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HomeMy WebLinkAboutBuilding Permit #76 - 3 Innis Street 7/27/2009Permit NO: Date Issued: _a BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received /O, 4t LLD 16'•NOI . of A ,p 1. DESCRIPTION OF WORK IO bt rMt:l-urcmtu: In ,f (I Ont r- n r 1-nCf-men� gowov'c /9—C &4z— - 6'l- 3 6 x q& r o Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED PLANNING & DEVELOPMENT ❑ COMMENTS DATE REJECTED CONSERVATION COMMENTS DATE APPROVED DATE APPROVED DATE REJECTED DATE APPROVED HEALTH Fl— COMMENTS COMMENTS 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 ❑ It I Zoning Board of Appeals: Variance, Petition No: Planning Board Decision: Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/Signature & Date Driveway Permit Located at 384 Osgood Street FERE DEPARTMENT Temp Dempster ©n,Slte Located at 12.4 Main Street Fire Department signature/date COMMENTS es n Dimension Nurneber 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-$1 000 fine NOTES and DATA — For department use U Notified for pickup - Date .................... ......................... ................. ............ ................ ..................... ................ ............. ............. .......... ........................ - ................... ................ ...................... ................ ........... ...................... Doc.Building Permit Revised 2007 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 o 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 o 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2007 Location 30 1- n V, (l S r— No. ---? Date 7—d 4 O 5 TOWN OF NORTH ANDOVER S e ; ; Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 2LL,'`' Building Inspector f I f ., M rA O z s.� q o 0 w z m c o w U a u w U o � x O z w w q ' c H O u o w° co a cn A O .aon w° c°' r.w E U `� w ,� rL w U W d U) cd w C7 t a�' w � w C r� o z cn Q o cn ui am • 0 M z 0 U O U A a O E L O V Z co O H � C I CCM CO2 Q CD M� �M�y� • CD gW W CD CD _� CL CL-) CD 0 0 e_vv o a CL CMa C013 C CD � Cccc v JCO2 .� d O t0.. C Z O V y O C CL C C H LLI YI LLI U) 12W W oc W co o m c o � ' c H O A O y V �d'fl d c m cc m c rL... O M p 40 40 E Q C=, : 2 g +, y 3 a N a- 0 = c ,r A :Oo cm mi m E- - o. 7 o o a O N Z �m s > tN > _� A to O ����iFFFF E m v cm O cm c O ��a ' N _ d c 'm0'C m �� o 9Z am m = o = m :oso„3 N 0 ;a o CD C* W c ev = e -0 L �E w .r o •N Z O LU C3 m p m E CO.) c CD O � C,* . O x g � �� a. -m:20 • 0 M z 0 U O U A a O E L O V Z co O H � C I CCM CO2 Q CD M� �M�y� • CD gW W CD CD _� CL CL-) CD 0 0 e_vv o a CL CMa C013 C CD � Cccc v JCO2 .� d O t0.. C Z O V y O C CL C C H LLI YI LLI U) 12W W oc W co rage or_ Windows, Siding and More JOB a `y JOB # r . NCUSTOMERGt � G. E-MAIL ADDRESS HOME PHONE D DATE G � WORK/CELL PHONE J_ (Circle one) ADDRESS BEST DAY TO INSTALL: M T W TH F / CITY, STATE ! (r/r r+'% (Please -Circle `one) I .� BRANCH:. ESTIMATED START DATE PRODUCT SPECIALIST TOTAL # OF # OF DOORS WINDOW COLOR rnp r.N OR Measureman Initials Date Crew Size Needed Time Frame to complete Job . Capping Type ME MORE MEMO NONE MEN K 01 MEMO MEMO ME 0 No HIM No MEN MEN ME ss iiiii Measureman Initials Date Crew Size Needed Time Frame to complete Job . Capping Type From Our Home to Yours... hQAvZeg #146589 -.-- Federal ID # 20-2625129 CT Reg #0605216 Nawlyinu58305 RI Reg #26463 Windows, Siding and More Corporate Headquarters, 26 Cedar St, Woburn, MA, (P) 800-342-2211 (F) 781-933-9626, www.newpro.com THIS CONTRACT MADE THE day of �' 20( between r � C--)4,7 r . / " _1z' of the "Owner" and NEWPRO Operating, LLC, "NEWPRO". (Horne Phone),, (Bus/Cell Phone) 17 Lo,/ 1 1# , j-, /,,-*/ e,� &�; (City) ,(State) (Zip) ❑ The job address is a condominium. NEWPRO hereby agrees that it will for the consideration hereinafter mentioned, furnish all labor and material necessary to install the following described work at the premises located at . (Job Address) (E -Mail) for oroDnetary use only TOTAL Windows Purchased J r / NEWPRO Additional Model Work Number Qty TOTAL CASH PRICE �J Window Color In: i„/. - j/ Out: �! / Sliding Glass Door -- Capping Color f r Steel Security Door `"-- Door Color In: Out: DEPOSIT WITH ORDER "r Model Name Model Numbers Qty Sidelites — - - Double Hung j New Construction Unit Picture Window Storm Door BALANCE DUE AT INSTALL Casement 'L Obscure Glass _2DP_ BOTTOM 2 Lite / 3 Lite Slider `— Screens -FULL Bay / Bow Frame Roof.' ❑ Garden Window Awning Hopper Shaped Other GRIDS Soffit: ❑ -- .