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HomeMy WebLinkAboutBuilding Permit # 4/26/2016 000TH 0 0 BUILDING PERMIT 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: 17A) Date Received Too Date lssued:z.l 17/(p tp— IJWPORTANT: Applicant must complete all items on this r/ ////i/,,iii, %/,/ / / / // / / /� �/� /,/ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ii New Building One family o Addition 11 Two or more family 1-1 Industrial —I--] Alteration No, of units: El Commercial FAepair, replacement Cl Assessory Bldg El Others: 11 Demolition FJ Other 5P f Identification Please Type or Print Clearly) OWNER: Name: ANDREA LEE Phone: 508-776-9294 Address: r n 11 ��/ / �� � /,//i ///,�r� /i/ ///�//i , o /// / .iii� �/ , / /, / //>r////i�„ //,ii//�� /i/, ///���/��� , ,�%iii/�/,�r/ii//� , ��/. //� �, �%,�/�%/�/��� , ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 PER S.F. Total Project Cost: $ 6,334.00 FEE: $ -] Check No.: IGA—ETA--S Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Yos, Oil! ,6 f I 8'"', nai n, ,0 r-11111111"911 AM NORTH I I C- ver flown of ® �y Z T O LAKE h , ver, Mass, AoA #fW- &-Mir COCHICHEWICH �• 0RAtEo 'IV, y U -` BOARD OF HEALTH Food/Kitchen IT& T Septic System PERM D THIS CERTIFIES THAT ......... BUILDING INSPECTOR ..................... .......... ....... ......... ............... . ......................................... Foundation has permission to erect .......................... buildings on ... .. ... �. .�...., .. .*,............ Rough tobe occupied as ............ .. �. .......... ......... .................................................................... Chimney provided that the person acce ing 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 I ;6 MONTHS ELECTRICAL INSPECTOR LESST IO S ARTS Rough ............ Service ................ .... .. .. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Kermit Required to Occupy Buddintr 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. ReneWal Agreement Document and Payment Terms 11;5AMerssen kd bl'Ama'Emn of klmom Andrea tne al Ire A-,$-, 170910 "N'ni,z4 Nanw- At "minact Phluz ldrela L e Cu,mcmnvi 1':%) Sir cet Add-revi.- 11 WneCleaVe Rd, North Andolifer, MA 01845 P ,miiv m zivphiL'Nun7b"eu: (5-0'8)776-9294 NuinkLu: 13"Ivol,q) hl.-reb,r joindy;ind by An,�!rz .n., bv. Ank:7!-crl 4A, all t md in chkAgrxvirvmi Do,ftwnerm and lerms, NoOrp. .,if 'ik�Tmnvv,Tc-rnls"I"d uiq ,7�t 11'#K', te f Wi,�. w +4z -.,I I ag I e ed r o by r kt,I v�]F7 11 n-- i�v,d i P,co i p ra r ed h-vre'n b Otho dt icu mett,i-arrachcd u, jj p".)e jj Y I lo)"I EV#L'jvrjo--, thEi k,' heT6oj-2�7row%to Ap TL T� a Lx)rnpL-,ipn oenaificmc A' TC h2,v camplurrd 311 ivuA undf. chit Arrurnicni- Tol.41,jvl)Ain-umm': S6,934 BY ,1, A 1wnt, 4nnNN 99 Am thm Ral mw Thr. awl,ihq Amount Fiji aruod'171 asr. k!tmitkl�!,,v 14veivcd: 53,334 BtitniguA Slarl: F-i IL,11 t"'I t cd", I,-,I I 11,tv I I t P 15: 6-8 wks 1-2 days S3,334 cashicheck %"Z-,-Ch 411e jITS7-011-ATiOnii on dair+,,if r.be iipjcJ cormj�au and, o'll Financing the carc in,, lriclt-i%,v C..mplerr-the mehnivA, Th-F to 1.