HomeMy WebLinkAboutBuilding Permit # 10/15/2015 00RT11
BU
,;",V.D ILDING PERMIT 0
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit N0:03 Date Received
Date issued:4L-
IMPORTANT:Applicant must complete all items on this page
L T
OC
...........
P R0)`P F/'-�,,
TYPE OF IMPROVEMENT PROPOSED USE
Res" ntial Non- Residential
0 New Building %P"One family
11 Ad 11 Industrial
,1 Ad [I Two or more family
teration No. of units: 11 Commercial
[f Repair, replacement [I Assessory Bldg 11 Others:
11 Demolition 11 Other
)w 6, 10 6"
h
Identification Please Type or Print Clearly)
OWNER: Name: "J"i Phone:
Address:
g
...................
iT
ARCHITECT/ENGINEER Phone:
Address: Req. No.
FEE SCHEDULE.,BOLDING PERMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ OPP FEE: $
Check No.: c3l;Irr-f Receipt No.:
NOTE: Persons contracting u4th 7n7e-gistered contractors do not have access to th Eua�Ia4&,,Ond
n
Sigiature ofAgent/Owner- Signature of contracto
NORTy
Town of z - 1 E •.1,
Andover
O
NO. * _
soh ver, Mass,
A_ COCHIC Htw9c. 1
Q \
7d A�RWTED 0'
7S V
BOARD OF HEALTH
PERMIT
Food/Kitchen
LD
•
Septic System
THIS CERTIFIES THAT f.. TBUILDING INSPECTOR
Imo. ...............�.� �.'..J.��
.....................................
has permission to erect.......................... buildings on ... �................:. .A"1 ... •. . Foundation
® Rough
tobe occupied as ..... ............ ... .... ........... t ... ................................ Chimney
provided that the ersori'acce tin this rmit
p p p g 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 M THS ELECTRICAL INSPECTOR
° UNLESS CONSTRUCTIO R Rough
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 Approved by the Building Inspector. Burner
Street No.
Smoke Det.
. . IV
r
The G'omonweafih ofMasstzehtasetts
DeParhuMf 0f1Md ia1Acca n4v
O,Bice o,flnvestigstiaaas
1 G'aatgx'ess&r Sake.X Otl
ROston,MA 02114-2017 ;
1
MV FP.inta 8-gov1d1a
WorIcers'Compensation insotranceAffidavit:Builders/Gong~actors/EIecfriciatnslI'lumbers }
A licaiotInformation
lease Print Le
Name(Business/UrganiaationEodhidnal): � 0
Address: 4.'` 4a
Canty/ tatel2a = £J au„-.R,) Mt _ el Efz Phone# r'— ) i Y�2- - G 2
Are you an employer?Check the appropriate boa: l ;
1-�I am a employer with -1 4. ❑ I am a general contractor and I Type of project(required). €
employees(full and/or parttime).* have Fired the stab-contractors ❑New construction
21 am a sole proprietor or partner- listed On the attached sheet 7. []Remodeling
ship and have no employees These sub-contractors have
working forme in any capacity. employees and have workers' S' 0 Demolition
[No workers' comp.insurance comp.inFsuranre_t 9- ❑Building additicn
3.(�required.] 5. ®.We are a corporation and its 10.❑Electrical repairs or additions j
I am a homeowner doing all wutk officers bane exercised their
m el£ l l.®Plumbingrepairs or additions
ys [No workers comp. right of exemption per MGL �
insurance required,]t c.152,§1(4),and we have no 12,® of'
zepan:s
employees. [Na workers' 13 then
comp.insurance required.]
'Any appticaatrhaz chGcleq hoK#I mustaiso fli onfthe section below showing Weir worldcrs'compensation policy infocmaEioo:.
t oy.tru to-tbwhosnbmitWisaffidavitnadicabmgWey aredoingallwodcandtheflblueoutsidecontractorsmustsubmstanmaffidavitindieadagsach.
