Loading...
HomeMy WebLinkAboutBuilding Permit #1141-2016 - 95 APPLETON STREET 5/3/2016 k- �11 �/p �U poerh ti J BUILDING PERMIT TOWN OF NORTH ANDOVER I� ' APPLICATION FOR PLAN EXAMINATION ; s Permit NO: !!" Date Received Ar Date Issued: �9SSgcHus�t�y I PORTANT:Applicant must complete all items on thisa e LOCANT til' a �a wi A .iadx fie. < - Fl ✓r. EP,R6PERTY--'WNE t t � r11 Prt PARCEL ZtNJNG D#5TfklCP- Jis is " strict yes r3o� no R: - . �la� in� h �lilla e�� es TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential Ej New Building V One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other F Septic, 1 Wet# � Flo© plair� �Wet(ands � ❑ Wat�rshe��[stric� M +t-%rke l�-1in�ln� uv%tcyns O)E door C no 00 L Identification Please Type or Print Clearly) OWNER: Name: E1� S�Sa Otto Phone: .� + a18 809 `SSS Address: a5LA0►-, CONTRAA,7TORme #� �� Phone Su ervlsor°s�onstructian a icense "' .. p . a �xp Date I ome lmproverent Llense� ' �cpdte w r ARCHITECT/ENGINEER Phone: Address: Reg. No. P FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ IS "4 6' FEE: $ 1 b 2 z Check No.: 3114 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund vi nature of}1 e rrtfOw r w, Si 9 ..._ ��atoref contractor ��. 1 t. r BUILDING PERMIT " of NORTfj q SLED j6 �O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � a. Permit No#: Date Received �SS9CHU`'�t Date Issued: IMPORTANT:Applicant must complete all items on this page i LOCATION Print PROPERTY OWNER i Print 10o Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes.. no J Machine Shop;Village , yes' no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic El Well E Floodplain. 0 Wetlands ❑ Watershed District, Q Water/Sewer.. DESCRIPTION OF WORK TO BE PERFORMED: I i I Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email Address: Supervisor's Gonstruation License: Exp. Date: Home Improvement Licenser Exp: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING 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.: NOTE: Persons contracting with unregistered contractors do not have access to the guar!nty fund fAnpnt/Owneri Location 6 4� "),P( 0� �-�- No. t — ? ,(p Date h1� • - TOWN OF NORTH ANDOVER Vi• Certificate of Occupancy $ Building/Frame Permit Fee $ (P 7, � Foundation Permit Fee $ Other Permit Fee TOTAL $ .s Check# i 0 3114, Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent 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 COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionfreceipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit t DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPNO ENE ,Temp Durnpsteron site yes _ Lor'cated at tl Main S reeti, Fire Dep ai-i�r�eni_.g��iafure/`date _ -- 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) LJ Notified for pickup Call Email Date Time Contact Name = 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. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application 4 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 OTE: 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 4. Workers Comp Affidavit 4 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 OTE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: 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 Town N®RTndover o L_ No. 'I � It - - * 1 h ver, Mass I U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT -. .....�,., , �.ee... BUILDING INSPECTOR has permission to erect .... buildings on 45.... .. .. ..` Foundation Rough to be occupied as ..... ........... Chimney provided that the person acceptint this permit shall in every respect conform to the terms of 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TION Rough Service .. .. . .. . .. .............. ....... ............ Final BUIL G INS ECTOR 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. i Page 1 of 5 MARVIN North Shore Window Sotutions LLC NSWS DESIGN GALLERY 239 South Main Street, Middleton, MA 01949 Phone: 978-762-0007 FAX:866-8139-3136 a complete window and duos�howioGm Massachusetts HIC P,egistratbn#172485 by NSAIS INSTALLED PROJECTS PROPOSAL DATE: 3/29/2Qlb NSWS REP: Linda Keating PROPOSAL#: KEETON-032916 Customer Name:Sasie Keeton _ C F Project Address:95 Appleton Street,North Andover,MA 01845 Primary Phone(where we can reach you prior to and during t)roject):978-807-7255 Email:smiekeeton@gmaii.corn ,rj(,Z,�jye , V�Ct G� .C tt r f WORK.TO BE PERFORMED: Install I Full Frame 2 wide casement wmdo existing RO(kitchen sink) �Q Specs: Marvin Integrity Wood Ultrex li 3 Exterior:Ultre?c;Stone White Interior: Pine; Prefinished White-Fac ied Glass: Low E 2 w/:argon Grilles; None Screens: Charcoal Fiberglass Mesh; ike Surround Hardware: Satin Nickel Interior"frim: Pipe;similar to existing G' Exterior Trim: PVC similar to existing \ Family Room and Living Room Install 2 3-Wide Full Frame Casement Window Units into existing Rough Openings 2 Casement Flankers w/Picture Window in the Middle Specs: FfAfnf. ' @ X(3 Marvin Integrity Wood Ultrex Exterior:Ultrex;Stone White �+0, �l,r Interior: Pine;Pretinished Glass: LowE 2 w/Argo Grilles: None . (� �y X �5 SAD,E Hardware: White Screens: Full; Charcoa i es ��te nrraund 11 2_ 9PAO� f Interior Trim: Pine;similar to existing Exterior Trim: PVC Similar to Existing I $ 10,605.00 �C��� � oLb 20 � RocaZ 92nd uTvqunow uoll SsEfi KV 9Z: 1ii7:6 9TOZ/TE/C ND Page 2 of 5 A Install 1 Entry Door into Existing Rough Opening Spens: 4AinR ThermaTru Smooth Star Entry Door(S90) Exterior: Factory Painted Mocha Chip Interior: Factors Painted Mocha Chip Material Type: Smooth Fiberglass Product Style:314 Lite Glass Style: Rain Glass Hinge:Ball Bearing;Brushed Nickel �� Prep:Bore for Lock and Deadbolt �p Sill: Composite Adjustable;Satin Nickel Finish Hardware: Erntek;Apollo Entry Handle Set with Geneva Lever and Modern Rectangle Rosette Emtek Interconnect Locking Mechanism(Panic Lock) Color:Satin Nickel Weatherstripping:Bronze Interior Trim: Pine;Similar to Existing Exterior Trim: PVC:Similar to Existing 2,862.00 J AUL '***The Price includes a FIVE YEAR installation warranty**** TOTAL PRICE (Materials, Labor, and Sales Tax).' 3,4§7.00 TERMS: 1/3 total price deposit rewired, 1/3 total price required upon delivery, 113 total price payable at completion of above mentioned work to be performed. WORK INCLUDEDS THE INSTALLATION OF WINDQWS AND/OR DOORS;ALL NECESSARY FRAMING MATERIALS,ROOFING SUPPLIES WHERE APPLICABLE;NEW INTERIOR AND EXTERIOR CASING,SILLS,AND STOOLS AS NEEDED;THE REMOVAL AND REINSTALLATION OF INTERIOR STOPS AS REQUIRED:CAULKING SUPPLIES,NECESSARY INSULATION,SHIMS,AND FLASHING SUPPLIES;SUFFICIENT SIDING TO REPLACE THAT REMOVED DURING INSTALLATION AS REQUIRED; SUFFICIENT DRYWALL SUPPLIES TO REPAIR THE INTERIOR INALLS FROM THE INSTALLATION,ALL NECESSARY FASTENER AND ADHESIVES;REMOVAL OF CONSTRUCTION DEBRIS.Permit fee not included,Will be billed independently to customer at face value of permit. THANK YOU FOR THE OPPORTUNITY TO HELP YOU! www.nswsformarvin.com / F, aA9ed uTvgUnoW uoaI 1S3fin WV LZ: DD:6 9TOZ/T£/8 i Page 3 of 5 Contract W Installed Projects North Shore Window Scluticros LLC.dba Marvin Design Gallery by NSWS 239 South Main Street,Middleton, MA 01949 Phone:978-762-0007 FAn:868-809-3136 Massachusetts HIC Registration: 172535 Contract#: KEETON-032916 CUSTOMER NAME: Susie Keeton STREET ADDRESS:45 Appleton Street,North Andover,MA 01845 PHONE:978-807-7255 This contract applies solely to the labor and materials required to install the exterior windows and doors specified an the attached proposal which is included as part of this corAract.If hidden conditions such as,but not limited to,rot,insect damage,or substandard framing per the MA Building Cqde, interfere with the proper installation of the products, the work will strp immediately. Such situations will be referred to NSWS"s representative to determine the appropriate action.Such action may include NSWS's subcontractor performing repairs at additional cost, however any contmetor of the homeowner's choosing may be employed to perform the additioriai work. NSWS also reserves the option to decline supervision of such work at which time additional charges would be billed to the homeowner directly by the subcontractor.Any new charges incurred through NSWS will be due upon completion of the additional work.Billable rate @S90.DD Ve an hour plus materials. CUSTOMER INITIALS DEFINITIONS,INCLUSIONS,AND EXCLUSIONS ®FULL FRAME REPLACEME=NT:these windows will usually be installed from the outside of the home.The installation,will include windows or doors, all necessary taming materials,roofing supplies for bay and bow windows where applicable,new interior and exterior casing,sills,and stools,caulking supplies,necessary insulalion.shims,flashing supplies,sufficient siding to replaea that removed during installation,sufficient drywall supplies to repair the interior walls from the installation,and any necessary fasteners,and adhesives needed to complete the installation. ❑INSERT OR SASH REPLACEMENT:these windows wiil usually be installed from the inside of the home.The installation will includ:the windows, caulking supplies,necessary insulation,shims,and fasteners.The interior stops will be removed and reinstalled. EXCLUS16NS:NSWS will not be responsible for any existing items that are made unusable dueto the installation of new windows or doors. These items include,but are not limited to:blinds,shades,curtains,shutters,storm windows,storm doors,wallpaper,air conditioners, awnings,window and door hardware,etc.Unless specifically listed in the proposal,the items not included will be:new interior and eAerior casing, sills,or stools,or replacement of the existing window frame,A change order may be issued to co'�-.r extra charges to fix or replace items not included, NSWS will not be responsible for alarm systems encountered during installation.The homeowner will be responsible for contacting and sohaduling the alarm service company to perform any neoassary alterations to accommodate tree new wiodgws. Any required electrical work is not included In this proposal. If existing wiring needs to be relocated or eliminated in order to accommodate any new windows and or doors to be installed,this may result in added cost. Any additional cast for electrical will be handled as a Change Order and is the responsibility of the customer and not included in this p oposal TOTAL COWMACT PRICE AND PAYMENT SCHEDULE Norah Shore Window Solutions LLC.(NSVVS)agrees to perform the work,furnish the material and labor specified above,clean the site and dispose of waste for the sum of.,$13,467.00 PAYMENTS WILL BE MAIZE ACCORDING TO THE 9{h.1-IVVING SCHEDULE: $4,4139.00 (33%OF TOTAL SALE PRICE UPON SIGNING CONTRACT) $4.489 (33%OF TOTAL UPON COMMENCEMENT OF WORK)T PERMIT FEE $4,439 (BALANCE UPON COMPLETION OF THE CONTRACT) Payment for this work is subject to additions or deductions in accordance with the provisions of this contract and any subsequent written change orders.Upon completion of contracted work,if manufacturer warranty service is required to correct any defect in the windows/doors; the homeowner may holdback up to 10%of the contract total until such service is performed.The actual amount of the holdback will be determined by the homeowner and the NSWS representative,but in no event shall exceed 10%of the contract ae r the items)which is the subject of the defect.Credit Card information to be provided to NSWS as security,even if paying by check;, C su tomer Initials At the time of the final payment specified above,NSWS will certify,at the request of the owner,a complete release of all liens arising out of the contract. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of NSWS,which may be the main office or branch thereof,provided you notify NSWS in writing at the main office or branch by ordinary mail posted,by telegram sent or by delivery,to be reviewed by NSWS no later than midnight of the third business day fLillowing the signing of the agreement. See attached notice of cancellation for an explanation of this tight.Terms continued on pages 2&3 are integral parts of this contract.'Do not sign this contract if there are any bunk-spaces**` t / J CUSTOMER SIGNA"M/Irl" U l. -, NSSiV I NATURrz ' &.�.rv� c�i, Z. DATE: DATE- iv 02'ed uzvqunoW uoaI 1931:1D WV 6Z t D t6 9T0ZIT2/E Page 4 of 5 The fotioMrig acts or occurrences shall not constitute default on the part of North Shore Window Solutions LLC.(NSWS)in connection-with the date of substantial completion and shall entitle NSWS to reasonable extensions of time to perform under the contract:acts of god.,strikes,acts of war, emergencies,failure of NStntS's suppliers or vendors to timely deliver materials to NSvb'S,failure of the owner or is agents to supply NSWS'w+ith job site availability on a timely basis,or any other acts or conditions not within the direct exclusive control of NSVVS. 1.INSURANCE: A. NSWS'S LIABILITY iNSURANCE,NS6VS agrees to keep in force at it's own expense during the entire period of construction on the project such liability insurance as will protect it from its claims,under workmen's compensation and ocher employee benefit laws,for bodily injury and death,and for property damage,that may arise out of%work under this contract,whether directly or indirectly by NSVVS,or directly or indirectly by a subcontractor paid for or employed by NSVVS for the above referenced project..The minimum liability limits of such insurance shall not be less than the limits specified by lave for that type of damage Maim. B. OWNER'S LIABILITY INSURANCE.Owner(s)agrees to maintain in force their own liability insurance during the construction on this project. and reserves the right to purchase such additional insurance as In their opinion.is necessary to protect them against claims arising out of NSWS's operation,without diminishing NSWS's obligation to carry the insurance specified herein on his part to be carried. C, PROPERTY DAMAGE INSURANCE ON WORK SITE.Owner agrees to maintain at his expense during construction of the property,damage insurance on the work at the site to its full Insurable value,l=tuding interest of owner,NSWS,and subcontractors,against fire,vandalism,and other perils ordinarily included in extended coverage.Losses under such insurance will be adjusted with and made payable to owner.NSWS, and subcontractors,against fire,vandalism,and usher perils ordinarily included in extended coverage.Losses under such insurance will be adjusted with and made payable to owner as trustee for the parties insured as their interests appear.Upon request,owner shall nie a copy of all such policies with NSWS within a reasonable time atter Construction begins herein. O. WAIVER OF WORK SITE DAMAGE CLAIM]TO EXTENT OF INSURANCE COVERAGE.Owner and NSWS hereby waive at claims against each otherfor fire damage or damages from other pewits covered by insurance provided in paragraph"C°of this section. 2.WORK CHANGES'Owner reserves the right to order changes in the stature of addltlons,deletions,or modifications,without invalidating the contract, and agrees to corresponding adji sttnents in the contract price and time for completion.All changes wtil be authorized only by a written change order signed by owner ar by his agent.The Change order wilt include confirming changes in the contract and completion time.Work shall be changed,and the contract price acid completion time shall be modified only as set out in the written change order.Any adjustment in tete contract price resulting in a credit or a cttarge to owner shall be determined by mutual agreement of the parties,or by arbitration,before starting the work involved in the change. 3.TRASH AND CLEAN-UP:NSWS is responsible for interior and extetior clean-up in rooms and areas directly impacted by the construnGori,including ii-ash removal and vacuuming.Dumoster expenses,as needed,are Included In the total price. d.TERMINATION:If owner eanoeis this contract withouf legal cause after any right to rescind period,he shall pay NSWS the amount of expenses incurred to that slate plus 15%of the Contract price.If NSVVS cancels this contract prior to commencement o:construction,NSVVS shall return to avrner any amounts paid to that date.That shall be the owner's sole remedy In law or equity. 5.COMPLETION CERTIFICATE BY OWNER:On completion of NSVVS's-work,owner shall execute and deliver to NSWS a completion certificate confirming that the owner of his agent has inspected NSWS's work and that the work!acts been satisfactorily completed to the owner's satisfaction or Eternizing any deficiencies or the specific complaints in NSWS's work. 6.LIMITED WARRANTY:NSWS WARRANTS ITS INSTALLATION ONLY TO BE FREE FROM DEFECTS IN WORKMANSHIP FOR A PERIOD OF FIVE(5)YEARS FROM COMPLETION.THE GOODS INSTALLED HEREUNDER ARE SUBJECT ONLY TO ANY WARRANTIES OF THE MANUFACTURER.ANY WARRANTY HEREUNDER EXTENDS ONLY TO OWNER AND IS NOT TRANSFERABLE TO SUBSEQUENT PURCHASERS OF THE REAL PROPERTY OR TQ OWNER'S HEIRS,REPRESENTATIVES, SUCCESSORS,OR ASSIGNS.IF A DEFECT IN WORKMANSHIP COVERED BY THIS WARRANTY OCCURS,NSWS WILL AT ITS OPTION REPAIR,REPLACE;OR PAY OVdNER THE COST OF REPAIRING THE DEFECTIVE WORK AT NO COST TO O%NNER.TO OBTAIN WARRANTY PERFORMANCE,NOTIFY NSWS OF ANY DEFECT OF CLAIMS FOR BREACH,AND THIS SHALL BE THE OWNER'S SOLE REMEDY IN LAW OR ECUITY.THE PROV DED SAID LIMITED WARRANTY IS SUBJECT TO THE FOLLOWING EXCLUSIONS: A, THE GOODS INSTALLED HEREUNDER ARE SOLI?ON AN'AS IS*BASIS BY NSWS.THE ENTIRE RISK AS THE QUALITY AND PERFORMANCE OF SUCH GOODS IS WITH OWNER. SHOULD SUCH GOODS PROVE DEFECTIVE, OWNER,AND NOT NSWS ASSUMES THE ENTIRE COST OF ALL NECESSARY REPLACEMENT OR REPAIRS.THE GOODS INSTALLED HEREUNDER CARRY THE MANUFACTURERS'WARRANTY ONLY AND NSWS WITHOUT IN ANY WAY ASSUMING RESPONSIBILITY OR LIABILITY THEREFORE AGREES TO EXTEND OR PASS ON TO OWNER SO FAR AS IS POSSIBLE MANUFACTURER'S WARRANTIES. B. DEFECTS AND FAILURE FROM;AISTREATMENT,NEGLECT,OR FROM OTHER CAUSES BEYOND NSWS'S DIRECT CONTROL SUCH AS MOISTURE,EXPOSURE TO SUN,CRACKED,BUCKLE( ,WARPED,OR OTHERWiSE DEFECTfVE SURFACES AND SUBSURFACE,SETTLING,OR STRUCTURAL DEFECTS_ C. WORK PERFORMED BY,OR MATERIALS,APPLIANCES OR EQUIPMENT INSTALLED BY OTHERS NOT IN THIS CONTRACT. D. EXCLUSIONS AND LIMITATIONS-OWNER'S RIGHTTO REPAIR AND REPLACEMENT ARE THE EXCLUSIVE REMEDIES AND NSWS SHALL NOT BE LIABLE FOR INCIDENTAL OR CONSEQUENTIAL DAMAGES RESULTING FROM THE WORK PERFORMED BY NSVVS OR FROM THE GOODS PROVIDED FOR IN THIS CONTRACT. THIS LIMITED WARRANTY iS THE ONLY EXPRESSED WARRANTY NSWS GIVES. IMPLIED WARRANTIES,INCLUDING BUT NOT LIMITED TO WARRANTIES OF MERCHANTABILITY AND FITNESS FOR A PARTICULAR PURPOSE,ARE LIMITED TO A DURATION OF 60 DAYS FROM THE DATE OF INSTALLATION, THIS AGREEIAENT SHALL BiND THE CUSTOMER'S HEIRS,BENEFICIARIES,EXECUTORS,ADMINISTRATORS, SUCCESSORS,INQUIRERS,AND ASSIGNS OF THE PARTIES HERETO. 9 921ed uT-e unoW uoaI SS9IIJ Yid TS: DD:6 9TOZITC/C Page 5 of 5 REQUIRED PERMITS THE FOLLOwTNG BUILDING PERMITS ARE REQUIRED.IT IS THE OBLIGATION OF THE CONTRACTOR TO SECURE SUCH PERMTS AS THE HOMEOWNER'S AGENT_LIST ANY ANDALL NECESSARY CONSTRUCTION-RELATED PERMITS, NOTE:OWNERS WHO SECURE THEIR OWN PERMITS OR DEAL WITH U14REGISTERFD CONTRACTORS ARE EXCLUDED FROM THE GUARANTY FUND PROVISIONS OF hSGL C.I42A As required per town of North Andover Fermit billed separately of this proposal haled on total project cost,payable by customer to NSWS NOTE:ALL HOME IMPROVEMENT CONTRACTORS AND SUBCONTRACTORS SHALL BE REGISTERED AND ANY INQUIRIES ABOUT A CONTRACTOR OR SUBCONTRACTOR RELATING TO A REGISTRATION SHOULD BE DIRECTED T01 DIRECTOR,HOME IMPROVEMENT CONTRACTOR REGISTRATION ONE ASHBURTON PLACE,ROOM 1301 BOSTON,MAD 2108 647-72T-11588 UNLESS OTHERWISE NOTED WITHIN THIS DOCUMENT,1 HE CONTRACT SHALL NOT IMPLY THAT ANY LIEN OR OTHER SECURITY INTEREST HAS BEEN PLACED ON THE RESIDENCE. ARBITRATION NEWS A14D THE HOMEOWNER HERESY MUTUALLY AGREE IN ADVANCE THAT IN THE EVENT THAT NEWS HAS A DESPUTE CONCERNING THIS CONTRACT,NEWS MAY SUBMIT SUCH DISPUTE TO A PRIVATE ARBITRATION SERVICE WHICH HAS SEEN APPROVED BY THE SECRETARY OF THE EXECUTIVE OFFICE OF CONSUMERAFF.AIRS AND 13US114ESS REGULATIONS AND THE CONSUMER SHALL BE REQUIRED 7 -SUBMIT TO Sl1 H Aj�,BiTRAT10N AS PROVIDED[N kl.G.L.C.142A. NEWS: /L' , ! i l DATE CUSTOlAEft; DATE:' L 17l 1- �2 NOTICE.THE SIGNATURES OF THE PARTIES ABOVE APPLY ONLY TO THE AGREEIVENT OF THE PARTIES TO ALTERNATIVE DISPUTE SETTLEMENT INITIATED BY NSWS,THE OWNER MAY INITIATE ALTERNATIVE DISPUTE RESOLUTION EVEN WHERE THIS SECTION ISNOT SEPARATELY SIGNED BY THE PARTIES. ACCELERATION OF PAYMENT HOIAEOWNER'S FINANCIAL INSECURITY-A CONTRACTOR MAY NOT DEMAND PAYMENTS IN ADVANCE OF THE DATES SPECIFIED ON THE PAYMENT SCHEDULE IN CASES WHERE THE HOMEOWNER DEEMS HIMIHERSELF TO BE FINANCIALLY INSECURE.C014TRACTOR•S FINANCIAL INSECURITY-IN INSTANCES WHERE A CONTRACTOR DEEMS HIMIHEP,SELF TO BE FINANCIALLY INSECURE,THE CONTRACTOR MAY REQUIRE THAT THE BALANCE OF FUNDS NOTYET DUE BE PLACED IN A JOINT ESCROW ACCOUNT AS A PREREOUISITE TO CONTINUING THE CONTRACTED WORK.WITHDRAWAL FRONS SAID ACCOUNT WOULD REQUIRE THE SIGNATURES OF BOTH PARTIES. NOTICE OF CANCELLATION YOU MAY CANCEL THIS TRANSACTION WITHOUT PENALTY OR OBLIGATION,WITHIN THREE BUSINESS DAYS FROM THE DATE THAT THE CUSTOMER SIGNS THIS CONTRACT. AFTER THREE BUSINESS DAYS,AN ORDER FOR NON-STOCK WINDOWS ANDfOR DOORS MAY NOT i3£CANCELLED. IF YOU CANCEL UVITHIN THREE BUSINESS DAYS.ANY PROPERTY TRADED IN,ANY PAYMENTS MADE BY YOU UNDER THE CONTRACT OR SALE,AND ANY NEGOTIABLE INSTRUMENTS EY.ECUTED 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 SUBSTA14TIALLY AS GOOD CONDITION AS WHEN RECEIVED,ANY GOODS 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 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 CANCELLATION,YOU MAY RETAIN OR DISPOSE OF THE GOODS WITHOUT ANY FURTHER OBLIGATION,IF YOU FAIL TO MAKE THF 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 CONITP.ACT. TO CANCEL THIS TRANSACTION,(NAIL OR DELIVER A SIGNED AND DATED COPY OF THIS CANCELLA.T[ON NOTICE OR ANY OTHER WRITTEN NOTICE,OR SEND ATELEGRAM TO 149WS INSTALLED SERVICES,AT 239 South Main Street,Middleton,MA 01949140T LATER THAN MIDNIGHT OF (dale). I HEREBY CANCEL THIS TRANSACTION. Date: Buyer's Signature: The Commonwealth of Massachusetts Department of Industrial Accidents s I Congress Street,Suite 100 0 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/PIumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information `- .� Please Print Legibl >` y Name(Business/Organization/Individual): odk Sho W I'A1}Oy) Address: ��! 1"A 01 City/State/Zip: Phone 00Vl Are y u an employer?Check the appropriate box: Type of project(required): 1.71am a employer with 8 mployees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. E]Remodeling any capacity.[No workers'comp.insurance required.] 9. LJ Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 n Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ l 0 ' 6.F-1 We are a corporation and its officers have exercised their right of exemption per MGL c. 14. Other 6/1[1A�� '�/ 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *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. tContractors 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 ant m:employer t/tat is providing workers'compensation insu►•attce for my employees. Below is the policy and job site information. Insurance Company Name: ��`l�z l� I b V l I��✓ Policy#or Self-ins,Lic.#; WLT (,,859.}, Expiration Date: Job Site Address: � r1 ` City/State/Zip: N, Ai 3oI er, Attach a copy of the workers'colnpensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 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. I do hereby certify under the aims ar penalties ofpetjtrry that the ittforr/ratio/tprovided abve is true and correct. Sign re: ��. Date: 26L Phone#: "I!1U pq 76,;L Ot7 Official use only. Do not ivy-lie in this area,to be completed 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#: Information and Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every person in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association,corporation or other legal entity,or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer,or the receiver or trustee of an individual,partnership,association or other legal entity,employing employees. However the owner of a dwelling house having not more than three apartments and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not because of such employment be deemed to be an employer." MGL chapter 152,§25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of compliance with the insurance coverage required." Additionally,MGL chapter 152,§25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work until acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers'compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),address(es)and phone number(s)along with their certificate(s)of insurance. Limited Liability Companies(LLC)or Limited Liability Partnerships(LLP)with no employees other than the members or partners,are not required to carry workers'compensation insurance. If an LLC or LLP does have employees,a policy is required. Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit. The affidavit should be returned to the city or town that the application for the permit or license is being requested,not the Department of Industrial Accidents. Should you have any questions regarding the law or if•you are required to obtain a workers' compensation policy,please call the Department at the number listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. City or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant. Please be sure to fill in the permit/license number which will be used as a reference number. In addition,an applicant that must submit multiple peimitilicense applications in any given year,need only submit one affidavit indicating current policy information(if necessary)and under"fob Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to burn leaves etc.)said person is NOT