDNIGHT OF �!� --/.P-- .(Date) I HEREBY CANCEL THIS TRANSACTION. ------ x - - - - - - - - - - - - - - - � NOTICE OF CANCELLATION Date of Transaction �y``1� -/,�---. You may cancel this transaction, without any penalty or obligation, within three business days from the above date. If you cancel, any property traded in, any payments made by you under the Contract of Sale, and any negotiable instrument executed by you will be returned within 10 days following receipt by the Contractor ("Seller") of your cancellation notice, and any security interest arising out of the transaction will be canceled. If you cancel, you must make available to the Seller at your residence, in substantially as good condition as when received, any goods delivered to you under this Contract or Sale; or you may, if you wish, comply with the instructions of the Seller regarding the return shipment of the goods at the Seller's expense and risk. If you do make the goods available to the Seller and the Seller does not pick them up within 20 days of the date of your Notice of Cancellation, you may retain or dispose of the goods without any further obligation. If you fail to make the goods available to the Seller, or if you agree to return the goods to the Seller and fail to do so, then you remain liable €or performance of all obligations under the Contract. To cancel this transaction, mail or deliver a signed and dated copy of this cancellation notice or any other written notice, or send a telegram to Contractor: Renewal by Andersen Corporation, 104 Chis Street, No ugh, MA 01532, BY NOT LATER THAN MIDNIGHT OF . (Date) I HEREBY CANCEL THIS TRANSACTION. Buyer': Signature Print Name Date Buyer's Signature Print Name Date RbA Copy - White Buyer Copy - Yellow Buyer Copy - Pink ©JBUP2009.RBA-Pn MANH enewal19 R ^CWal by Andersen Corporation MA Home Improvement Contractor �� b i .M�i 104 Otis St., Northborough, MA 01532 License # 1708 10 (Expires 12/23/2013) ridersen. i WINDOW REPLACEMENT. an Andersen Company (508) 351-2200 • Fax: (651) 351-4810 Federal Tax ID #4I-1918413 WINDOW SPECIFICATION SHEET 3uyer(s) Date of Agreement _ L_I.nr-r';IeA r l,,'�T C r- C--ej II,✓ I u- a �?- lo-_ The Buyer(s) listed above hereby jointly and severally agree to purchase the goods and/or services listed below, in accordance with the prices and terms described on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, of which this Specification Sheet is a part. WINDOW DETAILS 1. Contractor will Install a total of windows in Owner's home, using the following individual quantities: Double Hung (DB) ❑ Equal 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 (CPVcj ❑ 1:1:I or ❑ 1:2:1 ❑ Standard handle ❑ Metro handle 2 Lite Gliding Window (GW) GIider / Picture / Glider (GPV T) ❑ 1:1:1 or ❑ 1:2:1 Awning Window (AW) Picture Window (PW) ay or Bow Window Patio Doors (see separate Door Specification Sheet) 2. Yes ❑ No Qty of Windows to be Custom Fit Replacement: �t 3. ❑ Yes g o Qty of Sills to be replaced by Contractor: 4. FJYes o Qty of Windows to be New Construction Full frame (includes new interior & exterior casings) and actual Exterior casings: ❑ Pine ❑ Maintenance -free material ❑ Factory applied 908 Fibrex brickmold 5. Glazing to be: V HP Low- E-4 TM ❑ Other If other, please specify: 6. Exterior color to be: �jhrhite ❑ Sand ❑ Canvas ❑ Terratone ❑ Cocoa Bean 7. Interior color to be: y White ❑ Sand ❑ Canvas ❑ Terratone ❑ Pine ❑ Maple ❑ Oak Note: Inte r color can only be white, wood or same color as exterior. Wood interiors need to finished by Owner. 8. Hardware : U �'nite ❑ Stone ❑ Canvas ❑ Brass ❑ Estate Hardware: Style:_ 9. ❑ Yes Vj No Install Lifts with Double Hung rindows 10. Screens: windows to have: ❑ Half or V Full screens Screens to be: ❑ Fiberglass /Aluminum ❑ TruScene GRILLE DETAILS 11. Windows have grilles: [L/Yes ❑ No If yes: ❑ Grille Between Glass (GBG) VRenrovable Interior Wood ON7M ❑ Full Divided Light (i Du Qty: � Qty Qty Qh': Qtv: Qtv: Oh*: Draw grille patterns above DH DH DH CW/Picture Glider CPW `Use additional sheet if needed Owner approved (ini+):( 11�g ADDITIONAL WORK DETAILS 12. ❑ Yes Vtoo Contractor will remove metal frames of windows. Qty of Units: 13. ❑ Yes VNo Contractor will install new paint -ready or stain -ready casings. Interco. sing qty of openings: Exterior casings qty of openings: ❑ Pine F-1 Maintenance -free material 14. ❑ Yes No Contractor will install new paint -ready or stain- outside stops qty of openings: Interior stops qty of openings: Exterior sto qtv of�penin S. ❑ Pine ❑ Maintenance -free material 15. Owner is a that Contractor does not do any painting. er Initials `•� S 7 (/� 16. ❑ Yes No Contractor:will wrap exterior casings with alu stock of color. Note: Wrapping may be required with storm window removal; removal of storm windows will leave screw holes in casing. I7. es ❑ No Contractor will insulate; caulk and seal windows with 3 -point system to prevent water and air infiltration. 18. �s ❑ No Clean up all job related debris including old windows will be removed. Vacuum nightly. 19. ❑ No A limited warranty shall be issued to Owner upon completion of the job and payment in full. 20. Yes ❑ No Building Permit—Contractor will secure any and all necessary permits. The fee for the permit(s) is not eluded in the Contract Price and a separate check is required at the time of sale for this fee. 21. yes ❑ No All discounts have been applied to this agreement price. 