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Home My WebLink AboutBuilding Permit # 9/14/2015 OORTH 9 BUILDING PERMIT � a h=�� ,;°ym o TOWN OF NORTH ANDOVER �i APPLICATION FOR PLAN EXAMINATION - Permit AVO: � Date Received Date Issued: �9SS•acHUS�� IMPORTANT: Applicant must complete all items on this page LOCATION :.. . Pant PROPERTY OWNER ..� �. " C'rtnt MAP NO PARCEL ZON(NG DiSTR(CT 1-(istoric District yes no 4 ' . ach�de Soh'i�p'1/ill�ge _.=des .-;no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg [I Others: � ❑ Demolition ❑ Other ❑Sep,tic;; [:Well 0 Floodp(airi, retb,nd Districfi O.:1Na#err/Sewer s, � � S'I c�� Lv i �j bar- C'.� �. �'� � 1��a� J n Identification Please Type or Print Clearly) OWNER: Name: '/ � �) C Phone: q 7 -3 G / Address: CONTRACTt3R Name Pnone: C ' Address Supervisor's Oonstrudtion License Exp Cate 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- $ 2- 9) 000 FEE: $ Check No.: '`L i Receipt No.: c 77d NOTE: Persons contracting wn stered tractors do not have access to the guaranty,fund k Signature of Agent/Owner Signature of contractor, - I: ;� x I oORTH -r e"" ' i ,own ol It e .J,, An A"%, "w du V 11 ® 10 ° h ver a ;616 ss o 9 7 COC HICNl W.CK �1• A04ATEo S u BOARD OF HEALTH IJERMIT . T L Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ........... ... ......... ..................... ........... . .. ........ . ...............L .. Foundation has permission to erect .......................... buildin son3.4...at?..... .`. ... . .... ............. a Rough tobe occupied as ........... ... .....e.......... .. ............ ................................................................. 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 PERMIT I ITHS ELECTRICAL INSPECTOR LESS CONSTR S T Rough Service ....... ....................................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to ccupV 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. Meadows Construction p 4 New Pasture Road Newburyport, MA 01950 j Phone: 978-463-4487 gofigureapp.net j Bob Barnett September 8, 2015 34 Old Village Lane North Andover, MA Project Details Siding-Biber Cement Clapboards James Hardie Evening Blue • Remove existing siding to sheathing. • Burnish and Install air vapor barrier over entire wall. • Burnish and Install membrane flashing at window and door openings. • Burnish and Install aluminum flashing at window and door heads. • Burnish and Install fiber cement clapboards. • Blind nail all siding.- Proposal Votes Existing trim to remain Remove existing shutters and replace with vinyl shutters provided by owner. Total Price: $24,000.00 1/3 Deposit 2/3 upon completion 2 Meadows Construction Signature/Date Customer Signature/Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,Mass. 02111 www.ntass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Meadows Construction Company LLC Address: 4 New Pasture Road City/State/Zip: Newburyport, MA 01950 Phone#: 978-465-4735 Are you an employer?Check the appropriate box: Type of project(required): 1. X, I am an employer with 40 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part time).* have hired the sub-contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. �• Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers' 9_ ❑Building addition [No workers'comp.insurance comp.insurance.$ required] 5.❑ We are a corporation and its 10. ❑Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑Plumbing repairs or additions myself [No workers'comp. right of exemption perm MGL insurance required]t c. 152,§ 1(4),and we have no 12. ❑Roof repairs employees. [no workers' 13. ❑Other comp.insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. tHomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contactors that check this box must attach 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 ane an employer that is providing workers'compensation insurance for eeey employees.Below is the policy and job site information. Insurance Company Name: Travelers Property Casualty Company of America Policy#or Self-ins.Lic.#: UB6B226814-14 Expiration Date: 9/12/2015 Job Site Address: 34 Old Village Lane 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 MGL 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 $250.00 a day against violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for coverage verification. I do herby cerci reunder the painsc nd penaallties of peejuty that the inforneation provided above is true and correct. Si natu .