The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 2/17/2016 tAORTy ofi BUILDING PERMIT O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Receivedq°�q 7 °RATED �SS�c o-au5E4 Date Issued: IMPORTANT:Applicant must complete all items on this page A LOCATION' Print PROPERTY OWNER, L PH MAP NO: ! PAROL; ZONING'DISTRICT: Historic pistridtye . no Machine Shap Village Ye ` no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building (One family Addition ❑ Two or more family E Industrial Alteration No. of units: I Commercial Repair, replacement ci Assessory Bldg I_I Others: Demolition Other aseptic, o Well , 1 160dplair cI Watershed District t Water/Sewed Ar Identification Please Type or Print Clearly) OWNER: Name: , cr Phone:9: �" Address: l CONTRACTOR' Name: J v� Ph6ni e Address: ontionicnseSupervisorsCExp bete: Horne Improvement License exp,, Date: ARCHITECT/ENGINEER ��TV� 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: $ Check No.: Receipt No.: , tO7, NOTE: Persons contracting 'h un istered contractors do not have access to the guaranty fund 9 - Signature of Agent/Owner Signature of cc�ntract� AM %A R TH lbwn ofAndover �' _ '' 0t ® s h ver, Mass,0 44L 6A.—K—A. COCKIc"t WICK 1• ATED RP4 V BOARD OF HEALTH Food/Kitchen 17ER T Septic System L U THIS CERTIFIES THAT BUILDING INSPECTOR ..... ...............................:... ....................... ..................... has permission to erect ........ buildings On Foundation p .............. g .......7.... .. . . ... ./.Lel ............ Rough to be occupied as .................. ...... ....,. .... chimney provided that the person accepting this permit shall in every respect conform to th Lrms 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 PERMIT1MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STARTS Rough �G%'� / Service ........... ................ ...... ............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Perinit 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. E.B. Window and Siding Co. Invoice 756 Western Ave Rt 107 Date Invoice# Lynn MA 01905 1/7/2016 52213 Bill To Susan Maderios 37 Glenncrest dr North Andover Ma P.O. No. Terms Project Description Qty Rate Amount Vinyl Siding Installed, Color: 1 22,500.00 22,500.00 Charter Oak Premium .46 siding 0.00 0.001, Strip and dispose existing vinyl siding,leave wood shingle 1 1,000.00 1,000.00 underlayment Scope of Work: 0.00 0.00T Strip existing vinyl siding 0.00 O.00T Insulate building with .38 Airlock double foil'Platinum'insulation 0.00 0.001' Cover fascia and rake boards in custom bent aluminum, 0.00 COLOR: Cover windows with aluminum 0.00 O.00T Install siding 0.00 0.00'r Install 5 pair shutters 0.00 0.00T Furnish and install.032 Seamless aluminum gutters.All gutters to 0.00 0.00 be installed using hex screw hanging system. Dispose of all job debris! 0.00 0.00'1' Any building permit required to complete pro.ject to be included. 0.00 0.00 Subtotal Sales Tax Total Payments/Credits Balance Due Phone# Fax# E-mail Web Site 781-592-9747 781-592-9746 ebwindowLrmsn.com www.ebwindow.com E.B. Window and Siding Co. Invoice 756 Western Ave Rt 107 Date Invoice# Lynn MA 01905 1/7/2016 52213 Bill To Susan Maderios 37 Glenncrest dr North Andover Ma P.O. No. Terms Project Oe cription Qty Rate Amount - 0.00 0.007 acceptance of proposal authorized signature Subtotal $23,500.00 Sales Tax $0,00 Tota 1 $23,500.00 Payments/Credits -$7.500.00 Balance Due $16,000.00 Phone# Fax# E-mail Web Site 781-592-9747 781-592-9746 ebwindowLrmsn.com www.ebwindow.com The Commonwealth of Massachusetts Department of IndustrialAccidents i I Congress Street, Suite 100 Boston,MA 02I14-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers. TO BE FILED A'VITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): Address: � � City/State/Zip: Phone#: `J Are you an employer?Check the appropriate box: Type of project(required): 1 JO I am a employer with__employees(full and/or part-time).