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Home My WebLink AboutBuilding Permit #116 - 26 GLENWOOD STREET 8/14/2007 BUILDING PERMIT of 0ORTI1��L.ti •+� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO.—LI Date Received /. �y� ,SBACiN15�•l Date Issued: yV j IMPORTANT:Applicant must complete all items on this p9L9e 26 Glenwood St. Rick, Kim Tudisco ; •= _ a � TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential i 0 New Building ❑One family 0 Addition ❑Two or more family 0 Industrial R Alteration No. of units: 0 Commercial 0 Repair, replacement 0 Assessory Bldg ❑ Others: 0 Demolition 0 Other IIIIIA 1111 DESCRIP I OF WORK TO BE PREFORMED: j Replace 4 windows. Id tific n ease Type or Print Clearly) j OWNER: Name:Rick, KIMTlldlSCO Phone:978-682-0531 Address:26 Glenwood St. North Andover MA 01845 " Brooks Construction Co. Inc. iO3-894-448tw!94 .. 254 No-• ,�� rth BroadwaySalerl�,., N H 03079 .. `j 026715 3- R± �� 8-08 �. 101682 - - 62908 iv,� ,:. ARCHITECTIENGiNEER Phone: Address: Reg. No. FEE'SCHEDULE:BULDING PERWT:$1100 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $1400.00 FEE: $ 3 0 Check No.: 11194-19— Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the g aranty nd Signature of Agent/Owner Signature of contractor Locatio�� C�id/�d�� No. filo Date fl.A D i NORTH ti TOWN OF NORTH ANDOVER f , F R Certificate of Occupancy $ E<� Building/Frame Permit Fee 3U s�CHus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 204o7 ccs. _-_ Building Inspector i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF•U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS DATE REJECTED DATE APPROVED CONSERVATION ❑ ❑ COMMENTS i j DATE REJECTED DATE APPROVED HEALTH ❑ ❑ III COMMENTS l ) ' I TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage(Body An ❑ Swimming Pools 0 Won ❑ Tobacco Sales ❑ Food PackaghWSales 0 j Private(septic tank,etc. ❑ Pcima=w Dumpster on site ❑ i . Zoning Board of Appeals:Variance,Petition No: Zoning Dec isionlrecelpt submitted yes i Planning Board Decision: Comments Conservation Decision: Comments i Water&Sewer Connectionisi nature&DateDrivewaw-PermiL i Located at 384 Osgood Street j FIREDEPARTMEN: T3up Inn"sof ._.. .. tib►.+. .u•-_ ;' Located at.�24Mairt.StreelE�� " cam. ' }"-co I -�irt3Department signattlreld ',<:�. _ x' s, -__ t,. - _r. .i. =r• �'; .. -.i:.r�:.: .: P R. I �CQMMENTS. a. ; �„ 147i 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 DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— For department use ❑ Notified for pickup- Date i i a v BROOKS SIDING- WINDOWS-DOORS 'DATE INVOICE# Family owned and operated 254 N.Broadway,Salem,NH 03079 WWW.BROOKSSWD.COM 7/23/2007 7959 603.894-4488 978-686-0260 BILL TO: SHIP TO: Rick,Kim Tudisco978-682-0531 978-6$270531 Rick Cell#978-314-1110 Rick Celt#978-314-1110 26 Glenwood St. 26 Glenwood St. forth Andover,MA 01845 North Andover,MA 01845 Due on receipt MD 7/23/2007 WM1@9M @M 4 Dbl Hung Harvey Classic Double Hung with grids,Low E, 350.00 1,400.00 Argon Gas. Total Due $1,400.00 P yments/Credits $-280.00 A service charge of 1/2% of the unpaid balance per Imonth will be added to O $1,120.00 balance if not paid according to terms of contract on completion of contract. xax:• 4 10:25 AUG 10, 2007 ID: FRED C. CHURCH TEL N0: 978-454-1865 #249099 PAGE: 1/2 • r r.,,' A i ACORDTM CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 08;10/2007 10:02 PRODUCER (800)225-1865 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION Fred C.Church ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE 40 Kenom Avenue HOLDER, THIS CERTIFICATE DOES NOT AMEND, EXTEND OR Haverhill,MA 01830 ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 800-225-1865 INSURERS AFFORDING COVERAGE NAIC# INSURED INSURERA American International Specialty Lines Insurance Con Brooks Construction Co.,Inc. INSURER 8: National CrfdngC 254 North Bmadhvay Salem,NH 03079 INSURER C: INSURER 0: INSURER E: COVERAGES 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR POLICYEFFECTIVE P40LICYEXPIRATI NN LTR an TYPE Of INSURANCE POLICY NUMBERDATE(MWDDfYYI LIMITS GENERAL LIABILITY EACH OCCURRENCE $1,000,000.00 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED PREMISES Ea occcun3nc9 $50.000.00 CLAIMS MADE OCCUR MED EXP(Any one person) $5,00.00 B MS002750 4/28/2007 4/28/2008 PERSONAL a ADV INJURY $1,000,000.00 GENERAL AGGREGATE $2,000,000.00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000.00 POLICY 171 PRO- LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ ALL OWNED AUTOS SCHEDULED AUTOS BODILY(Per person) $ (Per parson) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE (Per accident) $ GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ RANY AUTO OTHER THAN EA ACC $ AUTO ONLY: AGG $ EXCESS/UMBRELLALIABILITY EACHOCCURRENCE $ OCCUR FICLAIMS MADE AGGREGATE $ ]DEDUCTIBLE $ RETENTION $ WORKERS COMPENSATION AND I WCSTATU- OTN_ EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNERIEXECUTIVE WC6855423 5/16/2007 5/16/2008 E.L.EACH ACCIDENT $500,000 OFFICER/MEMBER EXCLUDED? It yes,describe under E-LDISEASE-EAEMPLOYEE $500,000 SPECIAL PROVISIONS below E.L.DISEASE-POLICY LIMIT $ SOO,000 OTHER DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES 1 EXCLUSIONS ADDED BY ENDORSEMENT 1 SPECIAL PROVISIONS CERTIFICATE HOLDER CANCELLATION Rick&Kim Tudi sco SHOULD ANY OF THE ABOVE DESCRIBED POLICES BE CANCELLED BEFORE THE EXPIRATION 26 Glenwood Street DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN North Andover,MA 01845 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR REPRESENTATIVES. AUTHORIZED REPRESENTATIVE P ACORD 25(2001108) Client i, 5295 Mst H Active WC/Liab Cert Cert iI 0 ACORD CORPORATION 1988 The Commonwealth of Massachusetts r I Department of Industrial Accidents i Office of Investigations 600 Washington Street Boston MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): F/W V ks s d 1 Address: A\, City/State/Zip: R 40/M , Phone #: Are you an employer?Check the appropriate box: Type of project(required): 1.ElI am a employer with 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. $ 7• ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 121-1 Roof repairs insurance required.] t employees. [No workers' 131-1 Other comp. insurance required.] *Any applicant that checks boz#l 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Q� /� Insurance Company Name: N cokb Policy#or Self-ins. Lic.#: W C ldExpiration Date: A A Job Site Address: d(o ��Nw�� Ci /State/Zi : /U, igAlL`�� MA ty p Attach a copy of the workers compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 of perjury that the information provided above is true and correct. Si mature: Date Phone#: 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#: 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 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-contractors)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' 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 n « p y ( necessary)and under Job Site Address the applicant should write all locations in city or PP ( ty 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 Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 Tel. # 617-727-4900 ext 406 or 1-877-MASSAFE Revised 5-26-05 Fax#617-727-7749 www.mass.gov/dia ��f�,uaelta ✓/W e� tions and Standards Board of Budding Re ula ENT CONTRACTOR HOME iMPROIJ Registration: 140996 Expiation: 1211712007 lug Type' Individual ALFRED DWRIMA 111 f , ,vDWRIMP ALFRED" 29 ELMW ?►dministrator SALEM,NH 03079 - 1 I NORT#1 Town of o No. s:: =. - �. o d0 LAKE over, Mass.," O COCMICMEWICK V' ORATED �7 BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System • BUILDING INSPECTOR THISCERTIFIES THAT.......... ..........�..........T .... ...�.►...0.................................................. ........... Foundation .... buildings on • has permission to erect................................... g ......,��........ �.��.�i .�.. ............. Rough to be occupied as........ .............:01K4.00as.�........ .... .. ..... ... Chimney provided that the pers accepting this permit shall in every respe conform to the terms of the application on file in Final 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 CON STR O TS Rough Ao ..... .......................... Service BUILDING INSPECTOR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det.