Contractors that check this hoxmust nttaobed an sdditi000t shectshowing the name of the seb tt�ntracxp�s and stale whetheror not those eutifiesheve
employees. If Wosub cnnlxactozshnvicemplaycessa the�'mustpmvidetheir.workers'comp,polisub
-cy tractor
.can r.
art empaayer tliatis pravidntg iiivrkers'evrr rerrsatiort nrsrrrance for my erg:playees BeXaty is the oli artrt ab site
iuforrnadom p ey j
Insm*anm CompaayName it fg,, OP` ;
Policy#ar Self-ins.Lic.# 003 pitation Date:� �� W
9
Job Site Address: City/State/Zip: ,
Attach a copy of the workers'eamqlasaon policy dec aration page(showing the policy number and expiration date).
Failure to secure coverage as required uud Section 25A ofMGZ a 152 can lead to the imposIWon of criminal penalties of a
fine up to$1500.00 and/or one-year impriso"motentl 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 of1his statementmay Abe forwarded to time Office of
Investigations of the DIA for insurance coverage verification,
X do hereby certify under tlr airs art enafdics v
P f,perjury that the infarmadon.provided above ishue and correct
Si at
I
• Date: .�'`
Phone#:
Official apse only; l3o not write ix tills are¢,to be cnmpleYed.by city or town vfjRcial
City or Town:
lPermiMicense#
.Issuing Authority(circle our±):
1,Board of Health 2.B'uBding Department 3.CityiTown Cleric 4.Electrical Inspector 5.Plu mbing luspector
6.Other
Contaet.Person: Pone#:
MA Reg N14utptW -,
CT Reg#0605216 contract s
Federal ID#20-2625129
Ri Reg#t28463 Hame tRprdvt:mastt 5otutlor)s
Corpofa[e Headquarters,26 Cedar St,Webum,MA,(P)81)0-342-2211(F)781-938-9628,vnwl.newprn.com -
THIS CONTRACT MADE THE day of _20./� bet'<veen
-
of !tel,4 �d -
(AdJfBE9f Pry/ I
(sYarel (✓YPJ
the"Owner"and NEWPRO Operating,LLC,"NEWpRO". (E-Aravfon-prieway only
NEWPRO hereby agrees that it Mil for the consideration hereinafter mentioned,furnish all labor and material necessary to Install the foirowing
described work at the premises located at:
The Job address is a condominium.
(Job Address
16 CAGi c.; •:' t4yP}}a
I DO :OpT
I° _ r;;.yc!__ .,,f:<a.•. -- - - =i;f�xa_;=t'ii;. _
.�,?± is-"•.,: _ .�;q.:. '.". _;;:::: _ .: •:,:._
VfiIN)id t •.� Q f(f J Grids:U YES [CONTOUR UDL
EURO '-DIAMOND ('
Windo c for QTY Window color QTY OBSITMP:gcwae'vn) Orap QBOTrOt1
Int: lni: ------s:(Exterior color Full screen standard) RdALF [FULL
E ' Ems: Vent latches: YES
Ca Ing color: 'c
OIL %'ATT.. ELeageln/t!s/.
PVC maofh LJ NoMarLa No ca r31r'�1 A /
In: Out; W.n.
Doubtehlung n Active: Left Center Ri t Cudomarunderstands th
2Life Slider HDWR:- SN BB BGE WH ' loss midoerypail9ngOfstalnk,g.
3 Lite Slider (114,tn,fAI (i
$Lite Slider (r)9,119,1te) e:whenrrmaring areplaclrig InteriorColor In: Cut: stoPat mi•NE-WPR071snal respo-
Casement(NingsdRight) Fiberglass Slee! nsibiWarmndlionsofcimumalancesbey-
SN BB AGB ORB ornlIts aotrollhduftoohdansa5onresu-
Tw nCasement t8id litd;$,'.1_e� i:�-f Irene firm or dw to prs-6*04 Wndillum
Stationary Casement Color In: Out: (W-f—V
TripleCesemeni pta,rrz•vl) i """�.`"`....,:,"•-,_.'«� CASH
Triple Cesemeni (try u+•rn( Color In: O t: Balencepaid o a eraimmpletlon
Picture Window HDWR: SN Be GB AB
Sash Only Lan inns Right Hinge FINANCE
Hopper
•;"" $ 1 i5?r Bank completion form signed at Ineleliallon
Awning Color In: Out;
Garden window ribergla Steal
Bay Window tRoofi sof6 ,.
1 HDWR: 8N AGB AB ORB Y= (l(l
BawWindow(Rooflsoffit)
Other
Out:
Other Color In: MTN,iX
DESCRISEWOR �pP,OMOT/ONSAPPLIE:
A
r7 �
,Est SfartL7afe 7S" ,-If Comp.bale.• j ' 67 Customer understands this is an"estimated date"
Owner has read and agrees to the terms and conditlons on the front anWilho reverse of this Agreement. dwrisr
specifically agrees to the(1)Total Cash Prl'oo;(2)work being performed;and(3)work not being performed. Owner
understands that this Agreement and any attachments contain all of the promises made by NEWPRO. Owner has been
orally advised of his right to cancel this transaction at any time prior to fnidnight of the third business day after the
date of this transaction and Owner was provided with two(2)copies of a cancellation form explaining this right,
DO NOT SIGN THIS CONTRACT If THERE ARE ANY BLANK SPACES.
(Rhode Island Salsa Only): Flotice to buyer: (1)Do not sign tbfe Agreement If any of the spaces Intanded for the
agreed terms to the extent of then available information are left blank. (2)You are entitled to a copy of this
Agreement at the time you sign it, (3)You may at anytime payoff the full unpaid balance due under this Agreement,
and in eo doing you maybe entitled to receive a partial rebato of the finance and insurance charges. (4)The seilor
has no right to unlawfully enter your premises or commit any breach of the peace to repossess goods purchased
under this Agreement. (a)You may cancel thls Agreement If It has not been signed at the main office or branch office of
the sellar,provided you notify the seller at his or her main office or branch office shown in the Agreement by
registered or certified mail,which shall be posted not later than midnight of the third calendar day after the day on
which the buyer signs the Agreement,excluding Sunday and any holiday on Whfch regular mail deliveries are not made.
80e the accompanying notice of cancellation form for an explenation of buyer's rights.
(Rhode Island Sales Only). Owner acknowledges receipt of required Contractor's Registration and Licensing
Board consumer education materlale._ (Owner's Initials)
ey EIN#__1'IDI Signed: ✓ f
Product BpaalallsYPrintedN�jama) h Owner
By GCS Signed: ! `
NEWPRO pora]Ing,6LgStgaafvraJ
Owner
Us-1s WHITE:Branch Copy YELLOW: Customer's Copy PINK:File Copy GOLD:Finance Copy R0714
CERTIFICATE OF LIABILITY INSURANCEaATEtlI(NdODTYYYY)
5/1/2015
THIS CERTIFICATE is lssueD 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_ PHIS,CERTIFICATE OF INSURANCE,DOES NOT CONSTITUTE A.CONTRAGT BETWEEN THE ISSUING INSURER(S), AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT-- If the certificate holder is ai.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
Meli
1�lackintire Insurance Agency 1E ssa Pflug Inc PHONE (50.8)366-6161
11 I-Test Main Street IL )ac Nc:(508)36675202
-ADDRESS,mel7.SSap@maoki-ntire.COIO
Westborclu h01581-1931
INSURER S AFFORDING COVERAGE NAIC#
g MA 0158 -7 93I
INSURED INSURERA Netherlands (24171
�Telrpro OPerati;Ig LLC--
INSURER a TX ibert a
Mutul/Peerless 297.98
26 Ceda+- St. INSURER CACaCUa Insurance Co.
INSURER D. I
FTOb1rn ? MA 01801 INSURER E I
COVERAGESIItISDRER .I
CERTIFICATE NUMBER34aster 14-15 REVISION NUMBER-
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERiO4
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT VATH RESPECT TO'THE
THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN JS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH FOUCIES.LIMITS SHOWN MAY HAVE SEEN REDUCED-BY PAID CLAIMS.
