HomeMy WebLinkAboutBuilding Permit # 7/29/2015 01 %AORTH 1
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION 0
Permit No#: Date Received rev rp" R5
Date Issued:4" zi 14"" f C LIS
' IMPORTANT: Applicant must complete all items on this page
LOCATION e7V IYIA'Al -.111C 9 "3
Print
PROPERTY OWNER <9/ ��4vzjvq
Prie 100 Ye6r Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
0
Machine Shop Village yesno
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building [I One family
11 Addition El Two or more family [I Industrial
El Alteration No. of units: El Commercial
epair, replacement El Assessory Bldg El Others:
El Demolition 11 Other
lyll,b]",�,
//' avy,816 Ri/"`151111
"'e W,/1" M
r,r
DESCRIPTION OF WORK TO BE PERFORMED:
aQ
Identification- lease Ppe or Print Clearly
OWNER: Name: 0 �,P44 C/O IAI Phone: 97,?—
Address:
Contractor Name:—t &, Phone: 6 7
Email: IC21 P 14 1
Address: 470 '931--hAX10- / 4!X
Supervisor's Construction License. -Exp. Date:
Home 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$125.00PER SA
Total Project Cost: $ 7V,33, 60 FEE:
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to ie guaranty fund
A- S
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tAORTH
Town of Andover
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COC MICHRWICK
�.9 A�OATEO
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BOARD OF HEALTH
PERMIT �T� L IIIIIIIIIIIIIIF� Food/Kitchen
Septic System
THIS CERTIFIES THAT .......... .. I d .... BUILDING INSPECTOR
.... .... .... ..
Foundation
has permission to erect .. buildings on
Rough
to be occupied as ..... ........ ..
.... ... .^... .�.!^�.�........................................................................ 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
IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
fA
LESS CONSTRUCTIO Rough
Service
................... . ..... .................................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Reguired t® Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
o Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. - Burner
Street No.
Smoke Det.
�f ieVltc�l MA Home Improvement Contractor.
License#170810(Expires 12/23/2015);
byAndei Sen- Renewal by Andersen Corporation Federal Tax ID#41-1918413;
wrnaow aerancrm rsr a,,.l n:,,<.•„,:=r
30 Forbes Rd. Northborough,MA 01532
(508)351-2200 Fax(508)-986-7072
CUSTOMER WINDOW AND DOOR REMODELING AGREEMENT
i
,Buyer(s)Name Date:
ELIZABETH EWING - MAY 18, 2015
Buyers Street Address City State Zi Code
149 MAIN ST. #C 237 NORTH ANDOVER MA 01845
Email Address Home Telephone Number Work/Cell Telephone Number
978-989-9979 508-517-3825
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 $ 7,433 0,mount Financed$ 7,433
0.00 at si 3,716.50 Check/Cash
Deposit Received(33%)$ De Posit 9 nin 9$ 8-10 weeks
Balance Start of Job(33%)$ 0.00 Check#
Balance on Substantial At Substantial Est.Install Time Credit Card
Completion of Job(33%)$ 0.00 Completion$ 3,716.50
1-2 days If credit card is selected,please '
see Credit Card Pa ment form :
No final payment shall be demanded until all adios are satisfied
Buyer(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there are no verbal understandings
ichanging 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 Buyer's right to cancel this Agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES.
Renewal by Andersen Corporation uye s ' Buyer(s)
)By:
�rrcce �eclG
Signature of Consultant Signature Signature
BRUCE PECK ELIZABETH EWING
X
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.
