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HomeMy WebLinkAboutBuilding Permit # 4/4/2016 If %AORTH BUILDING PERMIT 0. TOWN OF NORTHA DOVER APPLICATION FOR PLAN EXAMINATION PermitNo#. Date Received Date Issued: MPORTANT: Applicant must complete all items on this page LOCATION .2,3-e -,ZJ-Z �41 A/- `-'- . /- Print PROPERTY OWNER_,PeJXi? ,46'-1Ave)0 --/- CPrint 100 Year Structure yes no MAP 3 1 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes, J0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building El One family El Industrial El Addition X Two or more family El Commercial [I Alteration No. of units: El Repair, replacement El Assessory Bldg U Others: El Demolition El Other pwyg' MON"090 AN M, ,'' ' 10, DESCRIPTION OF WORK TO BE PERFORMED: /ef7- Identification- Please Type or Print Clearly OWNER: Name: Pe_.4k',e P h o n eX,,e Address: Contractor Name: Phone: /k Email: Address:- .zf Supervisor's Construction License: —Exp. Date: Home Improvement License: Exp. Date: ARCH ITECT/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. Total Project Cost: $ FEE: $ Check No.: Lk ReceiptNo.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund %A® TH Town ofa ndover •��• y" 0 ® 7AI - n ver, S, 4 .2oi4 ® LAKE AW.�. COCHICKEMCK V �®j�arE® BOARD OF HEALTH PER T LD Food/Kitchen Septic System 11 THIS CERTIFIES THATt4 .••.••..•. BUILDING INSPECTOR has permission to erect .... buildi&A& ., •• Foundation ................. ....... . .... . ... . .......... . . . ® Rou h g tobe occupied as ...... .. ... .................... ..... ......... .... ...... ... .................... chimney provided that the person accepting this permit shall in every respect conform to the terms 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T RTS Rough •.••.......... Service ................. ..... ...... .�.......... Final BUILDING INSPECTOR CTAS INSPECTOR Occupancy Permit Required to Oecugy Buildin Rough Display in S the Premises — Do NotRemove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvede Building Inspector. Burner Street No. Smoke Det. HI-Tech Window & Siding, Inc. ?7z6 IDIN Aegean Drive Unit 4 MA Reg. # '118836 Methuen, MA 01844 S � /,•��9 y Y �-800-85 1-0900 u --ria MA LIC # CS - 106508 ---0 CO www.hifechcorp.bizf€� Date: / _ / Consultant Il 1 NS2 JobNalfte:_��bi� Y u Teiegah®n Job Address: 0 Town: NO&ti &JOVYr Contractor agrees to start described work on or about weeks after final fittings,and complete described work in about T_r working clays.Contractor shall not be held liable for delays due to cause beyond our control.Hi-Tech shall not be held liable for any damage to lawns or plants.Contractor shall not be liable for any damage to painting or stain during installation of windows or doors.Hi-Tech does not 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 held back. The following work includes all labor and materials needed to complete your job in a workmanlike manner. -5—fid, S ' � of 901b Job Includes tck Trim Combination Job-Sidmn WWI Other;Vora ' 6 El P.Vc-Coated Atum Aluminum i E�-duildmg arta Elec.Permit - El Fasoa Tnm Fascia Treatment Siding Remova' Soffit Trim Fascia Ccicr r'reparabon Package 1.lindovr&Door Trim E Full Custom E] None Y"ccessory Package El Shutters Location Undedayment 1--a- El Gutters Soffit Treatment (ding �Do:vnspouts Remove Debris Lock.Elec.Meter soffit Color Preparation Includes El Center`len; El Fully Vented Non-Vented 11 Location Replace Visible Rat �Vented as Neede:! Window and Boor Casing Treatment Nih Energy savings/Bug Guard Start r NWindotvMtd Door Casing Color n Accessory El Full Custom Formed J-Less. 1:1 Full.Custom Formed P kage Includes Blind Stop Capping None Cn'rr: Location El Vinyl Light Blocks Vinyl Dryer Blocks - Vinyl Electric Ou;Iut Blocks �Vinyl Exhaust Vents Gutter&Downspouts Gutter Ce'o, Drr&nspouts Color El Vinyl Faucets 8"C"..s Vrn•.'l Gale Vents Location Underlayment Insulation To Be Used Special Motes El Hi-Tech 318 OtherIWA Location ` e V)T Area To Be Sided � Vnn NlVS $ ElComp -3 a Compete House Garage '"' Yb S l_t_-` 0 Siding To Be Used 11 S Color P y ent Policy Brand 0 of profile Bank Financing 1:1 OrmerToArrange El Hi-Tech ToAnange 1 pEl Cash Or Check El Master Card Corner P st To Be 649d Comer Post Color: Total Investment C' 190 11',Viae Insulated El Y:'ida Non-Insulated 1/3 Deposit '0 El Regular Insulated 0 Regu!ar Non-lnsulated 113 Payment G _... 1/3 Balance of Day Substantial Completion You may cancel this agreement if iY has been signed by a party thereto at a place other than the address of the seller,which may be his main office or branch thereto,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent,or by delivery, not later than midnight of the third business day following the signing of this a reement.See the attached notice of cancellation form for an explanation of this right. An interest charge of L5S11 per month(iw° per year)gill be Date of Acceptance added to any am unt unpi d of r 30 days from invoice date -. 1,,,,.,. C SSP 'lf 1 t h..t , _ .._,'i.l •.,,v. � -1" Signature I � H^�� r.rcrl 'L' 1 We glue Hi-T yjrpc ss o obtai�r all necessary permit.,. - C Sic Signature C H,-Tet : The Commonwealth of Massachusetts .Department oflndustrialAccidents 1 Congress Street, 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 Legibly Name (Business/Organization/Individual): s/• /f G� I��Cc�d✓ o��� j�✓� �/moi"v`�I S /7� Address: 2 % .��2ow✓®��d-� T" City/State/Zip: /f/e1-,f1lAw Phone Are you an employer?Check the appropriate box: Type of project(required): 1.JA I am.a.employer with employces(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.F1 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10F]Building addition 4.Q I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I L❑Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14..0 Other 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 am an employer that is providing workers'compensation insurance for•my employees.'Below is the policy and job site information. _ l� Insurance Company Name: Al Y r r 1��vc9Hc Policy##or Self-ins.Lic.#: W � ��s'-3 � o 'O J— Expiration Date: Job Site Address: a-S o �� �� S�` City/State/Zip: /� •�� 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 and penalties ofperjury that the information provided above is true and correct. Signature: Date Phone#• 73;' !�Yd }l Official use only. Do not write in this area,to be completed by city of,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#: ..; VCERTIFICATE OF LIABILITY INSURANCE DATE(PrMVDD/YYYY) 1 2/1 120 1 5 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 CONTACT 81 S MAIN ST NAME: PHONE IFAX BRADFORD, MA 01835 ° EMS AfC Ne) E-MAIL ADDRESS: INSURERS)AFFORDING COVERAGE NAICft INSURER A; LM Insurance Corporation 33600 INSURED - - - HI TECH WINDOW&SIDING INSTALLATIONS INC INSURERB: 29 ARROWWOOD ST INSURERC: -- M ETH UEN MA 01844 INSURER D: INSURER E: INSURER F 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. NOTWITHSTAND)NG 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. INSRADDL SUBR POLICY EFF POLICY EXP LTR I TYPE OF INSURANCE POLICY NUNIBER MM/DD/YYY MM/DWYYYY) LIMITS � ;COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE ❑OCCUR DAMAGE TO RENTED PREMISES Ea occurrence S _ �--I - - -- MED EXP(Any one person) S — PERSONAL&ADV INJURY 1 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY D PERO LOC PRODUCTS-COMP/OPAGG I s OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S — Ea accident) ANY AUTO BODILY INJURY(Per person) I�I ALL OWNED SCHEDULED I �AUTOS AUTOS r BODILY INJURY(Per accident) S HIRED AUTOS I NON-OWNED AUTOS PROPERTY DAP,AAGE � Per accident) I UMBRELLA LIAB I--I I OCCUR EACH OCCURRENCE _ 5 EXCESS LIAB I CLAIMS-MADEI AGGREGATE__ $ DEO f RETENTIONS I S A iINORKERSCOMPENSATION WC5-31S-383602-015 11/29/2015 11/29/2016 AND EMPLOYERS'LIABILITY YIN f PER ET2H 1 _ MANY PRO PRIETOR/PARTNER/EXECUTIVE ❑ EL EACH ACCIDENT S 5500,000 OFFICER/MEMBER EXCLUDED? N N/A _ .._ _ (Mandatory In NH) i If yes,describe under EL DISEASE-EA EMPLOYEE 5 50D,ODD DESCRIPTION OF OPERATIONS below I EL DISEASE-POLICY LIMIT I S 500,000 ' I i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be 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 - LM Insurance Gor oration ' VU J 1 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD !7467205 1 1-383602 1 15-16 TIC I Kartik Wali 1 12/1/2015 1:19:06 PM (EST) I Page 1 of 1 Massachusetts - Departrnent of public Safety Board of Building Rcgulatioms and Standards Construction ,upervisor License: CS-096516 TIMOTHY W WIcks 3 ELLIS ST PRI'1 I Methuen MA O1944 Expiration Commissioner 09/09/2016 - � , ��C�OlR9JlO-J[(G'BC[�L�0��.�GCfCJ9CCC�(ldalf �t �)0Tice of Consumer Affairs&Business Regulation 1.wE IMPROVEMENT CONTRACTOR registration: 118836 Type: i Expiration: 4/26/2017 Supplement Ce / HI TECH WINDOW&SIDING INSTALL INC 1 I TIM WICKS 29 ARROWWOOD ST METHUEN,MA 01844 Undersecretary i