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HomeMy WebLinkAboutBuilding Permit #530-13 - 461 SUMMER STREET 1/23/2013TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 2 Permit NO: Date Received Date Issued: .3 1113 IMPORTANT: Applicant must complete all items on this page CATIP-NI, P, 0� no --- 'fn 0 pr htT *1 � 'AP PARCEL y 0 1 $IT R 1, QT�, EL ON H, 00,riq, -i§ SU n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building 1] One family El Addition El Two or more family El Industrial El Alteration No. of units: 11 Commercial XRepair, replacement 11 Assessory Bldg El Others: El Demolition El Other O'Sbpticr El"W6 0"Pood' —PpinY, E ind 0 WatersheODistrict,�. o! Water/.Bowen DESCRIPTION OF WORK TO BE PERFORMED: Iden c71og,&a nt Clearly) L 7e Ty P Ty 9 771 OWNER: Name: �D�L ZY, ejnu Phone: 117, Arldrin-qc- 91 Jr C� N ITT F�; A, Q TT Q R" N� ft. A01 -re -S -ery n, e __ . is up _t License::_ LHbmetlmprovementLicense ARCH ITECT/ENGINEE 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: $ FEE: $ Check No.: Receipt No.: 2& //0 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty and ctor, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans El 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 COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS DATE REJECTED DATE APPROVED Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes _ Planning Board Decision: Comments Conservation Deci Comm r, Water & Sewer Connection/Signature & Date Driveway Permit DPW TowL Engineer: Signature: LOcatea M4 Usgooa Street FIRE DEPARTIVIFNT Temp Dumpster on site yes no 1Jre,"bePaftm&nt,sig 9-€s. nature/date f C011%IIVIENTS�``���"�'`�� '«t �,t����°-�°"".,� . � � .f;+;�,: rr..z '.�:,x� i�.�`�'cr'�{�`•»:���� � ` 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 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 appal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm`;tted with the building application Doc: Doc.Building Permit Revised 2012 Locatioxo on No. 6',5-6 / 3 Date 11.22 IJ 3 Check 26110 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ - TOTAL $ &-e� Building Inspector < 0 O 'a G � --I O _ =_ < CD N --I O o• n � m = o '�C-C 3 z o =r O v� 2; -• T ,� O O .*a m -h CDCD N W cD a N O 2 <D -1 O. O N CD 7• O 0 (O• N Q O O• 0 �►W (D N O CD •a '.a -r CL coCD 0 C O O c Z N N � CD N 0 � 7 < =• Om � N C. CD' y O U) (D CD 3 �C 1 Oko A �. 41 so .a �0 d � rt CD =r :� 1 CD :3 :• CD 1 �D N n rt O � - O (D CD •a @ •G O. f7 a) o � v CL Ln M v T :O T V1 w T C T n ;T7 T (n T O (D N O � -ri m M m -i ^ `0 Z C CD 0 2 z m m n r ZZ H n 0O > a O S M c C W n n O j of �o O aq S I D c� O 0- T = O v O T m 2 � 0 o v� a :3 ~• Cr CD Z. 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CD' y O U) (D CD 3 �C 1 Oko A �. 41 so .a �0 d � rt CD =r :� 1 CD :3 :• CD 1 �D N n rt O � - O (D CD •a @ •G O. f7 a) o � v CL Ln M co T :O T V1 w T ;o T n ;T7 T (n T O (D N M Z C j (D -ri m M m -i O' a O H N m O N 2 O S m m n r ZZ H n 0O > a O S M c C W n n O j of S 7 O aq S O 3 d O 3 C p Z N a N n 3 O 0- T = O v O T m 2 fD �y a I Qr O o H �,qm w tin Home ed Der& Full Worker's Compensation Coverage $4,000,000+ Liability Insurance Coverage Industry leading Warranties Flexible Payment Plans available Family Owned and Operated United Home Experts & United Painting Co., Inc. 200 Butterfield Dr. Suite I Ashland, MA 01721 508-881-8555 FAX 508-881-5584 www.UnitedHomeExperts.com Home Imurovement Contract MA HIC License # 157108 MA Constr. Supervisors License R1 REG # 22948 RRP License # NAT -28008-1 Project: Roofing Bid Date: 1/7/2013 Attn: Jennifer & Rusty Bildeau Phone #: 978-729-5173 Company: Work #: Address: 461 Summer Street Fax #: Email: City, St. Zip: N. Andover, MA 01845 Base proposal as per attached scope of work: Strip and replace existing roofing on home with new certainteed roofing $5,875 Prices good for 14 days rA x ivimN i: A non-rerunaabie deposit of 1%5 of ALL ACCEPTED PROJECTS is due upon authorization in the amount of $1,958 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 'h % 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. r'ri p 5 V/S4 i- 4wed-► t 3 -,ter- i Contractor signature Date Customer egnature at BBB ascovE� .; Addendum to Proposal and Scope of work Contract Price: $5875 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 I D # 04-3541521 MA HIC License 130101 Work scheduled to be started: 1/23/13 Work to be substantially completed: 1/30/13. 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. VW 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: (4-411te L&4�� 10, 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. NOTICE OF CANCELLATION...1/7/13............................. (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 0 172 1. Not later than midnight of ......1/10/13 .................................... (Date) I hereby cancel this transaction ...............................................(Date) Buyer's signature We have received a copy of this notice. ..................... �: / :....................... Buyer (s) signature Buyer (s) signature ............ { J. ........ Date ................................... Date IYIp JJgI/11UJCllJ - VCtJg11111Gi11 — I UV— Jp—Y Board of Building Regulations and Standards C"onsrruction, Super%icor License: CS -100077 MICHAEL KDi3DLEY- 137 CENTRA. STIUNIT,3 ASHLAND MA 01721` eall 4 �t' Expiration Commissioner 05/06/2014 -\ Office of Consumer Affairs & Business Regulation OME IMPROVEMENT CONTRACTOR Registration 415.71,08 Type: Expiration15/203Supplement t UNITED HOME EXPERTS- MICHAEL XPERTS MICHAEL DUDCE� D.Q 200 BUTTERFIEL� �3�T�E I g _ ! ASHLAND, MA 017211r7i Ate'''' Undersecretary +wrcud CERTIFICATE OF LIABILITY INSURANCE LDATE(MMIDD!YYY 08/13/12 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. TH 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. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED, subject the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to H certificate holder in lieu of such endorsement(s). PRODUCER 508-476-2101 CONTACT East Douglas Insurance Agency NAME: - PO Box 1370 508-476-1296 PHONEFAX Douglas, MA 01516 lac, No, Ext): (AJC.No): g EMAIL Marc Larocque ADDRESS: PRODUCER CUSTOMER ID ?1: UNITE51 - - INSURED United Painting INSURE - RS) AFFORDING COVERAGE NAIL n Company, Inc ---- - INSURER A: Western World Insurance CO. dba United Home Experts INSURER B : Commerce Insurance Company 34754 200 Butterfield Drive, Suite I - -- Ashland, MA 01721 INSURER C: Scottsdale Insurance Company INSURER D: American Employers Insurance INSURER E: CNA Surety Company rusuoco r . - 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 INDICATED THE POLICY NOTWITHSTANDING ANY REQUIREMENT TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT CERTIFICATE PERIO WITH RESPECT TO MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT EXCLUSIONS WHICH THI TO ALL AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID THE TERM: CLAIMS INSR------- - ADDL $UA'W — - EFF LTR TYPE OF INSURANCE POLICY NUMBER IC GENERAL MoLICY VYYY MM YYYY LIMITS LIABILITY , EACH OCCURRENCE £ A X COMMERCIAL GENERAL LIABILITY NPP8023401 04/15/12 04/15/13 6AMAGrT-6 RENTED - - - 1,000. "- - :n. -et £ CLAIMS -MADE X OCCUR -PREMISES'Ea000ure - - ------ - 100 MED EXPfAnr o -e person/ g 5. PERSONAL 3 ADV INJURY 1,000, GENERAL AGGREGATE GEN'L AGGREGATE LIMIT APPLIES PER 2,000, i PRODUCTS - COMPIOP AGG PROJEC 2,000, L—POLICY LOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO I BDGTQN 04/15112 04/1Ea acodent'. - -- 1,000,5/13 ALLOWNEDAUTOS BODILY INJURY,Per,ersoni £ X SCHEDULED AUTOS BODILY INJURY Per acadern: £ X HIRED AUTOS PROPERTY DAMAGE _ i Per acc oenl � X NON -OWNED AUTOS - C D UMBRELLA LIAB X OCCUR ACH EXCESS LIAB CLAIM$ -MADE E ---- OCCURRENCE XLS0073744 04/15/12 04/15/13 _AGGREGATE DEDUCTIBLE WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PP.OPRIETORIDAPTNER/EY.ECIJTIVE Y I N OFFICER/MEMBER EXCLUDED' NIA (Mandatory in NH) liyes, describe unaer WCC5010274012012 08/15/12 08/15/13 uc oi.rvr i iVly Ut UPtHA I IONS belOx A PERS PROPERTY NPP8023401 04/15/12 04/15/13 E SIDEWALK BOND 71285190 06/06/12 06/06/13 I DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES (Attach ACORD 101. Additional Remarks Schedule, it more space is required) United Painting Company, Inc United Home Experts 200 Butterfield Drive Suite I Ashland, MA 01721 ACORD 25 (2009/09) zZZZ001 s 4,000,1 4,000,1 £ WC STATU-OTH- TO.R0M ,Y-ITSL. X - ER EL EACH ACCIDENT S E L DISEASE EA EMPLOYEE c E L DISEASE - POLICY LIMIT £ PERS PROP BOND 500,1 500,1 500,1 93. 51 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% 7— Marc Larocque ©1 The ACORD name and logo are registered m of CORPORATION. All rights reserved. � The Commonwealth of Massachusetts Pnra`t Farm ' .. Department of'Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 Boston, MA 02114-2017 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Name (Business/Organization/Individual): Address: City/State/Zip: L:11(� y1�ii Are you an employer? Check the appr 1. I am a employer with __ ,, ``� employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all, work myself. [No workers' comp. insurance required.] t Please Print L At l�-- 0178 % Phone #: 500 f / by I— date box: 4. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.+ 5. ❑ 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.] Type of project (required): 6. ❑ New construction 7,-�JRemodeling 8. ❑ Demolition 9. ❑ Building addition 10.0 Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other *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. A C__ �7 Insurance Company Name: %'%% ' %7 ('G, Policy # or Self -ins. Lic. C -C-5-01 QZ -?7 I) z ,�C/-,v Expiration Date: Job Site Address: dVi"nr. - ,, , City/State/Zip:/y, 424, 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 of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby cer& under the pains and enalties oLEerjury that the information provided above is true and correct. 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): I. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #: