Loading...
HomeMy WebLinkAboutBuilding Permit # 11/19/2015 BUILDING PERMIT 0ORT11 TOWN OF NORTH ANDOVER 0 ...... APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received TED CHUS Date Issued: IMPORTANT: Applicant must complete all items on this page i am v" TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building A One family 11 Addition 11 Two or more family 11 Industrial [I Alteration No. of units: 0 Commercial ;K Repair, replacement [I Assessory Bldg 0 Others: D Demolition 0 Other '6rsb .......... Is r "IV p/ DESCRIPTION OF WORK TO BE PERFORMED: J-7-0 41C 41 Identification- Please Type or Print Clearly OWNER: Name:_/- i-,-o V A-A,:s Phone: "*7 0 -e4?;�F Address: x"' 7!7//7"a., IM (�' "I NO .......... ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.MOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ E .. cl, Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access04he guarantyfand NOi T#1 i own ot YA'. via% dove r ® TO No. ��K. h ver, Mass, Q 1 COCH AK WICK �,9 A°R^Teo PPa,��S S U BOARD OF HEALTH Pt= Rml i D Food/Kitchen Septic System THIS CERTIFIES THAT ....... . •JNR...... .. ................................................................ BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on . I....... .....rr ................... 11 ,, � Rough to be occupied as ....... ...............�1.�. �S'j I�. Chimney provided that the person accepting this ermit shall in respect corlybrm to the terms of thea lication p p p 9 p rY p pp 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 CONSTRUCTIO AR Rough Service ... ... ....... ........................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Perinit Required t0 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. 1011-.J- 5101KI 0 rG 11r /_ MP-Tech Window & Sldlng, rjnc. SIDING F71.0. Box 8234, Ward Hill, MA 01835 MA Reg. 118836 29 Arrowwood Se. Methuen, MA 01844 MA Lic # 016201 1-800-85160900 wiww.hitechcorp.bi ��t asps Date: b� l a � ���--5 – Consultant: Job Name: — e anJ N Teiel hofr;^e.: Job Address: a' r sfi. oi�: �/�►1 CONTRACTOR agrees to start described work on/or about 6 weeks after final fittings and complete described work in about Jf a0vorking days. it 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. Job Includes Trim 1 Combination Job-Siding With Other Work ❑ P V.C.Coated Aum Aluminum t && i Ii Building and Elec.Permit LWin(:1ov=,'i& a Trim Fascia i'eatiTtC�l'rt , Siding Removal Tim f idd Fascia Calor { r t� k '1 Preparation Package Door Trim 'Full Custom � -Pear kyr None Accessory Package Shutters Location �N � UnderlaymenlGutters Y � Dh B/ 0 U —S Siding f yr Downspouts Soffit Treatment Remove Debris f� Soffa Color - Q{-�(((n r1?d 1� �t fir l `A! Lock.Elec.f:4eler - - - if Center Vent Fully Vented Non-Vented Preparation Includes Location /10� Replace Visible Rot Vented as Needed / _ i — Window And Door Casing`t reatm/e�nt / Energy��3 !Bug Guard Starter 9 fq/ �V P l Ul� �nl d I Window And Door Casing Color S El Full Custom Formed J-Less El Full Custom Formed I$ Accessory package Includes �0 pt-® S/' r i t' E] Blind Stop Capping None Color: W I rX Vinyl Light Blocks Vinyl Dryer Blocks Gutter 8:Downspouts 10 Vnyl Electric Outlet Blocks Vinyl Exhaust Vents ---- Gutter ColorDownspouts Color Vinyl Faucets Blocks Vinyl Gable Vents Underlayment Insulation To Be Used Special Notes / ` Hi-Tech 3/8 Other Lf e I�Oj/�( SCf'� d{' 4 0ij { S/0 f Location �Il 0 -7C Olt refj ,area To Be Slded Complete House Garage I ' )A S(ZP 4Mt v2v f!S *CA QS '00A/*6/0 Siding To Be Eked ��{ 11�73n L._ r Colorpayment policy 3 Brand Bank Financing Owner To Arrange i� Hi-Tech To Arrange Q,f H11 2� Profile , -} _7, C'P �r f ,SS O Q�(1 ,� �t -mdh m �4 Cash Or Check El Master Card Corner post to Be Used �T��a��' , Corner Post Color: Pk (/I 11PIS Total Investment 711mv 00 Wide Insulated Wide Non-Insulated 1/3 Deposit 1,51500-00 , E]Regular Insulated Regular Non-Insulated 1/3Payment ff w f045 #I S)500, 00 1/3 Balance of Day Completion I G(d0 0rdp I 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 agreement.See the attached notice of cancellation form for an explanation of this right. An interest charge of 1.5%per month(18%per year)will be �, Date of Acceptance added to any amount unpaid after 30 da s-$om invoice dale. �;:,.r In the event of default of payment of this91de(r any pan thereof and the account i�rzferred Signature �.�� �i / / _ () to an atlomey tar collect on the purFin,ser agrees to pay—so na l atmma>. (H...avner) /I'L/ ✓ -�/ Il;;t I/We give Hi-Tech per-missi�to obtain allye lss2ry pernutss , Signature'' {3 e / g (Hi-T Sinaturh) - The Commonwealth of Massae husefis Q Department of111diustrialAceldents I Congress Street,Suite 100 U Boston,MA 02114-2017 www-mass-gov1dia %rke&Compensation insurance Affidavit:Builders/Contractors/Li lqctricians/Plumbers. TO BE FILED WITH TEE PERMITTING AUTHORITY. Please Print LeaLb Applicant Information ly Name(Busiucss/Organizatioulkdividtial): Address: AA City/State/Zip: Phone 17 7 7— 11�,y"— Al?OF a appropriate box; Type of project(Tequired): Are you an employer?6ec'kth lQJ am.a enrployerwith � �Ployees(MI and/or part tirac)-* 7. 