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Home My WebLink AboutBuilding Permit # 10/6/2015 OORT BUILDING PE ITILFD I m�s.�LE6�A'o TOWN OF NORTH ANDOVER `r. APPLICATION FOR PLAN EXAMINATION ® ` Permit Nod; ,F Date Received Date Issued: cHusti IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes(noMAP "°° PARCEL: ' ZONING DISTRICT: Historic District yeoMachine Shop Village yeo TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition IY�u/�rr,/�o,rl/•i�r❑i�+r(r!di!�De11a11,�w Am,��tor„ l„iSti,,oe�Ian �.[I Other ther "I'll / hr�ri, ,i r.i7..m,t/�ip (/1 4� �, o 7!�W� 'G1r%r,,I,/r�,�i/�1`/��I�,hr/r��/,rr/r„J,//�ar/f//�,,�l/�/t/�o/,N�,❑,/�,,,.r,,/rrr,,e�Wrr�/rn,/,l//r�.,/,.�/,11�e/,1r,,9!,�r«/tIir%.,r/lv,a�,//:1,rr,/r,,niu1/r,r,/lr�r,�/I/dlcr1��s/JIriir�r„r,,er//�I�lr�9rffJl tr�/rr/,,f„,ri,,/,r!i�r1�l/l,(A,,l,r/lyI,/r�,Jr 4�(�„�l/�rY,.❑.i1��1�1 Wr ar'E�f 1e1!(,,�,4r�/<s/�,�(l.h6/,e/mudJ 1rar.D�,V•rf t,Yt.rs(Y!r��tl+/'/nr;r/c��/� /,,�r„I;,,1l!,//,/i�,��//iI/Jl , ,,. DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: '%” Address: .• eX',1w Contractor Name: map`-%% �` 1� r�1° Phone: `7Y ~ a Email: Address: .9 e'7�- Supervisor's Construction License: -v�'&”�,:f-lz'& Exp. Date: Home Improvement License: //,?F Y 4 Exp. Date: ' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �P7 FEE: $ � ” Check No.: Receipt No.: 7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ftri�., I tkORTH owil Of lickiver ® ® - LAKs h ver, Mass, 2,60 C0C"1CM@W.CK tea• Q°RA�rEo S U BOARD OF HEALTH Food/Kitchen PERMIT I D Septic System THIS CERTIFIES THAT ........... ........6 BUILDING INSPECTOR has permission to erect .......................... buildings on ..............Q- FoundationejRough ................ to be occupied as .... .. ............ ......... ... .°....... :e....�r}".!�.'.... ...... ........... 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 PERMITI ES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION TARTS Rough Service ........ ... .�r��L�y,��.��. Feti.*n................................... �/ .............. Final BUILDING INSPECTOR GAS INSPECTOR ccupancy 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. HI-1 ech W,ium„ ,ow & SidingInc. SIDING 20 Aegean Drive Unit 4 MA Reg� # 118836 Methuen, MA 01844 re Was - MA Lit - 106508 1-800-851-0900 0--yw—C wwwNtechcorp.hriz MEMOEM Claw C , 5 Consultant: Job Telephone: --.- Job Address: w 5- ro n: working ontractor Z7,rees 777 (1,7,xibed work on or sibout weeks after irnal fillings,and complete des(Abed work in alrout.. days Coot(actor stiall not bq hold liable for delays due to cause beyond our control. HfIech shall not be held liable for any darnage to lawns or, Plants.ContrarAcir sh,.fll riot I)e Iiaf)le for arty claniage,to painting or stain(luting installation of win('iows or(locus. Hi-Tech(foes not do any g opaint- Inr staining In are event that a tnindi list sa hould accrue at ille and of the a job, rnaxinrurn of 2%is tire allowable a blrnorint to be held back. T The following work includes,all bo ll lar and niateri�als mx,�ded to complete yourjob a in workinanlike nwinnef, li, ob includes job Sirfing Wliin(Afror WC10” Coated Mini .......... Ading and U�c fleml,t NIM Fast Troatmont Val Fascia r:orI r1iTi 21f!rl.w,.r,.s,!�.� — 'rishmil L 2-7-7-- #so "T, ........ �i";'11 111',,k is X" soffit'Treatment Siding ? ---—------ Soffit Color 4 79 IL, I Cyck,Doc rr),etol ovo Debii� wui uRy ilentvd i-TrZ-7vented ..................... --freparatiort Includos .......................... ................. Midrall ow And Do,or Casing Treatment r wm y&mwp Rug Guard stwWl 9 Window Arid Dow C,isinq C"Aw Fwll Custom omied j txm,. ��rfnll Custom FoTfned Accessory Packago Includos None Firmt stol,Capping A. 1:711.7 Ir Gutter,&Downspouts "y 7;cefii Fllock4 7 Lo S OCIa" I NOWIS —i;;Wri—ay m et it"—IT is_u I a't io—n T-6 B—e-ki ............ Miry -1b0i 3/8 11C ............ Location e— ............... V !Lo'�!Mded - 1",",Tipiele House Gam�je 7 ........... Siding To Be Used ...........- Payrnwit Policy .............. [ Hi4ech IbArnanq Bar,k Financwg Owner To Arrange e brand P'A S Cash Or(.,heckMaste'r car(i ittnia-P—o t'T"o B is U se d Total investment 13 Cornor Post Color 1/3 Deposit worl non El 113 Payment 113 Baliance of Day Substantial Completion You rnay cancel this agreenrent if it has been signed by a party thereto at a place other,than the address of the seller,which may be his inaln office or brancli thereto, provided you notify the sellerin writing at his main office or branch by ordinary rnall posted, by telegrarn sent,or by delivery, riot h,)ter than midnight of the third business day following the signinc, ofthisag reement See the attached notice of cancellation form for at explanation of this right, An inloumst chwq,t of I plr moiM,$W%,Pei yVw),&�I be Date of A, raelrlr lnwiyaroounr unpandakw 30days from rmkd,0,,� Y w,jpvt✓ n,,- i % M ",-'v i,- 7 � Ij lech pennission to WAafn all riecum%ary peimit%, 1 Signature y .......... The Commonwealth of Massachusetts z Department oflndlustrialAccidents 1 Congress Street, Suite 100 -4 d Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/fndividual): ///'-7e- Address:Address: City/State/Zip: el,?V:v Phone#: 5'7k- Are you an employer?Check the appropriate box: Type of project(required): 1. F�l am.a employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in $, ❑Remodeling any capacity.[No workers'comp.insurance required.] • 9. El Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑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. 12.0 Plumbing repairs or additions S. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ t 13.[]Roof repairs These sub-contractors have employees and have workers'comp.insurance. 14,Z Other ..S 6.❑We are a corporation and its officers have exercised their right of exemption per MGL C. ��. oyees.[No workers'comp,insurance required.] 152,§1(4),and we have na empl *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 si bmit a new affidavit indicating such. TContractors 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. 1 am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: 4r/�/`��' ✓� ' /—/12_-r4 V W r'e Policy#or Self-ins,Lie.#: 6/4�" _AI K®70i 41' C7/ Expiration Date: «r�1�/✓`� Job Site Address: Yr /,/7 e City/State/Zip: moi, l`�l rte✓ 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. I do hereby certify under thepains andpenalties ofperjury that the information provided above is true and correct. Signature: % Date: rrr•_ i�r Phone 77 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): i 1..