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HomeMy WebLinkAboutBuilding Permit #093-2017 - Exception 7/28/2016 �4RTy O`�t�ec bq�0 BUILDING PERMIT o �C TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: ��� Date Received —1 ��j 79 A�RATlO IPP��S Date Issued: I G'�IkSSA ""Sti I PORTANT: App licant must complete all items on this page tzk -Z° - ➢ °' :mom nf% / Yr EYSm ➢ wfs kkniw `vA 4 Y +" l LO.CAfi ION h ,, x PROPRT1 OW» R f //�Y ` 111 - e i rkYA 9 R`mC -ac- MAP NO PARCEL O1 It D1S�f I �C � Hr trrdiD tdet „ .:� aj3rehoVlig �Y. s h rn TYPE OF IMPROVEMENT PROPOSED USE Residential p Non- Residential !-i New Building C-] One family Addition Two or more family % Industrial .✓Alteration No. of units: C:; Commercial ,:/Repair, replacement Assessory Bldg C-, Others: i Demolition % Other S�pt�c. D 1lNell � Floodplain "i 'Wetlandlb- Pm U Identification Please Type or Print Clearly) OWNER: Name: Aal � Phone: Address: () �)A , ( C) (_0 COIi3A+uORName �r � Phoned > � "'� s Add'ress w 10 Superrisor's/L; r��udttar Lrcelse E � Daf A3 r 3 n y - 4 > Homme mprovemen License . � ry- 71 11-7 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: $ 31&)3 -�'s FEE: $ 4-(.e — Check No.: V 4121 Receipt No.: ?x:Xp-1k NOTE: Persons contracting wit unregistered contractors do not have access to the guaranty fund 1 Signature of Agent/Owne�9 gnture of.contra BUILDING PERMIT O F NORTy, q is ,.Ci ED 16 TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION 2 y �A-O± F ^moo Permit No#: Date Received 7�p°Rwreo�4a�(y �SSgCHUS�� Date Issued: IMPORTANT:Applicant must complete-all items on this page LOCATION. 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 ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement - ❑Assessory Bldg ❑ Others.- 0 thers:❑ Demolition ❑ Other TSeptic .,Well' ,,❑ Floodplain ❑Wetlands ' ❑ WatershedDistract r.q t ^r t+`1+ .t c.t yrrc�. ,i " '{S. t r .^Y �.,' 1` "-�''�t-r _��� �-p. .a x:0 Water/Sewer -- t .11; ''' T 3_`• 's r t.+s ' _A «. C DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund i.gnature of Aaent/Owner Sioh6f* 6 of contractor Location A-e- No. - Ocl 3 `zw7 Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ �`"' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1 Check#1 1 � aJ . J Building Inspector "•`/ i 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 FORD PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments s !Dater & Sewer Connection/signature Date Driveway Permit DPW'gown]Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster onsite 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. i Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector p Yes N® DANGER ZONE LITERATURE- Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine i NOTES and DATA— (For department ruse) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 r I Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, 9 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 i 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/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 T Photo of H.I.C. And C.S.L. Licenses 4 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 Doc:Building Permit ReAsed 2014 n NORTH Town of o No. 1 h � ver, Mass d� c6 COCNIC Nf WICN U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT !`!„ BUILDING INSPECTOR ......4J.. .a............ .... ........................ ... ....... ...... .. .. .. .. .. .. ...... has permission to erect buildings on ........ ���twa , Foundation Rough to be occupied as ....`o...... .... ... .... .... .,,5........................................... Chimney provided that the person acceptin this permit shall in eve respect conform to the terms of the application g p every P pp 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 CONST TIO Rough Service .. . .. ....... . ..... .... ...... Final BUILDING SPE OR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. E.B. Window and Siding Co. Invoice 756 Western Ave Rt 107 Date Invoice# Lynn MA 01905 7/18/2016 53030 Bill To Ship To Jason Rollins 77 Edgelawn Ave 208 Green St #11 Melrose MA 02176 North Andover MA P.O. Number Terms Re Ship Via Rep p F.O.B. Project 7/18/2016 Quantity Item Code Description Price Each Amount Job Address:77 Edgelawn Ave#11,North Andover 10 remw Remove existing windows and prepare opening to accept new O.00T vinyl replacement windows 10 mic Furnish and install Fusion replacement windows 225.00 2,250.00T 20 mic Colonial Grids per