HomeMy WebLinkAboutBuilding Permit #1178-2016 - 20 STAGE COACH ROAD 5/11/2016 pORTF/
BUILDING PERMIT
TOWN OF NORTH ANDOVER °
APPLICATION FOR PLAN EXAMINATION * -
IM- 7,"t O Date Received °°
Permit NO: / 9 <a.,b..K. +`
Arlo
Date Issued: (t
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IMPORTANT:Applicant must complete all items on this page
LOCATION 20 STAGECOACH ROAD NORTH ANDOVER, MA 01845
Print
PROPERTY OWNER KAREN LUNNY
Print
MAP NO: 065.0 PARCEL: 0151 ZONING DISTRICT: Historic District yes no
Machine Shop Village ye no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building sorone family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
*Okepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
❑ Septic ❑ Well ❑ Floodplain ❑Wetlands ❑ Watershed District
❑Water/Sewer
REPLACE 20 WINDOWS & ONE DOOR- NO STRUCTURAL CHANGE
Identification Please Type or Print Clearly)
OWNER: Name: KAREN LUNNY Phone: 978-682-1583
Address: 20 STAGECOACH ROAD NORTH ANDOVER, MA 01845
CONTRACTOR Name: Phone: 508-351-2214
RENEWAL BY ANDERSEN
Address:
30 FORBES ROAD NORTHBOROUGH, MA 01532
Supervisor's Construction License: Exp. Date:
90125 10-06-16
Home Improvement License: 170810 Exp. Date:
12-23-17
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 Cpst: $ 32,214.00 FEE: $ 387.00
Check No.: MOO 6(4 k Receipt No.: 22 b1)
NOTE: Persons contracting with unregistered contractors do not have access the guaranty fund
ignature of Agent/Owner cSee ��e'�U Signature of contract
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
f
v
Planning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
- .
FIRE DEPAF�TMENT = Temp Dump est r on site ; yes ��7 3noosgoodSfireeY
Located t
Located at 124
Min Q, - ° "t ��
D=ire Depell Lill
ent°si.gnature
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Dimension
Number of Stories: Total square feet of floor area, based it erior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of((deter location, mast or service dro re-quires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
l
NOTES and DATA— (For department ease)
i
® Notified for pickup Call Email
i -
Date Time Contact Name
Doc.Building Permit Revised 2014 -- -
I
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits
Building Permit Application
Workers Comp Affidavit
Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Copy of Contract
Floor Plan Or Proposed Interior Work
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
Building Permit Application
Certified Surveyed Plot Plan
Workers Comp Affidavit
Photo Copy of H.I.C. And C.S.L. Licenses
Copy Of Contract
Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
Mass check Energy Compliance Report (If Applicable)
Engineering Affidavits for Engineered products
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
Building Permit Application
Certified Proposed Plot Plan
Photo of H.I.C. And C.S.L. Licenses
.44 Workers Comp Affidavit
4, 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
Doe:Building Permit Revised 2014
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Location I1
No. DateIl ,�
• - TOWN OF NORTH ANDOVER
Certificate of Occupancy $ _
Building/Frame Permit Fee
Foundation Permit Fee $
b
Other Permit Fee $ t
TOTAL $
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Check#` � '�
3035.8 Building Inspector
NORTF1
Town _ofndover
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fJ BOARD OF HEALTH
PERM TFood/Kitchen
//����� 11 Septic System
THIS CERTIFIES THAT ...................... ...............................
BUILDING INSPECTOR
.......... ice'... .......... .....
has permission to erect buildings on � AC.O..*JW Foundation
�e Rough
to be occupied as ... .. ..... ..... ,. .I �il . .M! .t.......�....... �I +w+*........... Chimney
provided that the
is
a e tin this permit shall in eve respect confol'm to the terms of the application
p P p 9 P every p pp 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 CONSTRUCTIO TARTSRough
:
Service
................. '.'^^................................. 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.
