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HomeMy WebLinkAboutBuilding Permit # 10/5/2015 01OosrH R,�CD BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION <.4nw N 1� Date Received 4ATE° 5 4? Permit No#: .. �Scwus� Date Issued: IMPORTANT:Applicant must complete all items on this page v LOCATION Print es o PROPERTY OWNER Print 100 Year Structure Y 00 ZONING DISTRICT: Historic District yes no MAP _—PARCEL: — Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ane family ❑ Industrial ❑ Addition ❑Two or more family ❑ Commercial ❑Alteration No. of units: El Assessory Bldg epair, replacement ❑ Others 0 other r«n r f4 IIN4liaiiDl r„ iro Jr»r i rr/ i% ��MElDemolltlo )I lW Sep#� Wr r rs ,. OF WORK TOB P � Identification- Please Type or Print Clearly Phone: --76–.)- OWNER: .)-OWNER: Name: Address: /6- Contractor Name: ate, Phone: Cca ► �/ Email: Address: 0 Supervisor's Construction License: ' Exp. Date: le)r Home Improvement License: f e-) r Exp. Date: ARCHITECT/ENGINEER Phone: Reg. No. Address: PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. FEE SCHEDULE:BOLDING PERMIT:$12.00 Total Project Cost: $ 62 `? dro FEE: $_____� Receipt No.: Check No.: NOTE: Persons corZtracting wit unregistered contractors do not have access to t,1ic uararaty fund _ __ OR 74 ORTH f %a-s ove ri own o n 1 • Co LANE h vVl ' aSS9 L ic 07,mz COCNIC NE WICK �• 'p.4VV x,95 U BOARD OF HEALTH PE �RMIT Food/Kitchen Septic System THIS CERTIFIES THAT .,,JL Ir%1k BUILDING INSPECTOR ........... LW............ ... ... ............ ............. .... ........... . . .. .... .... .... . . has permission to erect ...... buildings on .. Foundation AU% Rough --rr ............... to be occupied as ........... ....... .. . . .. .............4.0 OW4&.................................. chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR . UNLESS CONSTRUCTI 'STARTSRough Service ................................. ............... .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. _ 11- ------------- ----- ___ j tet.-� MA Home Improvement ConVactor byAndersen 9j+` Renewal b Andersen Corporation License 8170810(Expires 12/2312015) .IN Dow Hf:YtNOh'M IN ,i A.•.ler�.v��..:.;., ,, �' Federal Tax ID#41.1818413 30 Forbos Rd. Northborough,MA 01532 (508)351.2200 Fax(508)-986-7072 CUSTOMER WINDOW AND DOOR REMODELING AGREENTENIT Buyer(s)Name Date; I LAURA SHOTTES - AUGUST 26, 2015 Buyer($)Street Address City State Zip Code 15 ROSEDALE AVE. NORTH ANDOVER MA 01845 (Email Address Home Telephone Number Work/Cell Telephone Number LSHOTS I E01 AOL.COM 978-682.7528 617-850-2909 Buyers)hereby jointly and severally agrees to purchase the goods and/or services of Renewal by Andersen Corporation("Contractor"),in accordance with ithe terms and conditions described on the front and the reverse of this agreement and on the attached specification sheet(s)(collectively,this"Agreement"). Buyers)hereby agrees to sign a completion certificate after Contractor has completed all work under this Agreement. Total Job Amount $ 12,273 mount Financed S 12,273 Est,Start Dille Method of Payment Deposit Received(331%)$ 0.00 Deposit at sigrmg S 6,136.50 Check/Cash 10-i2 weeks Balance Start of Job(339b)$ 0.00 Chock# Balance on SubstantialEst. nstall`i-imti nt suuu,nuat Credit Card Complotkln of Job(3390)$ 0.00 Complelion S 6,136.50 1-2 days If credit card is selected,please No final a mens shall be demanded un>d all parties are sstsf•ed see Credit Card Payment form €Buyor(s)agrees and understands that this Agreement constitutes the entire understanding between the parties,and that there aro 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 lof both Buyer(s)and Contractor. Buyer(s)hereby acknowledges that Buyor(s)1)has road this Agreement,understands the terms of this Agreement,and has rrecoived 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. IRenewal