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HomeMy WebLinkAboutBuilding Permit #1260-2016 - 200 WAVERLY ROAD 6/2/2016 BUILDING PERMIT TOWN OF NORTH ANDOVER ° 6 APPLICATION FOR PLAN EXAMINATION - Permit NO: ' Date Received Date Issued: �9SSACNUS _kW I ORTANT:Applicant must complete all items on this page LOCATION 200 WAVERLEY ROAD NORTH ANDOVER,MA 01845 Print PROPERTY OWNER JAINE RITCHIE Print MAP NO: 015 PARCEL: 0038 ZONING DISTRICT: Historic District yes /noo Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer REPLACING 9 WINDOWS & 1 DOOR - STRUCTURAL CHANGE Identification Please Type or Print Clearly) JANE RITCHIE 978-686-2837 OWNER: Name. Phone: Address: 200 WAVERLEY 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: Exp. Date: 170810 12-23-17 ARCHITECT/ENGINEER Phone: U Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Co t: $ 31, 968 . 00 FEE: $ Check No.: ItQ p t 11��, Receipt No.. NOTE: Persons contracting with unregistered contractors do not have access t t e guaranty fund ignature of Agent/Owner�P� i Signature of contrac�r �� Plans Submitted ❑� , Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS II CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes i Planning Board Decision: Comments r _ Conservation Decision: Comments l Water& Sewer Connection/Signature� Date Driveway Permit ;! _ DPW Town Engineer: Signature: FIRED W Located 384_ Osgood Street _ �- EPAR�TMENT;emp Dump'ts er�,onsite yes .� . - '`�` nog "Located at 12 NIainos-'— 4 4FreGe}? r+ments gnaturYe%001, g ;COMMENTS. - - F i Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANCER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i i ❑ Notified for pickup Call Email Date Time Contact Name � I Doc.Building Permit Revised 2014 1 i 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 4. 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 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 i 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 Location Z GU Wc'a o No. Z-(00— 2 01 T / Date i . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee TOTAL $ _`--Check#`J �P-2, \ ` Building Inspector r 1 - NORTH - - - nc . ve,0 .. - ..... No. %t.R.�A- h ver, Mass, U.. c [ A- COC HIC«EWIC« �JiAs Rpt TED P4a,t'�� BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System THIS CERTIFIES THAT ..................J.11.4 .W.tw..... �... BUILDING INSPECTOR .. ...... . ..... ... has permission to erect ....... ........... b dings on Foundation ...... .. .. ...... ....alv�. .... .............-........... Rough to be occupied as ...�qICA........... ... 1.. .�. �. . ................ ... ................. Chimney provided that the person accepting this permit shall in eve respect conform to the terms of the application p p p g 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 CONSTRUCTION VARTS Rough ...... . 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. Agireemient Document and Paymien it Term 1' 114 jri RE*t*.dbi 6),4e"vii iEEMsii1 liiar9 MINA i WO vamp, virtual by ArderSel LIC 20%Wcf[Eq hd. paAh Andover,MA aIg4t, '1DFvtsEsRp l'Wii:hbarvllgh,.► , p632 G 7 :BGG1i'.