HomeMy WebLinkAboutBuilding Permit #522 - 250 WINTER STREET 4/6/2009BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit NO:� Date Received f W/ —417
Date Issued:
* �-n=
9 1.
TYPE OF IMPROVEMENT
PROPOSED USE
Resi.d -
Non- Residential
New Building
' One family`
Phone:
Addition
wo or ore amity
Industrial -
Alteration
No. of units:
Commercial
V"Repair, replacement
Assessory Bldg
Others:
Demolition
Other
"Septic Well r., l 'e,
Ploodplair :' Weflands
- 11r'aters to l istnCt w
:1later/Sewer;
� � �
DESCRIPTION OF WORK TO BE PREFORMED:
ARCHITECT/ENGINEER Phone:
Address:
Reg. N
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED /ON $125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.: al
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
oe
i nature of A ent/Owner--==Si nature;of°contr
L_
A1,9
Identification Please Type or Print Clearly)
OWNER: Name: V`C12 M/Ei-£
Phone:
Address: ;K49
CQNTRACTOR Narrie:
�6
Phone. W 5-3 -..
.Address: `�f,�`� ��.
� � �
.�
Supervisor's: Construction :License.',,
Exp. ateR,. Ad 2c
Home lm provementlicense.
1775? o Exp.. ;Dafie,
ARCHITECT/ENGINEER Phone:
Address:
Reg. N
FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED /ON $125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.: al
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
oe
i nature of A ent/Owner--==Si nature;of°contr
L_
Plans Submitted Plans Waived Certified Plot Plan
Stamped Plans
TYPE OF SEWERAGE DISPOSAL
t_ocateo J64 usg000 Street
Public Sewer
Tanning/Massage/Body Art
Swimming Pools
Nno
t
Well
Tobacco Sales
Food Packaging/Sales
Private (septic tank, etc.
Permanent Dumpster on Site
�' z
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
DATE REJECTED
PLANNING & DEVELOPMENT
COMMENTS
DATE APPROVED
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
}Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
t_ocateo J64 usg000 Street
FIRE DEPARTME"+1T - Temp Darnpst�r owsit�
Vires
Nno
Located 124 IVlatn.Streef A` =
4
at
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,
Fire'D�p�rrtnents���a#ur%la#e'�'x- �
ry
M
=
=-
-COMMENTS
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 I 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 2008
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: Building Permit Application
Revised 2.2008
TOWN OF NORTH ANDOVER
Check #� 7 �o
2 91 /.
Building Inspector
Certificate of Occupancy
$
s�cNusE`�
Building/Frame Permit Fee
$ Z l .7
Foundation Permit Fee
$
Other Permit Fee
$
TOTAL
$
Check #� 7 �o
2 91 /.
Building Inspector
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PELLA WINDOWS AND DOORS CONTRACT
1. TERMS AND CONDITIONS
These Ternts 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 pail 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.
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
delennined 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.
SUBSTANTIAL COMPLFTION
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 %n of the remaining unpaid
balance of the Price, whichever is less.
FINANCING
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.
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.
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 DANIAGES,
WHETHER FORESEEN OR UNFORESEEN.
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)
Pe%�� is obligateto and will obtain the following permits for this project:
_ 3,s . 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. V
See the attached Notice of Cancellation for an explanation of
this right.
Do not sign this contract if there are any blank spaces.
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. Customer signature
Date
NOTICE OF CANCELLATION
Customer Name: lt�e
(Please print)
Date of transaction: ?�)Z�t I�{
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 Doors, at 45 Fondi Rd., Haverhill, MA 01832
not later than midnight of 3 2,2 1 09_(three business days from the date of
transaction above).
I hereby cancel this transaction.
(Date)
(Buyer's signature)
DISPUTES
Job Name I' i 1 e � e,
Date
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 ARBIT ION AS PROVIDED IN M.G.L.c. 142A
Contractor
Homeowner
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.
AN
The Commonwealth of Massachusetts
Department of Industrial Accidents
NJ Office oflnvestigations
600 Wilshington Street
lqq5w www.massgov/dia
Workers' Compensation Insurance AMdavit: Buffders/Contractoirs/Eflectricnans/Plu m heirs
imnftamt IImfolmation Z ease print ]Le IR,
NaMe (Business/Organization/Individual): �� Q �� WJo AA -0 W.3 V td o d -s Ac
Address: q s® r-PA4
City/State/Zip:kverkli MA 01?3- °'MA&M-, ' 9 72 4-63--71 SS
Are you an employer? Check the appropriate box.
1. I am a employer with -4 S'
4. [:11 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. t
ship and have no employees
These sub -contractors have
working for me in any capacity.
workers' comp. insurance.
