HomeMy WebLinkAboutBuilding Permit #637-14 - 174 CANDLESTICK ROAD 3/18/2014TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
oe
Permit NO: �� - (� Date Received
Date Issued: i
IMPORTANT: Applicant must complete all items on this p
/.
LOCATION
tjl nt-
POERTYOWNER l
fw.
Print 100 Yearoid Structure yes, Q
B.
MAP NQ:lPARCEL: ZONING DISTRICT; ;HistoncTpistrict yes, n
Machine..E i p Village yes, n
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
❑ One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
X Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
❑ Septic° ❑_WellA
�Floodplan; D.1NetlarStls
UVatershedDistrict,
oWateUSevve�A
DESCRIPTION OF WORK TO BE PERFORMED:
Re V lace 32> L,%)\ v\h&LJ i PS C V 6-<— 1 Gc' 'r9'e-
OWNER: Name:
Address: I e? '-( C
Type or Print Clearly)
iy% Q --
C -k 2-0ac�
,
CONTRACTOR -'Name �) �1�i,cJc� ►.1_S-�-r1v �- Phone.
-,, _
:Address') S_t�I> �%` s��er✓�rvi�
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Supervisor` Construction ELicense. 0
r!o
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Home Impfoyement Licedse J;�` 7'`�_'� Exp Date=
ARCHITECT/ENGINEER XA7 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: .3 / FEE: $ '4 -
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
:Si nature of A ent/Ovvner . ;. Si nature of contractor
9 g_ u _ 9 _..
DInnc C,ihmifFoA n Dinno %AroivoA i—i t-,nr+ifinA Dlr%f Dion F1 C4omner1 Plone
Location
No.
Date
Check #15-73
27356
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ R
Building/Frame Permit Fee $}?
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Building Inspector
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. ❑
Permanent Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
CONSERVATION
COMMENTS
y
HEALTH
COMMENTS
DATE REJECTED DATE APPROVED
❑ ❑
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Comments
Conservation Decision: Comm
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Tow;! Engineer: Signature:
Locaiea &u4
FIRE ®EPARTME'N'T -'Temp Dumpster on site yes no
Located at 124 Mair, Street
Fire Departm' erit signature/date
COMMENTS
000 aueei
Dimension
Number of Stories:
Total land area, sq. ft.:
Total square feet of floor area, based on Exterior dimensions.
ELECTRICAL: Movement of meter location, mast or service drop requires approval of
Electrical Inspector Yes No
®ANGER ZONE LITERATURE: Yes No
MGL Chapter 166 Section 21A -F and G min.$10041000 fine
)oc.Building Permit Revised 2010
Building Depa
r.tm a rnt
The foli'owing is a list of the required forms to be
filled out for the appropriate permit to be obtained.
Roofing, Siding, , Interior Rehabilitation perm its
❑ Building Permit Application
❑ Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
Li Copy of Contract
❑ Floor Plan Or Proposed Interior Work rodUcts
❑ Engineering Affidavits for Engineered p a ent prior to issuance of Bldg Permit
g g rn
TE: All dumpster permits require sign off from Fire pep
Addition Or Decks
o Building Permit Application
❑ Certified Surveyed Plot Plan
o Workers Comp Affidavit
❑ Photo copy
of H.I.C. And C.S.L.
Co Licenses
Copy pY Of Contract osed Work With Sprinkler Plan And
❑
o Floor/Crossection/Elevation Plan Of Prop le
le b
b 'ca
Hydraulic Calculations (If Applicable) ort (If Applicable)
❑ Mass check Energy Compliance Rep
Ort
Engineering Affidavits for Engineer Fd e pepartducts rrlent prior to issuance of Bldg Permit
)TE: All dumpster permits require sign off from
New Construction (Single and Two FamilY)
❑ Building Permit Application
o Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses to Include Sprinkler Plan And
El Workers Comp Affidavit To Be Returned) p
❑ Two Sets of Building Plans (One
Hydraulic Calculations (If Applicable) .
❑ Copy of Contract
❑ Mass check Energy Compliance Report acts
❑ Engineering Affidavits for Engineered Department prior to issuance of Bldg Permit
OTE: All dumpster permits require sign off from Fire
10 ice must stamp the decision from the Board of Appeals
In all cases if a variance or special permit was required the
this recorded at the Registry of Deeds. One copy and proof of recording
that the app•,al period is over. The applicant must then g
must be subm.tted with the building application
Doe: Doc.Buhding Permit Revised 2012
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Ad WU63
MOYNIHAN-NORTH READING LUMBER, INC.
