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HomeMy WebLinkAboutBuilding Permit # 1/4/2017 ISO R7y BUILDING PERMIT TOWN OF NORTH ANDOVER 3= hri•- =�`''4 APPLICATION FOR.PLAN EXAMINATION o = J Permit No#: v� Date Received °j'Tnrso fed'. CHUS�C Date Issued: I EAPORTANT:Applicant must complete all items on this'page ®CAT1oN7 ra d S - . - ,--� PROPERTY OVIINER _ :,!� ` �nn t 1 ino MAP PARCEL �ONf NG D1STRtCfiT_._ ._ Historic Dsfnct y s rio Machine ShoPV 1 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 19'One family ❑Addition ❑Two or more family ❑ Industrial IXAlteration No. of units: ❑ Commercial gRepair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other CI Septic ❑ We'11 ❑Floodplainh 0 Wetlands Cl 11Vatershei- bistriat ff DESCRIPTION OF WORK TO DE PERFORMED: Identification-- Please Type or Print Clearly' OWNER: Name: _ Phone: Address: �a �9 - Contractor, Name _P+�4E ki th,' Phone:. . ��� .- .�� f� .��?�f_(4. Address: (V041> .super..-visor's Coristructioil License-... ��f � ___- _:. Exp: Date:,� - Horne Im.,gi,mg Lioehse•. _r ~T f1_ ".[0_ Exp` Date: t -k-_� !_ _. ARCHITECTIENGI NEER A_ Phone: Address: Reg. No. FEE SCHEDULE.BULDINO PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COSTBASED ON$125,00 PER S.F E notal Project Cost: $ 1 5'5 . C°4 .. _._. _. —FEE: $ 4aC1 Check No.: Receipt No. NOTE: Persons contracting witli unregistered contractors o�ktii e.ecce to the guaranty fund S`igiaure of_AgeritlOwrier Signatur+ f tractor' - i To �®RTil wn _ _ LAndover No. Lo 1 t IV, r h x K ver, Klass, Cpc.i[nE w[R ti •9 p0�4YEV APa�gS S U BOARD OF HEALTH Food/Kitchen PERNI Septic System THIS CERTIFIES THAT ... ... .., .. ,...... BUILDING INSPECTOR . ... ., Foundation has permission to a ect.......................... buildings on .. ..... . .. ... ... .. .. . ..... ...... Rough to be occupied as ... ...........� . ... ...�!/r0.� .. � ................................... Chimney provided that the er on accepting 1�lis permit shall in eve respect conform to the terms of the application p p p g p 171 p pp 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 CONSTRU ST Rough Service ... .. .�. ......... ................. B G INSPECTOR Final GAS INSPECTOR Occupancy_ Permit Required to Occui2y 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. ReneWal Agreement Document and Payment Terms byAndersen d"11mm—al by Am&ma of Bustorw Twm Kabuli HIC X-1170910 V -AOUs ..MR. 'C Cattunial,N) Nanw- TIM ROhert$ Datt_. 1V29116 Stiva Addum: Mom dford St, N Arodlwyer, MA 01845 ftlmuy I" Jvphcme Nnvn6en (9781689-4085 B and;4,avvJ v*qpot ro p ki r c h ait r 6r piud ki c us a.I i d io r b,f v ol Rz I ovaI by'Nit&neer LL .d A�,I R C n vv a IJy With t6c teagu5 11A Condalom acpaAwd fil.d1i t I)'�U )C(Ij IieTrvui,No6ce d 0,x&,.1r Rvr6p-Wvnowy, M A Add,-_rtJum,1,rnl t, ind Conkik4om OvvrKff,oj Builikc, Edearoak MA C:Onmaog'ArblF."CALkin, Rolcose, Irnm-e,aft-d M-Ve okhcf JOCURIM JAladicd rte thi; A t Do"miclat, the UT.M—s arwhiart arc ill aLftvd rw Ph, ibe particsand- MompLimwd hucin by rrks+ na��cffAlccd vely, this acolujAction all mmrk un&r thi,.s T(Aif job Amomht: S17,69$ BY Nigain g i4is AIgm,".1ml. FIA1_k1k;"kmv&i'rJp<-okat. tlmi7 RARmx Dzu, aml este Ammint vom"t he ou'lAu by ('htxle(tolik'orL.1' $0 517,698 Luirfuer.4 sqm- I'Afinuu'd(IMT41'ri6n: 8-10 weeks 