HomeMy WebLinkAboutBuilding Permit #473-16 - 230 FARNUM STREET 10/13/20156e,gN,V C p Jr
R BUILDING PERMIT
TOWN OF NORTH ANDOVER
Ar'%r%l lf1A-rl^Kl rf%rl Ml A61 r%/A11A1K1ATIP161
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
One family
❑ Addition
❑ Two or more family
❑ Industrial
VAlteration
No. of units:
❑ Commercial
Fe6epair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
Identification Please Type or Print Clearly)
OWNER: Name: /YIC/
hoe/ C� O Phone:b/7- 09-007,?-
Address:
9-007, -Address:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COS/TT BASED ON $125.00 PER S.F.
Total Project Cost: $ 9TH 70,00 FEE: $ _t 1 �'
Check No.: Receipt No.:
NOTE: Person cont ting with unregistered contractors do not have access to t,,guvanty fund
k.. I ey
„r
Location Cq3o 177�?/7h� ih J
`� r
No. '' Date Z;D.+N
Check #,�l
29518
it
TOWN OF NORTH ANDOVER
d
Certificate of Occupancy $
Building/Frame Permit Fee $V
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
Plans SubrnittEl ❑ Plans Waived ❑ Certified Plot Plan ❑ stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Swim,nrn
Tanning/Massage/BodyAlt ❑ gPools
Well ❑
Private (septic tank, etc. ❑
Tobacco Sales
❑ I Food Packaging/Sales
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF m U FORM
PLANNING a DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
HEALTH ,
COMMENTS
Reviewed On Signature
Reviewed on Signature
Reviewed on Signature
n
X
Zoning Board of Appeals: Variance, Petition No:
Zoning Decision/receipt submitted yes
Planning Board Decision: Com
Conservation Decision: Comments
Water & Sewer Connection/9
Driveway Permit
DPW Town Engineer: Signature:
FIRES®PRALocated 384 Osgood street
RiME-N,Y,�f,TernpjDurnpsteron site :yes.° '�'`� +rte 1 r
Located,at�12,4pMainiSt�eef in -b;
frt•—��•^� '`�� .� 3, 1 • ty� r ��• a� f �•. _`r v:
partra�enf signature/date r.` < , arc j.�� z;,'
COMMENTS " ,�S � +�o,! . •f r �x, �rt;w� . - t.�,_,' .+ i t,s,T , +r,i`"`'��'',
t"�., i l� 1t`s _ • t.� t^� it
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, wast or service drop requires approval of
Electrical Inspector Yes No
®ANGER ZONE LITERATURE. Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
Doc.Building Permit Revised 2014
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
4 Floor Plan Or Proposed Interior Work
14. 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
TOTE: 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
Engineering Affidavits for Engineered products
TOTE: 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
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VALLEY SIDING WHOLESALE, LLC 0)SLINes9
MA Lic. # 016201
Toll Free 1-877-302-2923 .
W �
Newton, NH 603-819-5158 • Saco, ME 207-284-6600 • Haverhill, MA 978-241-7343 •"�®
MEMBER
Date: Consultant:
Job Name: M /r� hLc��t�c Telephone: G 12- 79 - GO 7
-
Job Address: ,? 3_ o Town: �}J� 1�,t�(av�✓ a
VALLEY agrees to start described work on/or about__2 -,I'- weeks after final measure and complete described work in
VALLEY shall not be held liable for delays due to causes beyond it's control.
The following work Includes all labor and materials needed to complete your job In a workmanship like manner.
Removing Debris In A Legal Manner - Dumpster At Site Or Shop:
Dumpster And Location:
,[el Remove Existing Siding
apor Barrier House Wrap
❑ 3/8" Underlayment Leveling/ Backer Insulation
i,e' Other Fall 6,gck
Location: _1'616
House
❑ Other
Brand:el�,.(e,,, LQ,e of S/e Profile: D
'Center Vent ❑ Fully Vented
Location: Cam 2bff_4,, 1-,06
Full Custom Formed J -Less ❑
❑ Blind Stop Capping ❑
Location: /a_ _ _ ., i — t- .fej A
Location:
Amount W -
Or Cash LJ Credit Card
$ - /.2 working days.
