HomeMy WebLinkAboutBuilding Permit # 4/26/2016 %40RT#1
BUILDING PERMIT ;°�N®0
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Permit NO: Date Received
C
Date Issued: S S
IMPORTANT: Applicant must complete all items on this page
221
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
Li New Building *tne family
11 Addition Ll Two or more family [I Industrial
0 Alteration No. of units: 11 Commercial
*We—pair, replacement [I Assessory Bldg 11 Others:
11 Demolition Li Other
REPLACE 2 DOORS - NO STRUCTURAL CHANGE
Identification Please Type or Print Clearly)
OWNER: Name: SONYA TERRA Phone: 8604608506
Address: 250 BLUE RIDGE ROAD NORTH ANDOVER, MA 01845
AM,
HE
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.
Total Project Cost: $ or\ FEE: $ I(r—
Check No.: Ll U V) Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access t guaranty fund
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BOARD OF HEALTH
Food/Kitchen
PERM T L Dmmmb" Septic System
THIS CERTIFIES THAT ................. BUILDING INSPECTOR
................I
... ..... . .........Om... .................�......................
has permission to erect .......................... buildings on .... .... ... s .. ... r............... Foundation
Rough
tobe occupied as ..... ..... ... . .. .... . . ........................................................... Chimney
provided that the person accepting his 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 EXI l, MONTHS ELECTRICAL INSPECTOR
UNLESS TION STARTSRough
// Service
....................a<.... . .. .1:�:-:.......................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Bulldan Rough
Displayin 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.
I
Agreement Document and Payment Terms
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BUYER,MAY CANCEL THIS TENSA QAC AT ANY TME PRIOR TO AMNIGHT OF THE
JSINM DAY AFTER THE DATE OF THIS TILAN-SACnON SEETHEAMCHMNOTICE
IMON FORM FOR AN EXPLANUATION OF THIS RIGHT.
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KeneWal Itemized Order Receipt
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WINDOW►& a PATIO DOORS:z SPE-CIAIT` "i 0 MISC:a $6,296
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Dvaly It:fAf h Jr«sfda 1 ccraVtta`r
ri,f ee ofhts-ealgatioks
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Workers' Compensra on Inswracce lea 11datri€;
tr q " n t 10-Ma-Ago P14480 80 'r:it 1
A MY
name ti3usiness/t�rgar rattao�lndi��rtaa l;_ RENEWAL BY ANDERSEN
Adcireas�: 30 FORBES ROAD
C'ity/State-'7!p;,NORTHBORO,MA 01532_ Mow V: 508-351-2200
Aro,;fou an ew4goyer"Cheek!hc appropriate box: F6,
Q of proff er#tie airett)•
1. 1 arts a wnpleyer with ,30 __ 4• ❑ 1 am a gtarerul"tractor and I New Jtrt r equir
vfim
employees(fu;I and;'or pa;t-limo}.� iidv�e hired the wb-contractors
y.Q I am a sole proprietor orpattnt3r fisted cin the attached shit y i Remodeling,
ship atld have ns,omployeos '1)re"A s4b--�uuttwtdrs have S, ❑I)ermolttion
workingfor me m any capacity. workers.'carmp.iirsuran�V. 4. ❑Building addition
[Nu workers'tromp.int nce 5 ❑ We are a corporation.and ite
required.] (off cern have r ertnt eti their 10-0-FIft-trilcal repairs or 4ddit ms
3.01 am a hvweouner.doing all work right ormmloon per.Chia. -11:0 Mumbmg repairs or additions
myse+lf.1No workers'comp, C. 152,01(4),and w--a have no 1311 Roof repairs
insutance raquit ,d.j wrployees No workers' 13.x]Mehr
l- — r:orrp.instuancomquire3.l 1
'Anv oqiqmnc that arxks hox a 3 n:us t atse fill wi the wnn butia 4* ola utmr x.iT -7ucP ti:c4at;4nµrijcy sniuntrare
'l tome tsrrtrs uiw :httut thry at'iciarrt isadtc>,tut thct d:c•doing air uatb bJlti ttsett itiia n��zde cunitdr i:uts must aubmtt x affidavit tnd►Lviatt 3wh
''.'tAt11d�U[s tltnr�ne:1:thtc hsx.itrust t+tte�9'�Kt an add'tK.rcai uit�et;#•�y:na ltra nnt�ni tree sub-:�n�ra�mr,..and ttrsrr workar�canp.pnitey tnfar�itatwn
lam a»erttptover t&at is prurvh ft worAers'evfiWnsadoX 1MAffl1r0J0r jW employmt Rdlot,:&rhe po&y&W job abre
h vrmadot�
1nw ance Company Naive,- OLD REPUBLIC INS. CO.
