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HomeMy WebLinkAboutBuilding Permit #797-13 - 95 CAMPION ROAD 5/21/2013Permit N0:1 Date TOWN OF NORTH ANDOVER. APPLICATION FOR PLAN EXAMINATION i Date Received must -complete items on this no LOCATION "0."'_ Print VKurr Print ZONINGDISTRICT: Historic District yes°AW-SPARCEL MAP NO Machine Shop Village yes ,ado TYPE OF IMPROVEMENT p New Building ❑ Addition ❑ Alteration P1 -Repair, replacement ❑ Demolition _ _ r;.•n,_-ice,. li l•�TAII' . PROPOSED USE Residential jpne family ❑ Two or more family No. of units: ❑ Assessory Bldg ❑ Other ®® _.� i lON OF WORK TO3E; pEi '{0-D: DESCI — -- .. (Identification Please Type or Print Clearly) Address: Non- Residential 0 Industrial ❑ Commercial p Others: Phone: CONTRACTOR Name: " .�.tJ.o�s t 3z Address: 4s- supervisor's s Supervisor's Construction License: ©� Exp. Date: i0 • zc Home Improvement License: �9 '77 Y Exp. Date: ARCHITECT/ENGINEER Phone: . No. .',,, V . . Address: FEE SCHEDULE: BULDJkG PERM1 r: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED D�N $$125,00 PER S.F. � � FEE: $ `� Total Project CO st. $ Receipt No. Check No.: ,., rrrn. P,&vcnnc contracting with unregistered contractors do not have access to the guaranty fun >q Ci Location No. i� ( Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ "7 0 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ rx Check # ,L- U D 26427 v Building Inspector Plans Submitted ❑ Plans Waived ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ well ❑ Private (septic tank, etc. ❑ Certified Plot Plan ❑ Stamped Plans ❑ Taau1ng/MassageBodyArt ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVAT ION Reviewed on Signal+ire COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board -Decision: Comments -- Conservation Decision: Comm Water & Sewer Connection/Siglnature &Date Driveway Permit y DPW Town Engineer: Signature:, Located 384 Osgood Street FME DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main. Street Fite Department signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. 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 m1n.$100-$9000 fine NOTES and DATA — For department use ® Notified for pickup - Date Doc:.Building Permit Revised 2008mi Building Department The foiiowirg is a iist of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Wb-11%ers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products MOTE: 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 Cor'►'nact ❑ 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 iiNOTE: 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 CIerks 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: Doc.Building Permit Revised 2008mi CA m m m CO) m mm rte •~ CD O CL r C >to O OCDv �. CL CD O LWT O N O CA CD CD CD vs' N i O O a CD m cn 0 -Z-i cn � O0 � � m 2 O = < ( Cl) W, O 0 0 �' 1 O_ Q • COY O .�+ 0. O —0. �• m N N W m w cc 2 O 7 O O 0 �• Co C 7 _N• O O 4 O S O W O � O C .a 'rt �s Q. 0c� X CO co �' N •a vl c =rCL� o= a� Q_ H Q. < CD N O :� O H O O O O Cl) NW� FL CY -co- 0 - a ca � CD O O Cs� c 3 c� 3 CY W :(JO DC 23 :1 Cl)� 0 n d o' CL VI o CD o rn V1 r. Z co C r�o T W m D -� T > 2Lr- A O s C)3 H N T j V1 m 2 m x O m m n '- M A 0 z 21 3' m O oro T T c W /1 O � T �' wago (� T m O T O M CL . p C p z m m O N m 0 LA. (o 3 T O a m W O O D x * O O a0 m •1 s� �n w> o 1 p .,r � •r �►X * O n Ir 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/El please Print mbers bl _A hcant Information Name (Business/Organization/Individual): 'I i -b Address: City/State/Zip: 4IL0 Phone.#: Are you an employer? Check the appropriate box: 4. ❑ I am a general contractor and I . ❑- f am a employer with* have hired the sub -contractors employees (full and/or part time listed on the attached sheet. 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 These sub -contractors have employees and have workers' comp. insurance.t 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 requueu.j Type of project (required): 6. ❑ New construction 7. 0 Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ 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 entitieshave employees. If the sub -contractors have employees, they must provide their workers' comp. policy number. ram an employer that isproviding workers' compensation insurance for my employees. Below is thepolicy and job site. information. Insurance Company Name: Policy # or Self -ins. Lic # [. '_ -A Expiration Date: '` City/State/Zip: Job Site Address: ation page (showing the policy number and expiration date). Attach a copy of the workers' compensation policy declar 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 covera ge verification I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. �- Date: s 2-_t- 3 S i gnature 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): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person Phone #: _-1I page 3 of 4 p-� CERTIFICATE OF LIABILITY INSURANCE AC'ORI.