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Home My WebLink AboutBuilding Permit # 6/15/2015 VaORT11 BUILDING PERMIT 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#:. Date Received E D Date Issued: L"W"PORTANT: Applicant must complete all items on this page LOCATION7.— Print PROPERTY OWNER Vv Y09 e go.n Print 100 Year Structure yes <ffo MAP PARCEL: ZONING DISTRICT:_ Historic District yes Machine Shop Village yes <3P TYPE OF IMPROVEMENT— PROPOSED USE Residential Non- Residential Ei New Building One family [I Addition [i Two or more family [I Industrial [I Alteration No. of units: [i Commercial j? Repair, replacement 0 Assessory Idg — [1 Others: El Demolition ❑ Other W F. 'Wshed D ,�1/��W��er�Se„,wed”%cif/��%�� /��f��%��1��/�i/ DESCRIPTION OF WORK TO BE PERFORMED: t�z V'rAe Identification- Please Type or Print Clearly Phone: OWNER: Name: "YIle - Ore'1011-AOlf Address: 0 r 14�rec,4 - Phone: '0171' -*Ir4�T Contractor Name: P Email: e e 4-co A , 1.1#*x Address: Xo -les-erf �46- Sur -0 vl'p V'y S upervisor's Construction License: —Exp. Date: Home — or //sr r-r 4C e Improvement License: Exp. Date: 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. Vz Total Project Cost: $ FEE: $ P Check No.: (11"; - Z6), —Receipt No.: NOTE: PersonscoOtractting with unregistered ccVtractors (,o no have access to the guaranty fund �no Y)V,?�rinTrAl %aoRry Town ofE ..1.. ndover ® bio) ® i - ,t• - _ Zy t� o LAKE h ver, Mass,. COCHICHt WICK A°RATEDP mmmllft� S U BOARD OF HEALTH Food/Kitchen ER .MIT T L 1 Septic System THIS CERTIFIES THAT '� ~ BUILDING INSPECTOR ........................ ...................... ................................................ ............... ............ has permission to erect ..... buildings on . °.��5,,,... �� Foundation ....................® ..... ...... .... .. ................. ® Rough to be occupied as .............. `. .. 4.....V............................................................................................ Chimney provided that the person accepting this per it 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. . Final PERMIT E IR 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTR ARTS Rough Service ® ..... .. 5..................................®....................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required to Occupy Building 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. Wh i d ou%m/ -65 S o',d hn g, rC. 8 DO 11 N G R0. Box 8234, Vilfard Hill, MIA 8100-J5 MA Reg. # 118836 29 ArroVVWood eat. Me,hijizr, MA 0,18i MA Lic ft 0.16201 800-8-,--1 o-0 Cs 0 Datca: Os 0 rY- 15 Job Name: d No Job Address: r 0 e, 31 Ulf 0 I'M ra: CONTRACTOR agrees to start described work on/or about weeks after final fittings and complete omI t described work in abou working days. CONTRACTOR shall not be held liable for delays due to causes beyond Our control. The following work includes all labor and materials needed to complete your job in a workmanship like manner. yob Includes Job-Siding�Mfh Other�wok c Per. 'Prim f R Lj Combination Job-Siding With Other Work [L�`building and Ej RVC.Cci Aurn Elec.Permit Aluminum J, EKFascia Trim I �LJ41�i Removal Fascia Treati-ne-ni Rsoffit Trim fr ,.Pera".n 1`21k�ag. & �Vi&Door Trim ER�,-Paralicrn Package Fascia Cri li LZAccessory Package Custom Shutters None Underlaiment InsulationLocation 'Utters Siding bori it ireat i lent LVj Remove Debris Lock.Elea.fvietzrSoffit colo,, 5qj Freparatior Includes CenterVem Fully Vented ED Non-Vented A ffTPepl2Ce Visible Ret Location wy Vented as Needed rn.rq,Savings/Bug Guard Starter Window And Door*Casing Treatment if window And Door Casing Cofor Sqj Accessory,Pacf;age Includes Custom Formed J-Less' El Full Custom Forma 111111 d I II Color: C a Stop Capping 81,117s—.11 Capping1 _1*1 E] None Vinyl Light Blocks 1 11 1 ill ffVinyl Dryer Blocks Location P11, I!