1-2 days Mal"A to Elayment: Finaming V&�dmlkfl'; in�uIladoiNsImied on ik-alert al rhes Ott COAMICT aDdl the J;ItL rn mAlch Av CormplVtC thC teLhIT1k'_A IMASUMMILRti. AAtv that Kbte2i_ 45 degrae bay wc"Irc pro--iding JT thh tame oidy an irs.uniate,We will-comu-nmic-ake all [A-Cial dare 111.1d dMC U A LLtE,flag:. Wfin Ana narronc wcathu ary 411W U[JUIA�011H'fklf7-L11ASC-N.'f6e 6.9% at 120months 4jVlAY_ lira yi,tAsL,�1 agfivs And Und-t-11U141,111,443f. Tllii Age".mcm x ra iaytltx the OffifC. v hstmem the po rd�.,*Yr6t. thaware no wvW-1 ei thm 1kvkwr(s) 0 hm,rcaki rhis Ago�.mtot,,aft&I.Sfands-the EV-04,of ;I :nerd Jath copy of qbf-6 Ajwnomen(7.i.,nduding. thc ralm ginobA NKmic'mi an the Claw fiv-;a wfiEdem alxw And Zv was egAL]y itifitrimcd nMycr..ffthi w canod dbi% I TO OWNER: Do tip, dfitt4wjuja A'LA."&TJtj'me'emidud ma topy tjif IhL:Comr-act',It viae fimtt�lvnt >.ifym WE NOT LATER THAN M DN G YOU,THE RUYER, NM CAMEL TH IS TRAN.—SAMON AT ANYT I I HT OF 1.2102/2016 O.RTIIETHIRD MSINESS DAY AE-rERTUE:VATS OFTHIS TRANWTIM VER DXrE IS LATEIL SEE TUIE AITACHED N(YFICE OF C - LKrION FOnI FOR WHICM (AN ILL AN EXPLANS fION OF THIS;RIGA. LvzA IN'4mv k mwwA by Am&rma Uk CW4FJfMt(0 -at-Rrx�—A;4v kn&-rwn vf14v5tor7 I.A, sikullaule of Sal"— N'TAInel 'rim Roberts ftiiinx NAmc of SAL' llcv.ust E"fint Kann 11tint Name Renewal Itemized Order Receipt Andersen. ; a wal Aalli ma'~ � ruNrtoimruumvawuwrem�n;wmma a �, !wM LegalName:Ren�ormmuaomm n mu�o�m Nu imomi�i rma R otiawwry .%numnuwury ommmmm�Rmmwuio�d�wu�armmoiwmoowawiwmmu�uwn�o rc��wawm�+�emmmuromwNuaurrmm���am�mmrnrow�ma...mrm�;manu�oouwae�mm�mmoo�rtimwmar�wum� r o o n�mmmarrmwa»mmwowwmrcmauo�a!wwiuuuimmr ;msnummmmamommmwmniewiwwr g Renewal by Andersen LLC N A Bradford A O�.►'� Hl C#170810 N Andover,MA o1Ba5 ♦� 30 Forbes Road I Northborough,MA 01532 :(978)689-a085 C WINDOW Pe LA6EMlNT :(978)490-6687 '. Phone:508-351.22001 Fax:(508)986.7072 1 RbABoston0perations@AndersenCorp.com 101 FR Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SrnartSUn Glass, No Pattern, Hardware: White, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 2w x 2h, Sash 2: No Grilles, Misc: Aluminum Wrap, Aluminum Wra 102 FR Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only(INTW), Grille Pattern: Sash All: Colonial 2w x 2h, i Misc: Aluminum Wrap, Aluminum Wra i 103 FR Window: Double-Flung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash AIL High Performance SmartSun Glass, No Pattern, Hardware: i White, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 3w x 2h, Sash 2: No Grilles, Misc: Aluminum Wrap, Aluminum Wra 104 FR Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: Fiberglass, Full Screen, Grille Style: Interior _ Wood Only(INTW), Grille Pattern: Sash 1: Colonial 3w x 2h, Sash 2: No Grilles, Misc: Aluminum Wrap, Aluminum Wra IIS i t 11/29/16 Page 4 / 22 Renewal Itemized Order Receipt �//�►nndersen. � ����® , , �,,� �fidlhJnUWoIOMPi�uubdd N!WNM1AftMIWt.. 1�..... N I109UmU0Pub i NN�oNmmmN!mmouAIWN1NuuNAmwuNimM1JStlfircbfiNJminNOm�aaem4muawfurmfimmimwwwwwPNImwmNONdmW4ElJ✓aMM1ui�itiuwlNli6NMM�NN'uWM�N�NNrwJh4(bmwGOiN m omlmii a. balot�IDtl6vnMVou6ioo9iDoWfNwuwm�MVmuNromtilMmmomP,a,� ;►�+ Legal Name:Renewal by Andersen LLC 270 Bradford St `►.