HomeMy WebLinkAboutBuilding Permit # 7/31/2015 i
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BUILDINGPERMIT ®��t�F.o
TOWN OF NORTH ANDOVERo ; A
APPLICATION FOR PLAN EXAMINATION M . -
Permit No#
Date Received �Rp�"ATEo Cl
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Date Issued:
IPORTANT: Applicant must complete all items on this page
LOCATION A" - 'r
Print
PROPERTY OWNER °°JT
Print 100 Year Structure yes no
MAP & PARCEL: ,' ZONING DISTRICT; Historic District yes no
Machine Shop Village yes „ ow,
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑ Addition ❑Two or more family ❑ Industrial
❑ Alteration No. of units: ❑ Commercial
JM:Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: ' 4 Phone: � '"
Address:
Contractor Name: " r 4 °< " r Phone:
Email:
Address:
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$125.00 PER S.F.
Total Project Cost: $ 70 0 FEE: $
Check No.: Receipt No.: '°
NOTE: Persons contractIng with unregistered contractors do not have access to the gicaranty fu'xd
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-'14kAKIE h ver, Mass,
COC MICK2WICK y1•
A°RaTE o P.?
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BOARD OF HEALTH
iaER. MIT T D Food/Kitchen
Septic System
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THIS CERTIFIES THAT ,; „�,�,,,, ], !�;- , . . .. .. ... ., ,,. BUILDING INSPECTOR
.......... 1..�....r.....
. U Foundation
has permission to erect... .. ... buildings on ....S.S7.......................... ........
.. Rough
to be occupied as ......' !�.�....... .. .........i. ....... .I!6.�..... t. ...... ........................ Chimney
provided that the person accepting this permit II in every respect conform to the term f 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 E I ES IN 6 MONTHS ELECTRICAL INSPECTOR
.UNLESS CONSTRUCT
ST S Rough
Service
............... .. .. ..... .. ......................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Reguired t® Occupy Building Rough
Islay 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.
naech Window & Siding, Inc. SIDING
20 Aegean Drive Unit 4 ;
MA Reg. # 116636 Methuen, MA 01844
MA Lie 4- CS - 106506 1-0000-851-0900
www.hitechcorp.biz
Date: Db is corConsultant: ��l ( �ySc°•�
JoName: ��15 f n Wf N Telephone- WS
Job Address:
Contractor agrees to start described work on or about weeks after final
days.Contractor shall not fittings,and complete described work in about working
be held liable for delays due to cause beyond our
plants.Contractor shall ncontrol.Hi-Tech shall not be held liable for any damage to lawns or
ot be liable for any damage to painting or stain during installation of windows or doors. Hi-Tech does not do any paint-
ing or staining. In the event that a punch list should accrue at the end of the job,a maximum of 2%is the allow b e amo}�t to be held back.
The following work includes alt labor and materials needed to complete yourjob in a workmanlike manner. ((
,lob It�€;ILtdes Trina
Combination Job-Siding With Other Work P.V.C.Coated Alum
Aluminum
Building and Elec.Permit Fascia Trim -
Siding Removal �Soffit Trim - Fascia Treatment-�—----" -K ----
- Fascia Color
Preparation Package Window&Door Trim
Full Custom E] None
Accessory Package Shutters
t �� Location
Under(aymentc., Gutters
SidingEl Downspouts- - - Soffit Treatment
P _
Remove Debris Soffit Color
EDLock.Elec.Meter
Preparation Includes
Center Vent Fully Vented ij Non-Vented
"
eplace Visible Rot Location
Vented as Needed— —
Energy Savings/Bug Guard Starter Window And boor Casing Treatment
window And Door Casing Color
C to K Full Custom Formed J-Less Full Custom Formed
r�cces5ot�f Package Include, �'1��pf �� ,Da� F-1
c r � Blind Slop Capping None
Color. �v 1 j�
-- �(- gy
Vinyl Light Blocks Vinyl Dryer Blocks �Location pit v 1 C
Vinyl Electric Outlet BlocksVinyl Exhaust Vents Cutter '"' Downspouts
Vinyf Faucets BlocksVinyl Gable Vents
Gutter Color Downspouts Color
Location
Underlayment Insulation To Be Used Special Motes
❑HI Tech 318 oti,eyi�(� 1 �et
Location S O e
/area T Be Sided
Complete House Garage bd Qf
baa W dh { e wl
Siding"o e sed—"ht �°{�I� Q ChM$ Sv5+4
Color
►tV 0{' e S Y d Payment Policy
Brand Profile Bank Financing Owner To Arrange Ej Hi-Tech To Arrange
Cash Or Check ❑ Master Card
Cori-ter Post To Be Used _— -- —
Corner Post color: Total Investment 5i 0 U
Wide Insulated F-1 Wide Non-Insulated 1/3 Deposit Vic I
Regular I .ulated Regular Non-Insulated'��j- 1/3 Payment e�
C �h CU 1/3[glance of Day Substantial Completion J
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
be his main office or branch thereto,provided you notify the seller in writing at his i'raain office or branch by ordinary mail posted,
by telegram sent,or by delivery, not later than midnight of the third business day following the signing of this agreement.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. Date of/acceptance
In the event of default of payment citrus order or any part thereof and the account is referred
to an attorney for collection,the purchaser agrees to pay reasonable allomey lees. SlgnatUt e
I I We give Hi-Tech permission to obtain all necessary permits. (Homeown
Signature Signature
(Hi-Tech)
The Commonwealth ofMassqhusetts
Department oflndustrialAceldents
1 Congress,S'tr'eet,Suite 100
- = W Boston,MA 02114-2017
www mass.gov/dza
Workers'Compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FMED WITH THE PERMITTL\rG AUTHORITY.
