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HomeMy WebLinkAboutBuilding Permit #015-2017 - 168 SUMMER STREET 7/6/2016 LjF, J BUILDING PERMIT 01 NORTy q Iv 14 ft' TOWN OF NORTH ANDOVER �`✓�-� r\a� `APPLICATION FOR PLAN EXAMINATION ;A T Z t h Permit No#: Date Received gssq C H US�t Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER o� Print 100 Year Structure yes Ono Historic District es MAP 3� PARCEL. ZONING DISTRICT: � y Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial L�K&eration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: iii,c'( JJ,'► clew a�Q ec icy' G� e �' � �Y - res Identification- Please Type or Kint Clearly OWNER: Name: Phone: �-3J-,Rye Address: u G•�t�" Contractor Name: 3o&,-_D4 Phone: z/;>� Email: oitce,-r4 1rt_`T Address: Tg ftkx- g f/+vtr Supervisor's Construction License: 6.S–,O 6.S_Z,�o Exp. Date: /61, Home Improvement License: IYS-/g3 Exp: Date: 6 ARCHITECT/ENGINEER Jbk& Phone: �7k slj_Z, Address: /6 S" _s C� AJe_6y 6.,r4 00,rT— Reg. No. 91z yZ,. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /�'. M 6r ) FEE: $ T Check No.: Z J Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - - - - - --� -- i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools U Well ❑ Tobacco Sales ❑ Food Packaging/Sales , U. Private(septic tank,etc. ❑ Pennaneut Dempster 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 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: . t ed_D j-ayt_ 1�2� ,4'•IUsa l �`s''ig-ent a�.0re%d�"`•t z tsite,3 1y�es ,� _ Located384 o Osgood oo --ree FIEREPMENY �TeTumpserron caeiniStrettLEnt - — .� a e EN_ . ,• Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, rust 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) a. �I I ® Notified for pickup Call Email +. Date Time Contact Name Doc.Building Permit Revised 2014 r Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. j 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 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) i Building Permit Application 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 j Location / /�9�✓�� —r` � No. I /� Date • TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit fee $ �f Foundation Permit Fee $ A Other Permit Fee $ TOTAL $ Check# _I 1 [1 Building Inspector J LI `! Commonwealth of Massachusetts Official Use Only - Department of Fire Services Permit No. ` Occupancy and Fee Checked aM y BOARD OF FIRE PREVENTION REGULATIONS [Rev.1/071 (leaveblank APPLICATION FOR PERMIT TO PERFORM ELECTRICAL WORK All work to be performed in accordance with the Massachusetts Electrical Cod C),527 CMR 12.00 (PLEASE PRINT W INK OR TYPE ALL INFORMATION) Date: (N �. City or Town of. NORTH ANDOVER To the Inspector of Wires: By this application the undersignedgives notice- his or her intention to perform the electrical work described below. Location(Street&Number) - ✓�'l �� r� Owner or Tenant Telephone No. IL Owner's Address Is this permit in conjunction with a building permit? YesX No ❑ (Check Appropriate Box) Purpose of Building Utility Authorization No. - Existing Service Amps / Volts Overhead❑ Undgrd❑ No.of Meters New Service Amps / Volts Overhead❑ Undgrd ❑ No.of Meters Number of Feeders and Ampacity Location and Nature of Proposed Electrical Work: Completion of the following table may be waived by the Inspector of Wires. No.of Recessed Luminaires No.of Ceil:Susp.(Paddle)Fans No. of Total Transformers KVA No.of Luminaire Outlets No.of Hot Tubs Generators KVA No.of Luminaires Cl Swimming Pool Above ❑ In- ❑ No­.—of Emergency Lighting rnd. rnd. Battery Units No.of Receptacle Outlets V No.of Oil Burners FIRE ALARMS No. of Zones No.of Switches No.of Gas Burners No.of Detection and Initiatin Devices No.of Ranges No.of Air Cond. Total Tons No.of Alerting Devices No.of Waste Disposers Heat Pump I Number Tons KW No.of Self-Contained Totals: Detection/Alerting Devices No.of Dishwashers Space/Area Heating KW Local❑ Municipal El Other Connection No. of Dryers Heating Appliances KW Security Systems:* No.of Devices or Equivalent No.of Water KW No.of No.of Data Wiring: Heaters signs Ballasts No.of Devices or Equivalent No.Hydromassage Bathtubs No.of Motors Total HP Telecommunications Wiring: No.of Devices or Equivalent OTHER: Attach additional detail if desired,or as required by the Inspector of Wires. Estimated Value of Electrical Work: (When required by municipal policy.) Work to Start: Inspections to be requested in accordance with MEC Rule 10,and upon