HomeMy WebLinkAboutBuilding Permit # 10/29/2015 as
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO: ^ yU Date Received ms
Date Issued:
IMPORTANT:Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
1 New Building One family
0 Addition Two or more family CI Industrial
0 Alteration No.of units: LJ Commercial
0 Repair,replacement U Assessory Bldg I I Others:
I I Demolition El Other
'043;
Rug
Identification Please Type or Print Clearly)
OWNER: Name: Qty.. —RQDAx—ItE O(EhA2?= Phone:ON-U89-4
Address:
ARCHITECT/ENGINEER Phone:
Address: Reg.No.
FEE SCHEDULE:BULDINGPERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.0 PER S.F.
-
Total Project Cost:$ S_-,) FEE:$ 7-)'?
Check No.: r Receipt No.:
NOTE: Persons contracting hith unregistered contractors do not have acss to
he guaranty fund
SFg`rature at,4gi It4WVrrsr ignkufeAorltradtOi
Town of ®RTw ®ver
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h ver,Mass,
90
�,9 oR4Teo PRS�S
S D
PERMIT ® I BOARD OF HEALTH
Food/Kitchen
Septic System
1,,,,,,,,,,,,,,,,,,,,,,,, �� LD
BUILDING INSPECTOR
THIS CERTIFIES THAT.......... 1.1 Roy.......'......... ...... '. ...... .......
�gz ' e r�wa�. q*;je. Foundation
has permission to erect..........................buildings
yon.................... .......................... .............
tobe occupied as...... .. ... .. ...a...xr�.�................................................................. Chiumney
provided that the person acceptin 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 CONSTR c N ARTS R�agh
- Service
.......�..... ...................................... mom
. Final
BUILDING INSPECTOR
GASINSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place on the Premises—Do Not Remove Fna'
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Bar
Street No.
Smoke Det.
BETTER HOMES WINDOW AND SIDING
THE EXCLUSIVE WINDOW AND SIDING CONTRACTOR
978-372-6/385 TOLL FREE 1.800.668-3505 MASS REGISTRATION#122318
DATE A"l 21'< SOURCE CONSULTANT
HOME TEL. `1�7J'Y.,ti3W-LIE,\0 WORK TEL.MR./MRS. ..
THIS AGREEMENT,made and entered into between EllHOMES WINDOWS AND SIDING hereafter referred to as
a contractor AND 10 - Y2"A
rN
ADDRESS/STREET ,Z-Z fE�r'11r>� C�VfITY "�-" �+'OliAWTATE ' ZIP
hereafter referred to as owner.
THE SAID CONTRACTOR hereby agrees that it will furnish all labor and materials necessary to install the following
described work at premises located at:JOB ADDRESS `-"J sry-
CONTRACTOR agrees to start described work orl about weeks after final measure and complete described
work in about working days.
In addition to manufacturer's warranty,Better Homes Window and Siding guarantees our workmanship for ten years.
L HOME IMP20VEMENT C'ON"TRACTORS AND SUBCONTRACTORS SHALL BE REGISTERED IN AIA.INQUIRIES RELATLVG TO A REGISTRATION SHOULD BE MADE
RECTOR,HOME IMPROVEMENT CONTRACTOR REGISTRATION,ONE ASHBURTON PLACE,ROOM 1901.BOSTON.MA 02108,TEL 617-721-8598.
We hereby.submil specifications and V,II,MFu tor: qg�--�
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VF-�'s�+ISVSL l'�LSri .cS dtitFd�LCC. Z 1E S-CA. L. A'�GE,
�l� cf e�JS'f lv mf ItaGre.0 m�'a 3 lta$,ra^-+-. t.l e-,..y V Ltuv-.So�Frf`"
5Vi Cos'+NVT'tV4KL•sO ND `-` \2c(,-xK (2-2,p '-CMI-ndepc
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d e�mC wr" ati� s
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b't13Y"2oat 1`�}lwtx 3`1 W i 'fiD LC-'ur'L r2c»G'�� v�y.
