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Home My WebLink AboutBuilding Permit #281-16 - 193 LACY STREET 9/3/2015 TOWN OF NORTH ANDOVER APPLICATION FOR.PLAN EXAMINATION Permit N® Date Received g"°p .-. •�' Date Issued: _ IIVIPORTA.NT:A221icant must complete all items on this pMe LOCATION io PROPERTY OWNER CrtrQ ring Print —� MAP NO.- PARCEL: ZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑Newi3killding i Cine family i Addition I Two or more family ❑Industrial C.-i Alteration No. of units: 1:1 Repair,replacement ❑Assessory Bldg ❑Commercial 01 Demolition f.✓Movie relocation ::J Other I::1 Others: ❑Foundation only DESCRIVTION OF OT3 TO BE PREFqRIMED qEa lint l C1 Identification Please Type or Print Clearly) OWNER: Name: In r-C Phone OE7-7 3c_. _ Address: f `}*' CONTRACTOR Name: l 1 Phone: (k ,� Al,ia - Address: 24 KA6roaAU Supervisor's Construction License: – Exp. Date: Home Improvement License: 00 Exp. Dater A.RCHITECTIENGINEER 11A Name: Phone.- Address: hone:Address: Reg. No. FEE SCHEDULE..BULIDING PERMIT. $I Z 00 PER$�1Q000.00®F`THE TIBTAL ESTIMATED COST EAS D ON$125.00 PER S F: Total Prgject Cost :$—_2" $ � sQxl2.00=FEE:$ Check No.: Receipt No.: Page lof4 Location 2 i No. / Date v -fes" . - TOWN OF NORTH ANDOVER s 4 - • • Certificate of Occupancy $ Building/Frame Permit Feer $� Foundation Permit Fee $� Other Permit Fee $ TOTAL $ Check# r, Building Inspector r 7 7 NORTH _ - w: .. . . s f . . ve' . O No. �h ver, Mass, COCKIC Kl WICK �•9 q°RwrE o S tl BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT CA it..Lim............�, ., ,M„4,,,, t. ...... BUILDING INSPECTOR . �... ...... Foundation has permission to erect .......................... buildings o ...�� ....... ...........�. ............... 11 A gp' �.. . . .. ... ...�1 �...... ...... Rough y t0 be occupied as ..... ......... ... ............................... Chimney provided that the person accepting this permit shall in everMspect conform to th rms 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 NTH ELECTRICAL INSPECTOR UNLESS CONSTRU T T 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. Visit Cour Showroom At: Famous Brand Names 354 N.,,Bro?dway PELLERINa Certainteed Salem, NH 03079 - Mastic ion.. thru Fri, gam-5pm VINYL SIDING -Alcoa Most Saturdays Sam - 12pm , -Andersen or by Appointment Inc. -Harvey Tei. {603}898-2259 ®Therma-Tru Proposal - Agreement PROPOSAL SU 'BMITTE O 1 PHONE DATE STREETJOB NAME 1 3 CITY,ST TE&ZIP COD JOB LOCATION Tt t� rInI4, We hereby propose to furnish, all materials and labor necessary for the completion of the following products in accordance with the specifications and drawings ,5tr-..ice 5.i � ,j t ' � ICU ,� �d •e Stz (� trtt� ju5er hiLvii' 74 tdLSflte:'zrriy Qtd { ✓< r-- s X 1166.1-j. ez j/'4Vs' /me'ss . Fir, gyuj �eY"poiri4s K t A Total Contract price is: "' 14 dollars($ PAYMENTS TO BE MADE AS FOLLOWS: ,. l ALL MATERIAL IS GUARANTEED TO BE AS SPECIFIED. ALL WORK TO BE COMPLETED IN A AUTHORIZED WORKMANLIKE MANNER ACCORDING TO SPECIFICATIONS PER STANDARD PRACTICES. ANY ALTERATION OR DEVIATION FROM ABOVE SPECIFICATIONS INVOLVING EXTRA SIGNATURE COST WILL BE EXECUTED ONLY UPON WRITTEN ORDERS AND WILL BECOME AN EXTRA CHARGE OVER AND ABOVE THE ESTIMATE. ACCEPTANCE OF PROPOSAL-THEABOVE PRICES,SPECIFICATIONSAND CONDITIONS ARE SATISFACTORY AND ARE HEREBY ACCEPTED, YOU ARE AUTHORIZED TO QQ THE. rp WORK AS SPECIFIED. PAYMENTS WILL BE MADE AS OUTLINED ABOVE. SIGNATURE � `^ � $ L{' CUSTOMER HAS THE RIGHT TO CANCEL THIS CONTRACT UP TO THREE(3)DAYS AFTER DATE OF ACCEPTANCE. / DATE OF ACCEPTANCE / /lS� SIGNATURE This form satisfies all basic requirements of the state's Home Improvement Contractor Law(MGL chapter 142A),but does not include standard language to protect homeowners. Seek legal advice if necessary. Any person planning home improvements should first obtain a copy of"A Massachusetts Consumer Guide to Home Improvement"before agreeing to any work on your residence.You may obtain a free copy by calling the Office of Consumer Affairs and Business Regulation's Consumer Information Hotline at 617-973-8787 or 1-888-283-3757 or on our website. Homeowner Information Contractor Information Name Company Name e a:2C Street Address Q9:not Office Box address Contractor/Salesperson]Owner Name ---1Q-J3 La City/Town Pie Zip Code Business Address(must