Loading...
HomeMy WebLinkAboutBuilding Permit #038-2017 - 75 RUSSETT LANE 7/21/2016 •# NORT/{ q O !D BUILDING PERMIT �,�� b�`...:• .`_^°��°� �L,j' TOWN OF NORTH ANDOVER � ,�, APPLICATION FOR PLAN EXAMINATION 1 ti Permit NO: Date Received 0 q<�..<M.�.�^" • Date Issued: 9SSACNI!`��� IMPORTANT:Applicant must complete all items on this page LOCATION 77�Q 5 t Print PROPERTY OWNER n:-�J W 4& 1 L Print MAP NO: "1 PARCEL( ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resid ial Non- Residential ❑ New Building One family ❑Adci4jon ❑ Two or more family ❑ Industrial ❑bAeration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: 1 ,,��� Phone: �5 �� j -� LL I Address: 0 CONTRACTOR Name: r�,� '� Phone: : Address: Supervisor's Construction Li ease: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ J '3 FEE: $ 4 Check No.: 1k6 3`1 Receipt No.: -2�mp tI NOTE: Persons contracting with unregistered contractors do not have access to in fua my ignature_of Agent/Owner Signature of contrac� rt1"Wrt.e7r' Plans Submitted ❑ Plans;V aived ❑ Certified Plot',Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori Signature COMMENTS 4 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 DEPgRaTMENT - Temp Dumpster on site yes OWNo Located at 124 Maine Street - Fire Department signature/date C®MM_ ENTLS 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 DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) LJ Notified for pickup Call Email Date Time Contact Name 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. 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 4, Floor Plan Or Proposed Interior Work 4; Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4. 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application 4� Certified Proposed Plot Plan .4. 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 2012 IECC Energy code :rF Engineering Affidavits for Engineered products OTE: 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 Location No. 0 C,0 Date t • r, • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �40 w` Foundation Permit Fee $ Other Permit Fee $ _ y � TOTAL $ Check#� lding Inspector Bui Q* %AORT#1 BUILDING PERMIT '06 0 to TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received 41 LI-L V A Us Date Issued: ::=)I t 7 -k IMPORTANT: Applicant must complete all items on this page INNO 7'T ...... k g; ionnawswy, _C yt IN Jf F R. I Pei y 1 L 011005 'Y ' rc�a rlct Wi res r � t go i "I 5 TYPE OF IMPROVEMENT PROPOSED USE Resi5pilial Non- Residential 0 New Building ?'*One family 0 Ad 9ion 0 Two or more family 0 Industrial 0 eration No. of units: 0 Commercial -VRepair, replacement 0 Assessory Bldg 0 Others: 0 Demolition 0 Other YiUK911660V RVI 1,10 N Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: 1-W If t xF A ..... .... .. l. Z? �-J�gt-r Niv N t-A7.1-4 ARCHITECT/ENGINEER Phone: Address: —Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ _914:::) Check No.: 1-16 3,1 Receipt No.: to NOTE: Persons contracting with unregistered contractors do not have access to th gua n � c1pRT11 - Town o 1 ver O - �� OA h , ver, Mass, U ?i d 1 O .r K. 1. C0C"1C"1WICK V S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System j.m THIS CERTIFIES THAT ............................ BUILDING INSPECTOR .6..... .. .. ............. ....... . ... .. Rjw.j,.J.kA has permission to erect .......... buildings on , ... . ��........... Foundation Rough to be occupied as ......��...... ��...�i�. .....�.A.!!i.C. 0.W.�............................ chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUC TIO_ N Rough Service .... ...... .. .... ..... Final BUILDING INS TO GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Smoke Det. ® Window World of Boston, LLC MA MIC Registration Offices & Showrooms Number: O 15A Cummings Park U 295 Old Oak Street 166025 Woburn, MA 01801 Pembroke,MA 02359 Federal ID# "Simply the Best for Less" (781) 932-4805 (781) 826-6281 27-1481665 P y www.WindowWorldofBoston.com Customer: Ct r t 4K Lf u U<C—r Phone (h) 7"o� Install Address: o -t r,c Phone(w) City: 4012411tv- State: MA Zip �)s E-mail WINDOW WORLD GLASS OPTIONS 1000 Series Single-hung All-Weld $189 SolarZone Elite $99 7- 2000 2000 Series DH Mech/Welded Sash $195 Triple Glazed TG2* $175 _Z6 4000 Series DH All Weld $205, (*Series 6000 Only) 6000 Series DH All-Weld $240 �'' WINDOW OPTIONS 2 Lite Slider $334_2& "GI s Breakage Warranty $15 INCLUDED 3 Lite Slider (m,,r3,,r3) (1/4.1/Z1/4) $525 1/ creens $9 INCLUDED Picture/Fixed Lite $334 3 3V Insulation on Jambs and Head $11 INCLUDED Awning $260 Nhle Strength Glass $15 INCLUDED -Casement $290 Double Locks (> 26") $5 INCLUDED 2 Lite Casement $575 Full Screens $22 3 Lite Casement t,ia.,t�,,rai (1(4,1/2,1/4) $860 Colonial Grids (Contoured/Flat) $45 Basement Hopper $334 Prairie Grids $51Diamond Grids $69 Bay Window-Soffit Mount/INS Seat $2660 Simulated Divided Lite $182 Bow Window-Soffa Mount/INS Seat$2785 Tempered DH Sash (BSO) (TSO) $65� Garden Window $1880 Obscure Glass (BSO) (TSO) $35 Specialty Window $ Oriel Style (40/60 or 60/40) $30 Beige/Almond $40 Foam Enhanced Frame $35 Wood Grain Interior(Series 4000/6000 only)$100 PRE 1978 BUILT HOMES (Federal Lead Containment Law) (Light Oak/Dark Oak/Cherry/ Fox Wood Lead Safe Practices Required $25 Rich Maple) MY HOME WAS BUILT IN THE YEAR Initial a Brown Exterior(Arch.Bronze/American Terra)$100 Designer Color Exterior $155 MISCELLANEOUS Custom Exterior Aluminum Cladding Window Color L„ +C /,L-( �J U Textured$75 U Smooth G-8 $75 $ / lu� � reside outside Facing ColorMetal Window Removal $50 NON CUSTOM DOORS New Construction Vinyl Removal $175 Vinyl Rolling Patio Door 5ft.or Eft. $995 Specialty Window Exterior Trim $ Vinyl Rolling Patio Door 8ft. $10 Mull to Form Multi Unit $30 Add tob rice for Custom Rolling Patio Door 50 _Install Interior/Exterior Stops $50 ` O French Rail :ng Patio Door 5ft.or eft $1295 Install Interior Casing Starts At $95 French Rail Slid i Patio Door 8ft. $1395 Insulate Weight Boxes $20 French Rail Sliding do Door $1495 Roof for Bay/Bow Windows $500 Custom Exterior Claddi $150 Existing New Const. Ext. Retro Fit $150 SolarZone Elite or ETC GI $175 Removal of Existing Bay/Bow $250 Grids Patio Door $129 Repair Sill,Jamb or replace sill nosing $50 Woodgrain Inteno $295 Full Sub-Sill (Single) replacement $150 Exterior Design Colors $395 Interior Cas' 21/231/2 $175 .!_Mullion Removal $30_� Bay/Bow Conversion Ext. Retro Fit $350 Handle Options $ $ (New Siding Will Not Match) _Building Permit $150 1 j� Door Color / ROUND-UP FOR WINDOW WORLD CARES Inside Outside v Q# Ineln P1141.4-1.Ge —s.Yna.w:#wl Customer declines exterior wrap and understands�pa�i�nting and/or repair may be required Initial Customer declines grids on Ewindows/doors Initial DISCLAIMER:Customer is responsible for the following in connection with this contract Painting,Staining,Alarm System disconnecf/reconnect Building Permit fees in excess of$25.00,Homeowner and or Condo Association Approval,Historic District Approval.City of Boston parking&sidewalk Permit fees in connection with installation. NO EXTRA WORK IF NOT IN WRITING! Customer agrees to the terms of payment as follows: (L) Extra Labor&Materials $ V— u� , Site Set Up, Disposal&Delivery Fee $ $195.00 Total Amount $ 17o�Ca Custom Order Deposit 500� Ck# Balance Paid to Installer upon Compl n $ Amount Finanped $ Window World of Boston anticipates starting this work on —� 't 4nd being substantially completed in j_days.Security Interest:Yes Nom'" Any deposit required in advance of the start of the work SHALL NOT exceed 331/3%of the total contract price or the actual cost of any material or equipment of a special order or custom made nature,which must be ordered in advance of the start of the work to assure that the project will proceed on schedule.No final payment shall be demanded until the contract is completed to the satisfaction of both parties. All home improvement contractors and subcontractors shall be registered and that any inquires about a contract or subcontractor relating to a registration should be directed to:Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170 Boston,MA 02116.Phone:(617)973-8700 No work shall begin prior to the signing of the contract and transmittal to the owner of a copy of such contract. Window World of Boston under provision of Chapter 142A of the general laws is required to apply for and obtain all construction-related permits.Window World of Boston shall not be deemed responsible for delays in the work described in this agreement caused by regulatory,permit granting agencies,authorities or individuals. Notice:If the PURCHASER($)obtains his own construction related permits for the work described under this agreement or deals with unregistered contractors, the PURCHASER(S) is hereby advised that in the event of a dispute,judgement and nonpayment,the PURCHASER(S)`will not be entitled to make a claim or collection from the guaranty fund established by chapter 142A,M.G.L. You the buyer may cancel this transaction at any time prior to midnight of the third business day after the date of this transaction. Notice of cancellation must be in writing postmarked no later than midnight of the following third business day. THIS IS A QLJgZ9X.Q=R NOT FOR RESALE! This Window World®Franchise is independently owned and operated by Window World of Boston,LLC.under license from Window World,Inc. ,7<,yQQJ?