HomeMy WebLinkAboutBuilding Permit #549 - 217 BEAR HILL ROAD 2/3/2011Permit NO:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
TYPE OF IMPROVEMENT
PROPOSED USE
E
Residential
Non- Residential
❑ New Building
[ane family
❑ Addition
❑ Two or more family
❑ Industrial
❑ Alteration
No. of units:
❑ Commercial
aw<e'pair, replacement
❑ Assessory Bldg
❑ Others:
❑ Demolition
❑ Other
.Septic D Well
D Floodplain C Wetlands
q 1Nate'rshed District.
-.
❑ Wafer/Sewer.
DESCRIPTION OF WORK TO BE PERFORMED:
(� , CA e E IM a -^L `T- 1 o t -j 0 �qW
Identification Please Type or Print Clearly)
OWNER: Name: D &-v z.n Phone: Q743--u-7azx'
Address: X0'1 i kl 9D
CONTRACTOR Name: IPtr+ s►t.xaione .C�j')Q� 2l:S 1aSS
Address;HSFaua 2 4AII e -04A4.
Supervisor's. Construction License: b% - Exp.' Date:..'/IJ
Home.lmproveMent License: 'b Z>el -Z'1.y Exp Date:`
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT: $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COSI" BASED ON
$125.00 PER S.F.
Total Project Cost: $ �'o by FEE:
Check No.: (,,)--70 Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Ownergo3kc.,t:k-iSignature of contractor.
F—
Location a (q Ae7 el r- LLXX
No. 56— Date
NORTH
TOWN OF NORTH ANDOVER
3?o'�t�•D !•'ho
0
F w
a
Certificate of Occupancy $
Building/Frame
J,CHusEt�'
Permit Fee $
Foundation Permit Fee $
Other Permit Fee $
TOTAL $
Check # 60,_2q_v
23874
-----__
Building Inspector
Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Swimming Pools ' ❑
Tanning/Massage/Body Art ❑
Well ❑ Tobacco Sales ❑«� Q ElFood Packagin1g/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
s
COMMENTS
Reviewed on Signature
Reviewed on Signature
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Com
Water & Sewer Connection/Signature & Date Driveway Permit
DEW ']Gown Engineer: 9ignatu're:
Located 384 Osgood Street
FIRE DEPARTi NT"- Temp Dumpster on site yes no -
Located at 124 Main Street
Fire Department signature/elate
---I COMM
Dimension
Number of Stories:_— Total square feet of floor area, based on Exterior dimensions.
Total land area, sq. ft.:
ELECTRICAL: Movement of Meter location, ion, mast or service drop requires approval of
Electrical Inspector No
pANGER Z __I RATI)RE: Yes
No
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Doc.Building Permit Revised 2010/October
M
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/Crossection/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
N OTE: 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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
-Th 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
mnust be submitted with the building application
Doc: Building Permit Revised 2008
No
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The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston, MA 02111
www.mass.gov/dia
Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Name (Business/Organization/Individual):
off[ S +- ,Do6 i;,, s LLC.
Address:_ `15- 1=011L O rl
City/State/Zip: 1+&\J E1Z FL U lea Df t 3Z Phone #: Ci '? $ - Z 6S- 7J,5r
Are you an employer? Check the appropriate box:
1. ['I am a employer with z
4. E] 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.t
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.] t
c. 152, § 1(4), and we have no
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. R Demolition
9. E] Building addition
10.0 Electrical repairs or additions
11. ❑ Plumbing repairs or additions
12.0 Roof repairs
13. ❑ Other
-Any appncant tnat cnecKs oox N t 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 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 am an employer that is providing workers' compensation insurance for my employees. Below is the policy and job site
information.
Insurance Company Name: FRED C_ C j. U C
Policy # or Self -ins. Lic. #: 0 8W 6A1 L :5_ 7'1 c)- Expiration Date: -7-1-1
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 $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby cert under the pains and penalties of perjury that the information provided above is true and correct.
Signature: k,_). A e ri Date: 02 - /r
Phone #:
use only. Do not
City or Town:
area, to
or town official
Permit/License #
Issuing Authority (circle one):
1. Board of Health 2. Building Department 3. City/Town Clerk
6. Other
Contact Person:
4. Electrical Inspector 5. Plumbing Inspector
Phone #:
ACORD.
CERTIFICATE OF LIABILITY INSURANCE Qiioaiaoiao 19^0
PRODUCER
Fred C. Church, int:.
41 Wellman Street
Lowa{I, MAO{85l
(800) Zts•t865 TH15 C6RTIPlCATE 151S9UBD A9 A PflAif9R OF {NPOf1�lATfON
ONLY AND CONF6AS NO RIGHTS OPON THE CEtl1IpCATE
pL��R TH�HCOVEpAGe AFFGRGBD �YifiE POLICIES 8@LBW
80Q ZZ5•l 1185
INGUREti9 AND NRIC A
INSUAEC
CCMBI�I6OSINCLEUMIT
(Eaaeod1,1 51,000,000
lN9UAERAI CltiaenBTnlure�IaCampaRyaFAmetica
New$nglandWindow &Door LLC
45 Fond! Road
Haverhill, MA. 01832.1302
INsuREREI Wausau UAdatwdteta(nsuranceCnmpeny
INSURERCI
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SHOULD ANYOF THEASOVICESCRIBEO POLICIES BE CANCELLE08EFCRETHEEKPIRATICN
DATE TBERECP, TNS E5Sp191EINSURER WILL ENOEAVOR TO MAIL 30 DAYS WRITTEN
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SHOULD ANYOF THEASOVICESCRIBEO POLICIES BE CANCELLE08EFCRETHEEKPIRATICN
DATE TBERECP, TNS E5Sp191EINSURER WILL ENOEAVOR TO MAIL 30 DAYS WRITTEN
NOTICE TO THE CERTIFICATE HOLDER NAME0 TO THE LEFT, BUT FAILURE TO CC So SHALL
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A
PELLA WINDOWS AND DOORS CONTRACT
1, TERMS AND CQNIIi.TION5
171ese Terms and Conditions are an integral pati of the contract set forth on the
Product Order (the "Contract") between New Lngland Window and boor LLC
dba Pella Windows S, Doors, .Inc. ("Pella") and the person(s) identified on the
Product Order ("Chvner") 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 Adderndusn" 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 type; of items. Pella is not
responsible for pre-existing window coverings fitting on newly installed Pella
windows.
"e 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} leer Pella's installers to
deliver the Products and perform the Work..
3. PL"LLA
Pella will be responsible for and have control over construction means,
methods., techniques, se querioes and procedures and for coordinating all
portions of the Work.. Pella will be responsible for the Work of its Pella
Conttaetors who will install the Products.
Unless provided otherwise in tate Work d-cription, Pella will provide and pay
for all labor, materials, equipment, loofa and machinery, transportation, and
other facilities and services necessary for the proper execution and completion
of the Work..
The materials and equiputent furnished under the Contract will be gcx)d 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 of defects caused by abuse, modifications not executed by Pella,
improper or insufficient tnai.ntenance, improper opestttion or nonnal 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.
4. CFI.A.NGFS
111c Owner may order in writing changes in the Work consisting of additions,
deletions, or modifications ("Change Omer"). 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 bath Owner and
Pella to be effective.
SUBSTANTIAL COMPLETION
Owner understands and agrees iliat the Substantial Completion Date, is an
estimate only and that the actual date on which tine Work is compietezl .may be
extended to allow for Change Orders requested by Owner or if"the tinie to
ccnnplete the. Work is affected by conduct of the Owner, weather, tabor
disputers, availability of subcouuzictor.s, acts of God, .fie or other causes
rcasonabfv beyond Pella's control. If tin' arty reason the Workis not fully
completed by the Substantial C:omplction .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, tie 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 of the completion costs ur 10 %, of the renMining unpaid
balance of the Price, whichever is less.
6. FINANCING
if payment of the Puce is financ•ccl with a. fin tnc ial institutiou through Pel.ia, all
frnan cng paperwork must be completed upon signing of this Contract and the
requisite approvals and autlwrizations far the.fut.l arnounE of'flie requested
financing shall have been received from, the financial institution.
PAYMENTS
Pella shall be entitled to stop the Work upon written notice to Owner fin 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.
sdue.
CORRECTION OF WORK
Pella shall comTWI installation Work not in conformance with the. requirements
of the Contract, if notified in writing by the Owner within two years after the
Completion IJate or, if earlier, the date on which the Work is substantially
completed and paynien.t ofthe Purchase Price made subject to a. holdback as
provided above. Correction of Work as heiein provided shall be: Owner's scale.
reinedy for defective workinanship, 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 x Doors Limited Warranty. THIS LIMITED WARRANTY SHALL
BET HE SOLE WARRAN"TY.' WITH RESPECT TO THF PRODuCTS.AND
PELLA SPECIFICALLY DISCLAIMSALL OTHER WARRANTIES.
EXPRESS OR Il14PLIEib. WRITTEN OR ORAL (INCLUDING WITHOUT
LIMITATION ANY WARRAN'.TY OF .MERCHANTABILIT-Y OR FITNESS
FOR A PARTICULAR. PURPOSE:).
10. NO CONSEQUENTIAL DAMAGES
VNIDER NO C'IRCIRvIST.ANCFS SHALL: PELLA BE LIABLE FOR
CONSEQUENTIAL INCiDENTAL, INDIRECT, OR SP) Cl\L. DAMAGES,
WHETHER FORESEEN OR IINFORE'SEEN.
11.
HOME MIEPROVFMENT CONTRACTORS
All home improvement contractors and subcontractors shall be registered with
the director of the .Florae linprovetnent Contractor Regisuation 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, Horne Improvement Contractor Registration,
One Ashburton Place, Boston, MA 02108,61.7-727-8599
12. PERMITS (MA customer, only)
Pella is obligated to and will obtain the following permitlor this project:
homeowners who secure their own permits will be
excitrdect m 45te guaranty fund provisions of Massachusetts General I. zws,
chapter 142A.
hi addition to (lie rights and warranties enume ated in this agreement, you may
have additional rights under Massachusetts General Laws, chapter 142A and
780 Code of MassachusetLL Regulations R.ti,
13. NOTICE OF CANCELLA` 1ON
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 ogee or branch thereof, provided you notify
the seller in writing at his main office or branch by ordinary
hail 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.
C
Customer signature t
Date
DISPUTES
JobName
Date I - t -to --I I
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 T14E SECRETARY
OF THE EXECUTIVE OFFICE OF CONSUMER AFFAIRS AND BUSINESS
REGULATION'S AND THE CONSUMER 4ER SHALL BE REQUIRED TO SUBMIT TO
SUCH ARBITRA.'fION AS PROVIDED IN M.G.L.c. 142A
Contractor
Homeowner
NOTICE: THE SIGNATURE, OF THE PARTIES ABOVE APPLY ONLY TO THE
AGREEMENTOF THE PARTIES TO ALTERNATIVE, DISP )U
TE SETTLEMENT
INITIATED BY THE CONTRACTOR. THE OWNER MAY INITIATE
ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE "ITIS SECTION IS NOT
SEPAR-ATELY SIGNED BY THE PARTIES.
NOTICE OF CANCELLATION
Customer Name: ,�t
(Please print)
Date of transaction: >io '... 1)_._._
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 th.egoods 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 senda telegram to
Pella Windows and Doors, at 4.5 l ondi Rd., Haverhill, MA 01832
not later than midnight of _�_ (three business days from. the date of
transaction above).
I hereby cancel this transaction.
(Date) (Buyer's signature)