HomeMy WebLinkAboutBuilding Permit #983-15 - 43 VEST WAY 5/28/2015BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#:- L-' I Y�, I
Date Issued: 11.)
Date Received
MPORTANT: Applicant must complete all items on this pag
TYPE OF IMPROVEME-WT—
PROPOSED USE
Residential
Non- Residential
New Building
t4�e family
0 Addition
[I Two or more family
D Industrial
lion
0 Altera
No. of units:
11 Commercial
E;4 �epair, replacement
[I Assessory Bldg
11 Others:
0 Demolition
[I Other
EJ.i' oodpla-,i �n
heOiVi'stri
LR
e--> I nFzQr-P1PT1()N nF WORK TW13E PERFORMED:
ZL,) /^ d>4)Y,(J
ddentifica7ft n - Pie se Type or Print Clearly
6 6 Phone: 7/�r 10/01- -114
Ova—
OWNER: Name
Address: YL�
4:LL
or Phone,:,A,.,.1.,:.
ontr'ac't'
Namd- �,Jl
Zz-
Emal
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S' isor's�6 Q hstniclfiOn L,,icens,,,
Horn rfiprovpmen Licdnse-�,,
b
ARCH ITECT/ENGI NEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT., $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
ad
Total Project Cost: $ FEE: $ [61
Check No.: Cl (P C), Receipt No.: 9"R�
NOTE: Persons contracting with unregistered con�ractors do not have acc�s�—t5,0�guarantyfund
N-Jm-
Plans Submitted [I Plans Waived 11 Certified Plot Plan [I Stamped Plans
OF SEWERAGE DISPOSAL
FTYPE
Sewer
Pubhfic Sewer El
Tanning/Massage/Body Art El
Swh='ng Pools El
U -1
WWell 1
Tobacco Sales 0
Food Packaging/Sales El
Private (septic tank, etc. El
Pennanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On Signature'
CONSERVATION Reviewed on- Sionature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
u
4ing Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision:
Com
Water & Sewer Conn ection/S.ignatu re & Date Driveway Permit
DPW Town Engineer: Signature:
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
MGL Chapter 166 Section 21A—F and G min.sloo-sl000 fine
NOTES and DATA — (For department use)
13 Noti fied for pickup Call Email
Date Time Contact Name
Doc.Building Pennit Revised 2014
M
F. -.w
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
)TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
4 Building Permit Application
4, 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
Engineering Affidavits for Engineered products
JOTIE: 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
Location
No. q Date
Check # qtac��q s �
28849
TOWN OF NORTH ANDOVER
Certificate of Occupa ncy $
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
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a
Renewal
byAndersen,
OoNoaw Aff1t4cs"P41
W
License #170810 (Expires I 22W.0'
Renewal by Andersen Corporation Federal Tax ID #41-19184
30 Forbes Rd. Northborough, MA 01532
(508) 351-2200 Fax (508�-98&7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
Date:
APRIL13, 2015
RONALD SMITH
43 VEST WAY NORTH ANDOVER. MA 0.1845
Email Address Home Telephone Number Work/Cell Telephone Number
RSMITH7907@AOL.0
978-688-1092
Buyer(s) hereby jointly and severally agrees to purchase the goods andlor services of Renewal by Andersen Corporation ("Gontractor'), in accordance with
the terms and conditions described on the front and the reverse of this agreement and on Me attached specification sheet(s) (,collectively, this 'Agreemenr).
Stryer(s) hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement.
TabilljobAmount $ 8,954 S 8�954 Est, Start Date Method of Paym�t
DepoSit Reoewed (33%) $ 0,00 zill at!tiqrsnu 4.47TOO 10- 12 weeks CheckiCash
Balance Start of Job, (33%) $ 0.00 Check # —
Balam* an substantial At S.bstar&M Est. Install Time Credit Card
Gompletionof Job (33%) $ 0.00 Ccmpteb�� S 4,477,00 1-2 days 9 cred it card is pieaso
k, fmM mv��nk k--sEtd-mwded saa Credit Card Pa~� forf"I
is) agrees and undomtends that this Agreement constitutes the entire undwstanding between the parties, and that there are no verbal understandings
ling or modifying any of the term of this Agreement No alteration to or deviation from this Agreement will be valid without the signed, written consent
h Buyer(s� and Contrac, tar. Buyer(s) hereby acknowledges Otat Buyer(s) 1) has read this Agreement, undembinds. the terms of this Agretunent and has
,ad a cornpletedi signed and dated copy of this Agreement including the two attachad Notices of Cancellation, on the date first written above and 2) was
informed of Buyees right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
by Andersen Corporation
�yerls) Buyerts)
signature of Consuftant
L/ Signature Sqnature
x MARK SALEM
RONALD SMITH
Prtniod Narna of Cwsuttant
Prmted Name Printed Naff*
YOU, THE BUYEA(s), MAY CANCEL rNS TRANSACMN AT ANY TIM PAIOA TO MIDNIOW OF -ME THIRDOUSINESS DAY AFMA THE DATE OF -011S T14ANSACTIOW
SEE THE A'"ACHED NO1nCE Of CANCELLATION FOPAS MA AN ExPLANATfok OFTMS FuGHT.