* 7, E]New construction IF]I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 3.0I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 1 El Demolition 10 0 Building addition 4.❑I am a homeowner and will be hiring contractors to conduct alt work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5,F]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.Q Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ , 6.F-1wearea corporation and its officers have exercised their right of exemption per MGL c. 14- Other^ \�L 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f 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 state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I alit an employer that is providing workers'compensation insurancefor Iny employees. Below is the policy and job site i1tf01'I11ati071. Insurance Company Name: Policy#or Self-ins.Lie.#: � `�(_��(� �� Expiration Date: Job Site Address:�� y \�). �`� 1 — City/State/Zip:Vim• 6NCAQU Qr , Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 thepains annddp realties ofpe►jury that the irtforutationprovirled above is true and correct. Si nature Date: Phone# .— Official use only. Do not write i t 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: FEB-18-2016 03:06 From:E B Winow CO. 781 592 9746 To:19786889542 Page:2/2 Dr 'ate�v CERTIFICATE OF LIABILITY INSURANCE I�TE(MM/DD/YYYY) /le/2o16 THIS CERTIFICATE IS ISSUED A8 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 10LOER, THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AF ORDER BY POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING� HE INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certlflcato holder Is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIV(:D, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not con fl r rights to the certificate holder in lieu of such endorsoment(s). PRODUCER CONTACT NAM ; COMmer0ia1 Linea Admiral Ineurance Agency,inc, PHONE 70 Munroe Street (a (7t31)599-2000 FAX 0` fit)` �C,No): E-MAIL ADDRESS: Suite D _ Lynn MA 41901 RER 9 _ INSUAFFORDING COVERAGE NAIL:g - - - " wo sURERn:Prvidenee Mutual Fire I B Co 15040 INSURED INSURER B Guard Insurance EDMUND DBA 13YRNE 6 ED BYRNE WINDOW COMPANY INSURER C: 756 Western Avenue INSURFR D: INSURER E: - - LYNN MA 01905 INSURER F: COVERAGES CERTIFICATE NUMBBR:CL1561720927 REVISION NUMBER; �I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE OLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WI�H RESPEC'I' O WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO AI L THE TERMS, EXCLUSIONS AMC)CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. 7AC ADD1.9U It YPA OF INSURANCE POLICY NUMBER POLICY EFF POLICY EKp MMlDO/YYY MML.lr. VMIT3 CIAL GENERAL LIABILITY [PREMISE8():s (;H OCCURRENCE- $ 1,000,000 IM>3-MADE I K I OCCUR oN EDuurrencr. § BOP0063101 6/21/2015 6/21/2016D EXP(Anynne persue) S 5,000 PERZAONAL&ADVINJURY $ 1,000,000 CFN'LAGGREGAYELIMIT APPLUESPER! POLICY -- PRO- GENERgLAGGREGATF $ 2,000,000 J x ECT I ,ECT u LOC PR00VCTS-COM io F AGG S 2,000,000 OTHER: I'LL S 50,000 AUTOMOBILE LIABILITY COMDI -U 31NGLE LIMIT $ F accldrid) I ANY AUTO BOUILY INJURY�(P)r pdreon) $ ALL(>WNALIABOCCL)R EDULED AUTOSOS BODILY INJURY(Per aO'Cidenl) $ HIRED AUN-OWNED PROPERTY OAMA F OS (Peracridonl)_ S UMBRELLEACI.IOCCURRENE $ EXGE33 LCLAIMS-MAf�tAGGAIR.ATEDF,D B WORKERS COMPENSATION $ PER DTH. AND EMPLOYEgfi'LIABILRV ti'ATUTE E ANYPHpMEMDPR/PAHTNER/2XECU'I'IVF Y/N EDWC643855 12/13/2015 12/13/2016 E.L.EACHA(rCIDENT $ 1,000,Q00 (MfinEforyin H)FxCLUDED9 u N/A (Mandatory in NN) - - - It yes,dr--rripe Under E•I•DISEASE-EA TMFt-DYE § 1,000,000 DESCRIP'I ION OF OPFRA'1'IONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATION5/VEHICLES (ACORD 101,Add1110ns1 Remarks Schedule,may ba attached if more sPaC6 la required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED FOLIC ES BE CANCE TILED BEFORE North Andover InSpECtor THE EXPIRATION DATE THEREOF, NOTICE WILL BE Of LIVERED IN 1600 Ougood Street Bldg 20 ACCORDANCE WITH THE POLICY PROVISIONS, Ste 2035 North Andover, MA 01845 AUTHORIZED REPRRUENTATIVE (D1988-2014 ACORD CORPORAL ION. All rig,Its reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ) I N$025 lqm an t t BERKSHIRE HATHAWAY Worker.s Compensation and Emolover's Liability Policy- INSURANCE NorGUARD Insurance Company - A Stock Company HGUARDCOMPANIES Policy Number EDWC643855 Renewal of NEW NCCI No. [25844] Policy Information Page [1]Named Insured and Mailing Address Agency Edmund Byrne ADMIRAL INSURANCE AGENCY 756 Weston Ave 70 Munroe Street Lynn, MA 01905 Lynn, MA 01903 Agency Code: MAHARR12 Federal Employer's ID 20-1160335 Insured is Individual Additional Names of Insured (N2) Ed Byrne Window Company 1 [2] Policy Period From December 13, 2015 to December 13, 2016, 12:01 AM, standard time at the insured's mailing address. [3] Coverage A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation Law of the following states: Massachusetts B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed in item [3]A. The limits of our liability under Part Two are: Bodily Injury by Accident - each accident $1,000,000 Bodily Injury by Disease - each employee $1,000,000 Bodily Injury by Disease - policy limit $1,000,000 C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in item [3]A. and the states of North Dakota, Ohio, Washington, and Wyoming, D. This policy includes these endorsements and schedules; See Extension of Information Page - Schedule of Forms [4] Premium The Premium Basis and, therefore, the premium will be determined by our Manual of Rules, Classifications, Rates, and Rating Plans, All required information is subject to verification and change by audit. (Continued on another page) Total Estimated Policy Premium $ 10,055 Total Surcharges/Assessments $ 545.00 Total Estimated Cost $ 10,600.00 TNUWNA1USE L9_ Page - I - information Page MCA : EDWC643855 WC 000001A Date : 11/04/2015 MANOTE Issuing office: P.O. Box A-H, 16 S. River Street, Wilkes-Barre, PA 18703-0020 s www,guard.com ESERWINDOW AND SIDING CO. 7561 Western Avenue 4 Lynn, CSA 019015 Phone 751-592-9747 E-mail: ebwiiidow@insn.com To Whom It May Concern, I, Edmund Byrne, allow Jayme Byrne to apply for permits on my behalf. If you have any questions and/or concerns please call our office at 781-592- 9747. Respectfully Yours, el Edmund Byrn Office rpt"001suMer Business Regulation 1, ,� �if7ME lhfP&'�sl�4 LfifaN7dENT CT5RTI9, dTT' b4 Registrafiow 1,286,34 Typw fwd Expir�af6raMr: 512120,17 DBA DWlr ND BY'f'dN 755W ST'F,RN'a4VE LYNN,MAS,01902 1'atcfrrra ��,. cwrWeas u' �a P 'N ass Buo fTgl bs".p erlrne nl p�,jt,fic Safety °�T end BUH(f ng !enol Standards S()10870 1811 Woodrow"1"ewrr ca Lynn MA ()19O4 T TSNVation wus�Ee rnre�ffesr 07109/2017 a