required to complete this affidavit. The Department's address,telephone and fax number: The Commonwealth of Massachusetts Department of Industrial Accidents 1 Congress Street, Suite 100 Boston,MA 02114-2017 Tel. #617-727-4900 ext.7406 or 1-877-MASSAFE Fax#617-727-7749 Revised 02-23-15 www.mass.gov/dia ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) OS/12/2015 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: Patricia Tedesco Burns, Brooks & McNeil AJFAX CC,NN Ext: 860.482.5591 1(AIC,No):860.496.9713 www.burnsbrooksmcneil.com ADDRESS: ptedesco@burnsbrooksmcneil.com 69 Water Street P.O. Box 717 INSURER(S)AFFORDING COVERAGE NAIC# Torrington, CT 06790 INSURER A: National Grange Mutual 14788 INSURED North Shore Window Solutions, LLC INSURER B: National Grange Mutual 14788 239 South Main Street INSURER C: Middleton, MA 01949 INSURER D: INSURER E; INSURER F: COVERAGES CERTIFICATE NUMBER: 15-16 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. INS TYPE OF INSURANCE OLICY EFF OLIC P LTR I INSR WVD POLICY NUMBER (MM/DD/YYYY) (MM/DD/YYl'Y) LIMITS GENERAL LIABILITY BPT68 57E 05115/2015 05/15/2016 EACH OCCURRENCE S 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurre1=0nce) S 500,000 CLAIMS-MADE I OCCUR MED EXP(Any one person) S 10,000 A Y` PERSONAL&ADV INJURY S 1,000,000 GENERAL AGGREGATE S 2,000,000 'GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG S 2,000,OO POLICY M PRO- JECT LOC IS AUTOMOBILE LIABILITY M2T6857 05/15/2015 05/15/2016 (Ea accident) S 1,ODO,00 ANY AUTO BODILY INJURY(Per person) S B ALL OWNED F X SCHEDULED BODILY INJURY Per accident S AUTOS AUTOS ( ) - HIRED AUTOS NON-OWNED AMA S AUTDS (Per accident) I S X UMBRELLA LIAR X OCCUR CUT6857EI 05/15/2015 05/15/2016 EACH OCCURRENCE S 2,ODO,00 B EXCESS LIAB CLAIMS-MADE AGGREGATE S 2,000,00 DED I X I RETENTIONS 10,000 $ WORKERS COMPENSATION WCT6857 05115/2015 05115/2016 X WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN TORY LIMITS ER ANY PROPRIETORIPARTNERIEXECUTIV E.L.EACH ACCIDENT I S 5Q0 0QQ A OFFICER/MEMBER EXCLUDED? �N NIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S 500 )00 If yes,describe under DESCRIPTION OF OPERATIONS below E .DISEASE-POLICY LIMIT I S 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) E: Evidence of Insurance CERTIFICATE HOLDER CANCELLATION 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 To Whom It May Concern Patricia Tedesco, CIC ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD i Office of Consumer Affairs d Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement.-Contractor Registration -- Registration: 172585 - -__ - Type: Supplement Card NORTH SHORE WINDOW SOLUTIONStL -. --7 Expiration: 7/10/2016 DENNIS LASSELL 239 SOUTH MAIN ST - MIDDELTON, MA 01949 - Update Address and return card.Mark reason for change. SCAT C, 20M-05/11 Address Renewal 7 Employment Lost Card ,G,` ��e'�a�uruo�%rncalr/n�r'ljru.irrr�rr.le�' ' Mce of Consumer Affairs&Business Regulation License or registration valid for individul use only IN C I"s ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 7� Office of Consumer Affairs and Business Regulation ^y7fegistration:._.172585_ Type: 10 Park Plaza-Suite 5170 ' Expiration:.7/10/20.16: Supplement Card Boston,MA 02116 NORTH SHORE WINDOW SOLUTIONS LLC DENNIS LASSELL J (' 239 SOUTH MAIN ST MIDDELTON,MA 01949 Undersecretary _4Not ' without signature M �S S TTS= DRIVER' 80a--d -Department of Public Safety LICENSE q-c of Building Reguiati^vnS ani d '' :s � USA �u103iTuCufii9�u}7r9 ia;)T License: CS-091.857 � ) L9aEND 4d NDMBQi F 4 NNONE3 S9 ...4d DENNIS E LASSES, 571 West street 1� # n 15 SD(M: o - Leominster MA @453 i ' LEOMINSTER,MA 01453expI ratio ' 5DD10.24-2013Rev07.15-2009"ETERAA/ Commissioner 11/02/2016