�® OATE(MMIDDIYYYY) OBIO1/2012 A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS THIS CERTIFICATE IS ISSUED AS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED BELOW. THIS CERTIFICATE OF INSURANCE DOES 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). GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY a OCCUR CONTACT Dorothy A. Corlett, CIC, RPLU NAME: PRODUCER Fred C. Church, Inc. PHONE 978 3227231 FAX (978) 454-1865 HONE No ExtI: A1C No 41 Wellman Street E-MAIL dcorlett@fredcchurch.com ADDRESS: Lowell, MA 01851 (800)225-1665 INSURERS AFFORDING COVERAGE NAIC # PERSONAL & ADV INJURY $ 1,000,000 Citizens Insurance Company of America 31534 INSURER A CLAIMS -MADE Hanover Insurance Company 22292 INSURED New England Window & Door LLC INSURER B: INSURER CMassachusetts Bay Insurance 22306 45 Fond! RoadNew Hampshire Employers Insurance Company 13083 INSURER D : Haverhill, MA 01832-1302 INSURER E INSURER F: L.UVtKAUtO t.r,rnl rrrvn r I THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL INSR SUER WVD POLICY NUMBER POLICY EFF MMIDDIYYYY POLICY EXP MMIDD/Y LIMITS GENERAL LIABILITY X COMMERCIAL GENERAL LIABILITY a OCCUR EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100,000 PREMISES Ea occurrenceL-- MED EXP (Any one person) $ 10,000 PERSONAL & ADV INJURY $ 1,000,000 A CLAIMS -MADE ZBN8161407 7/1/2012 7/1/2013 GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 G EN'L AGGREGATE LIMIT APPLIES PER: X X LOC POLICY PEO - $ COMBINED SINGLE LIMIT 1,000,000 AUTOMOBILE LIABILITY Ea accident BODILY INJURY (Per person) $ C X ANY AUTO ALLOWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS IAUTOS ADN8162169 7/1/2012 7/1/2013 BODILY INJURY (Per accident) $ PROPERTY DAMAGE (Per accidenl $ $ B X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE UHN8167305 7/1/2012 7/1/2013 EACH OCCURRENCE $ 9.000,000 AGGREGATE $ 9,000,000 $ —RI TH- WC Stgru OER T Y I IT D N 1 A QQ0082601825 7/112012 7/1/2013 DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE - OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. EACH ACCIDENT $ 500,000 500,000 E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) Evidence of Insurance for Building Permit for the Town of Walpole L:tKI It - It A I t r1ULL1 Town of Walpole Building Department Walpole, MA 02081 Client # Mist # ACORD 25 (2010/05) SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE P. a28013 @1988-2010 ACORD CORPORATION. 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((o 0 7 v O Z m n FF cl 3 �D .-r CD CL 0 CL CD N yO V � e J / ; \ ƒ | D k -cg } ~� a \ ) \j ( ` �r § \ \ / Gco § c = CD � ! 1 _ n ) k \ \ z \ co w oSD k( > CD CL\ _C � \ J41 k 13 CL } / \ CD m ) (CD / \ o $ ( § ID 7 -D 3 m 0 m 101 r a V\ r a n (D 0 oa m- 2. v a w N X N 1 v v x -� c CD m �@ d) C Q ^) 0] 0) a o m v N 164 N A� O 0 0 v 0 W C)7 N N m 9) 00 00 O OD -N+ co co O z NOTICE OF CANCELLATION Customer Name: r— % 0-1 (Please print) Date of transaction: , 6' - r -3 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 s�/0 7/1-J (three business days from the date of transaction above). I hereby cancel this transaction. (Date) (Buyer's signature) DISPUTES Job Name_ / A,P�lj / 4 j G j Date b " l -3 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 Contractor om caner 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 7. PAYMENTS 1. TERMS AND CONDITIONS These Terms and Conditions are an integral part of the contract set forth on the Product Order (the "Contract") between New England Window and Door LLC dba Pella Windows & Doors, Inc. ("Pella") and the person(s) identified on the Product Order ("Owner") to supply the products (the "Products"), and perform the work (the "Work") described or referred to in such Contract. For Product Only purchases, a signed "Product Only Addendum" is a required part of the contract. 2. OWNER Pella is not responsible for any existing security systems. Owner shall remove all shades; verticals, blinds, curtains, drapes or window mounted air conditioners, prior to the installation of the Products. Pena'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 Palla'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 older in writing changes in the Work consisting of additions, deletions, or modifications ("Change Order'). Any Change Order shall include an adjustment to the Price and the Substantial Completion Date, as determined by Pella. Pella reserves the right to approve or disapprove any Change Order and any such Change Order must be signed by both Owner and Pella to be effective. SUBSTANTIAL COMPLETION Owner understands and agrees that the Substantial Completion Date is an estimate only and that the actual date on which the Work is completed may be extended to allow for Change Orders requested by Owner or if the time to complete the Work is affected by conduct of the Owner, weather, labor disputes, availability of subcontractors, acts of God, fire or other causes reasonably beyond Pella's control. If for any reason the Work is not fully completed by the Substantial Completion Date (including any extensions contemplated above), but is substantially completed by such date, i.e., the Product has been installed, but minor parts or components are missing or need to be replaced or repaired, a hold back proportionate to the cost of remaining parts or work to be completed is acceptable. However, the holdback will not exceed the amount of the completion costs or 10 % of the remaining unpaid balance of the Price, whichever is less. 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. 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. LLMHTED 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. ROME 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) Pella i obfg to and will obtain the following permits for this project- _ Homeowners who secure their own permits will be excluded from the guaranty fund provisions of Massachusetts General Iaws, 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. �A Customer s' nature Date