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HomeMy WebLinkAboutBuilding Permit #689-2017 - 150 LIBERTY STREET 3/22/2017 J r1ORTH q _ BUILDING PERMIT 3?�`t�n ��0 TOWN OF NORTH AN-'OVER APPLICATION FOR PLAN F 4AMINATIO - Permit NO: 1 Date jeived l ,- 7�t I Q I b ° Date Issued: - / PORTANT: Applicant must complete all items on this page 9 its 1 2 � �� ._ ���r A,'��5�Y � -- E ,,, js t .�Nr:.`.'. «fid s �' /Ni•,ya e� j t TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial i7 Repair, replacement ❑Assessory Bldg ❑ Others: D�pemoylition ❑ Other 7r ,� p sTjSRIl MCI Z a x �� rpt ,� m."nvo P((P%C -Ty ba- on ts�o -To tw, a " Identification Please Type or Print Clearly) OWNER: Name: Da V I 5f--AcoUe, Phone: Address: � [s 4• t €�� �� �`��Y �5 � r� R � � �#E�\���� �4R8�� �h������ y s�[ � �e R � E a� [�'P'�a, _ 5� ,k� s r� ��•.�.c � ��t �" ��i'. �',� ���� 3 d�f��a� �j4E`i..-; s �; u„s 4�� � y. �.��� 'x•{� � Fcs at ..<.I �wri`u, r i' vy4 ",v tu 1 ,�,• is a :t ,+ r-1 c °”" NN, 5,ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �' -S(50 FEE: $ a Check No.: 74# Receipt No.:__Z / Q NOTE: Persons contracting with unre ',tered contractors do not have access to the guaraftly fund NORTN BUILDING PERMIT o��T,ED TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EX kMINATION y Permit No#: Date Received ORATED A4Ry CHUS Date Issued: - MORTANT:Applicant must complete all items on this page Como RR LOCATION ------ - —' --- -- - - - -- :� Print CDC- 41 c �m ZA _� r a NE W_ u � - - Pnnt 1 DD Year�Str cure yes no EMAP __ PARCELS ZONINGDISTRICT �% Historic ®lstnct yesno - Y11n, S OPV Mac,. e r--p 111 Y� _no 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 ❑Assessory Bldg ❑ Others: ❑Demolition ❑ Other - Se tic4VVell -Floa'dplaii D Wetlands UVatersfied (] Dsf�ict . C]V1/ater/Sewer x _ DESCRIPTION OF WORK TO DE PERFORMED: r Identification- Please Type or Print Clearly- OWNER: Name: Phone: Address: Contractor Name:: _: Phone;, - '�"` •`%- - - - .-. .. _ - --_.. _ ._ ._. �n ,mss Pr-. ....,,< i. Supervisor's Construction License : - ._ Exp DateE °_ - �.1 .1 441 .r R' .. . -k.4. Z��.yec _ - _ Homeilmprovement License>:. . p r . Ex : Date ARCHITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. i_ _,Total Project Cost: $ FEE: $ Check No.: Receipt No;: NOTE: Persona contracting with unregistered contractors do not have.access to the guaar anty fund ;�iriiiati i�r�:rif Ari r;�Inz iilPr Sia*nattare of contractor- 1 J 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 o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products 110TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) o Building Permit Application o Certified Proposed Plot Plan a Photo of H.I.C. And C.S.L. Licenses a Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract act o Mass check Energy Compliance Report • Engineering Affidavits for Engineered products DOTE: 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 ice✓ Doe:Building Permit Revised 2014 i Plans Submitted ❑ Plans Waived 0 Certified Plot Plan ❑ Stamped Plans ❑ TYPSOF SEWERAGE DISPOSAL s" Public Sewer ❑ Tanuing/MassageBody 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 - U FORM /PLANNING &DEVELOPMENT Reviewed On Z) Lbl( Signature_ LLO -COMMENTS C®NSERVATION Reviewed on I 8iqnature/_i 1, WL_ COMMENTS ( 00 /HEALTH Reviewed on t 7i 2C*A Signature r COMMENTS "12 s ectSa-J - �J rc& a�I`7 - ko N 2.W 2 Cwt w c�n) f No New <<J��C ce oti170fgj 04rdu-f s "Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments vWater & Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT' - Temp Dumpster on site' yes no Located at 124 Main Street Fire Department signatureldate Cv COMMENTS ,, dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop,requires approval of Electrical Inspector lies No ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) � z LAJ C j I, VV N eo ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Permit Revised 2014 Location 150 L)1 e d c, No. �r 1 "' �,i Q 1 Date e ,_ • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �5 t` Foundation Permit Fee $ Other Permit Fee $ '` TOTAL $ Check# G y Building Inspector 31402 1 oil A� B o 1 ��^% �"'.� -, ,� � � ••, �.