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Name RENEWAL BY ANDERSE N
Addis: 30 FORBES ROAD
City/Stato'7* NORTHBORO,MA 01532. Pholle 7?;`508-351`2200
Are you an employer"'Cheek*c amwopriate box: 'lope of pr*rt(.regWred):
I M a"joyar with 30 g. n 1 am a semml ummactor and I
di i�eW cWtsuction
employees(full andrajt pan time-).* have hired the�ttl+-contractors
3.[� 1 arta a sole proprietor or pattt�= list•;d nn the attached _: � ". ' 1 Remodeling
ship acid have a,,employes These snit+-ticntttati.'tars have & 0 mmolition
Woddog for me in atri ixfwiuwkeW camp-insmaLe. 9. 0 Building addition
[Nei workem'comp.i vairiencc 3 0 We are a eognxat6nand ire
required-] office-i's have racm5ol dwir l0.0.Fle4tr cal res*m ur aaltl'tti".
I.atn a humecmner.do ng all wtuk right of mziption pet,'c G1. -11 PIuml;ing repabs or additions
Womelf I No workers'comps c. 1524 00and wi have m1 12[]Roof repairs
inma-ance r quu'W j a employees,[No:voti ers' 13.�]t)tlter
gip.insjuance jvgWm3.[ _.__,_.--- --
'Auv iAWk wa tW -,fox a must atyx:fill im tW v.,*m W-us,owwonS dmr wvik,—,: =4M"R p5iuy-MAWfi�.
t i M S wlW%i:.� 1 thh 4t�tG4vit ludicAt --Lha+x:tmg Stn%ork anu dM hat 11A&A&cu1G"rC IM"submit a M SAit&Vii" !EUA.
k'wtU*ADM PW Ci r$tlm axis M%t 111W.6d at additk-&W%IwO vc9tei the nwit ai*&wb--moramr.;.awl ft.*wOr '"MP,lenity RIfAF> 4
I ant an eVtot+er brat k pruwA tion workers'retWsa d"h Wej*JW&Nftft% helot,jy,'ke p0cy G"jib site
test:
br ance Cumpanb Nacre. OLD REPUBLIC INS. CO.
I'i,lic °#.or Sel%it». Lies. _ N�y1tt�3a5437QQ-.. Expiraton l7atc;_10-01-16
Job Skew; 20 STAGE COACH ROAD NORTH ANDOVER, MA 01845
Attach a cop. of the werlaera'comps den pnlic-a deciamtlrtn;rage(shooing the Park)number rind expiration dete).
Failure to secure coveiage as:equimsd:ruder Sectiitti 2 A tit'1NIGi,c: 15^can lead to the imposition of a:rimittal pe`rialti�;of a
Bme up to$1,500.00 andror one-year imprisonment,us well as(:yell p tiro in the fu-m oafs STOP WORK ORDER iW a fine
of up to S250M a day against the violator. Be advised that a copy of this sWint}ent may be fin•Kat7W to the Office of
1t±vectigations,of the INA for insurance covrrsge vetifcattWt.
I do Eby 'a for pains wtdjvnddn 00edmo,that the Eirj v►r ptvstdrkddbm-e it ow mrd A
a. -351-2200
0j*4d tcse only. Do not write-int this ores,We eo eyrkW by ri(n or town
CHS or Ti PerrnitrLicam#
Ism M1 Autbo its°(rirelr one):
1.Board of HeAlth I Building Department 3.Cit).rl'own C1erl- 4.Electrical Inspector.S.Phinibing hLqec#or
6.Other
%.4atact Person;_
Pltmte#:
ANDECOR-01 YADAVYO
CERTIFICATE OF LIABILITY INSURANCE °" °°
10011!111201155
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),AUTHORI2ED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the pollcy(les)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 Ileu of such endorsement(s).
