HomeMy WebLinkAboutBuilding Permit # 12/2/2016 %AORTH
BUILDING PERMI'"I�
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
Permit €) Date Received
ZSACHU5
Date Issued: (e7
TANT: Applicant must cq�lete all items on this jZ, ge�
LOCATION
Print
PROPERTY OWNER Prinf 100 Year Structure yes no
MAP [0 PARCEL: ZONING DISTRICT:_,--Historic District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT" PROPOSED USE
Residential Non- Residential
Ei New Building F1 One family o Industrial
Addition [I Two or more family
eration No, of units: o Commercial
epair, replacement Cl Assessory Bldg Others:
Demolition Cl Other
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OWNER: Name:
Address:
Contractor Name: 4ilp S-i-Qe 110 �,),tjZ Phone: q 7
Email:
Addr A C
J
Supervisor's Construction License: 0 Exp. Date:_
Home Improvement License. Exp. Date:
L-—
ARCH ITECTIENGINEER 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.
11
Total Project Cost: $ C2 C,� ci FEE: $ i
T Receipt No.:__--3- (-�')--7
Check No.: t q
NOTIE: Persons contracting ivith, unregistered contractors do not have access to the gnarantyfund
.qir1n!:ifiirP of cjent/Owrj-er--z2"" ature-
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own of = : ORTT` ndover . .
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No. - _
dollz
� oh ver, Klass,LAKE
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coc.Ic"twock R_
U BOARD OF HEALTH
LD Food/Kitchen
PERMIT T Septic System
THIS CERTIFIES THAT ' Ihl bOW BUILDING INSPECTOR
has permission to erect .......................... buildings on .. ' .....,..11 .�...,, ,� .. ........... Foundation
.R /.l�C.El.'1C1�.,......,.. /.� .� Rough
to be occupied as ..... ,. 10 .... ........................ 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 CONSTRUCTION4 ARTS Rough
Service
.......... .. .... . ... ................................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
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MI Windows And Doors
650 West Market St
CN Gratz,PA 17030
1650
DHIVINYL/Grids
NaIlonilFEnesiration Panel 18x2:Llte•1:(3!32",Clear,LOE,Annealed);Lite-2:
Baling nealrati (3/32",Clear,NONE,Annealed);Argon;35 314 X 41 114
MEI-AA 11-44220-00002
Individual products may be subject to variation In performance
ENERGY PERFORMANCE RATINGS
U-Factor(U.S,/I-P) Solar Heat Gain Coefficient
0.29 0.26
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0.46
Manufacturer stipulates that these ratings canton to appac4 a NFRC procedures for detefmin no whale product
performance.NFRC Ratings are determined for a fixed set at errifreanmentai candoons and a epecine product she
NFRC does not recommend any product and does notwenantthe wilablity or any product for ary specific use,Consult
manufacturer's literature los other product performance€nlormation.
WWrntrc org
�'ENERGY STAR" '
in All 50 Stat
Perf Grade L__+DP(ASD) -DP(ASD) Water
R-40 50.93 55.14 6.06
Max Teat Size Report# Florida ID - a
38.00 X 80.00 B7962.01 12234 %
Ratings are for Individual windows and doors only. For information regarding mulled
or stacked units,please contact your sales representative.Pos and Neg DP Ilmited by
unit test slze,Tested to AAMANVDMAICSA IOt11.S.21A440-05 Glass According to
ASTM E i 300.
Printed an
2647461 grab+1 .2 4126f2013M44:152PM
The Conamorrwefrrt5c of'llfftssac cfsetts°
Department ofljtdz��trir�Z.4ccicler�ts
_7 Offz"ce of1-nvestigations
' 600Wash ilzgtar�Street
. = �
Boston, lVM 0211.1
Mass. ovf,
wwW. �rIdif
Workers'ers� Coxnpensatiolx Ltls� ranceA fxda;vit: Railders/Controciors/Electricians/Pll�mbers
Please Print Eegibi
A licant information
. _.
Name(Bitsir ess/organization/Lndividuai):� X
Address: A. _ t`N ��/
J('7A-10 0/90/Phone�:—,��/ " � �� '- " S (�,
city/Istate/Zip _W = _ e of project(required):
Are you an employer? Check the appropriate box: rip p I �:
4, [] 1 am a general contractor and I 6 LI New const ction
1.[' s
employees(full and/or part-time). listed on the attached sheet. 7. Q Remodeling
2.[ ] '1 am a sole proprietor or partner- These sub-contractors have $. []Demolition
ship and have no employees employees and have workers' 9. ❑Building addition
working for rue in any capacity. comp.msurance.t
[No workers' comp,insurance 5. We are a corporationand its 10.❑Electrical repairs or additions
required-] �
officers have exercised their •11.[l Plumbing repairs or additions
I El I am a homeowner doing all work right of exemption per MGL 12.n Roof repairs
Myself..[No workers' comp. 152, §1(4), have no and we h
c. 13. they
insurance required.] employees,[lklo workers'
comp.insurarice required_] '
n their workers'compensation policy infbnliation,
and�,A,ny applicant that checks box#1 musk also fill out the section
below
wing such.
Homeowners who sukb box attachedaan additional sheetshpwingthe nage of the sokb-contractors and state whetherde contractors muA h or not those entitietss b ve,
ontractors drat cher�
work P
workers,comp.policy number.must provide their
eruployees, Tf the sub-contractors have employees,they
is iding ers'corrapensation insurance far my employees. Beloow is the policy and jab site
I am an employer that provwork
information. 72
Insurance Company Name:
f 6 C-' L.- J Expiration Date: /
Policy#or Self-ins.Lic, #:
.� t.,' o .t Ci ,fState/Zip: r."�
Job Site Address:, t""
Attach a copy
of the workers' compensation policy declaration page.(showing the policy number and expiration date).
inal penalties of a
Failure to secure coverage 4 required under Section 25A " 152 ead to tl�e forme o STEP WDA RDE`and a ane
fine up to$1;500.00 and/or one-year imprisonment,as penalties
of up to$2$0.00 a day against the violator. $e advised that a Gopy of this statement may be forwarded to the Offi.Ge Of
Investigations of the DIA for insurance coverage verification.
u
_.__.. is true and correct.
the ains and s p, ea� tliat the•information provided above �
2-do hereby cer-tzfy an�,d G
Dal—
Si
3 �
Phone.#�
Official ase only. Do not write in this area, to be completed by city or town official
Permit/License#
City or Town: —.
Issuing Authority(circle one):
1.Board of Health 2.Buildrszg Departanent 3, (,eat Clerk 4.Electrical lnspector 5.Plumbing lnspeetar
6.Other
Phone
Contact Person:
WINDO-2 OP ID: HI
CERTIFICATE OF LIABILITY INSURANCE171T1103/2016
E(MMIDDIYYYY)
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. S
ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED ATE
POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURE RBY{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
Senn Dunn -GSO NAME: Carli Witcher CISR, CBIA, CIG
3625 N. PHONE
Elm St. Arc No Ed:336-272-7161 FAX Net: 336
Greensboro,Ward,
,CPC aoo 6s_ CWi#cher senndUnn.com
C.Timothy Ward,CPCU,CIC
INSURERISI AFFORDING COVERAGE NAIC#
INSURER A:Citizens Ins Co of America 31534
INSURED Window World of Boston, LLC
118 Shaver Street INSURER B:Allmerica Financial Benefit
North Wilkesboro,NC 28659 iNSURERC;Hartford Fire Insurance Co. 19682
INSURER O:
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. NOTWITHSTANDfNG 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,
_,..
INSR' TADDL 5 OR -..
LTR TYPE OFINSURANCE INSR WVD POLICY NUMBER MMIDDmYY MM7D61YYXYY LIMITS
AM
A X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
J CLAIMS-MADE CXkj OCCUR 1066790252707 04/0112016 04/01/2017 PREMG T0_R_E -En
Business Owners SEa ocquarrenci) ;S 500,000
-- MED EXP(Any one person) S 5,000
—_ —
E GEN'LAGGREGATELIMITAPPLIESPER: PERSONAL 8gOV iNJiJRYg 1,000,000
POLICY�I PRQ LOC I GENERAL AGGREGATE S 2,000,000
�_.
PRODUCTS. -COM PIOPAGG S 2,000,000
OTHER: .�---...
:AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT
Ea,accident} T S 1,000,000
�ANYAUTO I i W68757615 06/16/2016 06116/2017 BODILY INJURY(Perperson) S �~
ALL OWNED SCHEDULED __ _
AUTOS AUTOS BODILY INJURY(Per accident) S
HIRED AUTOS NOM-OWNED c ��.�
AUTOS PROPERTY€IAMAGE "5
Peraccideni
X [UMBRELLA LIAB X OCCUR !
EACH OCCURRENCE S 1,000,000
A EXCESS LIA6 CLAIMS-MADE 066790252707 0410112016 04/01/2017
AGGREGATE S
DFD RETENTION$ -
WORKERS COMPENSATION I S
AND EMPLOYERS'LIgBIL€TY X PER I STATUTE ERT
C ANY PROPRIETORIPARTNERIEXECUTIVE YIN 122WECLJ2635 01/2712096 01/27/2017
OFFICERIMEMBER EXCLUDED? ❑ NIA E.L.EACH ACCIDENT I g 500,000
(Mandatory In NH)
If yes,describe under E_L DISEASE-FA EMPLOYEFJ$ 500,000
DESCRIPTION pFOPERAT€ONS below E .DISEASE-POLICY LIMIT:5 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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
Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS.
120 Main Street
North Andover, MA 01845 AUTHORIZED REPRESENTATIVE
r�
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
Massachusetts Department of °ubhr- Safety
Board of Building Regulations and Standards
3_icensa: CS-072772
C-Onstruct;on S=aoerr sa ';`
JEFF C STEELE
x
24 SHERWOOD AVE M O
DANVERS MA 01923
fti ✓tom- Expiration:
Commissioner 0410712018
� . 'v, .- ,. ,r...,,u -''% `i - !�<'..,Jrr�•, ✓_rpt.
Office of Consumer Affairs&Business Regulation
1' HOME IMPROVEMENT CONTRACTOR
3 Registration: 166025 Type:
' Expiration: 4112/2016 LLC
-ri%-
WINDOW WORLD OF BOSTON,LLC.
JEFF STEELE
24 CUMMINGS PARK SUITE 15-A
WOBURN,MA 01801 Undersecretary
License or registration valid for individual use only
before the expiration date. 1f found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
Boston,MA 02116
s
,eNot valid without signature