•Vii. p,� YF a r r �.. ,der"`}. �_. '+ � ��v �� ,` •'�' r t �`.. � �s♦ 1x1 r. �4 { � ' `` 1 1 st4' f r. M1OII �� f � DC7 ..ALM 1� " ¢ r 1 1 I I`I{1 II { Dura-Bilt Carports Attached Carports Select from a variety of styles. --� Simply select a Dura-Lock or - Dura-Therm Insulated Roof for added protection from summer sun and heat. The popular Aluminum Awning - may also be utilized as an attached carport. '�,� i 11fr1�"+s 6"Dura-Lock Attached Carport 0 00i _ National Sunroom Association Manufacturer Member 4" Dura-Lock Attached Carport _ ` r The Roof Support System is designed to support all = Dura-Bilt Roof Systems except gable roofs. It is ° used to support the Mounting Rail at the home when required. Engineering specifications with snow load information are available. Roof Support System Bulletin RA-12 - Order from your Dura-Bilt Dealer - Dura-Bilt Products, Inc. P.O. Box 188 Wellsburg, New York 14894 Specifications subject to change without notice. www.durabilt.com Dura-Balt Insulated Roofs Dura-Bilt has two styles of insulated roofs The lamination process seals the roof for you to choose from, Dura-Lock and panels, top and bottom, with seamless, Dura-Therm. Both feature thick, laminated pre-painted aluminum.'The result is a polystyrene roof panels to provide excellent roof that's tough on the outside and handsome strength and insulating properties. on the inside. Dura-Lock Insulated Roof With Skylights s. E y 4 +N For Patios, Porches and Decks @ qPal _ �� �:� ' blq �IOW! •�' .a.. _ _ _ w '� ;..rFtti�z^o .ay„r��'�y�.`w'v -y,f. _ �'"•F}.T_�".-�. tea,°'�`x++..,.y�,�� �'i�" �.�Y�M'�,p���.��•.� � . K�" � 1',��„bM, •• 1 6"Dura-Lock over Patio with Pillar Columns Dura-Lock Insulated Roofs Available in 3", 4" and 6" thicknesses I "m® I +� 0 Dura-Lock Insulated Roof with Railing and Pillar Columns Jim-- -A 1, im-_-A!, . This rock solid roof is available in 3", 4" and 6" thicknesses. Our unique roof panel locking Clay Color Dura-Lock Insulated Roof system results in a ceiling that looks virtually seamless. Each roof panel is 4'wide. The optional Fan Beam Roof °- P _ Panel provides an internal metal raceway for wiring and --- support for a ceiling fan and -- ---- - ' lights. Dura-Bilt Roofs are designed to extend to the left or right - . after initial installation. This ` allows you to expand your roof in the future. 2 Dura-Therm Insulated Roofs Dura-Bilt Roofs,Awnings and Patio Covers have been tested by Professional Engineers. Dura-Bilt roof components are designed to The superior design of our mounting rail, work as a single unit. This is how we achieve deluxe front header and support columns our outstanding wind and snow load all work together to produce the additional capabilities. strength for varying weather conditions. Dura-Therm Insulated Roof _ over a 3-Season Sunroom _- 111 11 1 11 r Lh, •> Dura-Therm Insulated Roof over a 3-Season Patio Sunroom The Dura-Therm Insulated Roof features .__ 2" or 3" thick laminated roof panels. These panels are joined with Dura-Bilt Roof �- �-=-- Girders to give excellent snow load strength. : ; This roof helps insulate your Sunroom or Screen Room from hot and cold temperature #` extremes. Dura-Therm 2" roofs are available ,- in white, roof panels are two feet wide. - Dura-Therm 3" roofs are available in white, ® # roof panels are three feet wide. Roof projections for both roofs are in one foot increments from 5 to 15 feet. - Dura-Therm Insulated Roof over an All-Season Patio Sunroom a�- IL i t I ctop, s. r - Dura-Bilt Aluminum Awnings Easy Living Awnings An easy-care Dura-Bilt {' Aluminum Awning lets you sit back and relax with your family and friends. With more than 600 sizes available we've got your deck, porch, patio or carport covered. t Select either the classic arched `pry awning or the contemporary straight line look...both available from Dura-Bilt. Aluminum Awning with Railing and Scroll Columns _ t ` Designed to extend. _-' � �, L■J ",_. left or right. After inital installation �R.� �� l;�` i��., R_- - � E:. ` Arched Aluminum _ this allows you to _ �F ��,, ' V Awning with . e -,resi!!j� .9ii Ililidin expand your - " Railing and awning in the Dura-Posts future. i i Galvalume Patio Covers The Galvalume Patio Cover offers .>. the desirable quality and appearance of our aluminum awning. Featuring special steel panels which have a hot- dipped zinc and aluminum coating for long term durability. The white baked enamel finish blends with any home. r !I Support components and extrusions are all aluminum. 4 1 Dura-Lock Insulated Gable Roofs 0o s Ap me , t rv.. p III ium �� _ rt . w Dura-Bilt Gabl ver A - faDramatic New Dimension with a Gable Ro The distinctive Dura-Bilt Gable Roof gives home owners a bold new look for their home. Add skylights for a touch of sunlight....or moonlight. The Gable Roof is available in a wide range of sizes to fit your home. This roof utilizes 3", 4" or 6" thick insulated roof panels. The gable design provides a cathedral appearance....quality throughout. r 1 HIM f� .... ..... :. , f 5 f over Porch with Dura-Bili Aluminum Railing r _ 1 e Venting Skylights i For Dura-Lock Roofs !