HomeMy WebLinkAboutBuilding Permit #49 - 7 COMMONWEALTH AVENUE 7/22/2008BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
o,,,,,,;,n.�• Date Received
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TYPE OF IMPROVEMENT
-
PROPOSED USE
Residential
Non- Residential
❑ New Building
ne family
El Addition
[I Two or more family
El Industrial
0 Alteration
No. of units:
❑ Comm ial
Repair, replacement
[IAssessory Bldg
❑ 70e s:
❑ Demolition
❑ OtsthAer
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OWNER: Name:
Address
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or Print Clearly)
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Phone-(
78- 7G�• � t S
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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: $ [ FEE: $��
Check No.: 9� Receipt No.: �3
NOTE: Persons contracting wil# uVegistq'ed contractors do not have access to �ftegy�RPantyfur d
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
DATE REJECTED DATE APPROVED
CONSERVATION ❑ ❑
COMMENTS
DATE REJECTED DATE APPROVED
HEALTH ❑ ❑
COMMENTS
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/signature 8 Date
Located at 384 Osgood Street Driveway Permit
Location 7 dq 11-cd4
No. Date / ' o))- - 0 a
MORTM TOWN OF NORTH ANDOVER
Certificate of Occupancy $
'y'7 J��ns • ssc� Building/Frame Permit Fee $ _Z.5AC NUS
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check #
2 ,, 342 Building Inspector
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): 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:
1. ❑ I am a employer with
4. ❑ I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2. ❑ I am a sole proprietor or partner-
listed on the attached sheet. t
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp. insurance
5. 0 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.]
*My applicant that checks box #1 must also fill out the section below showing their workers' compensation
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12. ❑ Roof rcpai. a
13A Oth A 1"+l
policy information
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 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 isproviding workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name:
Ace American Insurance Company
Policy # or Self -ins. Lic. #: WLRC44460798 Expiration Date:, 08/01/2008
Job Site Address: �7 —'q Ave-city/State/Zip:Cyr P1 o
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 maybe forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
1 do hereby
the pains d penalties of perjury that the information provi
„, I-- "— (Sears Auth. Agent) nate.
Home: 860-792-81%`-/ 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 #
is trate and correct.
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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 #:
a�anans
Boar o u�meejtlav/on�s
� One Ashburton Place - Room 1301
}� Boston, Massachusetts 02108
Horne Improvement Contractor Registration •
SEARS HOME IMPROVEMENT PRODUCT
LUBOS SVEC
1024 FLORIDA CENTRAL PKWY
LONGWOOD, FL 32750
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Board or Building Regulations anti Standards
I `'f HOME IMPROVEMENT CONTRACTOR
' Registration: 148607
Expiration: 10t11l2009
Type: Supplement Card
SEARS HOME IMPROVEMENT PR
11rjb69LSWC
1024 FLORIDA CENTRAL PKWY��
LONGWOOD. FL 32750 Administrator
Registration: 148607
Tvpe: Supplement Card
Expiration: 10t1112009
Sears Authorized Agent
Home - 860-792-8106
Celt - 860-753-0452
Update Address and return card. 'dark reason for change.
Address (J Renewal Employment t.ost Card
t,icense or registration valid for individul use only
before the expiration date. If found return to:
Board of Building Regulations and Standards
One Ashburton Place Rm 1301
Boston, Ma. 02108
`ot valid without signs t
-vy
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Home iM ! ii`M 4i! Registration
SEARS HOME IMPROVER
ALFRED NYMAN JR.
1024 FLORIDA CENTRAL
LONGWOOD, FL 32750
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Ro�#f�ritdiR4ais4
HOME IMPROVEMENT GONMCTOR
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RegiBtr;.� t4ti�D7`
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SEARS HOTS INO i ODUCTS INC.
ALFRED NYMAi+I
1024 FLORIDACE,
L041rWOOD, FL Adrulntstrator
Reaktratica: 14M07
Type: Public Corporation
oration
Expiration: 1011112CO9 Tr## 25!1,'xW,
Ase Addrm and Mom mrd. rAnriz a asau for cung-is
_idd [ icr ai Enplt►ynacrtr. •L � I:o t t~srd
Lkme or rrgi fttian vaNd Cor individul use only
before t'l* 4*ratiM daft_ It fcntxi retnrtt to:
Oohed of Badding RcgtMow uW Stmdards
baeAshburton Plm Rm 1301
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Sears Home Improvement Products, Inc. Job Na.:�t �1U � � (0 U
1024 Florida Central Parkway r/ Longwood, FL 32750 Home Improvement Products Phone #: 6T 8 t
FEIN 25-1698591
License Numbers: AL 5481; FL CGCO12538: LA 84194; Location:
�O� ►�
MA 148607; MS 50222; NC 47330; RI 27281; SC 105836;
TN 2319: Columbus, GA G17017; CT HIC.D607669 Siding
Name KG Vet A n,t ( c !I Phone: Res. 7t) q 6 6 % rrlBus.C97.0 -_ f. (o - % IS �
Address: City: f1V2.j1, Ar-Zomc2 St.: r" 4 Zip: 0/$Y_5'
VWe, the owners of the premises described below, hereinafter referred to as "Purchaser" 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:
(Street)
According to the following specifications:
(City)
(State) (zip)
NOT
INCLUDED INCLUDED SPECIFICATIONS
PREPARATIQN: 1. NJ ❑ Obtain all Necessary permits and insurances.