- - --- "` Colonial -SDL ; f=uro Please Initial: Customer understands that NEWPROO does not do any painting or staining. (ie: when removing or replacing interior stops or trim) NEWPROO is not responsible for conditions or circumstances beyond its control including con- densation resulting from or due to pre-existing conditions. CASH Balancr{t,jd to instaU�r2 installation FINANCE Bank completion form signed at installation DESCRIBE WORK: i f Est. Start Date: -e � r Customer understands this is an "estimated date" Est. Comp. Date: inJas Initials Customer understands all steel security doors will have a 3/4" aluminum threshold installed over existing threshold. It shall be the obligation of NEWPRO to obtain any and all permits necessary under this agreement, as the Owner's Agent. The Owners who secure their own construction -related permits, or deal with unregistered Contractors will be excluded from the guaranty fund provisions of MGLC, 142A. All Home Improvement Contractors and Subcontractors shall be registered by the Director and any inquiries about a Contractor or Subcontractor relating to a registration should be directed to: Director, Home Improvement Contractor Registration, One Ashburton PI, Room 1301, Boston, MA 02108, (617) 727-8598. If the Owner is obtaining financing by way of a Retail Installment Sales Agreement, such Agreement shall include a time schedule of payments to be made under said contract and the amount of each payment stated in dollars, including all finance charges. The Retail Installment Sales Agreement shall be inrnrnnrnfnA herein by reference. If the Owner is obtaininge! revolving credit line tn.nav in I.,f,^I^- Ih- - -__ _. .. - - QQ� �hWO y0 aa\ �N apo aQ zm W WN ="WV N g'o nuzIL W 4 ;� z 00 - ry C � A, � d � y ar C...9.. m OS C C 61 y::.. O N eQa Z c6 U 000 f6ZmO e (�E I �EIR'4„ I m O Im Z LU ,,nth,W 00n' Co u Ocn p aIx- Q u 'i N N W OOWLL �mel,W OC c L 0 we -c 0 Lu X a0 0 N "L' NZUW7 u C QQ ;mpg TU i ►+ 'A w/ �zu> O OC N m r r CUM LL L w w w aQd »» Zw pW WyJto �OiQ Z W W J� N U. L I O" m coLu I . N u M LL r IM L I J V Q � �0 c 0 �.0 z� 5 3 kap to IC fn mvlQ z c dem C " t L O d E ul 0L. rn cn�zo lu3 bcm0 zN3 a o U O 8 ma ce H 2 Vi 000000 000000 N C C � A, � d � y ar C...9.. m OS C C 61 y::.. 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W J W > 2 w m Coe K� gO �Qi 9� b 2 °Q Ja4i p510 ti _t m❑ rI. 3 I ' F S J 0 " F a w a Q Q i -FIaJy� 5 a o J( X K J H QQ V W x X W C 15 Z b 'Irm is � a0 fa of Q � Q Q d W O ppb F580 3 m m z P 0 K u O OL 0 B The Commonwealth oj massacnuseas Department of Industrial Accidents Office of Investigations j� 600 Washington Street Boston, MA 02111 www.mass.gov/dia «'orkers' Compensation Insurance AffidaNit: Builders/Contractors'Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Orzanization'Individual): IV E W P R 0 Address b C&_D1QP_ ST City/State.%Zip: k013UPni W O1 S01 Phone r: '781- 93.,1- 6'3bCb EXT �5 / Are you an employer' Check the appropriate box: . 9 I am a employer A ith 50't 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors ❑ i am, a noiC pruYii� tur 07 partner- ship and have no employees NN•orking for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] t listed on the attached sheet. + These sub -contractors have workers' comp. insurance. 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152. § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. Remodeling S. ❑ Demolition 9. ❑ Buildine addition 10.17 Electrical repairs or additions 11.7 Plumbing repairs or additions 12.❑ Roof repairs 13.❑ Other 'Anv 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. =Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy inforrnation. 1 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HQCkin+ire LnswnnCe AQer1CW _ Policy # or Self -ins. Li c. #: W G 2- to y S 99 4 Expiration Date: 5-1-2010 Job Site Address: 3 Ton -( ,5 S + , City/State/Zip: d C1 vc--rr-, Attach a copy of the workers' compensation policy declaration page (showing the police 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 51,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S250.00 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. I do hereby certify under the pains and penalties o ry that the information provided above is true and correct M phnnP:e• 1 9,1-q53- gtwtp 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 #•