❑ Non -Vented
Full Custom Formed M1
None
G rA
Owner to
,W,.;M�;:�1R) f::4:?[<w!.�•v:6:w:ii:.:: ,1'::iws� m;.w,,.,.....xy:: iii:.:::'o::.:.:........, �.:::::::::.:::::::::...:..:..:.:..:...................... -
-Wide Insulated ❑Wide Non -Insulated Total Investment: °=o
Regular Non -Insulated E] Custom d CIC /0 1/3 Deposit: j+; 3G ao
Corner Post Color: W , f
1/3 Payment At Halfway Point: p7 –E-4
—
1/3 Balance Day Of Completion: 2, CC? , '=
P.V.C. Coated Alum. ❑ Aluminum NOTE:
❑ If A Building Permit Or Electrical Permit With Updates Are
�':::;
Required
BY Your Code Enforcement, ment
They
Are Extra
And
Paid
;::: ;:>>;:< :»:>:»:
8 Full Custom ❑None For At The En&Of Job, At invoice Charge Only
Location: • a n
Any Wood Replacement That is Required After Start Of Job
Will Be Extra And Paid For At End Of Job, As Listed On Propoi
You may cancel this agreement if it has been signed by a party thereto at a place other than the address of the seller, which
may be his main office or branch thereto, provided you notify the seller in writing at his main office or branch by ordinary mail
posted, by telegram sent, or by delivery, not later than midnight Of the third business day following the signing of this agree-
ment. See the attached notice of cancellation form for an explaIation of this right.
An interest charge of 1-1/2% per month (18% per year) will be added to any Date of Accept ' a S�
amount unpaid after 30 days from invoice date. In the event of default in payment
of this order or any part thereof and the account is referred to an attorney for Signature
collection, the purchaser agrees to pay reasonable attorney fees. (HomeowneiHk_-#L#01X
I / We give Valley permission to obtain all necessary permits. Signature Q
(Valley) �a2
Preparation Package
Accessory Package Color:
Full Custom Fascia & Rake Trim Cover Color:
Full Custom Soffit Trim Cover Color:
Full Custom Window Trim Cover Color:
Shutters Color:
(a Gutters & Downspouts Color:
apor Barrier House Wrap
❑ 3/8" Underlayment Leveling/ Backer Insulation
i,e' Other Fall 6,gck
Location: _1'616
House
❑ Other
Brand:el�,.(e,,, LQ,e of S/e Profile: D
'Center Vent ❑ Fully Vented
Location: Cam 2bff_4,, 1-,06
Full Custom Formed J -Less ❑
❑ Blind Stop Capping ❑
Location: /a_ _ _ ., i — t- .fej A
Location:
Amount W -
Or Cash LJ Credit Card
$ - /.2 working days.
❑ Non -Vented
Full Custom Formed M1
None
G rA
Owner to
,W,.;M�;:�1R) f::4:?[<w!.�•v:6:w:ii:.:: ,1'::iws� m;.w,,.,.....xy:: iii:.:::'o::.:.:........, �.:::::::::.:::::::::...:..:..:.:..:...................... -
-Wide Insulated ❑Wide Non -Insulated Total Investment: °=o
Regular Non -Insulated E] Custom d CIC /0 1/3 Deposit: j+; 3G ao
Corner Post Color: W , f
1/3 Payment At Halfway Point: p7 –E-4
—
1/3 Balance Day Of Completion: 2, CC? , '=
P.V.C. Coated Alum. ❑ Aluminum NOTE:
❑ If A Building Permit Or Electrical Permit With Updates Are
�':::;
Required
BY Your Code Enforcement, ment
They
Are Extra
And
Paid
;::: ;:>>;:< :»:>:»:
8 Full Custom ❑None For At The En&Of Job, At invoice Charge Only
Location: • a n
Any Wood Replacement That is Required After Start Of Job
Will Be Extra And Paid For At End Of Job, As Listed On Propoi
You may cancel this agreement if it has been signed by a party thereto at a place other than the address of the seller, which
may be his main office or branch thereto, provided you notify the seller in writing at his main office or branch by ordinary mail
posted, by telegram sent, or by delivery, not later than midnight Of the third business day following the signing of this agree-
ment. See the attached notice of cancellation form for an explaIation of this right.
