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HomeMy WebLinkAboutBuilding Permit # 1/4/2017 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIOW, Rtm Permit Not#: � � �� Date Received RArE0^per, Date Issued. 4SSACHUB L"PORTANT:Applicant must complete all items on this'page LOCATION .._W... rG PROPERTY OWNER Pnnt 1 DO Year 5truct�re yes no MAP PARCEL. ZONING DfSTRIcwt­.._` . Hrstarrc District yes no M - -. . ..achrne 8h Villa -yes rip. TYPE OF IMPROVEMENT PROPOSED USE Residential . Non- Residential ❑ New Building 9 One family ❑Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial Repair, replacement C]Assessory Bldg ❑ Others.- El thers:❑ Demolition ❑ Other 0 Septic q 11VelI ❑ Floodplain U Wetlands 0 Vllatershecf Drstr c ❑.Vllater]Sewer: / DESCRIPTION OF WORK TO BE PERFORMED: Identification.-- Please Type or Print Clearly OWNER: Name: M, . Act,&.,,d C ArMre1V Phone: 711- a5 C Address: c7l Avb& LER (4 a y,-5;— COnttA0tbr NaM-q 9t.A 4CJ'6e1k Phehe_. . Address: �: Ir27 �A6_ o ► rrds � c� Supervisors Gatistructiori Lrcense � Exp. Date: Home : Irnprouemert License ! 7�? / Ex Date X3.1._7 _ . . ARCHITECT/ENGINEER /U/�i ' Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER 5 F G __ .rotal Project Cost: $ c2& i ' FEE: $ Check No.: Receipt.No- : iso NOTE: PeFsons contrae ing �al nregistered contra t1grr,,.do not ve:access to the guaranfy fund 5ignatuie_of.Agenf/Ovtirerm0 l coriractar'; NRT ® 1y own of �� _ LAndover No. o i1�K. h ver, Mass, AAJ. roc M1[++[wrcw �1' Al U BOARD OF HEALTH Food/Kitchen P E Septic System THIS CERTIFIES THAT . .. ... .. .. .......... ... ..... ... .. ..... BUILDING INSPECTOR . �. .� Foundation has permission to erect ...................... .. buildings on ,. ... .... .. .. ,.... Rough to be occupied as .....l.. ......� . .�.�.. ........... ..... krWWW Agreement iDocument and Pint Terms :rtyrwwu►�Fsw to*"&CROWN"Mwk umo ffinc ANN"WMAMA UCMA 61USn .®.. x► ����y�a�gw�,etc��n,�►����p�ii ems[�>r�r �►ya MIMSb Su,eaA".S7 CwW6s&k Rd,Molle Antiwar,MA 01 :ftywoimOEM ns► �r pt.dl. of It ar aw!bar! I dllr�Fa by saa► R in fir- .nd wadt�awAa En" AW Pqmcmt . M ' spy �d �ar +a Vinod la tir"I '�` and aa�*a�upe t �dpi ,dre �` ID= hcuh by W6ah - ,Ram W4 Firm w doa a, �t fir"tt�i hey. Thi A lE By avft dib WwAu4 hwwk4p dw the Mum bm ad dw art 24 dop "Ag4 cf p4meba 14&WKhV Vliwfimbk huwwimwdre w oft6,1. sad d�ri on Hca rc ell tl a is �n An i d ewe mralzwdKLRA&wd w=dw arc dw casi M Ew Plan l41.f atl auk# fid. da ddi "r ra 1mes lea rmd d tom## > knl tke t a#'i1� fir►` ra ar+rk�ira�e6�ddr ural 6�t . d ;t1 amt " bath tine,lwpoW wd 6 r'a vm it t f r f tf eooelrodnmpl d� ad + 4 p d t .abves and ws Or d.of dot to-z ...... lffl%TM B'L7YW Ma CMM. I=1'8 MAMON ff MffTM N .iAMTR IY AGMGM ioF llt"160RTMETHMDBUSDMED"AffU7=DAffROFTMTXAtMCINK lSwam IAMAW Me" Ciirrni Naw of lit pfbt Nuse Iktftf-1 f�1911 'Pug*11,14 YItemized Osier Receipt by t t1� by a Catherlaa Mit" 4 �IAwf;F,*rirn*by AftIIk W "I'( ra HIPC#1701110 Wa,! w:r.,MA fibs .., u.