} Optional extra This Skylight unit consists of thermal glass which opens and closes with an optional 57"handle crank. Skylights l are 24"wide x 48" long and are factory installed. ®� . 'I I °I; ! Support Columns Optional extra €: Your selection of aluminum support columns include: II " Dura-Post Columns .2','X 2" lily t' Deluxe Post Columns ..3"X 2" Flat Scroll Columns ..Wide l l 11 Corner Scroll Columns '8"X 8" I Pillar Columns................. X 4" r i I *. These white or cream columns are Ilhh available in several hey hts-In addition,Decorative A ehed Scrolls may be added to enhance the appearance of your addition. Scroll Scroll Dura- Deluxe Pillar ¢ Column Column Post Post Column (Corner) (Flat) Column Column it I Aluminum Railing Optional extra Well-proportioned railing, consisting of top and bottom rails with spindles, ^'n == - gives your deck, porch or patio a great finish. Entire railing is made of rust-free aluminum for years of ll�Illl�l��l����ii ��l��l�l�l�ll��III�IIII�IIIII01{IIIIIIIIIII � _ _ maintenance-free use. Available in white or cream. Optional Scrolls will give your railing a finishing touch. -- ' ' 6 Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TyPF-OF SEWERAGE DISPOSAL ` Public Sewer ❑ Tarming/MassageBody 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.- U FORM PLANNING & DEVELOPMENT Reviewed On gjDl�Signature_ o" .COMMENTS V7 CONSERVATION Reviewed on I . Si nature' I 1' L/L— V, Ali COMMENTS T ` ��a�� ` ��� l 6i_ HEALTH Reviewed on Si nature COMMENTS Yoning 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 DEPARTMENT' - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date v21 Westwood Circle Dover,NH 03820 Phone 603-750-7577 Fax:603-750-5111 MA HIC#178297 MA CSL#CS-084141 Cogtract for Services and Products Customer(Buyer)_ �Q�j� pR( I f,V0 Date � f A� Job Site Address p City • 0D 1+G✓State 4 Zipo'$�Phone._t_Y L- - Mailing Address_ City State Zip Email (/ ? �leQ ✓ty CJC�. GAb.LQ �I Cl ) ,a ��o;cc�� �. X }(oo,t(- w t -so►1►^cervtL i 3 � x� 8' C .4 004 -�---- Vic? IN f ; • w.ly, L ✓� J y - -Jc�. �GA$1 = F . C�E�t►t=4'rlls z4L sk-f j_ L'ha,e- 1-6_Sc rf�:, lt/h, jE .►�G CT�,p�9t, - E lYe r<C• -J, _lri` Je ,,,r�CLJeJ• `�_s_ _ ---Z -.Jj-" ;` -'1'',I (�Pi.e 1�4•., llr,/ _ Xyl 17 1��� -- � 1W�h,u _PVc��A:tL� r w�ant�� �►� F—,T.,2� �•�S i��-o C /i >>E� Com:-{ ( �z ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED.AL1.WORK IS TO BE 7777T)INA VdC)RKMANLIKF.,ti1.ANNER CORDING .TO STANDARD PkACTICES.'r111S CONTRACT CONSTITUTES TO ENTIRE UNDERSTANDING OF THE PARTIES,AND NO OTHER UNDERSTANDING,COLLATEXAL,'VERBAL,OR OTHERWISE,SHALL BE BINDING,UNLESS SIGNED BY BOTH PARTIES,THIS CONTRAC i V,"',![)ONLY WITH PROPER SIGNATURES.CONTRACT MUST BE RECEIVED IN F.ZE-BREFZI--ST ORFS OFF'CE 1,11i'N FOURTEEN i!d)DAYS OF CUSTOMER SIGNATURE WE RW HT TO CANCEL THIS CONT%ACT AT ANY TIME WITHIN ONE YEAR OF TNF-DATE OF THIS CONTRACT.IF WE CANCEL,W'--''RILL P;tOi`.•IPTLY R:,.,7JRN ANY PAYMENT(S)YOU HAVE MADE. START OF INSTAi,;P T ION WILL BE IN OR ABOUT-TJ—L WEEKS FROM THE ABOVE DATE AND IF APPLICABLE,PERMIT APPROVAL AND/OR FINANCE CLOSING AND WILL RE SUBSTANTIALLY COMPLETE IN OR ABOUT 2 WEEKS FROM T,-IE S i A Wr DATE. IT IS UNDERS-O DL,iiy y01) .Ht-.THr?FOLLOWIIJG COI "'IIJGENCIES.'.OUI,D\4ATF R1!LLY CHANGc•rHESE ESTI,\'JA DATES- 'WS R'S INAE'.LITY TO OBTAIN FINANCING,INCI.FMF.t;T WEATHER. i T Zj<ES 0,Ci'HER LABOR i)ISRU.PTIONSNON-AVAIL- . ABILITY OF MATF..tirALS,ACTS OQ�3 OD OTHER FOR COND:'"IONS BEYON ' Iur,_ rr '"" —" —•— -�'E ARE NOT RFbPONSIBLE 1 ZINC CONDENSATION RESy 1TING FACIA PR,•EXISTING CONDITIONS.THE LONGF`'ITY OF CAULKING,MATERLa.L DEFECTS ;,R ACJ` OTHER AC'_'S OF NA'IU'3E INCLUDING BUT NOT LIMITED TO LIGHTNING, FLOOD,PRRES AND ICE DAMS. BUYER'S RIGHT TO CANCEL BUYER MAY CANCEL THIS CONTRACT BY DELIVERING WRITTEN NOTICE TO THE CELLER AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINER LAY AFTER THE DATE OF THIS TRANSACTION.BUYER MAY USE THIS CONTRACT AS THAT NOTICE BY WRITING,"I HEREBY CANCEL'AT THE BOTTOM AND ADDING BUYER'S NAME AND ADDRESS.THE NOTICE MAY BE DELIVERED TO THE SELLER AT THE ADDRESS SHOWN ABgVE. SINCE THIS CONTRACT MAY CA r,L FOR MADE-TO-ORDER GOODS,IT IS NOT SUBIECT,O CANCELLATION EXCEPT AS STATED ABOVE.AND IF"OU CANCEL THIS CONTRACT AT ANY Tim z SUBSEQUENT TO THE THIRD BUSINESS DAY AFTER THE LATE OF Tr,'E CONTRACT AND PRIOR TO THE START OF WORK,YOU AGREE.'0 PAY US THE DIFFERENICE BETWEEN OUR ES'I'IM ' me cn'A nNn�.aR;(1�Roj ANT HZ p'!