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HomeMy WebLinkAboutBuilding Permit # 7/29/2015 ------------------ %AORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received rep PPp` 4y C"Us Date Issued: ? IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER int Print 100 Year Structure yes no MAP PARCEL:0 PARCEL: 490009 ZONING DISTRICT: Historic c District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 11 One family [I Addition [I Two or more family 0 Industrial 11 Alteration No. of units: 11 Commercial ,&Repair, replacement [I Assessory Bldg 11 Others: 11 Demolition 11 Other rfig VY DESCRIPTION OF WORK TO BE PERFORMED: Identification---Please Ty e r Print Clearly OWNER: Name: Phone: q71— 6"—103) Address: Contractor Name: Phone* Email: Address: TOO 11-er-6 L05 lo r- Supervisor's Construction License: R '70l ')--5— —Exp. Date: Home Improvement License: -7to 0 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. Total Project Cost: $ 75 FEE: $ Check NA O'�o 3 -7, Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access ie guaranty fund Town of t EAndover No. ;L61 - zTh ver, ass 116 o 1 > COC MICNl WICK V AERATED S U BOARD OF HEALTH Food/Kitchen P ERF41T T L wumo" Septic System BUILDING INSPECTOR CERTIFIES THAT .. (� Id �/�--dv�, ......................................... THIS C """" ............................................. Foundation has permission to erect ......... buildings on ....:� ..........•. . .. .......... ............................... ................. Rough 1 to be occupied as ... ........ ,r. G,/�, .........................:I...... .f�.v. :.............................. 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI RTS Rough Service ................. ........................................................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required to Occup-y 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. Rene-A by dersena ���� WINDOW• REPLACEMENT anMde:sanCom7aoy„ Wood/Vinyl Composite IF Dual Argon Low E4 SmartSun Double Hung 100-00473518-010 ERERGY PERFORMANCE RATINGS U-Factor(U.S)/I-P Solar Heat Gain Coefficient ADDITIONAL PERFORMANCE RATINGS Visible Transmittance ) F- 4-,2' Manufacturaratpulatesthat these ratill conform to appf-bja NFRC procedures for dalemtining whom product performance.NFRC niags are determined for a fixed sat of anvironmanmt condlioes and a specific product sea. NFRC does not recommend any product and does not warrant the suilaEl'ny of any product for any speelic use. Consuh manufacturer's feerature for othar product performance information. www.nlrc.olg p t ',lk SE,4 f.® Th"s product meets Green - se.re•ovir-omemal 3 standards governing energy etfciancy,heavy matats i t '•`the frame and•asA -. materel packaging,and Y�consumxr•ducalional �`�`I�rl�• "<<2-{ SS 'F �Ilpu n'�l DESIGN PRESSURE(PSF) rLWild*and 000r` h%nufacarersA-ccal"n �y ' www.wema.com ® � RbA DB Sloped Sill DH IN Testae 1o11AFS02.W1k%-.04/ttSA IWAS'M44S MWacuar s1' ke wMAna,"m nae icah%standards. daels or exceeds M.E.C.C.E.C,B I.E.C.C.Air Inllamtion requirements WDMA Nalmark Carlii'ation program. R f Do not remove until final code inspection. Save label for future reference. i t t , energystarmrcan- 41. i_ ,W ` � 5 I energystar.gov Qualified/Admissible Renewal ®®® fr?E<3 V ®®®® WINDOW REPLACEMENT nnAndersdnC:umpanp AND-N-35 Wood/Vinyl Composite FF --•••---........ ... Dual Argon Low-E4 SmartSun IMMUM Product Type: Glider ENERGY PERFORMANCE RATINGS U-Factor Solar Heat Gain Coefficient 0.29 1.65 021 U.S./I-P Metric/SI ADDITIONAL PERFORMANCE RATINGS Visible Transmittance 0e49 Manufacturer stipulates tnat tnEse ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are oeteardned for a fNed set of errvironmental conditions ana a specific product sae. NFRC goes not recommend any oroouct and boss not warrant the suitability of any proauct for any specific use. Consult manufacturer-literature for otner product performance Information. wisw.nfrc Arg Window antl Door , e rm-rt<ufapturers -..dnsbon Andersen Cor oration:RbA Glidin Window enurac urer s pu a as conformance o aro ovnng sn er s Standard Rating 'J3,.er1.sfl sfWC•�".iAfra�;°,'Fi?P:S.yP.:tCrJ p.&..... .. DP pSf1HS-•C-.3-5. . Y� Lr Tnls product meats — 0 �"> Green Seal's c environmental stanoaro- ;,governing energy Efficiency neavy metals � in the frame and sash ,V material,packaging.and consum. R` Materials. sf Etlutbtidnal 100-00512036-015 -meets or eaceeos M.E.C..C.E.C.8 LE.737ir InFiRrvion requirements WOMA H511rnarH Calcatiun Program 3 f v M. I < UAL CIL o Vin INV AN -N-:37 Dual QD olZtpOsite MIRterisl Ptnduat On Lowy-E4 SmartSun YP®: Pichire ' ENERQy PERPc7RMAhIOr= RATINGS . U-Factar SO(Sr Heat Gain Cueftle'rt 0.27 U.SJI-P Metrictsl v 22 ADDITIONAL PERFORMANCE RAIIWGS YiSibie Transmittance a,��+eene vuetaeaa.�a�s cnntomiID aPPtemfa HPRC rvFRC aoeo nec �Wa se°a�armY�aa iQ€Aee•etot�owev hraq i �,umu�O,�d°�� nee+ ee�mneay'n� Pte®ccYar+e�msep���'..�. mtarwmwrrramWaa, �rrPacac.�e. a arSanO rd 0 i! ogre, A'lAndEtrd Ratans Wus aet°r OBeA MA,nu.s. V40as OP psf F CSO ' a Gram /.raw®sr taeh sree®a aaoeeae 11. , 100-005 19006-00 7 mon refi+remorgs wrn�ta a. PRODUCT PERFORMANCE Andersen' MRC Certified Total Unit PerformanCe (canenued) Andersen Produci Glass Type LI-Factor' SHGC' VP 200 Series. - "Clear Dual Pane 0.45 0.60 0.63 - Clear Dual Pane with Grilles 0.45 0.54 0-56 - Tilt-Wash Law-E 0.30 0-32 0.55 j Oouhie_-HungWindow Lmv-E with Grilles 0.30 029 0.49 - HP Low-E4 SmartSun 0.30 021 0.49 HP Low E4 SmartSun w/Galles 0.31 0.19 0.43 Clear Dual Pane 0.45 0.51 0.64 - Narmliae" Clear Dual Pane with Gallas 0.45 0.54 0.57 - Duuhie-HungWindow low-E 0.30 032 0.56 Low E erith Grilles 0.31 029 0.50 Clear Dual Pane 0.44 0-63 0.66 - _ Narm!ine' - Clear Dual Pane with Gnlles 0.44 0.57 0.59 - Transom Window Low-E 0.27 034 0.58 Lmv-E with Galles 0.27 030 0.52 ffl 'moi Clear Dual Pane 0.45 0.60 0.63 - _ - Clear Dual Pane wdh Galles 0.45 0.54 .0.56 - Lm E 0.30 0.32 0.55 Gliding Window Inw-E with Grilles 0.30 029 0.49 Low-E SmartSun 0.30 021 0.49 Lm-,E SmartSun with Gnlies 0.31 0.19 0.43 ] Clear Dual Pane 0.43 0.61 0.65 - Clear Dual Pane with Galles 0.43 0.55 0.58 - Fued;Transom;, Low-E 028 033 0.56 71 Gircle Tap'Window Lmv-E with Galles 0.28 0.30 0.50 - Lmv-E SmartSun 027 022 0.51 Z! :3 M Lmv-E SmartSun with Grilles 027 020 0.45 Clear Dual Pane 0.44 0.61 0.64 - Clear Dual Pane with Galles 0.45 0.53 0.56 - tmv-E 029 032 0.56 - Narmline' - Low-E with Galles 0.30 029 0.49 "--Q-'' ij Gliding Patio Doors Lm*-E Sun 0.29 02D 0.31 0 71 M Low-E Sun with Galles 0.31 0.18 027' Imv-E SmartSun 0.28 021 0.50 Low-E SmanSun with Galles 0.30 0.19 0.44 Clear Dual Pane 0.43 0.61 0.64 - Clear Dual Pane with Galles 0.43 0-5? 0.56 - Low-E 0.28 0.32 0.55 - Perma-Shieid7. Lew-E with Galles 0.30 029 0.49 Gliding Patio Ila am Low-E Sun 0.29 0.19 0.30 '.. Low-E Sun with Gnlles 0.30 0.17 027 Law-E SmartSun 0.27 022 0.50 Law-E Sma tSun with Galles 029 0.19 0.44 Clear Dual Pane 0.43 0.45 0.47 - Clear Dual Pane with Galles 0.43 039 OAT - Law-E 0.32 024 0.41 Hinged Inswing La E with Grilles 0.33 021 0.35 - Patio DaarS - Low{Sun 0.32 0-15 023 Lmv-E Sun with Gallas 0.34 0.13 0.19 - Ww-E Sman$un 0.32 0.16 0.37 Low{SmartSun with Galles 0.33 0.14 0.31 - r.A r The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street.,Suite 100 Boston,MA 02114-2017 V www.mass.gov1dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aanlicant Information — RENEWAL BY ANDERSEN Please Print Legib ly Name(Business/Organization/Individual): Address:30 FORBES ROAD C NORTHBORO, MA 01532 Phone#:508-351-2200 Are you an employer?Check the appropriate box: Type of project(required). with 30 4. E] I am a general contractor and I IM I am a employer - have hired the sub-contractors 6. F1 New construction employees(full and/or part-time).