HomeMy WebLinkAboutBuilding Permit #921-14 - 12 UPLAND STREET 6/17/2014 NORTH
BUILDING PERMIT 0(UFO q1O
TOWN OF NORTH ANDOVER
02. 6 0�
APPLICATION FOR PLAN EXAMINATION
Ty y
Permit No#: �I� ( I Date Received ,TEo
SSACHUS�
Date Issued:
I P RTANT: Applicant must complete all items on this page
LOCATION` n '(-JP1,14nriL- rl �,
P .
�/
PROPERTY OWNER,.
-Print :100 Year Structure_ yes no
MAP / gsPARCELa ZONING DI$TRLCT -- Historic District yes o
��
achne Shop Village° yes no'
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ,9 Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
>gRepair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition 11Other
05, bt-
Sptc ❑1/Velf ❑ Floodpl:ain ❑'Wetlands a q Watershed District W
n Water/Sewer J
DESCRIPTION OF ORK TO BE PERFO ME
�n uld an 1k sick
/1/0 lcz,-a
Identi c tion- Please Type or Print Clearly
OWNER: Name: )9xr, Qpy,.c. Phone:
Address:
Contractor NameL Phone.
.. .SO $�_ Sr)'
Address: � r�
Superuis.or,s Construct�on'License � ,� Ex Abate
- p rt _ _
Home]lrnprovementa License. .. _. .. _.. T _, _ Exp rDate:-_
.�
�. _
t ..
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BOLDING PE
RMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED OWN$125.00 PER S.F.
Total Project Cost: $ 1� FEE: $
Check No.: 1713 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guars and
Signature of Agent/Owner Signature of contractor(w,� ;
I
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑
Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑
Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On Signature_
COMMENTS
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS,
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision: Comments
Conservation Decision: Comments
Watt-r'& Sewer Connection/Signature& Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
,FIRE DEPAR�TME_NT -_� em . .Dum ster on site: yes---
L,
yesno
P P =
Located.at 124;iMain,iStreet
Fire:Department signature/date
a
COMMENTS. g. _
�I
I
Dimension
Number of Stories: Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, mast or service drop requires approval of
Electrical Inspector Yes No
DANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine
NOTES and DATA— (For department use)
❑ Notified for pickup Call Email
Date Time Contact Name t
Doc.Building Perinit Revised 2014
I
Building Department
The following is a list of the required forms to be filled out for the appropriate permit to be obtained.
Roofing, Siding, Interior Rehabilitation Permits a
1
❑ Building.Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract j
❑ Floor Plan Or Proposed Interior Work
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
Addition Or Decks
❑ Building Permit Application
❑ Certified Surveyed Plot Plan
❑ Workers Comp Affidavit
❑ Photo Copy of H.I.C. And C.S.L. Licenses
❑ Copy Of Contract
❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Mass check Energy Compliance Report (If Applicable)
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
❑ Building Permit Application
❑ Certified Proposed Plot Plan
❑ Photo of H.I.C. And C.S.L. Licenses
❑ Workers Comp Affidavit
❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
❑ Copy of Contract
❑ Mass check Energy Compliance Report
❑ Engineering Affidavits for Engineered products
NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit
In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals
that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording
must be submitted with the building application
I
Doc:Building Permit Revised 2014
1
Location 2^
it
No. G- Date (� 14
o - TOWN OF NORTH ANDOVER
o - . Certificate of Occupancy $
Building/Frame Permit Fee $ a l�•
fit. J :7 Foundation Permit Fee $
Other Permit Fee $
TOTAL $
r-
Check;
27688
Building Inspector
NORTH
Town of
Andover
E ,
Ci
h ti ver, Mass,.
(. / n h,(
COCNICMl WICK �•
�AOx
A rE D RrP ,�q5
U BOARD OF HEALTH
Food/Kitchen
PE�� RMIT LD Septic System
THIS CERTIFIES THAT ................ '................. N..�w......................................................
BUILDING INSPECTOR
has permission to erect .......................... buildings on ......'0%.......... ...................... Foundation
Rough
to be occupied as ..�a..... IAli11.0.�. ........12.tAq.... #orm
s� .
� ......... Chimney
provided that the person accepting this permit shall in every respect con 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
am . • UNLESS CONSTRUCT S Rough
Service
S........................................................
Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Display in a Conspicuous Place onthePremises — Do Not Remove Final YV
No Lathing or Dry all To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
• � �Z. �' +�b � f y 1� rtfi s �.�
r
r t
sj
a — " u, voiiuuea T
. Massa�l�usett t of Pudic Safety r
ffice of-Consumer Affaws&Business Regulatio4�
Board of QultdIns and Standards
`? _ ME IMPROVF�VIENT CONTRACTOR
Construction Sup®rvisor ¢ Ty
Licenio: CS-100077 :RegistratiO _ � gupplem
ratl7 e
av f,r Expi2, -
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MICHALI,ICDUD . �� UNITED HOME _ = A"
Ashland MA 01721 ' ,!
( IC,HAEL.DUDIEY� r
200 BUT�ERFIELD D1
Expiration 1.`.• /ASHLAND,;MA01721 Undersecret,axyt r.
Commissigner
3
OP ID: ML
~`�^O CERTIFICATE OF LIABILITY INSURANCEDATE_(AIkbofYYYY)
04/14/2014
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(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
NAME:
East Douglas Insurance Agency PHONE FAX
PO Box 1370 ac No.Exq:_.. .."..----- -- - - --{-�to
'Douglas,MA 01516 E-VAILADDRESS:
Marc Larocqu@
CUsrOMR�D o;UNITE51 _
__.. -m_.,_,__"-"c
INSURER(S)AFFORDING COVERAGE NAIC e
INSURED United,Painting Copany, InINSURER A:WeStem World Insurance Co.
dba United Home Experts _ .__-.. .._.-.. .---__.... . ... _. .._.. —.-_. _,.
200 Butterfield Drive,Suite I INsuRER a:Commerce Insurance Company 34754
Ashland, MA 01721 INSURER C:Scottsdale Insurance Company _ —__ 24740 —
INSURER 0:America European Insurance Co.
INSURER E:CNA Surety Company -
INSURER F
COVERAGES CERTIFICATE NUMBER: 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 'A0*dL g-UgkT- - - — - - -----POLICY EFF POLICY EXP.... ... ........ ...
- -- ----
TR TYPE OF INSURANCE POLICY NUMBER MM10ONYYY MM/OOM/YY LIMITS
GENERAL LIABILITY - EACH OCCURRENCE $ 1,000,00
A X COMMERCIAL GENERAL,LIABILITY NPP8023401 04/15/2014!04/15/2015_PRSJ :$ _1.00,00
_ CLAIMS-MAOE X" OCCUR MED EXP(Any one person) S- 5,00
PERSONAL ADV INJURY S -1,000,00
GENERAL AGGREGATE S 2,000,00
I GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ 2,000,00
POLICY': PRO- LOC S
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,0
00
B ANY AUTO BDGTQN 04/15/2014 04/15/2015 _(Ea accident)
BODILY INJURY(Per person) S
ALL OWNED AUTOS
BODILY INJURY(Per accident) $
X_ SCHEDULED AUTOS PROPERTY DAMAGE
X HIRED AUTOS (PER ACCIDENT)
X- NON-OWNED AUTOS 'iY�� _- _ S_—
S
UMBRELLA LIAR X OCCUR - "- EACH OCCURRENCE $ 4,000,00
X EXCESS LIAB CLAIMS-MADE AGGREGATE _ - S_—_ -4,000,00
C - - — -- -— XLS0087858 : 04/16/2014 04/16/2015 -
DEDUCTIBLE $
RETENTION S S
ANN
D EMPLOYERS'UA8iuTY _! WC
Y
D ANY PROPRIETORIPARTNERIEXECUTIVE YIN IWCC5010274012013 08/15/2013 08/15/2014.
CFFICER/MEMBER EXCLUDED? -N/A E.L.EACH ACCIDENT $ 500,00
(Mandatoryin NH) E.L.DISEASE-EAEMPLOYEE $ 500,00
If'.
describe under --.. ...._. _...
DESCRIPTION OF OPERATIONS below ; E.L.DISEASE-POLICY LIMIT $ 500,00
A Personal Property NPP8023401 04/16/2014'04/16/2015;PERS PROP 93,00
A Building Coverage NPPS023401 04/1612014:04/16/2015!BUILDING 98,00
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule.N more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
United Home Experts ACCORDANCE WITH THE POLICY PROVISIONS.
United Painting Company, Inc
AUTHORIZED REPRESENTATNE :7
Marc Larocque
/
0 19 8- 09 A CORPORATION. All rights reserved.
ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD
,..
