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HomeMy WebLinkAboutBuilding Permit # 9/21/2016 0ORT11 BUILDING PERMIT 0 fFV 16 TOWN OF NORTH ANDOVER go APPLICATION FOR PLAN EXAMINATION f2 Permit No#: Date Received Date Issued- --—---- --- L IMPOWfANT: Appfic4nt must complete all iteiuon this pag ______ --------- LOCATION a r (I L/ Vv1 `4 11 Print PROPERTY OWNER [k, Stn4- & J 'Print 100 Year Structure yes no MAP F`ARCEL:CX7 ZONING DISTRICT:_,V\ 21 Historic,District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building [ One family El Industrial El Addition D Two or more family El Alteration No. of units: 0 commercial LeRepair, replacement 11 Assessory Bldg F1 Others: 0 Demolition 11 Other is ,,,W, e 6 of ; iriT/T Watershed f............ 64 0 v bt 7 x", PT� w , 10 DESCRIPTION OF WORK TO BE PERFORMED: TM C,< Identification - Please Type or Print Clearly OWNER: Name, Phone: "i C/75' -Z q kc� Address: /, (I U All S 01 A V1(4 Contractor Name: tt Phone: 2, 2.-C L/ Email: J Z Address: �o 3"1,oJ01S Supervisor's Construction License: qe� —Exp. Date: I& - cx, ­4, Nome Improvement License- Exr). Date: 2 3 ARCH ITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGPERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund SJ Agin h t[0.m L 0 1 C A4,0 _gna c.o-b-tr �ORToi q Town of ndover No. * _ o LAKE h ver, Mass, _ COCMICNlw1CK S U BOARD OF HEALTH PERMIT . T D Food/Kitchen s Septic System THIS CERTIFIES THAT ...... 4.0.!!h.6............... .041.46.V,,........ .... . .... . ..... .... . . .... BUILDING INSPECTOR has permission to erect ................—........ buildings on —..tar...rA ...... *.r.......... Foundation Rough t0 be 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 CONSTRUC ST S Rough Service .. .,.. BUILDING.INSPECTOR. Final GAS INSPECTOR Occu auc Permit Required to Occupy Puildin Rough J 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 Andersen. dba:Renewal by Andersen of Boston Eugene Jaysane .�% Legal Name;Renewal by Andersen LLC 55 Farnum St ��1� HIC#170810 North Andover,MA 01845 wiHnaw ne . ..... 30 Forbes Road 1 Northborough,MA 01532 H:(978)975-2480 Phone:508-351-2200 1 Fax:(508)986-7072 1 RbABoston0perationsCAndersenCorp.com Customer(s)Name: Eugene Jaysane Contract Date: 08/19/16 Customer(s)Street Address: 55 Farnum St, North Andover, MA 01845 Primary Telephone Number: (978)975-2460 Secondary Tclephone Number: Primary Email: declercgQbu.edu Secondary Email: Buyer(s)hereby jointly and severally agrees to purchase the products and/or services of Renewal by Andersen LLC d/b/a Renewal by Andersen of Boston("Contractor"),in accordance with the terms and conditions described in this Agreement Document and Payment Terms,Notice of Cancellation,Itemized Order Receipt,Terms and Conditions of Sale,Lead-Safe Form,Owner or Builder,and any other document attached to this Agreement Document,the terms of which are all agreed to by the parties and incorporated herein by reference (collectively, this"Agreement"). Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount: $7,500 By signing this agreement,you acknowledge that the Balance Due,and the Amount Financed must be made by personal check,bank check,credit card,or cash. Deposit Received: $0 Balance Due: $7,500 Estimated Start: Estimated Completion: Amount Financed: #fl 8-10 wks 1-2 days Method of Payment: Credit Card We schedule installations based on the date of the signed contract and secondarily on the date in which we complete the technical measurements.'The installation date that Notes: Visa we are providing at this time is only an estimate.We will communicate an official date 2499 @sign and time at a later date. Rain and extreme weather are the most common causes for 24990start delay. 