♦I HIC#170$10 N Andover,MA 01$45 30 Forbes Road I Northborough,MA 01532 N:(97$)6$9-40$5 w�xnow a� r.tieevnexr _ Phone:50$-351-2200 1 Fax:(508)9$6-7072 1 RbABostonOperationsoAndersenCorp.corn - C;(97$)490-6687 105 FR Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 3w x 2h, Sash 2: No Grilles, Misc: Aluminum Wrap, Aluminum Wra 106 LR Misc: Bay/Bow/Bump out skirt, Bay. DB-DBDB-D 107 FR Window: Double-Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 3w x 2h, i Sash 2: No Grilles, Misc: Alurnirlurn Wrap, Aluminum Wra TOTAL $17.69$ WINDOWS:6 PATIO DOORS:0 SPECIALTY:0 MISC: 1 UPDATED: '11/29/16 I 0r �r�rr"�� Renewal by Andersen is committed to our customers'safety by 7et1 complying with the rules and lead-safe work practices specified by the FPA. 11/29✓16 Page 5 / 22 m The Commonwealth of Massachusetts DeparMent of Indtt&dd Aecsidetus Offlee of Ineves*a&ns 600 Washington Sheet Bosfoin,Mat 02II1 www.massgot+/dia Workers' Compensation Insurance Affidavit:Bafldere/Contractorsi/Llectricians/Plumbers A 1 cant I—dwMAM BMW Mat Lid& Name(n tgenizadouaJlndividual): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD Ci /State/Zfp: NORTMBORO,MA 01532 phone#: 508-351-2214 Are you an employer?Check the appropriate box-. Type of project(required): 1.R1 I am a employer with 30 4. [-]I am a general contractor and I • have hired the sub-contractors 6. ❑New construction employees(full and/or part tune). 2.❑ 1 am a sole proprietor or listed eat the attached sheat. 7. ]Remodeling partner- shipand have no employees Thome sub-contractors have g. Demolibon y employees and have workers' working for me in any capacity. comp. $ 9. ❑Huilding addition � a workers'comp.insurance ca insurance. 5. ❑ We sure a corporation and its 10.C]Electrical repairs or additions 3.❑ i am a homeowner doing all work offieeas have exercised their l l.❑Plumbing repairs or additions myself[No workers'comp, right of exemption per MGiL 12.❑Roof repairs insurance required]t c.152,$1(4),and we have no employees.[No workers' 1313 Other comp.insurance required.] *My spphoent that checks box#1 must also till out the section below obowing their veo*rs'ocmpcwWon policy information. t Homccwom who submit this affidavit indlati ns they aro doing all wok and than hire outside contact=must submit a new affi4vithwicating ouch, klontrautom that okwk this box must attached an additional a uxt showing the Hama of the mud swowhethw or not theme aunties have eanployees. If the su have employ—,they must provide their wmi mss'comp,policy number. I aril an errspinyer that is pr Wdbtg workers'compewa&n hnun ee for my e#Vloyem Below k the poMy andjob site In ormatfori. lamnanceCompany Name- OLD REPUBLIC INSURANCE COMPANY Policy#or Self-ins.Uo.M. MWC30823100 Eq)irWon Datot: 10/0112017 Job Site Address: 270 Bradford Street City/Stato/Zip: North Andover MA 01845 Attach a copy of the workers'compensation policy declaration page(phawl the policy number and eapi3ration date). Failure to secure coverage as required under Section 25A ofMGL c.152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or arta-year imprisonment,as well as civil penalties in the farm of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of luvestigations IA for insurance coverage vmi&catitm I do h ccrhf, as Uses palm and penalldes of perjury shad dee iii for bn prgWed abawt els true aW coniva Si 13 12/2/2016 8-351-2214 Offldd tree ori(y. Do not write in Osis aurora,to be conopktod by wily or town gfflckd City or Town: Permit(tAcense# having Authority(elrcle onus): IZ.Board of Health Z.