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HomeMy WebLinkAboutBuilding Permit #334-14 - 49 WINDSOR LANE 10/2/2014 L NORTH BUILDING PERMIT 0 TLFD qq TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �9 gDgATED SSACH�1`�� Date Issued: IMPOR ANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes o MAP PARCEL:.ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial $Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: %h3 T!/ /� OiGL/e �/y�f �-✓�'��e�./S ��?.1 i�1.sT/� Identification- Please Type or Print Clearly ' OWNER: Name: ikeen e y ¢ 4ow,/Se1' Vi'it Phone: Address: ne Contractor Name:' e Phone: Address: 2"7 .-/AAo G✓4,4-a Si -,fe7,4ve-v /mak o/YYy Supervisor's Construction License: © 7,3-14a Exp. Date: 9- -/9 i Home Improvement License: Exp. Date: II. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED/ION$125.00 PER S.F. Total Project Cost: $ ,3 7, .s oa FEE: $ V Check No.: Receipt No.: NOTE: Per os contracting with unregistered contractors do not have ac ss to the guaranty fund -Signature of Agent/Owner _ Signature of contractor'`/ �'�� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageBody 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 - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS J HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 Call Email LDate Time Contact Name 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 o Building Permit Application ! o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks i o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) a 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit Li Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy p p Compliance Report o Engineering Affidavits for Engineered products NOTE: 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 �r�f Location � �-- No. 1� Date C . • TOWN OF NORTH ANDOVER' Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#-!`��L� J M) r Building Inspector F_ 7 V NORTH - ,� oh ver, Mass, 10 a coc«ic"awlCM y1' �,9S�RwTeU I, C> U BOARD OF HEALTH Food/Kitchen . PERMIT T LD Septic System 'j ,THIS CERTIFIES THAT ........ .......% .�1,Q BUILDING INSPECTOR has permission to erect.......................... buildings on .4.4....... • r,,.,.,,,,` ! ,,,,,,,,,, Foundation •, Rough p ...1� ..� .. .�....��. .... .�..... �Y. .. Chimney to be occupied as ...... .R�.�v�.� .............. � y provided that the person accepting this permit shall in every respect conform to the S ms of the applicati 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MOWS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONTS Rough Service ....................... .... ........ ..................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-096516 TIMOTHY WWI-'L,-- --- 3 ELLIS ST ° Methuen MA 01944 Expiration Commissioner 09/09/2016 r - - -- U✓ze�oo�a�na�acueczll�.a�C�/j�r�ac�cc�ellJ ! 1 __--_ ffice of Consumer Affairs&Business Regulation i = _ ME IMPROVEMENT CONTRACTOR 'Registration: 118836 Type., Expiration: 4/26/2015 Supplement fl HI TECH WINDOW&SIDING INSTALL INC TIM WICKS 29 ARROWWOOD ST METHUEN, MA 01844 i — Undersecretary ' /25/2014 (3:15:06 AM PST (GMT-8) FROM: 1000US-'1'0: ly/azUUtstib rage: z of z DATE(MWDDNYYY) A`CM0 CERTIFICATE OF LIABILITY INSURANCE 4/25/2014 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 endorsement(s). PRODUCER BARRY J KITTREDGE INSURANCE NA :CONTACT PHONE FAX 81 S MAIN ST F tl. Arc No: BRADFORD, MA 01835 E-MAIL ADDRESS: INSURERS)AFFORDING COVERAGE NAIC p INS URERA: LM Insurance Corporation 33600 INSURED INSURER B HI TECH WINDOW& SIDING INSTALLATIONS INC INSURERC: 29 ARROWWOOD STREET METHUEN MA 01844 NSUREF(D: NS URERE: INSURER F: COVERAGES CERTIFICATE NUMBER: 19954990 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 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.