Loading...
HomeMy WebLinkAboutBuilding Permit # 9/29/2015 dRT .. W h �bn,.M�„m.����.�,���o�,.�o..,w d� qL@D 0 Ad. BUILDING PERMIT �� �$ .`• `bI°0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION - »n Permit NO: Date Received Date Issued: ��„� '7 15 ACNus IMPORTANT:Applicant must complete all item on this age TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 11New Building One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ��/ / �,D �//, �nA I I l/df., C' sit ai � e �; � rw1J , Identification Please Type or Print Clearly) OWNER: Name: � C (A � d/V It Phone: Address: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 P R$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. tal Project Cost: FEE: $ heck No.: Receipt No.: ”.2 t-ff 25 NOTE: Persons cont 'ng wun is red contractors do not have ac ss to the g aranty,fund /, i, S►gr�ature of ontracc� haue o RgentJ( uu __ �/ rim AM tkORTH _t own of ItT.11., ndover 0 - 0% �O LANE h vert ass, CoCNICNEW ICK -�� �•4 AofaATE® S U BOARD OF HEALTH Food/Kitchen PEmMIT TU LD Septic System 4-t1;04 THIS CERTIFIES THAT ......... ....................................... BUILDING INSPECTOR ..................... ... . ..... ... ... ............... ��++ � Foundation has permission to erect .......................... buildings on .......5 ... J .......4i..j........... g � Rou h to be occupied as .. .. . .. . ....... ....... .......................`..................... ... ... �.... ....... Chimney provided that the pe n accepting this permit shall in every respect con orm o the ter s d'rthe application Final on file in this office, and to the provisions of the Codes and By-Lawns relating to the Inspection,Alteration and Construction of Buildings in the Towyn of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS I T Rough Service ................. ... . ...... .............................................. Final BUILDING INSPECTOR GAS INSPECTOR ccupancV Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. HE IN11,1RIES, INC. -3 ►- NFRc"� ssic Full Wel( DH Ba /Bow LaWelded Welded Sash Bay Lou—e Argon Foam Filled National FenestrationC W W D H ENS Rating Council® 0003-02684792-00 0110 Low-E Argon i -02 31 3/27/200f Q ' ENERGY PERFORMANCE RATIf U-Factor(U.S./I-P) Solar Heat G . 0 . 30 0 ADDITIONAL PERFORMANCE RATINL, Visible Transmittance Air Leakage(U.SJI-P) 0 . 49 ----- �: Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole product performance.NFRC ratings are determined for a fixed set of environmental conditions and a specific product size.NFRC does not recommend any product and does not warrant the suitability of any product for any specific use.Consult manufacturer's literature for other product performance information. www.nfro.o HE: wr,iuii uL vi aaau tv%.,na auu aca.j cia auu yivjioi urn iauvu- 1 Sps � iHED INUTIES, INC. -3 MtB �'QRCClassic Full Weld C H Ba /Bow Y Removed Before Welded Welded Sa Yh window Is Low—e Arson Foam F i 1 ad installed lcNational Fen CL,JWDI-1 ENERGY RallngCounal 0003-02684792-00 001( Low-E Argon STAR o QUALIFIED D' a -02 30 3/27/2009 FOR: L ENERGY PERFORMANCE RATINGS I Angle ALL 1 U-Factor(U.SJI-P) Solar Heat Gain Coefficient Ie mounted OTHER • gyre window VINYL ° 0 - 30 0 - 20 ,stalled *WINDOWS S` ADDITIONAL PERFORMANCE RATINGS 1, Stool Visible Transmittance Air Leakage(U.SJI-P) SILL 0 - 49 rl and are not intended . provided security or for . ects frorn the interior. Manufacturer stipulates that these ratings conform to applicable NFRC procedures for determining whole . . product performance.NFRC ratings and determined fora fixed set of environmental conditions and a specific product size.NFRC does not recommend any product and does not warrant the suitability of any commended that the hardware on Harvey productfor anyspecitic use.Consult manufacturer's literature for other product performance information. into&awning windows be lubricated twice a year or www.nft.org Jed with a light oil for years of trouble-free operation. NORTHS6 OP ID: DH 'wk.WE'- CERTIFICATE