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person: Phone#. ANDECOR-01 OU BEAA CERTIFICATE OF LIABILITY INSURANCE DATEIMMIDDITYYYf 9/291201 B THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the Certificate holster is an ADDITIONAL INSURED,the pollcy(tes)must be endorser(. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,cartain policies may require an endorsement. A statement on thfs certificate does not confer rights to the certificate holder in lieu of such endoneement(s). PRODUCER MANSE. WIllia Towers Watson Certitleate Center Willis of Minnesota Inc. "'44Ne 677 945.7378 NI:(888)467-2378 do 26 Century BI1ra P.O.Box 305391 ADORE :ceruflcstesomnls.com Nashville,TN3MO.5191INa 5 AFFORDI146COVERAGE MAIC■ INSURER A:Old Ra ublle Insurance COMP89y 24147 INSURED INSURER B Renewal by Andersen LLC INSURTe1 c 104 Otis Street INSURER D Northborough,MA 01532 INSURERE; 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. 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 18 SUBJECT TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. R TYPE OF INSURANCE POLICYNUMBER 10MOD1YYYY MMIOUCY DD LIMITS A X CouMERCIAI0ENERALLIAAILITY EACHOCCURRENCE s 1,000,00 MWZYsaB2aa 1010712418 4010712017 MISE$ e REKFED CLAMS-WADE E OCCUR n s 500,000 MED EXP Ipn ono wow i 10,000 PrReaNA1.SAOVINJURY s 1,000,000 OENIAGOREGATEUMITAPPUSSPEk GENERALAGGREGATE $ 4,000,000 X POLICY❑aE�° ❑LOC PRGDucra-COIJIP1pPAGG $ 4,000,40 i DT}IER: i AUTOMOSIMELABILITY COM�'N�81 ��►�T S ft,0a0,0a A )( ANYAury MWTB$08232 1010112070 10101/2017 BppILYINJURYEPilfP.? 5 A SNE© SCHEDULED BODILYINJURY6%rsoW*nQ ; AGE NOMWEV HIRED AUTOS AUTOS i UMBRELLAUAB OCCUR EACHOCCURREIICE $ EXCESS UAII CLWMS•MADE AGGREGATE S DED RETENTIONS _ : WORKERS COMPENSATION X PER ER ANDSMPLOYERCUAeN.111Y WC30823100 10/0112010 7010112017 1,000,0 A ANY PROPRIMRIPARTNERNXECUTIVE Y�NIA A E L EACH ACCIDENT S �rMut yEIn N'�ExcLAIDEo7 E,LWEASE-EAEMPLOYEE 3 71000,00 de6o �� n ELDISEASE-POUCYLIMIT t 1,000,00 ow DESCRIPTION OF OPERATIONS f LOCATIONS rYENICLES(ACORD 101,AdcKwial Ramaft Schadule,rmy ba~ad N mm apaCe Is requkmdl Evidence of Insurance. 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. Tows of North Andover AUTNORIIED REPRESENTATNE Mein Street Nor Norah Andover,MA 01845 012BB-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD MmmUr r / / ,,,, :. ll�lluiiinmlllllllllll III I I r / / 1 +'I 1 c r ra // rr fl 111111 �� 11{1ff 'I / / ✓� ", +' III 1,1 I r rr / V W / r / / I / / a � / J P , Y r / r r / / / a r / / rr r I I. / I , r� r / li I V f uuq // II I.„I 11� I h. r / J / v al OMP I. 01M, I r rrrrrrr / / I 18 v l� V I�II� / r r / / / / r r / III 1 r / r r . �I I l 1 , // 111ri f li1Gi1�1,1»t/ Ir ON, in %/r NTO����,IIi1,1111 I /1 of et /✓ i,1 G a �� _r r / G �,,, r r �' .... ................ .. ....... ... -lemma WIMDOWA REPLACESAEMT nnAnder olpccug WaadMnyl COmposite IF Baal Argm Luw E4 StnartSun DmUe Hung 100-00473518-010 EjaERGy LPERFORMUCE RONGS U•-Factor(U.S)A-P Solar Heat Gain Caefficient Jess U LA UMVI ADDITIONAL PERFORMANCE RATINGS Visible Transmittance Uw4Z. 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