�rcr fug k4d iherlbbarc ThrIWA01S3 rk:tsiStsTsv€54 rtrm""m F� e.�' 351 220111Fix MA) t�tc l r�st��€}G�r�rr�s�� ���r�r��,wp eaS�#�?���rr� a 1101 MiChen W, neNd Daublt,Hur g, Equal, Slope Sill lnse,-I, " a:d..TI IAI cl,rckr011, WeriarWhA:..tV, Irjerlor WhIle, Mass• A Sash' High PeHDFMiInCe 5rnWTSI5 GWA, Ne Patton, "ardwam.Stone, Ureen! fiberglass, Fut!,Screen, Grllla Style.- Inty-al Wogd Qoij fICJ'1"blf,,. Grille Patterson All%ash: LoW.Aai 4w x 2h, Mistt tyre 0. . Kitchen Wlpdasrw; [ gable• -rc), Equal, Slope Sill Inser3, Va-itionol C1remad, Ulti or Wh'«e„ I-Iterior Wh,te, Gass: .11 Sesta, IJ ub Pe rmance $matt.Sun CLL, No Pallom, Hardwwe- Stone, Ser ew Fibergiam, P'9uit stfeen, Grille stylet Ifttrrl-':Qr Wcod fs7ig l AT ti1'!I, Cori-llo Pattani: Ail Sash,.Colonia; 4w's �h, Mise: l�cir1e 103 Ki hen Whid ;Double-h urg, lcivaL 5601)e Sill Invert,itdslil r31141 C vzk.r,ail, Exterior �;i e, rrtvior Mite, 4llass jkryl 5�x.sla; lligh Petfbe encs. $matt5Lrm NP llmt ,Ternpeced Glass, I aF�wuar+o-; 53arse, 5�:r rrs Nberglass, Full 5tmvo, r141e Styk Iriteriarwaod.ooj(1141"W), Grille P$tl.ars:All S-ash Coktrial 4w:K 2h, Miss;risme 04 i Wkido w:Goud'.e-Hun9„ Equal, 5tape Sill In t,Traadil.lonal' Che:krail, Cxteror t fi'Ae, intenbr White, Mass;XJ Sash 14.19h Fe.,xivi4t b Sm r6un GlIm. No Pattern, lfardw&ry S10110, 5cr xr: >>ihorgt.ass, Full 5rrpon, Grllcla Style; tntr2 oc'6"tood Dn- GIWtW), Grille PatftM.I All 54s1r f alonia,,4w x 2h, 10155, Non* ��Ia�RTfD: [IFI�t1n P�rk4a r'.d hamized Order Receipt 5FCmmbm0kk eipt5Fk ICS 1t�1 NOM,fir,MA 01M K7i RMOV aSt 7G0 1 I i 7 1 Q CM71DW2 j Wlw+do w:Couhl-H ung,Equal:."SloPq 5111 trot,Vaclikobt C*eckrall,Enu-&r Whim Interior WhIM,Sk=AA Smtv High hdormancg SMit tit GIS.No r tterm.Rsgd* eSame, S�nRbOrglos,Fun Win.OtIN6,510c Ir Gericrt . e f111a Ponum.All Sah°CctcaW 4M4F x 2h, 1YS ki NOW 1116 U*2 11IIr4lo'%ia dciuble-Hua96 kqwk SIMe SIM IrOO,IVA00P.M. CWdcrei.Extcxlor 1l Ntse.bderlor W[h ..6:la AN S i:'POO ftdomska SjmdSm mow.No 1ittem,llicvdS w Saw: Flt"%lis,Ftp SUM,Gglw 5Vw kdariotfid; tl y adlip ftibm Al Sidi Colarfal 4w x 2b,, mbcl.. 201 Hall. wbHh trR:D9ubl9-Hw tgtal,.SWC$41"Inset,T!t idlunal CkKkrall., xterltf.Y l x x � [ p1 S t High SMwtsun Ghm,No Pattwn,Hoidwam SUM, Saserr,Fiber9ka.pA Wit,.4GdNo."%Wic hvwWvr Wood hfTW9 "lit' ll'e m All S ' alon�l 3w x�,.Mlt elm Bed 1 Idtfw.0oubk-Mxt%FQv*l.5101.*Silt . kIld0 Id. gcoreW,jmflclr Wl bh% 4or White,0tam AH Sadc High hdofmamwsmatdq.a G.44L Nq pa em, t Sane, t►r�;l titiO S.full Sawn,merle (1"T611/}.