�x;19-ah' ���2 14nC eratiRt� 'rtnsemn('Vpyam Q;r i'igi'rti IS) hJlld to—,. saine,othic � 4alpl.Pl"t, d tn�innrii l'�s lit�eq.t ul'cl'r ! � �hP Rd., F;ort Andcpyey, MA 0118-45 Pim5.3 y rdepliam Nutiibn,(978)686-M eorali ' t9e rr�e Nulaklkn iaywai;x�cI'aiTial: - i §Pi�� lith i '� flYil tiPisl�l rPil(I�;a;rte q 1791PRI�i�19,f llir161 (9te l4 klYlllai midcp dice kawil:15y An Jul— `" ll alfl,�ih lw�fvt al 4f A�lfiwk-ur l of"I..141 iifili ct1i11wwor, la am fildi4vr;S�Nbof�i�clis ts'1'@ia LilYil 0fFlkL�l lll;i�ti9 9!t�li��il.In 911 IN r�1�rC�FFi#iiC l lllfilpi?I9G W IN.iii#ril `l ri�i�;'f i�lrr oaf rig ll��>i .1'i r l� el oKl� Regeipjs%fri�t� ;"i?riiaN:,il�i ln l lr+nw l` ak, C WapOwnor Pkillilcr.Rdcagw,i5iit,slime►'�9': 1>��€iki�I i���1�1�Is40��4��1 * Oak k;;licalon 10P lime N.1,i�i��li.l�,;l*rAf�alift-in k,��rho, ritkiirii ikk�9ccE>ti �G 1101 cliiatiii..Iaciit-irne.llr ri �r5i�uiahlel:iiW nor ulke�4r�r ilL Arial�ri€,rsueJrw 61�tlip�.r �46�,ic lle ivg l �hi:<"E4gr� rlie>ns`)- 1�6uthryrry h rl,}�a r n i n1 a.run9�lcPi 7k S i n A'(nr.-r [ai-ii PQacto 11 sa l n ecl,nllI_*rw.k wrxhir diix �I git#1 1 14.�:ii1d}li lit: S11,960 Bp "iI prr rm Als air","Iutir;you���i+nr R�tliAt 41W 1-lum[xv, api.d!vht.Anc,00m FIRmccal Mum be li iirtlp lvv Pier±visol div0i.,W,u k;clic*cWhicad.or wh. S-0 �,al�n€c l�'l�i'•I '��1r��� I�pGlriat�,l�a�r�.l �tlii�r�Pa��":riinnl�lEi.ldal�l d+4 nii 1 l�.lna�i►u�91 i64 weeks 24 dam 3 1 X960 1"a.�mitlit: ; _ - 1 Snaadn %e xP.xJulc i as alrrions l-xsed-ii dic ndane of she skra icil carllrar and sewndadly an tlar:dac�ira aelrir.�v�u'ix�iat�.lei�tlx:Fe�f'unecai aaieaswtnFameruts�:itaxtallatirara d`a�Ge xlaa& +Gr"n Islay - 0 �s�im _is 9pr11y aa.�ir: 4 13791•rarnnliunlC3lPc aii ofl(i:�ia9 date, vini.a�r. _�di:rn);at thistPrer� En rbank plaid ZROA45 sled drtic;ac a 6[ r talc: IL-da avid atcmiie we-i-ithiii are the aiiouzarimiull csuse�rof intlal co pilatillon my(5)�,k(�rr'r r 5 afial r5i ii 9 n lrii LIafS} a illi pis. nilii r the eiritimr.ulnirJ4et aiillmts la i er ni.t P Md li r: t�icic ri;re liei,+ lliri'I rirt�[:isiapSLiBl fwai7�lai =oF eritar9p in� it f n tli tceprab o�rhi Jh«ta tiienr.. N'a ath"40ins w iib din°iad©ns rMan ihis AgrK:►.i viit'a�aig,be valid iefimul r it si ,, .Pi cceli im�rirc of bo[h the,leu sp rnd C0111raCEOr. Bu,- 19n '-j&%i�,aled iia 6up-rW :G y�s read;Phis _vinh.;9imr�tn k t f' tar a� b . ► +R►at_ ul-� _�ranor mf.1a.s , rip, la_.. Irl s►�snlrl :i ,and dri ofthU Agmnpait,inw uft Ilit I�r�?t ALULACdl NOLI xIOfC it Uaflaix on 9:lia:a ttfilgt wvi19cii z ;, i , :krid'�l 9zo,�llr ii1�Ct@,iilc7dl_��kigrt�s.I,�tn:no CAriLvl'rhN. r0i�t: N(31 GCEW OWNKJI't Minot Iiot aipfl LIi��;�iiiSCddFi a ii�I�ii1>li, it�[�alc4loal1 coiililri ct Net NEW. har'�liill. � r l4'V011 Trill"r.; MYER, M L � � I #� p �lTT � N 'LATER TI4 N irr1IDNI' FUT OF 0412 1201 .ORTHE THIRD AILISIMSS DAY AFTER THE DATE OF THIS TRANSACrION dilYrarnr'*r.n artr.Qa kAU&M TEM SE&UMUTACIUD NOTICE�OF CANCULATION FORM FOR AN $pill'u,W galcS lkwull, 1 f531ki�t- SIl,l1111t 113: him Namle pp S ku Pawn lirallt L'�sPsi� - IlriliP Na-mr. 122k7 . Noe 2 1 19 NcW NF►�flct4 . 76 Name: A e.. Address: a00 City/Town: 0 0(ZN1 fl vJ State Zip: 0 R.O. Phone: 119' 996- a X37 3 Job#: 3 a I h 0 703/4x57$/y ► Building Width: d New R.O. Size:: '�o 3flt Building Length: New Header Size: '� a x 1�, K.h Distance to Center Carrying Wall: #of Jack Studs: Wall Construction: l� o 07� Pitch of Roof. Best Estimate Carrying Load: a00 Snow Load Zone: So PSF J Load Bearing WaldfS 3__N JOB NOTE; _iA e,,) o p eA4 inn q �0 0qcc � S 3 L i (jot..t l(n�iZ-S i 2c o X 58 TECH'S ATTACH FOLLOW INFO: PICTURES (COMPLETE FRONT, SIDE&REAR),2 COPIES OF COMPLETE WALL/SIDE WHERE NEW HEADER AND CIRCLE AREA ON PHOTO RENEWAL BY ANDERSEN itemized Ord eir Receipt X 1 1 iIW,P aMJ lljs � i�rio FslA�tln few timp.i"uriewill hw firoJermn LK 201 VQ vltj Rd. 1170810 bl"m Andawet,MA :m.Rr FVWS.It"041WObUrough,IMAOi5M V I97 06-2837 Fhis- CO I FEo?:i54PM Kk 79W2 i KhREWanCp&aGnroII4m '101 K1110011 i►ll :,V baY With NO lfarn* Cut In; 11MV sVQAtllr� hed P 102 'Luing Patio Odor: A-Series Eirencb Dod2 Insvajing,2 Panel,Active Passive(Left� dight),EXTERIOR Terratone.6, 1UTEMOR fine. INTER IDR PPE-FI N[1H None, Gilmi;: All Tempered High POO'. Sf7>lrlrC�un Gia 3., Ift Pail;vrnr llltrrdw.aoa, Nek%iljuryo, 8rylht Drays, 5000RI:NO S0100, GrI110 Styli: 611101*$ 001We0h Gins.