HomeMy WebLinkAboutBuilding Permit # 4/10/2015 BUILDING PERMIT
NORrH
TOWN OF NORTH ANDOVER 0
o ;
APPLICATION FOR PLAN EXAMINATION
Permit No#. " Date Received
Ssgcwus�
Date Issued:
IMPORTANT: Applicant must complete all items on this page
' n
ht��r�rr rt r r a
a
p�I l� „'I+i�w r .v p r orfiu hnov�ilirr^,»ala V rluva�+nN 9mu71gllr v /
I
CI Ite�S ,O" a E , e o
a.
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition 0Two, or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
epair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
J 1l,r„�n?d,nr'tS ovx./Hm,°e��Il,iy�+I�c���I�e'i,i��fi�u r r/1r,e�r r�/�y/eI»J,;/�»af I/1-r�lrl��/,fr0!/�,yl��il�/%�l�rl�®,6i I��➢Ir/I cly�rtrrt�/G �.�uro,rl ll(orillV�kll ff,F7 '�2ai //1% /Ml1/c/t,A»N01J(lfGUcdomg/ 111 li c «JDr tr
.'r.,.
DESCRIPTION OF WORK TO BE PERFORMED' "A101
I entificatio Please Type or Print Clearly
OWNER: Name: � �tAX/ ' L-/ 4 Phone:
Address: V !��'°� � ��
Ave
fy //l dl rliein� " „ `/
Ell
a I �
u�� u�I r Wlv IM��Mr e a 9sa� �Iwall ''I mxv r Inim,tla ri h
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.
o0a
Total Project Cost: $ / FEE: $l� v 1
Check No.:
Receipt No.: 1-
NOTE; Persons contracting with unregistered contractors do not have access to the guaranty fund
FORTH
TownEAndover
O -
* ,9.
h ver, Mass
,
Q • LAKE 1
COC HICHF WICK
�d A�RPP
A'rED jpk \ �
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT LD Septic System
THIS CERTIFIES THAT .............�1.11.101 � 11 a. .... BUILDING INSPECTOR
..................... .....K.0................................... ... Foundation
has permission to erect .......................... uildings on . .!...... ►.4!�!R,. . .IJ:..... �....
Rough
to be occupied as ..........1............... �. ) .... ................................... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of 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 CONSTRUCTION STARTS Rough
�, Service
................ ...... . f ..... �
..... ............................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required t® Occupy PuRough
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.
eney MA Home Improvement Contractor
License#170810(Expires 12/23/2015)
�Andersenw Renewal by Andersen Corporation Federal Tax ID#41-1918413
WINaOW aEPIAREMENT or,Anxkrv+:n C:.mirNny '..
30 Forbes Rd. Northborough,MA 01532
(508)351-2200 Fax(508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
Buyer(s)Name Date:
SUSAN PAPALIA - MARCH 20, 2015
Buyer(s)Street Address City State Zip Code
24 RICHARDSON AVE. NORTH ANDOVER MA 1 01845
Email Address Home Telephone Number Work/Cell Telephone Number
SUE.PAPALIAORAVEIS.COM 978-685-9191 508-451-3575
Buyer(s)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation("Contractor"),in accordance with
the terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this"Agreement").
Buyer(s)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement.
Total Job Amount $ 16,998 Amount Financed$ 0 Est.Start Date Method of Payment
Deposit Received(33%)$ 5,666.00 Deposit at signing$ 0.00 Check/Cash
8-10 weeks
Balance Start of Job(33%)$ 5,666.00 Check#
Balance on SubstantialAI Substantial Est.Install Time Credit Card
Completion of Job(33%)$ 5,666.00 Completion$ 0.00
1-2 days If credit card Is selected,please
No final payment shall be demanded until all parties are satisfied I I see Credit Card Payment form
Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings
changing or modifying any of the terms of this Agreement. No alteration to or deviation from this Agreement will be valid without the signed,written consent
of both Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyer(s)1)has read this Agreement,understands the terms of this Agreement,and has
received a completed,signed and dated copy of this Agreement,including the two attached Notices of Cancellation,on the date first written above and 2)was
orally Informed of Buyers right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Renewal by Andersen Corporation Bu s) Buyer(s)
By: /OCL/L B&ty 1 4--1
Signature of Consultant Signal V
Signature
x JOHN BEAVER SUSAN PAPALIA
Printed Name of Consultant Printed Name Printed Name
YOU,THE BUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER THE DATE OF THIS TRANSACTION.
SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.