INSRI
LTR I -ADO BR _
.TYPE OF INSURANCE ! I r PUCY POLICY EXP
POUCY?IUAI9ER-_ I 1 MOCEFF I 113MMONYMI LIMITS
I X COMMERCIAL GENERAL UA-21LITY
EACHGRRENCE I1,000,000h CLAIMS-MADE I�OCCUR DM TO
RENTED
100,000
I i
PREMISES IEa ortuRertrE S
!I !CH° 95885?7 12/31/2034 12/31/2015 ME p(p(Ahy�e ersonl S 5,000_
! i i
IQc-RSONAL&ADVIiIJURY I= 1,000,00(1
GENLAGGREGAT_=U31lThFrtt'eSPcR: ;GENERt,LAGGREGATE is 2,000,000
FOUCY FrcO- 3
�� t JcCT LOC ( , 1
1. I �?RODUCTS-COMPlDPAGGIS 2,000,000
OTHER:
AUTOMOBILE LIABILITY r C0�I SLNGLEUMIT
i ! ICEaettdenU S i,UOa,JDD
A i ANY AUTO 5ChEDULED I I I BODILY INJURY(perper=)
I'IA-cI5
AL.OD
I AUTOS r AUTOS ! ! 35E4174 12/31;203, i 12131/20151 BODILY INARY(Prrecdden)) F•
I X HIRED Ai 05 3�I NOU-0lAS1S ED I PROPERTY DkAtAGe
` AUTOParau3dent S
I X UMBRELLA UA9 Urehaz red lno!ctist 8! 5l6mil s _0,000
OCCUR
I EXCESS UA8
I
I ! i 'cACHOt1RRENC_E ;9 5.VUti 000
B �( -,;!..x ! �Cui1M5�nn0c• ! } AGGREGATE ,S 5 DOD,000
WORKERS COMPENSATION I DED I RETENTIONS 10,0001 i ,CU 8582578 �12/3 2/3021 112/3L/20i5I Is
-
( ( I PER I I
AND EMPLOYERS'LIABILITY YIN� ! ( 1t Y' STATUTE ER
ANY PROPRIETORIPAP_TNERI=-C-CUTAtE F- 1
OFFICERIMEMSEREXCLUOED7 ! NIAI. IE?_EgCHACCIOFNF
( i� 500 000
C I(Mandatoryin NH) IAC-20-20-003506-02 15/_/2015 5/1/2026 I
I,yes,describe under 111 , 1-�F-L-�DIS (%SF-EA aaPLOIE4 S 500,000-
0-cSCRIPTIONOFOPEPATIONShe}or , I (E,L.p1SEASE.Pt]Lk^?1111rr S 500 OOD
1
DESCRIPTION OF OPERATIONS I LOCAYIONSI VEHICLES(ACORO 101,Additional Ronarls Schedule,may be attached Ifnioro space Is required) -
CERTIFICATE HOLDER CANCELLATION
SHOULD ANYOFTHE ABOVE DESCRIBED POLIGIES BE CANCELLED BEFORE
To Whom It May Concern THE EXPIRATION DATE THEREOF, NOTICE WILL BE DEUVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Timothy tdoynagh/MET,
Q 198&2014 ACORD CORPORATION.All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
INS02519n1ehti
`%bard ..f Su0dinc Regulations and standards
�ulistl'ucriNl Sttherciy+�r
License: CS-096093
i THOAIAS E+ PEACOC
P.O.Box 505 f'
Seekonk M4, 02771
ttY Y
ExPiratio
Oonimissioner 04/08/201
Office of Consumer Affairs &id Business Regulation
r p 10 Park:Plaza - Suite 5170
4. r!
? Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 146589
Type: Supplement Card
Expiration: 5/5/2017
NEWPRO OPERATING, LLC.
TOM PEACOCK
26 CEDAR ST.
WOBURN, MA 01801
Update Address and return card.Dark reason for change.
Address r-� Renewal F-� Employment host Card
SCS.1 <; 2CM-05i 11
free of Consumer Affairs&business Regulation License or registration valid for indwidul use only
ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to.
Office of Consumer Affairs and Business Regulation
i ..,.:Registration: 146569 Type: 10 Park Plaza-Suite 5170
Expiration:; 5/5/20.17 Supplement C:,rd Boston,MA 02116
NEWPRO OPERATING,LLC.
TOM PEACOCK
26 CEDAR ST.
WOBURN,MA 01801 Uudersecrctary N®t valid-Without signature