Aptlicant Information Please Print Lefibly
Name(Business/Organizatiordufflvidual): r" W A4 v--I;-A4 °
.Address: ,000/
City/State/Zip: e ``. ' a^ ° Phone#; - • t"
Areyou an employer?Check&e appropriate box: Type of project(required):
1.U.I araa employer with employees(fulland/or part time).* 7. ❑New construction
2.Q I am a sole proprietor or partnership and have no employees working for me in 8. [1 Remodeling
any capacity.[No workers'comp.insurance required.]
9. El Demolition
3.[J I am a homeowner doing all work myself-[No workers'comp.insurance required.]t
10 n Building addition
4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions
proprietors with no employees. 12.[]Plumbing repairs or additions
5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet, 13.[j Roof repairs
These sub-conhactors have employees and have workers'comp.insruance.t
6.FJ We are a corporation and its officers have exercised their right of exemption per MGL c.
14.PdOther — ` r f
152,§1(4),and we have na.employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also till out the section below showing their workers'compensation policy information.
i Homeowners who submif this affidavit indicating they are doing all work andthen hire outside contractors must submit a new affidavit indicating such.
tContractors that check this box must-attached m additional sheet showing the name of the sub-contractors and state whether or not those entities have ,
employees. If the sub-con1rac6s have employees,Viet'must provide their workers'comp.policy number.'
I am an employer"that is providing worlterw'compensation insurance for"my employees.'Below is the policy and joh site
information.
Insurance Company Name:
Policy#or Self-ins.Lic.#: /-V_4�04 orf_r Expiration Date:
Job Site Address: J_- ., OA Ale 141.*,?e City/State/Zip: Wlf-4�^"�
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance
coverage verification.
Y do hereby certify under the pains andpenatties ofperjury that the information provided ahove is true and correct.
Signature:. Date: 7 Jr/ r-
Phone# - 4r."
Official use only. Do not write in this area,to he completed by city or town official..
City or Town: Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person: Phone#:
`U 23T ' ) FF:Ohi: FA'CE gl:'1=r�
f.Te n X71 'I
CERTIMCATE OF
qY gMtea R A NC -I!!
CC-RTI
MILS IFICAT DDI; IS 1SSUEb Jr, A MATTER OF IIJFORMAT(ON ONLY A�tb CONFERS NO RIGHTS UPON THE CER?
GI;RTIFlCAYE ppES 1deY AFFIRMATIV6tY Ott NEG�LTNELY AMEND, EMEND Ott ALTEC'. THE COVERAGE AFFORDED BY THE POLDT j 5 r
BELOW. THIS CERTIFICATE OF INSURANCEIFICATE HOLDER!THIS
DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUIhIG INSURER(S), AUTHORIZI=b{i
REf'REgEfJiATIVia OR PRODU11 CER,AND THE CE�tTiPIC11TE HOLDER.
the tens NT: If fF,e certincate holder is an ADDITIONAL INSURED,the Policy(ies)must be endorsed. tF SU
the terns and conditions of the policy BROGAzIOt� IS Y1tANED,subject to
P cy,certain policies mrequire an endorsement. A statement on this certificate does not confer rights4othe
c2stificatr Fielder in lieu of such endo;-- ay
PRODUCER BARRY J KITTREDGE INSURANCs. E CoNrACT
81 S MAIN ST NAtae: `
BRADFORD, MA 01835 QHONE tp�
ADDRE"t-
INaURED 1
INSURER 9 AFFORDING COVERAGE NAIC3
WSURERA: LM Insurance Co oration
HI-TECH WINDOW,&SIDING INSTALLATIONS INC 33';00
29 ARROWWnQD ST- 01SURERB:
METHUEN MA b1844- ViSURIii Il
INSURER D
015UREFZE=
EOIJERAGES LYsuRERF:
TF(Is ISTG CERTIFY CERTlFtCATE NUMBER: 223152d0
THAT THE POLICIB$OF INSURANCE USED BELOW HAVE BEEN ISSUED To THE 10-1SUREQ NAMED ABOVE FOR THE POLICY PERIOD
INpICATED. N- OF ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OP.OTHER DREVISION
CU MEONTI WITH RESPECT 70 tNHICN THIS
CERTIFICA'T'E MAY BE ISSUED OR MAY PERTAIN THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS WITH
RCT TO ALL THE N THIS
.•
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.I.Mort'S SHOWN NAY HAVE BEEN I
rN R N REDUC.D QY PAID CLAIMS.