completion. INSURANCE COVERAGE: Unless waived by the owner,no permit for the performance of electrical work may issue unless the licensee provides proof of liability insurance including"completed operation"coverage or its substantial equivalent. The undersigned certifies that such coverage is in force,and has exhibited proof of same to the permit issuing office. CHECK ONE: INSURANCE ❑ BOND ❑ OTHER ❑ (Specify:) I certify, under the pains and penalties ofperjury,that the information on this application is true and complete. FIRM NAME: _ LIC.NO.:�Q � Licensee: Signature LTC.NO.: (If applicable,enter "exempt"in the license number line) Bus.Tel.No. Address: Alt.Tel.No.: *Per M.G.L c. 147,s.57-61,security work requires Department of Public Safety"S"License: Lic.No. � OWNER'S INSURANCE WAIVER: I am aware that the Licensee does not have the liability insurance coverage normally required by law. By my signature below,I hereby waive this requirement. I am the(check one)❑owner ❑owner's agent. Owner/Agent PERMIT FEE. $ Signature — Telephone No. ❑ 2012 Massachusetts Electrical Code Amendments 527 CMR 12.00§Rule 8: In accordance with the provisions of M.G.L.c. 143,§3L,the permit application form to provide notice of installation of wiring shall be uniform throughout the Commonwealth,and applications shall be filed on the prescribed form.After a permit application has been accepted by an Inspector of Wires appointed pursuant to M.G.L c. 166, §32,an electrical permit shall be issued to the person, firm or corporation stated on the permit application. Such entity shall be responsible for the notification of completion of the work as required in M.G.L.c.143,§3L. Permits shall be limited as to the time of ongoing construction activity,and may be deemed by the Inspector of Wires abandoned and invalid if he or she has determined that the authorized work has not commenced or has not progressed during the preceding 12-month period.Upon written application,an extension of time for completion of work shall be permitted for reasonable cause.A permit shall be terminated upon the written request of either the owner or the installing entity stated on the permit application. ❑ The Permit Extension Act was created by Section 173 of Chapter 240 of the Acts of 2010 and extended by Sections 74 and 75 of Chapter 238 of the Acts of 2012.The purpose of this act is to promote job growth and long-term economic recovery and the Permit Extension Act furthers this purpose by establishing an automatic four-year extension to certain permits and licenses concerning the use or development of real property.With limited exceptions,the Act automatically extends,for four years beyond its otherwise applicable expiration date,any permit or approval that was "in effect or existence"during the qualifying period beginning on August 15,2008 and extending through August 15,2012. ❑ Rule 8—Permit/Date Closed: ***Note:Reapply for new permit ❑ ❑ Permit Extension Act—Permit/Date Closed: Trench Inspection Pass F?1 Failed IN Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: SERVICE INSPECTION: Pass❑' Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: PARTIAL ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: ROUGH INSPECTION: Pass M Failed 0 Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: FINAL INSPECTION: Pass Failed Re-Inspection Required($.) ❑ Inspectors Comments: Inspectors Signature: Date: DEB WEINHOLD ...TOWN OF MERRIMAC,MA. . .......dweinhold@townofinerrimac.com J °The Commonwealth of Massachusetts w. F Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA-02114-2017 O^M SJ.V www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contxactors/Electricians/Plumbers. TO BE k'ILED WITH THE pERMMTMNG AUTHORITY. please Print Le 'bl A ••licant Information V `— C � - Name(Business/Organization/Individual): Address: e��bw 1,% �� 0 1( j 1`>�a,Sl 4 l'���Z� Phone#: �LJ City/State/Zip: :. ... .. : <... Are you an employer?Cfiecictlie appropriate box: Type of project()Vequired); em to ees(Al and/or Part-time')'* 7. ❑New'constriiotlon 1.❑I am a employer with P y 2±�I am a sole proprietor or partnership and have no employees Working for mein 8. n Remo deliiig f✓��any capacity.[No workers'comp.insurance required.] 9, ❑Demolition In 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 11.❑Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole bin re airs or additions proprietors with no employees. 