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Home My WebLink AboutBuilding Permit #544-2017 - 707 JOHNSON STREET 11/21/2016BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR. PLAN EXAMINATION Permit No#: l5 L6 �O i2 Date Issued: a F_ LWORTANT. Applican: Date Received il - d t must complete all items on this J;, L A I ' a -T g ,,� N, ,TIP, p P. -ON P, A, R- e, - km��.75__,._` IA AllHistoncfD r yes no` Village y— no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family 0 Addition 0 Two or more family [I Industrial 0 Alteration No. of units: 0 Commercial epair, —replacement 0 Assessory Bldg 0 Others: 0 Demolition 0 Other Septic Mvve 0 o EbWetI;4Hds_' Floodplain d.i ,cr6_�d bist" 1w 6 a fi District ly a DESCRIPTION OF WORK TO UL FLK1-UK1V1tL): CC Identification - Please Type or Print Clearly' OWNER: Name: 111FAd-1, \.A/-,11s�r� Phone: 7? - Address: el 0dntrFAb-tb'N a ffte- ddressw- —T. Pa_ A 14,�4Ay� osSk Supawi8ors 6n§irJ�tibi�iqensei. C.ff-07%.7_6'_E ltb..'--L Horne Irnprgvement License: Y -0. ��Xp, Pate ARCHITECTIENGINEE Phone: Address: Reg. No.. FEE SCHEDULE: BULDING PERMIT.• $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No., NOTE: Persons contracting with unregistered contractors do not have. access to the guaranty fund Signature bTcohtractor.'.- Plans Submitted ❑ Plans Waived Ell Certified Plot Plan ❑ Stamped Plans ❑ TypF'Z'F 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 Reviewed On COMMENTS Signature. CONSERVATION Reviewed on Sianature COMMENTS HEALTH COMMENTS Reviewed ature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Plarning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124. Main Street Fire Department signature/date COMMENTS Locatea M4 no Street -)imension 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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine Doc.Building Permit Revised 2014 _. . Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r 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/Cross Section/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 o CCo► tract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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: Building Permit Revised 2014 r Location -7U-7 No. S -q L/- U 1-7 Date ! f- d /—d01 b TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ qk � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check #� Building Inspector < 0 : 'a o ami = O N_ C CD -0 N O a �' CD nCL 0 � m • N• Z o S -0a N �_ NUX rtO O N rt - -n o o rt CL m C -+ =0) Cl) CDCD .�; N W -0 .n cfl = �• o Q - D o CLrt ..aC7 O O W �• z C=cCD -a -0 o �c b o�; n co ch c Z O CL Z X y Q0 � to 0 IC)cn — < — N CD /�/ N 'T coCDCA � cC �� Cr CL - Z CD _ `D CD 01 CD O N CD OCL z bcn CO CD I �� cow pix,, .a Z c CD s n N CD 0 ` 0 O G7 y m a 2 ?7 C N � C m CD n o O°' o �y C CL ko vs V) O (D rD Y LA rD D rr Op' co C j (D T m v 3 T j D) x O '�C S H H A --Iv 70a T O' 61 V) OO < DC7 3 m m A D N 00 T j °� ::u O aq 3' C W M y V 0 �' N 7' 7 x O �C 3 T O 7 C C p Z G1 N m V1 (D n �v 3 T O Q n s WO > p O m m a = .` n 7 Rolling Hill Avenue Plaistow, NH 03865 REPLACEhAENT WINDOWSII: 1-800-6934307 Fed ID 20-0124453 MA License 140588 Name in A � Phone # Work# Address City_00 AllState Zip Uwe, the owne f the premises described above, hereinafter referred to as "purchaser" offer to contract Seacoast Replacement Windows, to deliver and arrange for installation of all materials to improve the premises. Obtain all insurances and permits Re -measure all openings to ensure a custom fit Remove existing windows and install vinyl windows. Total new windows Wrap outside jam Remove existing windows and install a new viny ba or bow with all new unpainted, unstained interior casing and app~ priate trim on the outside /7 P��' 1 Install and shingle a custom made roof to fit bay or bow if no overhang exists within 18" Tif i S Remove existing windows and install a new vinyl garden window with the interior casing and exterior wood trim Cleanup of all job related debris O Issue manufacturers limited warranty ,�,/ � Contract price � VO) 01 Deposit' If this is a credit transaction, Ih tuue oy or upon completion) � e �men� —cfor\ itis contained on a separate document. All home improvement contractors and subcontractors shall be registered and that any inquires about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration, PO Box 871, Taunton, MA 027811-0871 508-821-9375 UWe the undersigning are hereby authorizing Seacoast