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HomeMy WebLinkAboutBuilding Permit #1036-2016 - 72 WINDSOR LANE 4/4/2016 NORTl� BUILDING PERMIT oF,s,.eo ,s�tio v I I TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 7D Permit No#: �� �P '�� Date Received �s4�RRP'�`5 gSSACHU`+��� Date Issued: 'I IMPORTANT: Applicant must complete all items on this page LOCATION 7,Z A-le Print PROPERTY OWNER Print 100 Year structure yes no MAP _PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building l(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 E_Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Resale 'All �✓, h !i aYL S �l;�g Identification- Please Type or Print Clearly OWNER: Name: Gla.,, t En%dr 0* Phone: P79= 0�',111--Pa79 Address: 7,z w,•yr.&O't /Q"re fl'-TGA r r;.r�l�'c✓ qc- S7-1,W,* Contractor. Name: Phone: Email: Address: Supervisor's Construction License: 0 Exp.. Date: Home Improvement License: Exp. Date: ''2�-l7 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 y; 7-ZQ� FEE: $ Check No.: o I Receipt No.: .--a 1Olt+ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 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 Dempster 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 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTc MENtT ;T mp®rnpr on Looe Xd)at124 Man S reet 0 Fire Departm nt siggn�a+t+erre date 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 DANCER 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 Date Time Contact Name F._......... Doc.Building Permit Revised 2014 Building Department Bu g p � 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 OTE: 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 4. 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 OTE: 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 --� �f�1Sa e2 1J No. U �u+' � �C�,► Datefl Lf • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $21' i�' Foundation Permit Fee $ y; Other Permit Fee $ TOTAL $ v tt Check# 30194 Building Inspector ITO NORTH I lOwn 01 ft nuover No. : ^�! h , ver, Mass, Awsp1m, R I mww'IYE C0[NICHl W1[R y1. RATED PPP��S U BOARD OF HEALTH AN Food/Kitchen Phmmm"&hIT T Septic System `� ®� BUILDING INSPECTOR THIS CERTIFIES THAT......... .... .. .. ........ ........................ .. . ... ..+... ........ .............................. has permission to erect Foundation p ...................... ... buildings on ... ...:. .... .� . . ..... ........4.................... • • � • Rough to be occupied as ... ... .� .. .. . .... .. .�... �. o.... .......................... Chimney provided that the person accepting this permit shall in every respect conform to the ter f the application 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S ARTS Rough Service ............. ...... BUILDING INSPECTOR. Final GAS INSPECTOR Occupancy Permit Required to Occupy Bu,tldin 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. F-L'H-Tech YnOndow e, Sidi�jg, �O-Dc. 0 Sc D I N 20 Aegean Drive Unit 4 MA Reg. # 118836 Methuen, FWA 01844 MA Lic # CS - 106508 1-800-851-0900 Date- 03 1 16 wvmr.hiLet Chcorp-biz Vit( Consultant:._- J o b 1\1 a , e.- Telepho AAA — f Job Address: Town: �-v v v v "---- P�Ire described t�vi)Tnd k on b k after�flnal fittings 'Zor cm not el11 c or a out '.'.'ee �e I described-.vork on or a ut veeks after final fittings,and complete ,.vork in about vork;no Contractor agrees 10 start r delays s due cause beyond our control. Hi- e ch s a 0 y lav ' to Ys to ia,.-,,rs o, Barr contra�tor shall no,be held liable for delays due to cause beyond our control.Hi-TechS.'1211 not be held liable for any d mane tr plants.contractor shall net be liable for any damage to painfing*or stain during installation o-,.,iindo,.-.,s or doors.Hi-Tech does not do any paiw Ing or staining.In the event that a punch list should accrue at the end of the job.a maxim materials needed to co urn of 2'e' is the alloviable amount to be held b'a:;k- The follov.,inq work includes JI labor and r Job Includes corn yourjob in a workmanfike manner. I rim :.:ng ana E:f"'c perrm! WMInUm st;a Tm.n Fascia Treatmqn, Re= i! i T II pnratmn packm e Fannia C(,:a, 11 cuskmn Nene Lcccaficn illi Sofflit Treatment f"Offil color PrePar, -Ition Includes C-wervea FOY ven!ed :`ep!:Icc V151b:O RCI SavinIa,-Or Window And Door Casig ng t reaa me 7w—(l PIY-/V A v".1 ff/7 qacAn:! C:::cf Ac essoage Includes FV!custnm Cr: Y! Drier Ncnc Ext-a-'nt Gu-,,er 2 Downspouts G C r: Lr�atnn Underlayment Insulation To Be Used Specia l\.1otes (T 'F1 Area To e Sided R Garage Ouse Siding To Be Used I C Y C C7:r Payment Policy ?A Brand /Y e pr3file Bank Fmanc:ng Ormer To Ak !� i-Tach To Arra--- Vt ge El Corner Post-L o Be sed 44 k-5 ❑Canh C)r C, El %lasier card Ccrnor Pcst total investment ED AN Ade M,.--Inf;L:!atcd 1/3 Deposit Li RPgt;i:'.r Insu'.3t" 1/3 Payment 1/3 Balance of Day Substantial You may cancel this agreement if it has been signed by a party thereto at a place other than the a dress of the seller,which may be his main office or branch thereto,provided you no'tilly the seller in writing at his main office or branch by ordinary mail posted, by telegram sent,or by delivery,not a, the tt" later than midnight of the third business day following the signing of this agreement.See. ached notice of cancellation form Tor an explanation of this right. If Date of Accepte ince— I I WC give mission to obtain all Signature tcessary permits. Sinnaat 0 Cft.- Signature The Commonwealth of Massachusetts Department oflndustrialAccidents "r -• :r, / 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information ,/� Please Print Ledbly Name(Business/Organization/Individual): T C "-0-44/ 2f _5-,e,11//P 1.0,c Address: cwc✓ooc/ �ST City/State/Zip: --c�e,-4X vee ^u v/7_y4" Phone#: 97,? 41PT /yP'67 Are you an employer?Check the appropriate box: Type of project()required): 1.&I I am a employer with . : employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. []Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.-insurance required.]t 4,F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 E]Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.0 Roof repairs • These sub-contractors have employees and have workers'comp,insurance.t 6.❑We are a corporation and its officers have exercised their right of'exemption per MGL c. 14..©Other 152,§1(4),and we have no.employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. i 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-coritmctors have employees,tYiey must provide their workers'comp.policy number. fain an employer that isproviding workers'compensation insurance for my employees.' Below is thepolicy and job site information. Insurance Company Name: SS'Rlt y Irl 4 ecly-e Policy#or Self-ins.Lie.#: 41 C ' 71J_ /.s' Expiration Date: //",Z Job Site Address: 7.Z Ju/,-t? SO2 l9/?e City/State/Zip: y 49W.,'-,e Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.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 t�he/pains and penalties of perjury that the information provided above is true and correct. Signature: �'Ja� Date: Phone#: 1!Y9 G k 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract oPhire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall. enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary, supply sub=contractor(s)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers' compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. • I City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"Job Site Address"the applicant'should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the ffidavit is on file for future permits or licenses. Anew affidavit must be filled out each applicant as proof that a valid a year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext. 7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia A�c"RO DATE(M WDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 12/112015 THIS CERTIFICATE IS ISSUED ASA 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 polfcy(ies)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 CONTACT 81 S MAIN ST NAME: BRADFORD, MA 01835 PHONE FAX (A/C,No): E-MAIL ADDRESS: INSURERn AFFORDING COVERAGE NAICS INSURED INSURER A: LM Insurance Corporation 33600 HI TECH WINDOW&SIDING INSTALLATIONS INC INSURER B: 29 ARROWWOOD ST INSURER C: M ETH UEN MA 0184.4 INSURER D, INSURER E- INSURER F, COVERAGES CERTIFfCATE NUMBER: 27467205 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 ADDL SUBR LTR TYPE OF INSURANCE POLICY NUMBERPOLICY EFF POLICY ExP COMMERCIAL GENERAL LIABILITY MM/DD/YYY -MM/DD/YYY LIMITS EACH OCCURRENCE s CLAIMS-MADE 1-1 OCCUR DAMAGE TO RENTED PREMISES Ea occurrences MED EXP(Any one person) s PERSONAL&ADV INJURY s GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY I—] COT LOC PRODUCTS-COMP/OP AGG S OTHER: s AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT s a accident) ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) s — AUTOS AUTOS BODILY INJURY(Per accident) s NON-OWNED HIRED AUTOS AUTOSPROPERTY DAMAGE S er accident S UMBRELLA UAB H OCCUR EACH OCCURRENCE S EXCESS UAB CLAIMS-MADE AGGREGATE s Dm I I RETENTIONS - s A WORKERSCOMPENSATION WC531S-383602015 11/2912015 11/29/2016 ANDEMPLOYERS,LIABILITY Y/N OER �ANY PROPRIETOR/PARTNER/EXECUTIVE EL EACH ACCIDENT 5 SOO,000 OFFICER)MEMBER EXCLUDED? N/A _ (Mandatory In NH) It yes,describe under E-L DISEASE-EA EMPLOYEE $ 500,000 DESCRIPTION OF OPERATIONS below EL.DISEASE-POLICY LIMIT S 500,()00 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedul%maybe 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 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORMED REPRESENTATIVE LM Insurance Cor oration ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD :7467205 1 1-383602 1 15-15 WC 1 Rartik Wali 1 12/1/2015 1:19:06 PM (EST)_ I Page 1 of 1 Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-096516 I Is TIMOTHY W WIC'kS 3 ELLIS ST Methuen MA 01944 yT r� Expiration Commissioner 09/09/2016 ��c�Qo�azoytn�true�rll/z af'C-�ff/�+a��rxa/r.u.rclti ` - — fee of Consumer Affairs&Business Regulation EtMPROVEMENTCONTRACTOR egistration: 11-86'6"'----, Type: Expiration! 4/26/2017; Supplement Cz� HI TECH WINDOW&SIDING INSTALL INC TIM WICKS F r= + 29 ARROWWOOD ST METHUEN,MA 01844 Undersecretary