—————————————
--—---------------------------------------------——————————————————————————— ————————————————— ———————i
NOTICE OF CANCELLATION NOTICE OF CANCELLATION
I
1Date of Transaction 5/IN/IS You may cancel this
Date of Transaction :i/IiS/IS .You may cancel this I
transaction,without any penalty or obligation,within three business days from the I transaction,without any penalty or obligation,within three business days from the
1 above date.If you cancel,any property traded in,any payments made by you under 1 above date.If you cancel,any property traded in,any payments made by you under
Ithe 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 folloaving receipt by the Contractor("Seller") of your I returned within 10 days following receipt by the Contractor("Seller") of your
i 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 will be
canceled. If you cancel,you most make available to the Seller at your residence,in I canceled. I£you cancel,you must make available to the Seller at your residence,in
i 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 i
Sale;or you may,if you wish,comply with the instructions
-.this Contract or of the ' 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 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
, If you fail to make the goods available I of the goods without any further obligation. If you fail to make the goods available
of the goods without any further obligation.
ito the Seller,or if you agree to return the goods to the Seller and fail to do so,then I to the Seller,or if you agree to return the goods to the Seller and fail to do so,then
lyou 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,I or any other written notice,or send a telegram to Contractor: Renewal by Andersen,
i 30 Forbes Rd. Northborough,D'IA 01532. 1 30 Forbes Rd.Northborough,MA 01532.
I HEREBY CANCEL THIS TRANSACTION,
I HEREBY CANCEL THIS TRANSACTION. I
I _
Buyeee signature Print Name Data i Buye(s SignaNre Print Name Date
Renewal Renewal by Andersen Corporation- MA Home Improvement Contractor
30 Forbes rd Northborough,MA 01532 License#170810 (Expires 12/23/2015)
wtrbAndersen,
(508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413
Window Specification Sheet
Buyer(s)Name Date of Agreement
ELIZABETH EWING MON, MAY 18, 2015
The buyer(s)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 the front acall the reverse of the accompanying CUS'I'ON,f WINDOW AND DOOR RENIODELING AGREENIENT,of which
.
the Specification Sheet is part.
WINDOW&DOOR DETAILS
Grille Glass
App. App. Appx Exterior/interior Color Hardware Hardware LowE4 Grille
Room If th window/Door St a Detail t
Casin�s Sash 2 Lifts -5
i��Ihl _Ext int Sash 1/3 _a
Livinq 103 29 46 75 DB a rail e oat insert slo ad sill
.�Wra White Standard FG martsu /2 12 a
��V--A —-E 3 _LNM — ! Is
Uvinq 104 29 46 75 DB a rail equal insert sloped sill Ext.Wrap White Standard-FFG L-adsur --2-/2—_-Yes-
Livinq 105 29 46 75 DBs rail a ual insert slo ad sill
fx-�WraWhite Standard FFG Smartsu INTW /2 /2 Yes
Uvinq 106 29 46 75 DBs rail ual insert sto ad sillrExt.Wra WH/WH White Standard FFG 3martSur INN 3/2 --2/2 Yes
Total 4 —A7pp—r.x --BAY,BOW&BUILD OUT DETAILS
Style Detail width/ Approx. Number Frame Window End center LowE Roof Hardware
ffi
of.
E0_0_m Interior Ext/int Color Grilles sashessashes Screens Smartsun Soffit Color
SPECIALTY DETAILS
Color
BAY/BOW ADDITIONAL WORK NOTES
Full/ Approx. LowE Specialty i__rr tl'�u"i,
f, C
aut"
Room .. olor C o-r h W A......h,6 dc,71 ind-,
Count
---Ln—sert U.I. §rnartSun Grilles ExUlntColor
them,�Ill be ci�nifrnu tan Ince.
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
removed prior to installation. We make no guarantee as to whether alarms or window
the homeowner to have the alarm system and window treatments/hardware
treatments/hardwarewill fit after replacement. Customer is also aware in some cases there will be glass loss. ffthere is,
the amount will be dependent on the type
2 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 bean 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.
