HomeMy WebLinkAboutBuilding Permit # 6/9/2015 BUILDING PERMIT NorarN
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TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION _
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Permit No#k: � �� Date Received �y aR ..rle
ArEa PpP��y
Date Issued:
MPORTANT: Applicant must complete all items on this page
LOCATION �13v°
P r'
PROPERTY OWNER �5m/ *
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 Buildinge family
El Addition El Two or more family 11 Industrial
❑Altergtion No. of units: ❑ Commercial
EA;Ve`pair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition
❑ Other
1
DESCRIPTION OF WORK TO BE PERFORMED:
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IV
dentificati n- Please Type r Print Clearly
OWNER: Name: owe/ Phone:
Address:
Contractor Name:_ A f Phone: C7
Email
Address:
Supervisor's Construction Licenser X94 f Exp. Date:
improvement License: /
Home Imp76 1 Ex Date: -- -,�-�5
p�_
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: $ L a FEE: $ (61
Check No.: AqllReceipt No.:
NOTE: Persons contracting with unregistered cont actors do not have access to guaranty fund
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BOARD OF HEALTH
P E �R Food/Kitchen
Septic System
THIS CERTIFIES THAT .. BUILDING INSPECTOR
.
has permission to erect . .................. .... buildings on .....�. .,.rf......AA.............. ............ ....WfWj'!jw................... Foundation
Rough
tobe occupied as .......... .... ... ... .. ........ . .. ..... ... ....................................... Chimney
provided that the person accepting rhis 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
EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
// ...................................... Service
.......... ..... . rtrP..:7...�; �: ;.. Final
BUILDING INSPECTOR
g�
GAS INSPECTOR
Occupancy Permit Required to Occupy Bu ldin 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 Approvedy the Building Inspector. Burner
Street No.
Smoke Det.
L I I I
MA Home improvement Contractor,
Renewal License#1701310(Expires 12123/2015)
'Andersen, Renewal by Andersen Corporation Federal Tax ID#41.1918413::
WMDOW AiPLACEMENT
30 Forbes Rd, Northborough,MA 01532
(508)351-2200 Fax(508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
.Buyer(s)Name Date:
RONALD SMITH APRIL 13, 2015
Buyer(s)Street Address city State Zip Code
43 VEST WAY NORTH ANDOVER MA 01845
Ernail Address Home Telephone Number Work/Cell Telephone Number
RSMITH79070AOL.COM 978-688-1092 1 1
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.
Est,Start Date Method of Payment
Total Job Amount $ 8,954 Amount Financed S 8,954
Deposit Received(33%)$ 0.00 Dwoait at slv.. S 4,477.00 10-12 weeks ChecklCash
Balance Start of Job(33%)S 0.00 Chock
Balance an Substantial At 8ubatanli8� Est.Install Time Credit Card
Completion of Job(33%)$ 0.00 Cotnpletri S 4,477,00 1.2 days If Ztedift card is selected,pteam
final paywe,A W diiiriiiided tff V can�s are sswrcd s;w Credit Card Payrnent 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
W both Buyeris)and Contractor. Buyer(%)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 Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Renewal by Andersen Corporation Suyei-(S) Buyer(s)
Signature of Consultant Signatu e Siqnature
X MARK SALEM RONALD SMITH
Printed Narnit of Consultant Printed Namo Printed Name
YOU,THE BUYER(S),MAY CANCELTHIS TRANSACTION AT ANYTIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY AFTER T115 DATE OF THIS TRANSACTION.
SEE THE ATTACHED NOTICE OF CANCELLATION FORMS FOR AN EXPLANATION OF THIS RIGHT.