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.PIumbing Inspector 6.Other Contact Person: Phone#: TTR KI EDIS INS , FGE 01 1'01 0:56:06 r(�t FST (.ET-�i FR:t4: (i!,j ; 37' '" )r T _ 2 C E R7 I F[ DATE(AfWDD' ) I it F LIABILITY INSURANCE 1 u1o1zD1•s THIS CERTIFICATE IS ISSUED AS A MATTER of iN A f0 ONLY AND CONFER NO RIGHTS UPON THE CERTIFICATE HOLDER I THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NE �Rl EtlEXTEND ORA TER THE COVERAGE AFFORDED BY THE POt11CBELOW. THIS CfiRT1FIGATE pF INSURANCE DOE C ON TfTUTE A CONTRAC BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIF JIT OL ER. IMPORTANT; If the certificate holder is an ADDITIONAI. INS RE ,the policy(ies)must a endorsed. If SUBRM, TION IS WANED, subject t the terms and conditions of the policy,certain polici a r uir�an endorsement. A atement on this certificate does not confer rightsjioo the certificate holder in lieu of such endor-ement s). 1 1 PRODUCER BARRY J KITTREDGE INSURANCE coNrncr ' 1 81 S MAIN ST NAME: BRADFORD, MA 01835 EMAIL .t91, i ADDR " i I s_URER9 AFFORDIN6COVERAaE NA(C. INSURED NSURERA: LM in urance CO Oration 33600 HI-TECH WINDOW &SILTING INSTALLATION INCIN9URER8: 29 ARROWWOOD ST n1bURERC: METHUEN MA 01844- NSURERD: - NBVNERE: INSURER F COVERAGES CERTIFICATE NUM R: 15 .5D REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE TI :ELCHAVE_BEEN 1S3StJE_DT NSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TE # O NU TION OF ANY CONT RAC OF. OTHER DOCUMEN7'NITH RESPECT TO WHICH THIS CERTIFICATE MAN' BE ISSUED OR MAY PERTAIN THE IN W �AF ORDED BY THE POLICI S DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMNS O I,LIAY�HAVE BEEN REDUCED 9 PAID CLAIMS. iN$R TU-13R — POLICYEFF �DIJD I:XP LMIT3 COMMERCEAL GENERAL UARILITY nMt/,nn EACH OCCURRENCE S CLAIMS-MADE M OCCUR P AGB'TO' S MED EXP(My ono orson) $ PERSONAL 8 ADV IIddURY 5 OEN'I.AGGREGATE LIMIT APPLIES PER: GENERALAGGREL3ATE 5 POLICY JECT 0 LOC PRODUCTS-COMPIOPAGG 5 j 0TI'IER. I EH S AUTOMOBILE LIABILITY I ANYAUTO an G S ALL OW14ED 3CHEO( BODILY 114JURY(Poepofr on) 5 AUTOS AUTUS RODILYINJURY(Pera.riderl) S I HIREDAUrOS NON.OVVIED AJTOS PROPERTY DAMAGE (Por�ccidam) uM4Ri,Lt.q ugi7 s I 9 GCCIJR EXCE93l1Ae CLAIMS•MADE I EACH OCCURRENCE g 1 AGGREGATE S j 1) D RETENTION 5 S I A AND EMRS COMPENSATION WC5-:3 b(1 -0 4 10/31/2U14 10 131 r2D15 V PTATUr GTH_ I AND EMPLOY R9'UA81Lrrr Y/N ANY PROPRIETOR)PARTNERIEY.CCIJTNE 9 5001 0 UFFICER/hlE&Il REY,CLUDED:• �NIA El EACH ACCIDENT (1land2tdry in NH) E_L.OISEASE.FA CMPLOYE If Yoe,dectba under S—� 5(J0 �D DCBCRIPTION OF OPERATIONg(vlaw E.L.DISEASE•POLICY lIh11T 5 500400 '',,.... f DESCR,PTtON OF OPERATIONS/LOCATIONS 1 VEHICLES (ACORD 101,Adm 211`1 ke SI hedule,maybe atlachad If mor apace la requirad) Workers compensation insurance coverage applies only to th ore Comppensation]am of the s Ill ofMA I This certificatr�cancels and supersede$all previously Issued ifi ale , ly as they(elate to vlork rs compensation coverage. I I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF TIE ABOVE DESCRIBED POLICIES BE CANCELLED BEFOR THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED I I. ACCORDANCE WITH THE POLICY PROVISIONS, I i I kAr_t'rNQRIZEOREVRFBFN`fATNE - LM Insurance Corporation 6I (0 1989-2014 ACORD CORPORATION, All rlghis rpsery'd. ACORD z5(2014/01} The AGORD na 7 le an ogG are mglstered marKs of ACORD i CEF'r NO,! --:315:50 CL:ENT CODC; 1917150 0101 Oa,,SOV 1//10/2 1 11:53 57 y (ear) ereq¢ L of L Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Superi-isor License: CS-096516 `t TIMOTHY W WIY�S I ry 3 ELLIS ST �� Methuen MA 61144 p-� I� JI I.11J Expiration Commissioner 09/09/2016 • z CV1C 1e woni'JtoMpeCc11111 O�C-��CC:I�CLC�!lJeCfJ flee of Consumer Affairs&Business'Regulation E IMPROVEMENT CONTRACTOR egistration: 118836 Type: Expiration;-4/26/2017 : Supplement Cs HI TECH WINDOW&SIDING'�NSTALL INC i TIM WICKS 29 ARROWWOOD STi f ,_;---- METHUEN,MA 01844 Undersecretary