PRODUCER ACT
NAME: Willis Certificate Center
Willis of Minnesota Inc. PHONE 877 945-7378
c/o 26 Century Bina A1C No): 888 467-2378
P.O.Box 305191 ADDRESS:Certlftca ttis.COm
Nashville,TN 37230-5191
INSURE AFFORDING COVERAGE NAIC 0
INSURER A:Old Republic Insurance Corn pany 24147
INSURED
INSURER e
Renewal by Andersen LLC INSURER C:
30 Forbes Road INSURER D:
Northborough,MA 01632 INSURER E:
INSURER P:
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 INSO gyyD POLICY NUMBER (MWDONYYY) (MMMDNYYYJ LIMITS
A X COMMERCIAL GENERALLIABILITY EACH OCCURRENCE $ 11000100
CLAIMS-MADE rK1 OCCUR LTOJZY 305440 10/01/2015 10/01/2016 PREMISES Me ocwmence $ 50010
MED EXP(My one person) $ 10,00
PERSONAL&ADV INJURY $ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 4,000,0011
X JECTF LOC
00
PRODUCTS-COMPIOP AGG $ 4,0 ,
POLICY El PRO-
OTHER:
$
AUTOMOBILE LIABILITY OBIKED s GLE L rr $ 6100010
A X ANYAuTO MWTB305438 10/01/2015 1010112016 BODILYINJURY(per person) $
ALL OWNED SCHEDULED
AUTOS AUTOS BODILY INJURY(Per Occident) $
NONHIRED AUTOS AUTOS
ED $
Per accident
S
UMBRELLA LfAB OCCUR EACH OCCURRENCE $
EXCESS IJAS CLAINIS-MADE AGGREGATE $
DED I I RETENTION$ $
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY YIN X I STATUTE I I ER
A ANY OFFICERIMEFABER EXCLUDED?
NIA IIAVIlC30543700 70/0112015 10/01/2016 E.L.EACH ACCIDENT $ 110001
(Mandatory In NH) E.L.DISEASE-EA EMPLO $ 1 OQO
If yy���describe under r
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 1,000,000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICI-ES(ACORO 101,Additlonal Remarks Schedule,may be aUached n mora space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED MI
ACCORDANCE MTH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Evidence of Insurance �Or-
019BB.2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marfts Of ACORD
s
Ma ..achucetts-DepertiBent of Pumc Safety
Board of Building Regutdiong. and Standard&
Construction S'upen-isor,
'.iGena&: 1ffi V 4t
y, �'
J
Comma Sv a
i
4 � Expiration
Ca r�r itlons 101i1wme
cqL
ue of Consumer Affairs&Business Regulation
WME IMPROVEMENT CONTRACTOR
Registraticm,: SD$ 0 Type:
Explratic145.__} Supplement Card
RENEWAL BYANDISIW046L
JAIME MORIN f; i
30 FORBES RD ��._•,,;---
NORTHBOROUGH,MA 01532 Undersecretary
Renewal
byAndersena SO
WINDOW-REPLACEMENT anAndeneaQ,.mpxtry
WoodNinyi Composite IF
Dual Argon Low E4 SmartSun
S3z'�tw• Double Hung
,•:M:•a�v:.o��amroci•�•x•�
r 100-00473518-010
ENERGY PERFORMANCE RATINGS
U-Factor(U.S)/I-P Solar Heat Gain Coefficient
0
o12,9
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
0
E342
Manufacturer stiputatea that these ralings coolonn toappS abla.NFHC.procedures for detarminingwhels product
performance.NFAC rai4W are Catenainadfor a fixed set of enviionmantal Condhiona and a apeCyto product Site.
NFRC does nm recommend any product and does not warrant the Suitability of any product fore"speeinc use.
Consuh manulaewrer's 1haraturo for other product performance Information.
www.nite.org
,r'Rofr This product moots Green .
�.. genre environmental Ceneaa +.,, •••:M1• :��,«�
,�� t standaMs govefningenergy y,j,�p,+,��;; tj, �•�'. •.'�r%'*:r,
eM�ciansy,heavy motaS in �•.,•.•.•• �� fy
'r`Ibe frame and cash FFFyyyiy�%5!.;'r.2ph
• !^.rymazarel Packaging;and -- F?,.'•�.'S.0101,
X Coneumereducationat
• �<a materials.
.n.ro..M
DESIGN PRESSURE(PSF); D
•�y�'(�7�]� //may,(/'��t • 'C arm Door
taallDdCDaDaaW�gr6s lbn 1]
•ti Jd.���CaD QJ w pedmn.S
RbA DB Sloped Sill DH IN
Tarsal totlAFSd2aAA:lAM1'AFAAC9AfInAS'AD00-0S MandastUa et tet oontormattoeromea IXaba atatldards.
1deats or exceeds M.E.C..C.E.C.&I.E.C.C.Arc Inffihration requirements WDMA Navinark Cendication Program.
�ZIA
FRODUMP RFOR A E
Andersen'NFs C Cartified wad Un iE P�Irformance(cdn&uad) .
Andersen'Product Glass Type U-Factor' SHGC'. VP.
- - 2O SSeries.: - ._ -
. - - pear Dual Pane - -0.45 0.60" --0.63. _ - -
. -. . . peao-0ual Pane w@It Grilles .051 0.56 _ -
- - - - - tilt-wash Lm E .0.30 032 0.55
Oou6le•6ung Window-.. LaxEwim(finites 030 029" 0.49
- - - - - - - - -HP Lom E4 SmartSun- -030 - 021" 0.49
_ .HP law{d SmarSun witifuies" "0.31" 0.19. - .0.43 . ?S _
pear Duel Pane 0.45- 0.61-. 0.64. . .
- :NainaOne': - - -peer Duel Pane with Gnlles 0.45 ._ 054- - 0.57
-Oouhie-Hung Windaw. -law-E 0.30 --
- - 0.5fi 71.^
Lm.,E,.ftGnlies 031 029 - 0.50-
- - - - - pear Dual Pane 0.44. 0.69.
- - NarraOne .pear Dual Pane Ah Grilles 0.44" 037 0.59
E. 027 - . .
- 0.34- - _0.58 a-
tmv-E%ftGalles 027 030 OS2
pear Oual Parre 0.45 - - 0.60 : 0.63 - -
-. vb Griiies - 0.45.
pear Dual Pane t _ ..
- - Gilding Madow L93w-E 0.30 032. 055 -+
Lmv-EwRh Gnlies. .0.30 029 -_0.49. .a - - .
Imv-E Sma4Sun 030_ - .. ..
02
1. 0.49 -
- - - - _
.. - .tnty-E SmartSuri alrh Gniies- -�091 � 0.43 - "� •�� -
- pear Dual Pane 0.43 Mm " :0.65"
.Clear Dual Pane withGrilles 0.43 - 0.55 . OSB. .
- - _ -Fixed-Traosorol.- - .�E- 028 033. .OS6
Circle Tap:'W6rdoai-', Lo-E.,.b Galles 0.9 030 OSO.
. - - - - - - LoiwESmarrSan 027 ..0.72 0.51 -
. . lmvE SmerlSun w8h'Gfiles - 027.. . . 02.0- " -0.45. -
.. pear Dual Pan - _
- - e 0-'t4
- 0.61 0.64
pear Dual Pane trdh Grilles- 0.45. - - 0.53. 0.58
Ldw-E .0.29r - .032 - .0.56 - -
- - - Narmline'. - -- - "."Inw-EwiDi Grilles 030 .0-29 -.-049 .2_j aj
- Gilding Patio Doors - L.E Sun - 029 - 020" 031 - - - - - - - -
. .- -
.. .. - .. .. .. - ._ . . - - - Lmv£Suwh Galles 031 _ -UJ,
'
. - - - Late-E SmartSue 0.28 -0.21- _ 0.50
law-ESmanSUa with Grilles 030 0.19
.pear Dual Paine- 0.43 - 0.61 _0:60 - -
. - pear Dual Pane with Gaft -0.43 .0 0:56.
_028- 032 -
- - - ParmaShieid': Lnet-E with-Grilles. 030 029" 0.49
'.Gilding Ma Duars - Lmr-E Sun 029 .0.1-9 030
-Law{Sun with.GMes- -0.30 0.17 .027'- -
. - - - - - -
Law-E Sm_arlSun 027 022 - -0:50
'law-E SmaitSun writ Galles .029 . .0.19 0.44
pear Dual Pane - 0.43' - 0.45- 0.47 _
. - - - - - - - - -Clear Dual Pane%AM Was-. 0.43 -039 .:0.40. - -
. . - - - - - - Luw-E 0.32 024
Al
_ Hinged Inswing '(mv-Ew10t.Was 033 .- . 021- -0.35
- Patio.Donis: - _ .
law-E9un 0.32 - "0_15 - 023. . ._ati -
. - - - Law-E Sun vim Gnlles- 0.34- 0.13= --0.19 - .
. - - LaxE SmartSun. 0.32 -0.37 .
Lox E Smarmun wm Galles 033' - - "014 - -0.31 -