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I TYPE OF INSURANCE DOL SUER POUCYPOLICY NUMBER MMMDf EFF MMIDCDNYYY LIMITS LTRIn WVD COMMERCIAL GENERAL UABLIrY EACH OCCURRENCEDAMAGE TO RE $ CLAIMS-MADE FIOCCUR PREMISES(Ea xcurroccel $ MEO EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE $ !ECT POLI(^Y E]PRO LOC PRODUCTS COMP/OP AGG $ $ OTHER. COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident UMBRELLA LIAS OAR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ DEC I I RETENTION _ $ A WORKERS COMPENSATION WC5-31 S-383602-013 11/29/2013 11/29/2014 V PER TE ER AND EMPLOYERS'LIABILITY Y/N ANY PROPRIETOR/PARTNERIEXECUTIVE E.L.EACH ACCIDENT $ 11)0 00 OFF, CERMIEMBER EXCLUDED? ❑N N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1 X0000 I( es,describe under 500000 DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attached If more space Is required) Workers compensation insurance Coverage applies only to the workers compensation laws of the state MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE TOWN OF NORTH ANDOVER THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN BUILDING INSPECTOR ACCORDANCE WITHTHE POLICY PROVISIONS. 1600 OSGOOD STREET NORTH ANDOVER MA 01845 AUTHORIZED REPRESENTATIVE } LM Insurance Corporation ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD :ERT No.: 19954990 Anne Chandler 4/25/2014 8:13:57 AM (PDT) Page 1 of 1 The Commrtonweal&ofti2'•amehusems off,five affnvesfigafeons 00 Wasfteo-w Street Roston,HA 02111 wow-rmsygovId a Wgrk,ex$i Comp emationlus vance Affidavit: erg p tcax�t armation PX a e_*rim >�Xy a1��(BusinessFOxgazt?zationl�vdzuiduat}: y Tt G d✓,•rt�lr�v 7�S: �'!.1 %�/5���T.•o/Jf /I!L Address: .29 �R/e o t✓ s T Phone 4:_ 7 - 4'7 9'` y.96 7 Are yorx aux esxtployex?Cheekthe appropriate Toim. Type ofpxojeet(required): 1.0 Tam a exnployerwith_ $, El Xam a general contractor and 6. -New c6nstmc-&A f employees(i ancl�ox art time}� have;nedthe sab-confractom rlisted on the attached sheet.T 7. remodeling 2.❑ T am a sole,proprietor orpartn.ex, _ ship and`haveno.employees These sub-contractorshave 8. U Dexnolztion workers,comp.insmance. 9, 133�1� addition working forme iv_any'oapacity. ] g ENO worlexs'corrop.ia=mce 5. ❑�l e axe a corporation and its 10XI Electeicalxepaixs ox additions xecpZixed.� officers have exercised.theix 3. S a�n a ho�rzeowner doing allwork light of exemption perM(A U.-E]Pi mbingxepaixs or additions myseL. coworkers'comp. c.152,§1(�},and wehave�o -12,Q Raof16Pahs insuxanc�xe ed. emmployees.INoworkers' 13.w OtTtex; of w,rra�•fj s comp.insuxancexecluired.� eA�'applicantthai cbecksbox#�Zm7xsEalsa�Tlouithese�fion.heln�t'showingtheirvrorkers'eompensationpolicyinformation. ,� . Homeovhersvrbo submitthisaffidayitindicatiug iey 'r;doing aAwDrXandthenhireoutside affidav1tind1ca5n9such. ?'Con-hactom iTiat.c1mktbh box must attached an additionat sheet show1agtfiename o�the sub-contracfors andtheix�orkers'camp.policy infounaizon. Ir izgz an exnvl`ay�x tlitcl i���avicli�tg l�o��e�s?compe�asaAgn insuran fo�Y�y egTloyees�. Se�ow i�tliejalicy tlmfjoh site infomaiion. Tnsmance CampanyName; A.P'e R Y T /�-'YLV-,e -0�!Z9 e 'e s vet rrh C e policy ox el ins.Trzc.