Replacement Windows to verify and review mylour credit record with an independent credit reporting agency and release them from all liability incurred from inadvertent omissions or errors. Verbal understandings and agreements with representatives shall not be binding: All understandings and agreements must be set forth in writing in this contract or on an attached addendum. Work will begin in approximately to weeks. You the purchaser may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. All warranties on the owner's rights under the provisions of 78o CMR R6 and MGL c 142A Purchaser understands and agrees that if this arrangement is cancelled after measurements have been made and production cannot be cancelled, complete deposit is forfeited. If production can be halted, a$100.00 measurement fee will be withheld. DO NOT SI' J THIS CONTRACT IF THERE ARE ANY BLANK SPACES - Signed _ Date_M� { ' Signed Re tative Si g Purchaser( /> Signed - Not Included Include D U # p # -# la O Issue manufacturers limited warranty ,�,/ � Contract price � VO) 01 Deposit' If this is a credit transaction, Ih tuue oy or upon completion) � e �men� —cfor\ itis contained on a separate document. All home improvement contractors and subcontractors shall be registered and that any inquires about a contractor or subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration, PO Box 871, Taunton, MA 027811-0871 508-821-9375 UWe the undersigning are hereby authorizing Seacoast Replacement Windows to verify and review mylour credit record with an independent credit reporting agency and release them from all liability incurred from inadvertent omissions or errors. Verbal understandings and agreements with representatives shall not be binding: All understandings and agreements must be set forth in writing in this contract or on an attached addendum. Work will begin in approximately to weeks. You the purchaser may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction. All warranties on the owner's rights under the provisions of 78o CMR R6 and MGL c 142A Purchaser understands and agrees that if this arrangement is cancelled after measurements have been made and production cannot be cancelled, complete deposit is forfeited. If production can be halted, a$100.00 measurement fee will be withheld. DO NOT SI' J THIS CONTRACT IF THERE ARE ANY BLANK SPACES - Signed _ Date_M� { ' Signed Re tative Si g Purchaser( /> Signed - Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers' compensation for their employees. Pursuant to this statute, an employee is defined as "...every person in the service of another under any contract of bite, express or implied, oral or written." An employer is defined as "an individual, partnership, association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enferprise, and including the legal representatives of a deceased employer, or the receivet'or trustee 6fan individual, partnership, association or other legal, entity, employing employees. •However the owner of a dwelling house having not more than three apartments and who resides therein, or the occupant of the dwelling house of another who employs persons to do maintenance, construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6) also states that "every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who bas not produced -acceptable evidence of compliance with the insurance coverage xequi'red." Additionally, MGL chapter 152, §25C(7) states "Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." -Applicants Please fill out the workers' compensation affidavit completely, by checking the boxes that apply to your situation and, if necessary, supply sub=contractor(s) name(s), address(es) and phone number(s) along with their certif cate(s) of insurance. Limited -Liability Companies (LLC) or Limited Liability Partnerships (LLP) with no employees other than the members or partners, are not required to carry workers' compensation insurance. If an LLC or LLP does have employees, a policy is required. Be advised that this affidavit maybe submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for thepermit or license is being requested, not the Department of IudustrialAccidenis. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy, please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town. Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition, an applicant thai must submit multiple permit/licer se applications in any given year, need only submit one affidavit indicating current policy information (if necessary) and under "lob Site Address" the applicant should write 5Gall locations in (city or town)." A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year. Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e. a dog license or permit to burly leaves etc.) said person is NOT required to complete this affidavit. The Department's address, telephone and fax number. The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston, MA 02114-2017 Tel. # 617-727-4900 ext. 7406 or 1-877-MASSAFE Fax ## 617-727-7749 Revised 02-23-15 www.mass.gov/dia 'he Commonwealth of jVjassa`"Setts _ Department of�Tndr�str"ialAcczdeaats X Congress Street, S5 ite 100 OZXX4--2017 F .Boston, MA uw Mass.gov/dla • VPalkexs' Compensation Insurance Affidavit: B•osldexs/Conixactoxs/El.eciricians/i'lum ers. TO BE FILED WITH THE PERMITTING AUTAOIUTY. ^^ ^^ v,.;-+ 1 Name (Business/Orgawzation&dividual): Address: City/state/Zip:_ Axe you an employer? the appropriate box: S f Pholle #: I.F] I am a employer with employees (full and/or pari tame).* 241 am a sole proprietor or partnership andhaveno employees Work ng forme in any capacity. [No workers' comp. insurance required.] 3.[] lam ahomeowmr doing all workmyself. [No workers' comp. insorance required-] t ¢,❑I am a homeowner and will be hiring contractors to conduct all work on my property_ l will ensure that all contractors eitherhave workers' compensation insurance or are sole proprietors with no employees. 5. ❑1 am a general contractor and l have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.t 6.F] We are a corporation and its, officershave exercised their right ofexemption per MGL c. 4 and vre have no emplivdes. [No workers' comp. insurance required.] Type of project (:required)° 7. ❑ Nevi d6nsir iciion 8. El R.emodelhig 9. C1 Demolition 10 E] Building addition 11.❑ Electrical repairs or additions 12. Q-PXu—mbuig repairs or additions 13•. [] R.bofrepairs 14.C1 Other 152, §1( ), _ — *Any applicant that checks bbX#1 maliom ust also fill o e are doing he section all work andthen hire w showing their outside emontraation Policyminf� a new affidavit indicating such. i Homeowners who submit•this affidavit indicating Y _ ?Contractors that check this box must attached'an additional sh 'dde their worname of kers' come.porenumber and state whether or not (hose entities have employees. 1f the sub -contractors have employees, they must Pro -.n P policy .. ...... X am an employer tliatispTovidingyvorkeNs' compensation insuancefor my employees. Below is tliepolicy aradjoh site information. Insurance Company Policy # or Self -ins. Lie. #: ExpirationDatel City/State/Zip: Job Site Address: Attach a copy of the vvorl�exs' compensation policy declaration page (showiaug the policy number and expiration date) - to 0-00 Attach to secure coverage as required under MGL alites , §§22in e £ rm of a SllTOP �O ORDER al -violation and a fine of up to $2050.00 a and/or one-year imprisonment, as well as p ement may be forwarded to the Office of Investigations of the DIA. f day against the violator. A copy oftbis stator jnsurance coverage verification. X do Iiereby certify antler tlzepains anclpenalties ofperjury t7aat the information provided above is trv_-e and, correct: I i / , /r / in this area, to be corr�pleted by city o-1 town official Official use only. Do notwrzte Permit/License # City or Town- DsujugAuthority (circle one): 1. Board of Health 2. Building Department 3. CiiylTovvn Clerk 4. Electrical inspector 5. Plumbing inspector 6. Other Phone #:, Contact Person• aauo+ss+uaW,o0 , uojjejLlL6 w" w uoi3e>>dx� _--- 9£0£0 HN -s31S3H3 +Ic t 1332LLS U31S3H0 k9£ NvAl-1-1t1S :4 NNOr �osinaadns uoi}onaisuo0 llei�ads � 9t6660-lSSO asuaoir f,�a}es Spue suoileln em Ho paeog splepueaQaAasnUoesseW 10U o �v. wow� Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 140588 Type: Partnership Expiration: 11/3/2017 SEACOAST REPLACEMENT WINDOWS - JOHN SULLIVAN 7 ROLLING HILL AVE PLAISTOW, NH 03865 Update Address and return card. Mark reason for change. Address [] Renewal [] Employment F] Lost Card W-w/i 1 &Xe a1ra� iw, ac11rcJelti Office of Consumer Affairs & Business Regulation HOME IMPROVEMENT CONTRACTOR Registration: 140588 Type: Expiration: -.11/3/2017 Partnership QST REPLACEMENT WINDOWS ULLIVAN VG HILL AVE )W, NH 03865 Undersecretary Tr# 273002 License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature