HomeMy WebLinkAboutBuilding Permit #951-2016 - 5 GREEN HILL AVENUE 3/7/2016t&ORTH
BUILDING PERMIT "' I N,
6
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received ArFo
C U
Date Issued:— I&PORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
0 New Building
X<One family
El Addition
El Two or more family
El Industrial
0 Alteration
No. of units:
El Commercial
�K-Repair, replacement
El Assessory Bldg
El Others:
El Demolition
er
C
ooti- 2 fig
--,. F -f
t
DESCRIPTION OF WORK TO BE PERFORMED:
;-AAM14 J-1
No
Identification - Please Type or Print Clearly
OWNER: Name: J-� " S Phone:
Address:
n't r, � No
V�
ARCH ITECT/ENG I NEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PEITT.- $1Z00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ C2 �= -- FEE: $ 36—
Check No.: � 2A,5\ Receipt No.: -3tbq1
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
4.
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. 1. C. And/Or C. S. L. Licenses
• Copy of Contract
• Floor Plan Or Proposed Interior Work
• Engineering Affidavits for Engineered products
40TE: 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 Co m -p 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)
ij Mass check Energy Compliance Report (If Applicable)
u Engineering Affidavits for Engineered products
JOTE: 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
Li Engineering Affidavits for Engineered products
IOTE: 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
Plans Submitted 11 Plans Waived 11 Certified Plot Plan [I Stamped Plans 11
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Swimming Pools 11
Well
Tobacco Sales
Food Packaging/Sales El
Private (septic tank, etc.
Permanent Dumpster on Site F1
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Signature,
Reviewed on Signature
Reviewed on
Sianature
Zc)ning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
i
PlEimning Board Decision:
Conservation Decision:
Comments
Comments
Water & Sewer Connection/signature & Date DrivewaV Permit
t-� 1�
DPW Town Engineer: Signature:
Locatea Jb4 usgoocl btreet
Dimension
Number of Stories: Total square feet of floor area, based -on Ex"'terior 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
MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine
Nu i t:b ana UA I A — (For department use
LJ Notified for pickup Call Ema
Date Time Contact Name
Doe.Building Permit Revised 2014
No
Location
No. qk)-
�2 t) ��
Check# 12 i �-j
L
7 - 3;- 7
6 1- r
�5 1-7 /
Date
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Inspector
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(D
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 C'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
contracL
2. OWNER
Pella is not responsible for any existing security systems. Owner shall remove
all shades- verticals, blinds, curtains, drapes or window mounted air
conditioncrs� prior to the installation ofthe Products. Pella's installers are not
responsible for the removal or installation of these types of items. Pellaisnot
responsible for pre-existing window coverings fitting on newly instilled 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
confonn 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.
CRANGES
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.
SU13STANTIAL 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 bysuch 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 wul 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.
it. HOME IMPROVEMENT CONTRACTORS
All home improvement contractors and subcontractors shall be registered with
the director ofthe 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! I .
ILI,, ocah;lf�
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.
.Z,e � qz�,
Customer signature 2/26/16
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
z �
fio m--eowner
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.
0Z
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BOS101 A 02114-2017
Mm.ifiass.govIdle
Workers' Compensation Insurance Affidavit: Belideirs/Contractors/Electricians/Plembers
AVAC—ant !gLo—rmation Mease Print LMLbj1
Name (BL'sifless/Organizafiofl&dividual):
Address:
I_LLY10LdLU1L1J): '
z pholle
M?
Aire You OR empRoyer? Che& the appropriate box:
1. 04 am a employer with -Z' 4- 1 am a general contractor aad I
employees (full and/or part-timO. * have hired the sub -contractors
2. U I am a sole proprietor or partner-
ship and have no employees
worhug for me in any capacity.
[No workers'comp. insurance
required.]
3. [11 am' a homeowner doing all work
myself [No workers'comp.
insurance required.] TI
fisted on the attached sheet.
These sub-contractois have
employees and have worl(ers'
COMP. insurance.+
We are a corpon, tion aud it
officers have exercised their
right of exemption per MGL
c. 152, § 10), and we. have ao
employ�es. [No workers,
Type of project (required):
6. n New construction
7. &eniodefing
8
0. [] Demolition
9. 0 Building addition
10.[] Electrical repairs or additions
11.0 Plumbingr repairs or additions
12.[] Roof repairs
13.0 Other
comp. msurance required.1 L
,Any applicant dilt checks box #1 must also fill out the. section below showing their workws'componsaLion policy Wbrination.
t Homeowners who submit this affidavit imlicating they are doing all work and then hire outside contractors Must Submit a new affidavit indicating such.
tContractors that check this box must attached an addiduaal sheet showing the name of the sub-coaltactors and state Miether or aot those entities have
employees. If the sub -contractors have employees, they must provide. their woacets' camp. policy number.
am an emPhTer that 1SPI-011iding workersCOmpefisadon illsaralicefOrittv w1ployees. Belowiithepofiqpandjoh site
informadox
Insurance Company Name:
Policy # or Self -ins. Lie. 9: 406 N 0 . ( Expirafion Date: 7—/-4?
Job Site Address: City/State/Zip:
Attach I copy a f the workers' compensation poncY &COMU00 Page (Sholving the Policy numberand expiration date).
Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition ofcrimhW penalties of a
file up to $1,500.00 and/or one-year imprisonment, as well as civil penalfies in he form of a STOP WORIC ORDER and a fine
of up to $250.00 a day'against the violator. Be advised that a copy of this statemeat may be forwarded to the. Office of
I do If greft C under diepains andp
_�Ifaldes � he in -o Pided above is trite and carreet.
f,periary that the
— - _L forinafiampi
—1
Offie'al USe On')' DO n0i XTRe iN IMS 48 -Ca, 10 be Cgffnpleted ky dV or iown officiaL
efty Or TonqM.. P00-MM400 '� q
A&RDT' CE RTIFICATE OF LIABILITY INSURANCE
--ii—
r DA (IM=DIYYM
THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE
1 0612912015
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 CONS71TUTE 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 policyj 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, Inm
Dcroihy A Codeft, CIC, RPLU
NAME:
41 Wellman Street
Lowell, MA 011851
(800) 225-1865
I
PHONE 978 3227231 (FAX.
IAfC, No Frfl: AIC Nok (978) 454-1865
E-MAIL
ADDRESR. dcagall@11radicchurckcam
— INSURER(S) AFFORDING COVERAGE NAIC #
.
INSURER A, Citizens Insurance Company ofAmedca 31534
INSURED
New England Window & Door LLC
New Hampshire Employers Insurance Company 113083
INSURERR:
INSURERC.'
45 Fondl Road
INSUREIRD:
Haverhill. MA 01632-1302
INSURER E:
INSURER F:
-W nn I iril.a I � M1 IIWK�W- -
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 OT14ER 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,
EXCLUS10145 AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
T5SR
LTR
—
TYPE OF INSURANCE
ADDL
INSR
SUBRI
WVQ
POLICY'NUMBER
POLICY -EFF
(MWDO/YYYY1
"EXP
401LDCD
LIMITS
GENERAL LIABILITY
OCCURRENCE $ 1.000,000
x COMMERCIAL GENERAL LIABILITY
FEACH
DAMAGE TO RENTED 100,000
PREMISES (Ea occurrence,
CLAIMS -MADE OCCUR
MED EXP (Any one person) $ 10,000
A
X - CGOODI
ZBN8161407
711 12015
71112016
PERSONAL& ADV INJURY $ 1,00a,000
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMPIOP AGG $ 2.000,000
POLICYF9 PRI
JECT F9 LOC
AUTOMOBILE
LIABILITY
COMIINED SINGLE UM11
CE, 'd.ntl $
—
ANY AUTO
BODILY INJURY (Par person) S
ALL OWNED SCHEDULED
BODILY INJURY (Per acciderd) $
—
AUTOS AUTOS
HIRED AUTOS NON -OWNED
AUTOS
PROPERTY DAMAGE $
—
(ParavJdentl
UMBRELLA LIAB
OCCUR
—
EACH OCCURRENCE 5
EXCESS LIAB
F]
CLAIMS -MADE
AGGREGATE $
_DED I I RETENTION$
$
WORKERS COMPENSATION
AND EMPLOYERS, LIABILITY YIN
I ER
E.L. EACH ACCIDENT S 500,000
ANY PROPRIETORIPARTNERIEXECUTIVEF]
OFFICERIMEMBER EXCLUDED?
NIA
400040101
7/1/2015
71112015
500,000
E L DISEASE - EA EMPLOY' $
(MandatoryinNH)
Ifff,describsundor
isEAsE . POLICY umilT s 110-000
D RIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional RLmarlm Schedule, it more space is required)
I n 0 ir!"M i rz nvs..Wr_K CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, MOT'ICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZE13 REPRESENTATIVE
41
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