12,:�Plum- g p 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13•,0 Ro6f repairs These sub-contractors have employees and have workers'comp.insurance 14.Fl Other 6.Q 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.] *Arty applicant that checks box#1 must also fillout the section below showing their workers'compensation policy information: fi homeowners who submit 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 have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: LVQ i Expiration Date. Policy#or Self-ins.Lic.#: ' � �V �yt j r City/State/Zip: fob Site Address: Attach a copy of the w9rkers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL e.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. erjury that the information provided above is trueand correct Ido hereby em ' under thepains andpenalties o . Date: Si e: Pho e#: 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 Phone#• Contact Person: 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'd'efnied 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'dr 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 employs 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 commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage r'equi'red." 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 Pleasb 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 certificates)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. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or 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 the 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"fob 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 burn 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 wwwmass.gov/dia I WINSL-1 OP ID: NB ACOR06 CERTIFICATE OF LIABILITY INSURANCE 705103/2016 E(MMIDD/YYYY) TVIS 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(ies) must be endorsed. If SUBROGATION IS WAIVED,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 Planright Insurance-Salem PHONE Jason M Mlocek FAX 224 Main Street Suite 3C A/c No Ext:603-890-6439 A/c No): 603-890-6521 Salem,NH 03079 ADDRESS:jason@santoinsurance.com Jason M Mlocek INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Acadia Insurance 31325 INSURED Joel Winslow INSURER B: 4 Amberwood Drive Atkinson, NH 03811 INSURER C: INSURER D: INSURER E: 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 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. ILTR TYPE OF INSURANCE B POLICY EFF POLICY EXP NSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 2,000,00 A KEN I LD CLAIMS-MADE a OCCUR BOA5095567-13 04/09/2016 04/09/2017 PREMISES Ea occurrence $ 50,00 X Business Owners MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 X POLICY❑PEC LOC PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A ANY AUTO CAA5095577-13 04/09/2016 04/09/2017 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED tid P BODILY INJURY(Per accident)AUTOS AUTOS ( ) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION XPER OTH- AND EMPLOYERS'LIABILITY STATUTE ER A ANY PROPRIETOR/PARTNER/EXECUTIVE Y/Y❑N N/A WCA5225000-10 10/19/2015 10/19/2016 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) 3A MA E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover, MA ACCORDANCE WITH THE POLICY PROVISIONS. 1800 Osgood Street Building 20,Suite 2035 AUTHORIZED REPRESENTyATI�VE, s� North Andover, MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Enter construction cost for fee cal - North Andover Fee Calculation Construction Cost 1800.00 m $ - $ 226.68 Plumbing Fee $ 28.34 Gas Fee 100 comm. $ 100.00 Electrical Fee $ 28.34 Total fees collected $ 383.35 168 Summer Street 015-2017 on 7/6/2016 finish basement 'I ffa &V�ak&4avg General Contractor ESTIMATE Contractor/Supervisor Lie. # 065280 Joseph Blanchet Home Improvement Lie. # 145193 24 Taylor Street Fully Insured Haverhill,MA 01832 978-994-6134 Date of Estimate: June,7 2016 Client Name: Amy Dion9, Job Location: same Address: 100 summer street North Andover Ma. 01845 Phone: 978-835-9422 Description of Work: Renovate basement - Install steel beam(wl2x35x17'-0")according to certified engineers plan and specs - Cover existing concrete walls with 2x4 frame@ 16 o.c. and insulated with r15 insulation, (some concrete walls are 40 inches high). - Frame for a 4-0 double door at bottom of stairs to enter boiler room - Frame closet at bottom of stairs with pull out double door - Frame angular wall near beam to section off boiler room - Walls will be cover with'/2 inch