Polk--y A ot•Self-ins. Lie. �._. tu�litt^�4;�i07QQ.... _ Expiration Date: 10-01-16
Job Site A"-ess: 250 BLUE RIDGE ROAD _ NORTH ANDOVER, MA 01845
Attach a copy of the workeW compensation poky dec armtfon;rage(shoving the pojy number Md esptratlon date
.Failure to secure covetage as requiri:A under Section 25A of'MGL c: 1511,can load to the imposition of criminal N-nalftie3 of a
fine up to$1,400.00 andror one-year itt+prisontnenn as well as chil penaltie in live f6zm of a S F()P WORK OMER and a fines
of up to$.'.50.00 a day against the violator. Fla advised that a copy of this statemettt may N f4rwardad t,,,the offlee of
Investigattons of the DIA for insurance covarage veiftication.
I do henmb eett{jy to r Chi painsr ndpenah*%of perjure that the ir�nr don pttutdtldd'bore A,ow and ca"W1.
A el
phone ; -351-2200
offleial rite only. Ido not Wtim ut this dreg,to be cvmpktetl by ri(t,or town v&•lel
City or Town: Perwit/License 0
Issuing Authority(4-irale one):
Y.Board of Health I Building Jepartinent 3.04'.Prewn C ierk 4.Electrical Inspector,5.Plumbing Inspector
6.Other
Contact Person; l'hoete#:
QN
q "O ANDECOR-01 YADAVYO
!`1� 1� CERTIFICATE LIABILITY I - DaTE"' DDIYYI'17
10/112015
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(les)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
NAME; Willis Certificate Center
Willis of Minnesota Inc, PHONEFAX
c/o 26 Century Biva No.Ext):(877 945-7378 a/c No): 888 467-2378
P.O.Box 305191 E-MAIL Certificates willis.com
Nashville,TN 37230-5191 ADDRESS`
INSURE S AFFORDING COVERAGE NAIC#
INSURERA:Old Republic Insurance Company 24147
INSURED INSURER B:
Renewal by Andersen LLC INSURERC:
30 Forbes Road INSURER D;
Northborough,MA 01532
INSURER E.
INSURER P:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POUCIES 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 TYPE OF INSURANCE POLICY EFF POUC EXP
LTR INSD D POLICYNUMBER MMIDWYYYY MWDDNYY LIliins
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
CLAIMS MADE OCCUR MWZY 305440 10/01/2015 10/01/2016 PREMISES(Ea occurrence) $ 500,000
MED EXP(Any one person) $ 10,00
PERSONAL&ADV INJURY $ 1,000,00
GENL AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ 4,000,00
X POLICY M JERCOT LOC PRODUCTS-COMP/OP AGG $ 4,000,00
OTHER: $
AUTOMOBILE LIABILITY CEOMED SINGLE LIMIT $ S,OOO,000
A► X ANY AUTO MWTB305438 10/01/2015 10/01/2016 BODILY INJURY(Per person) $
ALLOWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per socideni) $
NON-OWNED PROPERTY D- AGE $
HIRED AUTOS AUTOS Per ecGdant
$
UMBRELLA UAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DED I RETENTION$ $
WOR KERSCOMPENSATION _
AND EMPLOYERS'LIABILITY YIN X STATUTE F7
ER
AW OFFIPROPRIETOR EXGLUDED7 ECUTIVE N 1 A MWC30543700 10/0112015 10/01/2016 E.L.EACH ACCIDENT $ 1,000,0
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,0
UnIf yes describe under
RIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space to required) '..