0 Now construction I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.E]I am a homeowner doing all work myself-[No workers'comp.insurance required.]t 10 n Building addition 4.F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will sole 11.F1 Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are proprietors with no employees. 12. Plumbing repairs or additions 5.F]I am a general contractor and I have hired the sub-cofitractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insurance.1 14. Other--A, 6.Q We are a corporation and its offiqqrs have exercised their right of'exemption per MGL c. wo'. "'employees.Mo workers'comp.insurance required.] 152,§1(4),and have nQ.�pye l . . I *Any applicant that checks box#1 must also fill Out the section below showing their workers,compensation policy information. f d affidavit I Homeowners who submit tl-d affidavit indicating they are doing all work and then hire outside contractors must submit a new afdavit indicating such. TContraotors 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-cimlraci&s have cmployccs,khey rfilist provide their workers'comp.policy numbOr. I am an employer that ispidvid619 WoAvers'compensation insurance for•my empl6yees.'Below is the policy and joh site information. Insurance Company Name: Vx e Policy##or Self-ins,LiG. Expiration Date: " Job Site Address: .771VT city/State/ZipAW-0 t�-e_.4 orw or- oM declaration age(showing the policy number and expiration date). Attach a copy of the Workers' compensation Polley P Failure to secure coverage as required under MOL o. 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 verificatiOu. t110 I do hereby certify under thepains andpenalfies ofpely",IT t the information provided above is true and correct. Date: Signature: Phone#: 75"r 1%%Or'rr Official use only. Do not Ippite 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.Plumbing Inspector 6.Other Contact Person: Phone#: 6:14:05 a.I�f PST (GRIT-8) FROM: _1)J005—T0: 1vii*?'37?:,_�,60 Pacfe: 2 of — AC ® DATE(MM/DD/YYYY) CERTIFICATE F LIABILITY INSURANCEBt26/2015 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(les)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 BARRY J KITTREDGE INSURANCE NAM E: 81 S MAIN ST PHONE FAx BRADFORD, MA 01835 Af0 No): EMAIL ADDRESS INSURER(S)AFFORDING COVERAGE NAIC d INSURER A: LM Insurance Corporation 33600 INSURED INSURER 8: - HI TECH WINDOW&SIDING INSTALLATIONS INC 29 ARROWWOOD ST INSURERc: METHUEN MA 01844 INSURER 0: ENSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 26115035 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 ADDL SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE NSD WVD POLICYNUMBER MMMD[YYYY) fMMA)DIYYYYJ LIMITS COMMERCIALGENERALUABILITY EACH OCCURRENCE S CLAIMS-MADE r_1 OCCUR PREMG€ 0 R - MI 51f_a occurrence) $ MED EXP(Any one person) $ PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER. GENERAL AGGREGATE S POLICY JECT LOC PRODUCTS-COMPICPAGG $ PRO- OTHER. S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT We accident ANY AUTO BODILY INJURY(Per Person) 5 ALLOWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE S AUTOS Per accident 5 UMBRELLA LIAR OCCUR EACH OCCURRENCE S EXCESS LIAS CLAIMS-MADE AGGREGATE S DED RETENTION S A WORKERS COMPENSATION WC5-31 S-383602-014 11/2912014 11129!2015 7fSTATUTE ER AND EMPLOYERS'LIABILITY ANY PROPRIETOR(PARTNERIEXECUTNE YIN E.L.EACH ACCIDENT S 100000 OFFICCFUMEMBER EXCLUDED? N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYE S 100000 '.. If yes,describe under 5(10000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers compensation insurance coverage applies only to the workers compensation laws of the state MA. This certificate cancels and supersedes all previously issued certificates,only as they relate to workers compensation coverage. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED RtPRESENTATrvE + ! ✓V(f! �. 1 LM insurance Comoration t�JT t, ©1985-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 26115035 1-383602 14-15 WC dagadesh049C.APOLibeityIubjaL.cc 3/26/2015 9:11:06 All (EDTI Page 1 of 1 ��e �Par�zono�zta - Tice o£Consumer 10/�Z`iaJrrclzuJehJ li � _ Affairs&Bus E IMPROV Regulation EMEiness NT CONTRACTOR y,egistration Expiratib 118836 HITECI I VI/IND 4/26/2017 Type: OW& IDING'([ySTA�L INC Supplement CE; , k TIM WICKS 29 ARROWIVV OD ST I METHUEN,MA 01844 Undersecretary i Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-096516 TIMOTHY W WIcks 3 ELLIS ST Methuen MA 61944 i r Expiration Commissioner 09/09/2016 t