LTR YPE PF PNEURANCE S�SUER I
coM RIERCIALG )ERALUINSD BER Vwo POUCYRUMPOUCYEFF POU yEXP '
ABlL1TY IM DNYYVYI IMIM/DCp(yyyy LIMITS
CL41h{S}dRDB
OCCUR j EACH OCCURRENCE
P i'10'rt S
i
MEDEfi'(Any ona pnr-a) S I
GFN'L AGGRE(C'AAT-�E LIMIT APPLIES PER: PERSONAL 3 ADV IIJJURY S t ;j
POLICY f `'PRG-
I-_ JeCP LCC GENERAL AGGREGATE 5
O7rr-R.
PRODUCTS-COMP/OPAGG s '
AUTOi,1DBILE UABRRY i
S
ANYAt1TO c E v L I
ALL OVMEOrF a Jdant
AUTO: rtH-cCVLW BODILY lrWURy(Per0nI0n) 5 �.
AU7O5 , '..
DS NON•00.N-
„-
HIRED AUTO AUTOS cD ECOILYINIUAY(Pa�=.�dzr;) 5
PROPERTY DAMAGE
ura9AN;L,,R uA8 ; Par�eRdaat ',....
GCVJR ' g
i;KC;9d
CLAM
F)F- IS-MADE 1 EACH OCCURRENCE $ I f
Rf0NS S
A tVOR1C>:Rg GOMM-PO
VENNBA7tgN AGGREGATE
ANDe41FLCYi=Rg'tJA81LrrY C5-31S-607814-014�rOR/PARTNE
ANYPROPRIYIN10/31/2014 10!312015 PER
OFFIC_R/h1I
RlEY.ECU7NVE v'
_
Etd8ER EXCLUDED
(MandatoryinNN) Q N/A I
It yo;,ds:craTIONa undzr I EL EACHACCIDENr $ I 3�Qodbo
D-e6CRIPOFOF'cRATtOrv5h=Lzw I FL-pISEA$$-FAEb1P10YE 5 .)QQ QD
i
E.L DISEASE-POLWUP&T 5 ( SOOQ'00
DESCAlAT",,TNOFOPERATIONB/LOCgTIONSIVEHICLeS AC i
g ( GRD IU1,AddILon7l Rnmarkc Schedule,may be aBached lTmare cpacefII ragUlred) 111
This celsiificat�ec nctHs id uP8rg des al(p evlously(slued c workers
er;ifiG31 s only Rs they rzlete to,�Drk
A sat(on laws of the slaie(s)of NH I I
era CORlpgngation Coverage.
I
!
CEF;TIFICATE HOLDER
CANCELLATION ;
I
SHOULD
ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED'®E1=®R I
THE REXPIRATION DAA c THEREOF NOTICE WILL BE DELMERED I
ACCDRDANCE WITH THE POLICY PROVISIONS. I
I j
I
AL,iNORIi!EO REPRFBENTATNE� I
3 Insurance Corporation
t.C9RB I
5(2018/O1) The ACORD name and logo are req)sterelY marks 01 - 014 A CORD CORPORATION. All rtghts rsscry
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NO.! _Z31S250 ceerv= COM-:- >aL�zpo oid i
Trod) Fa.7c t o2 L
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"Q `VdJ7U/72w72CCtPCCLfJ!p,
—_ Tice of Consumer Affairs&Business Regulation
i � c`se
E IMPROVEMENT CON
RACTOR
'egistration 918836
HI TECH Expiratier 4126%2017' Type
WINDOW R'SIDING INSTALL INC SuPpiement C�'
TIM WICKS
29 ARRO
VWVOOD ST �
METHUEN,MA 09844_
_ Undersecretary
.s
Massachusetts -Department of Public Safety j
Board of Building Regulations and Standards
Construction Supern-isor
License: CS-096516
TIMOTHY W WI*S
3 ELLIS ST
Methuen MA 619-44
f
" `
'�`� Expiration
Commissioner 09/09/2096