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Z+LTT91N rii�f)Ng(.tlAv'14 viu' U\";$ V�A-f-I'fl Yl SVII1 Lli L.S-IiT,I
VZIb�,-Ls ie v f-- P-Li- P e6w,- z
WE PROPOSE HEREBY TO FURNISH TOTAL INVESTMENT -S
MATERIAL AND LABOR(IF SPECIFIED)- L1z�(J'tDEPOSIT5 0�=+d o�9
COM PLBTE IN FULL ACCORDANCE WITH DEPOSIT
ABOVE SPECIFICATIONS FOR THE SUM OF: BALANCE UPON COMPLETION K4
ANY WORK NOT LISTED ON THIS CONTRACTWILL BEAT ADDITIONAL CHARGE.BETTER HOMES WINDOW AND SIDING DOES NOT INCLUDE PAINTING eR STAINING
ON ANY PROTECT UNLESS SPECIFIED ON THIS CONTRACT.
You may cancel this agreement if it has been signed by a party thereto at a place other than the address of the selle',
provided that you notify the seller in writing at 18 Bates Road,Haverhill,MA 01832,by ordinary mail posted,by telegram
sent,or by delivery,not later than midnight of the third business day following the signing of this agreement.
ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED,.ALL WORK TO BE COMPIXTED INA WORKMANLIKE MANNER ACCORDING T O S'I"ANDARD PRACTICES.ANY
ERATTONS OR DEVIATION PROM'PHE ABOVE SPECIFICATIONS INVOLVING EXTRA COSTS WDI,BE EXECUTED ONLY UPON WRITTEN WORK ORDER AND WILL
BECOME AN EXTRA CHARGE OVER AND ABOVE T HE.ESTIMATE.THIS I.S'1O INCLUDE,BTI'SNOTLIMITED TO.HIDDEN DA AGES THAT ARE UNCOVERED DURING
THE COURSE OF THETOB AND A IMINNAL WORK REQUIRED BY LOCAL BUILDING URP TORS.ALL EI.Fav1ENT5 OF THIB AGREEMENT ARE CONI INGEN'I'UPON
STRIKES,ACC'IDEN'r5,OR DELAYS BEYOND OUR CONTROL.
NOTE,THIS PROPOSAL.MAYBE V15FIDItAWN BY CONTRACTOR
IF NOT ACCEPTED WITHIN DAYS. AUTHORIZED SICNATil DATE
ACCEPTANCE:'EHE ABOVE PRICES.SPECIFICATIONS,AND CONDITIONS ARE AAN—CFOR,AND ARE HEREBY ACCEPTED YOU ARE Ali DINELOH)TO
THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE.
AN INTEREST CHARGE or I-UKA PER SAN'PH(18%PER YEAR)WILL BE ADDED TO ANY AMOUNTUNPAlDA£'It 90 ROM INV TE:
/� DO NOTTRACT IF'I �RE ANY ' S E D
SIGNATURE`KJLLX.N-�� 1'DA SIGNATOR DATE
The Commonwealth ofMassaehusetts
Department of ZndustrialAceidents
1 Congress Street,Suite 100
Briton, 0govldi 017
wwWlsmnass.gov/dia
Workers'Componsation Ina w.—Affidavit:Hudders/C.ntsactors/r,b tleiana/Phtmbors.
TO Fl•:FILED WITH THE PERAMUNGAUTdORIIY.
A licantlnformation Pleasa Print Lo ill
Name(Rnaroeas/organi=ation/rna;�.dnal): tc%`�Vrw`�a�J D(i!i �z�•vr �'�Vvs.-c=am
Address: \`b �/�–t �v0 1"\A v'Ftst�., �.A.a. Cit t3
city/stab,/Zip: PnGne Z
Arcynv ave ptoyer?Checktheappiopriafe Lox; Type.£project(('egnired):
1.�amaemployerwith 2=empl'_(fall and/orpart-Time).* �,❑New constmctloR
2❑lam sotoproprietoror PaMcrslup and bave no employee working formein $,❑.R�odelvig '..
arty capacity.[No workem comPinsman mpuired.7 9.❑Demolition
3.❑Iam ahmneowrier doing all workmysalY.[Noworlmre'comp,inennmeexequUed.]P
4.❑I am ahomeowner andwill bebiring contractors to cmWuctall workonmy property.Iwill 10
[]Building additl0n
xetbat au contmarors eimerhave vrorkers'nompenaation insarvreoor ere sole 11,❑Iilechicol repairs or additions
P�opr;erora withno employees.
12.E]Plumbing awaits or additions -
5.❑lamagenemtcontracmxend Ihave hircdtheaub-wntracrors lisced on Ibe attached sheet. 13.❑Roof Cepah's
Tbese dub-cobactorsliave einployces andbave vrorkers'camp.innuaace,t
6.❑Weary acorpomtionpnd its of5cers have exemisedfhevright oflcxcmptionper MGL c. 14.F1Othel_
15,l'pt,),and we bavo vq.emp]oyees.lNoworkers'comp.hussu ce.gaed]
1L yapplicantthat cheoksbox41 mast also Ell oattho seotionbelowshowmgthelrwoxlmm'compeasatiovpolioyinfnrmetlon.
t Homeevmem who sutlmil{,affidavit indlcatiugnoy are doingaal kandthcnlwc outside wnhnctbrsmastsbmita oHidavkiadicatmg s,ld,
tConlmctors fhatcheckfhis box must zgaehed vn additional sheet showing tha aama of the snb-contractors and s[atowhetheror potthosoentitiea have .
emplayees.ffthe snb-contractors Save employees,ltiey must pravida their workeis'comp.policy number. '
Zam an empleyerfliat isprdvdding nvorkers'compensation drsaraneeformyemployees,11e1D isthepoldcyandjobsite
idler—tton.
Insurance Company Name:
Policy#or self-ins,Lie.#:11���u Ci–z�C7�6eU–S–iS axpirati.nDate: `�–Z`i–i
Job Site Address: 2-Z Z 3CCt`*r1,.c a a 9 \t -L� City/State/Zip: _
Attach a copy ofthe workers'compensafior,policy declaration paga(simwing the p.Hcynumber and expiration date).
Failure to secure coverage as required under MGL c.152,§25A is a crunutal violation punishable by a fine up to$1,500.00
and/or one-year balghonment,as wall as civil ponaltiea in the form of a STOP WORK ORDER and a fine ofup to$250.00 a
day against the violator.A copy of this statement may be forwarded to the Office oflu—tigathule of the DSA for i.eareare
erverage
verification.
I do hereby c rdfy ander ihepatns andpenald s of_nerjr'y that the information provided above,is true and correct,
sienatnre �' 7 Date:2`l lle.� 20
Official use only.Do notivrite fn this area,to be completed by city or torvnciaL.
City or Town: Permit/License# _
Issuing Authority(circle
S.D...d of Health 2.130dirg Department 3.City/Town Clark 4.Idloduked Inspect.,S.PlumbingSnspect.r
6.Otbar
Contact Person: Phone#:
10/18/2015 03:14 9783747769 RB KIMBALL PAGE 01
ACORN CERTIFICATE OF LIABILITY INSURANCE DgrE 1012812015128/2015zenols
11.1. EP Plronr:(STU114—A P.RANCEAG(97AAGENCY,
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
R.D.KIMBALL INSURANCE AGENCY,INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
107 MERRIMACK ST MOLDER.THIS CERTIFICATE DOES NOi AMRND,EXTEND OR
HAVERWILL MA 01830.6208 ALTER THE COVERAGE AFFORDED YTPOLICIES RELOW.
INSURERS AFFORDING COVERAGE NAIC#
INSURED .... .,., _ .... ...
NSURER A
LAW MICHAEL J. WII (INNSSURER B Travel
CIO BETTER HOMES WINDBOOWSS AND SIDING -- ..
(IURER C EOCO
iB BATES ROAD .... p I urence
HAVERHILL MA 01832.3704 INSURER D:
...........
NSURER E:
COVERAGES
TUE POLICIES,OF INSURRANCE LISTED—0"H0.YE eEEN I66UE0 TN
IHF,IN6URED CAMEO ABOVE FOR THE ROucY fSP.IOtl rNDICATEO,NOYWIinsraxDlNG
ANY REOUIREMENY, OR CONDITION Of ArvY CpNTRACi OR OTHER DOCUMExT T RESPECT YO WHICN THIS IERTIPICATE MAY SE ISSUE.OR
PaII PFRTaIN,TnE INSURANCE ARFOg0E0 BY TErS POLICIES OESGPI9ED nEPER
Is SUBJECT TO ALL
THE TERMS,.NOLI"ONI AND CONDITIONS OF SUCH
CIS-AOOREOnTS LIMITS1 MAY nAVS SEEN REDUCED C,
iraMCD
UPEOf SU NCE OUCYNUM ER Pou R�o T'C l s
.—NALBr
% CO MERCIAL vokLG (LAB LRT "NOD 7000,000
1KYAGE TO-115
6 $00,000
CLPIM4 DLtuR 1
E (An I +
'13.000
0 LI AI
ooD DDD
a00REGn AF IESPER: Gf Efl PG Gnrf S 2000000.