� 1Z 1 f� Owner.Db not sign if there are any blank spaces. Date / t < 'Sratn man:Do not sign if there are any—blank spaces. Date Owner:Do not sign if there are any blank spaces. Date Boston 07-15 White Copy-Original Yellow Copy-File Pink Copy-Customer Hayes Printing 888-667-1116 I I The Commonwealth of Massachusetts Department of Industrial Accidents %+ Office of Investigations 600 Washington Street -- Boston,MA 02111 ��',M s•�� www.mas&gov/dia Workers' Compensation Insuran e Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orpnization/Individual): An.1 \ Address: City/State/Zip: A41,?a Phone Areyo employer?Check the appropriate bog: Type of project(required): 1. am a employer with 4. ❑ I am a general contractor and I 5. ❑ New construction 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 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me is.any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5_ ❑ We are a corporation and its required.] officers have exercised their ME] Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL I1.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4), and we have no 12-El of repairs insurance required.] f employees. [No workers' 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 such. tContractors 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: ( � 1 Policy#or Self-ins. Lic.#: Expiration Date: Job Site Address: 71EWU�4 J/Wj , City/State/Zip: lW 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 may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under pand p allies of perjury that the information provided above is true and correct Si ature: Date: Lz�, Phone#`.. Oficial 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#: WINDO-2 OP ID:HI ACORO' CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDmm) 1 07/18/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT Senn Dunn-GSO NAME: C.Timothy Ward,CPCU,CIC ON 3625 N.Elm St. AHI o Ext:336-272-7161 C,No): 336-346-1397 Greensboro,NC 27455 oRLss:tward@senndunn.com I C.Timothy Ward,CPCU,CIC INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Citizens Ins Co of America 31534 INSURED Window World of Boston, LLC INSURER 13:Allmerica Financial Benefit 118 Shaver Street INSURER C:Hartford Fire Insurance Co. 19682 North Wilkesboro,NC 28659 INSURER 0: INSURER E INSURERF: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MM/DD MWDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE X OCCUR OB6790252707 04/01/2016 04/01/2017 DAMAGE O RENTED PREMISES Ea occurrence $ 500,00 Business Owners MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY❑PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,00 B X ANY AUTO AW68757615 06/16/2016 06/16/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE OB6790252707 04/01/2016 04/01/2017 AGGREGATE $ DED 1 RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE Y/" 22WECLJ2635 01/27/2016 01/27/2017 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,00 IfS describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) i CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town Of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St.Ste 2043 AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD i ?:lassaciiusetts Deaartmerit Public Safety Board of wilding Qeuula`,i�rs and Standards icense_ CS-072772 JEFF C STEELE 24 SHERWOOD AVE -' DANVERS MA 0.1923 Lcmmissio r Expiration: 04/07/2018 _.:.T.Office of Consumer affairs&Business Regulation _ =`HOME IMPROVEMENT CONTRACTOR _ Registration: 166025 Type: ' Expiration: 41121268 LLC WINDOW WORLD OF BOSTON,LC. JEFF STEELE 24CUMMINGS PARK SUITE 15-A WOBURN;MA 01801 �— Undersecretary i i I Liregistration valid for ik ividual use only befo expiration date. If founc return to: of Consumer Affairs and Bu iness Regulation 4 Plaza-Suite 5170 " Boston,MA 02116 ,Not valid without signature - i i i