--------------------------------------------------
NOTICE OF OWCElLLATION N0'rICL OF CANCEI.IATION
Date or Transaction . Now moi, cancel this
triuootetion, without any penalty or obligation, �ithia tb- buhtes. ds. from tht,
abow date. If �.. --I, any property traded in, any payments made by you and"
the Contract of Snic, and any negotitible instrument -ecuted by you win be
retarotil %vithin 10 dacya foll(rwing receipt by the Contractor ("Selter") &fyoote
cancellation nmlcet atut any �t,arily Interest Arising out of the transaction �iu be
canceled.
sohmmitially, a% go" condition as when rec.i-d, any good. delhvved to you under I
this Contract or Sale� - you truiv
.. if Ion w6ht comply %with the instructions of the I
Selt� regarding the return shipment of the gvo& at %be Seller's eupemw and risk.
If you do make the gootis available to theSeller and the fielfee does out pick them up
widda 20 day& of the date of yout, -Notice of Caroatladen, ytm way retain or dispo"
afthegoo&withoataayfurth"*bl*atim. IfyoufAilto-a the goods availahte
mthe Senor, or it �*.Agre* to return the gootts to the SqUerood fair to'htsa' then
you remain hable for peaormance of all obligadmw under the Contract. To cancel
th6 tr�acdou, mail or d*Nwr a x1goett and dated eopy or this cone.11.6ion notice
- any other ritten - end . telegram to Contractor. Renewal by Andersen,
30forb�' Rd. NorthboroughMA01532.
I. HERMV'(ANcFA. nMfRAN&'kCaoN.
Door of T ---ti- i � 31 � I "I V- -y co --d th"
ftAosacilon' without Any penalty or ahugdoa' vvithl. the" business days Irom the
.h- date. If you -1, any property anded in, any pajoum" made by)ou under
the Contract of Nate, and any negotiable i"trument executed by you wo be.
returned u4thin 10 days inflowing receipt by the clantraefor ("Selter") of your
-11.dan tttiee� and any socoriq hu�t ar-61ni; out of the transaction will he
caneeted. it you cancel'you most nuke Available to thesotter at yourceshleftee, In
*.hstamiafly as good too&tioa as heo recei-A, any good.J.Rv-A to you under
dtis Contra" oc you imty, if �,&. wish, comply with the Instructions of the
Wire regarding the return shlipmeat of the goo& at the Seller's expense and risk�
If you do makw the good* atoidabi,* to tht. q0tar and the setter dine. not pick th- up
vA;Wm 20 dA�ys of the dat& of of Cancellation, you may retain or di%pose,
of the gootis without any further obtligation, If you W to make the goods, avaaa te
1. 11- Sell-, or if you agree to remro, the rr-,dA in the S.11- and 6a to do so, then
you remoln Rable fur performance of an obligations under the contract. U cautel
this ara-tion, --H - dell, ... igned -a dated of thi. ca-Hatitm notice
or am, other written notice, orsead a telegram to rumewal by Andersen ,
50 Fbes FUL Xortbbomgh, NIA 01532.
I HEREBY C-ANICU THIS TRANSACTION,
ely-1 Rlim N. -I D.1� bu'-'� ST'4--t N- D�
30 Forbes rd Northborough , MA 01532
— 4 — a CAQ a 7n��
MA Home Improvement Contractor
License #170810 (Expires 12123/2015)
9�Al lr%,6M1_A01QAi%
Window Specification Sheet
'Btiver,s,� Nanw Dale of Agreement
RONALD SMITH
MON. APR 13, 2015
"I'lic huvcr Ikwd abovi, lit-I'dw
orl the �ati( In shl"et anct the firmi.and tha I(, ct�w ol, the ("A."STON1 VVENDOW ANI)DOOR of which
V
tile Nficrifivalioll Sheet is part,
WINDOW& DOOR DETAILS
Apo Pow F)ftnorilntedor Coil Harov"'re kardware LOWE4i Grille G'11je
# ,vh Woiclow/00of Style Detail I Screens Sim�Uun Gfilles Sasl�!a SwbO Ufts J Op
Room �a m Ext,lnt Color S" -tions
Total I BAY, BOW & RETILD OUT DETAILS
ourn Style
Style Detail AWox.
FWnkm, twiahl Casingn Angle
Nwnbef Frame
Lilou Intorio,
Whdow
ExOnt Color
GJ�JiW S Erd Center SC UIWE?
ashas sashes mens smXtstin
Roof/
son
Hardware
Color
--500M __E_
Dining 101 �2y 1:2:1
--
DS.PWDBsq 97, '�11 Full 41,45
a Birch
TTAVH
INTW 2/2 514 FFG SmanSun
noor
Stone
SPECIAIXY WINDOW DETAIIS
—RAY/HOW ADDITIONAL WORKNOTES
GOles Grille S to ExOnt Color 0�,tpm,i, *A,� 1�' 7� il.�
Full i Approx. =L�E
Room Cover Style Insert Ut� srmnSuei
ADDITIONAL WORK DETAILS:
1: No Contractor will wrap exterior,casings with coil stock color of
2
Owner is aware that Contractor does not do any painfingisraining or ramovallinsiallation of alarm system or vvinakiw treatments1hardware. It is the lesp sibility of
the homeowner to have the alarm system and window freatmentsitIardware removed prior to installation. VVe make no guarantee as to whether alarms or window
treatments/hardware will fit after replacement, Customieris also aware in some cases there wX be glass loss. If there is, the amount will be dependent on the"
of existing windows, type of installation and window a". ft make no guarantee as to the amount of gless loss. Customer is aware and understands any and all
unseen rot is not included in this contract. Should any rot be found there will be an additional charge for time and materials unless so stated in this contract
3 ytK Contractor will insulate, caulk and seat windows with 3 -point system to prevent Water and air infiltration. Removal and disposal of all job related debris,
windows, doors, storm windows and vacuum nightly included. Upon completion of the job and payment In full, a limited warranty shall be issued.
I Ye,-, Building Permit --Contractor will secure any and all necessary permits. The fee for the oermil(s) is Included in the total contract price.
Yes All discounts have been applied to this agreement,
Vvs No Owner agrees to be present on the final day of installation for final inspection and to deliver final payment/ tinarroa form(s).
lwwi� z", t�� cd�'h� diat ha�� wad d1i", sp'cifi�nlioo
Renewal by Andemen Corporation
Signature of Consultant g re Signature
MARK SALEM RONALD SMITH
Print Name of Consultant Print Name Print Name
The Comwnweafth ofMassackuse&s
EE� DePartment ofIndusirialAccidents
Offke of In vestigadons
Is I Congress Street, Suite 100
Boston, AM 02114-2017
www.mass.gov1dZa
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ApBlicant Information Please Print LeLdb1v
Name (Business/OrpnizafionAndividual): RENEWAL BY ANDERSEN
Address: 30 FORBES ROAD
NORTHBORO,-MA01532 Phone #: 508-351-2200
Are you an employer? Check the appropriate box:
I . 03 1 am a employer with 30
4. F1 I am a general contractor and I
employees (full and/or part-time).*
have hired the sub -contractors
2-0 1 am a sole proprietor or partner-
listed on the attached sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers,
[No workers' comp. insurance
comp. insurance.:
required,]
5. E] We are a corporation and its
3. El I am a homeowner doing all work
officers have exercised their
myself [No workers' comp.
right of exemption per MGL
insurance required.] t
c. 152, § 1 (4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. E] New construction
7. W11 Remodeling
8. F-1 Demolition
9. E] Building addition
10-F1 Electrical repairs or additions
11.(3 Plumbing repairs or additions
12.[] Roof repairs
13.[:] Other
*Any applicant that checks box 01 must also rill out the section below showing their workers, compmsafion policy information.
f Romeownen who submit this affidavit indicatingthey are doing all work and then hire outside contractors must submit a new,affidavitindicatingsuch.
tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not thow entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I am an employer that Isproviding workers'compen&atlon inmrancefor my employeeL Below Is the polky andjob ske
information.
Insurance Company Name: OLD REPUBLIC INS. CO.
Policy # or Self -ins. Lic. #: MWC 30293800
Job Site Address: V-3 V�P-5/- vl
Expiration Date: 10/01/15
City/State/Zin- /A/4
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 kere#16Fiff
,Apder the pains andpenaMff ofperlurY Mat Ike information provided above is ftne and correa
9/15
-22.00
Oijklat use only. Do not write in this area, to be conWleted by city or town o
.Ticial.
City or Town: PermWUcense N
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
Contact Person: Phone #:
ANDECOR-01 YADAVY0
CERTIFICATE OF LIABILITY INSURANCE
DATE (MWDWM-Y)
1 101112014
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* N the certificate holder is an ADDITIONAL INSURED, the policy(les) must be endorsed. If SUBROGATION 15 WAIVED, subject to
the term 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 endorsement(s).
