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HomeMy WebLinkAboutBuilding Permit #352-15 - 35 PENNI LANE 10/10/2014 BUILDING PERMITOF NORTHo q 4t-t167 NO TOWN OF NORTH ANDOVER 0r °- °� ,APPLICATION FOR PLAN EXAMINATION * ,� H Permit No#• �- Date Received �44 R`"" `_P gSSACHUs�� Date Issued: � D M ORTANT: Applicant must complete all items on this page ' e / LOCATION Pnnt PROPERTY OWNER li�E?l/nG �t rhe _ Print 100 Year Structure yes no. MAP PARCEL: ZONING DISTRICT - - Historic District yes no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New BuildingJne family ❑Addition ✓❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic El Well ❑ Floodplain El Wetlands El Watershed District Water/S-ewer _- DESCRIPTION OF WORK TO BE PERFORMED: �X(v 6WAJ� Jdl�mf Id en i tion- lease Type or Print Clearly OWNER: Name: % k74'-'7?7 Phone: 7F o"V, ,2-16� Address: Contractor Namea 'fJ�-/ � Phone: a tw - Jolr-'�•`r - - - - Address: _ AoU11'CJ'", M-,� .0/7102/ Supervisor's ConstructionLicense. ,/,a� 7 :Exp. Date: ��6 _,- ' Home Improvement:License: . _1, p - _ Exp. Date: S/,� 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: $ D 7 FEE: $ Check No.: /�s Receipt No.: �J 1 NOTE: Persons contracting with unregistered contractors do not have access to the guarantvfund Signature of Agent/Owner-] Signature of contractor ; 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o 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 L3 Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Li Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products ' De 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 o Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o 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 Doe:Building Permit Revised 2014 1 - - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE'OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming 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 PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature 1 COMMENTS HEALTH Reviewed on Siqnature COMMENTS s Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Sgnature& Date Driveway Permit r DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT Temp'Dumpster onsite yes no Located at 124 Main Street Fire-Department-signature/date 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 Yes No DANGER ZONE LITERATURE: Yes No t MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine j NOTES and DATA — (For department use) II I f ❑ Notified for pickup Call Email i Date Contact Name Time Doc.Building Permit Revised 2014 Location No. Date(D V/� I o - TOWN OF NORTH ANDOVER . Min), i Certificate of Occupancy $ Building/Frame Permit Fee $J ` M1 I Foundation Permit Fee $ Other Permit FeeXV TOTAL $ Check#� .] 26 127 �"''Building Inspector NORTji E Town of _ Andover No. �-t _ - �oh -h ver, Mass, 0114 C 0C.41 Mt WI[K �1' % SRATEO )I,?19L y U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ..............`...v h. ............ ..`.. .Mtr�............................. .. has permission to erect ........ ...!�, _.................. buildings on . �............. nn,.,.........le.#-o-osam Foundation Rough to be occupied as ........... .�..0.11......0 rin ... 0.1.I.�.IMI�... ............ Chimney provided that the person accepting this permi halevery respect conform to the term f 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCT04 ST S` Rough 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. OP ID:ML ACORO DATE CERTIFICATE OF LIABILITY INSURANCE (M9120 4 08119!2014 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 CONTACT NAME: East Douglas Insurance Agency PHONE FAX PO Box 1370 (AIC,No,Ext): Sac,No): Douglas,MA 01516 ADDRESS: Marc Larocque PRODUCER UNITE51 CUSTOMER ID 0: INSURER(S)AFFORDING COVERAGE NAIC a INSURED United Painting Company,Inc INSURER A:Western World Insurance Co. dba United Home Experts INSURER B:Commerce Insurance Company 34754 200 Butterfield Drive,Suite I INSURER C:Scottsdale Insurance Company 24740 Ashland,MA 01721 INSURER D:AEIC 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 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 ADDLSUBR' POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/YYYY MMIDD/YYYY GENERAL LIABILITY EACH OCCURRENCE S 11000,00 A X COMMERCIAL GENERAL LIABILITY NPP8114634 04/15/2014 04/15/2015 DAMAGERENTEb PREMISESS( RENTED- Ea occurrence) $ 100,00 CLAIMS-MADE X OCCUR MED EXP(Any one person) S 5100 - --- PERSONAL 8 ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER PRODUCTS-COMP/OP AGG $ 2,000,00 . POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 B ANY AUTO BDGTCIN 04/15/2014 04/15/2015.{Ea accident) BODILY INJURY(Per person) S ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ , X HIRED AUTOS (PER ACCIDENT) X NON-OWNED AUTOS $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 4,000,00 X EXCESS LIAR CLAIMS-MADE AGGREGATE $ 4,000,00 C - XLS0087858 04116/2014 04/1612015 — -- —' —"- DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- _ AND EMPLOYERS'LIABILITY .-......_TORY LIMITS. X-ER D ANY PROPRIETOR/PARTNER/EXECUTIVE Ya WCC5010274012014 08/15/2014 08/15/2015 E.L.EACH ACCIDENT $ 500,00 OFFICER/MEMBER EXCLUDED NIA - - --- - (Mandatory in NH) E.L._ DISEASE-EA EMPLOYEE $ 500,00 I If yes desaibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S 500,00 E Street opening 71554333 06/11/2014 06/1112015 BOND 1,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION UNITP02 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN United Home Experts ACCORDANCE WITH THE POLICY PROVISIONS. United Painting Company, Inc - AUTHORIZED REPRESENTATIVE ' Marc Larocque ©1988-108 CORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD f The Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations I Congress'Street,Suite 100 Boston,'MA 02114-2017 www mass.gov/dia Workers':Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Printte ibl Name(Busidess/Organization/Indivtdual) : / 4?41 >/r , ! �'. Address: �0� J (: � , .. VYV City/State/Zi 7(�)-/`Phone.