include a street address) 14-Andaer MA -Se . Cltc�. /cll Daytime Phone Evening Phone City/Town State ,Zip Code Mailing Address(it different from above) Business Phone Federal Employer ID or S.S.Number Home InquofEment Contractor Reg.Nu mer Expiration date );.nR're9arrY9 trim mOri0n1C St. impmvement comma=have a viNd Mish28on number f A:✓1 �j f. S The Contractor agrees to do the following work for the Homeowner. tlf C iIC! (Describe in detail the work to completed,specifying the type,brapd,and grade of materials to be used,use additional sheets ifnecesca_ro.) I'lovia on Required Permits-The following building permits are requited Proposed Start and Completion Schedule-The following schedulat will and will be secured by the contractor as the homeowner's agent: be adhered to unless circumstances beyond the contractor's control arise (Owners who secure their own permits will be excluded.from the Guaranty Fund provisions of Te D Date when contractor will begin contracted work MGL chapter.142A.) __i3&I___Date when contracted work will be substantially completed. Total Contract Price and Payment Schedule The Contractor agrees to perform the work,furnish the material and labor specified above for the total sum o Payments will be.made according to the follolving schedule: $ -3Pon signing contract(not to exceed 113 of the total contract price or the cost of spec order items,whichever is greater) or upon completion of ! g t✓ ;Y1� Y / 1 S �`� Y i/ or upon completion of M ((�� J $ upon completion of the contract. (Law forbids demanding full payment until contract is completed to both party's satisfaction) The following material/equipment must beecial sp $ to be paid for ordered before the contracted work begins in ander to meet the completion sched P ule.( *) $ to be paid for NOTES:(*)Including all finance charges(**)Law requires that any deposit or down-payment required by the contractor before work begins may not exceed the greater of(a)one-third of the total contract price or(b)the actual cost of any special equipment or custom made material which must be special ordered in advance to meet the completion schedule. x rens Warr n -1s m e$ cess warranIX bgIngrovided v the contractor? No❑yes alt to of the w rrga u b a chest Subcontractors-The contractor agrees to be solely responsible for completion of the work described regardto the c ntract less of the actions of any third party/subcontractor utilized by the contractor. The contractor further agrees to be solely responsible for all payments to all subcontractors for materials and labor under this agreement Contract Acceptance-Upon signing,this document becomes a binding contract under law. Unless otherwise noted within this document,the contract shall not imply that any lien or other security interest has been placed on the residence. Review the folIoving cautions and notices carefully before signing this contract. • Don't be pressured into signing the contract.Take time to read and fully understand it. Ask questions if something is unclear. • Make sure the contractor has a valid Home�ravement Contractor Retrtstrahon. The law requires most home improvement contractors and subcontractors to be registered with the Director ofHome Improvement Contractor Registration. You may inquire about contractor registration by writing to the Director at 10 Park Plaza,Room 5170,.Boston,.MA 02116 or by calling 617-973-8787 or 888-283-3757. • Does the contractor have insurance? Ask the Contractor for his insurance,immnanv inirn—lin„a^tt—+ The Coinmonwealth of l assach setts Department of Industrial Accidents f ce 0f Investigations 600 Washington Street Boston,AM 4.2111 ww . ass govt is Workers' Compensation.Insurance.Affidavit:Builders/Contractors/Electricians/Plumbers ApRlicant Information Please Prifl a ibl Name (Business/OrganizatianlIndividual):„ Fo Sv"'. ts"Olf Y Address: ' City/State/Zip: H 030 'hone#: Are you an employer?Check the appropriate box: T , ,`- YPe of project(required):1.1 3 t am.a employer with- -- 4. ❑ I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).' have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7.. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑:Demolition working for me in any capacity. workers' comp.insurance. 