The Commonwealth of Massachusetts
.DepartmentAaflndustraalAcctdents
Office of Investigations
Congress Street;Suite 100
t_ _ Bostbh.'AIA 02114-2017'`'
www mass.gov/dia
Workers'.Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers, . :,,;
A licant-Information'}-},i`l Please Print-Le ilii 'r
ct ia'i ,
Name (Busntess/Organization/Individual) .r r " , . ° '.if /�� 1.,"a .,}s 11 .., :.,z 1! -13,. tA'Q
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CitylState/LZ>t '> o? Phone# W( .<K> ft
Ary an emploj/er'►Check the`appropriate k:
Type of proj&t(required)
1 I am a employer�with" �� ` '}�-�' >a4��❑xI atn a'g�neral°contractor and I s� ��r I to n
,* fez r,� have hired the°subcontractors6 construction
--employees(fill and/or part tune)* ,'a t' _
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ship and have no employees ❑Demolition
,-;.,.�-.--,_.. t•�- r , •,mem to ees.and:have workers':.�4
working for me°m,any-capacity. p, y. �. Buildin addition
No workers' comp. insurance comp. insurance.: ❑ $ i - "Ji A.I.j
rre aired 5 ❑ We area corporation and its 10❑Electrical repairs or additions
3.❑ 1 vgtixi.El l] n rtg� i C :} LF?'T a,� `J 1 lilt- ` t nirt�of
I am a homeowner doing all work officers have exercised their 11 ❑Plumbing repairs or additions
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myself. [lo workers' comp.r; A s', �� nght of exemption per MGL. x,12 ,. Roof re airs
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t c 152,`§1(4),and we have no ❑' J'p
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a: a _.comp insurance regiiied,] t>,.. . ,.ve _�:; r 'r. ,, xl to z y ;• a�:
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'Any appi�cant that checks box#1,must also fill out the section below showing thea workers'compensation policy information
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t Homeowners'who submit this affidavit mdic'ating thtey are doing Mork'and then hir6'outsidetontractors must submit a new affidavi indtcatm such;
?Contractors that check'tlii"s box-must attached`an aiiditional-§beet showiiig thetnain'e`of the suco+ntraciorstand"state whether or not thosenii ie's hm iTJ
employees.<<If thp,.Wh-co4#actors•haye:emPY Yto gm.ffie"must P royide,thdir;workers'comp::policytnumber' g jl q; �3 y
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I:,am an.temployer,tl:at_is providing oorkKers�.compensation insurance for,,;Mj,,.Wiio fe6.-.rB'elowis llae olicy andlob`
information. frstoy� zti?:;
Insurance Company Name
ffi' eP.�
Policy#or Self ms Lic #. f�(),�D�*.; 1�/ "' zla'-M`' Eacpiratioii Date:'
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Failure to,secure coverage as_requued under Section 25A o MG_c 152`can lead,to the unposition of criminal pena�,4,_s,of a it
r "ecvaeA � � hi
fine up to$1£500 00 and/or one year'*iisonme!k,as welta's civil penalties m the form of a STOP W012K O�ER and a fine
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of up to$250.00 a day againstEthte violator ^B6e ayd-v}i5�s�ed+that a copy ofnthis statement may be forwartdead to the Qffce ot�_,
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I do hereby certify under the pam and penalties of perjury that flip 1nformutlon provided abowie u t►i a aid correct
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City or Town: T :Permit/License#
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
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ADDITIONAL PERFORMANCE RATINGS
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MANUFACTURERS ASSOCIATION
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UnitedUnited Home Experts & 4 16
Home Experts" United Painting Co., Inc. -va, � "Ca
@am@
200 Butterfield Dr. Suite I *;113C0
Ashland, MA 01721 AM MC License#157108
Full Worker's Compensation Coverage 508-881-8555 FAX 508-881-5584 MA Constr. Supervisors License
$4,000,000+Liability Insurance Coverage WWW.UnItedHOmeE% erts.com R1 REG#22948
Industry leading Warranties p RRP License#NAT-28008-1
Flexible Payment Plans available
Family Owned and Operated
Project: Siding& Windows Bid Date: 5/30/2014
Attn: Dan& Denise Noone Phone#: 978 886-5131
Company: Work#: 508 683-2061
Address: 12 Upland Street Fax#: Dan.NooneglEPTECHNOLO
Email: GIES.com
City, St. Zip: North Andover, MA 01845
Base proposal as per attached scope of work:
Remove and replace existing siding on home with Everlast composite clapboards. 18,120
Remove and replace existing windows with Integrity/Marvin window system
Prices good for 14 days
PAYMENT: A non-refundable deposit of 1/3 of ALL ACCEPTED PROJECTS is due upon authorization in the amount
of $6,040 with 1/3 of EACH PROJECT due upon half of completion of EACH PROJECT, and the balance of
EACH PROJECT due upon completion of EACH PROJECT along with any additional work requested by customer.
DISCLOSURE: State law requires us to inform you of contract liens. Any contractor, supplier, or subcontractor may
lien your real property if you or the general contractor fail to pay for goods or services delivered or installed at the work
location. Some contractors and suppliers automatically send letters of notification similar to this notice. At your request,
we will provide original lien release documents from anyone who provides said materials or service. Please call if you
have any questions regarding liens.
ACCEPTANCE: The signature on this proposal reflects acceptance of the proposal as per the attached scope of work,
authorizes commencement of the work, and hereby guarantees payment as outlined above. Any amounts not paid within
thirty days of invoice are subject to service charges of 1 %2%per month(18%APR). All costs of collection, including
reasonable attorney fees are to be paid by the customer. You may cancel this transaction at any time prior to midnight of
the third business day after the date of this contract. United reserves the right to assess a service charge equal to 25%of
the contract amount if the job is cancelled by customer AFTER three business days.
PERMITTING: The signature on this proposal authorizes a representative of United Home Experts to sign for and obtain
any permitting necessary to complete this project.
19 VIS4 V�(^1,46d sibol�
Contractor sigrfature Date stomer si tore Date BBB
Addendum to d Scope o Proposal n f work
p a
Contract Price: $18,120
To be paid: 1/3 down, 1/3 at half completion, 1/3 upon final completion
Contractor: United Painting Co. & United Home Experts Inc.
200 Butterfield Dr. Suite I, Ashland, MA 01721
Fed ID # 04-3541521
MA HIC License 130101
Work scheduled to be started: 6/23/14
Work to be substantially completed: 07/14/14. Add any days where
inclimate weather made the work not possible.
Notice: All home improvement contractors and subcontractors shall be
registered and that any inquiries about a contractor or subcontractor relating
to a registration should be directed to;
Registration Divison, Program Coordinator
One Ashburton Place Room 1301
Boston, Ma 02108
Tel: (617) 727-3200 ext. 25239
Liens: a lien or security interest HAS NOT been placed on the residence
as a consequence of the contract.
Permit Notice:
a. A Building permit IS required for this project
b. It shall be the obligation of the contractor to obtain such permits as the
owner's agent.
c. Owner's who secure their own construction-related permits or deal with
unregistered contractors shall be excluded from access to the Guarantee
Fund.
Y
Arbitration:
The contractor and the homeowner hereby mutually agree in advance that in
the event that the contractor has a dispute concerning this contract, the contractor
may submit such dispute to a private arbitration service which has been approved
by the Office of Consumer Affairs and Business Regulation and the consumer
shall be req u" o submit to such arbitration as provided in MGL c 142A.
Owner:
Contractor:
NOTICE. The signatures of the parties above apply only to the agreement of the
parties to alternate dispute resolution initiated by the contractor. The owner may
initiate alternative dispute resolution even where this section is not signed
separately by the parties.
NOTICE OF CANCELLATION 5/30/14............................. (Date)
You may cancel this transaction, without any penalty or obligation, within
three business days from the above date.
If you cancel, any property traded in, any payments made by you under the
instrument executed by you will be returned within 10 business days following
receipt by the seller of your cancellation notice, and any security interest arising out
of the transaction will be cancelled.
If you cancel, you must make available to the seller at your residence, in
substantially as good condition as when received, any property delivered to you
under this contract or sale; or you may, if you wish, comply with the instructions of
the seller regarding the return shipment of the property at the seller's expense and
risk.
If you do make the property available to the seller, and if the seller does not
pick such property up within 20 business days of the date the seller receives your
notice of cancellation, you may retain or dispose of the property without any further
obligation. If you fail to make the property available to the seller, or if you agree to
return the property to the seller and fail to do so, then you remain liable for
performance of all obligations under the contract.
To cancel this transaction, mail or deliver a signed and dated copy of this
cancellation notice or any other written notice, or send a telegram to: United
Painting Co. Inc. & United Home Experts Inc. 200 Butterfield Dr. Suite I
Ashland, MA 01721.
Not later than midnight of......6/2/14.................................... (Date)
I hereby cancel this transaction...............................................(Date)
..........................................................
Buyer's signature
e have reciv copy of this notice.
v
..... ..................................
Buyer s) signature Date
............................................................ ..................................
Buyer (s) signature Date