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Home My WebLink AboutBuilding Permit #102-2012 - 57 LINCOLN STREET 8/4/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: lD �CoZ Date Received Date Issued: L/t/�/ I IMPORTANT: Applicant must complete all items on this page LOCATION J4JF 11tJcp1tJ S1-41 Print PROPERTY OWNER "I20-hczt SP,61e. Unit# Print MAP NO6 34 0 PARCELOIJ6 ZONING DISTRICT: Historic District yes Machine Shop Village yes no !It 100 year-old structure yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building `4 One family ❑Addition ❑Two or more family ❑ Industrial KAlteration No. of units: ❑ Commercial K Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other �zSeptic �W le 1 � � �Flood''lam fO UVet1 �T `0 atershed str`iet DESCRIPTION OF WORK TO BE PERFORMED: 12-:00 ' es tky rte. e cCg. s,a I Irl � tt�1—C I� co a ems, l��—moo �u'�-� �t�, 7o-eQ F�np &J1!*S4 nradyid CkealARU (Identification Please Type or Print Clearly) OWNER: Name: F-obzK.� Phone: 918-�eS-Li Address: r r-oIri CONTRACTOR Name: Adz h&d PkkPi 'Emi;nc' Phone: Sl 9 -901 1-I N Address: 33S R 1ZS Rrcn}ywet>d l&) osb33 ` Supervisor's Construction License: J a9 15S Exp. Date: J X1.5�a.ol i i Home Improvement License: I y D tai Exp. Date: 091Q011 it ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 1 a, oao FEE: $ Check No.: 9-/141 Receipt No.: -2 4C�yZ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature ofAgent/®wnea ,r cont�actor� ,,,� _1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packa ❑ Private(septic tank,etc. ❑ El 'ra Permanent Dumpster on Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments _ I Water & Sewer Connection/Signature& Date Driveway Permit I 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 I ❑ Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 o Copy of Contract ❑ 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 Perry, Addition or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Repoli (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Perm[ New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan o 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) o Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg .Perm' 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: Doc.Building Permit Revised 2008mi S t Location No. 40 2 - .2 DDate Y NOR,h TOWN OF NORTH ANDOVER D i , + ; . Certificate of Occupancy $ CNUsE<� Building/Frame Permit Fee $ �y — Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # O / 24442 A Building Inspector NORTH Town of 0. over, Mass., G Y O LAKE 1, COC NICHE WICK 0 RATED U ` BOARD OF HEALTH Food/Kitchen Septic System -PERMIT T D BUILDING INSPECTOR �G .VTHIS CERTIFIES THAT................................................................................................................................................................. Foundation has permission to erect........................ buildings on` 04V ...r.c. ... .. ....................................... Rough Chimne to be occupied as.......................�.�' /.�1, ..... ....... f'....,�-�e�. .......................................................... y provided that the person accepting this permit shall in every respect 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 CONSTRI C I ION ST'ART'S Rough 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. DTVANCED SIDING AND WINDOW CO. S UNROOMS AND PATIO ENCLOSURES SOLARIUMS, GREENHOUSES AND PATIO ROOMS 335 RT 125 - BRENTWOOD, NH 03833 Phone 800-519-9944 - FAX 603-679-2844 - E-mail aswc@ttic.net www.advancedsidingandwindow.com License Numbers:MA •Also Licensed in Maine,Vermont&New Hampshire -RESIDENTIAL CONTRACTING AGREEMENT- Read this agreement and make sure you understand it before signing it. This agreement has legal force and effect and binds those who sign it. Notice: All home improvement contractors and subcontractors engaged in home improvement contracting,unless specifically exempt from registration by provisions of Chapter 142a of the general laws,must be registered with the Commonwealth of Massachusetts.Inquires about registration and status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place,Room 1301,Boston,MA 02108 Advanced Siding and Window Co.Registration Number: #140123 Federal I.D.#: 02-0492513 Salesperson Name: This agreement is made onetween Advanced Siding and Window Co.,Inc. of 335 Rt. 125,Brentwood,NH 03833 (ADDRESS) (CONTRALTO / (603)679-2466 hereafter called"Contractor"and , •- Q�2 WTJ4/6 G r of (PHONE UMBER) �` (c� `i/�,. I' W � '� 6�� E`..7�• �� p��hereidlfter G/'1 (ADDRESS) \J , (PHONE NUMBER) called"Owner". Check if: I,DETAILED DESCRIPTION OF WORK TO BE PREFORMED AND MATERIALS USED O Schedule attached Contactor a ees to perform in a good and workmanlike manner all work detailed below.Such work consists of the following: O Schedule not attached t/ v � t U.PRICE �� Contactor agrees to do all work described in Section I for the total price of$ v d a III.PAYMENT �(1 Payment will be made as follows: Z.0I - ($ upon signing Contract: ($ Llri upon completion of___��'�s� � ��'�"--- •-�� ($ )upon completion of and the remaining %($ )upon verification of the work by Owner and contractor as having been satisfactorily completed,which verification shall take place promptly after completion. Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor mt make,in advance,to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is eater. If the net unpaid balance upon completion is financed thro h the contractor,the terms of the Retail Installment Sale Agreement dated between the j Owner and the Contractor are incorporated herein by refer ce.The Retail Installment Sale Agreement specifies: j Finance Charge: $ i Number of Payments $ Amount of Monthly Payments $ ($ vv )upon signing Contract: ($ )upon completion of ($ )upon completion of e1 w ��- and the remaining %($ )upon verification of the work by Owner and contractor as having been satisfactorily completed,which verification shall take place promptly after completion. Notice: No agreement for home improvement contracting work shall require a down payment(advance deposit)of more than one-third of the total contract price or the total amount of all deposits or payments which the contractor mt make,in advance,to order and/or otherwise obtain delivery of special order materials and equipment, whichever amount is greater. If the net unpaid balance upon completion is financed thro h the contractor,the terms of the Retail Installment Sale Agreement dated between the Owner and the Contractor are incorporated herein by refer ce.The Retail Installment Sale Agreement specifies: Finance Charge: $ Number of Payments $ Amount of Monthly Payments $ IV.COMMENCEMENT AND COMPLETION OF WORK Contractor will not begin the work or jorder the materials before the third day following the signing of this Agreement,unless specified here in writing.Contractor will beg' the work on or about _(date).Barring delay caused by circumstances beyond Contractors control,the work will be completed by (date).The Owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the ContrMorall not be considered as violations of this Agreement. Notice:The terms of this agreement are contained on both sides of this page. ` RIGHTS TO CANCEL The Owner may cancel this agreement if it has been signed by the Owner at a place other than an address of the Contractor which may be his main office or branch thereof, provided that the Owner notifies the Contractor 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 attached Notice of Cancellation. HOMEOWNER:DO NOT SIGN THIS CONTACT IF Pl ARE ANY BL :K7SPES. i i` Co-owner's SignatureSi e Co wner's Signature Date Signed l Accepted by Officer .S.W.C. V d Contractor's Signature Date Signed I I ✓tie -coam..nox.Wa oy✓ataaoacsu aeaa License or registration valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR /-/"D\ Office of Consumer Affairs and Business Regulation Registratiota,�, 40123 10 Park Plaza-Suite 5170 Expira g0f-421 11 Tr# 7001.14 Boston,MA 02116 Type,� Y_ vete T oration ADVANCED Sd am TIO ENCL CO INC _ _ �\ JOHN WILUSZ' ( I 335 RT 125 BRENTWOOD,N Undersecretary t valid without signatur I I I I • I .k. 11";1 sachus : � Board of 13"il- Department ildimrof Public Safety Construction SRlaitons and pervisStandards License: CS 52975 License j��iminlluy� t} SCOTTA WO17 MANSEE OAD KINGSTON, NH . 03848 1t+_ 4� Expiratio n: 1/25/2013 Tr#: 14319 I I 3/11/2011 9:50 AM FROM: 603-935-7207 Watson Insurance TO: +1 (603) 679-2844 PAGE: 002 OF 003 ACORO CERTIFICATE OF LIABILITY INSURANCE DA D/1^fF3/11/2011 1 PZODUCER (603) 668-4800 FAX: (603) 668-2400 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 1"'?•.�tson Insurance Agency, Inc. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE South Main Street HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. I Manchester NH 03102 INSURERS AFFORDING COVERAGE NAIC# WISURE0 INSURER A:Endurance American Specialty State Home Improvement, LLC INSURER 8: . ,338 Route 125 INSURER C: INSURER D: Rrentw d NH 03833 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 F•9AY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CONDITIONS OPSUCH POLICIES.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR DD' POLICYEFFECTIVE POLICY EXPIRATION I POLICY NUMBER (MMIDDA^M) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,000 X COMMERCIAL GENERAL LIABILITY 1713- PREMISES Ea occurrence $ 50,000 CLAIMS MADEX1 OCCUR INDER/GL 3/15/2011 3/15/2012 MED EXP(Any one person) $ Sj 000 PERSONAL 8 ADV INJJRY $ 1,000,000 I.'. GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2 000 000 POLICY PRO X LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANY AUTO (Ea accident) $ r. ALL OWNED AUTOS BODILY INJURY SCHEDULEDAUTOS (Per person) $ i i I HIREDAUTOS BDINOWOWNED AUTOS (Peri accident)RY $ PROPERTY DAMAGE Per accident)) i GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ { ANY AUTO OTHER THAN EA ACC $ t AUTO ONLY: AGG $ i EXCESS/UMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ I I $ DEDUCTIBLE $ I _ 1 RETENTION $ $ 1_ WORKERS COMPENSATION WC STATU- OTH- 1: I AND EMPLOYERS'LIABILITY Y/NDRYLIM c I ER i.ANY PROPRIETOR/PARTNER/EXECUTIVE❑ E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes,desoibe under E.L.DISEASE-EA EMPLOYE $ SPECIAL PROVISIONS bet ow E.L.DISEASE-POLICY LIMIT $ OTHER )E 'F;bPTION OF OPERATIONS/LOCATIONS I VEHICLES/EXCLUSIONS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS r �s, i (Covering operations of the insured. i � 'CtkTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION For lA£Ormat10Aa1 purposes only DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN I NOTICE TO THE CERTIFICATE HOLDER NAMEDTO THE LEFT,BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER,ITS AGENTS OR If REPRESENTATIVES. ^ 'F AUTHORIZED REPRESENTATIVE - k,�.._ Jim Watson/JSC ACCORD (2009/01) 01988-2009 ACORD CORPORATION. All rights reserved. " ��?Sy200oosot) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF INSURANCEp� This certifies that ® STATE FARM FIRE AND CASUALTY COMPANY, Bloomington, Illinois 1r ❑ STATE FARM GENERAL INSURANCE COMPANY, Bloomington, Illinois ❑ STATE FARM FIRE AND CASUALTY COMPANY, Scarborough,Ontario ❑ STATE FARM FLORIDA INSURANCE COMPANY, Winter Haven,Florida ❑ STATE FARM LLOYDS, Dallas,Texas irtsares the following policyholder for the coverages indicated below: Name of policyholder State Home _mprovement Co., L:,C N Address of policyholder 335 C Route 125 Brentwood, NH 03833 ` Location of operations various Description of operations f TtiaF policies listed below have been issued to the policyholder for the policy periods shown. The insurance described in these policies is `subject to all the terms exclusions,and conditions of those policies. The limits of liability shown may have been reduced by any paid claims. POLICY NUMBER TYPE OF INSURANCE POLICY PERIOD LIMITS OF LIABILITY - Effective Date Expiration Date (at beginning of policy period) Comprehensive BODILY INJURY AIV>1 Business Liability PROPERTY DAMAQS This insurance includes: ❑ P ----- -- -Co---mp-----let--ed--O-pera----tions--- --------- -r--d- - ❑ Contractual Liability ❑ Underground Hazard Coverage Each Occurrence $ ❑ Personal Injury ❑ Advertising Injury General Aggregate $ ❑ Explosion Hazard Coverage ❑ Collapse Hazard Coverage Products—Completed $ ❑ Operations Aggregate POLICY PERIOD BODILY INJURY AND PROPERTY DAMAGE- EXCESS LIABILITY Effective Date ; Expiration Date (Combined Single Limit) ❑ Umbrella Each Occurrence $ ❑ Other Aggregate $ Part 1 STATUTORY Part 2 BODILY INJURY I Each Accident $ Disease Each Employee $ Disease-Policy Limit $500,000 POLICY PERIOD LIMITS OF LIABILITY POLICY NUMBER TYPE OF INSURANCE Effective Date Expiration Date (at beginning of policy period) `29-2019-APP1 Workers Comp. 03/15/2011 03/15/212 Bodily Injury by Accident $100,000 Each n Bodily Injury by Disease $100,000 - Each Emploveg Bodily Injury by Disease $500,000 Policy Lim' 'i^,fE CERTIFICATE OF INSURANCE IS NOT A CONTRACT OF INSURANCE AND NEITHER AFFIRMATIVELY NOR NEGATIVELY AMENDS, EXTENDS OR ALTERS THE COVERAGE APPROVED BY ANY POLICY DESCRIBED HEREIN. If any of the described policies are canceled before its expiration date,State Farm will try to mail a written notice to the certificate holder 30 days before Name and Address of Certificate Holder cancellation. If however, we fail to mail such notice, no obligation or liability will be imposed on State Fa or its agents or rep ese atives_ Signature of Authorized Representative Richard Lombardi 03/29/.4A- Title Dat¢ - Agent's Code Stamp R. Lombardi 29-2019 AFO 2019 E `T� Neta Hampshire AF0 F876 .6584§4 a3 04-1999 Printed in U.S.A. r,01,DEN TRIANGLF DG(1'!11 1 1 +.7 IDIAI The Commonwealth of Massachusetts Department of Industrial Accidents 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): 31n-ru- }dime 1 ue { i Aefft Address: 3-S 'eT 17,C- City/State/Zip: bre.n1 1U�- 0 033 Phone #: �6W S71q 9c Ny Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g• Demolition working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance. 9. E] Building addition 10. Electrical repairs or additions required.] 5. ❑ We are a corporation and Its ❑ P 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself o workers' com right of exemption per MGL Y � P• 12.aRoofrepairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.0 Other comp. insurance required.] Any applicant that checks box 41 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 an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: bttq Policy#or Self-ins.Lic.#: acj` am 19 " lA PP 1 Expiration Date: 3 Job Site Address: S S 1 tNC01t,) City/State/Zip: 0. 4taddues- Mp 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 nature: _Date: �a`i I a0!1 Phone#: 8w- Sri -qq yN 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#: