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Home My WebLink AboutBuilding Permit # 8/4/2016 TOWN OF NORTH ANDOVER „oeTti APPLICATION FOR PLAN EXAMINATION � � 9 Permit NO: Date Received �SsacKus�t Date Issued: IMPORTANT: Applicant must com lete all items on this a e LOCATION S 61-1 C-k Qq In C "^ T Print j� PROPERTY OWNER -�- - ' �'F� L4-e � 1 z Print MAP NO.: 21 PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential '.... New Building F One family ❑Addition ❑Two or more family -1 Industrial C Alteration No. of units: KRepair,replacement C Assessory Bldg ❑Commercial C Demolition C i Moving(relocation) E. Other h Others: Foundation only DESCRIPTION OF WOW TO BE PRFIFORMED } Identification Please Type or Print Clearly) OWNER: Name: t4 VJ- Phone: -7 `" O Address: CONTRACTOR Name- -0�� Phone: c C� Address: 2- La- c t �-A Supervisor's Construction License: Coil (. 2— Exp. Date:, Home Improvement License: ( - Exp. Date: L /I ci Z-0 17 ARCHITECT/ENGINEER Name: Phone: Address: Reg.No. FEE SCHEDULE.BULDING PERMIT.•$12.00 PER$1000.00 F THE TOTAL ESTIMATED COST BASED ON$125 00 PER S.F. Total Project Cost :$ x12.00=FEE:$ Check No.: Receipt No.: Page lof4 ,A®RTH Town o ® - + V6 2 No. C, LAKE h " ver, Mass, coc"'C"t ,C. 40 AreD okfp 5 S V BOARD OF HEALTH Food/Kitchen PER T LD Septic System THIS CERTIFIES THAT !. 4.... .... � ,,......,�, ,�.,,, BUILDING INSPECTOR ............. .... ..... . . . ..........at has permission to erect .......................... buildings on .. 1� . . 1� �... ... .......... Foundation . Rough to be occupied as .2.(e..... • � 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. 3 1P1 PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit, Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR- UN LESS C NST TI Rough Service .. .. . ... ...... .... .. . BUILDiN NSP TOR. ., Final GAS INSPECTOR Occupancy Permit Required t® Occupy Builder 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. Major Window&Contracting Invoice 21 Lexington Ave. Methuen,MA 01844 M 1 = MA CS.# 86282 MA HIC.#134277 6/29/2016 Phone f- 978-807-3416 Majorwindowandcontracting@yaho... _.. ax 19 978-688-0644 Jots Address Mark&Maureen Hentz Same 864 Chickering Rd. No.Andover, MA.01845-1912 978-886-0109 Furnish and install 24 Harvey Classic white vinyl replacement units.(21 double 14,200.00 94,200.00 hung and 3 picture window units). All units to have Cnergy Star efficient glazing, half screens on double hung, grids between the glass to match existing windows(kitchen area to conform to the rest of the house), white exterior capping of window sills and casings. Repair 4 exterior sills and casings. Haul away all debris and clean work area. No painting is included. If lead paint exists an additional$30 per unit will apply. Building permit included. u u i - i t 3 i Total $�� , %_, -' 16 13:14 FROIL- 9785572130 T-091 P0001/0002 F-081 CERTIFICATE OF LIABILITY INSURANCE DATE ori 0IYYM FICATE IS ISSUEDAS A MATI"ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS E DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT; If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement($). N A PRODUCER NAME: Michaud Rowe and Ruscak Insurance Assoc pHaNN _ Na:97B-557-2130 PO Box 188 ADDRIESS: North Andover,MA 01$45 PRODUCE INSURER(S) AFFORDING COVERAGE MAIC# INSURED IN$uAERA: Hanover Insurance Co INSURER 13 Major Window Installations Brian Major INSURER 0; 21 Lexington Avenue INSURER D: Methuen,MA 01844 INSURER E.' IN$URf=R F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT,'TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMIT$SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILT R TYPE Of INSURANCE IMSRADL U6R MA POLICY NUMBER M pD FIVOtY BFF MMlRI)11 `f LIMITS A GENERAL LIAVILITY OHN-5719675 09/06/2015 09106!2016 EACH OCCURRENCE S DAMAGtz TO REN I EDi x COMMERCIAL GENERAL LIAMUTY PREMI l occurrence $ CLAIMS-MADE OCCUR ---' MED EXP(Any one person) $ 5[s00 PERSONAL&AOV INJURY $ 1000000 6ENERALAGGREGATF $ 2000000 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMPIOP AGG $ POLICY, PRO- El LOC $ AUTOMOBILE LIA9ILITY COMBINSD SINGI.O LIMIT $ l (Ea accident) ANYAUTO BODILY INJURY(For petaon) ALL OWNED AUTOS BODILY INJURY(Per acd(1511) S 3CHERULEDAUTOs PROFERTYDAMAGE $ l (Per accident) HIRED AUTO$ NON-OWNED AUTOS $ I I $ UMBRELLA LIAB OCCUR EpGH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ _ 11 S DEDUCTIBLE S RETENTION $ I WC STATU- I OTH- WORKERS COMPENSATION To lie Issued by Carrier LIMITS AND EMPLOYBR&'LIABILITY ER ANY PROPRIETOWPARTNERIEX£OUTIVE YIN ,> FAON ACCIDENT S OFFICERlMEM8ER EXCLUDED? N I A ((Mandatory in NH} E.L.DISEASE-FR EMPLOYE $ fr yes,describe under E.L.DISEASE-POLICY LIMIT $ E'FF DESCRIPTION OF OPERATIONS 1 LOCATIONS r VEHICLES(Attach ACORD 101,Additional Remarks$chedute,if frtor05PTCe 16 RCIUIMCI) CERTIFICATE HOLDER CANCELLATION Town of North Andover SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELI.PD BEFORt THE EXPIRATION DATE THEREOF, NOTIAE WILL BE DELIVERED IN ACCOROAMCE WITH THE POLICY PROVISION$. 1500 05900d Street North Andover MA 01845 AUTHORIZED REP NTA 0 19 -2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD 08-03-' 16 13:14 FROM- 9785572130 T-091 P0002/0002 F-081 yy DATEA,co!zv CERTIFICATE OF LIABILITY INSURANCE {ManlonrwYYl 08/03/2016 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 TKE 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:—Fthe 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 endersernant. A statement on this certificate does not confer rights to the certificate holder in flew of such endorsement(s). PRODUCER N ME r Jason Michaud MICHAUD, ROWE AND RUSCAK INSURANCE ASSOCIATES, INC. PHON o e (978)688„8829 (Fc No I E-MAIL ADDRESS: jmichaud@mrtinsurance.com PO BOX tgg 1PU-q1jRFRt-t91 AFFORDING COVERAGE NAIC# NORTH ANDOVER MA 01845 INSURER A: TRAVELERS PROPERTY CAS CO OF AM 25674 INSURED INSURER 15: MAJOR BRIAN DBA MAJOR WINDOW INSTALLATION INSURER C- • tN�utzEA D; 21 LMNGTON AVENUE INSURER E.; METHUEN MA 01844 INSURER F: COVERAGES CERTIFICATE NUMBER, 74267 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 SEEN REDUCED BY PAID CLAIMS. I I TYPE OFINSURAINdE ADL ROUCrYNUMBER P U EFF POLICY YYl LIMIT'S COMM4RCIALOENERALUABILITY EACHOCCURRENCE S CLAIMSWADE OCCUR PREMISES Es occurrence MEQ EXP(An ane rson) $ p N/A PERSONAL$ADVINJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GI»NERAI,AGGREGATE S PROLOC- PRODUCTS-COMPIOP AGG $ POLICY❑JECT $ OTHER: AUTOM0MILE LIA0ILITY COMB[NEQ SINGLE LIMIT $ E� cci n ANY AUTO 100DILY INJURY(Per person) $ ALL OWNED SCHEDULED N/A BbDILY INJURY(Per trecidsnt) $ AUTOS AUTNON-OWNED I PROPErtTYQA Eis HIRED AUTOS AUTOS (Per s UMBR6LLALIA0 OCCUR EACH OCCURRENCE s UX003 LIAB CLAIMS-MADE NIA I AGGREGATE $ DEO RETENTIONS $ WORKFRSCOMPENSATION XI&7T UTE ETH AND EMPLOYERS'LIAe31.IrY YIN ANYP,{OPRIETCRIPARTNERfEXECUTIVE E.L.GACHAOCIDENT $ 100.000 AOpPICERlMEMBER EXCLUDED? NIA NIA N/A 7PJUB0236MO5016 09/11/2015 09/11/2016 {Maedatpry)n NH) E.L,DISEA8E-EA EMPLOYEE]$ 1 OD,000 If yea,describe under DESCRIPTION OF OPERATIONS belowE.L.DISEASE-pdLICY LIMJT $ 500,000 I N/A DMORIP1'ION OF OPERATIONS I LOCATIONS I VEHICLES(ACDRD 901,Additions]Remarks umou[a,may be attached if more space is rogwred) Workers'Compansation benefits will be paid to Massaehusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no autho€ization is given to pay Claims for benefits to employees in states other than Maasschusetts it the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy in force on the data that this certifowe was issued(unless the eypirstion date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of,Coverage-Coverage Verification Searoh tool at www.mass.govllwdhvorkerg-rompensAliontinvestigationsl. Sole proprietor has not s[ecled coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLIOIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street AUTHORIZED REPRESENTATIY6 North Andover MA 01845 yanje M Cro y,CPCU,Vice President—Residual Market—WCRIBMA m 1988-2014 ACORD CORPORATION. All rights reserved. ACO RD 2S(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth ofMassgchusetts .. : Department of IndustrialAccidents I Congress Street,Suite 100 J Boston,.1YA 02114-2017 :Vh„r www tnass.govldia tai kcxs'co.nnpe�satio�z Lmrance Afcdavit:Builders/Contracto rsLEXectrdciansLPl mbars. TO BE QED WITlT TBE PFIWMTZ'ING AUTkCOR'Ty. l'l ase Print Le " l Applicant Information Name,(Susiness/OrganizationUdividual): opt, t V\,ct(T 1 l' .Address: G city/state/zip: Phone#: 7 v Areyou an employer?Checl�tsie apli,`rapriatebnx: Typo of project( �aitllired}: 1.