by Andersen Corporation / Buye(s � _ Buyer(s) Signature of Consultant SignalurfT Signature X BRUCE PECK LAURA SHOTTES Printed Nama of Consultant Printed Name Printed Name YOU,THE DUYER(S),MAY CANCEL THIS TRANSACTION AT ANY TIME PnIOn 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. f ----------------------------------- ---------- -------------- � r I NOTICE OF CANCELLATION I NOTICE OF CANCELLATION r i I)the or TrnnNactI ;1/;!6/I) lou may cancrl Ills I Duty of T—nAactiou It/.!n/I;Y You nuty cancel thlu 1 ora—etion,without any prnatty or obligation,within titre.busiurss dayv Gout ate I three hu.,lo—days front Aim labove date.If you cancel,any property traded In,any payments made by you under 1 ab...date.If you cancel,any property traded in,any paytnents made by you under I the Contract of Sale,and any negotiable instrutuenl executed by you will be 1 the Contract or Sale,and any negotiable Invtrunnent executed by you w411 be returned wi iln,10 days following receipt by(ho Contractor("Seller")of your r returned within 10 days following receipt by the Cnntraclor("Seller") ar your 'cancella Uon ttotico,and any Necurity imprest arising out or Ili.Iransacliou villi be 1 e—collatimt notice,and any Necurily interest arklhg out of the.IrAnsaction will be jcanceled, Ir yo t vaned,yen,must ruAlte avn 11 able to the Sellar it your reshles-v,It 1 canadtxh If you lancet,you mual make avnihtblp fo the Sclipr nt your raidence,to iwubstunihtly ns gond atndtton us ultra recclvul,any goods J.II•cred a.you antler 1 subulanUnlly as good condhlon us whrn t•ecclved,any goods th+Hverr•al to you under i`thls Contract or Sale{or you tnay,If you wisely cotupty with the instructions of the 1 tbb:Contract or Saler or you ulay,If you wish,comply with the Instructions of the Seller regarding the return shipment of the goods at the Seller's exp,ase and risk. I Seller regarding the return sklptuent of the goods at die Seller's expense and rick. 'sH you do make the goods available to the Seller and the Seller does not pick them up I If you do snake the goods available to the Seller and the Seller does not pick then up withhh 20 days of the date of your Nodee of Cancellation,you unay retain or dispose I tvithhh 2e day,s of the slate of your Notice of Cancellation,you may retain or dispose of We goods without any ILrther obligation. If you fall to make the goods avn Hnble I of the goods without any further obligation. If you fail w make flip goods available �fo the Seller,or if you Agree to return the goolN to thr Seller and Rill w dr.sq then I m the Selivr,or if you agree to return the goudw to the Sr11er and fall to do so,Ibro you rmmiln Ifuble Por perforhnunca of ulr ohltgndmts uodcr the Cnnlruct. Til haler/ you rentals llable for performance of all obligations under the(Ionlract, Tn cancel this transaction,nhall or deliver u slgned and dated copy of this cnuce11a1lon notice 1 tits transaction,mall or deliver a signed and doled copy of this cancellation notice for any otter written notice,or wend a telegr nu to Contractor Renetval by Andersen,I or any other written notice,or scud a telegratu to Contractor: Reuetwal by And.".en, ?30 Forb.w Rd. Northborough frLA01532. 1 301'orbes Rd.Nordtlhorough,NIA 01532. �I HEREBY CANCEL THIS TRANSACTION. I I IIERFBY CANCEL THIS TRANSACTION. 