HomeMy WebLinkAboutBuilding Permit #1055 - 134 BERKELEY ROAD 6/15/2015 l �� NORTH
BUILDING PERMIT uF�T�go ,bgtio
TOWN OF NORTH ANDOVER 0 � A
APPLICATION FOR PLAN EXAMINATION
Date Received �q A�RAiED'PP��y
Permit No#: US SSACHUSE
Date Issued:
I ORTANT:Applicant must complete all items on this page
LOCATION /3y eeR/ce<y ,ST
Print
PROPERTY OWNER W*yo e Gc'o./Aa I
Print 100 Year Structure yes
MAP PARCELS � ZONING DISTRICT: Historic District ye4=-- Machine Shop Village yes
TYPE OF IMPROVEMENT PROPOSED USE Non- Residential
Res' ential
❑ New BuildingOne family
❑Addition El Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
Repair, replacement ❑Assessory Idg
[IOthers:
❑ Demolition ❑ Other
-- - • _
❑ Septic [i Well Floodplain Wetlands ❑ Watershed District
❑Water/Sewer _
DESCRIPTION OF WORK TO BE PERFORMED:
S/�s1.// 3 f vvite ids�die /e s�C .f;�i'n
Identification- Please Type or Print Clearly
Phone:
OWNER: Name: "Y4-- �e"°�'�'�
Address: i3y ,Pe�tke��- s i
Contractor Name: IA- e,.4 ���� s"�"� Phone: ?78' "1�9.
Email:
Address: X-0 c&e -4 " A'
Supervisor's Construction License: 0 -Exp. Date:
Home Improvement License:
/l Fl S3 6 Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$15.00 PER SFJ
Total Project Cost: $ .3 s� 9 9� e O FEE: $ ` v
Check No.: Receipt No.: 0 1 NOTE: Persons co tracting with unregistered c tractors do no have
acess tguarantyfund
I
Location 14
No. �'�7 Date �� S
t
. - TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee $ Z'-
Foundation Permit Fee $
� Other Permit Fee $
x
.� TOTAL $ `
Check# �
0 °"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. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF a U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH, . , Reviewed on Signature
COMMENTS "
Zoning Board of Appeals;Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
I
Conservation Decision: Comments
Water& Sewer Connection/Signature Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
"FIRE DEP $T�IME�,N�T wATe►T►pDumpster n s�ite;;;y se �o
Located at 124 MaintreetR ,,- -- -- ��---� ---��_
Fire Deparum nts gnatur�e%cl.ate '_ 4 } ' `'CR offt�-
4
�__
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
®ANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
i
I
® Notified for pickup Call Email
I Date Time Contact Name
Doc.Building Pern-t Revised 2014
Building Department
The followingis 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
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
4 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
4 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
i
NORTH
Town of
2 E 1Andover
h h ver, Mass
o KO
CQCNIC"t WICK(
�d RATED
7V u
- BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT Qe� BUILDING INSPECTOR
.................0*144'44L.
................... ............. .... ... ..:......... .............
has permission to erect ... buildings on V
L'�.. Foundation
c'k , Rough
to be occupied as kt d1..... y
provided that the person accepting this per it 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 CONSTRARTS Rough
. Service
door�
n
.... ............................................................ 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.
I
'®Tec. in ® Inc. SIDING
R O. Sox 8234, WarO Hill, IVDA 01835Siding,
MA Reg. # 118836 29 Arrowlivood St. Methuen, [VIA 01844
MA Lic#016201 1-800-851-0900
d�j / 02 / 15 VVWW.hitechcorp.biz
®ate:
PamJob Marne: clbin Consultant: I
Telepho e: X o
Job Address: r
i v
I
CONTRACTOR agrees to start described work on/or about weeks after final fittings and complete described work in about working days.
CONTRACTOR shall not be held liable for delays due 410 causes beyond our control.
r The following work includes all labor and materials needed b complete your job in a workmanship like manner.
.lob Includes i
! Trim
Combination Job-Siding With Other Work i - 1
E]YaEJ P.V.C.
uifding and Elec.Permit Coated Aimn Aluminum
Fascia Trim �
-Siding Removal RSoffi(Trim Fascia TreatmentLoP -
j
reparation PackageFascia Color l ('
V�"ndow 8 Door Trim
Accessory PackageFull Custom None
El Shutters
Undedayment Insulation Location
utters W
Siding
ownspouts So€fit Treatment
j _ -
Remove Debris Lock.Elec.Ivleler Soffit Calor
Preparation includes Center Jen! Fully vented
- 13 Nor.-Vented
le Rot Vented as Ne
epiace Visibt Location
eded
energy Savings/Bug Guard Stoner Window And Door Easing Treatment
{
1 l4rindovi And Door Casing Color Sql G'
Accessory Package Includes
Full Custom Formed J-Less Full Custom Formed
El
Color:
C r Blind Stvp Capping In
11 None (�
Vinyl Light Blocks Vinyl Dryer Blocks Location Q oust ni J W SI f J J
Vinyl Electric outlet BlocksGutter&Downspouts -
Vnyl Exhaust Vents .. -
Vinyl Faucets BlocksVinyl Vents Gutter Color r//tJ ,C Downspouts Color COm C
Gable l-f t
Location Ip Ince g e i7
Underlayment Insulation To Be Used. Special Notes
LJ Hi-Tech 3!8
[her
Location 0), e
gnJ(t
Area To Be SidedLldI
I
Complete House Garage QQ « 0
i
i
Siding To be Used
Color .. -
Wl� 3� Payment Policy.