-
---------------------------------------------------------------------------
NOTICE OF"NCEI.LiTION
NOTICE OF CANCEI-LiTTON
Date or Tiraosa,tloa I You may cancel this I Date of Transaction 1-4/1" , lira may cancel this
transaKion,without any prrnaldy ar oblirbation,within three husiness days from the transaction.wItho.t any penalty or ohU4.flr-,-Ithbi three business d.)s from the
alame date.If you cancel,Any property traded I.,Any p.vatettlantath,by you"der 1 above data.It you cancel,any property traded in,any pajaiftits made by you under
the Contract of We,and any negotiable instrument executed by you will he I the Contract ofbale,and any negotratdr instrument executed byyou will he
-turned.1thin 10 days fallowing receipt by the Caeuractor("8e21.,")of v,-r
raux"d within 10 days follcovig receipt by the.Caair-uir of your
-aMlatinn notice,and Any security bittc*sst arising out of the transaction will be i eartet"Athm aotlee,and any securliv interest arbilog out of the transaction t4ill be
canceled. It you to the Seller at your resithnv,in 1 cuoveled. If you cancel,you must"-available to the Seller at your residence,1a
imbstaiatiallya.good—dithrio as when received,Any goods delivered to you trader I *uh.4-ii.fly-goad tandition as wire»received,any goads delivered[a yoss under
this Contract or Sale;or you may,It you wish,comply with the histrattious of the I this Contract or Sabel or you may,if you uiAt,comply with the instructions of the
Seller regarding the return shiputeint of the goods at the,Seder's expense and risk. I Seller regarding the re-turn shipment of the goods at the S*IIer`A expense and risk.
It you do make the goods Available to the Seller and the Seller does not pick them or)1 It you do make the goods available to the Seller and the Sell—do—not pitl,them,up
within 20 days of the date of your Yoder of CaaMlation'you may retain or dispose within 20 days of the date of your Notice of Cancellation,you may,retain at dispose
,or the goroto without any further obligation. of the goods without any further obligation. If you fail to intake the goods Available
to the Seller,or if you agree to return the knolls to the Seller And fail to do so,then to the Seller,or if you agree to—to—the goods to the Seller and fail to do scr,th"
gations um
tinder the ContratA, ]a cancel you reain liable for perfornartac,of all obligations under it.,Contract,'to cancel
you remain liable for performance of all obli,
traosactio.,mail or deliver a signed and dated copy of this cancefladon notice
this transaction,mail or deliver a irlVed and dated�-py of this Auc.lbtlon notice
or any other rvrittea notice,pr send a telegram to Comrartnr:Renewal by Anderson,I or any other written omice,or send.ttleg—to Comractort Renewal by Anderae
30Forbes Ind, NouthbortaighASA 01512. I 30 Forbes Rd,Northb.—ugh,WL 01532.
I HEREBY CANCEL TMS TRANKACTION'. 7 HERFZV
en 'v�� Renewal by Andersen Corporation MA Home Improvement Corsfracior
byAndersen z 30 Forbes rd Northborough:MA 01532 License#170810 (Expires 12/23/2015)
,WINDOW REPLACEMENT ,;,,: .-;,,i.,.,,;..,,,. (508)351.2200 Fax:(608)-9$6.7072 Federal ID#41.1816413
Window Specification Sheet
i uyer;s;Naniv Datc of`Agreenicut
RONALD SMITH MOnt, APR 13, 2015
I ht.l.)ttlf 1';1listed al)rlly hvrvb,,joillk and 14`t'('t':lttt'agrvv It)pnit-haw Illi',r,•'tlods and/til sellif es listed la-low,ill ac.r ordaltcc 1Filh Itit,prici-N Gild wrins tlewribed
suer tilt,sprt�ifit°miolr sheet and the tiuuf.alld lilt,rc:velsi'cel`dm aeee)rrtpart)'iifp (:C:Si"(}\.l'I1LL\DOW A ND llOOR RENIODE LLINCI AGRI-C\liiV"t;of,Which
the Spccitiradon Slat-1 i,part,
WINDOW&DOOR DE'WLS
8{^ti App, A{;p6 Exterkor/1ntevfor Colo, ifiwklaaro iiaitt,vvVv Lok"E's t Grir8 ("Ne Glass
Room a ,n:d;tr tkipor u.r. WindowlDoor Style Detail Casings Ext•lnt Color 544- S—ac Smarrun Grilles Sash 1 3 sa it" Utts Q tion%
Ibial I IIAY now&Rini D Ou'I DETAILS
Styla Chetah nn
1 ,,icary Apprax. Ntxritter Fiaa window Ead Center Lowll f Roof! Hardware
Roo,n Catntt Stylet f.mkCrs i>e'ht Cr,slt a Nt477u Laos Interior ExL%it Color Gt l,.)s sashes ut has Scrcu;+ts &PA tstui soffit Color '..
