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HomeMy WebLinkAboutBuilding Permit #774 - 477 BEAR HILL ROAD 6/26/2008BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received =4'®4 Date Issued: .2.6 -ke IMPORTANT: Applicant must complete all items on this page LOCATION 6/77 J •41 ' ,j r�,6/ ,C) Print PROPERTY OWNER FffA �Lz&e/Nd Print MAP NO: PARCEL:_ ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne famil Addition r more family Industrial Alteration No. of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: AVz/k1C-ff6-)y-r ANO Identification Please Type or Print Clearly) OWNER: Name: �'i4WK Phone: ri"7e -447-W:S 60 CONTRACTOR Name: C.... Address: VC fgwo r gV f�l-ve'lg --V M/r 643- - Supervisor's Construction License: 0 *'y k -S`3 Exp. Date: f '•z6 - Home Improvement License: /,� 977 y Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BOLDING MIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 1. �� FEE: $ !2-- Check No.: �p Receipt No.: a�z7 j NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of.Agent/Owner ,,, 4—/t Signature of contractor Location No. i`aL/ Date MORTM TOWN OF NORTH ANDOVER Certificate of Occupancy $ ;�b •'t�' Building/Frame /Frame Permit Fee $ �— sS cNusa 9 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # f V + we 2,279 �d G.Bwlding Inspector 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: a C .Planning Board Decision: Conservation Decision: Comments Comments Zoning Decision/receipt submitted yes Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT Temp Dumpster on site Located at 124 Main Street Fire Department signature/date COMMENTS Located 384 Osgood Street yes no Dimension Number of Stories: Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. 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 Doc.Building Permit Revised 2008 r 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: INSPECTIONAL SERVICES DEPARTMENT:BPFORM07 Revised 2.2008 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organizition/Individual): Address: q S, U. -ow s avxd moors kc. . City/State/Zip: 4Ayer 11 MA 01931 /PMA6*;­, ­, ' 9 7?-4_6S•72.SS Are you an employer? Check the appropriate box: 1A I am a employer with 2'S .4. ❑ I 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 the7attached 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. ❑ I am a homeowner doing all. work right of exemption per MGL .myself. [No workers' comp: ci 152, §1(4), and we have no insurance required.]'t employees. [No workers' comp. insurance required.] An 1'cant that U-1— b a' Type of project (required): 6. El New construction 7. [1 Remodel ing 8. E] Demolition 9. E] Building* addition . 10. El Electrical repairs or additions 11. El Plumbing repairs or additions 12.0 Roof repairs 13.❑ Other J app r c ec ox must also fill out the section below showing thei v.orkers 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. tContridors that check this box must attached an additional sheet showing the name of the sub -contractors and their workers' comp. policy information. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy, and job site information. Insurance Company Name: C. C�urc�1 Policy # or Self -ins. Lica #:_� Expiration 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 ©£"iltis 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 information provided above is true and correct Sitmature Date 6 26 —0 Phone#: 0g- 265.7Z.S'S O, f ficial use only. Do not write in this area, to be completed by city or town offkiaL City or Town: Permit/License # Issuing Authority (circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5... Plumbing Inspector 6. Other Contact Person: Phone #• ACORD. CERTIFICATE -OF LIABILITY INSURANCE "Y" MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH 07/11200709 PRODUCER (800) 225-1865 Fred C. Church 41 Wellman Street Lowell, MA 01851 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. 