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HomeMy WebLinkAboutBuilding Permit #647-2017 - 44 Kingston Street 12/16/2016t y r ✓ �2ORT111 ,v/(1 1 `./e ///���� j(�►.`J 1/' � � W► BUILDING PERMIT o �-,".6.. �� TOWN OF NORTH ANDOVER ° ; APPLICATION FOR PLAN EXAMINATI- � Permit NO: / 7 Date Received ©� •-• . +' �a AAArea 'PP` Date Issued: 1(p (/ SSACHUS�� IMPORTANT: Applicant must complete all items on this page LOCATION H 4 K to Print PROPERTY OWNER[✓11i\I ��rc�cl(�Soh Print MAP NO:PARCEL: ZONING DISTRICT: Historic District yes Ano Machine Shoo Villaae ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building VOne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial i/Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Septic ❑ Well ❑ Floodplain ❑ Wetlands Watershed District ❑ Water/Sewer rt Identification Please Type or Print Clearly) OWNER: Name: -5,e �0.cK Sova Phone: 7% 1 - SaG - S `!' q �r Address: Ll y Kin Q skoh 54- CONTRACTOR -1•_ CONTRACTOR Name: Phone: ? F I—,;L7 1- S 3s s` .era a SM Address: G5- F-asSlXJ1n Sk. 1--oWeU MA 01.$'70 Supervisor's Construction License: Exp. Date: 0 70 53 t 7 Home Improvement License: , _ _ Exp. Date: 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. 00 Total Project Cost: $ a s3 �O . FEE: $ Check No.: lqy 71 Receipt No.: % NOTE: Persons contrac •ng with unregistered contractors do not have access to ,8ignature of Agent/Owner Signature of contractor Permit No#: n2tp i.c;.qiiPri- BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family 0 Addition El Two or more family El Industrial 0 Alteration No. of units: D Commercial D Repair, replacement El Assessory Bldg 0 Others: 11 Demolition 0 Other 0 El Weil Floodplain ElWetlands F -8­bptic ..[1Water/-Se"wer—, 4W -lit DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly' OWNER: Name: Address: Phone: .7 dnit�5 b -to N a" ffife R h e hi�-. A, d :4 Home -.e- tlic'e-h—sef_ ,4-m­pitgvj��- ARCHITECT/ENGINEER Phone: Address: -Reg. No. FEE SCHEDULE. BULDINGPERMIT: $IZ00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. i. _,Total Project Cost: $ FEE: $ Check No.: Receipt No, NOTE: Persons contracting with unregistered contractors do not have, access to the guaranty fund ig fia�e_of.-A ent/Cw­ her Sidnaturo of contractorF 4� . -"AV Plans Submitted ❑ Plans Waived 0. Certified Plot Plan ❑ -% Stamped Plans ❑ fiypE bF SEWERAGE DISPOSAL Public Sewer ❑ Tanuing/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 COMMENTS Signature. CONSERVATION Reviewed on Signature COMMENTS Fi"EALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes N Planning Board Decision: Conservation Decision: Comments Cc 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 Located 384 Osgood Street no limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meier location, mast or service drop..requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.$10041000 fine No 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 CContr act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: 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 Clerics 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 4 Doc: Building Permit Revised 2014 idpp-: 8 0 LL O D Q O m aV_+ \ 0 O O LL j. U Q N N 0 W a Z O Z m c O m 'O 7 O LL L O CC cuZ C E L U C LL o W Z Z J a L m O 1' C LL 0 a Z J u u J W L OD O d' U v (n _ f6 c LL O W Vf Z VI Q O L to O m c lL C~ W C ce Q W W LL v i C m O N i N a+ Q) o (n n " O O A' 2 � � (DQ U Q. C i- p1i1 u 0• 0 <u W r►; _ r p Go�lQoP Al o m !� _ V H: O QJ E C. ; ■ " d c � � L .4+ cn L•• c/i d 'a • t/1 O O 'a > O •E w C R CO L Cn -■ 2 O s= � ® :; RiteWoo Castonguay Enterprises Inc DBA Hometown Rite Window (rn ®111111 185 New Boston Street Woburn MA 01801 P:781-491-0419F:781-491-0425 !I U ��dIII �% AMitionalTerms & Condoms on the reverse side hereof shall constitute a part of this agreement MA HIC °1387221 federal iD # 02-0520578 1 `I Name: ��=f— KS c ✓ Phone: 7 6 — Phone: E-Mail: Zc­vN3 2vegc n A'7t-c0 .Z I I ( Used for Status Updates only) Mailing and Install Address 1-0 r�r"'7a-14VOO it 1_ZT Zips S Windows Color of vinyl and hardware is white inside and toui Assi n6ted othenNise O 4 Double Hung Glass Package _ U-value ' % Lock or (Wtrite / ickel f Broas) 1011051 White Dal Tilt Locks mDHwmdows2i^mid gmtersnmdmdlocks onless d= 21'Vide Oriel/ Cottage styleoriel nonage pryk.,,, i:TA, Lt r. r„e.A-ief Conversions (Change ofwindowstylefrom M to 211teSiider (Hardware white /beige/nickel/bronze) U-value U {J Picture Window U-value I #D a `7 P L 6--, 3 Lite SliderSeries (Equal Litel. or Ratio 1 ) U­ value' m in! Casement Hinge (Left or RightHinge as view froside looking outside) (Caste Hardwartw!!! White orBeige Only) Ll- value Twin Casement U­-value i Triple Casement (Equal Lite or Ratio) U- value } t i E Awning Window ( Awning HaYniware White or Beige Only) U-vahie 1 Basement Hopper Ifdryer vett[ draw diagram inside looking out U- value � 0 Ce ,X7 b Contoured Grids m between glass ( Draw configuration and label) .