Dini lilt Ba 1:2.7 DS.PlMDfissi 97 10 Full 41'45 3 Birch ir1WH iNTW 212 5f4 FFG sniausun f Stone ',
SPECUUFY WINDOW DETAMS
Full r Aporax. trs:vE: Specialty
DAY/I10tiy ADDITIONAL WORK NOTES
Room Ceunt style . rns-K U.I. - smanstrn Grilles Grille StyW ExOnt Color r:vr•i,;x- ,.tr,•ltzok lglt;f - i:,f..r:, h r).iurh,i
ADDITIONAL WORK DETAI Si
No Contractor will wrap exterior casings with coil stock color of
Owner is aware that Contractor does not do any painfingistaining or remavailinstaiiatfon of aterrn s}stem or window treafinentslhaniware.Itis the lespansibility of
the homeowner to have the alarm system and window freatmentslhardware removed prior to installation. bee make no guarantee as to whether aiarn)s or window
treatmentsthardware will fit atter replacement, Customer is also aware in some cases there will be glass toss, 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 Yea 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.
f Yes Building Permit--Contractor will secure any and all necessary permits. The fee for the parmit(s)Is included ill the total contract price.
Yes All discounts have been applied to this agreement.
Y"', N(, Owner agrees to be present an the final day of installation for final inspection and to deliver final payment/finance formis).
:11 ii al,r4<rl purl kill,1,rxa)rtd Ira and la,IsAtier)tLr palfi"N that ifrc,SIN 612;ltioa slim.!,aluttv uiih Iger(:LL4 i'('3\t tl'1\Dt.11t'dNf)Di}C)tt ftl St(J7)!d l\t:,ItIILLt lg1\r,u,naituu rltrr ubrr
iundrr,tuudin>y L,rurru tilt 1 relic.,and rk rig sn•nu resbal untlt r r u,Gns;v til nra.inr;r,r r t.dtiirt:, In n(rho u-int.."['iii,Sri,,,ifirari($n Sip t t nrtr n l hc f nr its lemic IDldiificd Uc t;aicd in
alts n.n nult•a,sue li elr,utr;s•,O,w is+gitnr>..'ctrl,i},peel fw Writ IN,lhn r, 1{ tr ;44gm: (,4rCer'i 1 here I),ar to cd*,111:11 lio"1;,t Its rt,trl tIli::tiltr,�fit Mi<,),t.`'SLtrl,
RanawaibyAndersen Corporation
If !t Ililvk
Signature of Consultant g lure Signature
MARK SALEM RONALD SMiTH
Print Name of Consultant Print Name Print Name
The Commonwealth of Massachusetts
Department of IndustrialAccidents
Office of•In vestigadons
' 1 Congress Street,Suite 100
Boston,AIA 02114-2017
www.massgovldia
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant Information Please Print Leribly
Name (Business/Organization/Individual): RENEWAL BY ANDERSEN
Address:30 FORBES ROAD
City/State/Zip:NORTH BORO, MA 01532 Phone#:508-351-2200
Are you an employer?Cheek the appropriate box: Type of project(required):
1,OF I am a employer with 30 4. 0 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 8. ❑Demolition
working for me in any capacity. employees and have workers'
insurance. 9 El Building addition
comp.[No workers' comp.insurance P•
required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions
3.E3 I am a homeowner doing all work officers have exercised their I I.M Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] t c. 152, §1(4),and we have no
employees. [No workers' 13.❑Other
comp. insurance required.]
*Any applicant that checks box*l 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.
tContractors that check this box must attached an additional sheet showing the name of the subcontractors and state whether or not those entities have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy number.
I ane an employer that isproviding 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 330293800 Expiration Date:10/01/15
Job Site Address: V-3City/State/Zin• 1414 �V/����✓
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do here a der the pains and penalties of perjury that the information provided above is true and correct
i anatue. Date: 05/19/15
Ehone -351-2200
Offlelal use only. Do not write in this area,to he completed by city or town official.
