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Home My WebLink AboutBuilding Permit #691-2017 - 270 BRADFORD STREET 1/4/2017BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR. PLAN EXAMINATION TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 90ne family ❑ Addition ❑ Two or more family ❑ Industrial ,NAlteration No. of units: ❑ Commercial 'Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other D Septic El Well' _ ❑ ITloodplain Wetlands � Watershed District, Water/Sewer _.. - DESCRIPTION OF WORK TO BE PERFORMED: rCiuP��G�n?G (s� !kjrIJDC�� Identification - Please Type or Print Clearly' OWNER: Name: TvK tZo 2Ts Phone: M T Contractor NamPhone:. -5 Address:�2i3C-3 0 Supervisors Construction,License:; CCS /,Z _ Exp: Date Home Irn M- ARCH H- ARCHITECT/ENGINEER AULlt Phone: meni Reg. No. FEE SCHEDULE. BULDING PERMIT.- $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 4;1a, e Q FEE: $ 2' b Check No.:_ �� Receipt No_.:_ NOTE: Persons contracting with unregistered contractors of have acceto the guaranty fund S�ignature_of_Agent/Owner Signature of tractor Location `-' No -01- 611 Check # S (j3 Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ Building/Frame Permit Fee $Q t Q— Foundation Permit Fee $ -, Other Permit Fee $ TOTAL $ Building Inspector Plans Submitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ IF SEWERAGE DISPOSAL ic Sewer ❑ F Tanning/MMassageBody Art ❑ Swimming Pools ❑ ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Siqnature COMMENTS HEALTH COMMENTS Reviewed on Siqnature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes a Planning Board Decision: Comments f Conservation Decision: Comments Water & Sewer Connection/Siqnature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT = Temp Dumpster on site yes Located at 124. Main Street Fire Department signature/date COMMENTS Located 3M US900CI Street no -)imension 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 ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine M 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 ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: 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 NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Ei Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: 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 CIerks 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 J 2 LL O in � O m Nm L Y \ O LLL Y U Q N p H Z C7 Z C O fy6 "O 7 LL L =3 K Ncu C U C LL O N Z c7 m J d L UO K i.i s 0 H Z a � U W J W L tw 0 u Ln LL OU a Z y C7 t -3' to K C U- Z LAJ Ot a W � ui � LL ` N i m O z ++ it N N 4J Y O N E w O f 0 EEO 0 f•� O LU CL Z :0 m 2 Z y O co Z Ckm l) X. W V F- M a Z Q L RmewalA_ �r� m", ent Document and Payment Terms -- d&u k me -A br,hmckn-ea of Baademi iIM!s¢owfu teat t ira r. HtewaI b Ar4#rsen LLC 3s't4I#radl4rd 51 HIC 4178310 M.Anik%-Er. Mkt ♦a 1345 MM r■.,�t 30 Faks PAWI Mmhborough, mA oi5v K i4MSfi89 Q85 Kxxv- 503-351-2209 1 Fax: MP lOnO!erallan-,GAr4c+ ec;r'nrp.