OF LIABILITY INSURANCE DA-FE 0610 712 0 1 YY) os/a7t2o1 5 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 certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER Phone:978-777-9394 CNpME:cT Dan Hurley Dan Hurley Insurance Agency PHONE F Chestnut Green,Suite 24 Fax:978-777-3306 C No E :978-777.9394 aC No:9I8-777-3306 Seven Federal Street ADDDRESS:dan hurleyinsurance.com Danvers,MA 01923-3620 Daniel J Hurley INSURERS)AFFORDING COVERAGE NAIC 4 INSURERA:AIM Mutual Ins.Co. INSURED North Shore Window&Siding INSURERB: James Sheilds 40 Preston Road INSURER C: Somerville, MA 02143 INSURER D: 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. INSR ADUL SUB11 PO LIC EFF POLICY EXP LTR TYPE OF INSURANCE SR POLICY NUMBER MMIDO MMtDDNYYY LIMBS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY NOT HAN DL ED BY THIS AGY PREMISES Ea occurrence $ CLAIMS-MADE r_1 OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ POLICY JECTPRO, M LOC $ AUTOMOBILE LIABILITY COEa aBINEDtSINGLE LIMIT $ ANY AUTO NOT HANDLED BY THIS AGY BODILY INJURY(Per person) $ ALL OWNED SCHEDULED id P BODILY INJURY(Per accent $ AUTOS AUTOS ( ) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident UMBRELLA LIAB OCCUR \ EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION WCSTATU- X OTH- AND EMPLOYERS'LIABILITY T LI S A ANY PROPRIETORIPARTNERIEXECUTIVE YIN WC400-7025974-2014A 05/1812015 05118/2016 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? � N/A (Mandatory In NH) SEE NOTES E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS t VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space is required) Jim Shields is exempted from workers compensation policy. WC insurance coverage applies only to the workers compensation laws of the state of Massachusetts. CERTIFICATE HOLDER CANCELLATION CERTAIN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Northshore window& Siding THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 40 Preston Rd. ACCORDANCE WITH THE POLICY PROVISIONS. Somerville, Ma. 02143 617-628-7204 1-800-439-7205 AUTHORIZED REPRESENTATIVE Mass. Reg. 101562 ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD The Commonwealth ofMassachusetts _Pri_c warm= Department of Industrial Accidents — Office of Investigations - _ I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gav/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le k 'bl Name (Business/OrganizatioJ v'duat} ,�1 t1 6L(2)/Ja') + (AL _ r ar Address: City/State/Zip: Phone #: Are you an employer? Check the appropriate box: Type of project(required): E1 am 1. a employer with < ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors' 6. ❑ New construction 2.ElI am a sole proprietor or partner- listed on the attached sheet. 7. modeling 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 per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(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 their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit g 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'com ens tion in urance for my employees. Below is the policy and job site information, s Insurance Company Name: 14 t Policy#or Self-ins. Lic.#: - xpiration Date:_ Job Site Address: 3 7 U City/State/Zip: �w 7 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 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 Investigation the DIA for insurance coverage verification. Ido hereby rtify nderh ains a d ties ofperjury that the information provided ab ve is Irl e and correct Signature: Phone#: 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 Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-068424 JAMES J SIITELDS' 40 PRESTON RD27 SOMERVI LLE 1VIA 021J44 i Expiration Commissioner 10/01/2016 V�e IDOJIUIILOOztOeCll�!L o�(%lwcJJcrClwveffu Office of consumer Affairs&Busi6ess Regulation rxME IMPROVEMENT CONTRACTORgistration: 101562 TyNe: piration: ---612612016_ DBA NORTHSHORE WINDOW&SIDING ' James Shields 40 Preston Road Somerville,MA 02143 Undersecretary