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector
6.Other
Contact Person: Phone#:
ANDECOR-01 YADAVYO
CERTIFICATE OF LIA [ a INSURANCEDATE(MMDyM)
10/1/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 NAME:
certiflcatesl@wiills.com
Willis of MinnesotaIncNo Ertl:Inc. PHONE
C10 26 Century BIVO (877)945-7378 11M No):(888)487-2378
P.O.Box 305191
E-MAIL
Nashville,TN 37230-5191 ---------
INSUR S)AFFORDING COVERAGE NAIC0
INSURER A:Old Republic Insurance Company 24147
INSURED INSURER B:
Renewal by Andersen Corporation INSURER C:
30 Forbes Road INSURER 0:
Northborough,MA 01532 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 O
L SUBS! POLICY
L POLICY NUMBER IMMIODIYYYYIMMR?On!YYY LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,00
CLAIMS-MADE Al OCCUR MWZY302940 10101/2014 1010112015 PREMISES(En occurrence) $ 500,00
MED EXP(Arty one person) $ 10,0
PERSONAL&ADV INJURY $ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ _4,000,00
X POLICY❑JECT LOC PRODUCTS-COMPIOPAGG $ -- 4,000,00
OTHER: $
AUTOMOBILE LIABILITY COMBI c �Eeo s E IMIr a 5,000,00
A X ANY AUTO MWT8302576 10101/2014 10/01/2015 BODILY INJURY(Par person) S
ALL OWNED SCHEDULED BODILY INJURY(Per acddent) b
AUTOS AUTOS
aweDAMAGE
HREDAUTOS AOSP s
s
UMBRELLA LIAR HOCCUR EACH OCCURRENCE S
EXCESS LIAO CLAIMS-MADE AGGREGATE S
DED RETENTIONS 6
WORKERS COMPENSATION X
STATUTE
AND EMPLOYERS'LLIABILITYER
A ANY PROPRIETORIPARTNERIEXECUTIVE YIN MWC30293800 10/01/20140101120115 E.LEACH ACCIDENT $ 1,000,00
OFFICERAAEMBER EXCLUDED? Fff I NIA
(Mandatory In NH) E.L DISEASE.EA EMPLOYEO$ 1,000,00
It yea,describe under
DESCRIPTION UFOPERAIIONSbelow I I I E.L.DISEASE-POLICY LIMIT I S 1,000,00
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 701,Addlttonal Remarks Solwdule,may be attached M more apace Is raquhed)
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 REPRESEHTATNE
Evidence of Insurance VK
(O 1996-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supen*or
License:CS-M125 yz t
JAi L MORIN `
86 GARDINER S7E
LYNN MA 01905'
Expiration
Commissioner 110108!2016
IIfice of Consamer Affairs&$uainess Regulation
OME IMPROVEMENT CONTRACTOR
Registration: 170810 Type: i
EXPIM00n: 17n3121115 Supplement r
RENEWAL BY ANDERSON CORPORATION
,!AIME MORIN
104 OTIS STREET
NORTHBOROUGH,MA 01532
Undersecretary
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ENERGY PERPORMANCE RATINGS
U-Factor -50far Heat Gain Coaffloje t
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ADDITIONAL PERFURMANCe RATI1vGS
Visibie Transmittance
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Renewal
byAndersenr
WINDOW' REPLACEMENT AnAnder,=Company
WoodNinyl Composite IF
Dual Argon Low E4 SmartSun
Double Hung
100-00473518-010
ENERGY PERFORMANCE RATINGS
U-Factor(U.S)/I-P Solar Heat Gain Coefficient
.J 9
0029
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ADDITIONAL PERFORMANCE RATINGS
Visible Transmittance
Om42
Manufaeturar stipulates that these ratings conform to applicable NFNC procedures for d.l urniningwhole product
performance.NFHC ratings are detannined for a fixed sat of environmental conditions and a epecil'io product s¢a.
NFRC does not recommend any product and does not warrant the suitability of any product for any specilic use.
Consult manufacturer's literature for other product performance information.
�+- e www.nfrc.org
This product meats Green I q*
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Zstandards govantnq energy d+µ40i,5J:�.°.°.a. rj, ^r-' ? -t•-�•�'•''�*�,
efficiancy,heavy metals in S/r:;• "'-� .o'•�
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