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HomeMy WebLinkAboutBuilding Permit #614-11 - 209 VEST WAY 3/16/2011TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: h/ Date Received Date Issued: &';" -�� T IMPORTANT: Applicant must complete all items on this page LOCATION 7"1 YEA— Qk� Print PROPERTY OWNER RIfA611 &A -LS -5 �J Print MAP NOWPARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9-eT05 family ❑ Addition ❑ Two or more family ❑ Industrial ❑ AI ration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other iQ eptrc �� Well r �� iF-rc( l YWetlW§ i IN WS ershediI)istrict DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: Address: -Z-o9 Mss- 6LA:f, CONTRACTOR Name: �Jt, Phone: Address: . Pai ion h-o�-- Supervisor's Construction License: Ofrf£ 5'3 Exp. Date: l0 - 2-1- - /-�-- Home Improvement License: 7 `7 ( Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. N .578/ FEE SCHEDULE., BULDING P RMIT, $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ do©— FEE: IAb 7 MW� Check No.: ��'" Receipt No.: t9 39 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund l7- -Cffi ' Cwl Ir= rivi 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 DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Sianature & Date Driveway Permit � r• d ' DPW Town Engineer•,S'gt��ture: � `' Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 - Date Doc:.Building Permit Revised 2008 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit M ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Grossection/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 (VOTE: All dumpster permits require sigr� 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 Chat 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 Doe: Doe -Building Permit Revised 2008mi m m m m co ismm �c OZ y 'v C3 ^; O xC'" o: � d h Cl) CD n Z y '0• CL r o � ? CL H O O f1. n O aCO, O CD ov CD O CD CD CD S CD CL y CD CO) O CO !OD S- CO) O 1CD Z o CD 0 C CD O 'Q I C O O z o• m O _ cc 0 CO cc CDcoc O _ H o� a H H m _��_� d x z . y O. Q : Cos = 3 Ll c cD C* O.p ® Q Co C! D. n m y O .-r C �. =dbd_y C= .-« _ .. m � .. CL o CD � Cc') .=t y � O � CA CD CS C7 Z O1 Oy l07 CL,., ,... c. - m H A� CLCCD m :�• c a m y H So D) CA V ff-I qj Im o� CD .+ O o CA � 3 CD o m y CD � o 03 SCD: nom• OZ C3 ^; O xC'" o: OO C O w op roIt O ro O G CL w O a F: y 0 0 c OZ O xC'" n OO ro w op roIt O ro O G CL w O (D 'n n cn � O O f1. n O y 0 0 c The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www mass.gov/dia pensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): -I-- Address: F011L0 r_ fro City/State/Zip: 1+&V F.f21t k MA 61 SU Phone #: Ci TB -Z6SS 7J,5r Are you an employer? Check the appropriate box: Type of project (required): L ETI am a employer with 7-5— 4. ❑ I am a general contractor and I 6. New construction employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub -contractors have g. ❑ Demolition workingfor me in an capacity. Y P tY• employees and have workers' comp. insurance 9. ❑Building addition [No workers' comp: insurance required.] .T 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3. ❑ I am a homeowner doing all work officers have exercised their 11. ❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 13. [1 Other employees. [No workers' comp. insurance required.] *Any 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. tContractors 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 -contractors have employees, they must provide their workers' comp. policy number. I ant an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: F!&E6 C ct�urac_4 Policy # or Self -ins. Lic. #: 0 8 W gN L 15_'7 7 t_i- Expiration Date: 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature: ti,- Date: a Phone #: I use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License # Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: ACORD,. CERTIFICATE OF LIABILITY INSURANCE DAT20100DIYYYY) 07/02/2010 /DDff PRODUCER (800) 225-1865 Fred C. Church, Inc. 41 Wellman Street Lowell, MA 01851 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. INSR LTR 800-225-1865 INSURERS AFFORDING COVERAGE NAIC # INSURED INSURER A: Citizens Insurance Company of America INSURER B: Wausau Underwriters Insurance Company New England Window & Door LLC 45 Fondi Road Haverhill, MA 01832-1302 INSURER C: INSURER D: INSURER E: EACH OCCURRENCE $ 1,000,000 CnVFROGFS 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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR DD' INSR TYPE OF INSURANCE POLICYNUMBER POLICYEFFECTIVE DATE POLICY EXPIRATION D DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TOE TED PREMISES Ea occurence $ 100,000 X COMMERCIAL GENERAL LIABILITY MED EXP (Any one person) $ 10,000 CLAIMS MADE FTI OCCUR PERSONAL &ADV INJURY $ 1,000,000 A ZBN8161407 7/1/2010 7/1/2011 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000 %{ POLICY PRO LOC JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 X (Ea accident) ANY AUTO BODILY INJURY $ ALL OWNED AUTOS (Per person) A SCHEDULED AUTOS ADN8162169 7/1/2010 7/1/2011 BODILY INJURY $ X HIRED AUTOS X NON -OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG $ EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ 9,000,000 AGGREGATE $ 9,000,000 X OCCUR CLAIMS MADE $ A URN8167305 7/1/2010 7/1/2011 $ DEDUCTIBLE $ X RETENTION $ }( JORY WC LIMIT ER WORKERS COMPENSATION AND E.L. EACH ACCIDENT $ 500,000 B EMPLOYERS' LIABILITY WCCZ11259957010 7/1/2010 7/1/2011 E.L. DISEASE - EA EMPLOYEE $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? E.L. DISEASE - POLICY LIMIT $ 500,000 If yes, describe under SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Proof of Insurance titK 1 IhII;A 1 t I'1ULUtK w England Window & Door LLC Fondi Road verhill, MA 01830 ACORD 25 (2001/08) Client # ?QFn Mst # 10-11 GL, UMB, WC, Cert # Auto SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL IMPOSE NO OBLIGATION OR LIABILITY OF ANY KIND UPON THE INSURER, ITS AGENTS OR AUTHORIZED REPRESENTATIVE U ACCIRD CORPORATION 15RfS 2 \ § JP \ m \ a A U) . ` \ > >§y } C g \ : ;0) © =g 0 § , 40 Z �: . � ul 7 2 ƒ §I \ 2 2 3»\ E i a\ 4 m I � I 0 9to9)m � st cv U2 ti l"7 V' 0 CD co M 7C LL �► � N O Q XO m oiS F a r Y-- _ O co N p ca > a d9 a==a co 70 S i x r- n r O VY S ' E o N a r o ;. m to ci M us O N r Cn l� n' sc ua 2c Q1 Q Ute' oaoAt i, -a Q o U") a wx > w CO Uuj h" ' VkCD YC N z U a� ck d � CD c w m O �. w E »rr�. 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("Pella"') and the person(s) identified on the Product Order ("Owner") to supply the products (the `Products"), and pert'orm the. wore:. (the "Work") described or referred to in such Cnntr'aei.. For Product Only purrfuisas, it signed "Product Orals Addendum" is a required pari of the COnti:WA. 2. OWNER. Pelta is not responsihle for any existing security systems. Owner sl[a]t reynove. al] shades: verticak. blinds, curtains. drapes or wimkm mounted air comliboncn, prior to file installation of the. product". Pella s instalte.rs are riot responsible l'or the removal or insta)ltrt.ioa of these types of items. Pella is not responsible for pre-existing window coverings fitting oft newly installed Pella windows. The Owner shall provide complete access: to the work site bebveen the hours of 7:00 a.rn. an(] 6:00 p.m, (Monday through Friday) fur Peliri s insta.11exa to deliver die .Products and peTform the Work. 3. PL ,I:A Pella will be rmpontitb.le for and have control over construction irmam, methods, letrni.ques, sequences and procedures and for coordinating all pott.ians of die. !'York. Pella writi he responsible for rhe Work of its Pella C:olmactors wlin will install the Products. Unless provided otherwise in the Work description, Pella will provide and pay for all laho:r: materials, equiprneln, tools and machin ry. transportation, and. other racilit.ies and services .a:ces-wry for the proper execution and completion of the work, The materials and e.gaipment furnished under the Contract will he goat] quality and new unless otherwise requimd or: permitted., the',Fork will be .tine from defects not inherent in the cluality Tequired or permitted, and the Work conforin with the require.nlents of this Contract. Pella ;hall not be responsible for damage", or defects caused by abase, modifications not esccuted by Pella, improper or insufficient maintenance, unproper operation or nornat wear and (ear. Pella will keep the premises and surroundin;; area free frn.m accu.rnufatioll of waste: materials or rubbish caused by performance of the s't'ork. CIYA1i'GI; S The Owner ala)' ol*r.iii R7lting changes in tete Wov' consisting cif addl6ons, deletions, or modification:, ("Change Order"), Any Change Order shall. inchufe 11.11 aciustment to the Pricy; and the Substantial Completion hate, as determined by Pella. Pella reserves the right to approve or disapprove any Change Order and any suet, C:harrge Order must in siped by ix)th Owner and Pella ro be effective. SUBSTANTIAL C;OliI1"LUION Owner undeerstods and agrees that the Substantial Completion Pate is art estinlime only aad that the actual date on which the M ork is completed maybe extended to allow for Change Orders requested by, Owner or if the tune to complete the Wo L is affected by conduct of the Owner, weather. lahor disputes, availabihtp of illbcontractors, acts of Goad. fireor other causes re;.t onably beyond Pell.a's control. If for any reason the Work isnot, fully completed by the Substantial Completion Date i including an.y rxt.e.n1ions contemplated above), but is substantially contple e -.d by such date, i.e., the Product tills 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 parrs or work to be completed is acceptable. However, the holdback will riot exceed the amount of the co.rnpletion cunsts or 10 % of the remaining unpaid balance of the Price., whichever is less. F.MANC:ING It' payment of the Pricv...is financed with a financial inscianiori through Pella, atl financing paperwork forst he completed upon si'gnmg of this Ccrnt:r-net alit] (lie requisite approvals and authorizations for the full amount of thee requested financing. sh;nll have been received from the fimincrial institution. PAVMENTS Pella shall be entitled to stole the: ib'ork upon written notice to Owner for any anateria.l default or failure by Owner, including but not. limited to, the Owners failure to pay Pella the amount due within seven days after the date payment is due., C:CfltRUC.'TIC)N OF WORK Pella. shall correct i nstal.l<ttion Work not in conformance with the: requirements of the Contract, if notified in writing by (lie Owner within two years after the Cotnpletioa Date or, if earlier. the date on which the work is substantially completed and payrnent of the Purchase: Pr•ic:e, made subjLct 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 ih'ork. is conditioned on Pella's prior receipt of all payments then due. LIMITED PRODITCT WARRA.N'I'Y Pella shall warrant al -1 Pelta lnoducts, but only in accordance with the Pella 61'iudows &. ])Hors l..imitecl \b'amaruy. 'T'Ti`I'S I.l`t-IITED WARRANTY SI.IALL BE: THE SOLE WARRANTY Wi'TH R1`,SPEC. F TO TIi:1 PRODUCTS AND PELLA SPECIFICALLY I:)ISCLAIMS ALL 0`11 i'R.WARRANTTES, EXPRESS OR IMPI..IED, WTRIT't'L3N OR ORAL (INC.IAMING WITHOUT 1.1101TA'1'.1ON Al` Y WARRANTY OF NMERC:ITANTABlld rY OR FITNESS FOR A PARTiC`ULAR PkiRPOSli:). 10. NO COA'S.I 4,UFNTIAL DAM -A(; iS UNDi':R NO CIRCU.MSTAtiCES SITALL, PELLA BE LIA11LE rOR. CONSEQUENTIAL. IN(: J:aF. vTA.L, INDIRECT, OR. SPECIAL DAMAutis, WHETHER FORESEEN OR UNI'MESEEIN. ACME IMPROVE1Vi:I N'r C:ON'I`RAC.TORS All home improvement contractors and .mbomtractors shall be registered with the director of the: Home Improvement Contractor Registration Program administered by the Boatel of Building Regulations and Standards. Pella and any of its suhcmitractors identified in this agreement have been registered. Any inquires abort Pella or any, of its subcontractors relating to registration should be directed to: Director. Route Improvement. Contractor Registration, One Ashburton Place, Boston. MA 02108, 617-727••8548 2. PERMITS (MA customers only) POLO'S ob&'ated to and will obtain the following permits for this project: ._ _ _ ""neow"m who secure their own permits will be exr.Iuded fiofn .lee guaranty fund provisions of 11.7'aassachusetts General Law's, chnpteT 1<12A. In addition to the rights and warranties enumerated in this agreernent, you may have. atiditianal .ciglris under Massachusetts General Laws, chapter 142A and 780 (.".ode of Massachusetts Regulation., Rfi. 13, NOTICE OF CANCELLATION ON You may cancel this agreement if it hats been signed by a party thereto) at.a. place other than an address of the seller, which may be his main office or bratich thereof, provided you notify the seller in. wnt.iri at his main office or branch by ordinary mail posted., by telegraiz:l sent or by delivery, not later than midnight: cif the third( business day .following the signing of this itj?'t'eeinent. Sex the attached :Notice of Cancellation for an explanation of this right. sign til-cilmtr acd:.if d8zere are any blank spaces. C:ustc'lracf`si;,.aatur •. DISPUTES Job Name Alas trd Date � ZU 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. PRTVATE ARBITRATION SERVICE WHICH HAS BEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS REGULATION'S AND THE CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS PROVIDED IN M.G.L.c. 142A Contractor x in r H o.. NOTICE: THE SIGNATURE OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEMENT OF THE PARTIES TO ALTER.N.A.TFVE 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:. — 3 . 0 4, I E - You znay 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 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 Pella Windows and _Doors, at 45 Fondi.Rd., Haverhill, MA 01832 not later than midnight of .p _- - (three business days from. the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) Locatiord 1/0 7- /,v �qg - No. /,.W-// Date !2 Z/ TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # 23960 Building Inspector