� 1!il�j�l� I . tj I fid --T7rnyl Electric Outlet Blocks Vinyl Exhaust Vents Gutter& Downspouts UV Vinyl Faucets Blocks Gutter Color Vinyl Gable Vents Downspouts Color Lo-firin qp14ce Underlayi L it 'Insulation TO Be Used f, _aerl �Spei al!Notes Lj Hi-Tech 318 Other I Location Area To Be sided if MKnelate Hious. El Garage lic o 5 Siding 70 be Used jl Color jil'r- Payment'Policy Brand ii Profile d Me" Bank Financing %viter To Arrange Hi-Tech To Arra El 0 a IU vultri Cash Or Check El Master Card Corner host To Be Used Corner Post Color: Sh, f' 3,.5'__-/ It kim Total Investment t/ Wide Insulated I /f qa,00 [—I Wide Non-Insulated /a/000 .00 MolUlor Insulated if Li Regular Mon-Insulated Id, 0 0 If l!3 Ealance of y Completion 00 it 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 q be his main Office or branch thereto, provided youl 110tifli the seller in writing at his other office or branch by ordinary mail posted, 11 . h It l!jj by telegram sent,or by delivery,not later than midnight of the third business day following the signing of this a greement.See the attached notice of cancellation'form for an explanation of this right. An interest charge of 1.5%per month(18%Per year)will be added to any amount unpaid after 30 days from invoice date. n the CiVelt of default offi,iYarent Of diri order orally Part thereofand the account referred Date of Acceptance Air 4 10 an"t-re-Y for the p.r.ha"-1-glo-to Pay reasonable attq,ney fa< /We give Hi-Tech n,' Ston toobtainallnecessa) Signature -iPoiomeo:oner Z Signatur 0�z Signature JK-T-ru � = The Commonwealth of assocfiusetts i:C 1)V#rtfnent of•Industriaal Accidents _ ®fftce ofInv,estigaations 600 Waashinon.Street Bostonlq 02111 www,M ass,gov/diaa Workers' Compensation Insurance Affidavit: Builders/Contractors/JElectricians/PIumbers Applicant 1nfor atio� i Please Priin Le iibl Name (Business/Organization/Individual): �}`- •6 ' ��,�. a `,,� ppA , d G.2y C�•'e,end) �lo�O��Gf1 6r�7 fC erJ� f�F�v'.�� Address: ;d �IAAO f ` _-- �,.�! ell. � City/State/Zip: — "� Phone#: ' , Are you an employer?Check the appropriate box: 1- I am a employer with ff'-_vea c_ 4 [] 1 am a general contractor and I Type of project(required): employees(full and/or pa 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 working for me in any capacity. employees and have workers' 8. []Demolition [No workers' comp.insurance comp. insurance.? 9. ❑Building addition required.] 5.,;[] We are a corporation and its 10.❑Electrical repairs or additions �-❑ I am a homeowner doing all work officers have exercised their myself. 11.❑Plumbing repairs or additions Y [No workers' comp. right of exemption per MGL insurance required.] c. l 52, §1(4},Viand we have no 12-[]Roof repairs employees. [No workers' 13.M Other ;a4w a. comp, insurance required.] 'Any applicant that checks box 41 must also f11 out the section below showing their workers'compensation policy information. 'Homeowners who submit this affidavit indicating they amdoing all work and thea 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-contractor have employees,they must protide their workers'comp.policy number. I atm an employer that isproviding workerscompensation insurance for my employees. Below is the policy acrd job site information. ;i Insurance Company Name: Policy#or Self-ins. Lic.#: €ff66-, S f - �;o t; I` �' r ��`f°' Expiration Date: /e -3,1- Job d-Job Site Address: 47y l3 e A 1,c ell City/State/Zip: Attach a copy of the workers, compensation policy declaration gage(shotiving 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 hereby certify under the pains and petra1des+ofperjwy that the information provided above is true and correct. Signature Date Phone#: 77. AlP, 770fficialTuos, only. Do not write in this area,to be completed by(city or town official. wn: Permit/I,icense# Issuing Authority(circle one): I.Board of Health 2.Building Department 3' .City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other ; Contact