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Home My WebLink AboutBuilding Permit #143-16 - 11 BEAR HILL ROAD 7/31/2015 �'^ T&ORTH t� -U BUILDING PERMIT 01.11"") 16 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received ��SSgCHuS�� Date Issued: / ORTANT:Applicant must complete all items on this page LOCATION 46-Ne Print PROPERTY OWNER Z-44 cot7' Print 100 Year Structure yes 6no MAPARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial X Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain El Wetlands ❑ Watershed District C]Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: ,T.art Y'.'et c e 47' Phone: 97r",ffx7-/71 7 Address: /l Be#R H,'// R,01-1 Contractor Name:'T�e4 5,-4 _# Phone: f7r- f79_ *"P�� z Email: Address: VP ,QA,4e 0/S�t`� -e II Supervisor's Construction License: y 96616 Exp. Date: 9-.9• /C r Home Improvement License: /l 74014 Jr Exp. Date: ARCHITECT/ENGINEER 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. Total Project Cost: $ 7, foo FEE: $ Check No.: U. � IT Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ■ LocationdV % No. a Date TOWN OF NORTH ANDOVER C" LED A _ Certificate of Occupancy $ Building/Frame Permit FeeAL $ s , J Foundation Permit Fee $ � Other Permit Fee $ � PO TOTAL $ Check# O Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS r r2oning Board of Appeals:-Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located. 384 Osgood Street FIRE DEPwARILMENT Tiern ®umpsterArontsite y�e5 ,L�o'catetl at12MainStreet, � Fire Departmen's gnature/dates k ,. Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA—(For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products IN OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan �. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application 46 Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of t E , Andover No. o LAKE h ver, Mass, CONIC«ew.c.c 9' S U BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT PERMIT% T BUILDING INSPECTOR ........... ..... . .. ...................... ......... . . Foundation has permission to erect ........................... buildings on ....�. .... � ..............'............ �.n c■� slh% Rough to be occupied as ........... .4K........t1..1�/ !a................................................................... Chimney provided that the person accepting this permit shall in eve spect 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 M� THS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI > . Rough Service .................................. .......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildine 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. Hi-Tech Window & Siding, Inca SIDING P-®. Box 8234, Ward Hili, MA 01835 MA Reg. # 118836 29 Arrowwood tit. Moth uen, MA 0i84 MA Lic#016201 1-800-851.0900 wlr �5 ° �5 ww.hitechcorp.Liz - Date: Consultant: Y, Ch45t3r_ Jab Name:o 4hdgrtn Vi1re� �"eieph€�l�e:��t- 6(150-1q(9 �,��- / Job Address:�� Rd y7f� /7 7 Town:1/dY daYcr CONTRACTOR agrees to start described work on/or about complete descri CONTRACTOR shall not be held liable for delays due to causes beyond our control king days. weeks after final fittingsand S , complete QQll bed twor In about + The following work includes all labor and materials needed to complete your job in a w kmanship like manner. Job Includes Trim ❑Combination Job-Siding With Other Work Ej P•VC.CoatedAium Aluminum Building and Elec.Permit Fascia Trim Siding RemovalFascia Treatment I Soffit-rim i Preparation f ackageFascia Color l vVindorr 8 Door Trim it Accessory Package t None Full Custom shuers � 6P r !,! Undedayment littmiafivnLocation E r Gtilt rs SC til'! 9� es OR Siding ownspouts� � Soffit Treat ent i emove Debris ❑Lock.Elea Meter Soffit Color Preparation Includes - Center VentVented Non-Vented Fully eplare Visible Rat d Location Ven[ed as Neede ❑Energy Savings✓Bug Guard Starter Wind D "And floor cast n Treatment i in And Door Casi torr. I-r Accessory ackage Includes jN0U Fut!Custom Fornted J•Less ❑Full Custom Fomred f Color: ❑Blind Sto Capping ❑None B]� Vinyl Light Blocks Location rU1t,.a,. t {u / Vinyl Dryer Stocks $ 00 Vinyl Electric Outlet Blocks Vinyl Exhaust Vents Gutter&Downspouts.