`[ir.-T')TA] S:•I$!'�1; r �STr R._r. R.OFt^I R ri.r0>v r2.arT S'R\LS AS YOiRR AUT HORtIZATIUN'FO CLEAkV1AD ITS REPRESL'N IATIVE::TO UB'1'AIN But t IiRctr' app ES rOR ZONID?G A°PLICATIONS FOECT. A g T rYf•epsIT C ,Nr, n T A OVE YOUR C IDED B'i US FOR PAYMENT Of'THE�AMOUNT FRMS SHOWN BELOW OR,IF WE COMPLETION CERTIF! ATE UPON-OMPLETION OF THE WORK,IF YOU FAIL'f0 PAY ACCORDING TO THE TERMS BELOW.YOU ALSO AGREE TO IAND HA`✓i NOT SIGNEll OUR NOTE,THE ENTIREOFCUNPAIB BALANCE BECOMES IMMEDIATELY DUE,AND YOU MUST PAY A COLLECTION COST EQUAL TO OUR ACTUAL COSTS OF COLLECTION;UP TO i5%OF THE TOTAL AMOUNT YOU OWE,PLUS ArTORN-Y'S FEES AND COUPT COSTS.ANY UNPAID BALANCES WILL INCUR IP1TEaEST CHARGES OF 19%ANNUAL-OR 1.58%MONTLiLY.n i i 1rV0 HAS A ONE YEAR WORKMANSHIP WARRANTY.FINAL PAYMENT IS DU PON REASUr:ABLE COMPLETION OF WORK. i L WAR. RANTIES VOID 1F BALANCE DUE 1S NOT FAID 1N FULL. Total Cash Pri a 560 Customer /� J /( Down Payment Grt� Date ---L—^ --� CAVA Second Payment to, Customer—.- Date Third Payment �/ r b. 3f C,71 PIT Oo 1\ �n S. A)LAV c" PCA 1 S ���; T, � lP[,I u)c).A dak I 3 —Rve Q- v\e �j Jpc p oC. QLJ I'll - luecj CAv^ Lj L 4 C) C) 0� CP b4 S��i.� NOV—IE-96 12 ".01 Pt1 ERAtERS TERGROUP 15084761888 P. 0 M :' " ��AGE I SPEC ALAN NO' RTHERN ASSOCIATES, INC. 342 H.MAIN STREET ANDOYER MA 018JO r&.- ,(508) 474 .4410 FAX ('508)474-5057 i. 4 AWTSAWk KXCMAEL A.,Q SUSAN VMD REP. JJOY / 000.E LocArxav ,too c.raERrr arRea, PLAN Mr. PLOli MS C?TY, Srt 7E: NORM AACOVI t AW.. BCAC!°� 1•• do• CAM. 1 D l @ J' S6 4" Av AW1415:4 39.45 DCOPORL rl do _ j SQ�San ' 150 2 story wood cr m L � h � rt ! • L 0 T" n. 87.120 af.+ AtI S t I 4 o. N I 370.S 7 I m (OT 5 I7RG,0 = Z,Ot/acltCS � Q M CA i , 31, \� Z6 \� <SrPTIC TghqK 6XiS7//VG {=,yp, AREA FxcAvglro Tb QEm(jVP1 N,✓Sc//7,4ts4 32�. 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BOX 1 z-7, (�,5- /27,3Z /N /NV END OF P/PEIz7,so z 1z6oz NOR �� 411-0 l z-7, oQ F02 N47-Lz2 ELEV,4T/ON /ZUIO MICHAEL ANL) MAu2F&/ MERTH .4VE2,46E sTON67 sc.4�� . � ''= 40DATE-.- Nov, DE107iq ,47 P,eOBE ✓oTE. T111s PL 4N 15 NOT ,4 W,,4,C1e4NTY C148I5TIA NSEN F SER Gl , INC. OF TI-/E SYSTEM BUT A YE,?1F/C,4T/ON /6,0 SUMMER 5MEET - HAVERN/LL ,MASS. OF T,�lE LOCATION OF T,-/E EX/S T/NC ST,eUCTU2ES. , North Andover MIMAP December 21, 2016 AJ 105.D-0166 090.8-0054 090:8-0057 #83- #645 #83#645 .,Li,..:ialc� tp..,: .,•ti t 090.8-0009 090.6-0058 617 #95 ante .: #108, 090.B-003 5 #107 090:B-0055 " <: _••��' •�- 090'8-0029. 090.6-0059 ID el _. ---t s1 ( #120 _•:" :::_' t 090.8-0056!;..:- := 090.6-0060 R1 #'1`19 l alto I �k :. 7. f FF 4150 i} 090.6-0062 #143 I " I ' 090.6-0065 a #157 t I Ott ' A& 090.8-0068 t ` } f f + -•'' y �ltr 090.8-0063 - jr. llji f'� 090..B-0064 . #171 .;... X090:B=001�2� .,•', •- f U. Middleton -- : • 0 MVPC Bo Zoning Overlay Zoning Cj Municipal Boundary ©Adult Entertainment Distdc 0 Busine s 1 District R Machine Sop Village Ove C Busine s 2 District Horizontal Datum:MA Stateplane Coordinate System,Datum NAD83, Rail Line 0 Watershed Protection Dist 0 Busine s 3 District Meters Data Sources:The data for this map was produced by Merrimack Shop Interstates 0 Historic Mill Area 6 Busine s 4 District '011 Valley Planning Commission(MVPC)using data provided by the Town of v Interstate ©Medical Marijuana 0 Genen Business District 0 t`ip 'qh, North Andover.Additional data provided by the Executive Once of —Major Road 13 Downtown Overlay District n Planne Commercial Dev ? e�� �••e OO Environmental AffaimfMassGIS,The information depicted on this map is Roads 0 Historic District Comd Development Dist 3 _ _ L for planning purposes only.It may not be adequate for legal boundary U Osgood Smart Growth(40 0 Corrid Development Dist O —• M definition or regulatory interpretation.THE TOWN OF NORTH ANDOVER i r Easements 13 Hydrographic Features Q Conido Development Dist F A MAKES NO WARRANTIES,EXPRESSED OR IMPLIED,CONCERNING Industri I 1 District ow- D Parcels Streams tl Indusm 12 District 4 THE ACCURACY,COMPLETENESS,RELIABILITY,OR SUITABILITY i4�4 ^ 4 OF THESE DATA.THE TOWN OF NORTH ANDOVER DOES NOT 'i Wetlands 0 Indusm 3 District 4 0 _ M ASSUME ANY LIABILITY ASSOCIATED WITH THE USE OR MISUSE OF a Industri I S District b U Exempt Lands Reside ce 1 District /,t °��r�o•��.