2. 91 ❑ Inspect surfaces in work area - renail loose wood, replace rotten surface wood where necessary in work
16.
❑
17.
❑
18.
19.
SIDING: 20.
PORCH 21.
❑
SYSTEMS: 22.
❑
23.
❑
CLEAN UP: 24.
❑x
25.
Q
WARRANTIES: 26.
area excluding roof, decking or rafters, and structural members.
Remove Existing siding: Type:
Fir out wal s on brick, block, metal or stucco areas: Location:
❑ Caulk and seal around all windows & doors in work area as necessary.
❑ Install approved non -corrosive starter stop. r,,, S Av rt C A (''
❑ Install insulation on flatwall areas to be si with -N4' i/4 udedpolystyrene insulation. (circle one)
El Custom Vyna-Kiad aluminum fascia system: Colon �r W .h C
Remove and reattadVdispose of existing guttering.
❑ Cover soffit areas of home with vinyl soffit
s em, except those areas noted below.
Weatherbeater ❑ Max ❑ Plus O Weatherbeater Other 1 1 (check one) Color: &(s[ Pattern:
❑ Custom Vyna-Kiad aluminum frieze boards:
Location: �r1C Color:GW Size: 00 1—
❑ Ju Mutt Andow trim: Location: Color: C SAS C
❑ Cult,wrap windows/sills/mulls/headers with yna-Kiad aluminum:
'bs.c'C dr� Color
Remove and reinstall existing storm windows/awnings/shutters.
Custom wrap door facings with Vyna-Kiad aluminum:
Locatfon:M-P.CY_Color: r.. .�,
Custom wrap garage door facings single/double with Vyna-Kiad aluminum:
Color:
Remove and reinstall storm doors
Deluxe corner posts: Color:
❑ Clip looking system: Location: C I es tir j= . -Twa C
❑ Install W lgrb ter ❑ Max ❑ Plus ❑ WeatherbeaterOther, fir, 1T— Solid vinyl siding. (check one)
TYP : Horizonte Vertical COLOR:
Porch po Location: Color:
Porch posts: Color:
Porch basins: Color:
Clean up and removal of all job related debris:
❑ Each job is over -shipped to avoid delays. Remove excess materials and re -stock.
❑ Manufacturer's warranty sent upon completion.
SPECIAL ITEMS:
Work not to be done: NO DRIP EDGE COVERED - NO PAINT APPLIED
All of the above check boxes and the'work not to be done" section have been reviewed and explained to me. Ix
TIME FOR COMPLETION OF WORK. Contractor shall commence work within approximately twenty (20) days from the date shown herein and will be
substantially completed within forty-five (45) days thereafter unless a different estimated completion date is shown herein.
Approximate starting date is: � —C C L J Approximate completion date is: wGG
NOTE. THE WARRANTY PROVISIONS AS STATED ON THE REVERSE HAVE BEEN EXPLAINED AND WYE UNDERSTAND THD FyLLY.
ADDITIONAL PROVISIONS AND WARRANTIES ARE: STATED ON REVERSE AND ARE PART OF THIS CONTRACT. IX lot _j
Please read the: following bold type and initial corresponding line.
Verbal understandings and agreements with representative shall not be binding. All understandings and agreements mListbq set forth in
writing in this Contract. Purchaser initials: X
The TOTAL PRICE for all Labor & Materials (including any applicable discount) is $ 32 _00 Contract Price $ 00
Down Payment $ w .00
Balance Payable $ 1, 00 State Sales Tax (_%) $
(If applicable)
Teens: Credit Z (Subject to the approval of the Credit Department)
Total Contract Price $ 00
Cash E (Final payment payable to Installer upon completion) Funded by: Bank:
City
St.
Aoot d —
10% Preferred Customer Discount(PCD) awarded for airy future Sears Hone Improvement Products purchases. Current prldng 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. I/We the undersigned are hereby authorizing Sear.; Home Improvement Products to verity and review my/our credit record with an independent
credit reporting agency and release them from all liability incurred from inadvertent omissions or errors.
IN WITNESS WHEREOF Purchaser(s) have hereunto signed their name(s) this �(,�rday of _ L 20 and acknowledge receipt
of a true copy of this Contract and unless otherwise specified, it is understood that the owner is ready this work to begin.
THIS MESSAGE APPLIES TO DOOR-TO-DOOR SALES ONLY. You the Purchaser(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.
Signature affixed below aLu as receipt that Pumhaser(s) received separate cancellation forms.
SUBMITTED BY: Representative DataMach nate
ACCEPTED BY: Atxhcxind signature for Sears Horne Improvement Pm4ucls, ft. Date Pu
02-,%0 - nay. ORM -