blue board and skim coat finish - 5 %2 base board will be installed around finished area - Ceiling will be drop suspended 2x2 tiles - Dumpster will be on site Owner responsibility: prime walls,paint walls and baseboard,hire electrician and plumber Additional Work: Any alteration or deviation from above specifications involving extras or vendor price increases will be discussed and will become an added charge over and above the estimate. Work performed at$60.00 per hour/per man. Laborers will be $23.50 per hour/per man. Total Cost of Estimate: $18,890.00 Payment: A deposit is required before work can be started. Starting payment will be '/2 and balance due upon completion. Quote is good for 30 days D—Z_ Manufacturing WARVEY ACKNOWLEDGEMENT BUILDING PRODUCTS Harvey Industries,Inc. 1400 Main Street.Waltham,MA 02451-1689 (781)899-3500 harveybp.com Dealer Quote Detail Salem BILL TO: SHIP TO: 413 Raymond Road SALEM,NH 03079-9283 Phone:(603)893-1611 Fax:(603)893-8196 A B CUSTOM CARPENTRY A B CUSTOM CARPENTRY III IIII'�I�I�III�IIIIIII�I��III�IIII 24 TAYLOR STREET 24 TAYLOR STREET 1� b Ialzl� b HAVERHILL,MA 01832-0000 HAVERHILL MA 01832-0000 Phone: 978-994-6134 Fax: Phone: 978-994-6134 Fax: QUOTE NBR CUST NBR CUSTOMER P ENTERED . DATEORDERED1 ORDER TYPE 4023012 1059685 1 7/5/2016 Quote Not Ordered I Cash ORDERED BY STATUS SHIP VIA DELIVERY AREA None Whse Pickup SALEM WAREHOUSE CLERK JOB NAME COUPON dsn -Dan Nicchols AMY LINE# DESCRIPTION QTY UNIT PRICE EXTENDED 10000-1 Vinyl Casement,Unit Size 31.5 x 41.5,RO 32 x 42 l $320.10 $320.10 *28,Call Height=36 Fiberglass Mesh,Screen Shipping Separate=Yes Window Label=Harvey,Sash Limit Devices=None,Egress Hardware, Operator Arm=Double 7„ Overall Glass Thickness= 11/16",Double Glazed,Double Low-E RS,Argon Filled,Custom Annealed IG=No,IG MFG=HY Base Color=White Performance Packages=E Star 6.0 2015 Ji9 North=Yes,North-Central=Yes ^� Unit 1:U-Factor=0.26,SHGC=0.24,VT=0.42,NFRC CPD Number= HII-M-38-01576-00002,Custom/Call Size Option=Call Sizes,New Construction,Hinge Right Unit 1 Glass:NFRC CPD Number=HII-M-38-01576-00002 Contour In-Glass,Colonial,Match Frame,3W3H Overall Rough Opening Width=32,Overall Rough Opening Height=42 Integral L Fin Adaptor,Receiver Pocket Room Location: None Assigned Pricing Details Egress Hardware Add-On $6.75 Low-E Add-On $16.20 Argon Add-On $3.60 Call Size Casement Base Charge $269.24 Low-E RS Add-On $9.00 Wrapping 1-Fin With L Adaptor Add-On $15.32 Last Update: 7/5/2016 10:29 AM Page 1 Of 2 Printed:7/5/2016 10:30 AM J QUOTE NBR CUST NBR I CUSTOMER P ENTERED DATE ORDERED ORDER TYPE 4023012 1059685 7/5/2016 Quote Not Ordered Cash ORDERED BY STATUS SHIP VIA DELIVERY AREA None Whse Pickup SALEM WAREHOUSE CLERK JOB NAME COUPON dsn -Dan Nicchols AMY "Note: Delivery charges may apply and are not included on this quote. This quotation is based on our interpretation of the information provided. All quantities,sizes,extensions, SUBTOTAL: 1 $320.10 grand totals,and specifications should be verified by the contractor prior to his/her bidding or ordering of materials. Harvey Industries,Inc.,is responsible only for the items as quoted above. Any changes or T $0.00 addendums will be subject to a requote. We propose to supply the materials as described above,subject to the terms and conditions as required by our credit department. The prices are guaranteed for 90 days from ORDER TOTAL:1 $320.10 the date of quotation unless otherwise noted. Delivery charges may apply and are not reflected on this quote.We appreciate the opportunity to quote this job. If you have any questions,please call your local warehouse. CUSTOMER SIGNATURE DATE Last Update: 7/5/2016 10:29 AM Page 2 Of 2 Printed:7/5/2016 10:30 AM / 5 4o IX 145W .7-I'igF XP f � 3(Q ,� ds is a v� 2 AVES, JR. CIVIL ,o 0.42426 -p� T �lSTEF��<.�Q NAL EN I r BUILDING PERMIT o� NORTF� q TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION * z Permit No#: Date Received �RA�q 1Tan PpP`^eg Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION u,k <S ►�-+ ' ' Print PROPERTY OWNER 4M.1 r Print -2100 Year Structure yes , n MAP 3 95 PARCEL. ZONING DISTRICT: Historic DistrictY es Uno Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial p- teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other x _ , ,, e F<oodpl• n ��We<a ds ,� . es DESCRIPTION OF WORK TO BE PERFORMED:: _ / �/JJ [/�/ gee,, R 6—,V &,r /`!-,-e 40/2S<&'_ 6'(' I ' i n ` Identification- Please Type orin�y OWNER: Name: &q 'Ze-'b,J p Phone: 9,7s g-3S""fyzz Address: J Contractor Name: J +( Phone: Email: .