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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 w co C o d C y 0 O o ` A� Wcn o w v cn U o w o w x U G w U a o w w W a W o w v cn G w O o w' c w" E 4. . w W cp z cn Q o cn w co C o d C y 0 O o ` A� O o V V �y Vd CLC cc ® C �o Nim" O u'� y L �' c 3 Q FWCL m 3� Q o m �N C V CD cm • m c C.-* W m C=2 �. N . m cm m� C C � m N R N ECD m o y m m CD p cya ' jo,Cr o� m�Z c� o a Q. o 2 g 30 1— o vs o .o. ~ CD W C ._.. 'fl �. •N uiCL •C C CLC3 'm CO2 CL. p m C m' ��_ = A .Q i N a m g 1 G6 C— . bD MM� M-iT1' U O O NNIU co cm i CD 0 M O O �E m m i O co t O� a� as � � O a a CMa c C) � CcCc v J .fl co C co Ci co C ca uj uj U) W W W. W N y 0 uj uj U) W W W. W N 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 INSURERDI ADN8162169 i/I12Q10 INSURER6: ECOILYI(VJ RY (Paraasi ee� $ Pt{CPERTYDAMAGE S (Paraealda�11 CLAIMSMACE I OCCUR A Lr-- GEUL ArIGRESATE LIMIT APPPERI . Z9N8161407 1 71112010 l 71112011 COCUR U CLAIMS MAOE A DEDUCTISLE X RETENTION S 6MPt0YER5 L ag1Nl•Se TICNANO 8 MAERE ANYPAOPAIETCRIPARTNOW02KEOUTIVET OPFIC CLUED I LOCATIONS I VEHICLES I w England Window & Door LLC Fondi Road verhill, MA 01930 URN8167305 I 71112010 1 71111011 =Z112599S7010 1 7/112010 1 11111011 25 (2009108) Client N scan Mst N 10.11 GL, UMB, WC, Cert 9 Auto 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 IMPOSE NC OBLIGATION OR 08141rY OF ANY KIND UPON THE INSURER, ITS AGENTS OR REPAESENTATIUES. �U4HCRUEDREPRESENtATwe d, AOTOMOBILOLIA8I6171( R ANYAUTO CCMBI�I6OSINCLEUMIT (Eaaeod1,1 51,000,000 BCCILYINJUAV (PArpliam) S A X X ALL OWNED AUTOS SOHEDULEDAUTOS HIREDAUTOS NON•OWNEC AUTOS ADN8162169 i/I12Q10 111!26(! 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G x 2 :3 CL m -C m 2 tn' co E CD 10-0 o S- 0 (D ca MIC 0 mm O -r- 3: U) wC11 In - mc: cn " = rd - co V.1 E cu M. in cc ow 0 00 as cm N N CL m E E -,r,-> .2 Q? 30 U -C=� cp (n C (D r- > 0 .2 m m M m 0 RCD 4) x xm 00 V) — -= — W X 75 75 7t- W ��= -0 a) a m W.S w 0 0 cu vi cy) cmay ;. t1b 0 a> ID im 0: X 0 co v E z Q N 0 z f�- N �C C z CU RA ra 't a m co co C� rn c> rn v N N �I,-- Lo m N 'Y m � � � LLlgmmoj CL oLO 0 /.f N A , (D X = C to 0 l i%:'r c" 11i t0 u) O z Q M^ ci I RA Z9 CD Ln A 3 v U c A (C1 d m N 'Y m � � � LLlgmmoj CL Z9 CD Ln A 3 v U c 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)