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Building Permit #807-2017 - 4 HOLBROOK ROAD 3/1/2017
BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION'-- Phone: XAMINATION., Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building <One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial /Q Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ";V1/ell `' s Floodplairi ❑Wetlands Watershetl` District DUVater/Sewer.��.�:%.. - DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: 7jj ,,c Phone.qi4Z,-9iV -36C Address: L.IS V -0v �. t .. jt . v'" ,. KContracfor NamePhone: N yj �tw�+[� fip�*6 :x� din „�rX �S »�t�,� ���a.= .. =e^ = ,, rt #C :,: ,}.*..r-�.-�;`-Lrr"� x t �4 • ��,��,�. •�f` � F"4 .. � i��k .fir v 4 i.L"+ �Y ii Supervisors Construction License>t __ x Exp. Date L�l� iWA-1- �Home�lrnprove„t��e�nt License ,*,,: ARCHITECT/ENGINEER Address: Phone: Reg. No. FEE SCHEDULE. BULDING P RM/T. $12.00 PER $1000.0 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. f Total Project Cost: $ FEE: $ Check No.:' ct 3 Receipt No,. INTO E: Persons contracting with unregistered contractors do not have: accT to the guaranty fund Signature of _ ge�FIV ner Signature o con ractor ;4 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 PLANNING & DEVELOPMENT Reviewed On COMMENTS Sign CONSERVATION Reviewed on Sianature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes d "--.Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea Jb4 usgooa Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124. Main Street Fire Department signature/date COMMENT limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Dieter location, roast or service drop requires approval of Electrical Inspector Yes No ®ANGER ZONE LITERATURE: Iles No MGL Chapter 166 Section 21A —F and G min.$10041000 fine Doc.Building Permit Revised 2014 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 ❑ 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/Cross Section/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 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 Doc: Building Permit Revised 2014 ............ .. . Location No. ko' f ` .) el Check # t ,7q 1 Date d TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL i Y�� Building Inspector E9* = LLJ 2 li O D O m N C aV Y O O LL O > n Q N (n p ~ UJ Vf Z Z m C O co O O LL OD O O W cu t U co C LL O w CL N Z Z J d t hq O K — ca C LL O w CL H Z v U J W •C UA O d' v u ? N (n co C LL oC O U w H Z � t tw O K — m C LL Z W OC Q W 0 LU LL O m Z Y N ( Y v N Y O N c r - O p �• CU O L � as c� w p +: o O: E Q. y0+ C O d O:E Im O O O N H Cc J i �: •' p ' d d � t w �O O 4" L N O C N > t — p CD -0 > =�Q C _ p . _.0 t O E C O Q N Z O d O 440. cn> O C c oCL M m 0 m L Cc 0 0 V O c c p � as Q L i RS O CL _p y t� in N ® W C 'a - O O .' CD — - W c 0 O W a Cl) CD 0 m O U CD Z Z W ) CL zJ W L) coW a Z M I C.� v N S E p[ A O Z C 0 � CD 0 -- WO -0 U) m O CD 0 cla O CL a. 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O a) m O c 0-0 (n (n L o w E 0) CO _ N a c N O U O 'N 0) O a r m o f 0 0 a c o) a) Co E a) -0 m E � c o U 0 4 U > N m — Co a) ,0 C E O m m 0 0) m m> C C a) m a r' m O c O m co N co o C L E N L N m U 0-0 > ♦+ . — .r c «- mm am 0- L� Co Cr - •- Y U m O = 2 t C .. m U C O cu — �a N U o m _ U . V ++ o `�- m Uc � ccco �� a) m c C E U> m N y `O U -0 O m 0 C O O C L cu c 0 L coJ c O O (n N �z `O O O a N N a c _ 07 c n M' M m 0 a C m a� C 3 O N dj L U O +, N v"i L O a CL m CLE o c O w E c°-) 'ca E 4- 0 m _ m m L U m It U N m - -0 E m m 4) E E O U O O �.O C N N N a� c E 0) > m -o 0 0 CU c � N m O C a) m -0 N Q >. i ca C I� O N p Co O 0) 0) Co c � C " 7 OM) E N � s CL O E zCU a co O co N cn a a N D U N 0 U 0 N N N 0 a a� C 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. 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. SUBSTANTIAL COMPLETION 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. 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. 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 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, 10 Park Plaza, Room 5170, Boston, MA, 02116, 617-973-8787, 888-283-3757 or visit the HIC website at http://www.mass.P-ov/ocabar/ 12. PERMITS (MA customers only) Pella is obligated to and will obtain the following permits for this project: Building . 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 spaces. stomer signature 2/21/17 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 PROVIDED IN M.G.L.c. 142A Pella Windows & Doors 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. NOTICE OF CANCELLATION Date of transaction: 2/21/17 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 transaction above). 2/24/17 I hereby cancel this transaction. (Date) (Buyer's signature) (three business days from the date of The Conanonwealth ofhfassachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 f Boston, M4 0211¢2017 www mass gov/dia INTorkers' Compensation Insurance Affidavit: Builders/Contractors/EIectricians/Piumbers. TO BE FILED WITH THE PERMI=G AUTHORITY. Applicant Information Please Print 1 Name (Business/Organizalion/tndividnal): 0 bo Address: F'0tJ 0 L Ab City/State/fip: 14AVErL doC AM 6431 Phone#: Are you an employer? Check the appropriate box: Type of project (required): 1104 am a employer with i! employees (fiill. and/or part-time).* 7. ❑ New construction 2. ❑ I am a sole proprietor or partnership and have no employees woddng for me in 8. Wemodeling any capacity. [No wod' comp. inc-- required.] 9. El Demolition 3. ❑ cen I am a homeowner doing all work myself [No workers' camp. ,ncnranrr. regr,jred.] t 4.0 I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 0 Building addition ensure that all contractors either have wodrors' compensation insurance or am sole. 11.0 Electrical repairs or additions 5.0 I am a general contactor and I have hired the sub -contractors listed on the aftcbed sheet_ These sub-cormactors have employees and have workers' comp. insurance T 6.0 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 workers' comp. insurance required.] 12:0 Plumbing repairs or additions 13.0 Roof repairs 14.0 Other ¢Arty applicant that checks box #1 must also 511 out the section below showing their women' compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit anew affidavit indicating such. t-Contracton that check tins box must attached an additional sheet showing the name of the sub-rontacton and state whether or not those entities have employees. If the sub-�s 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: Policy # or Self -ins. Lic. #: �� � (� Expiration Date: ® � Job Site Address: CitylstatdZip: 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 e. 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. X do hereby certify under the pains and penalties of perjury that the informaion provided above is true and correct Official use only. Do not write in this area, to be completed by city.or town offtezaL City or Town: PermitlLicense # 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 #: '`'� �'® CERTIFICATE OF LIABILITY INSURANCE 07/0DATE 7/2016MM/DDIVYW). 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. NAME CT Dorothy A. Corlett, CIC, RPLU PHONE 978 3227231 1 FAX (978) 454-1885 A/C A/C No 41 Wellman Street Lowell, MA 01851 (800) 225-1865 ADDDRESS, dceneh@iredcchurch.cem INSURERS AFFORDING COVERAGE NAIC # GENERAL LIABILITY INSURERA: Citizens Insurance Company ofAmedca 31534 INSURED New England Window 8 Door LLC INSURER B: New Hampshire Employers Insurance Company 13083 INSURER C: 45 Fondi Road INSURER D: Haverhill, MA 01832-1302 INSURER E: INSURER F: DAMAGE O RENTED PREMISES Ea occurrence $ 100,000 COVERAGES CERTIFICATE NUMBER: 56475 REVISION NIIMRFP- 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 rypE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS �p --.-- GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE O RENTED PREMISES Ea occurrence $ 100,000 1XI CLAIMS -MADE OCCUR MED EXP (Any one person) $ 10,000 A X CG0001 ZON8151407 7/1/2016 7/12017 PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 X PRO- X POLICY LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT e accident ANY AUTO BODILY INJURY (Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accitlent) $ NON -OWNED HIRED AUTOS PROPERTY DAMAGE $ AUTOS eracodent UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS -MADE AGGREGATE $ DED I I RETENTION $ $ WORKERS COMPENSATION X WC STATU- 0TH - AND EMPLOYERS' LIABILITY Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE 500,000 E.L. EACH ACCIDENT - B OFFICER/MEMBER EXCLUDED? N/A 8007024 7/12016 7/12017 $ (Mandatory in NH) E.L. DISEASE - EA EMPLOYEd $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below 500,000 E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS [VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CERTIFICATE HOLDER CANCELLATION Town of North Andover Osgood Street, Suite 2043 Nrth 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 POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE �p --.-- Client# Mst# 58475 CertHolder # ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD 0 � o e ° o y +r as h L w fl O w° I -M03 R R o O t +�' O c7C3 C L . CA LLw1 v C O a N :;zC.D L B N -..co C OBD Q J . � ` Q 4 o Q Opp A = a N an U) L c U ZJ EO �x ca (6 — (n W W = F- J q W M V df U) L 2 m 00 O E.> r 0 0 O N L C. ;C] M O O Z og 00 (j d W m § to d d W N •X Z O p.Q u" w w Z n it J Z Z o , WgEo�. ° w w LLJ Lo .