(°J THIS INFORMATION 33 Reside ce 2 District SSAC14Us� U R-idel ce 3 District l de ce 4 District 1"=209 ft "�}.de ce 6 District Y de ce 6 District 8--e Residential District North Andover MIMAP December1 • S 1 1 1 1 t I s. '•+,�£7�1 or, ¢ it E4 s r (* R.'��-"a54 '• 1 1 �� 1 �� r � ��'�r•/�•I11 .� k��t�l:�y'u � �f �s: �e.• � �i4�'' ,�4���''.�. cr�r,.�,�*t'•y .ycros ��,.� ..FFA„ � 1 1 I'1 e� � �' r'.. rr�} �?`. ... 4QT ,..+�F�.. 't + ig< Y� $' 1 i ? M At ?�. d. i yip Jr. s�' '��; �rv��-�+� 't � i 1 Y � � ; +E" �"E •'l� �'qK! • Y+� µ,� 'P a'° •ttrFz' y It f s `"R..Y' {wit{ „obi" F;{* 'fJ .. ,• w,k ti% ���. s t'4 �' �# -d•fi' s� '' t ea •�1; t ' 4M, +,i�t�q.�....y '4 � �_�1 1- 1 1 ..+.. Y t �� a' �3f' �k�°�i'1 r •� 'r�;. Y"t f ,fes �} 4 WWW ��' r.. 1 Ei' � • �� 2 E1F 5s� ��#'��yy e��� �F'��,�. ,r�3`i�'4��}'�"i"S r`r � ' ,r' ��'" �� 7 �s3a x�I$-�%1 ^ •",�" 11 le �rt k u;" Cl MVPC Bo Imorstates Inlerstate Major Road •.•_ Roads V&ORT" k7l Easements Parcels i 209 ft "COnvosite, P 3net Mfnd- Load -Span Che .. tl�[:ila - o 100 end F _ .. M 4MGsd 1 & compoafte Panel PIMA IVYWI 1-F - TM, ftw i FT. e'. - Mkt.rz a Nea1m @idri - _ .............. i SP6649t 130 m- sed F- 140 Mpik Vfind 6 - Uparbi Cwamnr' 66�dEw q -- 5-1�' 'AIf'- 7 - ' ; �'' 1 �- ' -i '-►3' t;!'-fid' �r 12.1 447 'e7" B` 17-x' P 'A ' I . �°e "r - " '��=il 1 i'-yt. P"'. 11'�I� 11!'-!a I *" Maxinnm Cm ' ' tes 'Whdir . - WOO '- M1Nitd a.1io � $I111ld1 Speed - it Paaig' a■. �h�' ie ow lh7 Cltw'spa csrsaa� 2111i*C00eidt6a ftnnia, ' " 21-i 2V-4" 9 3E9'-�k" .. �5e- 1 R 12W-+' -x_5` . - Till(s1Uff� t4AIECi3 _ _ ' `. "- '' ` lil"Mir 'amt EMU INit11 w ,`dEl'-ea ac '-Z" I $m _ ,� '�i�fl- ,.; -�2` Z3�"•�4�. d'='G` V-11�� et imat''i wo ditualli ft'. 1A1<liiil S000d - 130 _ _.#t; -Whd $.�® �!dbd rQi�''- 'I 15@e f7uaf a 'f ki Ci 151 W. Mr " � � 3�P� if�tXA4axs � -.�- ���aT.gFM. TK �6 =6 1'h MAIM 191n i =� 1 . � ,=j" �F►�Ib didtl M(litt o - ' '; �} 7 '.�� tt - � _�+ -tt. 9a" a_ iG` tro=e� i7' 'Waftepi t� Fnaa _ artL GM F,'fO* Sim Carp ft !.,Chart for *'Endlosee YAW Speed'- 1 fd E9 -fid'Speed._ ff, . In tiil� d Spind 7bfa. ..2 7+T lFiiF_ FL x 5dd swovelamisbu Wells gind,.ireai!! *I% 'lea' f' t�-S'' ��il 1±.:n 9 f'=7tY' 1 - n�'r 1 s is-�' 74 1" Iae ei>14nid 9 kIftiii i7�,$ di In r' 7g-11' i IV-427 1�'-2� i g�'-71 I ;+�°' 1����" i',4 1 A ' 1Ei^�" �fi Ermi �. �P�91�1PYF� A-I tbns6 AM 2W-1P :2tM'=Y'w - i f? 1a`��` 9Q°-+5� -CV-10 i'WARd , i5P1l �,t�uoes� - _ = 9 E4lgi:llL �Plrb!7I+ 14t1. MlilSd °uCd =_i ?!e! do9lll as "Par7 a � ! PM14 c"i C�IktiGl Tr ti meq. X it YGd$s vitt GUIN mum %m '6 -- : �€ir :1711 fisank t " i "= ��'-'i' �"`'. i3,F-�" ����` ''3'�1 1'�°-�" 91°=fid' i'ri,X10' Addjftn% Qw*jMa A Maugq ,il�r' 6{i 'e— t =t 1° 9'7'-u• ,. 1.5=x' t'S:-,1! 3 -d' @�F'-t ! ''-PP :1, now Taw M lout arta M!d r - - -- wfdl u��r im wi ait-ioCi : e� MIX. cv¢!a f6� el I ,L � lift. II`t' ''�';�R�fail1�k Enc+�3sl5f�"' Str t� 1 1J8d*d. ,AA d n I lt4tei iid We r'�carw��,l ae - 1 15 In tl. t3 aad 11-- i d $p+�e►d ice'' . ` - Mft�cw to resod ft M aftmnamn _I rr s' ,IM sa,�, -- Q I` ba Ibsta "nvw1: qFM of fi�tit6�rir �9VfF�d'ihi d�711�,i�ABi! am 4r' 9,5'e� Ir-Z`- t5—i1` 47 '9;iq i` 't�'�-! al'-G` d �� 1$'-1 ' tr-1w 93`-4P M*11 Ei Mt Added 4 WIM haft Ed -W" '911ttPidi 1U �'� M '. !' pe4 i+ff] err i �d'- ' in. Bandl P68d LAW I 17am 49_ Milk' Fh3LL Fii � w Fe `- ` Lfee Land <A $!tib Lost Is • - . j,14'4' " ft 21 ff7c 1 a1g it hi 9b6 D"d 9� !7"-QLOW a 7 4'-�� -Ek: j r ed Mind sperm+1'fir -h+'6i1M1tlUM-4i dite P�Mwl GP911 CKEWt De Load e n�nrr�,ne +ar �i8ad� LL % 1`�4. , -DL * LL 0 las t'sd,,,sE. [1L M- -42 ITield' #tPaid Palter I aa7f in a.vat. off � Fs _ 3P� _ nc�u i FTG- - - sit., -,- _ rout a�7c4�i�ll, ift i x FT' For MWIMmi Parieto Qa= spang 1w $ e� 11"meg 9 ele �e VAnd u4i i;{Qtllla7A 'r 1°'-� a5' 6' ' °" 1- V-7" 121 I�i>�;6t ? ► M1 1 N id ' cel jr R!�1'=_r '1511-'1�', " i i�'- " 9.rs' '�l -Qt' �a.l 'C � 1#'-�F" 9+41"-�I by 43'1 00L- LL 0,02 ' 4 1'L D .LL v 62. Q9 M VIL LL 19 7.2' 1'31q. 11 . SPQ= fis"d ffia iaf EXPOMiJMOL ,go. { camp--. f tl� F(R E�Iihwm ftnaQ Ciaer*S,piEfiE ib! Fr 33il4 c k Ft i:-v 1,1._11,. ,t,2., P i r#7114 ,t 1" 11`-i" 17 1. 'mid 71r as a,ems^pit a sWhA AURMAYM FL gra Mai i7-a&ils_ ,wtmm i,i a!a gam" eta 17t�rwtt'FStEtlu9a, r Mi Mi OWN&Dili hi W§-Bofflgi;WrAMnL� F:4.Elm tM fix ti fsas,N r } �,NY 1a1�t '1+i4k;w4sa�tl min ear t se+d7� ��9�- Iwai vr4i U, , 1 1 0" 1 S Md;ximum Composite Panel Wind Load Sporr Char{, for Screen Room " Wind Speed - 100 m.. twin d Speed - 110 m.p, Wind Speed - 120 m,p. . Compos'te. Panel p:. . Panel Overhang Condition Panel; Overhon Condition Thk Panel Overhon Conditton None 1 FT, 2 FT. Ttik. None ,1 FT.;: 2 FT.. Thk. None 1 FT. -)-FT. Metal Skin 3 201-4' 20'-S' 20'-a" 17_10"- 4 22`-3" 22'-5' 22'-8" 14I . 