(HingeLocations Inside LookingOta Vinyl Patio Door LL-value1 Door Size : 5',6',g' ( circle one) El EOX 0Rite Window may adjust opeu4 to accormnodate door 1 Door Handle standard white Ctolonial Grids 15 Lite 5 and 6 foot 20lite on 8 ' ( yes or no) Slide Left Slide Might t.;eavdswn rsm o 1 SpecialtyGrids (Diamond, Prairie, Perimeter, Simulated Divided lite) Jt t COLOR OPTIONS (Cherry in / White ext) (Oak Int / White ext) (White int / Clay ext) (White int / Browx ext) (White int / Sahara brown ad) * Dark Bto Or Locks on Wood Crain interior • i Bcige Vinyl (interior and exterior and beige locks) Tempered per Sash only( W ithui 18 inches off floor)l Obscure Glass (circle tempered or obscure)1 Full Screens Color- White is standard on White windows, unl noted otherwise (circle one) mckel / bronzeCp" here i i 1 Wmdow Wrap Whr afaanl PVC JIM Window wraps cvstomerdeclines here initial here _ Add Interiorstops (white quarter round) or (pine scotiaorsquares Add Exterior stops (PINE orPVC) Interior Casing (unfinished)Ci ncrC:ol®1PINE Picture Frame Style � �p a a;e9t- CSU! 1v ti Exterior Casing Flat pme inchesorPrinxdwhiteBrick mold vrv:,mo i-T Repair Sill or Jam Replace Sill ( wood or composite material bheie one) Insufflate Weight Pockets and Remove weights as needed Homeowner has received a copy of the "The Lead Safe Certified Guide to Renovate Right" booklet here The homeowner �is resp insible for touch up painting and 1 nishing to interior ani exterior window / door trim. NOTES-ro f'7 L L .EV.y,�7 /'9--G E 94 It Hit% io1 r1ati/fie�f StyN6GCC d>o`i't1sn1 -6oy 1 oyB'tES 'f2(R $ � ., � +? r_ F 14-4 N U r' !� �L.;� .P �r r- U es k' i IS" H r s-Gt x.14.'3- t i ' mss`-•�d•.0 f K,:>;+"-�=ic N I w i iti- r i Est matod Start Date $ i © tfimotod Completion Date S -10 i O-st mcr a ndcnl nds this is an estimated date irddal here 6to8wedajvnrmeaum is�picalonor&nJanumy to August I 8to10wa&jv"imwswvon�rders Sept thmDecernba (ealvkro*i;•9xu'I*slq— and bgg1&"mvlake&Mff) i You may cancel this agreement if it ha been signed by a party thereto at a place other than at the address of the seller, which may be his main of- fice or branch thereof, provided you n tify the se ler in writing at his main office or branch by ordinary mail phsted, by telegram sent or by deliv- ery, no ater than midnight of I ( the third business day following the signing of this agreement not sign this contract ifthere any blank spaces ' NORF-FUN-DSON CUSTOM' ORDERS Customer Agrees to the terms of Payment as follows:5 3 G Totai Amount OWnirr Date CttstomOrderDeposit t $ I ner Date _ Balance Paid to Installer $ FINAL PAYMENT will be CHECK / CREDIT CARD/ FINANCED 10 'y 1'7 G W Credit Card circle one MC VISA DISCOVER AMEX Sales Representative { SEE ATTACHED CREDIT CARD SLIP f � 1 i as owner of the subject property hereby authorize Castonguay Enterprises, Inc to act on my behalf, in all matters relative to work authorized for a building psi mit application. I Signature of Homeowner REV osn4n6 k RITE (�NFJ WINDOW Majestic Double Hung Window National fenestration ^gCourd' IAP—M-25-00166-00001 Vinyl Foam Filled Frame and Sash Energy ELITE Package ENERGY PERFORMANCE RATINGS U -Factor (U.S.A-P) Solar Heat Gain Coefficient 0.27 0.22 ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Air Leakage (U.S./I-P) 0.48 0.3 Manufacturer srpulats that Mese ratings conform m appinable NERC procedures for determtnmg whole product performance. NFRC ratnns aro determined for a fhred set of environmental condmons and a spedk product ske. NERC dos not recomend any product and dos not warrant the sulbbft of any product for any spedRc use. consuR manufacturer's literature for other product performance mformatlon. www,n morg Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.massgov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicantlnformadon Please Print Legibly Name (BusineWOrganization/individual): Address: $' S New P o .4 ovl S �. u r V MA O 1 P).Phone #• 7 k Are you as 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. 1 ani a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance # required.] 11 1 • 5. We are a corporation and its 3. 