An interest charge of 1-1/2% per month (18% per year) will be added to any Date of Accept ' a S�
amount unpaid after 30 days from invoice date. In the event of default in payment
of this order or any part thereof and the account is referred to an attorney for Signature
collection, the purchaser agrees to pay reasonable attorney fees. (HomeowneiHk_-#L#01X
I / We give Valley permission to obtain all necessary permits. Signature Q
(Valley) �a2
..A 1 %AIUnll .CCA1 C I I t_ WINDOWS
.1850. MAIN ST , UNIT,B
MA Lic. # 016201 NEWTON, ,NH 03.858
1,-877 302 2923 m $BB
'®' .
MEMBER
Dater—J / l s Consultant: /3,11 Cix arc S".?
Job Name: /r1 /M -4Q ale's Telephone: 40-27f-0076
Job Address: a36 Town: Ajo.*.tA
CONTRACTOR agrees to start described work on/or about 3 "weeks after final fittings and complete described work in about working days.
CONTRACTOR shall not be held liable for delays due to causes.beyond. our control. ,.
The following work includes alllabor,and materials needed to complete`your Job In a workmanshipllke manner
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:�:n,:•:,sem � c:...eJ:ph3<•o
•kik r,*::igo>: .. Q.'<
Combination Job -Windows With Other Work Srd m, 170 Q White Inside /White Outside
Building Permit If Required Q Beige Inside / Beige Outside ,
Preparation Package Woodgrainlnside / White 0utside
Deluxe Installation Package c, As Used On _Mt. Washington Q Woodgrain Inside /Beige Outside
�Q 8 Point Guarantee Program Q Light Q Dark Q Cherry
Q Glass Breakage Guarantee � bib >o �.• ., ...� r, k. k.
Remove Detiris In A:LegaLManner = Insulated Glass. Q Dpuble Strength: Glass
Energy Star; -;Low,- E With ,Argon
.. .. .:p<:: s: .:?: t::<s 3. 0: : .. •.h ... `} X }. yiff 6 �,F'v F/cR.?,:c :ii%C'Yy: -_ -
'Regular -Low - E With Argon
g
Q
Manufacturer Other
Model ::>:i........::..:€s
,..,.?i..,,.,.;i:.:i•r::i?.rrrkkr:.rr:?.:.:.,.r:. t.r?.rr,:.;..
�
Style aCJ &,,, 1v Q Contoured Q Flat
1�
Amounts (� Q °1ialf Screen Q Other
` "2 Lite Sliders
_ 3 Lite Sliders Q Fiberglass Q Other
r!fs. k';''i'raiyH:'•:l::`�j:H$Eu'$f:'•.k:i
,
1/3 - 1/3 - 1/3 Q 25-50-25 ��� „ � •
:.Picture Windows `
Amount Capping Color .