PRODUCER
Willis of Minnesota, Inc.
do 26 Century Blvd
P.O. Box 3051191
Nashville, TN 37230-5191
CONTACT
NAME: certificates 111B.Com
PHONE ExIIAM 90-7378 (8118) 467-2378
M NO
-ADDRESS:
J AFFORDING COVERAGE NAIC 9
IMW�MR
INSURER A: Old Republic Insurance Company 24147
INSURED
Renewal by Anderson Corporation
30 Forbes Road
Northborough, MA 01632
INSURER 0:
INSURER C :
INSURERD:
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN 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 13Y THE POLICIES DESCRIBED HERON IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
LTR
TYPE OF INSURANCE
AUDI.
BUHR
wvn
POLICYNUMBER
POLICY EFF
0"AIDOWYYY]
POLICY EV
(MMID011"M
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE X OCCUR
MWZY302940
10f01FA14
110011120115
EACH OCCURRENCE S 1,000,0001
500,001
MED EXP VM cm person) $ 10.0
PC NAL & ADV INJURY S 1,000,001
GEWL AGGREGATE LIMIT APPLIES PER:
Re Loc
POLICY F1 JPE T F
OTHER:
GENERAL AGGREGATE S 4,000,00(
PRODUCTS - COMPIOP AGG $ 4,WO.00(
S
A
AUTOMOBILE LIABILITY
ANY AUTO
ALL OYMED SCHEDULED
AUTOS AUTOS
NON-OANED
HIREDAUTOS AUTOS
MWTB302575
1010112014
1010112015
COMBINED SINGLE LIMIT $ 6,000,00C
(Ea Q;ckWQ
BODILY INJURY (Per person) 5
BODILY INJURY (Per amMe" S
-MWEffV
D—A-IME
ffloracmeno $
UMBMUA L"HOCCUR
EXCESS LIAB
CLAIMS -MADE
EACH OCCURRENCE
AGG
DED I I RETENTION $
$
A
WORKERS COMPENSATION
AND EMPLOYEW LIABILITY YIN
ANY PROPRIETORIPARTNERIEXECUTIVE r -U-1
OFFICERIMEMBER EXCLUDED?
(MvIxWory in NH)
R ym descMe urKW
DESCRIPTION OF OPERAIIONS Wow
NIA
MWC30293800
1101011120114
11OR111120115
X I STEARTUTE I I 84�
E.L. EACH ACCIDENT $ 1,000,=
E.L DISEASE - EA EMPLOYEE $ 1,000,=
E.L. DISEASE - POUCY LIMIT 3 1,000,00(
DESCRIPTION OF OPERATIONS /LOCATIONS I VEHICLES (ACORD UK. AdMonal RwmrkB SdwdWo. rnay be sftdmd 9 mom opm In raqL&eQ
07;1 � L-1 -M-11 I L-1 � I
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION BATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WTrH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
0 1988-2014 ACORD CORPORATION. All riahta reserved
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
Massachusetts - Department of Public Safety
Board of Building Regulations and
Standards.
Construction Supeni%or
License: CS41190125
JAIME L MORIN
86 GARIDINER ST
LYNN MA 0190f
Expiration
Commissioner
1181OW2018
(92.
ffice of Consumer Affairs & Sualuess xeg ublies,
INIPROVEMENT CONTIUCTOR
Tn*:
Supplemwo
RENEWAL BY ANDERSON CORPORATION
JAIME MORIN
104 OTIS STREET
NORTHBOROUGH, MA 01532
4;
Understeretory
cordKim awj=owm
Jeels or exceeds M.E.C.. C.E.C. & I.E.C.C. Air loffihrali�n requirements WOMA Hallmark Ceddicali� Program
V
Renewa
byAndersen. =4*1&
DESIGN PRESSURE (PSF)
wiNDOW, REPLACEMENT AnAndersen(>mpaoy
od/Vinyl Composite IF
H-LC25
Dual Argon Low E4 SmarlSun
RbA IDB Sloped Sill DH IN
Double Hung
").....standards
14=11MCUM SWUM& o0nWW"A TO M OPPHOMA StWWOS.
100-00473518-010
ENERGY
PERFORMANCE RATINGS
U -Factor (U.S)/I-P
Solar Heat Gain Coefficient
On29
0m19
ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
OA2.
maAufaciure'stipulatesthal the" ralin conformloapplicable NFRCproc6duffislWdelermiAinQWh6l6 product
performance. NFAC ratings are deferm 99
med for a fibred set of environmental conditions and a specific product ke.
NFRC does not recommend any product and does not wartant the sukababyttfawry product for any "cific use.
Consul manufacturer's literalists W other product performance information.
www.nfic.org
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