sash 12.00 240.00T 4 mic Mull window charge 35.00 140.001' 10 mic Install Window masonry opening 95.00 950.00T ctg Clima-techplus insulating glass including low e/Argon gas, 0.00 double strength glass gr .All Window to carry a lifetime warrantee to the original owner 0.00 0.00 including glass failure and breakage tbs Seal Windows in and out using'Tite bond lifetime sealant 0.00 rem "Take away all job related debris 0.00 v13 Any building permit required to complete project to be added at 0.00 0.00 cost to the final payment accept acceptance of proposal 0.00 0.001' authorized signatur Sales Tax 6.25% 223.75 All sizes on file ready to order Phone# Fax# E-mail 4ile $3,803.75 781-592-9747 781-592-9746 ebwindow@msn.com www.ebwindow.com The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/ uIF ers Applicant Information Please Print L ibl Name (Business/Organization/Individual): EB Window and Siding Co Address: 756 Western Ave City/State/Zip: Lynn, MA 01905 Phone #: 781-59279747 Are you an employer? Check the appropriate box: Type of project(require 1.0 I am a employer with 6 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. E]New construction f 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [No workers' comp. insurance com required.] 5. ❑ p. insurance. We are a corporation and its 10.❑Electrical repairs oA dditions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs o )dditions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.] t c. 152, §1(4),and we have no 13.0 Other employees. [No workers' comp. insurance required.] / *Any applicant that checks box#1 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 indicati uch. +Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities 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 j' , site information. Insurance Company Name:Berkshire Hathaway Gaurd Insurance Co Policy#or Self-ins. Lic. #:EDWC643855 Expiration Date: 12/13/16 Job Site Address: City/State/Zip: Attach a copy of the workers compensation policy declaration page(showing the policy number and expirati , date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal pena:. Ds 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: d 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains andpenalties ofperjury that the information provided ab ve is tr a and correct Si nature: Date: Phone#: 781-592- 47 t 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 Inspe Ar 6. Other Contact Person: Phone#: ACo® CERTIFICATE OF LIABILITY INSURANCE FDATE(MMtDD/YYYY) `.,../ 7/7/2016 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(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 CONTACT Commercial Lines NAME: Admiral Insurance Agency,Inc. PHONE (781)599-2000 FAX A/C Jig Ex A/C No): 70 Munroe Street E-MAIL ADDRESS: Suite D INSURER(S)AFFORDING COVERAGE NAIC p Lynn MA 01901 INSURERA:Providence Mutual Fire Ins Co 15040 INSURED INSURER B:Guard Insurance EDMUND DBA BYRNE & ED BYRNE WINDOW COMPANY INSURER C: 766 WESTERN AVENUE INSURER D: INSURER E: LYNN MA 01905 INSURER F COVERAGES CERTIFICATE NUMBER-CL1631522634 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 TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR POLICY NUMBER MMIDD/YYYY MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE U OCCUR DAMAGE TO RENTED 1,000,000 PREMISES Ea occurrence $ BOP0063101 6/21/2016 6/21/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY❑ PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 JECT OTHER: FLL $ 50,000 AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 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 LIAB OCCUR EACH OCCURRENCE $ �r EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION PER TH- AND EMPLOYERS'LIABILITY ST YIN ATUTE R ANY PROPRIETOR/PARTNER/EXECUTIVE EDWC643855 12/31/15 12/21/16 E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? n N I A B (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. AUTHORIZED REPRESENTATIVE J S Scholnick/MPB ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INSn25r9mami Office of C'onsu'mer Affairs&Husine.ss Regulation � iOME IMPROVEMENT CONTRACTOR ,Registration: 128634 Type: Expiration,.. 5l212017 DBA ED BYRNE V4INDOW CO EDWUND BYRNE 756 WESTERN,AVE LYNN,NIA 01902 (ndercecretary Massachusetts n Departn;entNof Public Safety SOardO'tsuUdintg Reguiationsar, Standards. _«r License: CS-010870 EDMUNDJHY '4 18 Woodrow T+emice ; ` Lynn MA 01904 1 �l s Exptratoc,n Ccsn issrsrrer 07!09/2017