(6131 I', Gralle Pa.t?tetn: :ash All: Coluniail 3w x 5h, Mls Non 01 1138thi Window. Double-Hung. equal, Slope Sill InI Traditional C-heckrall,EXTERIOR Tenwo nee, INIEN10A Utra'tc►oII GlI S40 All: 111oh PerPctrer orKe SmArtslin close, P?*pall'on, lempered GIIII Hardware: Dark.6ronxe, 50113110nt Tru$,t_Crk0 N.vith Exterior Colur Match, Tull Screen, Grifl:e Style..Grilles 9g1we •G ids$(GBG),, Grills P at<#or n: Sash All. CtAonial w x. 2b. Misci Aluminum Map.Aluminum Wray. Ped 1 'rkhl'.indotarl; 1).Dubliomhlung. Equal. Slope Slll Inse.n.lraditlohAl Oeck-roll, l;;i R10l4 letraito". , NrL RIO ATt'c6jone(p, '13lj&$'ji Sash All: I'ligh Perf4DIInurote Simirt5tin Gibs,. No Vatt(,rn, Hari Wiffe, Clark Bronze.•Scree;nr.TwScene%vith Exterior Color Matt h, Full Supen, Grille StOw: GrilIe.5 Between Glas,((iBG), Grillai Pattern,, Sash AD-Colonial 3w, 24, Mlic—Al umin um W)rijp, AluiThInum Wpa der Receipt rsen �f 4l� �llbrA491arMd ® te9*0?4MEI'WWMdI bWANclersen LtC: a�a ctlr�p rirl. j 1170810 MD4i Andover,MA 01845 30i kybEs Fbadl'r+r<arthherough,.pM-D15;7F PfiadFF: ?, i 22G FFA:f sc5`�E-74772 i FbQffosianOPwa6enM'A nt-vrn,€am Z01 iDed 1 iii ndewr [ iabl *Fi'rJng..Eg6JAI. SIOPC Sill Insa+rl, 11MI11bnAl [I eOrall, EXTERIOR 7irrtjo", Sash All: High Perf rar*-nE a 5ma rt 5u n r I ss� Pat en ; MardWare= Dark Bronze,Screens Trukeree with Exterior Color Mob:h, Fu 11 acroen. Griliri,StyrW Giril ies Betwtvrl Mass (G IIG), rGrlllil Parttbrrr,7 Sash AU:Colonial 3w 2h, Ml €; Al.urnlnurri Vkqxp, Aluminum Vim 204 :Ped 2 Window Double-Hung, Equal, Slope Sill [nsen. iraditlonal Che(krall, tXTI;RIOR:Teffat-0 III�f'_F,'feIOR Teffatoa(, , Qlasv: Sash All: Hi-�h Perfi3r ,3ace Smit tun Glass,. Nb Pallem, "Are lwrin Dark Bv>a+rr3e, ScrMn4 Trukonk,wilh Exterior Calcar l oich, x4611 scrr,+:rl, Grillo.stylol Grlllei 00txr"n Wfm (6 0G), GrIlk Paft®rrm Sash AD.Colonial 3w x 2h, Mlic Alurnlnurn Wrap, Al urnin um Mia , 'Bed.2 Window., Double-Hung, Equal, Slope Sill LnseF%. Traditional E:hfl(P rail. ";tTtRIOR.Ttitajo , INTFf oft,Tiffir-510nec-1 (�161c Sash All: High Porfafm rico SmartSun Glass, 11�*Faltoro, Ha ndwalre4 Da k Brrorrre. Scram `fruSCpaYt+r,+c lli We h. FU 11 Sur-en, Grillo,l tylo: 6rilIris oetwe.eau Gim,iG DW, Grille P'a tternn: Sash All_Colonial 3w x.2h, MIs Alurninurn Wrap, .dalurrninum Wra i 1. Pace 5 r '1-5 I n it itei ize d1 Order IRe, O.Jpt ANI RM -411111YAM � �uasq AEI9ff111� tied RGx?ae A[mewal bw Ard ffn ttt 2103 Wawa IP1 HSI. 1708110 k .Andover,MA 4!9 iwue ;39,E'€b-n mwd l m-",hhmugh, O-Ism 'ig k 65-.283 7 F 351-22901 Rai:Ig48Ma -7021 i rid W1ndow,� Douhle-Huff, E'chie 1, Sl ,p Sill Cnse.rt, 1e ditl nnI �Cl3� l r ll, ATERIOR 7ei'ii aM,o , l"TL 101 Terfalaneo, Wan Sash All: Hirth Perfvma Ee Sm.