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Home My WebLink AboutBuilding Permit # 3/2/2017 .. .u9i:. %A0R 1`{l. BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION) FOR PLAN EXAMINATIO * - Permit O: .� a� ��"' �� Date Received �� ac�+u Date Issued: IMPORTANT: A licaiat rmust coria mete all items on this al;e LOCATIONd , PROPERTY C WNER �G r I�rrnt' Print _w w °�0�no ' MAP NO F�AF CEL: � BONING DIUI T:1 Historic District � yes Machine Shop,Village yes _.._.._.____.___.___.___ ----------------- TYPE ____---__TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition °'Two or more family Industrial Alteration No. of units: Commercial Repair, replacement i Assessory Bldg Others: Demolition Other FJ Septic l Well b Ooodplain 0 Wetlands I i Watershed District n Water/Sewer N -----_---__...-. ..-_..__.-- Identification Please Type or Print Clearly) OWNER: Name: ` �°s � . Phone: , ... Address: r --- - CONTRACTOR Name. _ _ ` Phone:mT I�w Address,—, Supervisor's Construction License: Exp...Cate: Home Improvement License: � Exp. Plater ARCHITECT/ENGINEER Phone: Address: Reg. No._ FEB'SCHEDULE:BULDING PERMIT:$12.00 PER,61000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Tot �� w. ..�. FEE $p Checlk No.ect Ccr . Receipt No.: NOTE: Persons contracting with unr°egiti•ttved contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of`contractor a t4®RTHown of '9 ' -1 � 1F, ---ftd®ver , ® �+► ®o fib_ al � - 0 : � $ •• ver, Mass, ,9 IIRa r�v A��,�•(t) M� DS � BOARD OF HEALTH Food/Kitchen PER T Septic System THIS CERTIFIES THAT ........ED.....%010�0......0 ......V I.A.Irv_0.0m..............;d. .I".0.... Foundation BUILDING INSPECTOR has permission to erect .......................... buildings on ...... .�� .....�!!�! .1 ....A ........... ... .vt. `. ......... ..4- �.. ....... b.#*.K. Rough t0 be OCCUpied a5 .......... � � 0 .. ................................. 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 Fina! IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR.- L Rough Service ............. .. .. .. .............. Final BUILDING INSPECTOR GAS INSPECTOR Occy2ancE Permit Rqguired to Occupy Byildin 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 wilding Inspector. Burner Street No. Smoke Det, F_, B Window and Siding LLC Estimate EB 756 Western Ave MA 01905 Date Estimate# 2/22/2017 10074 Name/Address Mian I loang 110 BOX 543 Peabody.MA 01960 Project Description Qty Rate Total 4 Walker ltd 115,North Andover Remove existing patio door and prepare opening to accept new door 0.00 !Furnish and install 61061 Patio boor white 1 1,700.00 1,700.00 V alio door is have Low I?,Argon Gas and carry a lifetime warranty. 0.00 0MOT Seal door in and out using Tite Bond lifetime sealant 0.00 0.001. (.Over full easing with custom hent aluminann. 0.00 0.001, 'fake away all job related debris. 0.00 O.tlO"1" Any building permit required to complete project is to be added at 0.00 0.00.1, cost to the linal payment. Note:To change to Itarvey door price will stay the same,however the Alside door is recommended Ru:�your lrroject. /\LIIIIOI-i/.ed Signature, ,, 0.00 0.00.1.. Customer Signature �� ,✓ �� Total $1.700.00 Phone# Fax# E-mail Web Site 741-592-9747 741-592-97,16 e1>windcrw(1i?nasn.com www.ebwindow.cona I i The Commonwealth of"Massachusetts Property" Address Department of Industrial Accidents - I Congress Street, Suite 100 = Boston, Al 02114-2017 u rt w .nmss,gov/dta -" NVorkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. j TO BE FILED WITH THE PERMITTING,AUTHORITY. Applicant Information Please Print Legibly Name (Btisitiess/Organizatioi>lln(lividual): E.B. Window and Siding Co. - Address: 756 Western Avenue City/State/lip: Lynn, MA 01905 'hone #l: 781-592-9747 Are yon ari employer?Check the appropriate box: Type of project(required): 1.E]'I ani a employer with_ 6 employees(full and/or part-time).* 7. ❑ New construction 2.M I am a sole proprietor or partnership and have no employees working for me it) 8. ❑ Remodeling any capacity.[No workers'comp.insurance required] 9. ❑Demolition 3.[]1 am a homeowner doing all work myself.[No workers'comp.r`nsurance required]r 10 E] Budding addition 4.M I art)a homeowner and will be hiring contractors to conduct all work on my properly. I will ensure that all contractors either have workers'compensation insurance or are sole 11.M Electrical repairs of additions proprietors with no employees. 12.E]Plumbing repairs or additions 5.0 1 ara a general contractor and I have hired the sub-contractors listed on the attached sheer. 13.[:]Roof repairs These sub-contractors have employees and have workers'comp.insurance." 