9. ❑Building addition (No workers' comp.insurance 5. ❑ We are a corporation and its required.) officers have exercised their IO•❑Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. (No workers' comp. c. 152,§1(4),and we have no 12.Q Roof repairs insurance required.]t employees. [No workers' 13.f(Other ALI S comp.insurance required:] *Any applicant that checks box 41 must also fill out the section below showing their workers'compeusat7.on 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 their workers'comp.policy information. I aria can empl®yer°that is providing workers'compensation insurance for my employees. Below is the policy and job site in/brmation. Insurance Company Name: t ” Policy#or Self-ins.Lic.#: S 1'1"� ��? j ] Expiration.Date: :lob Site Address: r City/State/Zip: Attach a copy of the workers' co ceasation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal.penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD ODDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I ado hereby certify under telae ins and penalties of per,jury that tim information provided above is true and correct: e Signature: Date: Phone#: Official use only. Do not write in this area,to be con pleted by city or town official City or To Permit/License# Issuing Authority(circle crane): 1. Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing lnspector� 6.Other Contact.Persoan: Phone#: COntridetor Arbitration The Home Improvement Contractor Law provides homeowners with the right to initiate an arbitration action(as an alternative to court action)if they have a dispute with a contractor. The same right is not automatically afforded to a contractor,however- The contractor would have to resolve any dispute he/she haswi jh a homeowner in court u-- both parties agree to the optional clause provided below. This clause would give t unless he contractor the same right arbitration as is afforded to the homeowner by the Home improvement Contractor to Law. The contractor and the homeowner hereby mutually agree in advance that in the event the contractor has a dispute concerning this contract,the contractor may submit the dispute to a private arbitration firm which has been approved by the Secretary of the Executive Office of Consumer Affairs and Business Regulation and the consumer shall be required to"344it to such arbitration as provided In Massachusetts General Laws,chapter 142A. < a)U'L- Homeowner's Signature Contractor's Signature NOTICE:The signatures of the parties above apply only to the agreement of the a resolution initiated by the contractor. The homeowner parties s rt e to I ternative di spute may initiate alternative dispute resolution even where this section is not separately signed by the parties. Homeowner's Rights A homeownees rights under the Home Improvement Contractor Law(M0chap L a con protection laws(i.e.MGL chapter 93A)may not be waived in any way, ter 142A) n d oth r e surner even by agreement. However,homeowners may be excluded from certain rights if the contractor they choose is not properly registered as prescribed by law. Homeowners who secure their own building permits are automatically excluded from all Guaranty.Fund provisions of the Home Improvement Contractor Law. The contractor is responsible for completing the work as described,in a timely and workmanlike manner. Homeowners may be entitled to other specific legal rights if the contractor guarantees or provides an express warranty for workmanship or materials. In addition to guarantees or warranties provided by the contractor,all goods sold in Massachusetts carry an implied warranty of merchantability and fitness for a particular purpose. An enumeration of other matters on which the homeowner and contractor lawfully agree may be added to the terms of the contract as long as they do not restrict a homeowner's basic consumer rights. If you have questions about your consumer/homeowner rights,contact the Consumer Information Hotline(listed below). Execution of Contract The contract must be executed in duplicate and should not be signed until a copy f al exhibits referenced Parties are also advised not to sign the document until all blank sections have been documents have been attached. P ti 0 1 xhi ts and refe enc filled in or marked as void,deleted,or not applicable. One original signed copy of the contract with attachments is to be given to the owner and the other kept