Basement Hoppers Q P.V.C. Coated Aluminum Q ,Aluminum,,,•_
Awnings Q Full Custom Formed Q -Blind Stop Capping
'Casements — Y/1- e RSG A.ewUZI To Be Done (V $
1 Lite. _ _ 2 Lite _- Q .-3 Lite � n .
No Tnm Cover
Q. m.. �.., , n... .. 9
Bay Windows e _�'� i l
Q Double Hung Vents Q Casement Vents R e ��Ga�R �' e ��� G r
Bow Wintlows
Q 4 Lite " Q] -5 Lite 0 `6 Lite
Q Hip Roof Q Shed Roof Q `Copper
,.. ?..•,; .. o..:a::«•k t•'<+:•r•, x't.:.::t.. ..i ..:..::. .. ;'•':.k.::.s <t;k.:x:'s`•„'tq y,
•Y'� ?” <':k;:\kk;�:kY��k::r 't •s•`•eQ.`��:.Y?i.,`1<"G,:,.
Patio Sliding Doors>::. .i. t i'*'"
s:'k
., .t. S:: �0'k d::.::. ..m,.,.�. ,,K4•:a;•x :. �'. •lk•' T � En»i'N �'+:�^.ti. t.sh ..
Q 5' Door 0'' 6' Door 0 8' Door Bank Financing Owner to Arrange Va11ey To Arrange
.:...y,aa ss:t?<•;;::?t,::•r;'r.,. .....;:,...::.::'?.s:.,..s:..:.,:.:.r'y.. tos'r6 r.<essk: �:?;.:.,,y;,
:t>?.:A,:y:...nr,.i""k'.:.r::.:•ss:"s+.:: ..t. .:. ..,.. :.. .:.,,:.. a.:. k:." :+,.:::s?s.: t •;i;?.ss!:r:; i^?; •s �u.:: •C
Master Card
ar
Cash t,
None - Any Woodwork Needed Will Be Extra ,
Inside Casings Total Investment
Q Insidistops Q 9
- =.—Inside Sill Q Outside Casings ' 25°k Deposit iJci4f c_ 4
Q Outside Stops Q Outside Stool : 25% Payment' At Check Measure
Q Other 50% Balance Day Of Completion21°O
You may, cancel this agreement If It has been signed.;by a party.thereto at a place other than the_sddress,of these ler, which
may tie his main office'or branch thereto, provided you notify the seller in writing at`hts main o'fflce"or 'tanch`by ordinary mail
posted,.by,telegram.sent, or by,defive:ry,,not later than,mldnight of the lhird_business day.following the sig ning..ofahWagree-
ment. See the attached notice of cancellation form for an explanation of this right.
An interest charge of 1-1/2% per month (18% per year) will be added to any Date of Acceptance
amount unpaid after 30 days from invoice date. In the event of default in payment
of this order.or any part thereof.and the ac countis¢referred o an attorney for Signature {
collection; tie purchaser agrees to pay 'reasonatile attomeyfees. ` (Ftomeowne0
I / We give Valley permission to obtain all necessary permits. d; Signature
(valley) i,
The Commonwealth of Massachusetts
Department oflndustrialAceidents
I Congress Street, Suite 100
Boston, MA 02114-2017
www.mass.gov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/PIumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Name(Business//Organization/Individual): I 1
�+ Q L
Address: 6 s/ U — do
City/State/Zip:
Are you an employer? Check the appropriate box:
Phone #:—(003- 01i"7 9
l QKaam a employer with I -1 d employees (full and/or part-time).*
2. ❑ I am a sole proprietor or partnership and have no employees working for me in
any capacity. [No workers' comp. insurance required.]
3.❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t
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
proprietors with no employees.
5.❑ 1 am a general contractor and I have hired the sub -contractors listed on the attached sheet.
These sub -contractors have employees and have workers' comp. insurance.$
6.❑ We area 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.]
Type of project (required):
7. ❑ New construction
8. remodeling
9. ❑ Demolition
10 ❑ Building addition
11.❑ Electrical repairs or additions
12. ❑ Plumbing repairs or additions
13. ❑ Roof repairs
14. ❑ Other
*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.
$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 art employer that is providing ivor/rers' compensation ir:suratice for my employees. Below is the policy and job site
information.
