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Home My WebLink AboutBuilding Permit # 7/28/2016 51 a� � PERMITBUILDING TOWN OF �. a H ANDOVER APPLICATION FOR PLAN EXAMINATION * � Permit NO: Date Received w s c w� �� Date Issued: I PORTANT: .Applicant must complete all items on this page LOCATIDN1 Print PROPERTY IiNER Print MAP NO: PARCEL:�� ` O I lG DISTRICT: Historic District � " yes no Machine ho Vi11ge yes no TYPE OF IMPROVEMENT PROPOSED USE Residential _ Non- Residential New Building One family Addition Two or more family Industrial ","Alteration No, of units: Commercial /,'Repair, replacement r Assessory Bldg Others: Demolition Other I Septic L Well LI Floodplain (-j Wetlands District Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: ` Phone: t Address: CONTRACTOR Nam Rhoneq; .. Address: u,p; Supervisor's Constructionicenso r �� pw D t w C � Horne Improvement License: E p. Cit , - �� . ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:SULLDiNG PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total roject opt: D `w FEE: $ Check No.: t I Receipt No.: NOTE: Persons contracting waunregistered contractors do not have access � . guaranty.fund w nature of ontrct ,,row , M Signafirure'of Agent/Owner � ..� � ._._. g NORTFI Town of TAndover r - h 4 1 7 ver, Mass � �t cacw�cMew.cR 1' �,gs RATE[) U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System BUILDING IV N .. BUILDING INSPECTOR THIS CERTIFIES THAT ...,. ..... ......... ..... ......................... i. has permission to erect ..... .................... buildings on ....�t ....................................... ,�.. Foundation 141104% i� Rough to be occupied as ....I()...... ..., .....Y : ....�. ........................................... Chimney provided that the person acce tin tIs !ermitshall in eve respect conform to the terms of the applicationp P P J Pevery 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 CONST TIO Rough Service .. ....... . ....... ...... ....... Final BUILDING SPE OR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 Date Invoice# Rt 107 7/18/2016 53030 Lynn MA 01905 Bill To Ship To Jason Rollins, 77 l,dgelawn Ave 208 Green St oil Melrose MA 02176 North Andover MA P.O. Number Terms Rep Ship Via F.0.B, Project 7/18/2016 Quantity Item Code Description Price Each Amount Job Address: 77 I'dgelawn Ave fi 11,North Andover 10 remw Remove existing windows and prepare opening to accept new 0.001, vinyl replacement windows 10 uric Furnish and install f'nsion replacement windows 225M0 2,250.007 20 mic Colonial Grids per sash 1100 240MT 41 nlic Mull window charge 35.00 140.001, 10 Inic Install Window masonry opening 95.00 950.00T ctg (,1ima-iechplus insulating glass including low e/Argon gas, 0.00 double strength glass gr All Window to carry lifetime warrantee to the original owner 0.00 0.00 including glass tailLIN and breakage tins Sea] Windows in and out LlSing'fite bond lifetime sealant 0.00 rern Take away all Job related debris 0,00 03 Any building permit required to complete proJect to be added at 0.00 0.00 cost to the final paynient accept acceptance of proposal 0.00 0.001, authorized signatm_ Sales Tax 6.25% 223.75 All sizes on file ready to order 1 ^99 $3,80175 Phone# Fax# E-mail r e 791-592-9747 781-592-9746 ehwindoxv(41111sn.com Nvww.ebwindow.corn 'l The Commonwealth of Massachusetts { Department of Industrial Accidents � (Office of'Investigations I Congress Street, Suite 100 f �' Boston, MA 02114.2017 ' �•� www mass.gov/dia Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plu yrs Applicant Information Please Print L `><� EB Window and Siding Co Name (Business/organization/Individual): �� r Address: 756 Western Ave �' Zi Lynn, MA 01905 .Phone M 781-592-9747 City/State/ Are you an employer? Check the appropriate box: Type of project(require ;": I.M I am a employer with 6 4. ❑ I am a general contractor and I ❑ New construction employees (full and/or part-time).' have hired the.sub-contractors 2.F-11 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling and have no employees "These sub-contractors have 8. ❑ Demolition working for me in an capacity. employees and have workers' 6 Y p Y 9. [❑ Building addition [No workers' camp. insurance comp, insurance.t required.] 5. We are a corporation and its 10. ] Electrical repairs o lWitions 3.{� I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs odditions > right of exemption per MGL myself. [No workers comp. 12.n Roof repairs insurance required.] '� c. 152, §1(4), and we have no employees. [No workers, 13.® Other > comp. insurance required.] i r' j *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. � t [fomcowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicatia -uch, tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities t've employees. If the sub-contractors have employees,they must provide their workers'comp.policy number, I atn an employer that isproviding workers'compensation insurance for my employees. Below is theposite information. Insurance Company game:Berkshire Hathaway Gaurd Insurance Co � Policy#or Self-ins. Lie. M EDWC643855 Expiration Date: 12/13/16 Job Site Address; AVCity/State/Zip: N Attach a co of the workers compensation otic declaration page(showing the olio number and a irati date). copy p policy p' > ( g policy p 9�� ) Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal peva bs of a tine Lip to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WOR�QRDE � 11 nd a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office j Investigations of the DIA for insurance coverage verification. l Ido/tereby certify trader the pains crud Itenalties o/per;luty that the itzfornratian provided ab ve is tr ye and correc � Sip,naturc: °' Date: M, Phone#: 7$1-592-K, 47 Official use only. Do not write in this area, to be completed by city or town official. City or Town: Permit/License # Issuing Authority (circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspe� �r 6. Other r Contact Person: Phone#: . ® DATE(MMICiDlYYYY) AC CJ CERTIFICATE OF LIABILITY INSURANCE 7/7/2016 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT Commercial Lines PRODUCER PHONE (781)599-2000 0 Na Admiral Insurance Agency,Inc. rAlc•.ttQI _.._- - ----- --. _„ 1: E-MAIL �- - 70 Munroe Street: _A-DDRES$;_- Suite D INSUR�Rf§)AFFORDING COVERAGE MAIC# Lynn MA 01901 INSURER A Providence Mutual Fire Ins Co 15040 INSURED INSURER 13:Guard Insurance ..._—.--- EDMUND DBA BYRNE & ED BYLINE WINDOW COMPANY INSURER_c: 766 WESTERN AVENUE INSURER D: _INSURER E LYNN MA 01905 INSURER F' COVERAGES CERTIFICATE NUMBER:CL1631522634 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 - INSR TYPEOFINSURANCE POLICY NUMBER MMIDDIYYYY MMIDDIYYYY LIMITS LTR }( COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ... _._. _._..._-_ DAMAGE TO RENTED- 1,000,000 ` PREMISS ES IEa-accurrence $ ,.,.._._ A � CLAIMS-MADE �X OCCUR 5 000 ' BOP0063101 6/21/2016 6/21/2017 MED EXP(Any one person) $ PERSONAL&ABV I#3JURY $ 1,000,000 ._ ___,_ ..... GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 21000,000 PRODUCTS-COMPIOAAGG Ll $ 2,000,000 X POLICY JE a LOC ELL $ 50,000 i OTHER: 1COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident _— II BODILY INJURY(Per person) $ V ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ ' AUTOS ... AUTOS NON-OWNEDPROPERTY DAMAGE $ HIRER AUTOS AUTOS Per accidence_-._ I UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1 EXCESS LIAR CLAIMS-MADE AGGREGATE $ _..._.-- DED RETENTION$ $ I WORKERS COMPENSATION STATUTE AND EMPLOYERS'LIABILITY OOO,OOO [ANY PROPRIETORIPARTNERfEXECUTIVE YIN EDWC643855 12/31/15 12/21/16 E,L.EACHACCIDENT $ 1, _ i OFFICERIMEMBER EXCLUDED? C- 1 N!A _E.L.DISEASE-EA EMPLOYE $ 1 000,000 B EIMandatoryfnNH) ----- If yes,describe underE.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may he attached it 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 J S Schol]ick/MPB ©1968-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ��:. - i:li;r/ls..:!!',_f1 r��:1 r'.j' f�✓1i=i7i`fla l<'��r 0fficc of Coitsulite r A ffairs&8uslitms 14egulafinn #� HOME IMPROVEMENT CONTRACTOR Registration: 128634 Type: t* "Expiration: 502017 DBA ED BYRNE WINDOW CO EDWUNQ BYRNE 766 WESTERN AVE. LYNN,MA 01902 lisdcrsecrclarw I�Tass rf}a�srtts D�,p.,wt;jerat of pE.oi lic S t/ Fard cil Ptdl9ci( r Rc1;€Izatf�;tt., and;t.;llrarc#s ire nse: CS-090870 ED I MD J 13YR E 18 Wood row'I'err-jcc Lynn NIA 01904 F:x.pira#int, C fan3€zti,siesn�r 07109121117 i