� c �,n ,��`7- 5 Address: Supervisor's Construction License: CSS–l)�.5'Z � Exp. Date:__ Home Improvement License: Exp./f Exp: Date: l zh z/6. ARCHITECT/ENGINEER J kA) Phone: Address: /6 Sok _s ���` AJe-,*.,..,e4 , ?rT— Reg. No. VZ�IZL FFEESCHEDULE.'.BBULDIING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON 025.00 PEER�: _ .Project Cos1E $ FEE: $ a a ck No Res Che = � Receipt Noy 1OTE 7Persons contracting with unregistered contractors do not have access to the guar fxd ; s. is _ i o e e • .R:_., .., .. 3•i w.. =L'bL'�1.'_ �. AYE' .... .... ....-..... ...... .. ............ ..au.... �. r- '1 NORT11 - 40 _ _ 1c . " ve. _ No. �� �� t h , ver, Mass, COCMICMIWICN y1. 7d A�k.tTEO r"P��,�S S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT tgm-.'�aBUILDING INSPECTOR ....f. .......................................................... . . ... has permission to erect...................... buildings on ../.g...g...... �I.!!��!�.�.�.... ..... Foundation Rough to be occupied as ... ' ... ..... ...... ..................................................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS ON S Rough maliervice .. .... . .. ..... ....... .. ..... ....... . . ....... .. .. Final BUILDING I TOR 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. M rat1 l3-Zig �e- vjvft,/A, L,la-d o AwbFA/el� LA 1 66-le A i i 3yxyl LA)1 f L Cwlwae�, � v , s � 3-v 33 v" 3�l i The Commonwealth of Massachusetts Department of IndustrialAceldents a I Congress Street,Suite 100 - Boston,MA 02114-2017 www mass.gov1dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Q Please Print Legibly Name(Business/Organization/individual): _�Qsp��� lam` jiJ�/►!C�( '" Address: I Z.q Tp ke .S-r City/State/Zip: llyy-P7-�t%l f26L Phone#: `�'�8 �g L/ C/ 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, []New construction 2.�7am a sole proprietor or partnership and have no employees working for me in 8. emo deling any capacity.[No workers'comp.insurance required.] 3.F1 I am a homeowner doing all work myself.[No workers'comp-insurance required.]t 9. El Demolition 10❑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. ❑ 13.0 Roof repairs • These sub-contractors have employees and have workers'comp.insurance.$ 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.❑Other 152,§1(4),and we have no,e!nployees.[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 subrivf 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 have employees,they must provide their workers'comp.policy number. Iain an employer that is providing workers'compensation insurance formy employees.'Below lithepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: Job Site Address: City/State/Zip: 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 ofperjury that the information provided above is true and correct. Signature: Date: / Phone#: 2 S 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#: i 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 o£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 employs 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 commonwealth for any applicant who has not produced acceptable evidence of compliance with the 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'contractor(s)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. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or 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' compensatioii'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 the 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 do license or ermit to burn leaves etc. said person is NOT required to complete this affidavit. ( g p ) 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 L L OZ/OZ/60 :uorlealdx3 Jau0issluaw03 y'-1 — Z£8L0 VW llIH83AVH r t 133211S NOIAV-L VZ �f 131-13NVIs J Hd3S0f. } aosiAJadn S u0i13njlsu00 08Z990-S3 :as u a3j l spaepue;5 Pue su04ein6a /Ixa;eS oilcind 40 luaua}jeda d 6uiplin8 3o pjeoe s s�asnyoesseW C��ie ((�n,�nwaoa�caea���o�CJ/��idrac�ccaeC�. Office of Consumer Affairs&Business Regulation License or registration valid for individul use only DOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: J registration: 145193 Type: Office of Consumer Affairs and Business Regulation Expiration::°__1:2(22%2016 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 JOSEPH BLANCHET' - JOSEPH BLANCHET 24 TAYLOR ST HAVERHILL,MA 01832 Undersecretary / 11 t valid without signature