�ILat lila ,xx-ary p"wit-o"411-1i;at tbi5 rfina,,•k miniaw, WC, wifl!o-i-ninlunrk-ate;41)offiddl dare Nui—Depo$it of $3000 check 862 and uirnoc,:a[, IhUIX Lhil". ELM ind Izxt'vOrk.,wt:wdu-�i-a.re tlr.-�:ime-t, airomcin l'im lk�j qf4(') .+,};[.'vs LJl-1dkT1T,-0!` 111W dli.' we"dhe 111.(4c k)11", #Sa"n, ing'.;heriwetr-I rh-t pfr�6:;: vid,dul. thtre-Jue no"vabol ui vJ c-,*,i.a r i d- i I V 11.,C 'JUM�iJiF ov-rjuAl T(L-rrna;Ml"I'W:Apvvntcrit. N'F dt 6&-l' vift bc v0id' rhk"iiiii'llod, of lipth dw ;nd Cf-miu.p.- -ir h p L�ijwxrpls!i hi Hirwrl'i 1,i his,read th'i" kladvvsrarjdir:hx,avrj)"-(if[his Fl T$: �d 1)1, -jk A t,iindjadl- -n ToM, tipt zcd, nd doai:4 cop. il - gxviyten chf,-nwu attachod Nd ic.-i a""Q-ancd III if,131,on dic d.m:fir-u%,,-fl:tcn Axwe and orally mfilrimcd rit-RLr"z" right r-ri cani::d this N0110ET00"WNFIZ: D1,1311I1 14pl thio.CCffirlCt IfNLIlk- YOU AIV UTILidr-Af L"A'I wpl'Uf lilt: eat l]at dLC YOU,THE BLIVER,,.NIAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TIL ANSACTION. SEE THE AI-rACHED NOTICE OF CANCELLATION FORM FOR AN EXPLANATION OF THIS RIGHT. ajjjn Rtmcwd:bv Am&rma LIC CMtfNw.,vj-"! fir Af.,2ripfl rif G A vk� Sq;wurt: Duncan Fields Andrea Lee n 11a Nani 1sl,S:dv4 P-r.win linins Kgrin: Vi int Mume -4q ReneWal Itemized Order Receipt hAndmen d6v ltd bT,Andcmen of bion Andrea too Ff,, 101 Roorn I it -`hkAd, 61 rlg,, i :q E'T n F r-'T 1,1E. patfeff VaNDOM 0, PATIO,DMRS:I SPMALTYMISC-0 Takt S,6,334 P G,AT E D:! 01 314 T i j i?u,r ,v e vo rj j and j to iif',P4 The Conownt Peafth of Mmsrackina s Offu'e of nves4oat oks 600 4114sUH9100.�:eer Roston,AM Vill wmmayr,,gerldla Wo-r-ke~ss' tiampens tflon nbtt_•acce AMllav is�tti�de s/�'o�t�actu l��tve�r�c�a�s/ '�um t~�s A,qWkvgt Into ati M-4480 t'r:otR-A °. l�`t;fne tl3usinesslivra Yratiovnndiwlttua;i; RENEWAL.BY ANDERSEN- Add- re&r,: 30 FORBES ROAD City/Stute-'7.ip; NORTHBORO,MA 01532. PholW rF: 508-351-2200 Are oo an etnplayer"Cneck`:hc appropriate box: ~I�.— 'i�-1w of peter#t'requiredy I arts a eliipleyer with 30 4. C3 1 am a gea�l contractor and I New trtirrtion employees(full an&or past-times).- htiv hired the nth-cottbaators 3.[) l am a sole prtipr rrtor or pattzier iistsd on the attached Sheat.y ' Itemodelirig strip and have iu--employcos .fhese sub-,!wittaw ors have 8. Q mmolitlon .workingfor me its any,aafnicty_ workers.'comp-insurance. 4 (Nu workets'4omp.ittfit m-me 3, 0 'Ale are a corporation and it~ El Building addition required.l offic:cr)i have merci"tt-ir 10-El Flet:tt`Ical repairs ur add wns i.[.,.1 I.am a homeowner,doing ull work right ofemmiption per MG1 -11:O Plumbing repairs or additions iv}self,1No workers'comp: C. 15-1,4,10),and w°.have tits 12,01 Roof Tepair4 insuiance requbW.11 orrtployce- ,[No:workers' } 13.[1[Mier l comp,rnstntirieet eluire3i E -•---__.—___ 'Any joemat that am&s box ii must at st'ftll WI the w.�n ttctaa i1t0u nit:itetr uv�+s .