❑T am.a employer with_,,,,�_..1...,emPloyees(full audlorpart time) 7, New col]si et7i4n S sm a sale proprietor or partnership and have no employees working for me in $. Remo doling any capacity.ENO warkers'comp.insurauce required.] S n D emolition. 3.[]T am a homeowner doingall work myself[No workers'comp..insurance required.l' 10 ❑l3uildirrg addition �#. l am a homeowner and-wilt be,hiring contractors to conduot all work on my property. Swill 1 Eieotricrepairs or additions ensure that alI contractors either have workers'compensation insurance orare sole . , al propzletors vathno employees. 1.2 fJ Plumbing repair's or additiozrs 5.FJ S aua agenerat contractor and Shave hired tq sub-contractors listed on the attached sheet. i -E]Roff iepails These sub-contractors Have employees and bave workers'comer14..insurance. Otllcr 5 5.❑We are a cazporat on and ifs officershave exercised their right a£'exemptionperMUL c, rppIoyeas.jNaworkers'comp.insuraucerequired] I52,§1(4),and�vahave q.e i' `Any applicant that checks box M must also M out the section below showing theirworkers'compensation policy information j; Homeowners wire sdlimit fids aZdavit indieatingthey are doing all.workaud then]afire outside contractors must sgbmit anev�affidavit irdieating such Contractors bat checkthis box must•gitached an additional sheet showing for name ofthe sub contractors and state v�lrather nr not thane entities have employees. Ifthe sub corilrar dors have employees, Iiey must provide their workers'comp.policy number.' xan an epriployertliat rspYovdirzgworkers'compensation insurance for my employees'Belo is thepolicy arid'jab site information. Insuranev Company Name: Policy#or Solf^ins.Iic.#: E piratiora Date: lob Site Address: City/State/Zip: vvixrg the polzcy number and expixation date). Attach a copy of the Workexs' compepsation policy declaration page(sho Fall-ore to secure coverage as required.under MGI,c. 152, §25A is a criminal violation punishable by a fine up to$1,500.00 and/or one�year imprisonment,as well as oivil penalties in the form of a STOP WORD QItDEI and a fine of up to$20.00 a day against rile violator.A copy Of this statement may be forwarded to the Office of.fnvestigatiorrs of the DIA.for insurance coverage verifloation. X do hereby cernf under the pains and penalties of perjury that the information prodded a7�ave is Prue and correct. Date: J ' Signa re: Phone#: CJ tZ ' in this area,to be completed'by city or toren official, Official use only. bo not write City or Town: PermitlLicense# fssuing Authority-(circle one): E I.Board of Health 2. 6uildin Department 3.City/Town Clerk 4.Electrical Inspector 5.PlumbingInspector• G.Other Phone Contact Person: Massachusetts Department of Public: Safety Board of Building Regulations and Standards DRIVPR"S' License CS-086282LICENSEi i�"' C;onstrucfonSu "nr4fPsow " ®GBNp AdNUM6@R iV u'qNONE 563226745 BRIAN A MAJOR _: 1�, a(�E �� a nDO 21 LEXINGTON AVEC��1�� y� P i �� 04.1 1.66 � METHUEN MA 01844 �� ,c ass M' 10 X,� II Ilh (� , 0 21 k EXiNGTO AV .�h l-✓`� NtElHtlEN,MA01844.1420 Expiration: C ' �4 �c .h �.'c'mmi sioner 04/12/2017 ']�ooq��na�zotaaevovtseoae 0 'SJ,t7/011,p //J, Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 0211.6 Home Improvement Contractor Registration Registration: 134277 Type: DBA Expiration: 10/19/2017 Tr# 271678 MAJOR WINDOW INSTALLATION BRAIN MAJOR 21 LEXINGTON AVE. -_.__....._ _-_... METHUEN, MA 01844 Update Address and return card.Marls reason for change. Address [] Renewal F.] Employment [j Last Card SCA 1 CJ 2OM-05111 �r%✓�-�on��rr��rrircni�//r c�i"'l�l r�"tac�r�3�rffs ., Rice of Consumer Affairs&Btisirress Re8ulition License or registration valid for individul use only I` OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 134277 Type: Office of Consumer Affairs and Business Regulation A 10 Park Plaza-Suite 5170 Expiration: 10119!2017 DBA Boston,MA 02116 MAJOR WINDOW INSTALLATION I BRAIN MAJOR u r 21 LEXINGTON AVE. ,,0.,..rµ METHUEN,MA 01844 Undersecretary Not valid without signature I