�rr.Sun Glmt, No Pattern, Ha.rdWare, Dark Efonze.,:Screen, TruSceme valh Exterior Color Match, Fu 11 Screen, Gri tstY116! GrillM Between Qyss (GBG), Grille,iPngnrin: Sasha AU:Colonial w x 2hr, MJ%C- Aluminum 4lcrra�p; Alunilnum Wea 207 office W1nAaw, Double-bung. Equal, Slope Sill Insert, 11racliticanal ' Qherkfail. t TiER101R 11M11141019Tvratoneo. Qla,w: Sarah All; High Pert'-ormaace SmartSun Glass, No Paluero, Mardwortio (dark Bronze, Strbifind Tr60rtiv with Exleribr Cnlor, IAPv h, FU11 .racer n, (cillostylol (J*rllles 006-V.Von chafe (GBG , Grille Pnftarw, Sash An:Colonial 3w x 2M, Mlst, AturninUrn Wrap, AI urnin um 4fV'l:a 1dim wfnxlowu Double-Hring. Equal, Slap Sill Insert,Traditional Check,rail, EXTERIOR iTatonea, INTERIOR Terratoanerffi, Gles®, $01 All: 14101) Port rmance Smor1.5un 4Ajss, 11*Pati 1lemptrintl Gins% "OtdWam mark nrowat. Sueant TFU$nnO %%lith Ex,lerlor Colix Malch full S rwn, Grlill'ie Mylc Grilles 141w 3-lass(G,BG% Grille Pa'l;terh: Silli All: !C010641 3.iv x. 2b, Misc; Alum-inure Map,.Aluminum Wra, MW1ND�'hhl o P010,1BI iCYo 11 SPE 111.g Mist T TOTAL 011,968i UPDATED; 041,12116 akrarmd r.A*derirv0.01 eommola+d 10 vor ew.ffmm1100,fier 6y rmPr r)rice avird4.Wr vafrf Of)d�rf ur e �Idror�r{,I Fy�rn'�,trc�n�y AW r.i8�lb Noe 6� 'p� Ren ewal by Andersen Ca. oration mene wa 11 30 h'ar`bes 6ta2d*�,Tartu a�ual? .0 ssmcI nsetu 011'532' � �t4an G��n-vMCU Cont.rp nld rsen. �'6oane�S�l�j�g C-� •0'���a3'p��Go��2 c�s�i a�-�r �'tM430 Ie�e�if 6txleeaN�'�c,Lia>r .�11�7i!lazil,t3 w DOOR NIMMUNC ACIMNOWY eAgrWnW t r)ky auL beton r nl ty Aiukrsett C6rj crsikwt paid jane Ritchie-C"T yee). e0.rHtactorAnd Pra.ver )1 , agm-,tc an"dnsl n*xMfy the Agimm ni as; file[as"CInC � indi IW ice. iC that�b". a+lit�;iattilcaF a k aa. 1 ua'1 aV'U110LI .O theAgvw enf�,�,•i R amakm 9m,rul1 turfs snd edea., '.hE&Amejsdrm,w Is wrt ick ille�1i'9`�t�A"d cv)TO t Ors car the.�i,Q't�`i51�7L 1i- !'rsllawl"g n�i:;K xl� aft-rail iam�,.or dek-dav s totlh ,ptvdwt4.ard +?1� .SuyerO)orders :.am bein nisde: 1✓timutr ing die roof of the,bayto,a EL1P Cvi ram nata shed ram Also dia112En ttie PM PtleM mf tk hay window to diamond grlliles betweewflwREM,patle rn ifies wf11 no he,as a1713 v&devu IA the-ha t�.,unit Tbie diamond oonfli ju ration will be ap prror� I! utelu 17 dEarn rads nay,tbe-sI&%9Bdow and appeoAmately.31 d12mands,Inthr eenterfixed%dAdftw.As per eustomr-S-rMuestwe WHI be the g,the factory recommendation for the pattern that rill best ift the unit and el'oselg re,,. e pl"uc .the current de dga Found On the-otter ttralts-cors the 11r't tl'oor. TihN TNM add art add3itl'ora15'x'3.6.Will&will be Paid at die tFan of install amduot:odded'to financing. i a riSWIr of these•eh=- .;M 11te .Wjjq,, hamtt c44he a1w cilan bir,(if t1wre:is nochsnge,an heal wHI k� leh ilrl w k Lw rrl:ia�euiiaa�'�ti!':ft?l'":i1!rel�atls��El�i1�,t5t��Itraa applla�,:. 1 T�tw1 Viols auiaerfla 9.r;,� pa� artr Virohd� mit la ciaxi,:S1�],ia��..0 Greerfsky Fittawe l m UaLmicr at 5tmat.Pfj'u'h!$11-1 2-141M �t m'� �i�:1ta�•G Nens 13alwo on 345:.041 alt~e1, aede�t SutdavNit CorapIctian afjtib $1[.124-01) $6:968.00 Encibmik 13220A GrecaSky Fifunce it.ftpuft" , and p - haft acbmi- Irwi,�has' md- Amc t smd lra<s as t 4. -d cf*- w- maAv t an�tWv wavilm be uw. sl �tt.t ar Fkti9rtdi 1 J'a ne itch;,j @' t . Ip:ws:asnss�.;2 ma Kam Fhvdcl mAnRaer , The COMNAVAPM&AI of MMMAJOWds :Uepe.��aesi�ull�:dr�st�� �cC:it�nrx J(fire of hwes4aadiw waTh ft on&ver Barton,M18«111 wiviv n ngevldlta Workers' Compensrdon fouracce Affidavit:r� DuRde:s/trontractorsl,;tetriclarlumbers, . p'iteantn;+utt►attu�t a'tena�i ,rrt n"".8me RENEWAL BY ANDERSEN AdJ- rftg: 30 FORBES ROAD City/Stalo7.ip- NORTHBORO,MA 0153_2.4 pyotle -508-351-2200 Arejou an employee C;reck the appropriate bots: Y 'lope Of pr*rt(wired t 1. !art►a atnpleyer with _304. [1 1 am a Saml exuWador and I 6. [�hew crosftc#ion e�ttplo nes(full Anx0t,part-times).' nave hire4i the�i:t+-cantrat�ors jj . � ?.Cl I ane a sole proprietor or patuter (Mcd on the attached*at.. Remodeling ship and have no employeos JI"stib-cmitwu)m have S. o mmolition working, for me in am tmpacity workers'camp-insumev. 