e 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 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 bc1\vcc11 the parties that this Slic,t'along rill,(he CUSTOM WINDOW AND DOOR REMODELING AGREE'NIENE,constitutes the entire
'u_' -chan his Sp-i(ication Sheol may 11�)t be changed or its terns modified or varied in
Iluderstanding Ix,tween the parties,and there am I verbal undm.landing, ongur lliorlil�ingany of the terms.'I
any Nva)unics-such changes arc in writing and signed 1))lx)tl,the 13u)cr(,)and Contractor lluyCns) a,k,uI,dW that 13u)ci(s)has read this Specification Slicer
Renewal by Andersen Corporation Buyer,,)
731-11ce Peck,
Signature of Consultant Signature Signature
BRUCE PECK ELIZABETH EwING
Print Name of Consultant Print Name Print Name
Renewal
J-YA- ndc.-ter5ent,
WINDOW ALPLACEMER1
n to _ ,. �
'fioy tlztwed,fres, "44
` . F - mar ' . a #:�d{_tvOf
P 'Y
1. q M 5f. 57, Norlik, A:, MA 03,84$
nj
N'o ft:bonjugh,MA,015®8 2
Plume(508131 1-21,M
.PD,M)8)M_7102
UCtAtit:+n a �r:ale a aA r art
Rene� i
®®
WINDOW, REPLACEMENT nnMdw%TtCnm7rnoy,
r WoodArinyi Composite IF
Dual Argon Low E4 SinartSun
Double Hung
100-00473518-010
EVERGY PERFORMANCE RATINGS
U-Factor(U.S)/I-P Solar Heat Gain Coefficient
ADDITIONAL PERFORMANCE hATIRCS
Visible Transmittance
r`;
6fanufacturer pyulatac that these nZr,g conlomi 11 appF:and NFAC procedmas for dal amiining whota product
pedormanee.NfAC ratings are dztermined iorafaad eat of anvironmentaleonaitioro and aepem7e:product ma.
NFAC does not recommend any product and does not warrant the auhaDiity of any product for any epeeBG:use.
su
Conl manufaclurer'a 0emtura for other product pedomnance Wormat'ton. "
W1Wl.n1morg
I»� vao y pg. ;
'k�; The product meets Green sem'
y. Seal.enYaonrt*nad caaas '^.,�,..^.�';..�:+ > •,ivy M1
standards governing energy i �.��°''� ,)�.' �•.,� 1•.L
efficiency,heavy metals it Vii.• .: t r>:'`
1M lame and.ash
ntateret,packa&Q,and
Y�`�consumer adugtgml ti`��,"jfy'w���>;$<y }fjr '..
materials. as.rRw •34 e1i,<%%}Yl���t
YaM ref-�'fY tv
Mwin�Y.r -P •'S-----—tra�4---
DESIGN PRESSURE(PSF) r
". �.. wiaow1ana Due .�:�
hbn�wwEmun mt6n
RbA DB' Sloped Sill DH Its
T� WILAFS02af AAIAA''AHUC 101AVAH00i 6taM.Gaa([st' tre curtormtrtoeu tnaa CpDbstYgartls.
Naets or exceeds h1.E.C.,RE.C,f3 LE.QC.A'r InitAration nquiremenis WOh1A Aa�nark Cera''/i^ation Program. '.
.. r
The Commonwealth of Massachuseas
Department of Industrial Accidents
Office of Investigations
saw I Congress Street,Suite 100
Boston,MA 02114-2017
www.mass.gov1d1a
Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ApRUcant Information Please Print LettlblV
Name (Business/Organization/individual)' RENEWAL BY ANDERSEN
Address:30 FORBES ROAD
City/State/Zip-NORTHBORO, MA 01532
Phone#:508-351-2200
Are you an employer?Check the appropriate box: Type of project(required):
1.M I am a employer with 30 4. [] I am a general contractor and 1 6. E]New construction
employees(full and/or part-time).' have hired the sub-mritractors,
2.El I am a sole proprietor or partner- listed on the attached sheet. 7. X Remodeling
ship and have no employees These sub-contractors have 8. n Demolition
working for me in any capacity. employees and have workers' 9. n Building addition
[No workers' comp.insurance comp.insurance.$
required.] 5. E] We are a corporation and its I O.El Electrical repairs or additions
3.El I am a homeowner doing all work officers have exercised their I I.E]Plumbing repairs or additions
myself [No workers' comp. right of exemption per MGL 12.[:]Roof repairs
insurance required.]t c. 152, §l(4),and we have no
employees.[No workers' 13.[]Other
comp.insurance required.)