€gm � C�7 gp�fi87 ►L,.srrxA*trL*+1 ) Naine_ TIM R*be C.rr f�%feet Adder: 270 gratlfor d St., IIVI Andover, MA 01 $45, purr i lCtltjalao NaIji6ei- (M)689-4,085 pjifr r':I_ar►ai]_ bmm9n4$$3 malI,cI3m Canr=act D;ur- 11s 16 Sowft&yy Eniid_ Bu u(s) hueby jointly ahrl sever y ag m w purchase &c p Wucu and/or xrvwts of Bcncaral by.Amkrxn II.0 d&fa. Rxmcwil by Andeigm a +sra("C tt=atI in wwOmm w[ -Lb clac cacumrd conditions iicmA" in. d ds Agmetntm Erxu=m anti payment 'limn Nudcc of Cnnw14-dkrrr licmbr_Ak)Fdr.T %P i i. WArinw, MA A.ddenadcarQ,'l`etMt end inn d idons tffSak, L -SnEe Burn.. ter, 0%,= err Buildkr. ll;lecrronic C*msenr, MA Comtracdt+r Admimian, Releagr rlgrormenr, Inuv, and ;znyr odkr dlocumesn acracbed rol rliics _etmar*t Ducume•nt, the teretes of vrlc3ch ace all agxmd, to by dlae parties and im ar:p nmd hrreia hy refesvact {cam-tnve1 , -EhM- Fetrrrasrt'). ltrvecj�j apme; 3i a.tx�or�+l'at�n otrcihc�te after l=orntca�mhaspieted,all �Nvi� rendes ori s,rCeerrceart, TasA Jrrl, Am am: S17,698 lly signirrrg &4 agr4crmerct, }'"u 7xknvwWgc Am the I40- la F1 :L* Rd, Ifie AMOlLanr Flunced mom 6 wac#� b' I1 o l i .4 bink die&,. It cam. t►1- h. CMe�dit 1Le>�Ivsd: so @aEC"Dsc: S17,698 atiMairil5r2fi_ Ectii'ri#tex>s'1 am.pkl.im: $=10 mks i-2 do" hltdtcr d a! i2a.�rsnesr,t: FJPai-/lig 'We scfbdde sl inlsala tiom bwcd -on e dare of rhe sitec4 d mau and seodrd;arily on the date m which we mmjActe the dedmical measurement:;. T6.=—&a16tIva d'atz that NA mek 45 da gr ee hay we am pturift .at this time is only an esaimatc. We Kill corm anicace ars official dare and. dint az a bus date. Rain. and t3ctpude wearker am qhc resat #drTlmon causes for 6.9% at 120 Months delay Bugs(r) agrees and. undencukU d iat vhis h emenr iris nmirw-m cfic enure umltd ir>. berwr_r.Er cbe parries aed drat dmrc are no wAal r�rau is ae tsiacli%i;r�f, ai w ofthe dttcxd irhns erl acc�rttrd:: t*i ,a r��e c�c lads na ftam dlrec, ncccr rpt �v94�, i ar2M witIv i daft *igned, wri rr_.en. �,a�r of hcprh alae �,� � ��o�sr�rnr. Bu�et�tl � tla<is �� i'I Ll�r€ rend i.Fci� hgreemenc, Un t' und5 rfie rerma f rchis hgreemtnr„ azo fi re eiar�d a camplerel4 cd, and 4gy ofEd�. recmenr, lirScludie> the MG astacdte i' tiAess a�FQ'arx�latvecn, r►n t}c'e dine fent Nrrir#en a9suvr ural N9aeF off infncmed taf Burnes"s ti t der rsnrEl this N(MCE `i"{M l i F R: W crus rla6 cotitawt I-MwLVau asrt entided dear f rtir of dit c orrreatt at rfit dict yw 4p. �Z�A,L/�byU+, THE Bti+�r®.l3yp+4+F MM CANCEL Ar-g7ISTRA SACTI�+JJ,'M L'6�1� J ��7�y s ly 1�1�A..�{�'L �.'.�r, NUDN1i.Gll.rl..�. 1�r��.'�OW.. 0�1'y 710, Alas �� ,■"1 ; V SI-Ll�W i4i�AY AP may® ry�� r".E�wA4��" �E ,OP JS T - MNS �s .L, gX yF� �7� 'rr� �� 1fMMA:_ 14fi-�q,[V'�*P�r,K+�7J�TJ'.t T AS, 1�AT r�'-THEE 7� ED 11iOTI _r_.Oi" C 'C.L.A61J��1'S'� PAL. RM .IQ'O�r+i�C' N �Y'IY,l1'ldl'N O TM RIGHT. L.k�� Si"IeofSaltsIWSun Si,gnadutt Signiture Mi~: )Butler Tim Il;fir Ptard Vic• of Sales Remit Print N=tt Nnr. Mufte 1 112WI6 paile 2 + 22 Itemized Order Receipt dbas Renewal by Andersen of Boston moi% Legal Name: Renewal by Andersen LLC 270 Bradford St �jON HIC #170810 N Andover, MA 01845 wiaoow ae uc.Mear 30 Forbes Road I Northborough, MA 01532 H: (978)689-4085 — Phone: 508-351-2200 1 Fax: -(508) 986-7072 1 RbABostonOperations@AndersenCorp.com C:(978)490-6687____ ._ D• ROOM: 101 FR Window: Double -Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 2w x 2h, Sash 2: No Grilles, Misc: Aluminum Wrap, Aluminum Wra 102 FR Window: Double -Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash All: Colonial 2w x 2h, Misc: Aluminum Wrap, Aluminum Wra 103 FR Window: Double -Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 3w x 2h, Sash 2: No Grilles, Misc: Aluminum Wrap, Aluminum Wra 104 FR Window: Double -Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: _White, Screen: Fiberglass, Full Screen, Grille Style: Interior - Wood Only (INTW), Grille Pattern: Sash 1: Colonial 3w x 2h, Sash 2: No Grilles, Misc: Aluminum Wrap, Aluminum Wra 11/29/16 Page 4 / 22 Renewal Itemized Order Receipt Andersen. dba: Renewal by.Andersen of Boston Legal Name: Renewal by Andersen LLC HIC #170810 WINDOW NE IACEMENT 30 Forbes Road I Northborough, MA 01532 - — — -- Phone:-508-351-2200 1 fax: (508) 986-7072 1 RbABostonOperations®AndersenCorp.com - - -- 270 Bradford St N Andover, MA 01845 H: (978)689-4085 C: (978)490-6687 105 FR Window: Double -Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 3w x 2h, Sash 2: No Grilles, Misc: Aluminum Wrap, Aluminum Wra 106 LR Misc: Bay/Bow/Bump out skirt, Bay. DB-DBDB-D 107 FR Window: Double -Hung, Equal, Slope Sill Insert, Traditional Checkrail, EXTERIOR White, INTERIOR White, Glass: Sash All: High Performance SmartSun Glass, No Pattern, Hardware: White, Screen: Fiberglass, Full Screen, Grille Style: Interior Wood Only (INTW), Grille Pattern: Sash 1: Colonial 3w x 2h, Sash 2: No Grilles, Misc: Aluminum Wrap, Aluminum Wra WINDOWS: 6 PATIO DOORS: 0 SPECIALTY. 0 MISC: 1 TOTAL $17,698 UPDATED: 11/29/16 aRenewal by Andersen is committed to our customers'safety by complying with the rules and lead -safe work practices specified by the EPA. 11/29/16 Page 5 / 22 The CommonweaM ofMaasae tusetts Department of Ltdus9Ad Aeeldents Offlce ofInvesagations 00-Wsshin2ton Shied — Boston, MA 02111 NW www.gov/dia Workers' Compensation Insurance Affidavit: BaRdere/Contractors/Eleddejane/Plambers Applicant Information Please Print Laidbly Name RENEWAL BY ANDERSEN A,ddrew: 30 FORBES ROAD Gni S . NORTHBORO. MA 01532 Phone M 508-351-2214 Are you an employer? Cheek the appropriate box: I. W1 I am a employer with 30 4. (]I am a general contractor and I T �� jeet ( )� employees (falland/or gars time). s have hired the sub -contractors 6. ❑ New construction 2. ❑ I am a sole proprietor or partner- listed on the attached sheet. 7. Rtm►od0ing ship and have no employees Them sub-contrwtors have S. ❑ Demolition working for me in any capacity. employees and have workers' insurancat 9. E) Buildipg addition [No workers' coup. insurance required.] comp. 5. ❑ We are a corporation and its 10.0 Electrical repaim or additions 3. ❑ I am a homeowner doing all work office= have exercised their 11. ❑ Pigg repairs or additions myself [No worker,' oomp. right of exemption per MGL 12.❑ Roof repai:a insurance requhv&] t a. 152, ¢ 1(4), and we have no 13.❑ Other employees. [No workers' cramp. insurance reauired.l *=a that dheote boor ill must x1w till one the seatlan Wow showing than wadta ' oompow@don policy iaoramion t 13omoownags who su ma this sett indwting they oxo doing all wet sad thea him outside oamtoeton nwdm9=h a new Ws&Vk mdotimg soap. :Con t c ms that sheat this box met Kwwhed an additional sheet showing don=* of the sobcoetrsoh n sad wte wietia or not those sonde hwe a Vlayeea. ]f the sub-cM� have emeplayocs, they moat pmvide their woolen' comp, policy n=jM Ism aur ar1eyer that br pmrddlag wadws ' coxwenaadae hanoroftvfor a'V exphycm Bdow is tl ie pe ft and jab ache WormadxL Insurance Company Name: OLD REPUBLIC INSURANCE COMPANY Policy # or Sof--ins. lie. M MWC30823100 B 10/01/2017 xpiratian Mata: Job Site Addc+ess: 270 Bradford Street C3ty/S .North Andover MA 01845 Attach a copy of the workers' compensation pokey dwjwafion page (s mmft the pollsy n=bar sad espiradw date?. Failure to secvm coverage as requie+ed under Section 25A of