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HomeMy WebLinkAboutBuilding Permit #519-2017 - 23 LYMAN ROAD 11/16/2016Permit No#:_jr44J - aq617 BUILDING PERMIT �/ "QRT� TOWN OF NORTH ANDOVERo APPLICATION FOR PLAN EXAMINATION'-- *0 Date Received'ED SSACHU Date Issued: I I - 1 (0 - &W I k*;O - DRORTANT: Applicant must complete all items on this page — ; - 0. lo i rin 4 RTY M)PRE --"n*_ N-1, Wry �gpgbgr tF[lb ha PA�RCE Z®NING DISTRICT: H no n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building One family t 0 Addition ITwo or more family u r I 0 Industrial 0 Alteration No. of units: 0 Co rci,, 0 Commercial k2 - rRepair, replacement 0 Assessory Bldg Others: s. [I Others: VO'Demolition 0 Other Se F q 6 blain Wetlands. V .8 18 Hat -- a er S .- DESCRIPTIOrl OF 7 & Identification - Please Type or Print Clearly' OWNER: Name: "3,tf L"44A-pv ARCHITECTIEN G I NEER Phone: Address: Reg. No.. FEE SCHEDULE: BULDING PERMIT: MOO PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. rotaI Project Cost: $ 5-60-0- FEE: $ Check No.: Receipt No. - NOTE: Persons contracting witlz unregistered contractors do not have: access to the guaranty fund Signature of contractor`,`)d M Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application a 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.1. C. And C. S. L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/EIevation 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 DOTE: 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 r Doc: Building Permit Revised 2014 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 'TYPE bF 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 a U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH 4� L.: COMMENTS Reviewed On Signature, 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/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT = Temp Dumpster on site yes Located at 124. Main Street Fire Department signature/date COMMENT Locaiea Jd4 usgood Street no -Nmension 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 rnin.$100-$1 ODD fine Doc.Building Permit Revised 2014 Location LV r j► tit V _ r No. 1�} "0 (7 Date Check # TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $_ f VBuilding Inspector CD Q O S' CC CD O F CO O y 0 0 CD 0• CD NCD� U) O 0 0 cD O n s < O= O 2 O � p = o .. � � N O > R .n O � rL 3 M Z o• y O' 5 O � ,oma. N o o : a 0 m dwagm N WCD I -IL 'a N cOD 2 woo C 0 >1 n N Q. = rr O O .-► n W '+ (:D" fD C CCD U3 y' r« (D O y - "' D r� 00 rr 0' o CD =r :S =oma �• ,, _ 0 y C < a Q. 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CL a m a N m O O O Z 00 ca 0 C a °a R z J :l w O] d w o J O c C CD j < /R C7 co f� M Ip C Or f':y: a— &i w o ( O c CD C7 co Ip C Or f':y: a— &i o' N � � N •.. aarnw _tti"v -a ,�19 w Co. cD a PELLA WINDOWS AND DOORS CONTRACT These Terms and Conditions are an ktegtal part ofthe contract set tbnh on the Product Order (the "Contrast') between Now Bngiend Window and boor LLC dbaPolla Windows & Doors, Inc. ("Pella'? audthe person(s) identified on the Product Order ("Owner") tosupply *aproducts (tha`Troducis l and perform the work (the "Work') described or mf>med to In such Contract. Por Product Only purchases, asigned'Troduct Only Addendum" Is a required part ofthe contract. 2. OWNER Pella fs not tesponaible *r guy existing security systems. Owner 86911 remove all slmde4 verticals, blinds, curtains, drapes or window mounted air conditioner; prior to the installation of the Products. Pella's installers aro not responsible forthe removal or installation of these types of items. Pella is not rtspmmeibleforprovdatingwindow coverings fitting on newly installed Pella windows. The Owner shall provide complete access to the work site between the hours of 7:00 am. and 6,00 pm. (Monde y tbrougit Friday) for PeUe's installers to deliver the Products and perform the Work. 3. PELLA Pella will beraponsible for sad have control over construction nwaas, methods, techniques, soqueaces and procedures and fbr coordinating all Portions ofthe Work, ?A will be responsible for the Work of its Pella Contractors who will ionall the Products. Unless provided otherwise in the Work description, Pella will provide and pay lbr all labor, materials, aqulpment, tools andmachfncry, transportation, and other fhellities and services necessary for the proper execution and completion afthe Work Tho matetf cls and equfpmeat famished under the Contract will be good quality and new unless otherwise required orpermifted, the Work will be A= fkom defects not inherent in the quality required or permitted, and the Wort coafbrm with the requkemerrts ofthls Contract. Pella shall not be. responsible for damages or defects caused by abuse, modifications not executed by Pella, Improper or insufficient maintenan ce, Improper operation ornormsI wear and bear. Palle will keep the ptemfses and surrounding sma Hee fkom accumulation of waste materials or rubbish caused by performance ofthe Work. 4. CIIANGES The Ownermay order in writing obaog%in the Work consisting of additions, deletions, ormodilloadons (' Change Order"). Any Change Order shall include an adjustment to the pries sad the WAaotial Completion Dale, as ' determined by Pella Pella reserves the right to approve or awrave uw Change Order and any such Change Order must be aigced by both Ownerand Pellato bo of hotive. SMTAN1TIAi. COMPLETION Owner understands and agrees that the Subehmtial Completion Date is an estimate only and that the actual date on which She Work is completed may be extended to allow far Change Orders requested by Owner or ifthe time to complete the Work Is affected by conduct ofthe Owner, weather, labor disputer, availability of subcontractors, data of God, fire or other causes reasonably beyond Pella's control. Rfor any reason the Work is not fUliy completed by the Substantial Completion Date (ineludingany eateodons contemplated above), but Is substantially completed by such date, Le, the Product has been installed, but minor parts or components am missing orneed to be replaced or repaired, a hold back proportionate to the cost of remaining parts or work to bo completed is acceptable. However, the holdback will not exceed the amount ofthe completion costs or 10 % of the remaining unpaid balance of the PAM whichever is less. 6. NWANCING If payment ofthe Price Is financed with a financial institution through Pelle, all financing paperwork must be completed upon signing of this Contract and the requisite approvals and authorizations for the fUH amount of the requested financing shall have been m;cIved from the financial irWtudon. 7. PAYMENTS Pella shall he entitled to stop the Work upon written motive to Owner for any material delimit 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. CORRECTION OF WORK Pella shall correct installation Wodr not In coriftmenee with the requirements ofthe Contract, If no dfled in writing by the Owner within two years after the Completion Date or, if earlier, the date on which the Work Is substanthgy anmpleted and payment ofthe Purchase Price made subject to a holdback as provided above. Correction of Work as kerma provided shall be Owner's sole remedy for defective worlonansWp, and is provided is lieu ofany end all other remedles. Fell* obJlgation to correct Work Is conditioned on Pella's prior recelpt of all paiymeois then dere. 9. LIAMI)PRODUCf WARRANTY Pella shell wantart all Polls product% but only in accordance with the Pella Windows & Doors Limited Warranty. IM LWIMD WARRANTS' SHALL BE UM SOLE WARRANTY VMH RESPECT TO THE PRODUCTS AND PELLA SPECIFICALLY DISCLAIMS ALL OTTER WARRANTY'S, EXPRESS OR YNPLIED, WRITTi3N OR ORAL (INCLUDING WITHOUT LIMITATION ANY WARRANTY OF MERCHATTlABY.1TY OR FITNESS FORAPARTTCULAR PURPOSE). 1Q NO COMEQUENTIAL DAMAGES UNDER NO CIRCUMSTANCES SHALL FELLA BE LIABLE FOR CONSEQUENTIAL, INCIDENTAL, INDIRECT, OR SPECIAL DAMAGES, WI•IBTM FORESEEN OR UNFORESEEN. IL HOME At1PROVEIItM CONTRACTORS All home Improvement contractors and suboonttactors sball be fegfstemd with rho director ofthe Home Improvement Contractor RoOstration Program administeredbytheBoard of2tuldhrgRegulatiowand Standards. Poltaand any of its subcontraclors identified br this agreement have been registered. Amy inquires about Pella or any of its subcontractors roiatingto reeshation should be dlreeted to: Dlreotor, Home improve hent ContractorRegistmation, 10 ParkPluk Room 3170, Boston, MA 02116,617-973-8787, SHB -283-3757 or visit the MC website at httpdJwww.maw gov/oeabd 17. PERMITS (MA customer@ only) P la; if rod to end will obtain ft hollowing permits for this project �UlilTl . Homeowners whosecmtheir own penabwill be excluded firom the guaeaniy fund provisions of Massachusatta General Laws, ohs bu 142A. In addition to the rights and warranties enumerated in this agrcoamart, you may have additional rigblsunderMassachusetts General Laws, chapter 142A and 780 code oYMassachuoft RegulationsR6. 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 K there are a blank spaces. X� Customastgaatum 10/17/16 Date DISPUTES 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 CONSUMER SHALL BE REQUIRED TO SUBMIT TO SUCH ARBITRATION AS P OVIDED IN M.G.L.c. I42A —z -t Contractor X Homeowner NOTICE: THE t . O A ABOVE APPLY ONLY TO THE AGREE 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: 10/17/16 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 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 Doorg, at 45 1~ondi Rd.. Haverhill. MA 01832 not later than midnight of transaction above). 1 0I GV f 1 6(three business days from the date of I hereby cancel this transaction. (Date) (Buyer's signature) UVThe Gora=nwealth. of Idassachuse& .Iiepaittrnent of IndushiafAcciderty 1 Congress Street, Suite 100 Boston,MA02114 2017 a ww.m assgov1d1a WOrkers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers, TO BE FILED Wim THE rERMITI'ING ADTHORIly Name (Business/Orgaaizaiion/Individuai): Address City/stafezzip --JfAy e , Are you as employer? Check the appropriate box: Phone #:-- S4° 69_ V94 am a employer with �� employees (full. and/orpart time).* 2.❑ I am a sole proprietor or partomship and have no employees wodang for me in any capacity. [No workers' comp. insurance required.] 1E] I am a homeowner doing all workmyself [No workers' comp, insurance required•] t 4._0 lam a homeowner and will behiiingcontactorsto condu allwork on my Prgpmly _I .wi71.._ ensure that all cantractor� either have wodrers' compensation insurance or are sole - Proprietors -with no employees. _ 5.❑ I am a gena contractor and I have hired the sub -contractors listed on the attached sheet These sub -contractors have employees and have worker' comp,. i surance t b. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c, 152, § 1(4), and we have no employees. [No wodmrs' comp. insurance required.] Type of project (required): 7. ❑ New cons ruction S. CRReruodeling 9. ❑ Demolition 10 Building addition ILE] Electrical repairs or additions .12: Q Plumbing repairs or additions 13.E] Roof repairs 14.0 Other *Airy applicant that checks box #1 mast also fill out the section below showing their workers' eompensatinn policy inf conation t Homeowners who submit this affidavit indicating they are doing all work and thea hire outside contractors must submit anew affidavit indicating such. tContaxtors that check tins boxmust attached an additional sheet showing the mune of the sub -contractors and state whether or not those entities have employees. If the sub -con mdors have employees, they must provide their wod=s' comp. policy member. I am an employer that isproA ing workers' compensation insurance for my employees. Belaw is thgolicy and job site information. Insurance Company Name: 6k blaOVA in r� Policy # or Self -rias, Lic. #: Expiration Date: Job Site Address: City/5faielTap: , Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c.152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 -do hereby certify under the pains and penalties of perjury that the information ProWded above is true and correrL Offccial 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/Towu Clerk 4, Electrical Inspector 5. Plumbing Inspector 6. Other A o CERTIFICATE OF LIABILITY INSURANCE 07/072016MMIDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER Fred C. Church, Inc. 41 Wellman Street Lowell, MA 01851 (800) 225-1885 CONTACT Dorothy A. Corlett, CIC, RPLU NAME: PHONE 078 3227231 FAX (978) 454-1885 AIC o Ext), AIC No E-MAIL doodett@fredcchurch.com ADDRESS: INSURERS AFFORDING COVERAGE NAIC # INSURERA: Citizens Insurance Company of America 31534 INSURED New England Window & Door LLC INSURER B: New Hampshire Employers Insurance Company 13083 INSURER C: 45 Fondi Road Haverhill, MA 01832-1302 INSURER 0: INSURER E: INSURER F : COVERAGES CERTIFICATE NUMBER: DU4" REVISION NUMBER: THIS IS TO CERTIFY THAT 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. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER EFF MMIDDPOLICYIYYYY EXP MMIDD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED100,000 PREMISES Ea occurrence)$ CLAIMS -MADE M OCCUR MED EXP (Any one person) $ 10,000 A X CG0001 ZBN8161407 7/12016 7/1/2017 PERSONAL& ADV INJURY $ 1.000,000 GENERAL AGGREGATE $ 2.000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY X X PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY $ AUTOS AUTOS (Per accident) NON -OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS er accident UMBRELLA LAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LAB CLAIMS -MADE $ DED RETENTION $ WORKERS COMPENSATION X I V1iC STATU- OTH- AND EMPLOYERS' LIABILITY YIN 500,000 B ANY PROPRIETOR/PARTNER/EXECUTIVE NIA 8007024 7/12016 7/72017 E.L. EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? 500,000 (Mandatory in NH) E.L. DISEASE - EA EMPLOYEd$ Ifyes, describe under DESCRIPTION OF OPERATIONS below 500,000 E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover 1600 Osgood Street, Suite 2043 Nrth Andover, MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICYRROVISIONS. AUTHORIZED REPRESENTATIVE j) Client# "°. Mst# btt4/5 CertHolder# /yDDD ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 26 (2010/05) The ACORD name and logo are registered marks of ACORD ��.-oz E �� XZ : 3 gym' =Aziz j G) - Dy...oz xy m o n cn m m n oo N ,A C rip ca rw A ee,< y a m k c 7 ti CL A A + 7 ;tr' 0 S A i N O ft 'f r y'OQPQ i Vi0 i 0 CD yCL o o e a A < v, ''64 M1 fD n y C C (IQ O eo O •• O a o <m � r 0 0� SSD (D Q. u) N rrM OS Vr it K m �� 0 CD S w+ D n n �y O oGpp O r" � 51�7 R 3 y (D W' N W � o (D 0 < Gin 0 w (D 61 Q S 3 M (n O to -« OX .t r N 23 tt n 0 Q v O K g