Bend Profile 9 Bank Financin
y d I Yls 9 �Ov,nerToArrange El Hi-Tech To Arrange
` 09Y Li Cash Or Check
I L] Mosier Card
Corner Post To Be Used I
I
Corner Post color. Spit f- n 3 . Total Investment
FI 3,`79ar
Wide Insulated 00LJ Wide[don-Insulate"
p
1/3 Deposit �a�000.0o
Regular Insulated
RegularNon1/3 Payment
'q/a,o�o.Go
1/3 Balance of Day Completion i 1 00
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 uniting 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) be
added to any amount unpaid after 30 days from invoice date_ i —
In the event cf default of payment or this order or an Date of Acceptance
Ip an attorney for witeuien.the pUfdr35Cr agrees 10 Paan thereof and the acoounr is referryd
I/We give HiTecho 9 pay ren sonableattgrneytees.
4 Signature '•1:
Sion to o}btain all necessa�v permits.
Signatur l(' Lj.'�/,`
--^ Signature
w � r' i jHi.Tech)
i
d TheiCommonwealt�i ofMassachusetts
. -r. i
=�5===r; Department of lndustrid Accidents
• ' Office oflnvestigations
600 Washington Street
j" Boston,MA, 02111
Workers' j www.massgovldia
rs Compensation Insurance Affidavit:Builders/ContractorsXlectricians/Plumbers
Applicant Information 1
Please Print I.egltlb
NaI118(BusinesslOrganization/Individual): Via'—
I
Address: W-rJ(W S,7_
City/State/Zip: �,qa 3
lPhone#:
Are you an employer?Cheek the appropriate bog:
1Ja I am a employer with r=e4 Q I am a general contractor and I Type of project(required):
employees(full and/or parttime).` 11, have hired the sub-contractors 6. E]New construction
2.❑ I am a sole proprietor or partner- { ; listed on the attached sheet. 7. []Remodeling
ship and have no employees These sub-contractors have
working for me in any capacity. employees and have workers' 8' Demolition
[No workers'comp.insurance ' ` comp.insurance.? 9. ❑Building addition
required.] 5. 0 We are a corporation and its 10.❑Electrical repairs or additions
3-❑ I am a homeowner doing all work officers have exercised their
myself _ i l l.❑Plumbing repairs or additions
Y [No workers comp. right of exemption per MGL
insurance required j; 1 C. 152,§1(4),land we have no 12.C]Roof repairs
employees. [No,workers' 13.2 Other ,,a
I comp.insurance required.] �~
Any applicant that check boil roust also&!1 out the section below showing their workers'compensation policy information.
I Fomeowners who submit this affidavit indicating they areldoing all work and then hire outside contractors must submit a new affidavit indicating such.
•'Contractors that check this box must attached an additional!sheet shoving the name of the sub-contractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must pro�ride their workers'comp.policy number.
lam an employer that is providing►vorkers'coinpensation insurance for my employees Below is the policy and job site
information.
Insurance Company Name: 'feltfroY ;•.rdarvlsn¢a
Policy#or Self-ins.Lie.#: t�� �a~ ,�- - , 4 I Expiration Date: .010
Job Site Address:
City/State/Zip: /� �.�.Le ✓tics
Attach a copy of the workers'compensation piolicy declaration1page(showing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c-I 52 can lead to the imposition of criminal penalties of a
fine up.to$1,500.00 and/or one-year imprisonment,as well as civill penalties in the form of a STOP WORK ORDER and a fine
of up to$250.00 a day against the violator. Be advised that a copy lof this statement may be forwarded,to the Office of
Investigations of the DIA for insurance coverage!-:erification1
; .