800-225-1865 POLICY EFFECTIVE INSURERS AFFORDING COVERAGE. NAIC # INSURE)INSURER Pella Windows & Doors, Inc. 45 Fondi Road A Hanover 1nsl =Co Company CO. INSURER B: T Win Ci ce tY Fire Insuran INSURER C: Haverhill, MA 01832-1302 INSURER D: GENERAL LY181LITY INSURER E . . ww��rw � www THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSl1ED 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 NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, BUT FAILURE TO DO SO SHALL POUC1f NUMBER POLICY EFFECTIVE POLICY EXPaiATKIN LIMITS AUTFKIPMEpREPRESENTATIVE:. .:.. ........::::::: GENERAL LY181LITY EACH OCCURRENCE s 1,000,000 X COMMERCIAL GENERAL LIABILM 500,000 -PREMISES=mence$ CLAIMS MADE E .00CUR MED EXP Wq one $ 10,000 A ZBN8161407 7/1/2007 7/1/2008 PERSONAL aADVINJURY $1,000,000 GENERAL AGGREGATE $2,000.000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ 2,000,000 POLICYF�ffm PRO- . X LOC AUTOMOBILE LIABILITY ANY AUTO COM13IINNEDD SINGLE LIMIT $ 1000 000 (Fe eodden0 , X ALL OWNED AUTOS A SCHEDULED AUTOS BODILY INJURY $ (perPate) X ADN8162169 7/1/2007 7/1/2008 HIRED AUTOS - ; X NON -OWNED AUTOS BODILY INJURY (Per soddwt) _ PROPERTYDAMAGE _ (Per sodderd) GARAGE LIABILITY AUTO ONLY - EA ACCIDENT $ OTHER THAN EA ACC $ ANY AUTO AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY ' TJICFI OCCURRENCE $ 9,000,000 AGGREGATE $ 9,000,000 X OCCUR % F CLAIMS MADE A UHNS167305 7/1/2007 7/U200H : $ DEDUCTIBLE X RETENTION $ = WORIMRS COMPENSATION AND WC STATU- OTH EMPLOYERS' LIABILITY E.L. EACH ACCIDENT $500,000.00 B ANYPROPRIETOwPARTNEwEXECUTrvE O8WBNL5742 7/1/2007 7/1/2008 E.L. DISEASE - EA EMPLOYE $ 500,000.00 PMEOFFK desoMMBER EXCLUOEM N deaalbe caber E.L. DISEASE - POUCY LIMB _ :500,000.00 SPECIAL PROVISIONS bebw s OTHER DESCRIPTION OF OPERATIONS I LOCATIONS / VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT I SPECIAL PROVISIONS Pella Windows & Doors, Inc: SHOULD MY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION S Fondi Road DATE?HEREOF. THE ISSUING INSURER WILL ENDEAVOR TO MAIL 10 DAYS WRITTEN Haverhill, MA 01830 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 REPRESENTATIVES. ePnon •le ienn� rne� AUTFKIPMEpREPRESENTATIVE:. .:.. ........::::::: client # ZYW Mst # U7-08 GL. Auto, WC dt Cert # ® ACORD CORPORATION 1988 Umb & f : \ / \ < m p r X / § § : \ ;0 Z § . ? o � ; : G mm2 , m 0.�» 2 'COO /\/a :zx2.)� «�� � ..6 »±■ E .. 3 § k :a \c 02 �. CLo § I . / .� . V� Q O \r_ Ow A4 M 00 M .r Q V� N N Zit M 00 rn ON a� ° z q H w� PC zzAadCc, p tm1� QI .7 ow L N .2 Od :s��Zav°q" i. O L L O 7 . 00 AO�Ozv�aadtiaaa0.� �7aaavv� •.�+- O a a PC 1 o tz 00 16. 00 H 00 J NcA •°20C'io x ego 04 A o Omx 800 a a zw a00 w y 3 y N 00 N 00 G a O 00 w 0 0 o w �, w �w U w � zw aaaaUx aaa,w U Ow A4 z N a ° � o MD .s a, aX`" o Q o b �o0a�a �ad3 F O L a 2 LIS A 0 O O � O 3 U° , o; 4-4- P4 o oa�oiar 3 a0i�� U U Cd� cs 0 o O --} 0 cd 4r U O,.O ti N o.., N y U sU. y U U �Ui O y 1.y tC Cd try 14, p .fi U' O U O sU. 4r A rn o ami ' .. r✓ 4 +, U O to cCt N o mo c cn o ;a v,Cd Cd a >-4 O G�>,ca d) a M 4-4 p ° '''o b N U � N .� c40- O c� o a� O .O U OU ".O U.1 � t � it 0 ^� .ti .0 , F•+ OA a Q _ 'd O bA o 0 b O - c 3.340 N ou U M DISPUTES Ai . AoJ20 V47, -e4 yl— 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 ON AS PROVIDED IN M.G.L.c. 142A Contractor 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. PELLA WINDOWS AND DOORS CONTRACT 1. i 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. 4. 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. 5. 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. 6. 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. 8� t "�_ Kam 11— 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. 8. 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. 9. 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, One,Ashburton Place, Boston, MA 02108, 617-727-8598 12. PERMITS (MA customers only) Pel is oblig t d to and will obtain the following permits for this project: Homeowners who secure their own permits will be excAfded from thejuaranty 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 Miac`t if there �re a�y blank spaces. Date nJ N M ✓q' NOTICE OF CANCELLATION r Date of -transaction: s r3 ho e 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 CMZ (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) i W x �50 �a� v w Ca o � a G4 O vv a o a U ►" OO p `� ID o O C w A o m EQ • O 0A .� V y cn m v � oCE = cd w m 4~ . H W x :j rx° co w • �. o z cn 0 cn O FM4 0% LU z E fq M H y C O R cm m cm c 10 S CD z 0 W A.r O O L O V z Q. 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