------------------------------------r ------------------------------------ I
NOTICE OF CANCELLATION I NOTICE OF CANCELLATION I
Date of Transaction 3/20/15 You may cancel this I Date of Transaction 3/20/15 You may cancel this
transaction,without any penalty or obligation,within three business days from the transaction,without my penalty or obligation,within three business days from the
above date.If you cancel,any property traded in,any payments made by you under I above date.If you cancel,any property traded in,any payments made by you under
the Contract of Sale,and any negotiable instrument executed by you will be I the Contract of Sale,and any negotiable instrument executed by you will be
returned within 10 days following receipt by the Contractor("Seller") of your I returned within 10 days following receipt by the Contractor("Seller") of your
cancellation notice,and any security interest arising out of the transaction will be I cancellation notice,and any security interest arising out of the transaction win be
canceled. If you cancel,you must make available to the Seller at your residence,in I canceled. If you cancel,you must make available to the Seller at your residence,in
substantially as good condition as when received,any goods delivered to you under I substantially as good condition as when received,any goods delivered to you under
this Contract or Sale;or you may,if you wish,comply with the instructions of the I this Contract or Sale;or you may,if you wish,comply with the instructions of the
Seller regarding the return shipment of the goods at the Seller's expense and risk. I Seller regarding the return shipment of the goods at the Seller's expense and risk.
If you do make the goods available to the Seller and the Seller does not pick them up I If you do make the goods available to the Seller and the Seller does not pick them up
within 20 days of the date of your Notice of Cancellation,you may retain or dispose I within 20 days of the date of your Notice of Cancellation,you may retain or dispose
of the goods without any further obligation. If you fail to make the goods available I of the goods without any further obligation. N you fail to make the goods available
to the Seller,or if you agree to return the goods to the Seller and fail to do so,then to the Seller,or if you agree to return the goods to the Seller and fail to do so,then
you remain liable for performance of all obligations under the Contract.To cancel I you remain liable for performance of all obligations under the Contract.To cancel
this transaction,mail or deliver a signed and dated copy of this cancellation notice I this transaction,mail or deliver a signed and dated copy of this cancellation notice
or any other written notice,or send a telegram to Contractor:Renewal by Andersen,) or any other written notice,or send a telegram to Contractor. Renewal by Andersen,
30 Forbes Rd. Northborough,MA 01532. I 30 Forbes Rd.Northborough,MA 01532.
I HEREBY CANCEL THIS TRANSACTION. I I HEREBY CANCEL THIS TRANSACTION.
I '
I
Buyer's signature Print Name Date Buy."S signature Pant Nema Dale
Renewal by Andersen Corporation MA Home Improvement Contractor
Noniidt�rsen.rA 30 Forbes rd Northborough,MA 01532 License#170810 (Expires 12/23/20115)
WINDOW REPLACEMENT -A 1—n( jiv (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413
Window Specification Sheet
Buyer(s)Name Date of Agreement
SUSAN PAPALIA FRI, MAR 20, 2015
The buyers)listed above hereby jointly and severally agree to purchase the goods and/or services listed below,in accordance with the prices and terms described
on the Specification Sheet and the front and the reverse of the accompanying CUSTOM WINDOW AND DOOR REMODELING AGREEMENT,of which
the Specification Sheet is part.
WINDOW&DOOR DETAILS
App. Apo. APPx ExterlorAnterlor Color Hardware Hardware LowE4 Grin. Grille Glass
Room # !!dlh hal ht I Wlnclon��Detail Casinos Ext-Int Color §!yle Screens Smarlsun Grilles sash 1/3 Sash 2 fla O tions
_k� __Is U__
Bath 1 101 31 43 74 DB a rail a ual Insert slo ed sill ------- wH/wI White Standard HAL SmartSur GBG 3/2 ----- No
Bed 1 102 31 55 86 Ds a rail a trial Insert slo ad sill ------- wi-iml- White Standard HAL SmartSur GBG _112 No
Bed 1 103 31 55 86 DB a rail a ual Insert slo ad sill ------- wH/wl- White Standard HAL SmartSur GBG 3/2 ----- No
_Bed2 104 31 55 86 DB a rail a ual Insert slo ad sill ------- wHivil- White Standard HAL SmartSur GBG 3/2 ----- No
Bed 2 105 31 1 55 1 86 DB so rail equal Insert slo ed sill ------- wHiwi- White Standard l HAL martsurl GBG 1 3/2 1 ----- I No
Bed 2 106 31 55 86 DB so rail actual Insert sloped sill ------- -WH/wi- White Standard HAL 3martSur GBG 3/2 ----- No
Bath 1 201 31 43 74 DB rail a List Insert slo so sill ------- wH/wi- White Standard HAL 3mar!Sur GBG 3/2 ----- No
Bed 1 202 31 55 86 DB lqlqll e wHiviti- White Standard HAL 3marlSur GBG 3/2
Bed 1 203 31 55 86 D13 so rail Royal Insert sloped sill ------- wH/wi- White Standard HAL 3 martSur GBG 3/2
Bed 2 204 31 55 86 1 DB a rail a Lai Insert slo Ed sill ------- wHmi- White Standard. HAL SmartSur GBG 3/2 ---- No
Bed 1 20,5 31 55 1 86 DB so rail eaual Insert sloped sill ------- wHm" White Standard HAL SmartSur GBG 1 3/2
Bed 2 206 31 55 86 DB s rail a nal Insert aro ed sill ------- WH/W White Standard HAL Smarsur GBG 3/2 ----- No
Total 12 BAY,BOW&BUILD OUT DETAILS
Approx
Style ai
Detl width/ Approx. Number Frame Window End Center LowE Roof/ Hardware
Casinos Angle Lhes Interior ExIlInt Color Grilles sashes I
_aocinn Count 111. lisnMre W. sashes Screens Smartsun Soffit Color
SPECIALTYWINDOWDETAILS
Full/ Approx. LME/ Specialty BAY/BOW ADDITIONAL WORK NOTES
Room Count St q Insert U.I. SmartSun Grilles Grille Style Ext/Int Color C.qis—thm,,ilh b,,/bow,id..d,,72 inches
there,ill be si&'ficant 0—1
ADDITIONAL WORK DETAILS:
I No Contractor will wrap exterior casings with coil stock color of
Owner Is aware that Contractor does not do any painting/staining or removal/installation of alarm system or window treatments/hardware.It is the responsibility of
the homeowner to have the alarm system and window treatments/hardware removed prior to Installation. We make no guarantee as to whether alarms or window
2 treatments/hardware will fit after replacement. Customer Is also aware In some cases there will be glass loss. If there is,the amount will be dependent on the type
of existing windows,type of installation and window style.We make no guarantee as to the amount of glass loss.Customer Is aware and understands any and all
unseen rot is not Included In this contract.Should any rot be found there will be an additional charge for time and materials unless so stated in this contract
3 yes Contractor will insulate,caulk and seal windows with 3-point system to prevent water and air Infiltration.Removal and disposal of all job related debris,
windows,doors,storm windows and vacuum nightly Included. Upon completion of the job and payment In full,a limited warranty shall be issued.
4 yes Building Permit--Contractor will secure any and all necessary permits.The fee for the permit(s)Is Included In the total contract price.
5 yes All discounts have been applied to this agreement.
6 V Yes I No Owner agrees to be present on the final day of Installation for final Inspection and to deliver final payment/finance form(s).
It is agreed and understood by and between the parties that this Specification Sheet,along with the CUSTOM IVINDOAV AND DOOR REMODELING AGREEMENT,constitutes the entire
understanding between the parties,and there are no verbal understandings changing or modifying any of the terms.This Specification Sheet may not be changed or its terms modified or varied in
any way unless such changes are in writing and signed by both the Buyers)and Contractor. Buye,,hereby acknowledge that Buyer(s)has mad this Specification Sheet.
Renewal by Andersen Corporation �•r(s) _Pl� Buyer(s)
LLA_J�e
By_ -7,W,,,,z&o CA/VL -4 J __ __r
Signature of Consultant Signattkd Signature
JOHN BEAVER SUSAN PAPAILIA
Print Name of Consultant Print Name Print Name
The Commonwealth of Massach usetts
Department oflndustrialAccidents
a
Office of Investigations
x I Congress Street, Suite 100
Boston,M4 02114-2017
b" www mass gov/dia
Workers' Compensation Insurance Affidavit: builders/Contractors/Electricians/Plumbers
Applicant Information .Please Print Ltgibly
Name (Business/Organization/Individual): RENEWAL BY ANDERSEN
Address:30 FORBES ROAD
City/State/Zip: NORTHBORO, MA 01532 Phone#:508-351-2200
Are you an employer?Check the appropriate box: Type of project(required):
L I am a employer with 30 4. 1 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. M Remodeling
ship and have no employees These sub-contractors have g• R Demolition
working for me in any capacity. employees and have workers'
insurance.$ 9• E]Building addition
comp.[No workers' comp. insurance P•
required.] 5. R We are a corporation and its 10.0 Electrical repairs or additions
3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.E]Roof repairs
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#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 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:OLD REPUBLIC INS. CO.