*Any applicant that checks box#1 must also fill out the section below showing theirworlml compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such,
lContractors 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 jab site
Information.
Insurance Company Name:OLD REPUBLIC INS. CO.
Policy#or Self-ins.Lie.#;MWC 30293800 Expiration Date:10/01/15
Job Site Address: 149 Main ST. #C 237 City/State/Zip:North Andover, MA 01845
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 MOL 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 kerebyce!16y and un r the pains and penalties of perjury that the inform adon provided above is true and co
Siemature: Date.
Ebone#:1,60, 1-220
Offlhduse only. Do not write In this area,to be completed by city or town official.
City or Town: PermiVIAcense#
)
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#:
ANDECOR-01 YADAVYO
A404 >R® GATE(MWDDIYYYY)
�,,,,,,� TIFI� T°� LIA ILt I� IJ 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(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the pollcy(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 CONTACT certlflcates@Wlllle.com
Willis of Minnesota,Inc. PHONE 677 945-7378 F
c/o 26 Century Blvd No En:( ) Ho.(888)467-2378
P.O.Box 30591 ADDRESS:
Nashville,TN 37230-5191
INSURER(S)AFFORDING COVERAGE NAIC N
INSURER A:Old Republic Insurance Company 24147
INSURED INSURER 0:
Renewal by Andersen Corporation INSURER C:
30 Forbes Road INSURER D:
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.
ILTR NSR TYPE OF INSURANCE POLICY NUMBER IMWDDIYYYYI (MMIDDIYYYYILIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,0E
CLAIMS-MADE a OCCUR MWZY302940 1010112014 1010112015 PREMISES Ea occurrence $ 500,00
MED EXP(Any one person) 3 10,00
PERSONAL&ADV INJURY $ 1,000,00
GEN'L AGGREGATE LIMIT APPLIES PER: GFNERALAGGREGATE $ 4,000,0E
X POLICY❑jE� n LOC PRODUCTS-COMPIOPAGG $ 4,000,00
OTHER: $
AUTOMOBILE LIABIL"Ya a13INErD s G rr $ 5,00_0,00
A X ANY AUTO MWTS302575 1010112014 10/0112015 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per aodden� $
NON-OWNED PE TYOAMA E $
HIREDAUTOS I
AUTOS e
$
UMBRELLA UAB HOCCUR EACH OCCURRENCE $
EXCESS UAB CLAIMS-MADE AGGREGATE $
DED RETENTION $
WORKERS COMPENSATION �(
AND EMPLOYERS'LJABILITI STATUTE ER
A ANY PROPRIETORIPARTNERIEXECUTIVE YJN MWC30293800 10101/2014 10/0112015 E.LEACH ACCIDE14T $ 1,000,0E
OFFICER/MEMBEREXCLUDED? N❑ NIA
(Mandatory in NH) E.L DISEASE-EA EMPLOYE $ 1,000,00
If yes,descrbe WO
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY UMIT $ 1,000,0E
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Sehsdule,may be attached If more space la required)
i
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
i
iEvidence of Insurance
01988-2014 ACORD CORPORATION. All rights reserved,
i
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
a
i
Massachusetts-Department of Public Safety
Board of Building Regulations and Standards
Construction Supen'isor
License:CS-0801gS � <
JABS L MORIN
86 GARDINER SSE
LYNN MA 0190f
Expiration
Commissioner 10/06/2016
` � (�� �panv»zo�eurea����aaoa�rcvelti =`
(rice of Consumer Affairs&Business Regulation
OME IMPROVEMENT CONTRACTOR
Registration: 170810 Type;
Expiration: 12/2312015 Supplement r
RENEWAL BY ANDERSON CORPORATION
JAIME MORIN
104 OTIS STREET
NORTHBOROUGH,MA 01532
Undersecretary
f