"QUALITY BACKED BYA DESIRE TO PLEASE"
164 Chestnut Street FEIN:04-2261995
North Reading, MA 01861A XContractor Reg No.:
978-864-3310 / 781-944-8500 W W Exp. Date: _/_/_
Salesperson(s): //—
Salesperson(s):
HOMEOWNER INFORMATION
Name II --
iy c ;YIA�P �4,cy Rdclicj
Street Address ( Not P.O. Box)
City[Town State Zip Code
Daytime Phone
Evening Phone
Mailing Address (if different from Street Address)
WORK TO BE PERFORMED AND MATERIALS TO BE USED
Moynihan -North Reading Lumber, Inc. agrees to perform the work set forth in Exhibit A for Homeowner and to
use such materials in connection therewith as set forth also in Exhibit A, attached hereto and made a part
hereof.
The following schedule shall be adhered to unless circumstances arise beyond Moynihan -North Reading
Lumber, Inc.'s control: Work scheduled to begin: _ /_/_ Expected date of completion: _/—/—
May be based upon arrival of special order material
TOTAL CONTRACT PRICE AND PAYMENT SCHEDULE
Moynihan- North Reading Lumber, Inc. agre s ,r rm.ihe work, and furnish the material and labor set forth in
Exhibit A for the Total Contract Price of: $ i (which amount includes all finance charges).
Payments shall be made by Homeowner according to the following payment schedule:
$ "11 6MR 00 Initial deposit upon signing this Contract (the initial deposit shall not exceed the greater of
one-third (1/3) of the Total Contract Price as set forth above; OR the Total Cost of Special/Custom
rders as et forth below).
$ d ly! I. by—/—/—or upon completion of delivery of materials
$ by_/ / or upon completion of install
$ upon completion of the Contract
In order to meet the completion schedule set forth above, the following materials/equipment must be special
ordered before the Contract work begins, for a Total Cost of Special/Custom Orders of $
$ to be paid for building permit
$ (.A to be paid for :E
$ to be paid for
CDO.,NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
2 2011 Moynihan -North Reading Lumber Inc. `� // ' y
Y 9
er's Signature Date Contractor Date
le+,elr (a Kc7c°IAFf ' Bv: Dale Fuller
Homeowner's Name (Printed) Installed Sales Coordinator
You may cancel this Contract if it has been signed by a party thereto at a place other than an address of
Contractor, which may be its main office or branch thereof, provided you notify Contractor in writing at
its main office or branch by ordinary mail posted, by telegram sent or by delivery, no later than midnight
of the third business day following the signing of this Contract. See attached notice of cancellation for
an explanation of this right.
See reverse side for additional Homeowner Terms and Conditions
1057 -NR 1/11 White - Office Yellow - Sales/Service Pink - Customer Page 1 of 5
HOMEOWNER TERMS AND CONDITIONS
The following terms and conditions are an integral part of this Contract between
Moynihan -North Reading Lumber, Inc. ("Contractor") and Homeowner.
1. All payments are due upon presentation of billing, and a late charge of one and one-half percent (1%%) per month will be applied to past due
charges. Homeowner shall pay Contractor court costs, attorneys' and paralegals' fees, and any other expenses incurred in the collection of
past due accounts.
2. If Homeowner is borrowing money from a construction lender to perform the work, Homeowner represents that the construction loan fund is
sufficient to pay Contractor and any other contractors performing work on Homeowner's property. Homeowner irrevocably authorizes
Contractor to communicate directly with the construction lender regarding payments and loan balances, and authorizes the construction lender
to make payments directly to Contractor.
3. Homeowner shall be in default if it breaches any provision of this Contract; if any warranty or statement to Contractor in connection with this
Contract or Contractor's extension of credit to Homeowner is false or misleading when made; if any statement to a lending institution in
connection with financing for this Contract is false or misleading when made; or if Homeowner becomes insolvent, makes and assignment for
the benefit of its creditors, or files or has filed a petition for bankruptcy.
4. If the Total Contract Price includes allowances, and the cost of performing the work covered by an allowance is either greater or less than the
allowance, then the Total Contract Price shall be increased or decreased accordingly without the need for a signed Change Order. Unless
otherwise requested by Homeowner, Contractor shall use its judgment in accomplishing work covered by an allowance.