4, O Building addition [No urorkas't ome.ivurarrce 5• ❑ We are a e oration.tern!'it; ' y t+egttirad,j affim.3 have me sed their 10[�_,F.1ex-Wical rvors ur AQ ism X�.j l.am a tu,meowner.doing all work riga cif -uptiun pet GIl� Phmnbiug regains or additions my self:1-No worker'comp, c 152,41(41,and w have no 12.D Roof rgmirs instnance reeluit�Aj cmpkwees.,[bio Warl ers' 13"D l- "r p.insivancemquireJ.iL 'Aai, heat s bre a rw8Yit iadiaumatq:fret,.M tw V,*M Deena Otto+�vtg�d�wvA:+.+":N!��r•.sat.:.•n p'ri�c�miurma�. 1 IOI11CaNYra s RLo*::h4tF thin a1 7ti �;9w ;:dom_a ail cork bjW den torr Matiuk�vOGld1R a�muu aU rt at6davit arkliiatiatt a . ".'Attt dSttl[s tW:.it 4 11M by%mat arta Aa an add-UMW rte--U-%me the not(W the Wb,-,mq&-w.;.amt thsir R'1Dt1C9LR',=t11,tudtcy tmamatwn I am an mrtayer Pkat is pmvi&W worAers'coaVwnSWoat�e/or enrptoyte�. Jltelot, the p cy aNdJub site kdomditiom .Imursnce CumMd Name: OLD REPUBLIC INS. CO. relic '#�.or Set%inx Li��. _.._MYV_C457_4�.. �__..._.. .. __ l:kpiraton Bate 10-01-16 Fob Site alddtess: 200 WAVERLEY ROAD _City�`'Sfata'Lip:NORTH ANDOVER,MA 01845 Attach a copy of the worliwrs'compettsetdon polies deciamtlon page(shoring the poRty number and expiration de te). Failure to secure coveta$e as required un&-. Section 25A of NtGi,c. 151 can kad to the itnposition of criminal penahi��of a fine up to$1,500.00 ar or one-year injprisomertt,as w-ell as(:ivil pcnidt' in the ffu'.rtn'if a 5 0P WORK')RI?F R and a fine of up to S:-V,00 a day aping the violator. Be MAW that a copy of ati,s stato petit stray be fmwardad tt)the Once of lPve attoea of the MA for insurance covaVe vet'ification, I ort hereby e,vtlfj litldpr oke a penaKes+>f prrJ�+rl'rhe[fie fnjni� rhran inrridrlad�rbat w Arm rad csrroect phone#: 508-351-2200 ,,#kiat use 0)*- Do not write int this ansa,to be coder!by 4#,of town gMtali City ori own" Permit&kense# Issuing Autho-zity(circle one): 1.Board of He an 2.Building Department 3.City!Tewn-t`erk 4.Elmtriml inspector.S.plmabbg- r 6.Other z ontaet Penson: pbmtt:#: ANDECOR-01 YADAVYO CERTIFICATE OF LIABILITY INSURANCE FDATE(MMJDD0YYYY) 10/1/2015 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 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 endomement(s). PRODUCER NAME Willis Certificate Center /O 28 Century Blvd .of Minnesota Inc PHONE 877 945-7378 ac No: 888 467-2378 C/O 2 P.O.BOX 305191 ADDRESS:Ceriffica llis.corn Nashville,TN 372304191 INSURE AFFORDING COVERAGE NAIC p INSURED INSURER A:Old Republic insurance Company 24147 INSURER B: Renewal by Andersen LLC INSURER C: 30 Forbes Road INSURER D: Northborough,MA 01532 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 CONTRACTOR 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. LTR TYPE OF INSURANCE INSDPOLICY NUMBER Mro uMrrs A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE T OCCUR NPAZY 305440 10/0112015 10/01/2016 PREMISES Me occurrence) $ 500,0 MED EXP one person) $ 10,001 PERSONAL a ADV INJURY $ 1,000,00 GEN'L AGGREGATE LBAIT APPLIES PER X r LOC GENERAL AGGREGATE $ 4,000, JECTPRODUCTS-COMP/OPAGG $ 4.000, POLICY 1:1 PRO- OTHER: III AUTOMOBILE LIABILITY EOMBINED