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HomeMy WebLinkAboutBuilding Permit #182-13 - 225 MARBLERIDGE ROAD 9/4/2012 NORT1i BUILDING PERMIT 96 OOH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received / 171— 7 A0.Ara° �SSACHUS�� Date Issued: ` 2� IMPORTANT:Applicant must complete all items on this page _- -.- Pnnt PROPERTiYf'O�WNE:RI _- - �v cPnntr 100rYearxStrgcture} yes rip) `MAPr21,0) PARCEL Z©NINGDISTRICT�_ ,HistornctDistnct yes,; no, - . - - -- - MacfiineiSfiop)�'Lillager yes? no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 9.One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 'Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - ,_ �, ..,- r —__. , tid,- ❑1Septict 'Well} ®1Floodplami ❑;Wetlands;. , 0:V1latershed,Distnct;: DESCRIPTION OF WORK TO BE PREFORMED: ��p �l �hJ�// 1'u�✓ c�r �����-mss . �/��t��ation�ease Type or Print Clearly) OWNER: Name: / Phone: l� O Address: ��� mads Gr C'®N TRACT,'ORI Name• �'�lZG/ G� Phone . q0 � � -r t y - ,� I Add cessy� Cl r Super isors60,6structiontLicense. i7� is " e_nt Lice' Horrtelmprovem /S-.7- I' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ /, 9� FEE: $ /c2-O oe90 Check No.: t c�- q Receipt No.:_�ess �- NOTE: Persons contracting with unregistered contractors do not have accto the guaranty fund nature of Agent/Owner Signature of contractor 6 ✓ 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 o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses Li Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products MOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract ❑ Mass check Energy Compliance Report o Engineering Affidavits for Engineered products @OTE: 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 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 ❑ ❑ I COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS c Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments f Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit I DPW Town Engineer: Signature: Located 384 Os ood Street FIRE DEPARTMEfVT ~Temp D`umpsfer onsite "yes t rio fi Fire�Department'signature/date . ' A t COMMENTS' F ry i 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 2010 Location No. Date I Z- p - TOWN OF NORTH ANDOVER p v�'L I,D� 4 1 Certificate of Occupancy $ Building/Frame Permit Fee $ 17-0 &0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ f^ Check# ,ZLy 25678 Building Inspector � r10 R TF•� Town of Andover Zy � o h ver, Mass, 4 2az coc«�c«ewic« �•9 AOJSATED rPp��`� S U BOARD OF HEALTH Food/Kitchen PERMI . LD Septic System THIS CERTIFIES THAT .. .. .... �,,, , ,� ,,,� BUILDING INSPECTOR has permission to erect .. g 1 . „ Foundation ........ .............. buildings .. .� .. • Rough .. ...........................•........... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of.North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 ONTH ELECTRICAL INSPECTOR UNLESS CONSTRUC T R S Rough lab % Service ............... .. .... ............................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place. on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and. Approved by the Building Inspector. Burner Street No. Smoke Det. SEE REVERSE SIDE United United Home Experts & 'Oa g'k Home Experss'° _ United ainting Co., Inc. � 20 d Dr. Suite I PROM Ashland �r G� 01721 rt14G Full Worker's Compensation Coverage 508 81-8555 508-881-5584 $4;000.000+Liability Insurance Coverage MA K1C License# 157108 Industry leading Warranties .Unit omeExperts.com MA Constr. Supervisors License Flexible Payment Plans available R1 REG#22948 Family Owned and Operated Home Imnrovement Contract RRP License#NAT-28008-1 Project: Siding Bid Date: 8/21/12 Attn: Michelle Fox Phone #: 978-828-5880 I Company: Work#: Address: 225 Marble Ridge Rd. Fax #: Email: City, St. Zip: N.Andover, MA 01845 Base proposal as per attached scope of work: Alternates: Any additional customer requested carpentry work will be billed at $52 per hour+materials. Replace ace siding on home with new cedar siding $9,964 total $9,964 Prices good for 14 days PAYMENT: A non-refundable deposit of 1/3 of ALL ACCEPTED PROJECT i P S s due upon authorization in the amount of $3,321.33 with 1/3 of EACH PROJECT due upon half of completion of EACH PROJECT, and the balance of EACH PROJECT due upon completion of EACH PROJECT along with any additional work requested by customer. DISCLOSURE: State law requires us to inform you of contract liens. Any contractor, supplier, or subcontractor may lien your real property if you or the general contractor fail to pay for goods or services delivered or installed at the work location. Some contractors and suppliers automatically send letters of notification similar to this notice. At your request. we will provide original lien release documents from anyone who provides said materials or service. Please call if you have any questions