HomeMy WebLinkAboutBuilding Permit #530-2016 - 2053 SALEM STREET 10/29/2015Serge/,VL D ll -y -/S
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: 6'N— 7-zl? Date Received
Date Issued: 1A I 1
IMPORTANT: Applicant must complete all items on this page
.Pant
PROPERTY OWNER aOs,P _- R< -,(4-,_ t i - _
Pant 100 Year-Str'uctuee
MAP PARCEL I ZONING DISTRICT: Historic D�str
t. -- _ -
Machine Shop, Villaqe
V-SSLHC ,6 .NO\
4
o
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:y no
eS no
s no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
❑ New Building
A One family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
K—Repair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
5epti.c ❑ .Well
❑ Floodplain ❑ Wetl'ands
❑ W.atershe-d'District
El Wat'e:r/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
e r�
A6
Identification - Please Type or Print Clearly
OWNER: ,Name: P-L&zaj Phone: gk,72--
a
Address: Zo S 3 -SkLA---, sr
Contractor Name /.A , Vit' Ph = 7 •GAS__•. � ''7?--
_ �. ,Iv � �► K,L,.,_ - one -,
Email=__ -------
Address
Supervisor's Construction License: ��Ts_ _ _ _ -_Exp.
Home lrnprovement License: -__/ 3 %-Z_ _� �.-_ _ Exp. Date.:
--
ARCHITECT/ENGINEER
Address:
Phone:
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: $ CXDC), FEE: $ �(®
Check No.: Receipt No.:_M!:,Td
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
gnature of AgenUOwner�tti, __ __ :_ 'Signature of contractor
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
HEALTH
COMMENTS
Reviewed On
Signature
Reviewed on Signature
Reviewed on Siqnature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
�* Planning Board Decision: Comments
' Conservation Decision: Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
' AT ME`NT _._.m.r ,.�..�
PATernp.umpster€ons situ Gyes�� _no `
at24 MainSteetf
epartrnent signature/dafe ___
PINTMA:,
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
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
No
Doc.Building Permit Revised 2014
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
❑ Building Permit Application
❑ Workers Comp Affidavit
❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses
❑ Copy of Contract
❑ 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
MOTE: 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
Doc: Building Permit Revised 2014
Location
No. " 7 C� �ts Date
1
TOWN OF NORTH ANDOVER
Certificate of Occupancy $ •'
Building/Frame Permit Fee $3"�
Foundation Permit Fee $
Other Permit Fee $
TOTAL $_=
Building Inspector
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PELLA WINDOWS AND DOORS CONTRACT
1. TERMS AND CONDITIONS
These Terms and Conditions are an integral part of the contract set forth on the
Product Order (the "Contract") between New England Window and Door LLC
dba Pella Windows & Doors, Inc. ("Pella") and the person(s) identified on the
Product Order ("Owner") to supply the products (the "Products"), and perform
the work (the "Work") described or referred to in such Contract. For Product
Only purchases, a signed "Product Only Addendum" is a required part of the
contract.
2. OWNER
Pella is not responsible for any existing security systems. Owner shall remove
all shades; verticals, blinds, curtains, drapes or window mounted air
conditioners, prior to the installation of the Products. Pella's installers are not
responsible for the removal or installation of these types of items. Pella is not
responsible for pre-existing window coverings fitting on newly installed Pella
windows.
The Owner shall provide complete access to the work site between the hours
of 7:00 a.m. and 6:00 p.m. (Monday through Friday) for Pella's installers to
deliver the Products and perform the Work.
3. PELLA
Pella will be responsible for and have control over construction means,
methods, techniques, sequences and procedures and for coordinating all
portions ofthe Work. Pella will be responsible for the Work of its Pella
Contractors who will install the Products.
Unless provided otherwise in the Work description, Pella will provide and pay
for all labor, materials, equipment, tools and machinery, transportation, and
other facilities and services necessary for the proper execution and completion
of the Work.
The materials and equipment furnished under the Contract will be good quality
and new unless otherwise required or permitted, the Work will be free from
defects not inherent in the quality required or permitted, and the Work conform
with the requirements of this Contract. Pella shall not be responsible
for damages or defects caused by abuse, modifications not executed by Pella,
improper or insufficient maintenance, improper operation or normal wear and
tear. Pella will keep the premises and surrounding area free from accumulation
of waste materials or rubbish caused by performance of the
Work.
CHANGES
The Owner may order in writing changes in the Work consisting of additions,
deletions, or modifications ("Change Order"). Any Change Order shall
include an adjustment to the Price and the Substantial Completion Date, as
determined by Pella. Pella reserves the right to approve or disapprove any
Change Order and any such Change Order must be signed by both Owner and
Pella to be effective.