#-.. c c,�• 3��5 ,38.Ac 01 -o/r3xpixatzon Dade: 1/-Z 9' /y doh bite ddxess;: '�`� �✓i if�Sv/t /w a CityfState/Zip: ��s�o tie A IV4- Affaeh,a copy OMewoxkers'comPensationToltey declaratlon page(s1zuw1ug•tAo policy nmuber and expixataoa date). Failure to secures coverage as regrdxecl der Soetlon.ZA 09MO ,c.1.52 cart leadto the imposition o£cximinallienaXtzes of a fmo�to$X,500.00and/oTone-year impxisoxnnent'a�well.aschApenardesi thefoamo a �OPV1�OF.I ORbEI arida e ofupto$250AUaday against theviolatOL Be advised that acopyofthisstateraentmay'bet'oxwardedtothe0.fEGO'Of Xnvestigatlons oa:the WA fox ismauce coverage veriRcation. do Xie�ei7y ee fy xc icle lee iair�s ax�cln �e yal0jp '91 y txiatzrie ir2f0 ct�tion p�ovi ec�a ioYe i due antico� e, Date: /o ' Zr- / 5`z�natuxc• � yhoxie y 79 offcmZ use mly, Do riot write in this area,to be comyletetiliy city or town of eiaf. +Cate'or Town; �exxnat/License# Sssuzn!gAn.th.oxity(circle one): 1.$aa &CatyAoym Clerk 4.BIectricalluspectox 5.Numbing f.Other y Information and instructions Massach-asefts General saws chapter X52 requires all employers to pxovidewoxl exs'compensation foxthei emplo�rees< Puxsaanttothis stame,an eviployeeh do&ed as,,_evexypexsonixitlie sexviceof amothexuudexany cokkiract oybire; • express(x•iMpRed,oral oxwxitten." An era�roye' �s de�zed as"ao.zt�.dzv.`tdual,paxiaership,assoczafzoxt,coxpoxafzo�x a�otftexZegal e�fity,ox anyfwo orxnore. . of*D foregoing engaged is a joie,entexpxise,and includingthe legalxepxesenfatives ofadeceased eln lQ�ex,.or the receiver ofxrisfee ofan hkdividual;partnership,association ox other legal entity,employing employees. �Sowevex fhe owner Of dwelfinghouse having notmoxe than three,apartments andwho resides 1`herein,orthe ocoupantofthe dwelling l Ouse of another who employs persons to do maintenaace,consttuetioxt oxrepaix woxlC on such dweltbkg house or onthegrounds oxbuilding appuxtenantthexefo shallnotbecause of such employinentbe deemedtobe an employer:" MGL chapter 152,§25C(6)also states that"every state or to cal XZcensing agency sb aTl wzfiiItoZd lb e tysrxance or renewal of a license or permit to operate a business or to a constrkxet bafldfngs irk the comzmoxzwealtlx for any applicant who has not pro duce$.acceptable evidence of complfanee with the rance coverage required:' Additionally;MGL chapter 152,§25C(7)states`�1 eitb er the commonwealth nor any ofits political subdivisions shall enter info any confract fox fhe performance ofpublic woxl unto acceptable evidenoe of compliance with th e insurance xagwremenfs of this chapferhave beextpresentedto 16 contractingauthadfy.» .capl+ucastts Pleas10PI out the workers'comp ensation of davit completely,by checking the boxes that apply to your situation and,if iiecessarp,supply sub-confxactor(s)name(s),addxess(es)and,Phonenumbex(s)alangwit7k theix cextifxcate(s)of insuxauce, ZimitedUability Companies(LLC)orLimitedLiabilityPaxtnerships Pp)withno employees othertbattthe knembers oxpaxtnexs,arenotxequixec to caxrywoxkexs'compensattonh uxanco. Z anL7 C orELP doeshave employees,apolicyi xequixed. lie advisedthatthis afdavitmaybe sabmittedfo the DepmtUaCI t of 7ndustxial A r,cidenfs fox confiksnafion of insurance covexage. .Also be sure to sign and date the affldavi: 1he affidavit should he xebarued to the city or town fhatthe application fox thepennit or license is being requebfed,xto the D 4 arim ent of Indastfial A.eeidenfs. Shouldyou have any questions regarding the law or i Eyo rt axe xeq*ad to obtain a p,�oxkexs' eompensatienpolicy,pleamcalltheDe�partmentattligmtmber.listedbelow Self-h rredcom paniessltouZdenter tEte7r • self%nsurance lz_censo number on the appropriate,&a. city or Town officials Please,besuxeth-atIlia,affidavit iscomplete and pxintchagibly. T aDepattmanthasProvidedaspacsatthebottom ofthe awdavit fox you to 0 out in the event the office,Of I_uvestigafions has to 66ntactyou regarding the agRcant Pleasebe-suxetoxillin.thepomaif/licensanumbexwhich'will be-use