* listed on the attached sheet. 7. Remodeling 2.El I am a sole proprietor or partner- These sub-contractors have 8. Demolition ship and have no employees employees and have workers' working for me in any capacity. comp.insuranceJ 9. []Building addition [No workers' comp.insurance 5. E] We are a corporation and its I O.n Electrical repairs or additions required.) officers have exercised their I I.n Plumbing repairs or additions 3.El I am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §1(4),and we have no 12.[]Roof repairs insurance required.] employees. [No workers' 13.E]Other_ comp,insurance required.] *Any applicant that cheeks box 4l 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. LD REPUBLIC INS.CO. Insurance Company Name*0 Policy#or Self-ins.Lie. #:MWC 30293800 Expiration Date:10/01/16 Job Site Address: 281 Middlesex RD City/State/Zip:North Andover, MA 01845 Attach 2 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. ec I do hereby fy u der the pains and penalties ofterfury that the information provided above is true and corn Date: 51-2200 _4_ewuse only. Do not write In this area,to be completed by city or town official. City or Town: PermitlUcense# 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- CERTIFICATE OF LIABILITY INSURANMWDDff CE �1oiv2oiaYYY) 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(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 certfflcate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME: cerdflcatesWilis.com Willis of Minnesota,Inc. PHONE -7378 -2378 Eat:(877)945 do 26 Century Blvd E-MAIL P.O.Box 3051191 ADDRESS: Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAICN INSURER A:Old Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andaman 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. INBR ADDL SUBRI POLICY EFF POLICY Type OF INSURANCE POLICY NUMBER MMID MM/DDlYYY LIMITS A X COMMERCIAL OENERAL LIABILITY EACH OCCURRENCE 3 1,000,00 CLAIMS-MADE OCCUR ZY302940 10101/2014 10101/2015 PREMISES Ea oaurrence3 500,40 MED EXP(Any one person) 3 10,00 PERSONALB.ADVINJURY 3 1,000,00 GEN'L AGGREGATE LI MIT APPLIES PER: GENERAL AGGREGATE $ 4,000,00 X R LOC PRODUCTS $ 4,000,00 POLICY❑j OTHER: 3 AUTOMOBILE LIABILITY C a accident rr $ 5,000,00 A X ANY AUTO MWM302576 10101/2014 10/0112015 BODILY INJURY(Per person) $ ALLOED SCHEDULED BODILY INJURY(Por acddanQ $ NON-OWNED PE TY DAMAGE 3 HIREDAUTOS AUTOS a 3 UMBRELLA UABHCI-AJMS-MADE OCCUR EACH OCCURRENCE $ EXCESSLJAa AGGREGATE 3 DED RETENTION $ WORKERS COMPENSATION X I STATUTE ER AND EMPLOYERS'LIABILITY A ANY PROPRIETORIPARTNER/EXECUTIVE YIN MWC30293800 1010112014 110/01/2015 E.L.EACH ACCIDENT 3 1,000,00 OFFICERIMEMBEREXCLUDED4 NIA (Mandatory In NH) E.LDISEASE-EAEMPLOYE S 1,000,00 Myea,de!cribetnder E.LDISEASE-POLICY LIMIT $ 1,000,00 DESCRIPTION OF OPERAT IONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,AddRional Remarks Schadtde,may ba attached K mora space Is 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 Evidence of Insurance ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD t} Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen'isor License:CS-090125 „1 JAM L MORIN 96 GARDIlVBR ST s 4Nk;; LYNN MA 01905 ";{;i o-- y �rtN to Expiration Commissioner 10/06/2018 C-�i�e�ponw»za�euieu/DE�O!�aaaaa4i�telti �r free of Conanmer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR Registration: 1701310 type: Expiration: 12/23015 Supplement r s RENEWAL BY ANDERSON CORPORATIORt '1. JAIME MORIN ' 104 OTIS STREET NORTHBOROUGH,MA 01532 Undersecretary I I i