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HomeMy WebLinkAboutBuilding Permit #435 - 80 OLD FARM ROAD 11/30/2006 TOWN OF NORTH ANDOVER NORTF� APPLICATION FOR PLAN EXAMINATION o�<t�•° °;9'►% �O A Permit NO: Date Received 0 0 7 A�RA7ED,.PPS.�y Date Issued: CHUS�� IMPORTANT: Applicant must complete all items on this page LOCATION P PROPERTY OWNER . ofPt nt Print MAP NO.: PARCEL: 6q ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building kOne family ❑Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: XRepair, replacement ❑ Assessory Bldg ❑ Commercial ❑ Demolition ❑ Moving(relocation) ❑ Other ❑ Others: ❑Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) Tw OWNER: Name: >rct4, Phone: -7qq- ?6`��- . Address: ` tt� CONTRACTOR Name:���--�� C,�✓1�'�-�'^�S j� � Phone: Address: F,,X, 0. 4 "- Supervisor's Construction License: flg2 3`� Exp. Date: 6�- Home Improvement License: 2� `� Exp. Date: ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost FEE:$ _2 Check No.: Receipt No.: Page I of 4 TYPE OF SEWERAGE DISPOSAL Swimming Pools F]LlTanning/Massage/Body Art ❑ Public Sewer Well Tobacco Sales ❑ Food Packaging/Sales L1❑ Permanent Dumpster on Site ❑ Private(septic tank,etc. ❑ Electric Meter location to project NOTE: Persons contractin : u egi eyed co tractors do not have access to the guaranty d Signature o 9genOw er ture of contr for Plans Subm ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Aans ❑ 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 FIRE DEPARTMENT - Temp Dumpster on site yes no Fire Department signature/date COMMENTS Zoning Board of Appeals: Variance,Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water&Sewer connection/Sianature&Date Driveway Permit Building Setback (ft.) Front Yard Side Yard Rear Yard Required Provided Required Provides Required Provided Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: NOTES and DATA—(For department use) Page 3 of 4 Doc:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Created JMC.1an2006 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 Addition Or Decks ❑ Building Permit Application ❑ 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) 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 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 Dec:INSPECTIONAL SERVICES DEPARTMENT:BPFORM05 Page 4 of 4 Location & Oleg rl&t No. y ,� Date /f` RC1 -Qli �oRTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ �aJwCMUS Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 5©yy 19839 Building Inspector Contract Pella Windows& Doors, Inc. ti 3 l 45 FONDI ROAD ® HAVERHILL MA 01832 Phone: 978-373-2500 Fax: 978-373-7274 Customer Project/Ship-To Order James,Andrew& Debbie James WME North Andover Date 00/00/00 Quote No. JAMES 80 Old Farm Road 80 Old Farm Road Order No. Need Date 00/00/00 N ANDOVER,MA 01845 N ANDOVER, MA 01845 Sales Rep.Name Keating, Linda/WME ESSEX ESSEX Prepared by Payment Terms Deposit/C.O.D. Owner: Andrew& Debbie James Architect Bus. Phone: ( ) - Bus. Phone: Jamb Depth Bus. Fax: ( ) - Home Phone:(978)794-9646 P.O. No. Cellular: ( ) - Branch Order No. Home Phone: (978)794-9646 Order Type Installed Sales Order Glazing Design 20.00 psf. Pressure Branch Name Pella Windows& Doors, Inc. Branch Address 45 FONDI ROAD Phone 978-373-2500 City HAVERHILL Fax 978-373-7274 State MA 01832 Comments: Customer has paid$14,093.06 deposit(50%of contract total) Customer has paid using a check. The remaining$14,093.05 will be paid upon completion of the Installation. U e 6u-1 Permit Fee$280 �� f;G For information regarding the finishing, maintenance, service, and warranty for all Pella products,visit the Pella Website at www.pclla.com. Printed 09/18/06 Contract-Page 1 of 1 1 Contract for Customer James,Andrew&Debbie Project: James WME North Andover Order No.: Outside View Item No. O,ty. Summary D c ri tion Item# 140nit Price Extended Price Qty:2 Vent-DH Standard Jambliner Precision Fit Window,Make Location: dining room Size:19-1/2 X 53:Architect Series,Clad, Model 3, White, Half Vent R.O: 1'8" X 4'5-1/2" /match Half Vent, 5/8" InsulShld IG Glazing, Full Screen, Satin Nickel Spoon Hardware, Std Primed Interior Value Added Items: Standard Pre-Fit Install-Qty 1 Disposal per Unit-Qty 1 Paint Window-Qty 1 Notes: Outside View Item No. Oty- Summary Description Y� UnitPrice Item# 145 Qty: 1 Fixed Double-Hung, Frame:39-1/2 X 53:Architect Series, Clad, Extended Price Location: dining room Model 3, White, 5/8" InsulShld IG Glazing,Fins(single unit per R.O: 3'4-1/4" X 4'5-3/4" design), Std Primed Interior WallCond: 3-11/16" Value Added Items: Paint Window-Qty 1 Full Frame Pre-Fit or Exterior Pre-fit install-Qty 1 Disposal per Unit-Qty 1 Notes: Thank You For Purchasing Pella Products '-'2(�_ Taxable Subtotal $26,843.91 Customer Signature4�� Pel ales Represen ' e Signature' Sales Tax at 5.0000% Non-taxable Subtotal 1,342.20 T��O o.00 Date �— Total $28,186.11 Date Deposit Received $ 14,093.06 For information regarding the finishing, maintenance, service, and warranty for all Pella products,visit the Pella Website at www.Della.com. Contract-Page 10 of 1 1 NORTH F Town of 0 No. &/Jj," E dover, Mass., �� �e • dG COC L.NEWICK V AERATED 5 `s BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR THISCERTIFIES THAT......AA44.4 ....... ................................................................................. Foundation has permission to erect........................................ buildings on .....&40........... r-d... � � ....... ......... Rough to be occupied as...�� i•.. i1.0.. ........................................................... Chimney ... . . . .. . . .. provided that the person accepting tfwpermft shall in every respect conform to the terms of the application on file in Final 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 S�bow PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTI A ELECTRICAL INSPECTOR Rough ........... .......... Service . . . . . .............. ............... ........... BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. ACORD CERTIFICATE OF LIABILITY INSURANCE DATE CERTIFICATE TM 07/05/2006 13:54 PRODUCER THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C.Church ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 41 Wellman Street Connector Park HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Lowell,MA 01851 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSURERS AFFORDING COVERAGE NAIC# INSURED INSURER A: Hartford Insurance Company New England Window&Door Inc. 45 Fondi Road INSURER B: Hanover Insurance Company Haverhill,MA 01830 INSURER C: Mass Bay Insurance INSURER D: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD'LTR NSRIJTYPE OF INSURANCE POLICY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMBS GENERAL LIABILITY EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DPREMISES Ea ocwrence AMAGE TO RENTED $500,000 CLAIMS MADE a OCCUR MED EXP(Any one person) $ 10,000 B ZBN8161407 7/1/2006 7/1/2007 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 1 17 POLICY 7 PRO JECT n LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $1,000,000.00 ANY AUTO (Ea accident) X ALL OWNED AUTOS BODILY INJURY $ C SCHEDULED AUTOS ADN8162169 7/1/2006 7/1/2007 (Per person) X HIRED AUTOS BODILY INJURY X NON-OWNED AUTOS (Per accident) $ PROPERTYDAMAGE 5 (Per accident) GARAGE LIABILITY I AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG 5 EXCESS/UMBRELLA LIABILITY I EACH OCCURRENCE $ 9,000,000 7X OCCUR FICLAIMS MADE AGGREGATE $ 9,000,000 B UHN8167305 7/l/2006 7/1/2007 5 DEDUCTIBLE I $ X RETENTION 5 S TORY LIMITS —1 ER- WORKERS COMPENSATION AND WC STATU- OTH- EMPLOYERS'LIABILITY A ANY PROPRIETOR/PARTNER/EXECUTIVE 08WBNL5742 7/1/2006 7/1/2007 E.L.EACH ACCIDENT 5500.000.00 OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000.00 If yes,describe under SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT I 5 500,000.00 OTHER Blanket Building&Contents B Property ZBN8161407 7/1/2006 7/1/2007 $5,540,OOODeductible$1,000BIanketBusiness Income$4,500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION New England Window&Door,Inc. DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN dba Pella Windows&Doors,Inc. NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL 45 Fondi Road, Haverhill,MA 01830 IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE /1 ACORD 25(2001/08) Client# 2960 Mst# 0607 all lines Cert# Evidence of fNsurance J�/` ©ACORD CORPORATION 1988 (5111f,\ The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations Washington on Street - St c � Boston,MA 02111 www.mass:gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ADplicant Information r // Please Print Legibly Name (Business/Organization/Individual): I ytG(�,1 S JD a Act <D0T.3 Address: 415- Fool , . City/State,/Zip: yaverkilt, ZIM e193-2 Phone #: 97�Z6S-7Z SS' Are you an employer? Check the appropriate box: Type of project (required): 1..K I am a employer with -Z S 4. ❑ I am a general contractor and 1 6. ❑ New construction employees (full and/or part-time)-' have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. $ ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.El Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.] t employees. [No workers' 13.❑ Other comp. insurance required.] '.my applicant that checks box n I 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 XContractors 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 polio'and job site information. Insurance Companv Name: 46tr4 �O y� ��S U t✓IC2 �y CLr�� Policy#or Self-ins. Lic. #: Q?h) aNL S 7L/2- Expiration Date: Job Site Address: City/StateiZip: 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 SI.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 certifi'under the pains and penalties of perjury that the information provided above is true and correct Si�rnature: Q Date: Phone#: 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#: .i=�:z- -�.! ��e U/O�/YL))7.042!/fCCLLIIL C�ii�LCtGGQCftUb2f�1 BOARD OF BUILDING REGULATIONS <. a License: CONSTRUCTION SUPERVISOR Number: CS 089839 '3 Birthdate: 06/19/1972 Expires: 06/19/2008 Tr.no: 89839 Restricted: 00 SCOTT P HOUSE 854 BROADWAY#1 HAVERHILL, MA 01832 Commissioner / Board of Building Regulations and Standards HOME IMPROVEMENT CONTRACTOR Registration: 129774 Expiration: 11/2/2007 Type: DBA PELLA WINDOWS AND DOORS SCOTT HOUSE 45 FONDI RD. HAVERHILL,MA 01832 -� -- Administrator