dasaxefexencencunber, Tnaddition,�xtapplzcant that xnust submitxnultiple pekmitJlicex�se applications is any givenyear,need onlysubmit one affidavitindzcati-ng cuttent policyiufoxmatiou(%fnecessaxy)and under"J'obSiteAddress"the applicant shouldwxite"alllocadonsin (city ox. towb)"A copyo tlieaffidaviuthathasbeonofciallystUdavedOxmarkedbythecityoxto-tvnzmaybepxovldedtofhe applicamtaspxoofthatavalid afYidavit•ison le or,Wapem tsorlicensou. Aaewa f7davitmustbefilledouteach year.Whexaahome ownexorcitizenxsobtazningaliceweoxbermitnotrelated toany'business orcomsmexcialventure (1.0-a.dog 1ieense orlien itto bum 10 Ms eta)said pexsonis NOT xegui adto complete this affzdavat. The Office d,£fnvestigafions'would 1&e to thank you in advance for youx cooperation and should you have arty questions, ' please do nothesitate to give us a call. The Depatiment's address,telepAone,atcl faxnumber: DgaTbGilt QfTnCTU&a1 AColdents oxce oialwuagatto.0 60 WaWttaa ROAQ4,9--A 02111 :°dr 617-42-7-49,00 W406 Yw 1-8,i 7,zU •ah ri' Revised 5 26-os Fax#617-M-7749 WWW- amaldia Sidin SIDING Hi Tech Window & g, Inc. P.O. Box 8234, Ward Hill, MA 01835 } MA Reg. # 118836 29 Arrowwood St. Methuen, MA 01844 3 r MA Lic# 016201 1-800-851-0900 www.hitechcorp.biz I MEMBEP Date: /_ a3 1 Consultant: �� � e h o e- _ --- Job Name: _ �� - - Telep _— AVI Town: __ u� — - Job Address:_-- — — CONTRACTOR agrees to start described work on/or about weeks after final fittings and complete described work in about - orking days. CONTRACTOR shall not be held liable for delays due to causes beyond our control The following work includes all labor and materials needed to complete your job in a workmanship like manner. Jo ncludes Trim Combination Job-Skiing With Other Work 11 PVC waled Alum Aluminum Budding and Elec Permit Fascia Trim Fascia Treatm nt Siding Removal Soffit Trim Fascia Color Pr paration Package Window&Door Trim mull Custom G ❑ None Accessory Package Shutters ,7 Loc tion 1;5 — V Q U Underlayment-Insulallpn Gutters t, , Soffit Treatment , icing Downspouts Scf4,t color03 tk Remove Debris Lock.Elec Meter Non-Vented Center Vent Fully Vented Preparation Includes Lccanon Raplace Visible Rot Vented as Needed Window And D or Casing Treatment Energy Savings•Bug Guard Starter Windova And Door Casing Color 0 Full Custom Formed J-Less � Full Custom Formed Accessory ckage Includes El Blind Stop Capping None Color \ L.�canon V W' — arm O j VVinylight Blocks Vinyl Drrer Blocks Gutter& WnS OUIlecincOutlet Blocks Vinyl Exhaust VentsGutter Color Downspouts Color aucets Blocks Vinyl Gable Vents y-� Locaunr 1 rCln Special Notes Underlayment Insulation To Be d t HI-Tech 3 8 Other n 1 Locattoi- — It p Area To Be Sid - �1ow Complete House Garage Siding TqAke UsedI( Payment Policy Color Bank Financing F� Owner To Arrarge HI-Tech To Arrange Brand Profile Cash Or Check Master Card Corner Post To Be Used Total Investmen o U Corner Post Color t t Q V(� i 1/3 Deposit Fj Wide Insulated \4fide Non-Insulated Re ular Non-Insulated 1/3 Payment 0 0 U `��� Regular Insulated 9 1/3 Balance of Day Completion U 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 agreement. See the attached notice of cancellation form for an explanation of this right. Date of Acce a An interest charge of 1.5%per month(183/6 per year)will be added to any amount unpaid after 30 days from invoice date. Signature �• � ,� In the event of dela Ult of payment of this or0ar 01 any part thefP,ol and the aCCOuot is rele.ri eo to an anorr Ey for COIleCf0l'the purchaser agrees t0 pay reasonable attorney fees. (Ho neowner) I/We give Hi-Tech permission to obtain all necessary permits. Signature (Hi-Tech) i Signature