SI G LIMY $ 51000100( A X ANYAUTO MWTB305M 10/01/2015 10/01/2016 BODILY INJURY(Perpersm,) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per acddanq $ HIRED AUTOS AUTOS NOR-OWNEDPROPERTY AUTOS Per aockw $ R UMBRELLA LU16 OCCUEACH OCCURRENCE $ EXCESS IJAa CAMS MADE AGGREGATE $ DED RETENTION$ woRlcels COMPENSATION s AND EMPLOYERS LIABILITY Y 1 N X QTH- ST TOTE ER A ANY OFFICERIMEMBER EXCLUDED? CUTIVE � N J A MWC30543700 10/01/2015 10/01/2016 EL EACH ACCIDENT $ 1,000, 0 yan Gln NH) EL DISEASE•EA EMPLOY $ 1,000 DESG�RIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERATIONS J LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached M mere space is nrquUsA) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTFIORC!ED REPRESENTATIVE Evidence of Insurance C 1986-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Ma aachu setts-DepxrtrneM of Pub&c SMety Board of Building ReguteWmo and Standar" Construction Supervigor Um LOOM r ' Expiration Ca: tion� 101D8i'3�'if; CJlze�ommwowfea�o�r'�aeoac�aewe�a I #R-egIstreUan,: e of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR Type: Expiradcw-120wq Supplement Card RENEWAL BY AND Lt JAIME MORIN 30 FORBES RD ;�:•3 --- NORTHBOR000H,MA 01532 Undersecretary fi it WINa0 W5-n00 n5 - - d��sa I i !Andersen'NFRC Certified Total Unit Performance (conunued) Andersen'ProductGlass Type U-Factor' SHGCI Vf' . Andeisen'Product Glasslype U-Fectoi' SHGC' VT' r r- Architectural - 400 Series - _HP Low F4 _ 0.27 0.35-_ 0.60 d - IIP Lmv£4 0.32 fl._28- 047- j:_ - --HP Low E4 with Gilles 026:--•.0.31 0.54 _._y -L4 With Gtnles_ 0.32-- 025--- 0.42 -t"•. - IIP Low•E4 Sun -0.27--_0.21---0 33 __ HP Low-E4 Sun- 032- -0.17. 0.28Circle Top- ---- - _ . Casement Window - - -'- _ Casement Window HP I Dw.E4 Sun with Grilles 0.29 0.19_-0.30 - '- .•"� -- IIP Ian E4 Sun vvilh iii 032 -0.16. 023 IfP tax E4 Smartsun 0.26 0.23 0.54 l - - -__HP Low•E4 Sm ifti n_0.31 0.18 _ 0.42 - pq L --•- _i.-------- qr HP Low E4 Smartsun yr/Grmes -031 0.17 HP 1 ow-E4 SmmtSun w/Gdlles _HP Ldw_£4 03Z 02_8 -D 47 -"t HP law•E4 0.27_0.35 0.60_ -- - - Imlaw r4 with Grilles -_0.28 031- 0.54 f - Ire low-E4 vdth Gdlles _032 -025 ._-0.42.! i F M `-HP Law E4 Sun 0.27_ 021 -- 0.33_- - r'- French Cosemeot .._tm Low•E4 on -032 0.17- 028 X71 ti E- circle 8 oval Window lip law-EM1 Sun with Gilles- 0 29._ 019_ 030 4` ] Window HP Law£4 Sun with GnRies 032 -0.16 -023 -- - IIP low•E4 Smar4Sun 031 0.18 0.42 '"L HP Imv E4 SmedSun 0.26 023 0.5 -- HP law-EA Sorensonw/GdlJrs. 0.28---021 049 x. .( flP low Fil SmadSun w/('rilfps ---031 0.17. 038- Ire law-E4 0.28 • 033 058 NP low-E4-032 _ _028 - 0.47 --- •HP Low-E4 with Gfifes 0.28 .030 0.52 �% `• - -_tip Low.rA with Grilles -032 025u -0.42 '"t S9! ----- tip lour E4 Sun 0.28 0.20 031 Gx- - _ -_,., lip Low-E4Sun --032 --- 0,17 026 7.1 n. - .. :AwninglHindow -- Arch Window - •'-' - -- - .9 18 - r - ��� � � HP lox-EM1 Son wnh Gilles 032 016 0.23 _ HP ImrE4 Sun wilh Grilles 0 29 0.18 _0 28_ -+_ -_- _ - - fIP Low-F4 smarlSun 0.27_ -023 0.52 T i 'lrl_ - -_- HP Low-114 SmatlSun 031 0.18 0.42_- _t -- i fmmr hEM1 SmaiSun w/GnTles 031 0.17 0.38 V fid �j lip Loi•E4 Sorenson w/Gdllr, 028- 0.21 - HP Low-E4 0.27-_ 03_3 _0 68 --- fIP Low-E4_031_-032 055 r - HP Low-E4 with Grilles 0.31 029 049- J-t I IP Low-FA with Gilles -0 28 0.30 0.52 _-. --------- - IiP Law.E4 Sun 027 020 _ -_03_i_ 4'>�_ Cesement/Awning -__ __ _wr E4 San 031 020 031 - FleArrome Windowr HP I_o_w E4 sun with Gillies _0.29__- 0.18 _0.28 "+ - Picture Window --HP low E4 Sun.with Grilles: 031 0.18 0.28 i Ilphaw - lip Low-E4 Smartsun 026 -_02_3._- 0.52 _E1Smer]Sun- 0.31_ 021 0.8 ___0 f7 - HPLan-E4 SmartSun w/GdllW 028 0.21 0.46 tIP low-E4.SmaASun yr/Galles 031 _0.19-0.44 -+i _ HP Law f.4 0.30 031 0.64 q HP Law-E4 0.31 0.33 0.58 --.