Insurance Company Name�Qye_hs ns
Policy # or Self -ins. Lic. #:1g - J�, j 74' a 0 ' / _S_ Expiration Date: Z off- k-1 4o
Job Site Address: 07.30 riW AJU1 __ �� City/State/Zip: A% AM d1O-C 4 'u
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 $250.00 a
day against the violator. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
verification.
I do hereby certify undea tts a d penalti iy that the information provided above is true and correct.
Signature' "�" Date:
Phone #• &03 " P—/ 9 -
Official use only. Do not write in this area, to be completed by city or town official.
City or Town: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
CERTIFICATE OF LIABILITY INSURANCE- 'DATE1��zo�
THIS CERTIFICATE 18 ISSUED A$ A MATTER OF INFORMATION ONLY AND CONFERS �O RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFUtUATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES RESNOT-.CONSTITUTE A CONTRACT BETYVEF�1 THE ISSUING INSURER(S), AUTHORIZED
OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If ft osrd icata hal der iS an ADDITIONAL IIiISURED, the policy(ies) must bd sndorsed. If SUBROGATION IS WAIVED, subject to
the 101116 and condWons of 010 policy, certain PO)iCJe3 01" require an endorsement A statement on this certificatB
09FI kOW holder in 1191.1 Of such endorsement(s). I des not confer dghIs t0 the
PRODUCER Nratrr )
Costello Xneurance icy, inc.
2 S. Kimball St. No
• n �
PO BOX 5240
Bradford Ml 01835
iii Rm ..-- rN8(IREIi A
valley Siding Wholesale LLC INSURERR:
18S South Mein Street INSURER C:
unit 8 ( D,
Newton MR 03858 E
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN IS
INDI•CERTIFICATE MAY BISSUED R MATANoING ANY Y PERTAK THETERM OR E INSURANCE ADITION OF ANY CC
FFORDED BY THE
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LJM[T$ SHOWN MAYN[AVE BEEN RED[
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UMBRELLA LfAB [::FCVREXCESS LL .._--
807BO00a55
(978)521-3127
ULD Til THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
ITRACT OR OTHER DOCUMENT WTH RESPECT TO WHICH THIS
'OLICIE$ DESCRIBED HEREIN IS SUBJECT TO ALL THE TM.
.
I= BY AID CLAM,
LIMITS
i EACHCCCURRENCRS 41000,000
� P ooaureres s 50,000
4/7/2015 i 4/7/2018 MEDEXp,m+apyraon) 4 5,000
PER8ONAL8ADV INJURY S s,000,oQ0
GEI(ERALAGGREGATE _2,000,000
PRODUCTS . cpNIPIOF+ASS g
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BODILY INJURY (PW Pvr=) t
1020015829.o2 3/17./201.5 13/11/2016 BODILYWJURY(Psreply $
. PERTY $
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IFves, dosoi6a
ORSORIFRON OF OPERATIONS I LOCATIONSI VEHICLEB (ACORp 101, AtlIB MW Iitarla 00IMmLOs,tlta9ls asses
workers compensation policy is ffor NA Only.
for info mation only
ACORD 25 {2014/01)
INSWS (201401)
. S
E
cIDENT 4
- EA EMPLO 5
- POLICY LOA. s
spsq is
z=000,000
5,400
SHOULD ANY OF TOE ABOVE DESCRIBED POLJCIES BE CANCELLED BEFORE
THE EXPIRATION I DATE THEREOF, NOTICE 1N" BE DELIVERED IN
ACCORDANCE WITS THE POLICY PROVISIONS.
'Emily CoatelloVHOYECI
01888.2014 ACORD CORPORATION. All r4oft reserved,
The ACORD IIAM and logo are registered marks pf AOM
I
_ - ;:� lndaviduai
r�ck,.0
5 ��'��,' Unde#seerefary
Licensed
Construction Supervisor
�3.
Meals