20'-6 F20'=7: 20'-11" 4: i9'-1" 19'=2" 1s`.-.6a .,, 6 27'-8" 2T-9" 2T-11" 6 25'_6" 25' ,T 25-10 6 23'.79" 23'-10 24'-1"; Foam Wind Speed - 1,30. m.p. Wind Speed 140 M.pA Wind ......Speed - 150 m.p; Pane!I Overhona Condition Panel Overhang Condition Ponei Overhang Condition Thk. None 1 i r. 2_177 on , Thk; Ne t FT. 2 FT. Thk: None 1 FT. 2 FTi 3 15'-it 16 ;0 16'-5' Metal Skin 3 12 4' Ank ,; 12'-s" 12'-ti" 3 t2'-4" 12'=6" - 4 1T-5" 17 6"` 1T-1 ° 4 13-6" 13'-8" i4'-i' Foom 1.0# Density E.0.,S, ¢ 13'-S" 13`-$" 14'-1" Aturhinum - .024'', 3105-Ht4%H25.AI 6 21 -9 22'-0" 6 16' 9":'16'-11 t7'-3'. Patent 4,769,91;3 & 5,086,599 6 16'-9" 16'-11" 1T-3"' fl Maximurn_`Com ;'?site 'Panel Wind. Load Sporn Chart for "Open" StruCtj es Notes Wind Speed - 10 rn,pe, Wind Speed - 110 rn,p,, . Wind Speed - 120 m.p: Panel Overhon Condition Pones Overhon Condition Panel OverhangCoridiiion Chats SI1O.W Maximum Clear .Spans Thk, _ Ftane, t FT.` 7 FT. Thk. None t FT: 2 IT, Thk;. None 1 FT. 2 FT. for'. Snop'-N-Lock.Composite, Panel 3. 21 -4" 21 -5': 2i'-8" ' . 21 -4" 211-57 21'=8° 3 20 ZO'�5" Zp'-8 4 23-5' 23•-6` 23'-9" Structures classified os "Screen 4 23=5 23 6 23-9' ¢ 22'-3" 22'-5" 22'-8" Rooms con.€oin "solid roofs with 6 29'""-1° 29'-2' 29'-4" 6. 29'=1" 29'-2 29'-4" 6•v 2T-8 2T-9" 27-1i=" at least one solid waft usually the: Wind Speed - 130 m.p. Wind Speed 140 rr1.p.; Wind Speed - 1.50 m.p host structure, eg: Attached "Sere, Pones Overhon Condition Panel. Overhon Condition Ppnel OverhOn condition & V,Inyi Rooms `Only, - Thk, None. t FT. 2 FT. Thk. No 1 FT, 2 FT. I Thk. None Af FT. 1 2.FT. - Awd 3 18'-0 18'-i" ['2 8 `5" 3 .12'-4" 12'-6"'12'-11 3, 12'-4" 12'-6" Structures classified as "Open'` 4 19'-9" 19'- D0'-2" ¢ 13'- " 13=8" i4` ' conEpin solid' roofs with no stilid 24'-7" 24'=8" 4:-11" tj 1S'-9"' 16'-t1:" 1T�3 wolisi only ;post and beam roof 6 16'-9 16'-1 i" 17-3supports. eg. Free Stonding1.Carpo. rt Moxirrlum Composite Panel Wind .Load Span 'Chart for "En:c;lo.sed" Str.0 Urree Stonding Polio.. Covers, & Free cc Wind Speed i00 rn.p:. Wind Speed - 110 rn.p. Wind' Speed - 120 m.p., �adtng Walkway Covers. Panel Overhon Condition Panel Overhon condition •Panel Overhan .condition Structures classified as "Enclosed 7h k. None 1 FT. 2 FT Thk. None' 4, FT. z FT.. Thk, None 1 FT, Confgin •solid woks and roofs. with. 3 iS 11" 36 4' 18-5 3 1d'--6" .14'=1 D'' 15'-3' 3' 13-5' t3'.7" 14'-1" Glass glazed windows.,& doors it 4.' 17-5 i7'-6` 1T-11: 4 16'-2" 16'-;3" i6`-7" 4 14'-9" 14 11" i5' 4" them, eg. Glass Rooms, Additions,' 6 2178" 21'-9" 22'-r0" 6 20'=1" 20'-2' 20..=5 - tt3'-10„ Garages & Houses, Wind Speed - 13p m.p. . Wind Speed - 1:40 m p,..', Wind'.Speed - 150 m.p. Structures classified os ":Partially Ponel Overhon Condition Ponef 0verhano Condition Panet' Overhon Condition EnCI05etl" fiontoirl solid W011s and Thk. None. 1 FT,' 2 FT, Thk. None 1'FT. In 2 FT; Thk, None 1 F7, FFT. •roofs With -Glass glazed windows 3, 11 5" 1 11 -7" i2'-1' doors in them, :eg. Cl'ass 400m ¢ 13 6" t3•-8' i4'-1" ¢ 12 6. 12'-8" 13'-i" " 4 11 -8" `11'-10 11 -10" Additions Garages & Houses. Or 6 15'.-6" ;15'-8" 16'-0' _T"' T4 B"• 14'-8" 15-1," solid roofs with dt least One solid WaU usuoil:y the hest structure, eg Max: Corriposite Panel Wind Load Spon Chart "Par:t'ially Enc:losed'1 Stru, uplched Carports, Attached Patio Wnd 'Spee.d - 100 m.p. Wind Speed - 11 ;0 m.p, Wind .Speed - 12Q m.p. Covers & Attached Wolkway Cover . Panel Overhang condition panel averhan Condition Panel Dverhon Condition, 71115 Chart ,i5 used as an alternate 7h k. None .:. 1 FT. 2 FT. Th k. None 1 FT.. 2 FT„ Thk, Nona 1',FT. PFT, to in.stolling impact glass or thutt s � 3 14 'I` 14'-2' 14'-7" 3 IV-0141112=11" t3'-4' 3 11 -7" t1'-9" 12r-3" in. Wind borne debris areasand 4± t5'-5" 15'-7" 15'-11" ¢ 13' 1't 14'-t 14'-6" accounts for added internal buil.din 12-8".. 12'-10" 13'_4" 6 1'9'-2" 19'-3'. 19-7" 6 17 4" 1T 6"' 17'-10" 6 15'-9" 1b-11." 