5. If Contractor agrees to do any installation work, Homeowner will procure at its expense and before the commencement of work hereunder "all
risk" insurance with construction, theft, vandalism, and mischief endorsements attached, the insurance to be in a sum at least equal to the
Total Contract Price. The insurance will name Contractor and any subcontractors as additional insured. If the project is destroyed or
damaged by accident, disaster or calamity such as fire, flood or storms, Homeowner shall pay for work done by Contractor in rebuilding of
restoring the project as extra work.
6. If Homeowner defaults under any of its obligations under this Contract, Contractor may:
Stop work until any payments are received or defaults are otherwise cured.
Terminate work upon seven (7) days written notice and recover as damages, at its option, either the reasonable value of
the work performed through termination, or the balance of the Total Contract Price plus any other damages including
reasonable attorneys' and paralegals' fees Contractor suffers as a result of the default.
7. Contractor shall be excused for delay in completion of the Contract caused by contingencies out of its control, including acts or delays of
Homeowner or other contractors, acts of God, labor trouble, acts of public agencies or inspectors or public utilities, extra work, breaches of this
Contract by Homeowner, problems obtaining materials from suppliers, or other contingencies unforeseen by Contractor. Under no
circumstances will Contractor be liable for monetary damages caused by delays as set forth above.
8. If Contractor encounters unforeseen conditions that were not reasonably anticipated by Contractor, Contractor shall call the conditions to the
attention of Homeowner and the Total Contract Price and schedule will be adjusted by the extra work necessitated thereby. No installation,
plumbing, electrical, flooring, decorating or other construction work is to be provided unless specifically set forth herein. In the event
Contractor is to perform the installation, it is understood that the price agreed upon herein does not include possible expenses incurred in
addressing hidden or unknown contingencies found at the jobsite. In the event such contingencies arise and Contractor is required to furnish
labor or materials or otherwise perform work not provided for or contemplated by Contractor, the actual cost of such additional unexpected
work plus fifteen percent (15%) thereof will be paid by Homeowner. Contingencies include but are not limited to: inability to reuse existing
water, vent and water pipes, air shafts, ducts, grilles, louvers and registers; the relocation of concealed pipes, riser, wiring or conduits, the
presence of which cannot be determined until the work has started; or imperfections, rotting or decay in the structure or parts thereof
necessitating replacement.
9. Homeowner shall be responsible for the coordination of any work performed by itself or other contractors, and shall be responsible to have the
work site ready for contractor to proceed. If installation is involved, with its work through the completion date. Any work performed by
Homeowner or other contractors shall not hinder Contractor's schedule. Contractor does not warrant any work performed by Homeowner or
other contractors not working for Contractor as its subcontractor.
10. Homeowner understands that some products described in this Contract may be specially designed and custom built, and as such Contractor
will take immediate steps upon execution of this Contract to design, order and construct those items as set forth herein. Except as provided
on page one of this Contract, this Contract is not subject to cancellation by Homeowner.
11. The delivery date, when given, shall be deemed approximate and performance is subject to delays caused by strikes, fires, weather
conditions, acts of God or other reasons not under the control of Contractor, as well as the availability of the product at the time of delivery.
Once the delivery date is determined, Homeowner agrees to accept delivery of the product(s) within one (1) week.
12. The risk of loss, damage or destruction, shall be upon Homeowner upon the delivery and receipt of the product. If Homeowner is not ready to
accept the product, the delivery payment will by made as agreed upon and an extra storage fee of Fifty Dollars ($50) per week will be
charged.
13. Title to the items sold pursuant to this Contract shall not pass to Homeowner until the full price as set forth in this Contract is paid to
Contractor.
14. Contractor agrees that it will perform this Contract in conformity with customary industry practices. Homeowner agrees that any claim for
adjustment shall not be reason or cause for failure to make payment of the purchase price in full.
15. This Contract sets forth the entire understanding of the parties. Any and all prior contracts, agreements, warranties or representations made
by either party are superseded by this Contract. NOTWITHSTANDING PARAGRAPH 4 NO CHANGES SHALL BE MADE TO THE WORK
DESCRIBED OR TO THE CONTRACT PRICE UNLESS AND UNTIL HOMEOWNER AND CONTRACTOR SIGN A WRITTEN CHANGE
1057 -NR 1/11 White - Office Yellow - Sales/Service Pink - Customer Page 2 of 5
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f1� 11c" ERTIRCAT OF LIABILITY 114 URAE
F7%0:8!07ff113
�
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIR10ATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BERrVEEN 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).