24990completion Buyer(s)agrees and understands that this Agreement constitutes the entire understandings between the parties and that there are no verbal understanding changing or modifying any of the terms of this Agreement.No alterations to or deviations from this Agreement will be valid without the signed,written consent of both the Buyer(s) and Contractor.Buyer(s)hereby acknowledges that Buyer(s) 1)has read this Agreement,understands the terms of this Agreement,and has received a completed,signed,and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was orally informed of Buyer's right to cancel this Agreement. NOTICE TO OWNER:Do not sign this contract if blank.You are entitled to a copy of the contract at the time you sign. YOU,THE BUYER, MAY CANCEL THIS TRANSACTION AT ANY TIME NOT LATER THAN MIDNIGHT OF 08/23/2016 OR THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION, WHICHEVER DATE IS LATER.SEE THE ATTACHED NOTICE OF CANCELLATION FORM FOR AN N4 RIGHT. customers) a:Rene An emn o Boston C� Signature of Sales Person Signature Signature Duncan Fields Eugene Jaysane Print Name of Sales Person Print Name Print Name 08/19/t6 Page 2 1 10 a a Renewal Itemized Order Receipt byMdersen. dba:Renewal by Andersen of Boston Eugene Jaysane MI Legal Name:Renewal by Andersen LLC 55 Farnum 5t HIC#170910 North Andover,MA 01845 WIN30 Forbes Road I Northborough,MA 01532 H:(378}975-2480 Phone:508-351.2200 1 Fax:(508)986.7472 l RbABostonoperations®AndersenCorp.Com ROOM., DETAILS: 201 Room 1 Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR Canvas, INTERIOR Canvas, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: Canvas, Screen: Fiberglass, Half Screen, Grille Style: Grilles Between Glass(GBG), Grille Pattern: Sash AIL Colonial 3w x 2h, Misc: Non 202 Room 1 Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR Canvas, INTERIOR Canvas, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: Canvas, Screen: Fiberglass, Half Screen, Grille Style: Grilles Between Glass(GBG), Grille Pattern: Sash All: Colonial 3w x 2h, Misc.- Non 203 Room 1 Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR Canvas, INTERIOR Canvas, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: Canvas, Screen: Fiberglass, Half Screen, Grille Style: Grilles Between Glass(GBG), Grille Pattern: Sash All: Colonial 3w x 2h, Misc: Non 204 Room 1 Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR Canvas, INTERIOR Canvas, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: Canvas, Screen: Fiberglass, Half Screen, Grille Style: Grilles Between Glass (GBG), Grille Pattern: Sash All: Colonial 3w x 2h, Misc: Non 08/19/16 Page 4 1 10 Renewal Itemized Order Receipt byAndeMn. dba:Renewal by Andersen of Boston Eugene Jaysane FQ Legal Name:Renewal by Andersen LLC 55 Farnum St HIC#170810 North Andover,MA 01845 wiNanw a lACEAIENT 30 Forbes Road I Northborough,MA 01532 H:(978)975-2480 Phone:508.351-22001 Fax:(508)986-7072 1 RbABostonOperationsdAndersenCorp.com r •O• DETAILS: 205 Room 1 Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR Canvas, INTERIOR Canvas, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: Canvas, Screen: Fiberglass, Half Screen, Grille Style: Grilles Between Glass(GBG), Grille Pattern: Sash All: Colonial 3w x 2h, Misc: Non WINDOWS:5 PATIO DOORS:0 SPECIALTY:0 MISC:0 TOTAL $7.500 UPDATED: 08/19/76 Renewal by Andersen is committed to our customers'safety by complying with the rules and lead-safe work practices specified by the EPA. 08/19/16 Page 5 1 10 r �K byAnders a� FyMbQW' REPLACEME." nn Mdrun(:n�tpaisy :g Boal {fgcn Low R ftar€Si�n 100-00473518-010 -EN'ERGY P QRS E RUEMS U-Factor C9.S 11 P Solar Tat Cain Coefficient UA ---�... 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The COM1100111pealylt 01 massachasetts Department etj'latelustelal Aceldet:ts ©fflee of Investlgatlons 600 Washington Street Boston,MA 62111 r _ fuwip mass govIdla Workers'Coin pens odon Insurance Affidavit: Builders/Contraetars/Eiectrlcia ns/Plumbars ApAcant Information Please Plot Lggyfblx Mame(Business/Oiganizationl rglvidunt):_Renewal q Andersen Address, 30 Forbes Road _ Ci /SlatcfZip; Northboro NIA 01532 Phone#: 508-351-2200 Are�ou an employer?Check the approprinte box: 1.L1t1*I ata a employer will) 3Q 4. ❑ I alis a general contractor at►d I ape of protect(repairs<I): employees(full and/or part-time), have hired the sub-contractors 6. ❑New construction 2.❑ 1 am a sole proprietor or partner• listed on the attached shoo. 7.itRemodeiing ship and have no employees These sub-contractors have S. ❑Demolition working for me in any capacity. employees and have workers, corn insumnce.;< 4. E]Btdlding addition (tdo workers'comp,lnsurance p• required.] 