HomeMy WebLinkAboutBuilding Permit #54 - 22 MIFFLIN DRIVE 7/23/2008Permit NO: Sq
Date Issued:
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received 7-2-3-®P'
IMPORTANT: Applicant must complete all items on this page
LOCATION- A4# -A -Liu bR
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PROPERTY OWNER M' CW FJ16 A4Vo 5 (
Print
MAP NO: , / PARCEL: 2.3 ZONING DISTRICT- Historic District yes
Machine Shop Villageyes
TYPE OF IMPROVEMENT
PROPOSED USE
�i
q
1�
TYPE OF IMPROVEMENT
PROPOSED USE
Res'
Non- Residential
New Building•c
One family
Addition
more family
Industrial
A
No. of units:
Commercial
Repair, replacement
Assessory Bldg
Others:
Demolition
Other
Septic Well
Floodplain Wetlands
Watershed District
Water/Sewer
DESCRIPTION OF WORK TO BE PREFORMED:
s
Identification Please Type or Print Clearly)
OWNER: Name: Mle!>`�t )02o
Address: ?-X 6
CONTRACTOR Name:��/,4)*V0 �uS z.Nuc (s Phone:
Address:.__lZra.a..�
Supervisor's Construction License: O eIT -Y-4 Exp. Date: /0
no Improvement License*./.If 77 If _ Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: 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: $ 71 FEE: $�
Check No.: "I iq y Receipt No.: 0 � liq Y
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
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
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
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
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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07
Revised 2.2008
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 Reviewed on Siqnature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
G
Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Siqnature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osaood Street
FIRE DEPARTMENT - Temp Dumpster on site yes no
Located at 124 Main Street
Fire Departmentsignature/date
COMME
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
NOTES and DATA — For department use
❑ Notified for pickup - Date
Doc.Building Permit Revised 2008
1►C7
Location -2 2- b N -WW
No. 51 Date z3 -ow—
2-, 348 Building Inspector
TOWN OF NORTH ANDOVER
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Certificate Occupancy
$
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Building/Frame Permit Fee
$
Foundation Permit Fee
$ '
Other Permit Fee
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TOTAL
$ `
Check #
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' The Commonwealth of Massachusetts
Department of Industrial Accidents
Office. of Investigations ,
` 600 Washington -Street .
Boston, MA 02111
www ntassgov/dia
Workers' Compensation Insurance Affidavit: Builders/Cois
ntlractors/Electricians/Plu
plicant Information mbers
Name (Business/o pwzatiowindividual): e t. tq Z w S q-14 Doors nC
Address: qS
City/5tate/Zip:yeck; D1� 'Z rl�libi i :�„ •
`Z 2
7 SS
Are you an employer? Check the appropriate box:
1. � I sin's employer with 2.S '
4. I am a
❑ general contractor and I
Type Of project (required):
employees full and%r partrtime).*
(
2. ❑ I am a sole proprietor
have hired 6.
6.
•6 Q New construction
7•
or partner•
ship and.have no employees .
listed on theaaaclied•sheet, t
These sub -contractors have
❑ Remodeling
8:.0 Demolition
working for me in any capacity.
o workers' comp. insurance.
workerscomp. insurance. '
5. Q We are a corporation and its.
g; . Q Building addition
g
required.)
3. Q I am.a homeowner
officers have exercised their
10.Q Electrical repairs or.additions
doing ail -work .
myself
ys [No -workers' comp: '
insurance
right of exemption perMGL
ci 152, §1(4), and we have no
It- Plumb' '
Q mg repairs'additions
12.Q Roof repairs
required,j't'
employees. [No workers'
13.0 Other
•M
comp. insurance required.]
t Y applicant flat che1.cks box #1 mutt alio M put the Section blow showing `.: '
Homeowners who subini this -.6*t=P %U policy infomadw
_ atndavitr� catiug dici-im do' all work and Hien tike outside
ConbraUM that deck �g man sutupit i`aew affil vit indicating such.
Wil hoz must.attached an additional shat showing the name of sub-coatnctors and their workers. MV- policy infoimaOion._
Ian an-enf6yer that:is providing workers' conlpensation insuranci for my en�loyee.>» Below is the o ' and job site
.lnfor iption. p ►:
Insurance Company Name• t~ C C , C:1 V r �► '
Policy # or Self -ins. Lic.: #$ ' W C3 L 507q2. Expiration Date: 2.00
Job Site Address: Ci /Sts t
ty t�'p:�
Attach a copy ofthe workers' ,coin '
pensatton policy declaration-page-(ah,01*14 ttie policy nuntbeti and -expiration date).
Failure to secure covetage as required under Sectidn.25A of MGL c. •152 can lead:to the ini sition of criminal
Po penalties of a '
fine -up to $1,500.00 and/or one-year imprisonment, ai well as•civril 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 coply '
Investigations of the DIA for insurance coverage verification. A ibis statement tray be'focvYarded to the Office of
I do hereby certify tinder he pains aid penahks of perjury that the infomiadon provided above is true and correct
Sienature: (moi' 6L /✓,y =
Date 7-2-3.
�o
ftone#: • 26S•.ZSS
FConfort
se only, Do iwt write in this arca to be cornpletid by city or town of iiciaL
own: Permit/License #
uthority'(circie ones•
Lof Bealth..Z• guiidin� Iepartment 3. City�rawn Clerik 4 Imtrical Inspector S. Plambiag Inspector
.. �.�:.
ptis•
AO -RD, CERTIFICATE OF LIABILITY INSURANCE
07io�00811142m .
PRODUCER (800) 225-1865
Fred C. Church, Inc.
41 Wellman Street
Lowell, MA 01851
THIS CERTIFICATE 1S 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.
POLICY NUMBER
800-225-1865
POLICY EXPIRATION
LIMITS
INSURERS AFFORDING COVERAGE - NAIC # .
INSURED
New England Window & Door LLC
45 Fondi Road
INSURER A Citizens Insurance Company Of America ,
INSURERS: H8n0Ver Instfanr1e Company
INSURER C: Massachusetts Bay Insurance
Haverhill, MA 01832-1302
INSURER D: Twin City Fire Insurance Co. 129459
PREMISES IF occurencel $ 500,000
INSURER E:
PERSONAL a AoV INJURY $ 1,000,000
.-~Cnwr_ee
THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING
ANY REQUIREMENT, TERMOR 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
TYPE OF INSURANCEGENERAL
POLICY NUMBER
POLICY EFFECTIVE
POLICY EXPIRATION
LIMITS
A
LIABILITY
X COMMERCIAL GENERAL LIABILITY
CWMS MADE a OCCUR
ZBN8161407
7/1/2008
7/12009
EACH OCCURRENCE $1,000,000
PREMISES IF occurencel $ 500,000
MED EXP one $ 10,E
PERSONAL a AoV INJURY $ 1,000,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY PRO- LOC
PRODUCTS - COMP/OP AGG $ 2,000,000
C
AUTOMOBILE
X
X
X
LIABILITY
ANY AUTO
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
ADN8162169
7/1/2008
7/1/2009
COMBINED SINGLE LIMIT
(Ea accident) $1,000,000
BODILY INJURY
(Per Peen) $
BODILY INJURY $
(Per accident)
PROPER DAMA E•,
TY G
(PeraeddenQ '
GARAGE LIABILITY
ANYAUTO
AUTO ONLY - EA ACCIDENT $
OTHER THAN EAACC $
AUTO ONLY:. AGG $
B
EXCESS/UMBRELLA LIABILITY
X OCCUR F CLAIMS MADE
DEDUCTIBLE
X RETENTION S
UHN8167305
7/12008
7/12009
EACH OCCURRENCE $ 9,000,000
AGGREGATE $ 9,000,000
$.
$
$
D
WORKERSCOMPENSATION AND
EMPLOYERS' LIABILITY
ANY PROPRIETOR/PARTNERIEXECUTIVE
OFFFFIICERIMEMBER EXCLUDED?
If M describe under SPECIAL PROVISIONS bebw
08WBNL5742
7/12008
7/l/2009
. :..._
ATU- OTH-
X WC STIM
E.L. EACH ACCIDENT $ 500,000
E.L DISEASE - EA EMPLOY14 $ 500,000
E.L DISEASE -POLICY LIMIT $ 500,000
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (.EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Proof of Insurance
GtK I RIGA 1 t I'IULUtK GANtitLLA I IUN
New England Window & Door LLC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
5 Fondi Road DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
averhill, MA 01830 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
REPRESENTATIVES.
AUTHORIZED REPRESENTATIVE y
iG0KU 25 (ZUU9/UB) Client # 2960 Mst # U8-09 GL, UMB, WC, Cert # w m umLp %.vmrvr.A mjn leo
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DISPUTES
Job Namel.'a
Date JA
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 ONSUMER SHALL BE REQUIRED TO SUBMIT TO
SUCH ARBITRATIOIy OVIDED IN M.G.L.c. 142A
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
Customer Name: L J I� 1 7 ✓-Vk
(Please print)
Date of transaction:
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 day& 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 ofD (three business days from :the bate of
transaction above). 41
I hereby cancel this transaction.
7/3 L4Z
(Date) (Buyer's signature)
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 of the 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.
4. 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.
5. SUBSTANTIAL COMPL19TION
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 of the 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 of the completion costs or 10 % of the remaining unpaid
balance of the Price, whichever is less.
6. FINANCING
If payment of the 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 of the requested
financing shall have been received from the financial institution.
7. 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.
8. 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.
9. 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)
Pella is obligated 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