by the contractor. Any modification to the original contract must be in writing and agreed to by both parties.Contracted work may not begin until both parties have received a fully executed copy of the contract,and the three day rescission period has expired. Accelerated Payments A contractor may not demand payments in advance of the dates specified on the payment schedule in cases where the homeowner deems him/herself to be financially insecure. However,in instances where a contractor deems him/herself to be financially insecure,the contractor may require that the balance of funds not yet due be placed in ajoint escrow account as a prerequisite to continuing the contracted work. Withdrawal of funds from said account would require the signatures of both parties. Additional Information If you have general questions or need additional information about the Home improvement Contractor Law or other consumer rights,or if you wish to obtain a free copy of "A.Massachusetts Consumer Guide to Home contact: Improvement" Consumer Information Hotline Office of Consumer Affairs and Business Regulation 10 Park Plaza,Room 5170,Boston,MA 02116 617-973-9787,898-293-3757 Or visit the OCARR wobsito at ljqL3�,,. lraL If you want to verify the registration of a contractor or if you have questions or need additional information specifically about the contractor registration component of the Home Improvement Contractor Law,contact: Director of Home Improvement Contractor Registration. CERTIFICATE LIABILITY p� ` y PELLE-3 OP ID: €�B • , 1 A TE {�I1 1 1INSURANCEDATE(MMIDDIYYYY) 0812612015 THIS GER FICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE BOLDER. 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 poiicy(ies) must be endorsed. If SUBROGATION 13 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 NAME: James ASanto Ptanrlght Insurance-Salem PHONE FAX — 224 Ruin Street Suite 3C rc No ;603-890-6439 No):603-690-6521 Salem,NH 03079 ntiDREss: amie santoinsurance.com James A Santo INSURERIS)AFFORDING COVERAGE NAIC# INSURERA:Acadia Insurance 31325 INSURED Pellerin Vinyl Siding INSURER B: 354 North Broadway Salem,NH 03079 lrasuRERc: INSURER D: INSURER E: - 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 C_O_NDITIONS OF SUCH POLICIES.LIMITS SHOWN MAYHAVE BEEN REDUCED BY PAID CLAIMS. IEXP LTR .—_ TYPE OF INSURANCE POLICY NUMBER AVUL _ EPOLIC MY EFF OLICY YYY LIMITS S —�—-� A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ _ 1,000,00 CLAIMS-MADE F�OCCUR BOA512276440 10128/2014 10128/2015AGETtSRrilIr-s PREMISES(Ea occurrence $ 500,40 MED EXP(Any one person) $ 5,00 PERSONAL RADV INJURY II -- -.1,ODD,00 GEN'L AGGREGATF_.LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY EI PRO ❑ JE LOC PP.ODUCTS-COMPtOP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident) $ 1,000,00 A ANY AUTO BOA5122764 10/2812014 10/28/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ NUN-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS I P6r occident $ T UMBRELLA E_IAS OCCUR EACH OCCURRENCE $ EXCESS LIAR �+ — CLAIMS-MADE AGGREGATE DED RETENTION$ $. .._ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'.LIABILITY A AI,IY PROPRIETOR/PARTNERID-ECUTIVE Y 1 N ( CA5122768-11 10128/2014 10/28/2015 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED? NIA _ (Mandatory in NH) 3A NH E.L.DISEASE-EA EMPLOYEE $ 500,00 If yes,describe under ----- —--- DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LltifT $ 500,00 DESCRIPTION OF OPERATIONS t LOCATIONS I VEHICLES (ACORD 101,Additional Remari(s Schedule,may be attached if more space is required) Ken Perignyy&Paul Pellerin have elected to be excluded from 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 Carol Stannard ACCORDANCE WITH Tae POLICY PROVISIONS. 193 Lacy St AUTHORIZED REPRESENTATIVE North Andover, SIA 01845 Q 1988-2014 ACORD CORPORATION. All rights reserved. 4 Massachusetts -Department of, ubijc Safety Board of Building t'- ulat;ons and Staridaarm construction Supervisor L icen e: CS-037603 SALEM IH 033010 i C rt3 z(ssiunea 04117/2016 i �flC 7w O?II/}%,�OI?tt/CCGt�flG��L$JCY('�ICdC�I%,1 Office of Consumer Affairs&Business Regulation ME IMPROVEMENT CONTRACTOR egistration 100286 Type: xpiration: 6!1512016 Private Corporation PELLERIN VINYL SIDING Kenneth Ped gny 354 N.Broadway l , Salem,NN 03079 --- TJudersecregary