5. ❑ We are a corporation and Its 10•❑Electrical repairs or additions 3.Q I am a homeowner doing all .York officers have oxoraised ihcir 11.EJ Plumbing repairs or additions myself,[No workers'comp, right ofexempiion per MOL 12.ED Roof repairs Insurance required.]s C. 152,§1(4),and we hi vo no employees,[No woricors' 13•0 Ulher -, camp,insurance required,) •Any applia pt.shpt ehecla box Yi must Biro till out the section below showing tlwr workers'compensation policy inPomraliaA. t liomaowners n hosutmill thls attidovit indicating they Are doing all walk rand then trim outside canimctors roust mrbntlt a new nikldavit indicaitngsuch. $Contractors that oheck this bm west ssteahad an additional shoo shtwing the ammo of the sub-contrackrrs and stats►vhethcr or not thaw entities Irnve employees, If the sob-eontraatars More employees,they mist provide ibeir workers'comp.policy anniber. I am all enlpla}rer Mal is providing workers'compensuflan trearlrance fur 11pt employees gelolp Is 111e Polley RHel Job site bubrH71r11011. Insurance Company Name: Old Republic Ins. C.O. Policy#orSelf-ins,Lie.ti:-M}j,#IC 3(54370() Expiration Date: 1011/16 Job SiteAddross; 55FARNUM STREET -City/Stalvalp: NORTH ANDOVER, MA 01845 Attach a copy of the workers,compensplion polley declaration page(site►Ping the policy number and expiration date), Failure to socuty coverage as required under Stratton 25A ofMGL c. 15.2 can land to the imposition oforiminai penaities ora tine up to$1,300.00 and/or one-year Imprisonmem,as well as civil penaltles in the forrn ora STOP WORK ORDER and a fine of up to$250.00 a day against ii:c violator. Be advised that a copy of tliis statement nifty be forwarded to the Offlca of Investigations or the IIIA for insomnee coverage verification. I ria hereby cert04 rrder 11 prrlits lied peltlrttles of perJrlry Ilial I/10111falfitlddon prorlderl ubuve telae r/rrd rarrecr ai re: 09/19/2019 Phalle �f,jrclirl marc'ol1ty. Ao uat rvrlle lH Ihls arert,la 6e rarrelrtelert 6y clfy ur 1otpH oJpclrtt, City or Town: Permit/Licenso o Issuing Authority(circle one), 1.Board of health 2. Building Deparimcnt 3, Cityfrown Clerk 4,Electrical inspector 5.Plumbing Inspector S.Other Contact Person: Phone#: I A*MCOR4H VAQAVV0 TM c9KnWAT8 19*BUBO 116 A NATTER OF INFORMAMON ONLY AND CONMRS W Mona UP"THE CERTIFRIATI HOLMM,THIS commang OM NOT AFFMIUTIMY OR MMWMW AMEWO, WEND OR ALTER 7W COVOME APPO ROM RYINS pioW= NgLOW. TM MNnFMTB OF MURANCE DOES MW CONO1TFM19 A GONM= BETWM TMEtSBUN&MBURFAs),At"Hojq= REPMONTAIM ON PRDWCEFLAtO THECMIROATO HMWit mom wiffla cord solft cordw vamatiommue ^lim, 945-7378 —1 M&Nat(M)46Y4M �rroirdi.otse wars MA�HWA.lold Z414rl by Arardnraan[1.0 e: 30ftdmRud Roftbwmqh,MA 01632 mawAm a] de~orarsr r: Opy pa CENTUWATE:NUNIBLIRt REVWN NUIUSM �THEE IS T�TWY THAT"*!POUGM9 OF NSURANM LIMED BUOW HAVE BEEN HNUM M7HE fmaURW NAMMAPDVE FMIME Powy FoRlob WWATEED NOYNTHSTAKANG ANY REOUPMENT, TERM OR OONMON OF ANY COWYKAOTC)ROrMgRDOOLWa4TVffmRESECTTCkVMICHTHJB CeWy CATE IAW BE IM1W OR MAY PERTAIN,THE INSURWE AFFUMIED BY INE PCUC4ES J)ssCRWW HCRM T BWLUSUMAND COMMON OFSLICH POUCM&L)WMSHMWVAYHKVEGE9NKWWW By MDCL*Jhffi. IRSMW TOALL-nETERMS. -- Tmop&SWAWI PoI.i69WUNBR umm A c=mwmmLsr--wALumurf roz"DO CUUMS40M Mon" 30JAK0 Imme MOLE PEO ZAADVWAM Iry PM SWERULASSWATE—a 4� r4LW Loc �AW I ow A nAwmm im=s m my m w p., ARrFDe ;DOILY Wuuwvws**w. # WMAUM AMM HWr FACK� rE Fjmm� lulgimoNs A *%DWMWMWUA8WV Tin A" 001"Mo ML am 1 OFF011 lallia�? Ar,=RW 1, 3 famo KLVWMji.HAempLQ=j a e,�beI13AB8•P81lCYLaN€R a eI r"y"*be"prom*PRO ranwft* I'-, CANCE"7w" 4IM"AW Of TFS AW3%%DE"RED F%iaMX5ECAN0ALm WMIM TO WWWT= DAM 7WWW, ROM "LL to DELWIWM IM ACODRW=MM THE pq=r p"W=NL GOWGRAMOK All Acmo Z( umf) do,0 irb pn(A 4� Massachusetts-Department of Public Safety Board of Building Regulations and Standards Construction Supen•isor License:CS-=125 JAIMR L MORIN 86 OARDLUR SST LYNN MA 81905 )Asti t` Expiration Commissioner 101=016 C-�/ie Wamnonurc��t/�o�C�ae�r.�a�uiaeCld • ce of Consumer Affs Ira&Business ftulatiou ME IIUPROVE�I:NT CONTRACTOR e�istratic ;:=='tom 10 Type: Expir."44i Su q, .;.;-.�•., .. .„ PPlement Card RENEWAL 8Y AND ,L4�-' ; JAIME MORIN 30 FORBES RD ;�.t�_a���•�, NORTHBOROUGH,MA 09532 - LJndersccretary