Policy#or Self-ins. Lic. #:MWC 30293800 Expiration Date: 10/01/15
Job Site Address: 141/ ez, City/State/Zip:
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do herebycertif un the pains and penalties ofperjury that the information provided above is true and correct
Si pure: Date:
Phone#: -351-220
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#•
a
�s
Massachusetts -Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor
License: CS-090126
JAIIM L MORIN
96 GARDINER ST t, (
LYNN KA 0190$
Expiration f
Commissioner 10/06/2016 I
(92.
1Q09)ir�lt04L[!/E O�(JJdIJP. 6 j',
Hike of Consumer Affairs&Basiness Regulation
OME IMPROVEMENT CONTRACTOR
Rgistrattbn: 17081
Type, r.
f Expiration: 12)23/2015 Supplement�.
RENEWAL BY ANDERSON CORPORATION
JAIME MORIN
104 OTIS STREET 4L ,
NORTHBOROUGH,MA 01532
Undersecretary "
3i
ANDECOR-01 YADAVYO
CERTIFICATE OF LIABILITY INSURANCE DATE(INrlpplyYm
10/1/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOl D �S
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 IN RD
AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER
IMPORTANT. N the certificate holder Is an ADDITIONAL INSURED,the polky(ies)must be endorsed, H SUBROGATION IS WANED,subject to
the terms and conditions of the policy,certain Policies may require an endorsement. A statement on this certlncate does not confer rights to the
certificate holder In lieu of such endorsements,
PRODUCER "`T certificates Ilis.com
Willis of Minnesota Inc.
do 26 CenturySiva PNON; :(877)946-7378
P.O.Box 306191 No:(888)487-2378
Nashville,TN 372305191 Aoo�;
s AFFORDING COVERAGE NAIc M
INSURERA:Old Republic Insurance Compan 24147
INSURE
INSURER B
Renewal by Andersen Corporation INSURER C
30 Forbes Road INSURER D:
Northborough,ILIA 01632
INSURER E:
INSURER F;
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THI5 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 CONTRACTOR 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.
LTR TYPE OF INSURANCE POLICY NUMSER
A X COMMERCIAL GMERAL LIAelurr LIMA
EACH OCCURRENCE $ 1,000100
FP CLAIMS-MADE ®OCCUR 302940 10101/2014 10/01/2016 PREF E $ 600,
MED EXP one person S 10,
PERSONAL 6 ADV INJURY S 1,000,00
�AGGYRE GATE LIMIT APPLIES PER:ESC ❑LOCGENERALAGGREGATE : 4,QOO,QO
1PRODUCTS-COMP/OPAGO t 4,000,00
:
AUTOMOBILE LIABILITY t
raodde I L t 6,000,00
A X ANY AUro 302676 10/01/2014 10/01/2015 BODILY INJURY(Par person) S
AALLOUTOS D sSCHE �
7BODILY INJURY(Peraoddent) s
HIRED AUTOS AIN R OWNEO R E `
UMBRELLA LJAB Ni
OCCUR EACH OCCURRENCE j
EXCESS LAO CW -MDE
MSA
DED I I RETENTIONS
AGGREGATE $
WORKERS 00MPELSAn0N $
ANDHAP10YERS'LLABNLITY r/N X sT
A ANY PROPRIETOR
OFF IIISM BER
EXCLUDE ®NIA 0293800 10/01/2014 10/01/2015 E.L.EACH ACCIDENT
(MysensdFR
o wyAtN►q $ 1,000,
DESCRIPTION under OPERATIONS below EL DISEASE EA EMPLOY $ 1,000,
E.L.DISEASE-POLICY LIMIT $ 11000,
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addlgonsl R.-"-ftWh le,airy be atfadred 11'"N"space Is requk"
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLIOS BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS,
AUTHORIZED RE+RESEWATIVE
Evidence of Insurance -
01988-2014 ACORD CORPORATION. All rights
ACORD 26(2014101) Tho®cnRn nu..,e...s r....___ - - - ----- reserved-.-'j
ReneWal
ne
KPLAC ERV §a
wAwn oodmqw CMIPOSM
pp S�IFW@-4
numb"M
100 0-010
PERFUMACE IMICs
U-F'act®r(1.S)A-p War gloat Giro CcattEcfent
0111ML PE CE RATIEWNS
tax
Own � Nrnq C �
�Q¢q � tib br
R� Y
� iso �� �• � e�4—p
D�ItatV�6i�SdIR�(P�� '
d0 Sloped Silk. DR IN