HomeMy WebLinkAboutBuilding Permit #771-14 - 585 SHARPNERS POND ROAD 4/29/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATIO
�.Iiq
Permit NO: Date Received u v
r
Date Issued:
L' OCATION'=
PR'QPERYY OW.N
MAP' N(
PORTANT: Appft
int m st complete all items on this
0e
`Print
'ARCED ZONING
1 UutYear vi
�RI;CT `Historic,Di
yes: nogIf
yes �n,o
ves. , :nQ),
.TYPE OF IMPROVEMENT.
PROPOSED USE
Residential
Non- Residential
❑ New Building
X One family
11 Addition
El Two or more family
❑Industrial
❑ Alteration
No. of units:
[I Commercial
19 Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
= _
❑Septic Q'0 ell
.Floodplain wD Wetland's
sEl Watershed ®istrlct
t
water/Sewer:
DESGKIF I IUN Ur VVUKtX I U 6c rr-Mrvr-Umr=v.
74 4
Identification Please Type or Print Clearly)
OWNER: Name: Phone:
Address: ,i-gs Sl4RPi2e� /1� —
�- why W c,/�S _ Phone:: 9 7__�
CONTRACTOR Name / _. .- __ _
e
e.�
,
i
G.SIG Ex Date: _�1 1
Supervisor s�Constructlon License=
s
Ex Date
HoKn:e Improvement License. _ l!�-3 — _ p. -
ARCHITECT/ENGINEER 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.
$
Total Project Cost: $ �-�2-� FEE: ---
Check No.: Receipt No.: 2J�� .
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Plans SubmittedLi Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
Plans Submitted ❑ Plans -Waived -11.1;
Certified Plot Plan ❑
Stamped Plans ❑
TYTE _OFF SEWERAGEDISP.OSAL
Public Sewer'
Tauning/Massage/Body Art ❑
g El'
Well ❑
Tobacco.Sales ❑
;Food Packaging/Sales ❑
Private {septic tank, etc:_ ❑
PermandiA Dumpster on --Site ❑
THE..FOLLOWING SECTIONS FO.R'OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
r:.. DATE REJECTED DATE,A_PPR=OVED
PLANNING & DEVELOPMENT ❑ ❑
COMMENTS
,CONSERVATION
COMMENTS
G
HEALTH
c
COMMENTS
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes_..
Planning Board Decision:
Comme
Conservation Decision: Comments
Nater & Sewer Connection/Signature & Date Driveway Permit
DPW Tovv:: Engineer: Signature:
Located 384 Osgood Street
FIRE DEPARTIi Ir`NT : Ter"ri.p 'Dumpster onsite ..yes no
Located at:124 Ma'in
Streets
3
Flre Departmert signatgre/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
DANGERZONE LITERATURE: -Yes No
MGL.Chapter166.Section 21A --F and G min.$100=$1000.fine
MUTES and DATA — (For csepartment use
® Notified for pickup - Date
Doc.Building Permit Revised 2010
Building Department
The following is a=lrst of;the .required forms to be filled out for:the appropriate:permit to''be obtained.
Roofivg, Siding, Interior Rehabilitation Permits
Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster,permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
o Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the apn,-�al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be subm.tted with the building application
Doc: Doc.Bui?ging permit Revised 2012
Location
No. Ili '" t , Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy i$
Building/Frame Permit Fee $
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Check #
27515 E51
Building Inspector
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
I Congress Street, Suite 100
Boston, MA 02114-2017
IV www.massgov/dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
,Applicant Information Please Print Legibly
Name (Business/Organization/individual): 11 ` ICfl
Address: -25' s7—
,
'e f"n v "/ /tea. O /i' yy Phone #:
Are you an employer? Check the appropriate box:
1.� I am a employer with Ili- -lee--4 4. ❑ 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-
ship and have no employees
working for me in any capacity.
[No workers' comp. insurance
required.]
3. ❑ I am a homeowner doing all work
myself. [No workers' comp.
insurance required.] t
listed on the attached sheet.
These sub -contractors have
employees and have workers'
comp, insurance.=
5. (] We are a corporation and its
officers have exercised their
right of exemption per MGL
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
, - Al- 77-- k1 7,6 a'
Type of project (required):
6. 0 New construction
7. ❑ Remodeling
8. ❑ Demolition
9. 0 Building addition
10.0 Electrical repairs or additions
11.0 Plumbing repairs or additions
12.0 Roof repairs
13 J, Other gf5o d e- j &`54
.Any apprtcant that checks box # t must also till out the section below showing their workers' compensation policy information.
t Homeowners who submit this affidavit indicating they arc doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must attached an additional sheet showing the name of the subiwrttractom and state whether or not those entities have
employees. if the sub -contractors have employees, they must provide their workers' comp. policy number.
J am an employer that Is providing workers' compensation Insurance for my employees Below Is the policy and Job site
information.
Insitrance Company Name: .lJ,I i AY�� �! is c' jam '_ . `I! f l� tt i 1 e -
Policy # or Self -ins. Lic. #:-k11-J- Expiration Date: //- 7
Job Site Address: SYS City/State/Zip: 41 e i le v e- Az-
Attach
LAttach 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 S 1,500.00 and/or one-year imprisomnent, 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.
Ido herebx certify under the pains and penallies ojpeyjury that the Information provided above Is true and correct
Phone ft,_
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. Cityfrown Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person: Phone #:
M11-01
n
WD
J
Qw
O
D
®c
m
v
u
+
N
Ix
o
V
a
H
Z
Vi
Zcl
m
O
2
0s
U
LLI
a
occc
Z
z
co
D
d
CC
®
W
Z
J
Q
U
oCLLI
U
W
W
ix
O
u
a
H
Z
z
LJJ
Q
W
LL
Z
++
O
Y
\
'6
LL
N
u
wcu
(A
N
0
LL
t
O
w
N
C
:EC
U
LL
t
Op
O
K
C
LL
L
b0
O
K
O1
u
N
V)
C
LLK
O
_
ra
O
i..�
N
C
7
m
N
V)
N
Y
O
E
V
O
_
0 CO
In • .Fa _
O O
dQ
o
o �
E Q
L
7t4�cc o
i tm
V L
4-N
0cc
CD =
> O L
0 0
U)=
0
__ s V Q
CLc•0
0 o
N
ini: �U)3
c 0
� o
CL CD
<a o 'M
= am
F o N
O m
W = -0 +�•• O o
L6 .N O R N =
Ln i uj
O �� :~
W E V = O
U Q O -0 d
N -0• 0
cn014-3--
CDCL
U)
_
cu
as
m
0
CF)
c
0
N
O
t
O
Z
0
Q
J
X
l
Z Ag
W
CO
a Z
w O
�v
U)
OC W
LLJ -i
CL Z
F'
v
0
Hi -Tech Window & Siding, Inc. SIDING
P.O. Box 8234, Ward Hill, MA 01835
MA Reg. # 118836 29 Arrowwood St. Methuen, MA 01844
HBO -
MA Lic # 016201 1-800-851-0900 e=1
,.....
www.hitechcorp.biz
Date: 0� / Consultant:
Job Name: .= v; -- ------ ----
Teleph
Job Address:_ % --- --- Town:
CONTRACTOR agrees to start described work oWor about weeks after final fittungs and complete described work in about __ working days.
CONTRACTOR shall not be held liable for delays due to causes beyonc our contrc;i
The following work includes all labor and materials needed to complete your job in a workmanship like manner.
Job Includes
nCornbrnat,on Job - Siding N'rth Other Work
u.ldmg and Eec Permit
Fascia Treatment
;c,ng Remo'=al
Gff 7r.m
aratun, acka ge
�' ,hr,-; v. g Door Tram
ccessnr, Paz+.a9�
� Snunc-r; i
ndenaynlen,Juetdai+cy
Gu!!ers
Sicing
El Dc'nspou!s
Rerr..ore Debr:>
u Lou'. Eie:: •!.Ie!e:
Prepar ion Includes
ElYore
e lace Visible Rel
Vented as Needed
nergy Savings, Bug Guard Starter
Special Notes
Accessory Pa kage Includes
cel,:
r
�
11�aryl I Ignt Bloc'cs
`Jmv Orce• BIeCKs
myl Electric Outlet Blocks
",rril Exnaus; Ven!s
Vinyl Faucets Blecss
v
`/'nyi Gno'e Ver:=_
CM, ) I L
Payment Policy
Underlayment Insulation To Be Used
H -Tec n 3 8
E217' {
Cas. Or Check
kla<_!er Card
Area 1?2e Sided
7mpc[e HJUSC-'
El Garage
113 Deposit
Siding To Big Ysqd4Ili`
113 Payment
113 Balance of Day Completion
Cator
brand
P file "
Corner Post To Be Us d
Cornu Post Color.
'ode hsula;ed
� ','vide Non-!„ su!atec
Regular Insulated
Regu'ar Non-hisulated
Trim
P ; C G:ra:e Ai,:rn
Aluminum
Fascia Treatment
i_.J Nore
Soffit Treatnleryt
Sc^�! _ 1
.,. r- I':; ❑ =;: It 'J=l:iei:
❑ Nor-JP.n!e!1
..acaben Uri
Window And Door Casin Tr atment
`:d'ndc,:•: As :Door Casing Color
B:.:: S; :.n a ;:;;
ElYore
Gutter & & n uts
Special Notes
-7
U'
CM, ) I L
Payment Policy
Bank F:nar_ El O::rer To .�rrarr�e
El H -Tec' Tc Arr-rge
Cas. Or Check
kla<_!er Card
Total Investment
113 Deposit
113 Payment
113 Balance of Day Completion
(k o
0. � a-7
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 o this agreement. See
the attached notice of cancellation form for an explanation of this right. r
:kn .rdez cnwge of 1 .. . Per monih , 1 per year, ..II; beed :� any an- : M day: f -em ;;,v_ - ;;e Date of Acceptances'
.craw :ze a, .raw,a .attune, 4e Signature !
I r We give Hi -Tech t,qfmissiohtai; necessary permits. rt�meo-vne;
Signatu� Sigr�ure
T2 n
1
-Window & Siding AffAi
Installations, Inc.
NATIONAL TOLL FREE 1-800-851-0900
Name ol Consumer
Name of Consumer
11V -T` NjuVQ
City/State/Zip
YOUR RIGNr TO CANCEL.
You are entering into a transaction that will result in a
security interest on your home. You have a legal right
under federal law to cancel this transaction, without
cost, within three business days from whichever of the
following events occurs last:
1. The date of the transaction, which is;
OR
2. The date you received your Truth -in -
Lending disclosures:
OR
3. The date you received this notice of your right
to cancel.
If you cancel this transaction, the security interest
is also canceled. Within 20 Calender days after we
receive your notice, we must take the steps necessary
to reflect the fact that the security interest on your
house has been canceled, and we must return to you
any money or property you have to us or anyone else
in connection with the transaction.
You may keep any money or property we have given
you until we have done the things mentioned above,
but you must then offer to return the money or
property. If it is impractical or unfair for you to return
the property, you must offer its reasonable value. You
may offer.to return the property at your home or at the
location of the property. Money must be returned to
NOTICE OF RIGHT
TO CANCEL
MASS REGISTRATION #118836
Pursuant to the Truth -In -Lending Act and
Regulations, we are delivering to each Consumer
two copies of this Notice.
HI -TECH WINDOWS & SIDING INSTALLATIONS, INC.
Seller
By:
ri
of Transaction
the address below. If we do not take possession of the
money or property within 20 calender days of your -offer,
you may keep it without further notice.
How TO CANCEL.
If you decide to cancel this transaction, you may do so
by notifying us in writing at:
HI TECH WINDOW & SIDING INSTALLATIONS, INC.
29 ARROWWOOD ST. METHUEN, MA 01844
You may use any written statement that is signed and
dated by you and states your intention to cancel, and/or
may use this notice by dating and signing below. Keep
one copy of this notice because it contains important
information about your rights.
If you cancel by mail or telegram, y must send the
notice no later than midnight of
( ate)
[or midnight of the third business day following the latest
of the three events listed in the section "Your Right to
Cancel"] If you send or deliver your written notice to
cancel some other way, it must be delivered to the above
address no later than this time.
I WISH TO CANCEL
Each CqnsLarner signing below acknowledges copies of this Notice of Right to Cancel.
Consumer's Signature
Consumer's Signature
ORIGINAL COPY—White CUSTOMER COPY—Yellow
(Date)
Consumer's Signature
t � r
(Date)
(Date)
OFFICE COPY—Pink
04/24/2014 23:15 9783733360 KITTREDGE INS PAGE 01/01
4/25/2014 8:16:07 AM PST (DIT -8) FROM: 100005 -TO: 19703733360 Page: 2 of 2
ACQ CERTIFICATE OF LIABILITY INSURANCE DATE (MI411DD
41251204
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI i
CERTIFICATE DOES NOT AFFIRMATWELY OR NEGATIVELY AMEND, EXPEND OR ALTER THE COVE GE AFFORDED BY THE POL ICIEP
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE
REPRESENTATIVE. OR PRODUCER, AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WANED, subj
the terms and conditions of the policy, certain policies may require an endors®meet. A statement on this certificate does not confer rights E6I the;
Certificate holder in lieu of such endorsement(s).