---- --•------- f ----...---------.-...- '--. -'- - - ..- IIP Law-E4 with Grilles -030 033 0.57 fm Law-E4 withGJlle - 032 _030 052 _ - __ - -• -- - - --lip Lowk4 Sun 0.31 0.20 0 31- ! -_ _ lip Low`F4 Sun_ 0.31 _ 022 03fi Spingline Window -• - -- specialty Window HP Low E4 Sun with Gilles- 03_1 020 032 _ HP l_avE4 Sun wiUt Gdnes__0_33_ -__ 0 28 �_ - - ImLaw-E4Smar$un_030_ 0230.52 1 - -_NPIuwk4SmartSun 0.30 0.58 - 02 4- IIP Low-E4 SmadSun w/Gilles 0.32 -021 0.46 1'.$ lip Low-E4 SmadSun w/Grilles 0.30 022 0.52 _HP_Law_£4 _0.30 0.27_ 0.45_ lip LorrE4 032_--022 037 ---- _-IIP lnwk_4 with Grilles _0.32 023 __039 tip lmvE4 with Grilles 033- 020 0.33 --�--- HP ImvE4 sun- -0.31 0.16 0.25 +��iS Hinged Inswing- -HP law-E4 Sun _ 0.33_0.14- 0.21 - Fronchwood' --- ------- r-E4 sun with Gilles_ 0.34 . 0.13 0.18 - I� -_. •---�•--• - ..-• - - French Door Imlm Gilding Pato Door HP Iow£M1 Sun vdth G_does 032_ _M14 -_0.22. - - -•-IIP Iow£4 SmarlSurr 030 _Q18 0.41 NP Lon-E4 Sorensen 032- 015 0.33 NP law£4 SnmrlSun w/Gini 0.31 _0.16 0.35 1" Ire lots-E4 SmartSun w/Galles 033 014 0.30 - Qy HP Lovi E4 0.33 025 0.41 ra - t _ - HP Law M. 0.31 024 _ 0.41 1`4 --- ----- �, HP towk4 with Gnllts 032_ - 021 __IIP low E4 With Ghnies._ 034 --0_22 0 36 --- -_ HP LLaw•E4:Shm_._0.31 -0.f5 073 s Ct+ Hinged Outswing _ •--._- HP low-E4 Sun 0.33 016__023 ca a Frenchwood'Hinged - - -French Door JHP lax•E4 Sun with Grilles 035-014 : 0.20 Inswing Patio Door HP low-E4_San with Grilles 0.32 - 013: 0.19 - t _- - .-- --- --- --- - --- - -- lip Low-E4 SmadSun 0.32 0.17- 0_37 - 1 7f t"l �•� _ HP Law E4 SmariSun 030 0.16 _0.37 - -- - --- IIP lawE4 SmertSun w/Gives 0.31- 014. 0.31. IIP lavr•E4 SmarlSun w/Gilles 0.34 015 - 0.32 = E o _ _flPtm'1*4_ 0_.31 _0250.41_+. &'7 -__--_ #If tmvE4 033 0.23 0.38 - - can`, -_-- Ire Law-E4 withGrilles -0.3_2 0.21. 035 -•• ' HP law-E4 with Gilles _0.33---021 0.34 HP low•E4 San 0.31_ _0.15 _ 0.23_ T NH Fixed French Door HP taw E4 Sun 0.33 -014- 021 FYenclwrood'Hinged iP: - Outswing pato Door HP Low-E4 Sun with �j Sidelight NLaw-E4 t Grilles -0.32 _-_0.13 - -0.19 1 t __ -_ E4SunwithGillies 034 013 0.19-- --- 3 ----- - _HPLowE4 smattS_un 0.30 0.17 0.37 t i - _HP Low-114 SmadSun 0.32 - -0.15 - 03_4 - i _ tip tow-E4 Smansun yr/Gnlies�033: 0.14 030. - tip low-E4 SmadSim W/Gives 031 0.15 0.31 C s ' HP Lax•E4 _ - 0.31 _022 _ 037_f'I _".� --._-_-:_NP Wvk4 -032- X025- :0.41 HP lmvE4 with Galles 032-- 020_ 0.33 --_HP_Lr'E4 with Iles 0.33-_-_0.22._0.37 - --- - Low-E4 Sun 032 - 0.14 021_- .' i Fixed Transom - _HP Lmvbt Sun NP 032_ 015 0.23 Frenchu'ood' ----`-.- --'- --- French Door- HP la_w•FA Sun with Gives- -0.33. 0.14 0.20- - - - Patio Dom sidelight Ire Low E4 Sun with Gdlles _032 - 013 -0.18 _._ - -- -- - -- --�--_HP law-154 0.31 0.15 0.33 HPLow-E4SmanSun- 0.32 - 0.16- 0.37 -,-- -- - - _ _...------_--.._._......__..__.....--.-.- w-MinartS HPLounw/Goes .33 032 0.15 0_ -IiP Low-EllSmarlSun w/Gives 0.32 0.14 019 + 'x'17 _ - HP LavrE4 0.30 02M1 0.40 - fm Low•FA -036_ 026-0.44 - -_HP I.ow£A with Grilles- 0.30 021 .035 =%r - E3- -HP Low-E4 with Grilles 0.36---0.23._0.38 _- ----.......