1 I I Renewal Renewal by Andersen Corporation MA Home Improvement Contractor byAndersen, 30 Forbes rd Northborough,MA 01532 License#170810 (Expires 12/23/2015) ,WINDOW nEMACEMENr (508)351-2200 Fax:(508)-986-7072 Federal ID#41-1918413 Window Specification Sheet Buyci-W Name Dale oI'Atrrcentent LAURA SHOTTES WED, AUG 26, 2015 i The IRIV01"sl listed above Iterehy jointly and set orally: roe to purClra c the gnorls and/or services listed hehtw: ht accordance teitlt the prices mid terns describer) on the Specification Sheet and the tient and the reverse of the accompanying CUSTOM WINDOW tLND DOOR REMODELING AGREILMENT,of t:hick dte Specification Sheet is part. WINDOW&DOOR DETAILS Ppp. W. /y^px ExteriarRnteror Color Hardware Ha�xara t9'nE•t/ rx-ale Gnfln; Glass Room 4 w1,- h.,-,ht U.J. Window/Door Style Detail Casings Ext-Int Color style S�ez�s smart— G,riVes Sash 1r3 Sash2 Ufts Options Bed 1 101 36 54 90 D13 sq rail equal insert sloped sill L-Trim WWWH White Standard HTS StnartSur GEG 4/2 412 Yes Bed 2 102 36 54 90 DB sq rail equal insert sloped sit] L-Trim NJRVH White Standard HTS smartsur G8G 412 4/2 Yes Bed 2 103 :ill 54 90 DB sq rail equal insert sloped sill L-Trim VH/WH White Standard HTS smartSur GES 4/2 4/2 Yes Bed 3 101 36 1 5.1 90 DB sq rail equal insert sloped sill L-Trim VRNVH White Standard HTS PmartSur GBG 412 4/2 Yes Bed 3 105 36 54 90 DB sq rail equal hsert sloped sill L-Trim •VwWH White Standard HTS SmartSur GEG 412 4/2 Yes Bath 1 106 28 38 66 DB sq rail equal insert sloped sill L-Trim I-IMH White Standard HTS SmarlSur GEG 412 4/2 Yes Temper Bed 2 107 213 38 66 DB sq rail equal insert sloped sill L-Trim IVRMH White Standard HTS smartsur GBG 4/2 4/2 Yes Temper Kitchen 108 41 40 81 GW full frame rafo Int/Ext MF 908 MMH White Standard FTS SmariSur GEG 412 4/2 Yes See notes Total 8 BAY,BOW&BUILD OUT DETAILS pprox Stylo Detail! v;idth/ Approx. Number Frame Window End Center Lov.E! Roof/ Hardware Room Count Style Flankem hnl ht cxa -,.gs Angro Lites Interior Ext/Int Color Grilos sashes sashes Screens Smansun Soft Cola SPECLf.LTY WINDOW DETAILS FuII; Approx. Lai�•E! specialty BAY/BOWADDITIONrALWORKNOTES '.. Room Count Style In-Gert U-I. srartsua Grilles Grille Style ExVint Cc!or Cue:om<�is--l'.'h b»./tu,:c"!.d-"-&'T±i.,I- Ih.:,r•..ill he aiStnilinii 0a..:1osr_ '. ADDITIONAL WORK DETAILS: 110 knows 900 on kitchen will took different ON out side. HD wart kitchen tail.trim preprinie& t No Contractor will wrap exterior casings with coil stock color of i Owneris aware that Contractor does not do any paintibg/staining or removal/installation of alarm system or window treatments/hardware.It is the responsibility of the homeowner to have the alarm system and window treatments/hard:vare removed prior to installation. :ore make no guarantee as to ivhetheralamis or window treatments/hardware will tit after replacement. Customer is also aware in some cases there will be glass loss. It there is,the amount will be dependent on the type 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 rat be found there will be an additional charge for time and materials unless so stated in this contract s 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. 1 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. ti ✓ 1<_; No Owner agrees to be present on the final day of installation for final Inspection and to deliver final payment/finance form(s). ill i>agreed and nudcnlaxl by and bruiTen rhe Irl ica th:It Iii,Sfkv illruiron 5h 't,;.!on 'g the fiUs"POM NVINDOAV ND DOOR RP\IODELINC::ICRLI MFNT vmi iiluus the main• �underaandigg Iks:erten tut ding,dian{ilw or,nuelifeing any of the term..'chi,sp-ifieation Shert ln;w nen b..ehallged or it;trill,mMJifirrd or.:�rirxl iu :uly w ry unk_; 'mit Ran a.,an•in"Titin,and.igned by Will Ifiv 8 gecf,,i awl Contru:a r. Bolen.)Il'-wlsy arktto:i d �thsr H tl r.;h:,,rrrd Illi,Specilitatio I Sitret. Renewal by Andersen Corporation 1Suye r�sj �-� ISm r(�j It, Bv([Ce, PC[/ � Signature of Consultant Signature Signature BRUCE PECK LAURA SHOTTES Print Name of Consultant Print Name Print Name D 00 nut remove unm Ind code inapectiai.Sane lapel trim mtrimca '` n Cr e � I V W c Renewal I ,nhvpw pnuev.e.T �,�a...ca,...,• N�FrMF9aan{n AND-N-36 O WoodMnyl Composite FF Dual Argon ow-E4 SmartSun Prod uct Type. Glider j ENERGY PERFORMANCE RATINGS I U-Factor Solar Heat Gain Coerticlent 0..29 :11.66 021 ADDITIONAL PERFORMANCE RATINGS Vlsibie.Transmtttanee 0.49 sun�r�..tnn/Ime�rn[wn.