MGL e. 152 can lead to the Impodtion of minting penalties of a fine up to 51,500.00 and/or one-year imprisonment, as well as civil penalties in ilio form of a STOP WORK ORDER and a tine of up to $250.00 a day against the violator. Be advised tint a copy of this statement may be forwarded to the Office of Tm+astigationsIA for insurance coverage verification. CST,." .111 ,r, dwp�* andpenames alpe►a7 ON due bu$rMe aionPiowed above is trite acrd eaamact 12/2/2016 4 Offl dal true ons. Do not write in A& waff, to be cora plaAed by city or town egiciaL City or Town: # Lasing Authority (dick one): L Board of Hcolth 2. Building Departawnt 3. Chy/Town Clerk 4. Electrical inspector & Plumbing Inspector 6. Other Contact Pa's' Phone M ANDECOR-01 DUBEAA '4`. Rv- CERTIFICATE OF LIABILITY INSURANCE DATEPIMIDDITYM THIS CERTIFICATE 18 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: N the certificate holder Is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to the ten. 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 endorsenhent(s). PRODUCER Willis of Minnesota Inc. Flo 26 CaMury Bhra� P.O. B= 305181 Nashville. TN 37230-5191 tee; Wlllls Tawere Wateon Certillcate Center PHONE 8 945.7378 No :((ON) 467-2378 ADORE . eertiflcates@wilgs.com X coNuw=ALOENERAL LIAmw CLAIMS4IADE ❑X OCCUR INSUREIK AFFORDING COVERAGE NAH: INSURER A:Old Republic Insurance Company 24147 10/01/2016 INSURED INSURER B: INWRE R C : Renewal by Anderson LLC 14SURER D : 104 Otis Street Northborough, MA 01532 INSURER E: INSURER F: S CGVERAGES CERTIFICATE NUMBER: RFIRAVW NIIYRFR- 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 TOALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSK LTA TYPE OF INSURANCE ADOL SUSH POLICY NUMBERMID POLICY EFF POLICY EXP UNITS A X coNuw=ALOENERAL LIAmw CLAIMS4IADE ❑X OCCUR MWZY 308234 10/01/2016 10101/2017PREMISES EACH OCCURRENCE S 1,000,00 Me 0=ff==) S 500.00 MED EXP (Any cm Pow) S 10,0 PERKMALLADVI&AIRY S 1,000,000 GENI.AGGREOATELIMIT APPLIES PER PRO- X POLICY JECT ❑ LOC OTHER GENERAL AGGREGATE s 4000,00 PROMMS-_COMPA)PAGG S 4,000,00 S A AUTOMOBILE LIABILITY X ANIYµITO AUSED OSCHEDULED HIRED AUTOS AU�TOSWNEO MWTB 308232 1010112016 10101/2017 COMBIN® WALE LIMB S 0,000,0 ODDLY INJURY (Per pamm) $ ODDLY INJURY (Per aod" s $ S UMBRELLA LIAR EXCESS UAB OCCUR CLAIMS -MADE EACH OCCURRENCE s AGGREGATE $ OED I I RETENinms f A woa¢RS COMPENSATION AND EMPLOYERS' LIABILITYTE ANY PROPRIETORIPARTNERIEXECUTIVE YIN = EXCLUDED? N❑ === H deecrDe Yltder OF O NIA WC30823100 10M112016 10101/2017 X TH- ER E,L EACH ACCIDENT $ 1,000,0 E.L DISEASE- EA EMPLOYEES 1,000,00 E L DISEASE - POLICY LIMIT` $ 11000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AdcNansi Rm WYe ScheduK may be eweW If mere apace is M"I nd) Evlderm of Insurance. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 120 Main Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 AA f L ®1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD Massachusetts Depar'trent of Public SOety Board of B u dd i na Recaulations wwd License: CS01 .SAME L MOFUN GARDINER ST LYNN MA 01905 -*,�ssioner ExpitANUUM ('r � r 1• r • t a frier of �.OUS1lrll[ r Affairs & Busilless Itcl;ulAliun ME IMPROVEMENT CONTRACTOR Reg istratio-n: 170310 Type; Expiration, 12/23!2017 Supplement Cared RENEWAL BY ANDERSON LLC. JAIME MORIN t 30 FORGES RD iORTHBOROUGH, MA 01532 Undersecretary r. cn, -W-4 Lu U. cP3 ca r-4 r4 OR co so cl 6" c-3 CL cu 90 0 Amm, C IAD V. Me oil r.