regarding liens. ACCEPTANCE: The signature on this proposal reflects acceptance of the proposal as per the attached scope of work, authorizes commencement of the work and hereby guarantees payment as outlined above. Any amounts not paid within V2 o thirty days of invoice are subject to service charges of 1 /� /°per month (18%APR). All costs of collection, including reasonable attorney fees are to be paid by the customer. You may cancel this transaction at any time prior to midnight of the third business day after the date of this contract. United reserves the right to assess a service charge equal to 25% of the contract amount if the job is cancelled b customer AFTER three business J Y ss daY s. PERMITTING: The signature on this proposal authorizes a representative of United Home Experts to sign for and obtain any permitting necessary to complete this project. i VISA Contractor signature ffate Cummer ssg'`ri ture DateBBB Esc VER Great People, Quality Service, Fair Prices, That's United! -- Addendum to Proposal and Scope of work Contract Price: $9,964 To be paid: 1/3 down, 1/3 at half completion, 1/3 upon final completion Contractor: United Painting Co. & United Home Experts Inc. 200 Butterfield Dr. Suite I, Ashland, MA 01721 Fed ID # 04-3541521 MA HIC License 130101 Work scheduled to be started: 9/3/12 Work to be substantial) completed: 9/30/12. Add any days where e inclimate weather made the work not possible. i Notice: All home improvement contractors and subcontractors shall be registered and that any inquiries about a contractor or subcontractor relating to a registration should be directed to; Registration Divison, Program Coordinator One Ashburton Place Room 1301 Boston, Ma 02108 Tel: (617) 727-3200 ext. 25239 Liens: a lien or security interest HAS NOT been placed on the residence as a consequence of the contract. Permit Notice: a. A Building permit IS required for this project b. It shall be the obligation of the contractor to obtain such permits as the owner's agent. c. Owner's who secure their own construction-related permits or deal with unregistered contractors shall be excluded from access to the Guarantee Fund. Arbitration: The contractor and the homeowner hereby mutually agree in advance that in the event that the contractor has a dispute concerning this contract, the contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and the consumer shall be required to submit to such arbitration as provided in MGL c 942A. Owner: Contractor: NOTICE: The signatures of the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The owner may initiate alternative dispute resolution even where this section is not signed separately by the parties. i i NOTICE OF CANCELLATION ...8/21/12............................. (Date) 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 instrument executed by you will be returned within 10 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 property delivered to you under this contract or sale; or you may, if you wish, comply with the instructions of the seller regarding the return shipment of the property at the seller's expense and risk. If you do make the property available to the seller, and if the seller does not pick such property up within 20 business days of the date the seller receives your notice of cancellation, you may retain or dispose of the property without any further obligation. If you fail to make the property available to the seller, or if you agree to return the property 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: United Painting Co. Inc. & United Home Experts Inc. 200 Butterfield Dr. Suite I Ashland, MA 01721. Not later than midnight of......8/24/1.2 .................................... (Date) I hereby cancel this transaction...............................................(Date) .......................................................... Buyer's signature We have received a copy of this notice. rture ............................. ....... .�j. !................ Buyer (s) si ate ........B ............................. ........ .................... Buyer (s) signature Date OP ID: I A`CORO CERTIFICATE OF LIABILITY INSURANCE 708/13/12 YY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THI; CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIE; BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZE[ REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. iIMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject t( the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to thf certificate holder in lieu of such endorsement(s). PRODUCER 508-476-2101 CONTACT East Douglas Insurance Agency NAME: PO Box 1370 508-476-1296 PHONE FAX (AIC,No,Ext):___ (AIC No): ':Douglas,MA 01516 EMAIL --- - ' Marc Larocque ADDRESS: PRODUCER UNITE51 CUSTOMER ID a: ------ -- -.