Person: Phone#: '' Qlj KITTREDGE IN •11/10/2014 8:56:06MPS (1771,17-E.,' PPAGE 01/01T F6;L�•hi: 1fJOgrl=-•r,); 151837333g) - Page: 2 oL CERTIFICATE y- �y �p y fro®� CE A IFI ` E OF LIABILITY INSURANCE N DATE(M�UDO�YYW( THIS CERTIFICATE IS ISSU[ b AS A MATTER DF INFORMATION ONLY ANb CONFERS NO RIGHTS UPON THE CERTIFICATE HOILDER IATHIS 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), AUTHORISED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMpbRTANT: If the certificate holder is an ADDfI IONAI INSURED,the policy(ies)must be endorsed. ff SUBROGATION IS WANED, subjl ct to the terms and conditions of the policy,cartain policies may require an endorsement. A stetefnant on this certificate does nvt confer rigntsjto the certificate holder in lieu of such enderoemenf s. I PRODUCER BARRY J KITTREDGE URANGE DNrncr INS 81 S MAIN ST NAME: BRADFORD, MA 01835 PHONE FAX EMAIL ADDR 4• INSURER 9 AFFORDING GOVERAae NAIC4/ INSURED INSURERA: LM Insurance CO oration 33600 HI-TECH WINDOW&SIDING INSTALLATIONS INC NBURERB: 29 ARROWWnnD ST INSURERc; ) METHUEN MA 01844- VS URER 0 BiGVRERE: I i COVERAGES B15URERF: ) 5 CERTIFICATE NUMBER: 22315250 REVISION NUMBER: THIS IS Tc CERTIFY THAT THE POLICIES OF INsuRANCE LISTED BELOW HAVE BEEN I$$(1ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD -'HIS'TED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OP.OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAI' BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE T , TERMS EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. TN$R M SUER ::::i;EFF �� LTR TYPE OF IN9uFANCE INBD wvo POLICY NUMBER POLIlunt/nn EXp COMMERCIAL GENERAL LIABILITYIxN UVITS ) CLAIMS-MADE EJOCCUR EACH 00 URRFNC@ S •To•� P g I MED EXP(M ono anon) $ ORM AGGREGATE LIMITAPPLIESPER; PERSONALBADVIIJJURY 5 POLICY 0 PRO- LOC GENERAL AGGREGATE 5 EOT ElPRODUCTS S j OTI'IER. PRII. AUTOMOBILE LIABILITY s ANYAUTO rx n Jen `' s ALLOWNED 3CHEDULEO BODILY INJURY(Perperson) S ) AUh05 AVT O EO 00DILYIALIURY(Paracudard) S HIRED AUTOS NON• HIN AUTOS PROPERTY DAMAGE Paraccidem um6RCLLA LJA(a 5 OGCIJR EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE $ i R ENT10N AGGREGATE $ j A ►YORKERS COMPENSATION /NIWC5.31 S-607814-pia 8 DEMPLOnR91VASILrrY YIN 1p/3112p1d 10131/2015 IPEARN7 OTT I• ANY PROPRIETORPARTNEIQFFIVEY.ECUTtvE (Man 2R/A1E6 N")EY•GLUDED? tJ/A E.L.EACH ACCIDENT $ I 500 0 (Manda(ory in NH} 9Y8a ,dIPTI N pFOPERATIOrvS below under DE L.01SEAGE-EA EMPLOYE. S 500 p0 EBCRWnO - E.L.DISEASE-POLICY LIMIT S I_500400 , DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,AddILlonal Romarke Sc I hetlule,may he abachad If more apace la requlmd) Workers compensation insurance coverage applies only to the workers comensation law>3 of the StBte(S)of N H I This certificate cancels and supersedes all Previously Issued certificates,only as they relate to workers compensation coverage. II I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR RE TME EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVED 1 ACCORDANCE WITH THE POLICY PROVISIONS. I 1 I AUTHORIzenR-PRF9ENTAnvE — -- LM Insurance Corporation (/ d 19BE-2014 ACORD CORPORATION. All rlghfs r,'ssery ACORD 25(2014/01) The AGORD name and logo era Mglstared marks of ACORD i CSET CL1�r CODE; 1817170 Oxa>, Uancas 11/1O1Z014 11:52:57 A:1 (esr) Ea•7c 1 of L ��e�o»rn>zanzcaecc��a��i��wJ�cc��caefL`1 � .flee of Consumer Affairs&Business Regulation License or registration valid for individul use only E:IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration _-118836` TYpe: 10 Park Plaza-Suite 5170 ' Ex iration: 4/26/2017 Supplement Cord Expiration': _ PP Boston,MA 02116 HI TECH WINDOW&Sl_DING INSTALL INC TIM WICKS 29 ARROWWOOD ST METHUEN,MA 01844 Undersecretary N valid without signature —----—-- -- Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-096516 i. TIMOTHY W WIV{S. 3 ELLIS ST Methuen MA 01$44 r Expiration Commissioner 09/09/2016