--, _ --- -- -` --- - Freuclhvxrod' HP lmv E4 Sun 0.30- 0.15 022 F't^ Faldkrg Daor tip Lrw-E4 Sun 0.35 0-16 .0.24 - -- - PaOn Door Transom -IIP Lmw-E4 Sun with Gilles 0.31 .0.13 020 w+ - HP laxk4 Sun tvih Gilles 0 38 014 0.21 - .-----=-------._----- -- --- - NP Low-E4 SmaiLSun 034 0.17- 0.39 - HP low-F.4 SmanSun 0.29 - 0.15 0.38 1 r- - .-.._ _.- .. ---- ---- ---------- ;;? HP tow-E4 SmartSun w Gdlies 0.36 0.15 0.34 - fmLom[•7SmarlSunw/Gdaes 0.30 -0.14 032 - 1 - / ._-..-. cantnueJanHad pap •ror NnIC certified total unit performance on omits with capillary breather tubes for high altitudes,please visit andersenwindows.com. •"Hlgh-Perform ance"l ow.F4•"(lip Law•E4),"High-Performance"Low-E•4'SmartSun"•(HP Low-E4 SmartSun)and'Iligh-Performance law-E4'Son-(HP Law-E4 Sun)are Andersen trademarks for"1ow•E"glass .- o U-Factor defines the a mount of he at loss through the total unit in BTU/hr sq.10F.The lower the value,the less local is lost through the entire product.Window values represent non-tampered glass.Use of tempered glass can - increase It-Factor ratings.See andersenwindaw5.a0m for specific performance values.Door values represent tempered glass. - 'Solar treat Gain Coefficient(SIIGC)derrnes the fraction of solar radletan admined.through the glass both directly transmitted and absorbed and subsequently released inward.The lower the value,the less heat is transmitted through the product. 'Visible Transmittance(VT)measures how much light comes through a product(glass and frame).Tito higher the w:lue,from 0 to 1,the more daylight the product lets in over the products total unit area.visible_hansmiltance. is measured over the 380 to 760 nanometer portion of the solar spectrum- - - - - - - - •NITIC ratings are based an modeling by a third party agency as validated by an independent test lab in compliance with NFRC program and procedure]requirements. • This data Is accurate as of December 2010.flue to ongoing product changes,updated test results or new industry standards or requirements,this data may change over time.Ratings am for sizess specified-by NFRC for testing and cerlilicatian.Ratings may Vary depending on use or tempered glass,different grnle options,glass for With altitudes,etc. - -- - rass.ve5un'glass values are rivallahhe entire at andersenwindowsemn. _ - 277 Renews . - - - e 4 WINDOW- REPLACEMENT an Artderaenf:;ompany WoodNinyl Composite IF °at>;.'�3.frte tt lt, Dual Argon Low E4 SmartSun igC .wc< ` Double Hung 100-00473618-010 ENERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient � o �219 0419 - ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0 ,342 Manuhacturer stipulates that theca ratings conform to appr aDb NFAC procadums for dotefminin9wAob product performance.NFAC ratings are determined fora(ked sat of environmental conditions and aspecific product eke. NFAC does not recommend any product and does not warrent the smla0ilhy e1 any product tar any apeeirro use. Consuk marafaelerer`a the return tot other product performance information. WWW.n1m olg This produat meets Green - - 9emrsenvuonmantal �ctandaMa rnb ere �'` �•r9..- '�r' heavy C�. effaiarxy.Aoavy motoC in j tae frame antl Leahy f1i'�+matarml pack391sm and eonaumereducatbnll - -. hr materials. acr u a;c-�yY�CcC':.. ,as w.•rn DESIGN PRESSURE(PSF) w laaovcw�sat�Door - , t�wwtgvvNn,a�a ibn o luipal ..m/1glO../`2/�l��m RbA DB Sloped Sill DH IN Tided tonAFSQ2aAAF.IAM1'AHA5Sh 101. M O.M htanaa tra ar fates conlormanoo to 0%OPP11021M stanoarde. deetc or exceeds A1.E.C..C,E.C,&I.E.C.C.Arc tnfrikmtien requirements WDKIA Natimark Cad'Akatbn Program. i i