22. Additional job detsls: n 23. 57 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. R is agreed and understood by and between the parties that this Specification Sheet, along with the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT, constitutes the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms. This Specifica ' Sheet may not be changed or its terms modified or varied in any way unless such changes are in writing and signed by both the Buyer(s) and Co trac or. Buyer(s) hereby acknowledge that Buyer(s) has read this Specification Sheet. Renew poraofib. Buyer(s)Ar By: Manager Print Name of Product Manager Signature Print Name Signature Print Name ReC1eWaI New Estimated Renewal b Andersen Corporation MA Home Improvement Contractor y p MA License # 170810 12/23/2013) byAndersena ���,, i (expires 104 Otis Street • Northborough, Massachusetts 01532 Federal Tax IN 41-1918413 wjnoow AEPIACEMENT I. p.AnaarcenCy, vny Phone (508) 351-2200 • Fax (651) 351-4810 CONTRACT AMENDMENT This Amendment ("Amendment") is to the CUSTOM WINDOW AND DOOR REMODELING AGREEMENT ("Agreement") by and between Renewal by Andersen Corporation and MATTHEW PETERSON ("buyers"). Contractor and Buyer(s) hereby agree to amend and modify the Agreement as indicated below. Other than as specifically indicated below, all the terms and conditions of the Agree- ment will remain in full force and effect. This Amendment is subject to the terms and conditions of the Agreement. The following addi- tions, alterations, or deletions to the products and services Buyer(s) ordered are being made: REPLACE ALL INTERIOR TRIM $700 As a result of these changes, the following terms of the Agreement are also changing (if there is no change, an item will be left blank or marked as "N/A", indicating that no change applies: NEW Total Job Amount: $10105.00 New Estimated Method of ✓ Cash ✓ Check ❑ Finance Starting Date: Payment: New Deposit Received (33%): $3000.00 ❑ Credit RECEIVED Card New Balance at Start of $3551.00 New Estimated Job (33%): CUSTOMER Completion Date: **If credit card is selected, please see Credit Card Deposit Form** New Balance on Substantial Completion of $3551.00 Job (33%): CUSTOMER By signing this contract amendment, you acknowledge that the Balance at Start of Job and the Balance on Substantial Completion of Job cannot be made by credit card and must be made by personal check, bank check, or cash. It is agreed and understood by and between the parties that this Amendment and the original Agreement constitute the entire understanding between the parties, and there are no verbal understandings changing or modifying any of the terms of this Amendment. Buyer(s) hereby acknowledges that Buyer(s) has read this Amendment and has received a completed, signed, and dated copy of this Amendment on the date written below. Renewal by Andersen Corporation By: Signature of Product Manager JOHN BEAVER Print Name of Product Manager Doc ID: 20120503114202799 Sertifi Electronic Signature Buyer(s) E Signed t 135/0412032 10-31 AM CSF .Matthew S' Petkson T IP: Tii74.41.33 "'.'"".. ;,--+-.... _DOCTPF791kZ050411AZAZ7" Signature ',5/4/2012 Date Date Nlassachusctt, - Department (al• Puhlic �afef% Board of Buil(linu, Rc,ulation, and SCtn(l:rrrl, - } Construction Supervisor License License: CS 95707 BRIAN DENNISON 86 CREST CIRCLE WORCESTER, MA 01603 Expiration: 9/8/2012 ( nuroi� i uu'r Tr=: 2622 \ Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR . Registration:.:.. -:1:70810 Type: , Expiration: 12/23/2013 Corporation RE 5/AL BY ANDERSEN CORPORATION BRIAN DENNISON, 104 OTIS ST. NORTHBOROUGH, MA 013 The Commonwealth of Massachusetts Department of Industrial,4ccidents Office of Investigations 600 Washington Street Boston, M4 02111 www.mass.gov1dia Workers' Compensation Insurance Affidavit: Bvflders/Contrastars/Electricians/Pinmbers A-pj2licant Information Please Print Legibiy Name (Business/Organization/Individual): e tr\ e U Address: LS�- City/State/Zip: CAIS 3� Phone #: S — S 1' -12l�L Are you an employer? Check the appropriate bor: 1. [ I am a employer with Q 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sab-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 Er7.. Er. zmodeling S. /❑ Demolition 9''[] Building addition 10.7 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. I 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'sub-contractors 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 Insurance Company Name:_ Q Jcb\ \ C r1 S C Z-1 . Policy # or Self -ins, Lic, #: �� C 1 1 1 �I c' �' Expiration Date: l a Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration gage (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 5250:00 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.certify u-nde—r:the pains;ran­dpenaltees ofperjury that the information provided above is true and correct SimaturI / Date: - 3 -I Z Phnne# ��'17—�5 k --A 0 k Official use only. Donor write in this area, to be completed by city or town offaciaL City or Town: Permit(L.icense # 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 #: