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HomeMy WebLinkAboutBuilding Permit # 4/4/2016 %AORThl BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION PermitNo#: Date Received rED C" Date Issued: 11 --PORTANT: Applicant must complete all items on this page LOCATION /L A 4& Print PROPERTY OWNER 41:-,ki,4 R14 6bio ZO Print 100 Year Structure yes no MAP PARCEL: NING DISTRICT: Historic District yes no no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential D New Building KOne family [I Addition [I Two or more family 11 Industrial D Alteration No. of units: 11 Commercial El Repair, replacement El Assessory Bldg 11 Others: El Demolition D Other 'At '01I.Water 5,sh [alp ba DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: -641n -71- Phone: Address: ZZ Contractor Name: Phone: Email: Address: Supervisor's Construction License: 0 P.K -Exp. Date: �F-Y- Home Improvement License: Exp. Date: ARCH ITECT/ENGI NEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST 13ASED ON$125.00 PER S.F. Cl Total Project Cost: $ FEE: $ Check No.: Receipt No.: CA NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund -�qqn ar 0 §dgnpf &/NU� y q_16", a %4R'T#1 Town of ndover 0 1 No. Aoil 4 h ver, Mass, °� - 1A14F C00041CHEWICK ��• ,4�®RArED 1?? " Lj S BOARD OF HEALTH Food/Kitchen PERIT T LD Septic System THIS CERTIFIES THAT ....... ....... ...... BUILDING INSPECTOR ........ .... .. .. ......... ........................ .... ... ..... ......... ........ has permission to erect �buildings on ... ............. Foundation Rough to he occupied as ... ... . . .... .. .. . . . ... ®.... Chimney provided that the person accepting this permit shall in every respect conform to the ter f 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S ARTS Rough Service ............. ...... E�2 .. ............. ........... Final BUILDING INSPECTOR IGAS INSPECTOR Occupancy Permit Required t® Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To BeDone FIRE DEPARTMENT Until s ected and Approved by the BuildingInspector. Burner Street No. Smoke Det. 2(3 �G�U�'�t Aegean Drive Unit 4 MA Reg. # 1 18836 Methuen, MA 01844 MA ►is # CS - '106508 1-800-851-00,00 03 16 vtnrnnr.k�iteehcorp.biz �Itll Date: . � .., / -- Consultant: ,-_� q3e .Son name: _ � 'j� Sl ----- - - ---- lelepho 1�l1fh Joy address: - Town: ._. I d Contractor agrees to start described:vork on or about weeks after final rittings,and ccmpiete described vrork in about :vork:ng days.Contractor shall not be held liable for delays due to cause beyond our control. plants.Contractor shall net be liable for any daHi-Tech shall not be held liable for any d mace to fawns or r mage to painting'or stain during installation of;vindows or doors.Hi-Tech doesnot do any paint- Ing or staining. In the event that a punch list should accrue at the end of the job,a maximum of 2%is the allowable amount to be field back. 'i The fofloe:ing vrork includes all labor and materials needed to complete yourjob in a workmanlike manner. 'I it doh Includes j trim ! ! Q =.V L i imrum7r:nr FasClaTreatn ;i 7rm 11, it prep::rat:cn Parr.w I, Fa::r.:a Cak,r R<:cr Trim L{ �i rrccscr,•Parkari,, �, ru!t calAwn t•!car. :acr!ayracnt':►.-.y-•.;-, LccaLcn Gaffe ; / d n :m!; Soffit Z•reatment bt Jo•^aspcuts Pcc Meter ri rtrmo:'n L'n:;:r, Salfil Cater f j �r@parliiOn IRCIUdeS t: ntrr Vt:r:t rutty Verged 1 :iCr:.'•trq VISCe hcl Cnraf.::n r •.•,rted�;2deednd r rf?:r/,/;"JSati':r.,s.cug t;::nrd Sta er Window And Door Casing TrEatmet I XC L (� neC ........:,n^..... .7 C:c:rt .-. r/��/• �p y / ti • ,crc e includes � ..;r.�,=.- Friem,:..i-ters 17V i� L.L� �'_ r- ;c,•E`.;-Fc cxha::r!„rr:', Gutter Do:vnsDoutS I I 1 Undettavrnent Insulation to Be Used "� if Special NotesQ' p SJ El N fn;:,28 Lc-t:.:rr, �S`C area To e SidedEJ i _on:plr.;r,Fiaae Gara�c ,t E' Siding To Be Used e_ Cn.ar ii Payment Policy ''tC l rle 1 �! Brand tJ r fl pr"Pe BankFirlancmi E]ownerToN- e 1A ®® — Qr j c,r 9 i•7echToArrargc V` l[ SS/6S �• ..y El c::::n or �:aster Card lr.y�, if if Corner Post to Be sed ii Ccmcr Pc:>t Co,:r - ), total Investment ❑J::an;rs:;latea e 04 !I I ! :rr:c'N,,:-to:crated 113 Deposit Reguinr!rr,.aatr: r't R �U0®C,7 L! c3,:'ar,.cr,•!rs a!ed 1/3 Payment 1/3 Balance of Day Substantial r f You may cancel this agreement if it has been signed by a party thereto at a place other than the a dress of the seller,which may j l be his main office or branch thereto,provided you notify ii by telegram sent,or by delivery, not later than midnight T"the third e seller rbusine writing day foat his llowing the signing ofain office or branch this ragrement.posted, the attached notice or cancellation form for an explanation of this right. n:rrr.I r cr'1 , Pern 4r I� d r Dale of Acceptance ve Strnature_L l!� t t 4 c gi �..c mission o�Wln all:4 c .ary permits.'• t .j Signa tu e__ 4 Signature 'i The Commonwealth of 1Mlassachusetts Department of IndustrialAccidents X Congress Sheet,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information / Please Print Ledbly Name (Business/Organization/Individual): ' s 'I'e c V _�5-, 5✓110 Address: City/State/Zip: �el-1_eo, spa or i Phone#: " �� ' �✓� Are you an employer?Check the appropriate box: Type of project(required): 1.P;q I am a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp..insurance required.]t �4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12. J Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.) 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14 ®Other Si' y 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. i 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 workeis'comp.policy number. X am an employer that is providing workers'compensation insurance for•my employees.'Beloiv is thepolicy and job site information. Insurance Company Name: XVX11-Y r�/V Policy#or Self-ins.Lic.#: 6✓C✓ Expiration Date: Job Site Address: 7,1 A✓,`h A/n e City/State/Zip: ,f/, X if 1,✓G 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 andpenaltles ofperjury that the information provided above is true and correct. Signature: 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 Penson: Phone#: r vCERTIFICATE OF LIABILITY Y I DATE(MM/DD/YYYY) 12/1/2015 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 BARRY J KITTREDGE INSURANCE CONACT 81 S MAIN ST PHONE 1FAX BRADFORD, MA 01835 E-P.9AIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURED ---_-------------INSURER A, LM Insurance Corporation 33600 - - --- ' HI TECH WINDOW&SIDING INSTALLATIONS INC INSURER B: 29 ARROWWOOD ST INSURERG: METHUEN MA 01844 INSURER D: INSURER E: INSURER F: I '. COVERAGES CERTIFICATE NUMBER: 27467205 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. (NSR ADDL'SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE ( POLICY NUMBER POLI MM/DD/YYY LIMITS '.. M COMMERCIAL GENERAL,LIABILITY I EACH OCCURRENCE s _ I ' DAMAGE TO RENTED CLAIMS-MADE u OCCUR PREMISES(Ea occurrence 5 MED EXP(Any one person) S � �---- PERSONAL&ADV iWUR-Y i5 GEN'L AGGRE(GAATTE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY j—I PRO- LOC PRODUCTS-COMP/OP AGG IS — OTHER: S AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT C Ea accident 1 J_ ANY AUTO BODILY INJURY(Per person) -- ALL OVV1`!ED SCHEDULED ts— BODILY INJURY(Per accident s AUTOS H AUTOS � _. '........, ` NON-OWNED I{ PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident I S_ __ UUMBRELLA LIAB OCCUR i �---� EACH OCCURRENCE $ EXCESS LIAB AGGREGATE___ _ S CLAIMS-MADE I DED RETENTIONS ( S A WORKERS COMPENSATION WC5-31S-383602-015 11/29/2015 11/29!2016PER OT"- AND EMPLOYERS'LIABILITY Y/N ✓ i STATUTE ER :ANY PROPRIETORIPARTNER/EXECUTIVE I OFFICER)MEMBER EXCLUDED? N N/A EL EACH ACCIDENT _ S 500,000 (,(Mandatory In NH) EL DISEASE-EA EMPLOYES 500,000 If yes,describe under - - DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY UNIT S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state MA. This certificate Cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION 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 } 11 J1 — LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014(01) The ACORD name and logo are registered marks of ACORD '7467205 11-383602 1 15-16 WC I Ka tik Wali 112/1/2015 1:19:06 Ptd (EST) I Page 1 of 1 Massachusetts - Departrnenf of Public Safety Board of Building Regulat on. and Standards Constructiori Supervisor License: CS-096516 TIMOTHY W WIGS 3 ELLIS ST Methuen MA 61944 r 110 Expiration Commissioner 0910912016 - LJ�e CntINQ9ttUealC�o�C-���CaJJ[7c�U'r'/�J (' fce of Consumer Affairs&Business Regulation WME IMPROVEMENT CONTRACTOR registration: 118836 Type: ^ Expiration: 4/26%2017^ Supplement C� HI TECH WINDOW&51DING INSTALL INC TIM WICKS 29 ARROWWOOD ST - METHUEN,MA 01844 Undersecretary I