SUBSTANTIAL COMPLETION
Owner understands and agrees that the Substantial Completion Date is an
estimate only and that the actual date on which the Work is completed may be
extended to allow for Change Orders requested by Owner or if the time to
complete the Work is affected by conduct ofthe Owner, weather, labor
disputes, availability of subcontractors, acts of God, fire or other causes
reasonably beyond Pella's control. If for any reason the Work is not fully
completed by the Substantial Completion Date (including any extensions
contemplated above), but is substantially completed by such date, i.e., the
Product has been installed, but minor parts or components are missing or need
to be replaced or repaired, a hold back proportionate to the cost of remaining
parts or work to be completed is acceptable. However, the holdback will not
exceed the amount ofthe completion costs or 10 % ofthe remaining unpaid
balance ofthe Price, whichever is less.
FINANCING
If payment ofthe Price is financed with a financial institution through Pella, all
financing paperwork must be completed upon signing of this Contract and the
requisite approvals and authorizations for the full amount ofthe requested
financing shall have been received from the financial institution.
PAYMENTS
Pella shall be entitled to stop the Work upon written notice to Owner for any
material default or failure by Owner, including but not limited to, the Owner's
failure to pay Pella the amount due within seven days after the date payment is
due.
CORRECTION OF WORK
Pella shall correct installation Work not in conformance with the requirements
of the Contract, if notified in writing by the Owner within two years after the
Completion Date or, if earlier, the date on which the Work is substantially
completed and payment of the Purchase Price made subject to a holdback as
provided above. Correction of Work as herein provided shall be Owner's sole
remedy for defective workmanship, and is provided in lieu of any and all other
remedies. Pella's obligation to correct Work is conditioned on Pella's prior
receipt of all payments then due.
LIMITED PRODUCT WARRANTY
Pella shall warrant all Pella products, but only in accordance with the Pella
Windows & Doors Limited Warranty. THIS LIMITED WARRANTY SHALL
BE THE SOLE WARRANTY WITH RESPECT TO THE PRODUCTS AND
PELLA SPECIFICALLY DISCLAIMS ALL OTHER WARRANTIES,
EXPRESS OR IMPLIED, WRITTEN OR ORAL (INCLUDING WITHOUT
LIMITATION ANY WARRANTY OF MERCHANTABILITY OR FITNESS
FOR A PARTICULAR PURPOSE).
10. NO CONSEQUENTIAL DAMAGES
UNDER NO CIRCUMSTANCES SHALL PELLA BE LIABLE FOR
CONSEQUENTIAL, INCIDENTAL, INDIRECT, OR SPECIAL DAMAGES,
WHETHER FORESEEN OR UNFORESEEN.
11. HOME IMPROVEMENT CONTRACTORS
All home improvement contractors and subcontractors shall be registered with
the director of the Home Improvement Contractor Registration Program
administered by the Board of Building Regulations and Standards. Pella and
any of its subcontractors identified in this agreement have been registered.
Any inquires about Pella or any of its subcontractors relating to registration
should be directed to: Director, Home Improvement Contractor Registration,
One Ashburton Place, Boston, MA 02108, 617-727-8598
12. PERMITS (MA customers only)
Pellohl' ed to and will obtain the following permits for this project:
. Homeowners who secure their own permits will be
excluded from the guaranty fund provisions of Massachusetts General Laws,
chapter 142A.
In addition to the rights and warranties enumerated in this agreement, you may
have additional rights under Massachusetts General Laws, chapter 142A and
780 Code of Massachusetts Regulations R6.
13. NOTICE OF CANCELLATION
You may cancel this agreement if it has been signed by a party
thereto at a place other than an address of the seller, which
may be his main office or branch thereof, 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 for an explanation of
this right.
Do not sign this contract if there are any blank spaces.
9ZOM4 (7 •
-4w� -
Omer signature 10/6/15
Date
DISPUTES
THE CONTRACTOR AND THE HOMEOWNER HEREBY MUTUALLY AGREE IN
ADVANCE THAT IN THE EVENT PELLA HAS A DISPUTE CONCERNING THIS
CONTRACT, PELLA MAY SUBMIT SUCH DISPUTE TO A PRIVATE
ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY
OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS
REGULATIONS AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO
SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A
Pella Windows & Doors
Contractor
s
pr,'r,,'�memner
NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE
AGREEMENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT
INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE
ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION IS NOT
SEPARATELY SIGNED BY THE PARTIES.
NOTICE OF CANCELLATION
Date of transaction: 10/6/15
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 agreement,
and any negotiable instrument executed by you will be returned within ten 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 goods delivered to you under this agreement; or
you may if you wish, comply with the instructions of the seller regarding the return
shipment of the goods at the seller's expense and risk.
If you do make the goods available to the seller and the seller does not pick them up
within twenty days of the date of your notice of cancellation, you may retain or dispose
of the goods without any further obligation. If you fail to make the goods available to the
seller, or if you agree to return the goods to the seller and fail to do so, then you remain
liable for perfonnance 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
Pella Windows and Doors, at 45 Fondi Rd., Haverhill, MA 01832
not later than midnight of 10/9/15 (three business days from the date of
transaction above).
I hereby cancel this transaction.
(Date) (Buyer's signature)
The Commourvealth of Massachuseti
Depar tent of Industrial Accidems
Of,�ic'.e of Investigations
1 Congress Street, Suite 100
Boston, MA 02114-2617
1r4rww mass gov/clic
Workers' Compensation Insurance Affidavit: Budders/Contractors/luleeMelans/Plumbers
Applicant Information Please Print Le�ibl
Hanle (Business/OrganizadomUdividual): 46AIDauls, b1,X) V2_ Ur
Address: 4_15- ra m ai- Kb
Phone #:
Are you an employer? Check the appropriate box:
1. [& am a employer with 7-S— 4. ❑ I am a general contractor and .I
employees (full and/or part-time).* have hired the sub -contractors
2. ❑ I am a sole proprietor or partner- Listed on the attached sheet
ship and have no employees These sub -contractors have
working for me in any capacity. employees and have workers'
[No workers' comp. insurance comp. insurance.$
required.] 5. ❑ We are a corporation and its
3. ® I am a homeowner doing all work officers have exercised their
myself [No workers' comp. right of exemption per MGL
insurance required.] ; c. 152, §1(4), and we have no
employees. [No workers'
insurance
+J
Type of project (required):
6. ❑ New construction
7. W. ernodeling
S. ❑ Demolition
9. ❑ Building addition
10.❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
1211 Roof repairs
13.❑ Other
°My applicant that checks box #1 must also fill out the section below showing their workers' compensation 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 hos must attached an additional sheet showing the name of the sub -contractors and state whether or not those entities have
employees. 1f the sub -contractors have employees, they must provide. their workers' comp. policy number.
lam an empkyer that is providing workers' corrapensation insurance for awry employees Below is the polig and jab site
information.
Insurance Company Name: N L4 P_nAQ Lo e!7& IN 5 oln
Policy # or Self -ins. Lie. Expiration Date: -7 % 1
Job Site Address: City/State/Zip:
Attach a copy of the workers' compensation 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 WORK ORDER 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.
1 do hereby certify under the pains acrd penalties of peCiruy that the information provided above is tare and correct
Phone #
Official use only. Do not write in this area, to be completed ky city or town offrciaat
City or To -w n: Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk 4e Electrical Inspector 5. Plumbing Inspector
ho Other
Cli
YCERTIFICATE OF LIABILITY INSURANCE
1 0612 2015MM/DD/YYYY)
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
Fred C. Church, Inc.
CONTACT Dorothy A Coded, CIC, RPLU
NAME:
41 Wellman Street
Lowell, MA 01851
(800) 225-1865
(978) 454-1865
PHONED 978 3227231 aC Not:
E-MAIL dccdett@fredochurch.com
ADDRESS:
INSURERS AFFORDING COVERAGE NAIC #
POLICY EXP
JMM1DD1YYYYILIMITS
INSURER A: Citizens Insurance Company of America 31534
INSURED
New England Window & Door LLC
INSURER B : New Hampshire Employers Insurance Company 13083
INSURER C,
45 Fondi Road
INSURER 0:
Haverhill, MA 01832-1302
INSURER E:
INSURER F:
%..crc I IrlliA I c tvumtstrc: - 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
LTR
TYPE OF INSURANCE
ADDL
INSR
SUBR
WVD
POLICY NUMBER
POLICY EFF
(MMIDDNYYYI
POLICY EXP
JMM1DD1YYYYILIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1.000,000
XD
COMMERCIAL GENERAL LIABILITY
AGE TO RENTED
PREMISES Ea occurrence $ 100,000
MED EXP (Any one person) $ 10,000
CLAIMS -MADE a OCCUR
A
X CG0001
ZBN8161407
7/112015
7/1/2016
PERSONAL & ADV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GENT AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPlOP AGG $ 2,000,000
POLICY X PRO X LOC
$
AUTOMOBILE
LIABILITY
COMBINED SINGLE LIMIT
Ea accident
BODILY INJURY (Per person) $
ANY AUTO
ALL OWNED SCHEDULED
BODILY INJURY (Per accident) $
AUTOS. AUTOS
NON -OWNED
HIREDAUTOS AUTOS
PROPERTYDAMAGE
Per accident $
UMBRELLA UAB
HOCCUR
EACH OCCURRENCE $
4EXCESSLU4B
CLAIMS -MADE
AGGREGATE $
DED RETENTION $
$
WORKERS COMPENSATION
X WC STATU- OTH-
AND EMPLOYERS' LIABILITY Y / N
i ER
I
500,000
E.L. EACH ACCIDENT $
B
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
N / A
400040101
7/12015
7/1/2016
E.L. DISEASE - EA EMPLOYEE $ 500,000
(Mandatory In NH)
If yes, describe under
E.L. DISEASE - POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (Attach ACORD 101, Additional Remarks Schedule, If more space is required)
�n irrvn r c nvwcrc GANGELLATION
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
ant# zilou Mst# rl...a un •... n
--�•• • •�•��, m — .��..-�...., .+�+.,.��, �vnrvr r rvrv. nn mynas reserves.
ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD
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