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
Evidence of Insurance %- �'✓�
01988.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
at
Ma0m hueette_Department of Public Safety
Board of Building Regulationo and Standards
Construction Supen-isor
F
Umnac
L mom
LYM MA U1
P �
S 'I Stu Expiration t
—swriice of Consumer Affairs&Business Regulation
ME IMPROVF.MF-NT CONTRACTOR
Registration*:,.'j $ Type
Explrat(grf1. Supplement Card
RENEWAL 13Y ANDLR8M L.G-,;77
JAIME MORIN
30 FORBES RD --
NORTHBOROUGH,MA 01532 Undersecretary
i
PRODUCT PERFORMANCE
Andersen'NFs C Certified uncal U est Pprf4)rj-,naflre(cOnDhued)
Andersen'Product
Glass Typo U-factor' SHGCr VP
• 200 Series.
Clear Dual Pane 0-45 0.60 0.69
Clear Dual Pane with Grilles O,tS 0 0.56 _
Tilt-Wash lmv-E 0.30 0.32 0.55 =j
Double-Hung Window' Low-E with Grillesa
0.30 029 0.49 _
HP Lmv-E4 SmartSun 0.30 021 0.49
HP L-I-E4 Smart4.un•.v/Gnlles 0.31 0.19 0.43 J A
_ Clear Dual Pane 0--0.64
Narrolihe' ---I ratio Ivantnlies 0.45 0.54 0.57
Double•Hung Window Low-E 0.30 032 0.56 �;I _
Lm'•,E'rrith Grilles 0.31 029 0.50
Clear Dual Pane 0.44 0.83 0.66 -
NarraOne• CIc3r Dual Pane with Grilles 0.44 057 0.59
Transom Window Lnw-E 027 0.34 0,58 a
Lmv-E%ft Grilles 027 030 052
Clear Dual Pane 0.45 0.60 0.63 -
Clear Dual Pane with Grilles 0.45 0.54 0.56
Gliding Windaw LovaE 0.30 032 0.55 7] -
Law-EwithGnlles 0.30 029 DAG
LmvESmartsun 0.30 021 0.49
Low-E SmanSim with Gjflj 0.31 019 0.43 •I';�
Clear Dual Pane 0.43 0.61 0.65 -
Clear Dual Pane with Gnlles 0.43 0-55 0.58
Fixed,Transom,. Lnw-E 0.28 033 0.5fi
Circle Trip"Ylndow Lmr{wiryt-.- 0.:9 0.30 0.50
LmwE SmartSun 021 032 0.51 `;in
Low-E SmartSun with Grilles 0.27 020 0.45 ;♦�� '.
Clear Dual Pane 0.44 0.61 0.64 I _'
Clear Dual Pane with Chilies 0.45 0.53 D.56
LGIV-E 0.29 032 0.56 -
Narmline• Low-E with GdOes 0.30 0.29 0.49
Gliding Patio Doors
LmwESun 0.29 020 031 } I
law{Sun with Grilles'0.310.18 02'1 .tet
lnr-E SmartSun V8 021 050
Lmv-E SmartSun with Grilles
ClearDual Pane 0.43 0.61 0.64 -
Clear Dual Pane with Grates 0.43 0.:.,4 0.56
low-E 0.28 0.32 0.56 -
Perma-shleld' Lw-E with Grilles 0.30 029 0.49
Gliding pada Doors Low-E Sun 0.29 D.19 030 _1
Low-E Sun wah Grilles 0.30 0.17 0.27• :j-
l w-ESmartSun 027 022 0.50
Low{SmartSun with Grilles 029 0.19 0.44 Jt
Clesraua,Pane 0.43 045 047 -
ClearOual Pane wuh Gullies 0.43 039 0.40 -
Lori-E 0.32 024 0.41
Hinged Inswing Law-EwithGrilles 0.33 021 0.35 -
Patio Boots Low-E Sun 0.32 0.15
LmwE Sun with Gdlles 0.34 0.13 0.19 -
Lo*E SmartSun 0.32 016 0.37
Lmv-E SmartSun with Grilles 0.33 014 0.31 -
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