Ido hereby certify un/der titepains andpetralties'ofperjury that the infortnation provided above is true and correct
Si nature:
Phone#: 9 76 -
I s
Official rase only. Do not write it:this area,tobe completedhjpil
i cit��or town official
City or Town:
Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department13.City/Town
6.Other Cl6k 4.Electrical Inspector 5.Plumbing Inspector
Contact Person:
Phone#..
i
-• L•JJVJ KITTREDGE INS
11/10/2014 8:56:06 flhi PST GJ�T-8) r PAGE 01/01
t FFCM: 1(�lt)(i 1r} 1978;733;60 -
page: 2 OL
'`°G G11J?b® CERTIFICATE OF LIABILITY INSURANCE DATEt"""'°° 1
HIS CERTIFICATE IS ISSUED ASA MATTER OF IN
CERTIFICATE DOES NOT /AFFIRMATIVELY OR NEFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER t1
GATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POI11C EIS
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poljcy(iesmust ust be endorsed. If SUBROGATION IS WAIVED,subiI ct lo:
the terns and conditions of the Policy,certain policies may requirean indorsement. A stieternont on this certificate does not confer rights' the
certificate holder in Lieu of ouch endomemen 9.
PRODUCER BARRY J KITTREOGE INSURANCE 0 C rio
81 S MAIN ST M .
BRADFORD, MA 01835 PHONE FAX !
EddAl DD1
AR
INSURER 9 AFFORDING COVERAOB '
MAIC
INSURED 1t1SURERA: L.M InBuranCB CO Oration 3360D
HI-TECH WINDOW&SIDING INSTALLATIONS INC NSURERB:
METHUENN MA 0184¢ NsvRERc:
NS URfA 0
e1SVRER E: a
COVERAGES CERTIFICATE NUMBER. 22315250 iISURERR: 1 9
THIS IS To CERTIFY THAT THE D(>LICiF$OF INSURANCE LISTED @FLOW HAVE BEEN ISSUED TO THE REVISION
�AIMED ABO EB OR THE POLICY PERIOD
INDICATED. NOTWIrHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OP,OTttER DOCUMENT WITH RESPECT PO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE I RMS•
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
Me"
LTR TYPE OFMURANCE IVSD VVVR POLICY NUMBER POLICY EFF IMtI(/AD FJIP
COMMERCUILCLaiERatUA81LRY M/A SITS
CLAIMS-MADE OCCUR EACH OCCURRENCE 3 I
i ro reERTE6 s I
P
MED EA'(An•ono m%on) S
OEN•L AGGREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY 5
POLICY -COF F-1 LOC GENERALAGGREOATE 5
Or13ER.
PRODUCTS-COMP/OP AGG $ i
AUTOMOBILE LIABILITY S '
ANYALITO F an S
ALL OWNED SCHEDULED BODILY INIURY(PerpaAioA) S
AUTOS AUTOS
HIRED ALTOS No"'A"eD eODILYINJURY(Peracddent) S
AUTOS PROPERTY DAMAGE
uMCR{LLA uAa $
OCCUR
EXCESS LIAR CLAIMS MADE EACH OCCURRENCE S j
R ON
AGGREGATE S j
A wORKERSCOMP ENSATION YIN WC5-31S60781a-p1a01a 10!3112015 f SAM S I
AND EMPLOYM'UA6)LrY 1013112
ANY PROPRIETORIPARTNERlE7!ECVr3ve
OFFICER/NErd!lER E7,CLUOED'/ N N/A E.L.EACH ACCIDENT S 5QQ Q
(Mandatory m NH)
Itf•pa,d¢rrhd under F_L.DISEASE-EA EMPLOYE S
DEBCRIPnON OF OPERArIpNS t+amw
EL.DISEASE-POLICY LIMIT $ I 5001 bol
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORO 101,Addlaenal Remarks Schedule np 0e
coverageY attached If more ecacelerequlmd)
rkers
ion
Tiffs certificatecancelsand supers ds all e applies
Issued certificates.�on(ps they relate o�wor ers�ccompensation coverage.
f
CERTIFICATE HOLDER CANCELLATION
1
J SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFO
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELVE�ED I
ACCORDANCE WITH THE POLICY PROVISIONS, I
,
I
AUY110RREO REPRESENTATIVE
— -- LM insurance Corporation
AC ORO 25 2014101 I uss-20 14 ACORD CORPORATION. All righic rers
( ) The ACORD name and 1090 are roglsterad marKs Of ACORD i
CERT NO,: ZZ3132$0 CL:&NT CODC: 1613150 V'dl 00-7-1 11!10/3013 11:5::57 Ah (ir9Z) Pa 3¢1 of L
J�Ilrice of Consumer Affairs&Business Regulation j License or registration valid for individul use only
E IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
eg1strati on:--�A-1,8 Type: ' 10 Park Plaza-Suite 5170
Expiratiofi:g�?4/2ra 017•(,(j _ Supplement Ci:,d Boston,MA 02116
HI TECH WINDOW e...&INO-'MTALL INC
TIM WICKS `i�'r'
29ARROWINOOD ST
-ti
METHUEN,MA 01844 Undersecretary j N valid without signature
S ..._.. _
J,, Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
a License: CS-096516 -
i TIMOTHY W WIp{S �;.
3 ELLIS ST ° ri
Methuen MA 01$44
Expiration
Commissioner 09/09/2096