- _ �— Anyl Faucets Blocks Vinyl Gable Vents Gutter Color Downspouts Color , A rtV an _ � Location Underlayment Insuin ion Ta liked ,1 �bQ Special lNotKesl l Hi-Tech 318 Other cArt e eJ Location r Area To Be Sided r Complete House Garage ` � wr dtw yrs �r Siding To Be lfsed Will ow (J , Color 0 �/.� �,Q�• Payment Folic s Brand Profile d��(� Bank Financing 9 Owner To Arrange Hi•Te /� ❑ ❑ ch To Arrange ft Gn ❑Cash Or Check ❑ Master Card Conner Post To a Used ` Comer Post Color: Q in wI Or C Total investment or), Oa ❑Wide Insulated Wide Non-insulated 1/3 Deposit ❑Regular Insulated ❑Regular Non-Insulated 113 Payment 1/3 Balance of Day Completion You may cancel this agreement if it has been signed by a party thereto at a place other than the address of the seller,which may be his main office or branch thereto,provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent,or by delivery,not later than midnight of the third business day following the signing of this agreement.See the attached notice of cancellation form for an explanation of this right. An interest charge of 1.5%per month(18%per year)will be If;-_ f;- 1J /,4 added to any amount unpaid after 30 days from invoice date. Date Df Acceptance v_0t r';� In the went of default of payment of this order or any pan thereat and the account is referr.J to anetfomey for collection,thepu¢ agrees haser to payroar bta onomey;ccs. $ i I tie give HIgnatur i-Tech permission to obtain all necessary permits. ignat•mei Signature Signature r The Commonwealth of Massachusetts Department oflndustrialAccidents f d X Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERNUTTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): /�� TeGLr• Q✓i`iJ�w .!'i of�y .Address: 29 ,�iP�o�✓u/�.6 ..sj' City/State/Zip: lyC-14--ca SVA algyOePhone#: Are you an employer?Check the appropriate box: Type of project(required): 1.Y[I am.a employer with employees(full and/or part-time).* 7. ❑New construction 2,❑1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity_[No workers'comp.insurance required.] 9. F1 Demolition I❑I am a homeowner doing all work myself[No workers'comp.ituarance required.]t 10 El Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. E] repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.Q Roof repairs • These sub-contractors have employees and have workers'comp,ins<uance.$ 14.,E Other XWI,,%Ze 6.❑We are a corporation pnd its officers have exercised their right of exemption per MGL C. -� 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. i Homeowners who subn if'this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must-attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors fiaye employees,they must provide their workers'comp.policy number. I am an employer that is pioviding workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: At'CA Y Jr, Ir.;,- 'A Policy#or S elf-ins.Lic. ✓1.0' 6°7 8iY ' °M/ Expiration Date: to -.7/- i6 Job Site Address: h'!l R44 City/State/Zip: iY. �.v.1s✓CA Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up 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 do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Signature: Date: Phone 4: Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." ' An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employ,s persons to do'maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the cbmmonwealth for any applicant who has not produced acceptable evidence of compliancewiththe insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill-out the workers'compensation affidavit completely,by checking-the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and-phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. B e advised that this affidavit may be submitted to the Department of Industrial Accidents foi-confirmation of insurance coverage. Also be sure to sign and date the aflxdavit. The affidavit should be returned to the cityor town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you'are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should'enter their- self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in'tb'e permit/license number which will be used as a reference number.'In addition,an applicant that must submit multiple permit/license applications in any given year,need.only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant'should write"all locations in ' ` (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel.#617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia __rLl'1Li:1�l e:a6-'06 ANI PST (GMT-E.'; Ft Or( 10 C:.-2'0: ^tt1''tL1L-jt INS PAGE 01/01 'I'J '978a7'��t4 CERTIFICATE OF LIABILITY tNSURANCE • DATEtRMSSIDD�Yri, CELS CERTIFICATE 15 15SUEb AS A III I'll OF INFQR6IATIOtd ONLY AND CONFERS NO RIGHTS UPON THE C CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATN 11/9012014 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE AGr;;ISSUAG AFFORDED BY, AUTHORIZED ELY Af»gE1dB, E)<'i'ENp OR ALTER THE COVERAGlr AFFQRDED BY THE POl11CIE5 INSUR REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the IpD1iCy(ies)mast be endorsed. 1F SUSROGATIOA9 IS WAIVED,subject to the terms and conditions of the oli I A cy,certain policies may require an endorsement. A statement on this eerti(ieste does not confer rights o the certificate holder in lieu Df such endorsemen s. PRODUCER BARRY J KITTREDGE INSURANCE cNracT &1 5 MAIN ST NoAME; - BRADFORD, MA 01835 FROVE I g� E ASNR9dt). ADDRE^C• 1 IN 9 AFFORDING CDYERAciE ' a 1N9VRED � D(SURERA: LM InguranCe CO Or2tiOn PWC9 a HI-TECH WINDOW&SIDING INSTALLATIOaasDD 29 ARROWWOOD ST 818URERB: NS INC METHUEN MA 01844- rAURERC: � INSURER O 1 _ RISVREft E: I COVERAGES CERTIFICATE NU1VIBbR: �'S0R°zF: 1 THIS IF TG CERTIF I THAT DIN"HE pANY R8 pF INSURANCE L ISrpO @FLOW HAVE BEEN 1SSUED Ta THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT4VGEJSSUEO 0 ANY REQUIREMENT,TERM OR CONDITION OF ANY COMPACT OR OTHER DOCUMENT ONWf V RESPECT TO WHICH THIS G£RTIFICArE MqY 96 135UED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POL(CI�DESCRIBED HEREIN IS SUBJECT TO AT THE TERMS,. IXCLUSIONS AND CONDITIONS OF SUCH I'OUCIES.LIPAtT$SHOWN MAY HAVE BEEN THE POD BY PAID CLAIMS. INSR LTR TYPE OF PNBURANCE 1N5o SUER Comm ERCIALGENERALLIASILRY VYVD POLICY NUMBER P10UCYEPF MMlDD EJ(P M!i] LButT$ CLAIA15JdADE a OCCUR EACH i OCCUFRENCE 5 I ihSFTO' P hdEDEXP(An-an opomm) GEN'LAGGRIZGATELIMn'APPLIESPER- PERSONALS ADVIN,NRY S ' POUCY �J� LOC GENERALACGREOATE 5 j 9 i OTMER' i auroraoBlLE UIPRODUCTS-CCMPIOPAGG 5 � ' s ANVAtrro tF aeldunt E 1 S AUTI2ALL OWNED AU'romSCHEDULED BODILY IhL1URY(P5rQ3r¢pA) 5 i HIREDALT03 I4ON431&-NED AJTCS CDILY INJURY(Pe � S I Q PROPERTY DAMAGE I PoraedduES I wwORl;l.uy clnfl 5 I GCOUR EKCE9d LUIe CLAPAS-MADE ; 1 EACH OccuRFENCE S i A DED RETENTIONS ! AGCRECATE S I b+ORKERS C4MpE113ATt4N $ I ANDERTFLOYpRa,WASArtY W05-319-607814-014 10/$11-7014 10I3112A75 PER ANY PROPRIFT'OfWARTNERVZCUTNE VIN - -� OFFIC--RMIEMIIER E7,LLUDED? a iN/A V ANT �• It ..dtory in NN} E1 EACHACCIDENr R yr,,dh-pnoaunder S 1 500(f00 DFSCRIPnO.y OF OPERATIONS R:tnw { E L-GIaEA$p_ �,{p(,pyF 5 I '500 OQ 1 Et DMEASE-PODGY LIPAT S l St)OO,�DO DESCRWTON OF opERATION3I LOCATiONs I VEHICLES I (AtDRD 101,Addlaorial llemarkc$chedule,maybe attacAtdi(more apacala raOuUed) - kerS compensation insurance coverage applies only to the'workers s)cumppensation laws DI Uls stste( of N H ThisWOrCertifiCBtQ Cancels and supersedes al!previously Issued Certificates.only Els they relate to vjorkers Compensation Coeregtl. i I v - i - I CERTIFICATE HOLDER CANCELLATION SHANY OF THE A E BOVE DESCRIBED POLICIES Be CANCELt ED BEFOR' ACC ORRDANCEWITHTH PON II LICYPROVISIONgE WILL BE DELIVERED M 1 I AU»IQRgE4 REPRE3ENrA17vE — -- Wi Insurance Corporation � AFOR9 25(20t4/01) The ACORD name(and logo are ragistered Marge oPACBP�b Ftb CORPOFtATlDAI. All r[ghbs rssary _ EnT::G.: x2315237 CL:A+i CPL: 18171�a vide 65nrat LLflvf2G1: of 1 I i i b C1fe�a�i�a��aarerr�a;�/� _flee of Consumer Affairs&Busines s Rcgulation etMPROVEMENTCONTRACTOR egistration 118836 ExpiratiGn Type: . 4/26/20r�s HI TECH WINDOW g g ' +` -� F Supplement C<� (DING INSTAL INC i TIM WICKS I 29 ARROZOOD ST METHUEN,MA 01844 --------------- Undersecretary E Massachusetts -Department of Public Safety Board of Building Regulations and Standards f Construction Supervisor License: CS-096516 `a c r.s n TIMOTHY W WIvks i 3 ELLIS ST Methuen MA 61$44 Iv Y Expiration Commissioner 09109/20116