�r!t�;tisa>s srt puitoy;ttiurrtta>ion I torn warom.uho x;ik t this.a tiusvit indicatuaf;gul. doing all uork and then Stitt mu, au6tntt x aftithtvit tnd ratlatt!each ;<'%h)bw,Wrs tve ifted th*4 ixx.mint t41cic806 an addit ural xlwt 4koAma t8a nit*of the tut>>wntr&­ttu::.and thou warkar`'W Pnttey inftli"*tit lam an ertgp4wr brat is proW4 ft worAers'conwmadox iwamnreJor AW enVloyM Mot,isthe polky and jab ske Wormanon. In4tiratice Company sone- OLD REPUBLIC INS. CO. Policw A or Self-im.be.�. tu�yitt' X740....__ __.,..,y. _ l:xpirai on t7ate- 10-01-16 .fob Site adeifess: 11 STONECLEAVE ROADNORTH ANDOVER, MA 01845 ---- _ _.�_.__._._._.�._-.._,u Gity•Stttte:Lip.__ _ Attach a copy of the workers'compensation policy declaration;sage(shwing the ponq number and ex*atlon data. .Failure to secure coverage as mqu mA;hide: Section 255 of IMGL c: 15-1 can lead to the imposition of criminal p.•m wl -i o1 a fine up to$1,1100.00 andior one-year iaitprisontneut,as well as(A'd pell"Itid in the fw m elf a STOP WORK!)RDFR anal a fine of up to$250 00 a day against the violator. He advised that a copy of this statement may be fitrvyardad to the Office of Investigations of the MA for insurance covorage verification. I do leandpenahki cif perjur3°that the i#jbr nWon prrrtdrlet 4bst e A trig arnd earmL She', ��:.. __.,...�._,.___� _ � • ..�. .�._ r� P rte:�. 5 -351-2200 ,kisl ut'r only. lin not write u1 thiv area,to he renriezed by ci(is or town vdi4 kt City or i own: Permit/License 0 Jrsctiing Authority(rirale our): 1.Board of Health I Building;lopLrtiaent 3.City!Town Clerk 4.Electrical Inspector S.Plumbinguapector 6.Other OptaCt Penotlt Phone#S ANDECOR-01 YADAVYO CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/1/2015 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 pollcy(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 Ileu of such endorsement(s). PRODUCER NAMEAcTWillis Certificate Center Willis of Minnesota Inc. PHONE Ezt:(877 945-7378 FAX c/o 26 Century Blvd (AM. A/C No):(888 467-2378 P.O.Box 30591 AD�s;Certificates illls.com Nashville,TN 37230-5191 INSURE S AFFORDING COVERAGE NAIC Y INSURERA:OId Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC INSURER C: 30 Fortes Road INSURER D: Northborough,MA 01532 INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER: 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. POLICY EXP LTR TYPE OF INSURANCE INSO U POLICYNUMBER MMIDDIYY F INMMIDDI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE XOCCUR MWrZY 30f►140 10/01/2015 10/01/2076 PREMISES @e occurrence) $ 500,000 MED EXP Any one person) $ 10,00 PERSONAL&ADV INJURY S 1.000,00 GEHL AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE S 4,000,00 X POLICY 1:1 JECT LOC PRODUCTS-COMP/OP AGG $ 4,000,00 OTHER: $ AUTOMOBILE LIABILITY CEOMeBI�NdE SINGLE LIMIT $ 51000,000 en A X ANY AUTO MWTB305438 10/01/2015 10/01/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident S AUTOS AUTOSNON-O ( ) HIRED AUTOS A T SWTIED fPerOBodden) E S $ UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ AND EMPLOYERS'LIABILITY YIN X RKERS COMPENSATION PER I R A OFFICEER OPRIET RIPAR NERIE � ANY EIVE DED? N� NIA MWC30543700 10/01/2015 10/01/2016 E,LEACHACCIDENT $ 1,000,0 (Mandatory In NH) E.L DISEASE•EA EMPLOYEE S 1100010 "yea describe under DESdRIPTION OF OPERATIONS below E.L DISEASE-POLICY UMR S 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is 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 �� ©1988-2014 ACORD CORPORATION. All rights reserved, ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD PRODUCT PERFORMANCE r Andersen'NflqC curfifled Teeej Uflj-perferl-fla sce(conannad) Andersen Product Glass Type U-Factor' SHGCr VP • 200 Series Clear Dual Pane 0.45 0.60 0.63 - Clear Dual Pane with Grilles O."s 0.54 0.56 _ Tilt-wash t.mv-E 0,30 0.32 0.55 :-t gouhle-Hung Windnw Low-Ewitlt Grilles 0.30029 0 _ HP tE4 SmartSun- .49 mv- 0.30 0.31 0.49 ' NP Low-E4 SmarSun a/Gn7tes 0.31 p,lg 0,43 _ Clear Dual Pane 0.45 0.61 0.64 Narration, C", ,r Dual Pane with Grilles 0.45 0.54 0.57 Douhla•Hung Window i Low-E 0„30 032 0.56 law-E with Grilles 0.31 0.2.9 0.561- Clear Dual Pane0,44 0.63 0.66 Narration, _ Cicar Dual Pane with Grilles0.44 0.57 0.59 Transom Window 0.57 Laur-E 1vhh GAPS 0.27 030 0.52 j Clear Oual Pane 0.45 0.60 0.63 - ClmrDealPaneyl GnIIs 0,45 054 0.56 - Gliding Window Low-E 0.30 03^.- 0.55 -11 Lmv-EwithGrilles 0.30 0.29 0.49 Lmv-E SmattSun 0.30 021 0,49 Lmv-£SnmrtSun with Grilles 0.31 DAG 0.43 -41 -7 Clear Oval Pane OA3 0.61 0.65 - Clear Dual Pane vgm Gnlles0.43 0.55 0.58 Fixed,Transom,. L w-E 0.28 0,33 0.56 Circle Top'window Lmv-E with Giles 0.78 U0 0.50 Wl Lmw-ESmartsun 027 022 0.51 ? Low-E SmartSun with Grilles 0,27 420 0.45 Clear Dual Pane 0." 0.61 0.64 _Clear Dual Pane i th Grilles OA5 053 0.56 Low-E 0.29 0.32 0.56 Narmline' Law-Ewith Gdlies 0.30 0.29 0,49 Gliding Patio Doors _ Lmw-E Sun029 0.20 0,31 Lmv{Sun with Gdllas 0.31 0,18 02 r u Lmv-E SmartSun 028 0.21 0.50 Lmr-E SmartSun whit GdOes 0.30 0.19 1,14 Clear Dual Pane 0A3 0.61 0.64 Clear Dual Pane with Gdiles 0.43 0.54 0.56 _ L.ow-E 0.28 0,32 0.56 f Permo-Shiold' Lm�r-E Grilles 0.30 029 0.49 Gliding Patio D.C. law-E Sun 0.29 0.19 0.30 Lnw-E Sun who Giles 0.30 0.17 0.27 _ Lmv-ESmartSun 0.27 022 0.50 Lnw-E SmartSun with Grilles 029 0.19 0.44 Cie erDual Pane 0.43 OA5 0.47 - Clear Goal Pane with Gnlles 0.43039 5.40 - Low{ 0.32 024 tl.41 Hinged.inswing LmwE%th Grilles 0.33 021 035 - Patio Doom Lmv-E Sun .` 032 0.15 028 Law-E Sun with Gdges 0.34 0.13 0.19 - law-E SmartSun 0.32 0.16 0.37 U _j q Lmv-E Smarts."whb Grilles 0.33 0.14 0,31 �o- r Mourmwhusette-Oepadment of Public Safety Board of Building Regulations and Standards Construction Supenimr UM d IRA 01 r, s n lu Expire Cs - rdmna 1 o C-�ulus �am:mzaazwea:�o�r?�a�iusef.fa I ice of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Registration:;;tj00#p Type: Explrl#gn }fit? Supplement Card RENEWAL BY ANDL4;tww r JAIME MORIN 30 FORBES RD -- NORTHBOROUGH,MA 01532 Uoderseeretary i