----- -- - INSURERS)AFFORDING COVERAGE MAIC a INSURED United Painting Company, Inc INSURER A:Western World Insurance Co. dba United Home Experts -. - INSURER B:Commerce Insurance.Company 347.54 200 Butterfield Drive, Suite I INSURER C:Scottsdale Insurance Company — Ashland, MA 01721 - —.... ------- INSURER INSURER D:American Employers Insurance INSURER E:CNA Surety Company INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOC 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 INSF2----- ---- — .. ADDL SUER-- —._. -. LTR TYPE OF INSURANCE __ GENERAL LIABILITY WVD POLICY NUMBER MMI D YYYY MM/DD/YYYY LIMITS , EACH OCCURRENCE $ 1,000,( A X COMMERCIAL GENERAL LIABILITY NPP8023401 04/15/12 04/15/13 DAMAGt-T-RENTED -— -" —PREMISES(Eaocc,r.ence) $ 100,( CLAIMS-MADE X OCCUR MED EXP(Any o-e persons i -_ ---- PERSONAL 8 ADV INJURY S 1,000,( GENERAL AGGREGATE 2,000,( GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS•COMP!OP AGG S 2,000,( POLICY PRO- _ __ I rT LOC $ jAUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ B ANY AUTO ;Ea accident: 1,000,0 ' BDGTQN 04/15!12 04/15/13 ------- 1 ALL OWNED AUTOS BODILY INJURY;'Per oerson) $ X SCHEDULED AUTOS BODILY INJURY Per accident; S X PROPERTY DAMAGE (Peraccident.HIRED AUTOS t - ' X NON-OWNED AUTOS " UMBRELLA LIAB X OCCUR EACH OCCURRENCE 4,000,0 EXCESS LIAR CLAIMS-MADE ` C XLS0073744 04/15/12 04/15/13 AGGREGATE $ 4,000,0 DEDUCTIBLE ---- ---" _. RETENTION $ WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITY WC STATU- OTH- D TQRY LIMITS,.x_ ER ANY PROPRIETOR/�XCLUDE/EXECUTIVE Y/N WCC5010274012012 08/15/12 08/15/13 E L EACH ACCIDENT _$ 500,0 I OFFICER/MEMBER EXCLUDED? � N I A (Mandatory in NH) I;yes.describe unser E L DISEASE-EA EMPLOYEE S 500,0 I DESCRIPTION OF OPERATIONS below --- A PERS PROPERTY NPP8023401 E L DISEASE-POLICY LIMIT S 500,0 04/15/12 04/15/13 PERS PROP 93,C . E SIDEWALK BOND 71285190 06/06/12 06/06/13 BOND 5,( DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) I CERTIFICATE HOLDER CANCELLATION ZZZZ001 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN United Painting Company, Inc ACCORDANCE WITH THE POLICY PROVISIONS. United Home Experts 200 Butterfield Drive Suite I AUTHORIZED REPRESENTATIVE I Marc Laroc u Ashland, MA 01721 q e --�-% i.` r z----- - ©19 - D CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD I The Commonwealth of Massachusetts $,fir Print�form`'' :` Department of Industrial Accidents Office of Investigations IF 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le ibl a Name (Business/Organizatiort/Individual): / �j , Address: City/State/Zip: ( y� -��/� / Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors 6. ❑ New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7,--tRemodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for me in any capacity. employees and have workers' 9. Buildingaddition coin [No workers' comp. insurance P• insurance. ❑ required.] 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.] � § O, t c. 152 1 4 and we have no ❑ p employees. [No workers' 13.❑ Other 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. -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: /--) /yI P Y /, Vi-In 611 C k2 C11,6- Policy#or Self-ins. Lic. #: I/t/CGS�/OZ 77'�/��/-� Expiration Date: Job Site Address-;?Z_5__ "/G/�`�i /�,� /� Cit /State/Zi : 1 V Ove r � O/M", U'' � Y p _ 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 u to$1 500.00 and/or one-year imprisonment,p onment as well as civil penalties in the Y P � p form of a STOP WORK ORDER and a fine of u to 250.0 a $ 0 da against the violator. p y g 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 cern gnLer the pains and a !ties o.EErjua that the in ormation provided above is true and correct Si ature: rJ DateL;- �_'_/li Phone#: 0 0 0 (1 Is S� Official 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#: i I i Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor License: CS-100077 K D&LEY-- k � MICHAEL ST UNInT 3: _ 137 CENTRAx, _ ASHLAND#A Ol 72:1'+ { Expiration Commissioner 05/06/2014 J i �! O face of onsumer Afair and Business egueA on 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 157108 Type: Supplement Card UNITED HOME EXPERTS Expiration: 9/5/2013 MICHAEL DUDLEY - --- - --- - -- --- -- - ------ 200 BUTTERFIELD DR STE I ASHLAND, MA 01721 Update Address and return card.Mark reason for change. 0PS-CA1 G 50M-04/04-G1o1216 j Address ❑ Renewal i7 Employment F--] Lost Card all -. .. ✓/e "C�o7rr�it49dr[ru lCfl o%l� l(ildJliClJ-Ic1et�9 Office of Consumer Affairs&Business Regulation License or registration valid for individul use only lslbefore the expiration date. If found return to: _TOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 157108 Type: 10 Park Plaza-Suite 5170 �r:; Expiration: 975/2013 Supplement c%ard Boston,MA 02116 UNITED HOME EXPERTS MICHAEL DUDLEY 200 BUTTERFIELD,DR STEL � � ASHLAND,S LAND,MA 01721 Undersecretary Not valid without signature I � l i I r I I i i I i t r I I i I �