OG
POLICY i
R PR.0 2000,000
r
A LEL BLTv 1449253 10/01/15 10/31/16 E S GLE LIMY B
UTO
ILO DAUi05
00 NJU
C NO X eC DAUT DS (Px ) s 250,000
REO Aur05
oNOwNFO Auras mIRY B 600,000
Pe°ear CAMPGE 4 250,000
LIA41LRY
nu' FnnCCIDE T
YAUTO 4
AUT IRTHAN EA C f ........
O ONLY, -"
GG&
F.rtcSsSIUMOSELLAUABILITY EAC.OCCUPR Nce f
OCCUR I.,._CLAIMS MADE AGG -'
S
DE000TIBLE
RETENTIONS
S
�wORrcERs cOMPeNs4nOx AND ]PJUB2E17B8051S 04129/76 04(29118 ioTM¢s
TBRS UAB ury
B to"��a.M DEPT TrvE E,I..E L r IIs _.. 500.00D
e.t.D _ 500,000
EL�D OICYL 1 600,000
I OTHER�
A
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/EXCL SIGNS ADDED BY ENDORSEMENT/SPECIAL PROVISIONS
JOB LOCATION 222 BRENTWOOD CIRCLE NORTH ANDOVER 01056
CERTIFICATE HOLDER CANCELLATION
TOWN OF NORTH ANDOVER BUILDING DEPT SHOULD ANY OF
THE n.OVE DESCPIesD POLICIES se GAxGELLED SEPORE TnE
1800 OSGOOD STREET fx>wA ryIONODIAtEE Tta r FGF.THE IssulNG War RVP r sxnva,rn n M,,,,.,o L
BUILDING 20 SUITE 2015 0060.HALL IMPOSE NO
CA"ON On LrpeS,LIT OFANYUPOu'nIE Iu&uIReN,c
NORTH ANDOVER,MA 01845 �s AGENTS DR REPgE9ErvinT"0
FAX:978-888-9542
HORIzED REPRESENTATIVE
Attantl— BUILDING DEPARTMENT
Malcolm D.Kimbell Jr.
ACOR025(2001/08) CertlOCate# 3080 pACORD CORPORATION 1989
10/26/2015 03:14 9783747769 RB KIMBALL PAGE 02
IMPORTANT
If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement
on this certificate does not confer rights to the certificate holder in lieu of such endorsement($).
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).
DISCLAIMER
The Certificate of Insurance on the reverse side of this form does not constitute a contract between
the issuing insurer(s),authorized representative or producer,and the certificate holder,nor does it
affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon.
ACORD 25-5(2a01/0e)
Carl'rfipate k3060
Massachusetts-Department of public Safety
Boartl o(B'Itl ng Reg I t' and Standards
Constit S 1 pis SI ialt\-
L CSSL-099887
MLCfipgL 71,AW � ,
. - b-Il
Hs
- Haverhill MA 01$32
3�
- � Commissioner 03/03/2076
cil/ `P ,� lr/��✓1- l;ger„
O[Cec fC me�A[f &Rusmese Regmah,a Lrc,nse,r reg�stranon valid far indrvrdul ns,only
F }10ME IMPROVEMENT CONTRACTOR before the expiroton date.If found return to
91st t 122318 Type: -Office of Consumer Affarzs and B,W—s ltegnlation
�E prat n 8/16/016 DBA 10 P.O,Plaza Snit,5170
BBoston,MA 02116ETTER HOMES WJNDO_y}.&SI411+(� '
MICHAEL LAW
18 BATES RD
HAVERHILL.,MA 01832 U drsecre[ar -
y Not vnhd svi hoot siynat re