PRO'
DrR 978 -534-5133
AnaeonBtea F
Insurance Agency, Inc. 978-534-9385
44 Main Street P. O. Box 360
Leominster, MA 01453
Richard fdl. Bagley
CONTACT
I111E:
PHONE
Ext : ac No
EMAIL
ADDRESS:
INSURER(S) AFFORDING COVERAGE NAIC #
INSURER A: Charter Oak Fire Ins Company 25615
INSUP.RB:TraweQers Qrsrtr�ey�slsifu of �4rs>;arir_a ry566�s
—. � '_...'.-
INSURED Shawn Arsenault &A
Eric Ars 'I It Cbl Arsenault
Brothers Construction
_. _.___._..
INSURER C: Travelers
105 Hamilton St 1st FL
Leominster, IZA 01453
INSURER D:
INSURER E:
INSURER F:
Moynihan Lumber Co.
164 Chestnut Street
North Reading, MA 01864
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Richard M. Bagley
Vu I AL:VKU I:UKF'UKAI IUN. AH rights reserved.
The ACORD name and logo are registered marks of ACORD
11— INVIVIor-M.
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICYPERIOD
INDICATED. NOTVOTHSTANDING 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.
INSRR TYPE OF INSURANCE
INSR
UBR
NPVD
POLICY NUMBER
POLICY EFF
MWDD
POLICY EXP
MM/DD/
LIMITS
L LIABILI Y
EACH OCCURRENCE $ 1,000,00
I t ERCIALGENEkAL LIABILITY
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DA A D
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PREMISES Ea occurrence)
MED EXP (Any one person) $ 5,00
CLAIMS-MADE OCCUR
PERSONAL & ADV INJURY $ 1,000,00
GENERAL AGGREGATE $ 2,000,00
gAANY
GREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,00
ICY PRO LOC
$
BILE LIABILITY
COMBINED SINGLE LIMITEa
accident $ 500,000
AUTO
BA-9672AS78-12-SEL
08126112
08126113
BODILY INJURY (Per person) $
OWNED SCHEDULED
AL"Og
"Ut
er acu en
HIRED AUTOS AUTOSNON-OWNED
PROPERTY DAMAGE $
Per accidenR
_
- — LIAB -
OCCUR
17
EACH OCCURRENCE $
EXCESS LIAB
CLAIMS -MADE
AGGREGATE $
DED I I RETENTION $
$
WORKERS COMPENSATION
WC STATU- OTH-
AND EMPLOYERS' LIABIUTY Y f N
TOP,Y LIMITS I ER
C ANY PROPRIETOR/PARTNER/EXECUTIVE
IHUB6650875713
04/02/13
04/02114
E,L. EACH ACCIDENT $ 100
OFFICERIMEMBER EXCLUDED?
NIA
,OO
E.L. DISEASE - EA EMPLOYEE $ 100,00
(Mandatoy in NH)
If yes, describe under
E.L. DISEASE -POLICY LIMIT $ 500,00
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required)
Moynihan Lumber Co.
164 Chestnut Street
North Reading, MA 01864
ACORD 25 (2010/05)
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Richard M. Bagley
Vu I AL:VKU I:UKF'UKAI IUN. AH rights reserved.
The ACORD name and logo are registered marks of ACORD
6 rf
BEVERLY
NORTH READING
PLAISTOW
82 River Street
164 Chestnut Street
12 Old Road
P.O. Box 1160
P.O. Box 509
Beverly, MA 01915
P.O. Box 128
North Reading, MA 018640128
Plaistow, NH 03865
(978) 927-0032
(978) 664.3310 • (781) 9448500
(603) 382-1535
FAX: (603) 382-1935
FAX: (978) 927-8201
FAX: (978) 664-0872
Subcontractor Workers' Compensation Waiver
1, Shawn Arsenault . , hereby acknowledge that I, as an
independent contractor, have been asked by Moynihan Lumber
Company to provide it with a certificate of Worker's Compensation
Insurance coverage for myself. Based on the exemption provided by
the Worker's Compensation -Insurance coverage for myself because 1
am a sole proprietor without employees. Therefore, I hold Moynihan
• - - -A LL -- A----1:—
Insurance and or Self Insured Lumber Business Association, Inc.
totally harm --- for any Injuries or cost of injartes incurred by-rMself - -
because I have voluntarily chosen to exclude myself from coverage
by engaging the exemption provided under. the Worker's
Compensation Laws.
I have taken this option of my own free will.
while %s ALV
Date:
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