1 am a homeowner doing all work officers have exercised their myself. (No workers' comp. right of exemption per MGL insurance required.) t c. 152, §1(4), and we have no employees. [No workers' comp. insurance reauired.l Type of project (required): 6. Now construction 7. Remodeling 8. Demolition 9. Building addition 10. Electrical repairs or additions 11. Phunbing repairs or additions 12. Roof repairs 13. Other, 7�Vh tA11Y applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. Homeowners who submit this affidavit indicating they ane doing all work and then hire outside contractors must submit a new indicating such. *Contractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether r�not those entities have employees. If the sub -contractors have employees, they must provide their workers'comp. policy number. I am an employer that is providing workers compensation insurance for my employees Below/is the policy and job site inform && (i Insurance Company Name: '' 11 i&116V t` V—h S U r� C v 4 Policy # or Self -ins. Lic. #: W S3 4 Expiration Date: y I / S/ 17 Job Site Address: City/State/Zip:N&A R parr MA 01 g y S 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 cerilvUnd. Ut pal d penalties ofP0.54" that the information provided above is true and correct Official use only. Do not wMe M this area, to be completed by city or town offle , City or Town: PermitlUcense # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cfty/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #• ACORO® CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYYY) 12/16/2016 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 Nancy Wallace, AINS VHCO No Ex (207) 985-2941 FAX No; (207)985-3122 Kennebunk Savings Insurance E-MAIL ADDRESS: y' g m nanc Wallace@kennebunksavin s.co 50 Portland Road INSURERS AFFORDING COVERAGE NAIC # PO BOX 770 INSURER A. -Hanover Insurance Co 22292 Kennebunk ME 04043 INSURED INSURER B: INSURERC: Castonguay Enterprises Inc, DBA: INSURER D: Hometown Rite Window INSURER E: [INSURER 185 New Boston St. F: Woburn MA 01801 COVERAGES CERTIFICATE NUMBER:16-17 TBD master 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE FXI OCCUR DAMAGET( RENTED 100,000 PREMISES E.occurrence) occurrence $ MED EXP (Any one person) $ 15,000. ZBP A905169 4/15/2016 4/15/2017 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1 PRO JECT ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY (CEO,M.cciBINED SINGLE LIMIT dent $ 1,000000 BODILY INJURY (Per person) $ 20,000 A X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS AWP A905294 4/15/2016 4/15/2017 BODILY INJURY (Per accident) $ 40,000 NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ Per accident Uninsured motorist BI split limit $ 500,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1 n00,000 AGGREGATE $ 1,000,000 AEXCESS RDED LIAB CLAIMS -MADE I X IRETENTION$ 10,000 $ UHF A905172 4/15/2016 4/15/2017 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N PER OTH- STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVEE.L. OFFICER/ EMBER EXCLUDED? � (Mandatory in NH) NIA WHP A905314 4/15/2016 4/15/2017 EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,000 If Yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) The General Liability Policy includes a blanket automatic Additional Insured endorsement that provides Additional Insured status to the Certificate Holder, only when there is a written contract between the Named Insured and the Certificate Holder that requires such status, and only with regard to work performed on behalf of the named insured. lhaYllaLh_\I;4:Lei III Uq 1 City of North Andover 120 Main St. North Andover, MA 01845 ACORD 25 (2014/01) INS025 nm4nn SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE Danny Edgecomb/NW ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD o -----==� ��1-P.• �C�?lLl�l-Q�?�.U�f1'l�f2C�. ���G•C.l�1ClCf?�!fi�'��. Office of Consumer Affairs Ld Business Regulation v 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Castonguay Enterprises,inc.dba Hometown JOHNFERGUSON 185 New Boston St Woburn, MA 01801 - .,.-..1 0 20?A-05!11 =- :Qnice of Consumer Affairs & Business Regulation -`ME IMPROVEMENT CONTRACTOR Registration: 138722 Type: - Expiration- 5/6/2017 Supplement Card Castonguay Enterprises,lnc.dba Hometown Registration: 138722 Type: Supplement Card Expiration: 5/6/2017 Update Address and return card. Mark reason for change. Address Renewal Employment Lost Card 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 JOHN FERGUSON 185 Boston St Woburn, MA 01801 Undersecretary Ilii valid without signature Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-070253FIN n., I JOHN J FERGUS(j* 65 East Sixth St ° (� Lowell MA 0185ff k wf� .. J,,4,,,, .f1jr"' Expiration Commissioner 01/07/2017 Location S-Ao P") No. Date J ol TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee TOTAL $ Check #10,311 j 4'