` ,L,it„-, C Date: 9/11/2015 PrintNatne: Brian Dias Phone#: 978-815-7149 Official use only Do not write in this area to be completed by city or town official City or Town: Permit/license#: Issuing Authority(circle one): 1.Board of Heath 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact person: Phone#: MEADO-3 OP ID:JA CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 06/24/2015 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(ies) 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). CT PRODUCER NAE: NAME:NTAMarcos W.Shaner Chase 8 Lunt LLC PHONE 97862 4434 ac No:978-465-6204 65 Parker Street vc No Ext Newburyport,MA 01950 E-MAADDRESS: Michael C.Howlett INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:First Mercury Insurance Co. INSURED Meadows Construction Co, LLC INSURER B:Safety Insurance 4 New Pasture Road INSURER c:Harleysville Insurance 23787H Newburyport, MA 01950 INsuRERD:National Union Fire Ins.Co. INSURERE: 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. NSRDDL UBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD 1WVD POLICY NUMBER MMIDD/YYYY MMfDD1YYYY A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 CLAIMS-MADE T OCCUR X MACGL000001642403 09/12/2014 09/1212015 DAMAGPREMISES E ( RENTED 5O OO Ea occurrence S , MED EXP(Any one person) $ EXCLUDE PERSONAL&ADV INJURY S 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY FX] PRO-- [::] LOC PRODUCTS-COMPIOP AGG S 2,000,00 JECT OTHER: $ OMBINED SINGLE LIMIT S 1,000,00 AUTOMOBILE LIABILITY (CE,accident B ANY AUTO 5059124 09/12/2014 09/12/2015 BODILY INJURY(Per person) $ ALL OWNED �( SCHEDULED BODILY INJURY(Per accident) 5 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident 5 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,00 D EXCESS LIAB CLAIMS-MADE 8517G130ALI 09/12/2014 09112/2015 AGGREGATE S 5,000,00 DED RETENTION$ $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE YIN N/A TO BE ISSUED BY CARRIER EL_EACH ACCIDENT $ OFFICE--EMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ C Equipment Floater CIM93977Q 09/12/2014 09/12/2015 RENTED 150,00 Special Forms EQUIP DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Lowell Housing Authority are listed as Additional Insured with respect to the General Liability if required by written contract. 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 REPRRESENTATTIVE�, I v 91988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE QU rMM/DD/YYYY1 T TIFICATE 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(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: CHASE&LUNT LLC PHONE FAX PO BOX 590 (A/C,No,Ext): (A/C,No): E-MAIL NEVt13URYPORT,MA 01950 ADDRESS: 73JGX INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: TRAVELERS PROPERTY CASUALTY COMPANY OF AMERICA INE-ADOWS CONSTRUCTION CO LLC INSURER B: INSURER C: INSURER D: 4 NEW PASTURE ROAD INSURER E: NEA713URYPORT,MA 01950 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 ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MMOMYYYY) (MM1DDlYYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ CLAIMS MADE F-1 OCCUR. PREMISES(Ea occurrence) MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY F-1 PROJECT [:]LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY COMBINED SINGLE $ ANY AUTO LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ (Per accident) NON-OWNED AUTOS PROPERTY DAMAGE $ (Per accident) UMBRELLA LIAR []OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION S $ A WORKER'S COMPENSATION AND X WC STATUTORY OTHER EMPLOYER'S LIABILITY YIN UB-6B226814-14 09/12/2014 09/12/2015 LIMITS ANY PROPERITOR/PARTNERlEXECUTIVE � NIA E.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTIONSISPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSL-ED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICATE HOLDER CANCELLATION y 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 REPRESENTjyPVE {/? ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 1988-2010 ACORD CORPORATION. All rights reserved. Office of Consumer Affairs and Business Regulation 1- 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 157479 Type: Private Corporation Expiration: 10/4/2017 Tr# 270240 MEADOWS CONSTRUCTION CO. MICHAEL MEADOWS 166 MIDDLE RD. BYFIELD, MA 01922 Update Address and return card.Mark reason for change. SCA 1 c: 20rn-05�1I Address ❑ Renewal ❑ Employment D Lost Card -- Office of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: j Registration: 157479 Type: Office of Consumer Affairs and Business Regulation r 10 Park Plaza-Suite 5170 Expiration: 10/4/2017 Private Corporation Boston,MA 02116 MEADOWS CONSTRUCTION CO. MICHAEL MEADOWS 166 MIDDLE RD. BYFIELD, MA 01922 Undersecretary of valid without ature Massachusetts _pe Board of Building �`pa rtn?ent°' public - Consh-uctio» S gu�"I ons Safety ras and Standards Lice ui�etl iSor nse: CS-075914 Brnan NJ Dias 7 Sir Isaac W, Hudson NII 03051R"I OF 11 t 111 � Commissioner Expiration 09/28/2016