PRDOUCER BARRY J KITTREDGE INSURANCE CONTACT
II
816 MAIN ST °Hc" o E rAX I
BRADFORD, MA 01835 E-MAIL
tNsURE0
HI TECH WINDOW & SIDING INSTALLATIONS INC
29 ARROWWOOD STREET
METHUEN MA 01844
INSURER E :
nel lQlnfl UVIR0101=13. I I I A
1.rVYGiViVGV vrl�lll lvr�.�•--•-.��. �. �.,.. �......
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE SEEN ISSUED TO THE; INSURED NAMED ABOVE FOR THE POLICY P j21 D:
INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIC 1 ITS.
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE T f [V!19:
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, I I
INSR
LTR
TYPE OF INSURANCE
AODL
y,)OR
POLICY NUMBER
>PO CY EFF
D
DO C1r EXP
D
LIMITS
COMMERCIAL OENERALLIABILITY
LM Insurance Corporation
E CK OCCURRENCE 5
P MI r n s
CLAIMSJAADE F1 OCCUR
* EXP (Any one person) 5 I
PERSONALBADV INJURY s
GEN'LAGGREGATE LIMIT APPLIES PER.
GENERAL AGGREGATE $ i
PFAODUCTS -COMP/OP AGG $ I
POLICY PRC FLOC
JECT
I S
OTHER:
CEM eco dant) SINGLE LIMIT s
AUTOMOBILE ummrrY
8 OILYINJURY(PerpRmon) S
ANYAUTO
ALL OWNED SCHEDULED
09DILY INJURY (Peraeddant) S
AUTOS AUTOSNED
PROPERTY DAMAGENON-OW$ I
raccident)
HIRED AUTOS AUTOS
$
EACH OCCURRENGE 3
UMORpLLA LIAROCCUR
A OREQATE $ l
EXCESS LUA9
HCLAIMS-MADE
I N 93
A
WORKLkSCOMPENSATION
WC5-3153$3602-013
11/29/2013
11/29/2014
ST RTE FRH'
E • FACH ACCIDENT $ I1 OOO 0
AND EMPLOYERS' LIABILITY Y/ N
ANPROPRIETORIPARTNERIEXECUTNE
0 FV ICERIMEMgER EXCLV0E07 O
N / A
E DISEASE - EA EMPLOYE $ I100 D
(MRndelory fn NH}
tla=(
150 D0 0
If Yee, a under
DESCRIPTION OF OPERATIONS w
E , DIEEA8E . POLICY LIMIT $
I
DESCRa1710N Of OP9KAYIONS f LOCATIONS IVEHICLES (ACORD 101, Addlttonel Remarks Sohedule, may qa eftechetl If more space Is requtredi I
I
Workers compensation insurance covwaQ a appl les only to the workers compensation laws of the state MA, l
This certificate concele and supersedes ell previously Issued certificates, only as they relate to workers compensatic n coverage.
I
I
I
� I
6.tK I II'14Af C nuI_uCR
---- —
I
SHOULD ANY OF THE ABOVE DE CRIBED POLICIES 9E CANCELLED B PORE
TOWN OF NORTH ANDOVER
BUILDING INSPECTOR
THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
1600 OSGOOD STREET
NORTH ANDOVER MA 01845
AUTHOIVZEG REPRESENTATIVE �}
LJ
aQ ��
LM Insurance Corporation
ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD
CERT ND.: 19954990 hnne chandLe.c 4/25/2014 8:13:57 AM (PDT) Page I =£ 1
• . _ " •s..:—.. ...._^.ate/.._..; — 1- p ',. _/�_�. �,-�/,—/..T_ ./. "�� .
} V �LG' �ryi77//77.0�/2C�P�LLIL L+�U(�GCtOdLLClLLCQ��Q,g f `
I ffice of Consumer Affairs Business Regulation
_— - ° ME dMPROVE-MENT CONTRACTOR I
o � .
=Registration g186836 Type
i= ;k
Expirat-rii
t"' �4/26/2015� Supplement i'
HI TECH WINDOW,'&'SIDING INSTALL INC
' TIM WICKS��Y J 4
I
29 AF ROWWOOD ST +E r 1
METHUEN, MA 01844r'
I
Undersecretary
Ir
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor .
License; CS -096516
I r: rrti
TIMOTHY W WIV-kS '
3 ELLIS STREEx
Methuen MA 01$-44 : r
Expratio'n
Commissioner 09/09/2014
r