#1#41Sft"amash.CaltaW.3w t:2h, MIM Um uln 111 WIG mat Sf 2� itemized Order Receipt PC*Mkd" W 1 617i16f a ;1�4OM N nl > Bpi I VAe r Double4lum lb"l SkW Slll 10"I.RMAIDnil krlotlw"et.Sri" I5. No.Man,HaNdwsrl.Sto* $vow. FNMgtast FA Saw,N dit Svc Inter waad only(O ,GrWjg ftftem AJI SmIN.Call'3w x 21116 Mliea No" . '1 l ater:bnubblp-Hung,N: ak e VIII In t. dltional. (aedr'BIL Exsedu w4riorwlwllt,64=AN.SMN H10 rrrwi *.Srn Gly ANG PatWn. :UO.Me,. full semn,Grime RAW kAq-M WOW lir#NlT;.M,soil& :Ail S Cclonki 3.w x 219,Yid N�rwe 3 BitCl Windem b *-�.9"k $lag SIN IMen,T"WW"kl cjmK wl,Wer lot.MO,l nUtlor Whilm:, 0165c Allf Suk.:High WwwCe SMar r#G No Fattern.MonIhmmo$None, Urow.Rbeftlaps,kA Win.Garlllrr ftp' y ;Grj% M S j5 h:Corlafial 3w is 2 more 206 Bed 2 Window.Daubk-1 n6.F901,SkPIN SMI fern,Undtionaf CbKkialil, 61aftr Vffige. kvtaftr VMte,d1m=AN Sash-High ftdorma n G Patterns Stm. (ij# M Grift art:All Swb;ColuvW 3w r 2N MWt Mane tNlAiti. ty111�11t� P4x24 Remind Order Rmipt 1 Xww 1WWM by Aft&dim ILE A WC X19 Ms ANRMkt AlIkG1f war .0 fhm bud I MA05M l��171fe >iwifol-sm I fes:ism 98&?M IR aft E h 207 Bath 1 VVI*dbvr.Dauf H .Equ. .SiaPC SIN kmd.RAdIdOnill 1%ftymnnKey 5 `t5un aim.NoPanierE',Tmp�d Gam,. IM FU4 SM".60111116' S Int.w1or 1kwdelf DMTV&Gr ftttIMM All Sibh; Cdo19k:§w.X 2h, W=NwW III! Bidh2. v&Waw Vain!!-[7.wq..Equal.Slope. $Alt l t. RRslIIN" Chcralk EM*riar Mitt,Interior White,Ply AN Ste;High 'Srwt$un GkkW Fla.F'atloi(ft.:Flan Wne, u ro:Fiberglass;.EUR 5MM.WV*MOW RAWX &V ONTM,arWA puttww Ail Soh.CotoMiA 3w x 2h, Vliet: H p Wado�w; Ubl6-tib,F4U.ML. Slaps SNI Ir f. lei f erformww#stm rdun.Gum. No Pattern,11#(1 1f.She. SCMIrt.fi.hergllass.Full Ste..Mille$44w lintooice I100d. Q ONTM,410111lrf rattorm AN Sash.ColeaW,3w Ir fir,MAI9C: 1Mnd4AlM:Clue -tib,E el,slape Sill Insede Vaciftn4l cwkrij,cx%f or Whft lntetior.Whita,GhM:A4 Saab.Will P&-6xmancu Smardw GW,%No Potters«, Hsrdw�:Sri, Mr Il15Qt+glaa3 Fel ScM4Mq GdUd fitp10 MWW WOW W.. fIN I YV}. I*�A N Sash:+Calsnia� a 2h,Mlle+c: Illi rra�us crr r t rr q 14 !ate 17Cs "Mmized Order RmIpt UW MM IIr#en ItW MMAR UC 5 CANUMk fW ftM MA W l 1 1New -W im 111! lkii�MeP,. ax ice"&"I 4m l FMC om MOM 1kt 211 W3 WbWmo,Daub"utg.Equal,Slope tffl ImotVWitiml chwkrkil,EAkda whftc hTwrior'ti!Mte'Go=Alt Salk.H summh'ribirgIM,fts sa. wo ad%V*:MOM Wood Kom X12 iced 3 VAndaw Double-14M,Eq SISill lftsilrt Tradidanar ChKirmil,pE"or��{w�W kAullar WhhIV, ham,/ty ph ftdwman �I Fibarg"g,Fu .$0111A styw.h1efjor WOM 0*ON I�� Sasha S1 ai ]t SEM, iiia: Fi O�D s .4 ids 0 TW� 40k4 A*&C Bic UITE6:`i 1!1!!i7 6 lack.a I f# Me Comm.- iweafth of'-"assochuxio& —� �epartn�e�of�'rt�rrs��t'Aecf�n� OfflCe of InvesdSO&P:s 600 WashhwOn Sbeet Soetosp MA 02.11.1 ' www=ass gol�/dl Workers" Compemation liunrance Affidavit:Bui:d=s Coxktrzetor*We tx4.cb dPlnmbers It Name : RENEWAL BY ANDERSEN Address: SO F'ORBES ROAD 13tateJ2 NORTHBORO,MA 01532 Phone#: 50"51-2214 Are yo t m empfaper'd Chwk dw approprkto bon T1 Te of prate(required): g0 4. ❑1 am a gtawral cootractur and 1 stn a employar vd� 6. ❑Now aotasSruGkitm eataployem(&U endlnr parmimu)." have hired the smb-contractors 2.Q 1 on a sole prpprigW or paatrre 6 listed an the attached sheen -7• imodaliq ehig and have no taatploytxs Those sub-oontractia havc g, [J DamolMon wording for the to any capacity. employot s ttnrl 11 ve worltcrs' 9. ❑Danding addita ! o wrnc M,Qcm hwumme p•it�sarence.$ p• 10.❑E1rctriQal rapsus or additiunr S. ❑ Wo tate a corpocatitnt and ite 3.❑ I stn a ho�neo�vnet doing all workoilitcars bave asauoised their' 11.[�Plttmbing repairs os xMitiom myself(No wo dms'oomp. 0.I5 of 1(4),a otr per MOL 12.C]Roof repairs tnsurastce�.)t c.1 S2, 1(4),and we 11aru�t nn 13.0 Odutr emplayee&.(No worke .insturapucex+equtrea.] _W_..; 'Aapr of eipplk t w)w lies[#1 nlmit suo t1110mt the ecotlon below&nft tb*V0*=e ao�*PUMion palioy h6 metiwu. V t 7E WMMN as' U eabmit this etllda*mdiawtiei&W SM4 2 all weak and then bite omtelda m0 tssch'most" aft a sow 2Mavk WW&8 eooh. xCtoatraottintt 0*A kfi&box=xt MbAnd as sddlt oW&eat rltarvina an no*of the xnb-c=rwM and erste whethw ormut t me KINgoe have etoptoyaar lgt�sub cord togs Ivo a"Oopm ti q mwtVmvkla th*w odml cone polity uumhar. 1 m ant a 9hV MO;Ik provf w�arifwl'co�wkn +mttae,�'o€nr s ym& Btaw b M ept�v � a e#w ratlGecbmp�►Name. OLD REPUBLIC INSURANCE COMPANY' Policy#orS�eli�ins. N;lMC308231 U0 H pimticmt Date: 10/01/2017 obSite Addreffs: 57 Candlestick Road City/Sbt op. North Andover, MA 01845 Attrtcdt a copy of the workm,rompansatiou ponq clan atton gnp(tlho ft trlrti pvlky number aid a*-MtZvn date . Failure to secure cavmgs as required under Sa tkm 25A of Mt31.,e. 152 can lead to Poe impos rboll of mimimd peltalties of t floe up to$1,500.00 and/or one-year imprisonment,as wish&o civil penalties in the fbi m of a S'L`OP WORK ORDER and a fine of up to$250.00 a day against the violahm Bo advised ftt a e4py of this sbatet mt maybe forwarded to the Oftico of IRvas# is #haDU for unsure =coverage varlflceti= I{gyp aMie psoirla to'd periai�of pr�trtry the#lea&�vrs�ar�ttao pmut��arbays is ire ram'aor� 12/09/16 �J F' 8-351-2214 Quo W Un off. Do rent write in tftfa a ma,sw be compwd by MY or Gown ogiicz d � Myor'faww. I'crituii�t �l � Ii ukV Aufhal*(drde one): L Hoard of Malth 2,BvBdtq Dt ppAment 3.C ltyPpmm C3o;k 4.FAKIrlcal I=pwWr S.lgwmbbg luapecto r S.falter O4xttact Fersolr Phone A ANDECOR-01 DUSEAA CERTIFICATE OF LIABILITY INSURANCE °ATE(IAMlDUIYYYYI 9/29/2016 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 THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDIEIL IMPORTANT: N the csrtlflcate holder is an ADDITIONAL INSURED,the policy(IOS)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 endorsems s. PRODUCER am Willis Towers Watson CertMcate Center Willis of Minnesota Inc. PHONEI'd),IBM 945-7378 No;(888)467-2378 c!o 26 Century Blvd P.O.Box 305191 ADDRE :cerufficateg@MRIS.com Nashville,TN 3723MI91 INSUIIE s AFFOROINGCpvaRAGE NAIC0 INSURERA.Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC INSURERC: 104 Ott:Street 14SUREI D Northborough,MA 01532 INSURER E: INSURER F COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CEFrnFY 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 CONTRACTOR 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. XP L TYPEOFENUURANC! POLICY NUMBER PAID OLICY F ItMND LIMITS A X COMMERCIALGENEiALLIANILITY EACH OCCURRENCE S 1,8118,011 W"140 TO 11101TED CLJUMS•MADE OCCUR MWZY 309234 10101/2018 1010112097 PREMISES Ea ommen $ 500,000 MED 1E XP(Any One pMaOn $ 10,08 PERSONAL&ADV KMRY S 1,000.000 GEWLAGGREGATEUMITAPPLIES PER GENERALAGG151E AT£ $ 4,000,000 X POLICY❑JPEGT ❑LOC PRODUCTS-COMPdXWAGG $ 4,000,08 111 OTHER IiYT AUTOMOWLELIITY COMBIN SINOLEL LABS 5,000,000 AX ANNAIIlO MWTS 500232 9010112018 10101/2011 BODLLYINJURY(Parparaon) S TOS O ED ASCHHEEDULEO BODILYINJURY(Per ao*enl) S AGE HIRED AUTOS AUTOS 1 Par I S S UMBRELLALJAe HO=R EACHOCCURRENCE S EXCESS LIAS CI.AIMS•MADE AGGREGATE S i DED RETENTIONS 'I WOMMCOWENSATION X PEFI ER AND aNPLOMS'L IABILITY A ANr PRoPwETowPAwNER&KEcunvE YIN NFA WC30123100 10101/2010 1010112017 F.L,EACH ACCIDENT 5 1,000,00 (arandibory In NH}ExCLu�o t E,L.DISEASE-EA EMPW $ 1,000,00 M d E.L.DISEASE.POLICY UMrT S 11000.08 D OPERl1 Sbelow DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101.Addltloml RertlorkS Schaduie,may be atteched Lr aver!space Is required) Evidence of Insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE YAM THE POLICY PROVISIONS, Town of North Andover AUTHORIED REPRESENTATIVE 120 Main Street 1 1 Norlh Andover,MA 01045 /y 019BB-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I !I � ," � / ' , / f� Alto /I r Building Rog J l r r /iii C� �IYp G S t' � ('o, t u jIVIY e/riv s � i � ( r, ST ( I 019/06 I I r' r i ii nlxll I J" s r i v, A/5 5 , I a0 f twow (it erAlw'ir I � ME IMPROVEVENT CONTRACTOR Rog istratio n: T7,081 oT ,r jr o �pp m / ' / JAIME MORIN /'� ria j(l//� ✓% ,/i%/rri „rri%�/io�%%%iii ////p/i��, // //i //i /i j //ai,//%/��/ f/ '' YX / rc i/ Vii, /c '4/a i� r FORBES RD r ,� l// x, _ ... Renewal �rittnnni• c�rtaceea�r �n�o, WIDOWnyl COWWta IF �Eks Dust LOW E4 Sf mrLSun Muble Hung 1004047361"10 ENERGY,°ERFGH ICC-RkTlifGS U-Pfactor(U.S)A-p Solar Heat Gain Coefficient 01. 9 ADDITIONAL PEFFORMm*�-,E lA7,--I (;S Visible Transmittance UA2 �_&_..__*mumchew utwpOW&.►toappip�7e AFBC proaWaea brana.ai ARQvA*M preawt /reerppnee.NHIG neYpsara dagenafee6 bra bead wtef anSCiEnareitlamd�isaaapa�aeie Peedwxs� cwB a OWN, rawcaawead aeypmdw[eod ae.speaw�eoaKeerU=-rpmd1"brawmpo laae. - - 1sei11:nItCA ►� maip dsinabemrao 'i �►a�oeeeal e irM aadprl maWie4 jmatapiw ad err tow DESIGN PFlESSIIHE(pSF) �' Mo•��.afema , TJL4jL"'�.: Rb QB Sloped 5311 DH IN 1a�abIfK89t«pytpq�tt ramrumrsen eM , Neeleq'eocoeedri[.EC.G.E.�C,its-G.G.Ak le�laeiaa»geeare�le xlp6Ul11e�aadcGel�caYaeq p��