16'-3" pressures: Wind Speed - 130 rn.p.t. Wind Speed 1.40 m.p.; Wind speed: - 150 m,p,' Panel Dead 'Load is calculated. of Panel: overhon Condition Pon el Overhon 'Condition Panel Overhon Condition 2 Ib. per sq. ft. The remaln der 'is. Thk: None 1 FT, 2 FT: Thk. None 1 FT. Z'FT. Thk. None 1 FT:" 2 FT, the Live'Loo.d or Snow Lao Id, 3 10'-9 10'-i 1" 3' 9'-11" '10-2" 10'-8' 3 9:-4- 9,'-7" - eg. 21 lbs / sq. ft. is i Ib Dead 4 12`-0 12'-6" ¢` 10'-11' 11'-1"" 11'-7" Load + 20 lbs. Live` or Snow. Load 4, 10'-3" 1o'-5' 11'-D" 6 14'-9" 14'-1Q" 151-3" 6 13'-7" 13'-•8" 14'-2' 6 12'-9" 12'=11" 13'=4" Overhang improves 'pone) span, 2 it Mtt1. ximurn Corrl:posite Panal Span Chart Dead/Live Load 11 maximum U as listed. DL + LL 0 22 Itis./sq;. : t.DL �. LLQ 32 Ib,s. s ... k.DL + LL Col 42 .abs, s. _ Ponels may be used in a .wall or / roof OO lic'otion. q p Pane! OvethOn Condition - Panel. Overhan Conddton Panel -Overhand Condition Thk: None 1 FT Z FT; Thk. None': 1 FT:, 2"FT; Thk> None i FT, 2 FT. For Maximum Panel :Clear spans f 3 le' 4" 14-6 14'-1'1' 3 t1 -1t": 12'=f" 12'=7" 3 1Q'-5" 10'-7 11'-2." 123 MPH Wind Speed, reduce value 15-915-11, 16'=3 ¢, 43'-1" '13'-3" b3'-8' 11 -5" 11 7" 12'-1" listed. in 1'20 MPH Wind Speed by ¢ 6 19'-7" 19' 16'--3' 16'-4" 16'.--s" 14'-2": 14'-4" 14'-9 ntultip!,ying' by 0.98 DL + LL @ 52 lbs./sq. t.DL + LL @ 62 lbs,/sq, .`DL + LLD 72 lbs,/sq. Spans listed are for Exposure B. Panel Overhan condition Panel averhan Condition Panel Overhon condition For Maximum Pone Clear Spans f 7hk.. None 1 FT, 2 FT.- Thk:. None i FT: 2 F.T. Thk. NO- 1 FT: 2.FT. 3 s'`4' 9'-7" - 3 8:=7" $'-5° 3 7... 1' H'-2" - Exposure C, reduce values.listed b 4" tD-3" 10'-5' 11'-0" 4" g-5" g-T - multiplying by 0.85 —61712'-9. 12'-11" 13'-4' ��* NF 6 71 -8 11'-10" 12'-4" 6`' i4-10' 11'-0" t 1 -7" `''�, Snap-N-Lack Composite Panel Span Chcr. Revised by JAMES E, BRADLEY PE N 1765 CARNEDIE DRIVE, CLEARWATER, FL 33756 - � - b. Licences AK-379t-E, AL 9972; AZ-09512,:AR-3573. CA-23285, C6-1040i, = ri Dura-eiRProducts,Inc. OE 450,FL-15595 GA-8787, iD-2689, IL-49.31, IN-•14298,IA-6869 KS-6826; . - Pale# LA-13772,.ME 3114;:MD-8588;Mk 24147; kit-20542,.MN-11181•MS-5859,- t P.O.Box 188 Fax 570-596-3296 Me-E-1Dtso:titT 4229E,.NE-E-3730 NN-3373. N,l-20610,NM-5447• NY-51580 �1 NC-5689,.ND 1645, OH36042,.:CK-9480,:OR-8287,.Pk 019214,SC-4763, - I 1 Wellsburg,NY 14894 Web.www:durablit;com SD-2387. Tx-36664 0'-3924, VT-3269, 10-15052,,Wi-12635. HN-6405, wY-1659 -r T Eze-Breeze'o Let the breeze in. Keep the weather out. l PGTI Eze-Breeze FOR MORE ENJOYABLE OUTDOOR LIVING � 00 Add more livability to your screened porch, deck, gazebo or pool enclosure with PGT Eze-Breeze Sliding Panels. They're versatile, attractive, strong and easy to operate. 4 r Open, they let in the breeze while screening out insects and debris. Closed, they provide protection from summer sun and changeable weather. Because Eze-Breeze Sliding Panels are uniquely designed and custom-made, they make it easy to enclose your existing porch. rg n VERSATILE VERTICAL FOUR-TRACK PANELS OFFER 75% VENTILATION rot, - These panels can be custom-made and are available in - " twin and triple units with a continuous head and sill to fit vir- tually any space.Their clean lines and pleasing proportions complement the style of any home. The lightweight vinyl-glazed panels can be raised or lowered effortlessly to open up three- quarters of the window area, or can be easily removed and stored for the season, leaving screens in place. Panels tilt in for easy cleaning and can be ordered in tinted colors to reduce solar heat gain. I 'Y STRONG VINYL GLAZING The strong vinyl glazing used in Eze-Breeze Sliding Panels is lighter in weight and more affordable than glass. The tough 10-mil vinyl offers a panoramic view, while keeping wind and weather out. If accidentally ,. ' distorted,the vinyl will return to its original shape withina minutes. If cut or damaged, it can be replaced easily and inexpensively by your distributor. Eze-Breeze® PGT® SERIES 100 CABANA DOOR The PGT Series 100 Cabana Door is an ideal companion to Eze-Breeze. This quality door's 1-3/4" heavy aluminum framing is complimented by our vinyl glazed vertical four track windows, is fully weatherstripped and comes standard with a deadbolt lock. It is manufactured to close tolerances to ensure a strong, dependable door designed to withstand the weather. The door is prehung with ( T three heavy duty hinges in your choice of left or right and is also available as an inswing or outswing ' i door. Standard sizes are 3'0 x 68", 2'8"x 6'8" and 2'6"x 68". However custom sizes are also I available. Door configurations are pictured below and consist of a full style with a 12" kick plate, half style with a 32" kick plate (ideal when adding a pet door), and full view style with no kick plate, i ii Full Style Half Style Full View Style (PG 1) (PG 2) (PG 5) EZE-BREEZE® VERTICAL FOUR TRACK and SERIES 100 CABANA DOOR OPTIONS FRAME COLORS VINYL COLORS