[er�irV�orR�¢wr.Mgswwa j car�n•m.K�l�.PM'.��Hwsrt M ersen d DrEmon: n now - • r eawtmvw np ' Standard Raeng . a+v wrxwuwn�putv�wp ..DP psPH6-G36- I ym- DYin�e�da�ra�x - ioo-ao5lavds-0i5 - ! Rear.MtAAM N�WW.tra4.dnr.u0� • f I f The iC'ommonwealtlt o,f Massachusetts Department of Industrial Accidents Office of Investigations 600 H'ashington Street Boston,MA 02111 www.niass.govldia "Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly Flame(Business/Organization/Individual): RENEWAL BY ANDERSEN Address: 30 FORBES ROAD City/State/Zip: NORTHBORO,MA 01532 Phone#: 508-3512200 Are-you an employer?Check the appropriate box: Type of project(required): 09 1 am a employer with 30 4. ❑ I am a general contractor and 1 6, ❑ New construction employees(full and/or part-time).* have hired the subcontractors 2.❑ t am a sole proprietor or partner- listed on the attached sheet.+ Remodeling ship and have no employees These sub-contractors have $. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their I0.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL MEI Plumbing repairs or additions myself [No workers' comp, c. 152,§1(4),and we have no 12.❑ Roof repairs insurance required.]r employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#I must also till 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 their workers'comp.policy information. I am an eniplt)yer that is provi&i)g workers'compeitsativit insurance for my employees. Below is the policy and job site information. Insurance Company Nante: OLD REPUBLIC INS. CO. Policy#or Self-ins. Lie.#: /IWC 30543700 Expiration Date: 10- Job Site Address: / &I., e_,O Alm ���' City/State/Zip: 0`rn 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 Investigations of the DIA for insurance coverage verification. I do hereby cerilfy r the pains and penalties of perjury that the information provided above is true and correct. Si nature: °,� Date; " 5, f Phone#: �84-35�1-2200 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#: ANDECOR-01 YADAVYO CERTIFICATELIABILITYIIV DATE(MM/DD/YYYY) 10/1/2015 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). PRODUCER CONTACT NAME: Willis Certificate Center Willis of Minnesota,Inc. PHONE g77 945-7378 c/o 26 Century Blvd A/c No Ext):( ) FAA/C No): (888)467-2378 P.O.Box,TN 37 ADDRESS:Certificates@Willis.com Nashville,TN 37230-5191 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:OId Republic Insurance Company 24147 INSURED INSURER B: Renewal by Andersen LLC 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. INSR ADDLSUTYPE OF INSURANCE B POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD/YYYY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 rvi CLAIMS-MADE I I _DAM7����OCCUR MWZY 305440 10/01/2015 10/01/2016 PREMISES(Ea occurrence $ 500,000 '.. MED EXP(Any one person) $ 10,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 4,000,000 LOC X POLICY n PRO- ❑ JECT PRODUCTS-COMP/OP AGG $ 4,000,000 OTHER: $ AUTOMOBILE LIABILITY EOMaBINEDiSINGLE LIMIT $ 5,000,000 A X ANY AUTO MWTB305438 10/01/2015 10/01/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY Y/N X PER EOTRH '.. A ANY OFFICER/MEMBER EXCLUDED? N/A PROPRIETOR/PARTNER/EXECUTIVE r� MWC30543700 10/01/2015 10/01/2016 E.L.EACH ACCIDENT $ 1,000,000 (Mandatory in NH) l'V If yes,describe under E.L.DISEASE-EA EMPLOYEE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supen-isor License: CS-090125 Iv !JAME L MORIN;` - %. 86 GARDINER ST LYNN MA 01905 A WExpiration Commissioner 10/06/2016 Moe of Consumer Affairs&Business R4ggtation *9 IMPRUY NTC. TITRACTAR Ids 6 itAtib�t 1 l fi5 SU'Olement r RENEWAI BY At i E R i 9 f-PORATION , JAIME .:MORIN 104 OTIS STREET NORTHBOROIJGH,MA 01532 --y--- Undersecretary t