[No workers' comp, insurance
5. ❑ We are a corporation and its
required.]
officers have exercised their
3. 111 am a homeowner doing all work
right of exemption per MGL
myself. [No workers' comp.
c. 152, §1(4), and we have no
insurance required.] t
employees. [No workers'
comp. insurance required.]
Type of project (required):
6. ❑ New construction
7. ❑ Remodeling
8. ❑ Demolition
9. ❑ Building addition
10. ❑ Electrical repairs or additions
11.❑ Plumbing repairs or additions
12.❑ Roof repairs
13.❑ Other
*Any applicant that checks box #1 must also fill out the section below showing thetWor`•lE it compensation policy information.
f 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 their workers' comp. policy information.
I art an employer that ds providing workers' compensation insurance for my employees. Below is the policy and job site
informatdon.
Insurance Company Name: fid -e4 C. (r.k
Policy # or Self -ins. Lie. MOR W G /V L- 5 W 2. Expiration Date: _7 & c
if
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 a£flus'•statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do hereby certify under the pains and penalties of perjury that the infordiation provided above h trace and correct
Sip -nature: Date: �D l
Phone e%'79'_ 2PS-7155 —
Offdclal nese only. leo not write in this area, to be coarleted by city or town ofiicdaL
City or Town:
Usulag Authority (circle one):
II'ermit Ucense #
L Board of Health 2. Building (Department 3. City/Town Clerk 4. ]Electrical Inspector 5. Plumbing Inspector
6. other ,.;•�.
Contact Person: ; Phone M.
i4CORDCERTIFICATE OF LIABILITY INSURANCE
07/02/2200811:42Y� ,
PRODUCER (800) 225-1865
zedi c
41 Wellman Street
Lowell,MA01851
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION
ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
ROIDER.IS tERTIFI
ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
POLICYNUMBER
800-225-1865
INSURERS AFFORDING COVERAGE NAIC #
INSURED
New England Wmdow & Door LLC
45 Fondi Road
Haverhill, MA 01832-1302
INSURER A Citizens Insurance Company of America ,
Hanover Insurance Com an
INSURERS: P Y
INSURER C: Massachusetts Bay Insurance
INSURER D: Twin City Fire Insurance Co. 129459
INSURER E:
EACH OCCURRENCE $1,000,000
rnvicear_ce
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. AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR
D'L
OF INSURANCEDATE
POLICYNUMBER
POLICYEFFECTIVE
POLICY EXPIRATION
(MMIDDAM
LIMITS
GENERAL LIABILITY
X COMMERCIAL GENERAL LIABILITY
EACH OCCURRENCE $1,000,000
UAMAGE -TO
PREM SES EaENTED occurence $ 500,000
MED EXP Any one person)$ 10,000
CLAIMS MADE a OCCUR
PERSONAL&ADV INJURY $ 1,000,000
A
N
ZBN8161407
7/1/2008
7/1/2009
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,000
POLICY PRO LOC
AUTOMOBILE
X
LIABILITY
ANY AUTO
COMBINED SINGLE LIMIT
(Ea accident) $ 1,000,000
BODILY INJURY
(Per person) $
C
X
X
ALL OWNED AUTOS
SCHEDULED AUTOS
HIRED AUTOS
NON -OWNED AUTOS
ADN8162169
7/1/2008
7/1/2009
BODILY INJURY $
(Per accident)
PROPERTYDAMAGE. $
(Per accident)
GARAGE LIABILITY
AUTO ONLY - EA ACCIDENT $
OTHER THAN EAACC $
ANY AUTO
AUTO ONLY: AGG $
EXCESSIUMBRELLALIABILITY
EACH OCCURRENCE $ 9,000,000
AGGREGATE $ 9,000,000
X OCCUR D CLAIMS MADE
$
B
UHN8167305
7/1/2008
7/1/2009
$
DEDUCTIBLE
$
X RETENTION $
WORKERS COMPENSATION AND
X I TORY LIMITS WCSTATU-OTH-
P
E.L. EACH ACCIDENT $ 500,000
D
EMPLOYERS' LIABILITY
ANY ECUTIVE
OF ICERIMEM ER EXCLUDE
0$WBNL5742
7/1/2008
7/1/2009
E.L. DISEASE - EA EMPLOYEE $ 500,000
E.L. DISEASE - POLICY LIMIT $ 500,000
If es, descdbe under
SPECIAL PROVISIONS below
OTHER
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS
Proof of Insurance
w England Window & Door LLC
Fondi Road
verhill, MA 01830
1w -
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION
DATE THEREOF, THE ISSUING INSURER WILL ENDEAVOR TO MAIL 30 DAYS WRITTEN
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
AUTHORIZED REPRESENTATIVE Q
ACORD 25 (2001/08) Client # 2960 Mst # 08-09 GL, LIMB, WC, Cert # w A%.uKu L vmrumA I nm Iwoo
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