SCREEN TYPES White Bronze Almond Clear Bronze Gray 1814 Charcoal 2020 Charcoal 1814 Gray 2020 Gray TWIN & TRIPLE 41 CONTINUOUS HEAD & SILL UNITS Distributed By: It just got easier to install Eze-Breeze Vertical Four Track Units. The continuous head and sill option makes it simpler than ever to install Eze-Breeze into larger openings. MM i 00 00ow! 00Nr. No 00 Twin Triple ©2009 PGT Industries, Inc. 10/09 MG0100300 The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 ,r• www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leizibl Name (Business/Organization/Individual): 2 (_Q,_ Address: JuCiJ C L t--\ Ci /State �y f' one' #: t� U2ty /Zi :p � Ah Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with _employees(full and/or part-time).* 7. E]New construction 2. I am a sole proprietor or partnership and have no employees working for me in $. Remodeling any capacity.[No workers'comp.insurance required.] ❑ 9. EJ Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]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. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof re ' s These sub-contractors have employees and have workers'comp.insurance.t 14. ]Other v1 (t7r/V� 6.❑We are a corporation and 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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors 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 have employees,they must provide their workers'comp.policy number. I am an employer tliat isproviding ivorlrers'compensation insurance for n:y employees. Below is the policy andjob site information. Insurance Company Name: Policy#or Self-ins.Lie.#: v To V Expiration Date: R / Job Site Address: l L � City/State/Zip: 1V f AJOV{r !A Attach a copy of the workers' compensation p licy 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 andp4Xrles of pe►juty that the information provided above is true and correct. Signature: -7—7 Date: 0 Phone#: _ O 7 T 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: �� - S�o9 ��Ol�� °ice �� -� C� ��1 y�,�, �� o�° ���U A66z@ CERTIFICATE OF LIABILITY INSURANCE DATE(MM`DDIYYYY) 12/22/2Oi6 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 HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WANED,subject to the terms 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 endorsement(s). PRODUCER CONTACT y Emma Panke __— NAME:_ Kane Insurance PHONE(AIr Ext): A1C No): - -- - - 242 State Street E-MAIL ADDRESS:ammo@kaneins.com INSURERS AFFORDING COVERAGE NAIC# Portsmouth NH 03801 INSURERA:United Ohio Insurance Co 13072 INSURED INSURER B: Clearview Sunroom And Windows LLC INSURER C: 21 Westwood Circle INSURER D: INSURER E: Dover NH 03820 1 INSURER F: COVERAGES CERTIFICATE NUMBER:CL16122215285 REVISION NUMBER: i 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 CONTRACT OR 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. ----- ------ INSR 1...- -- ---- - --- - - -ADDL SUBRi....-- -- ---._..-._.._ EFF POLICY EXP-r------..,_,__---------------------------------..._.._._...._..- LTR TYPE OF INSURANCE ) POLICY NUMBER I MM/D MM/DD LIMITS COMMERCIAL GENERAL LIABILITY i !EACH OCCURRENCE $ A CLAIMS-MADE 1:1 OCCUR i DAMAGE TO RENTED PREMISES(Ea occurrence) $ CPP0020981 10/9/2016 10/9/2017 I MED EXP (Any one person) $ --. -------,--_-- —__-- i I_PERSONAL 8 ADV INJURY $ ----- - GEN'L AGGRErGATE LIMIT APPLIES PER: GE------ AGGREGATE $ POLICY LOCPRO I PRODUCTS-COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNEDSCHEDULED -"--- ------- F AUTOS AUTOS f I BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident).__ $ l $ UMBRELLA LIAR OCCUR TEACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE I - 'AGGREGATE $ DED RETENTION $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY YIN N I j_ STATUTE ER _ ZANY PROPRIETOR/PARTNER/EXECUTIVE I E.L.EACH ACCIDENT $ IOFFICER/MEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101;Additional Remarks Schedule,may be attached N more space Is required) RE: 120 Liberty Street, North Andover MA. Operations Usual and customary to a Sunroom and Window Installation Contractor. The Certificate Holder shown below is an Additional Insured under the General Liability Section provided a written contract, agreement or permit to such exists prior to a loss. i CERTIFICATE HOLDER CANCELLATION gbrown@townofnorthandover. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover Massachusetts THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St - Building 20 ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025(201401) Oil x