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HomeMy WebLinkAboutBuilding Permit # 10/13/2015 „,,., m as ORT 1 1 "t41D16� AAp - BUILDING PERMIT ° a �TOWN OF NORTH ANDOVERL � APPLICATION FOR PLAN EXAMINATION - a Permit NO Date Received �9 °rodrew�ea�4h SSAC N�15iE Date Issued: 71-,3/1 IMPORTANT:Applicant must com fete all items on this 2age w, Lf�CATIt�N , ( II Parr PO �ITY11N�R rc �UI'AP N© PARCELONING IItTRICT Hston D�strlct yes na 11( ohln hop VIII yds np TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential a New Building V6ne family ❑Addition ❑ Two or more family ❑ Industrial ®'Alteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septo11l1(ell U Fltcdplafr C Wetlands U Watershed C �strNct I . tr� e1Nr gg � 9v � Identification Please Type or Print Clearly) OWNER: Name: (/,,,/,C,/. Phone:b,/Z Address: Address , perultor” on truotlor� L o nse� P I�orxre Impr�nr� ent Lloe� � Exp Date ' ; %i�%%r , 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: $ d FEE: $ � �— Check No.: 2. t Receipt No.: NOTE: PersonecontiWting witfi unregistered contractors do not have access o the guaranty fund aLe Signature ofAgentlOWne �ignjpture of contractor tk®RTH ndover town of A 0 0 No. ® � - � �..K. h ver, Mass, C OC MIC HI w�CK yq. A°RATE n S U BOARD OF HEALTH Food/Kitchen PERMI LD Septic System THIS CERTIFIES THAT ....... .. BUILDING INSPECTOR . .. ft Foundation has permission to erect ....:..................... buildings on o.... ..... . l.!4►..�/....... ....... r...... I 1 , Rough to be occupied as . .. .l.t,.....1.�1.!� ... ..... ...... ....`. .......lit .�... .0........ ........... Chimney provided that the person accepting i permit shall in every spect 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. A� SFinal PERMIT EI ESI 1'Y ELECTRICAL INSPECTOR UNLESS LECONSTRUCT ' ' 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. VALLEY SIDING WHOLESALE, LLC 0)SINE,90 IMA Lic. 016201 Toll Free 1-877-302-2923 "� p Newton, NH 603-819-5158 • Saco, ME 207-284-6600 • Haverhill, MA 978-241-7343 ® ® e MEMBER Date: 1 /,2�/_ Consultant: f3a/r- 4o se 5R Job Name: M.1m f hAdW feA. Telephone: 6,17- 22f- G017,8 Job Address: ,2 30.srZun 5 Town: A a.r_" M4 VALLEY agrees to start described work on/or about__2` S-weeks after final measure and complete described work in about working days. VALLEY shall not be held liable for delays due to causes beyond it's control. The following work includes all labor and materials needed to complete your job In a workmanship like manner. Removing Debris In A Legal Manner-Dumpster At Site Or Shop: L;a Center Vent ❑ Fully Vented ❑ Non-Vented Dumpster And Location: Location: oodp Remove Existing Siding MO" �AiiE I!`€ ....:,., Preparation Package »� �' �'> •�yt" Y ` '�.0;` Full Custom Formed J-Less Full Custom Formed Accessory Package Color: {y�� ❑ Full Custom Fascia&Rake Trim Cover Color: w�i.. ❑ Blind Stop Capping ❑ None Full Custom Soffit Trim Cover Color: (,v ,ji Location: a Full Custom Window Trim Cover Color: A..s j r'J-P 0 . Gr c Shutters Color: Gutters&Downspouts Color: Shutter Amount Location: :..:::.:..::.:. LLa 'Vapor Barrer House Wrap ❑ 3/8"Underlayment Leveling/Backer Insulation or. 1 Iue G� �• S ���'► ��+► l,0 Other r'ul/ fjAcA- Location: Co o6 Siddid omplete House L(� Garage ❑ Other L Brand: Profile: ,,N heck Or Cash ❑ Credit Card ❑ Owner to Arrange Wide Insulated ❑ Wide Non-Insulated Total Investment: ❑ Regular Non-Insulated ❑ Custom C/C /0 1/3 Deposit: 345 17 Corner Post Color: W , 1/3 Payment At Halfway Point: p-) =` 1/3 Balance Day Of Completion: -` ice........-... P.V.C.Coated Alum. ❑ Aluminum NOTE: ❑ if A Building Permit Or Electrical Permit With Updates Are Required B Your. Code Enforcement,nt They Are Extra And Paid Full Custom ❑ None For At The End Of Job, At Invoice Charge Only Location: L0Any Wood Replacement That Is Required After Start Of Job Will Be Extra And Paid For At End Of Job,As Listed On Proposal You may cancel this agreement if it has been signed by a party thereto at a place other than the address of the seller,which may be his main office or branch thereto,provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent,or by delivery,not later than midnight of the third business day following the signing of this agree- ment.See the attached notice of cancellation form for an expl56ation of this right. An interest charge of 1-1/2%per month(18%per year)will be added to any Date of Accept amount unpaid after 30 days from invoice date.In the event of default in payment of this order or any part thereof and the account is referred to an attorney for Signature collection,the purchaser agrees to pay reasonable attorney fees. (Homeowner) I/We give Valley permission to obtain all necessary permits. Signature (Valley) Signature VALLEY SIDING WHOLESALE, LLC WINDOWS 185 $0. MAIN ST., UNIT B l gJs` Sso MA Lic. #016201Q NEWTON, NH 03858 � m 1-877-302-2923 m o MEMBER Date:—/ /S Consultant: /G,/! Cdi"arm 5 R Job Name: m 1.6 Telephone: 61 Job Address: >3� r������ ---5 - Town: 4.1ar.4A 41v z • M 4 CONTRACTOR agrees to start described work on/or about--i-fl---weeks after final fittings and complete described work in about-2-LY-working days. CONTRACTOR shall not be held liable for delays due to causes beyond our control. _ The following work includes all labor and materials needed to complete your Job in a workmanship like manner. f> ,!}��'' y�H .�'�,., �;;�&�<na:�nth,.;.'•�;>t<�ryt»> sy: Combination Job-Windows With Other Work S,•cl:,v d o Q White Inside/White Outside Building Permit If Required Q Beige Inside/Beige Outside Preparation Package Q Woodgrain"Inside/White Outside Deluxe Installation Package,- As Used On Mt.Washington Q] Woodgrain Inside/Beige Outside Light Dark Q Cherry 8 Point Guarantee Program Q Glass Breakage Guarantee Remove Debris In A Legal Manner Q Insulated Glass Q Double Strength Glass Energy Star-Low-E With Argon Regular-Low-E With Argon Other Manufacturer ' Q s za ;, w �'z:•«,F,v4; .z....w. ,,;few xs t e,x,r N2 . Model •G • ,..,.:-:. ::u..w ;nr�«�„�•<<::�:�;;;:$�4 Flat` . >. � tyle l . . ` Contoured Double Hung M-1 :v` ; � �:3 tire`` •. .., 2 Lite Sliders Amounts v Q;Half Screen Q'Other 3 Lite Sliders Q Fiberglass Q Other 0 1/3-1/3-1/3 Q .: 3� 25-50-25 Picture Windows Amount Capping Color. Basement Hoppers Q P.V.C.Coated Aluminum Q Aluminum Awnings Q Full Custom Formed Q Blind Stop Capping' Casements - `/ L f AS tw No Trim Cover To Be Done Q "zrh.w s �. ��'ti•'z:✓�::.•���x : ra ^cz�°r�ec S f:�S��'�' 1 Lite En2 Lite (Q”3 Lite Bay windows a- `/ �9 s< '- 6 Q Double Hung Vents Q Casement Vents Bow Windows [� 4 Lite Q 5 Lite Q 6 Lite Q Hip Roof Q Shed Roof Q Copper Patio Sliding Doors <..w.,,`li ':� .« � ws'> a� az n :..x� .. 't..'.,. 's�:,>°As.. Q 5'Door Q' 6'Door Q 8'Door Bank Financing Q Owner to Arrange 'Q Valley To Arrange ,.7r..•�;;>:. :;$<.. ��2;•::��3` �`' k �";";� Q Cash Or Check Q.Master Card. None-Any Woodwork Needed Will Be Extra Q Inside Stops Q Inside Casings Total Investment �/ 3V7 w'4< Inside Sill Q Outside Casings 25%Deposit rllq� [� Outside Stops Q Outside Stool 25%Payment At Check Measure Q Other 50%Balance Day Of Completion O1 You may cancel this agreement if It has been signed;by a party thereto at a place other than the address of the seller,which may be his main office or branch thereto,provided you notify the seller in writing at his main office or branch byordinary-mail posted,by telegram sent,or by delivery,not later than midnight of the third business day following the signing of this agree= ment.See the attached notice of cancellation form for an explanation of this right. C� An interest charge of 1-1/2%per month(18%per year)will be added to any Date of Acceptance ! 9 L S amount unpaid after 30 days from invoice date.In the event of default in payment of this order or any part,thereof,and the account is referred to an attorney for Signature. collection,the purchaser agrees to pay reasonable attorney fees. (Homeowner) I/We give Valley permission to obtain all necessary permits. Signature, (Valley) Signature The Commonwealth of Massachusetts Department oflndustrialAceidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 "t www.mass.gov/dia Workers' Compensation Insurance Affidavit:Builders/Contractors/E lectricians/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Organization/Individual): I /7 z Address: /k�5_ SO /AJC City/State/Zip: Pecu Phone#: (0 03 Y"/ 1-2 Are you an employer?Check the appropriate box: Type of project(required): 1. t, I am a employer with /'/b 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 8. remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 Q 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 . 5.FJ I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repair's These sub-contractors have employees and have workers'comp.insurance.# 6.Q We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#I 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 a 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'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name �r��� Policy#or Self-ins.Lia Expiration Date: Zo b"V(a Job Site Address: 6;)30 16191ctul"21 _ J City/State/Zip:A)() 14)dace O t.✓ 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 DTA for insurance coverage verification. Ido hereby certify unde 1 a ns a td perralti erjrrry that the inforruation provided above is true and correct. Signature: Date: 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#: ACORD CERTIFICATE OF LIABILITY INSUM °A'E�'�'°°""'^'► I IVCE 7/13/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS I$10 RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVEIRAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT-CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certiflr,m holder is an ADDITIONAL INSURED,the p4liCY(ies)must brI endorsed. it SUBROGATION IS WANED,subject to ;the terms and conditions of the policy,Certain policies may require an endorsement A statement an this certificate does not confer rights to the cerftate holder in lieu of such endorsement(s), PRODUCER ME! Ela3ly Coste3la Costello Ineuranos Agency, Inc. PHONE (978)374 2 3, Kimball St. AINj,° _ N= cL978)8z1-s12T ADDR :ocostello@o0stalloinsurance.cm --- PO Box 5248 r—--� ------•w _—� Bradford DS1 01835 _ I RER M AFFORDING,.COVEkAGE # _—.. ..—_..._.._..,,._..—.' -- --• �__._�_, —FINGU�RCR IN8URE6tA&Wlia Insuran= _ INSURED ArI]e11 Protection Ins C valley Siding Wholesale LLC a .y _._, 41360To'ye rs Ind. CO of YL_AF 13579 185 South Main street Unit 8 RSR DiewtOn 03858 COVERAGES CERTIFICATE NUMBER:1=1571300084 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 POucm DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYNAVE BEEN REDUCED BY RID CLAIMS. MIR IL TYPE OF INSURANCE vM LICY NUMBER CY A1WD EXP _ UMITS — $ COMMERCfAL GENERAL LKML17Y EACH OCCURRENCE s _ 110_00,000 ArGENNLAG09fGATe CLAIMS-MADE ®OCCUR i PREM oxur rim a 50,000 8079000455 4/7/2015 i 4/7/2016 MEDEXP p„y,apv PGI8015) ; 5,000 PERSONAL&ADV INJURY S 11000,00 0 pL�IMaBAPPLIESPER GENFPALAGGREGATE $ 2,000_000CY JFB LOC PRODUCTS coMPtOPAGp S 2,000,000 ER I r w -- AUTOM091LE LIAMLITY I $ I MR1,000,000ANY AUTO SODorPMO) S ALL 01M$ED 7s: SCHEDULED 1020015825 03AUTOS AUTO$ 3/U7./2015 13/11/2016 BODHIREDAUTOS $ ADT RV4NED PRvV "-. —$-- or — Madtcai encs S — 5,000 u�eeRSl.la L1A8 O CCUR ' EACH OCCURRENCE $_ EXCESS LIAR N64MDE AGGREGATE „ ---- 5 DED RrTP=m-v WORKOtS COMPENSATION $ AND EMPt,QYERS'LABILITY Y l N R ST, ATL T _ ER ANY PROPRIETORIPARTNVvexaCLmvE — OFFICER/MEfA8ER MLUDED7 N/A EL EACH ACCIDENT S 7 00 000 (Men tafyI Nw). 6JOB-2127924-0-15 6/28/2015 I6/28/2016 —� E-L DISEASE-EA EMPLO S 100,000 D RIPTION of oPERATI S batov I E.L.DISEASE-POUCY LIMIT.IS 500,000 I I ' t)R$CMVWN OF OPERATIONS I LOCATIONS/VEIIICLES(gCONp 101,Adtlitiend RerttarlcF 8etteduk,msy be amcL¢tl 1r moep apace is required) workers compenuation Policy is ffor IM only. I CERTIFICATE BOLDER CANCI.LLATION $WOULD ANY OF THE ABOVE DESCRI9ED POLICIES BE CANCELLED BEFORE for information only THE EXPIRATION I DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE'UT THE POLICY PROVISIONS. AUTH MM REPRESENtAT Emily CostelloVXO EC7 0 1988.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD nanne and logo are registered marks hof ACORD INS025(zo14m) I Office of Consumer Affairs&Business Regulation OME IMPROVEMENT CONTRACTOR stratton TS�IAOg Type; xpiratron,_30 Individual WILLIAM P.Ct ASE 5( r r � vi WILLIAM CNAES �a - 15 KINGSBURY AYE S BRADFORD,MA 01835 Undersecretary x I f Licensed isor 1 t Cr f� 3 ,r� v ,*(, .M y � 15 Q �! 1 t I I v 4 p k 3 i k t { I v E