#.: W1.0 0 S Ar Y196an employer?Cheek the appropriate box* ` Type of project(regtiired).a 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. ,Q New construction s 7 listed, the attached sheet ` 7 emodelm r 2.❑ I am a sole pr'opriefor or partner-`` g '�`= ship and have no employees These,sub=contractors have' Demolition em lo. ees,and have workers' - workmg forme in'any capacity.. . . .. comp. insurances [No workers comp. insurance p• re(iaired. 5. We are a corporation and its 10.0 Electrical repairs or additions qui � -.!' ,. .fie d :i 3.❑ I am a hofmeo:wner doing all work officers have`exercised their 11 0,Plumbing repairs or additions "�` n t'of exem tion per MGL myself [No workers, comp. p p 12[]Roof repairs insurance require dj t ; c 1.52,§1(4),`and we have no employees:°[No workers' 13:0 Other` comp."insurance required.]' ' "My applicant that checks box#1,must also fi11 out the section below'showing their workers compensation policy information. t Homeowner's who'submit this a idavit indicating'they are doing'all work and then hire outside coirtractors must submit a new affidavit indicating"such: ?Contractors that check'this box must attached`an additional sheet showing thename of the sub=contiadois and state whether or not those'entities have' employees. If-the sub-contractors have employees;,,theymust provide,their_workers'comp.policy;number. I:am an,employer.tltat is.providing: orkers'compensadon insurance for my;eniplvy d. -Below ts4he'poftcy and joh.stt9 information. Insurance Company Name: Policy#or Self iiis Lic..#: l/1/ ( � �oZ�� � �y Expiration Date: Job Site Address: zz 5 Bhp A �h^C.' c J I'" L City'/State/Zip: Attach a copy of the workers' compensation policy'id -atioipage(showing the_policy,number and expiration date). Failure to secure coverage as required under Section 25A'bf MGL"' k2 an lead to the imposition of criminal.penalties of a }; . fine up to$1,500.00 and/or one year impnsonmeid,;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 forwarded to the'0ffice of Investigations of the DIA for'insurance coverage verification. I do hereby certify under the and penalties of perjury`that the injormdtion provided above is triie'dnd correct " Si attire: " Date: 6 Phone#: C�—Loy a. Official use only. Do not write in this area,­to he eompleted"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#: 1 L 1 4 I w f� w 7 FY Aft. y anwealm Al y t of Puk►lic Safe N MdSSachusleuk- °�'°'� .ice of Consumer AffaiPs&Business Regulatio. r Board of Buiidin r t�'''s and Standards M E IMPROVFNIENT CONTRACTOR Construction, uporvisor = ', Ty LlCen : �S-1 Registrati tk 0 e , �J r ? <' Expi j) sup' bffcl lE K u UNITED HOME26 TRI SMAT w. — ' l Astand MA 017,21 HAEL,Dy M1' 11iaGUDLEY BUTTERFIELD.D `i=� Expiration a /ASHLAND;MA 01721 Uuderseeret�a�t, N f res ;e ,�" �QP11111199it11eP Q51�1i�118 !r 1 '-i: , w t {U { r • `'•nI�r - + `�ii:�`.is.-�3!,IlY42il•`�{�.�r -�U r..+'4�,i�.�.,. �1r4 Wilted United Home Experts & Ms Home Experts United Painting Co., Inc. �r od iH45 200 Butterfield Dr. Suite I AIg;G Ashland MA 01721 � MA HIC License#157108 Full Worker's Compensation Coverage 508-881-8555 FAX 508-881-5584 MA Constr. Supervisors License $4,000,000+Liability Insurance Coverage RI REG#22948 Industry leading Warranties www•UnitedHOmeE%pertS.COm RRp License#NAT-28008-1 Flexible Payment Plans available Family Owned and Operated Project: Everlast Bid Date: 9/17/2014 Attn: Norma& Tony Lochmann Phone#: 978 682-2164 Company: Work#: Address: 35 Penni Lane Fax#: Email: City, St. Zip: North Andover, MA 01845 F_ Base proposal as per attached scope of work: Remove and replace existing siding on home with Everlast composite siding $24,845 Prices good for 14 days PAYMENT: A non-refundable deposit of 1/3 of ALL ACCEPTED PROJECTS is due upon authorization in the amount of $8,282 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 thirty days of invoice are subject to service charges of 1 V2%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 by customer AFTER three business days. 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. SIC Contractor signature Date signature Date BBB 6�15+C�1fER . ,' i Addendum toProposal and Scope of work Contract Price: $24,845 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: 10/07/14 Work to be substantially completed: 10/28/14. Add any days where inclimate weather made the work not possible. 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. i 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 142A. Owner: Contractor: (/� � -��✓ Gy 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 9 i NOTICE OF CANCELLATION 09/17/14............................. (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......9/20/14.................................... (Date) I hereby cancel this transaction...............................................(Date) .......................................................... Buyer's signature We have received a copy of this notice. i ....... ... .......................................... ............................... y_ s) signature Date ............................................................ .................................. Buyer (s) signature Date