14. ']Other 6.Fl We area corporation and its officers have exercised their right of exemption per MOL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required] *Any applicant that checks box It must also till out the section below showing their workers'compensation Policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors roast submit a new affidavit indicating such. "Contractors that check this box must attached an additionM sheet showing the narne of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I arty an employer that is providing worriers'compensation insurance for my employees. Below is the policy acrd jab site information. Insurance Company dame; Berkshire Hathaway Guard EDWC705625 Policy#or Self-ins.Lic. #. � �✓� � . ?✓xptt�tsit /Lation Date: 12/13/17 Job Site Address:. �� .. ` •'� / Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). .) Failure to secure*coverage as required under MGI,c. 152, §25A is a criminal violation punishable by a fine tip to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a tine of tip to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. .�,.. � � -�� , , I doDate hereby ccrtrfJ�esnder the pains andpenalties of erlu,yr that the rn.r orrnatr rovider aboveis tare and correct. g Phone# 781-592-9747 Official rise only. Ido not write in this area,to be completed by cih,or town official City or Town:_ Permit/t,icense# Issuing Authority(circle one): 1. hoard of Health 2, Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector G. Other Contact Person: Phone#: p a bp 2017 VTH CERTIFICATE PATE{MMID��YYYY OF LIABILITY INSURANCE I RTIFICATE 13 ISSUED A$ A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOD/ER, THIS CATE DOE$ NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLTCIE$ SEI LOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(5), AUTHORIZED REFI` ESENTATIVE 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 Polfcle8 may require an endorsement. A statement on this certificate does not confer rights to the certlfioato holder in lieu Of such endorsement(s). PRDOUGER *AM T GosnmerQxal Line9 Admiral Insurance Agency,Ina. (781)599-2a0aFAx 70 MUnr4e 5treet5 A RE88: Suite D LynnINSURER 8 AFFQRDINQ COVERAGE NAIQ P MA 01901 I0uREd INSURER A_Provi.denee blatUa,l FJ ro ins Co 15040 INSURER B:NorGUard TnRm-3h -- Co 31470 �nWND DR% BYRIM ED 8YRNE WXNDOW COMPANY INSURER C; -166 WESTERN Avrwm INSURER p INSURER E: LYNN MA 01905 INSORER F COVERAGES CERTIFICATE NUMBIER:CL173124890 REVISION NUMBER- THIS 1S T4 CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED, NOTWITHSTANDING ANY REQUIREMENT, TERNS OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT To WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THI± 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, L TYPE OF rNSURANGE U P L Qy NOtdBEPOLIICY POLICYIMMIDLIMITS X COMME=RCIAL GErNURAL LIABILITY EACNOOCURRENCE g 1,000,000 A CLAIMS-MADE �gGCUR pR6 tt3 EsooT1currernal 1,000,000 BDP00633016/21/2015 6/21/2017 MEOEiXP An or�eparSon $ 51000 ' PERSONAL&ADV INJURY 8 1,000,000 ;3 GErNTLAGGREGATELIMIT APPLIES PER: pfNIRALgGQREGATE $ 2,000,000 POLICY❑J'ECT LOC PRODUCTS-COMP/OP AGO $ 2,ODO,000 OTHER: 1 LI S 50.0'00 AUTOrdOBILr_UAMUTY C1NE0 31N I,h LIMIT *AA NY AUTOBODILY INJURY(Pef pmm)LL OWNED 3CHEOULED UT03 AUTOS SODILYINJURY(PerEmIden0 $IRED AUT03 NONAWIJEDAUT03 PR RTYDAMA iderd MMRELLA LIAR OCCUR EACH OCCURRENCE fOEe8 LIAR CLA{ISIS-MADE AGGR�flA7E 6D REr NTIONRS COMPI"IEBATIONPLOYERS'LIABILITY �,f N PSR TEOTH- OPMETORIPARTNEWFXECU'rNERWEM86R FJ(GLUDE09 N f A E.L.EACH ACCIDENT1000000loly In NNJ EDWG70662& 12/13/2016 12/13/2037 E.L.DESEAS£-EA EMPL6$under ] 000000Prt N OF Op RATIONS Ixlow E.L.DI&EASE-POLICY LIMIT S i 000 000 y r- DESCRIPTION OF OFERATIONG E LOCATIONS!VEHICLES (ACORD 101,Addlliongl Remueks Sctmaulo,may by attached If more apace Ee required) i -ERTIFICATE HOLDER CANCELLATION (978) 698-9542 SHOULD ANY OF THE ABOVE DESCMDED POLICIES BE CANCULLED BEFORE Town North Andover THE EXPIRATION DATH THERIROF, NOTICE WILL BE DELIVERED IN 120 Main StrQet ACCORDANCE WITH THE POLICY PROVISION$, North Andover, MA 01845 AGThORIZED REPAEBENTATIVE T S SCholnick/METS 01988-2014 ACORD CORPORATION. All rights reserved, WORD 25(2014101) The ACORD name and logo are registered marks of ACORD N5026{ Dww) wlaaoo......q....o ..n....y Board of 5dng Regulations and 5tangards " c CanFiructinn Ct��ers-icnr ' License: CS-010870 EDMUND J BYEiro' 18 Woodrow Terrfce•► � Lynn MA 01404 Expiration ', Commissioner 0710OM17 i +=/xn C6u>irnrt41)r.<a[t[r..1/•x%n l rtandeul[alln (311iCC'nrCunsumcrAll'nlrp 8c XfilelncadAeg¢latioa OMt'IMPROVEMENT CONTRACTOR i3oglitratlon: 128634 Type' Explratlpns;:,•.512./201.7: DBA 11p ByRNE WiND011U GQ EDWUND BYRNE 756 WE=STERN AVE LYNN,MA 01502 Ondergccretary ZIT:es,Qa 9�,L6 Z65 T8L -00 ,Nautm H :zuax LZ-EZ LTOZ-TO-fit'