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HomeMy WebLinkAboutBuilding Permit # 11/13/2015 "ORT#1 BUILDING PERMIT TOWN OF NORTH ANDOVER ,e APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: VS CH S IMPORTANT:Applicant m-ust complete all items on this page Ir IUl / ,/lir% r ,, r / �r /, TYPE OF IMPROVEMENT PROPOSED USE Resigential Non- Residential ri New Building r. One family 11 Addition Li Two or more family El Industrial Alteration No. of units: 11 Commercial [I Repair, replacement L-I Assessory Bldg I] Others: [I Demolition El Other gi I'm�W� fill Ts IN Now 1`11 Z�skfiwu a &vAawfil /,?,ay Atmlo—w C1 1�2(:Xll kZ41L-1 h Identification Please Type or Print Clearly) % OWNER: Name: I RDbW Uf Phone: (q7V) Address: 2e, MAM,ta" A16, 0001 ... ............... N WHY, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDIN&PERMIT.$12.00 PER$1000.00&'?fHE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. FEE:'$ Total Project Cost:- -3L7y7T 71 Recei check No.:.", Receipt No.: —7 4n4 O1417r �� �w i n cont alftyfi wcio rs do not'hiive,acc!rs NOTE. P�rso'fis� gp 6 01110 R "1 01 _4 "11,111" 41L N®R7 i own o2 • F . Andover 0 z y ver, Mass, COCMICA.. A°RAreo P'V' 65 S U BOARD OF HEALTH rt: RMIT L D Food/Kitchen Septic System THIS CERTIFIES THAT ............ ...... .. .... .. .. a� .................................................. BUILDING INSPECTOR . has permission to erect ... .................... buildings on ..................ioio...J ................... Foundation Rough to be occupied as ....... . ....... ........... ....�I/� Q ..................................... Chimney provided that the person acce ting this permit shall in ev 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES I 6 ® H ELECTRICAL INSPECTOR LESS CONSTRUC S S Rough Service .............. ... .. ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Kermit Required t® Occupy Building Rough Islay 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. about:blank Robert Hajar NATIONAL HEADQUARTERS 3172297 250t Seaport Chive.thestet 8A 1�Oit?Lr/ER October 10,2015 $88P;EM 1,tA H1CN 169816 CUSTOM REMODELING ANb IMPROVEMENT AGREEMENT Buyer(s)'information and Description of the Property: Project Number:31-72297 October 10,2015 e Robrt Haller ama.� 20 Bert Ave {g78)885-0513(Home) North Andover,MA,01845 County:Essex �311t i/ Township: Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services of power Home Remodeling Group and Its vendors CContractor")in accordance with the prices and terms described in this 5 page document and the Product Specifications,which are incorporated as part of the Agreement(collectively,this"Agreement'). This Agreement represents a cash sale of goods and services, Buyers)agrees to pay the cost of the goods and services purchased as described herein;regardless of timing or approval of any financing Buyer(s)may seekfor their purchase. Purchase Price: $6,416.04 Pre Installation Inspection Dates: Down Payment: SS,2ttl.tl0 tVbn 10r26 6elween t A0p and 2:00p Balance Due on 2 *3,*'04 Estimated Project Start:6 to 7 weeks Substantial Completion: Estimated Project Completion:i to 2 days Method of Payment: Check Buyerts)admawledge that a defsite start and oompletion dates are NOT of the essence.Delaysbey- ` :.Donvoctork control not includad in calculating time frames.see Delay/Unknown conditions. Buyer(s)hereby acknowledges recolpt of atopy of the pamphlet,"The Lead-Safe Certified Guide to Renovate Right;informing Buyer(s)of the potential risk of toad hazard exposure from renovation activity to be performed in or at Buyer(s)',Property,;it the add on above.Buyer(s)received this pamphlet on the date of this Agreement,before commencement of work. Buyer(s)'Initials This Agreement constitutes the entire agreement and understanding between the parties,and this Agreement replaces any and all prior negotiations,representations,or agreements,either written or oral. No amendment,modification or waiver of this Agreement" shall be valid or effective unlessin witting and signed by both parties. Buyers)hereby acknowledges that Buyer(s)1)has read the entire Agreement and has received a complated,signed,and dated copy of this Agreement,including the two accompanying Notice of Cancellation forms,on the date first written above and 2)was orally Informed of his/her right to cancel this transaction. Buyer(s)alsoagrees and understands that If Buyers)iirianoos the work with a third•party,the terms of that financing will be contained on separalelocumants,Including any finance charge: Future promotions not applicable: DO NOT SIGN THIS AGREEMENT IF THERE ARE ANY BLANK SPACES. i have read and received each page of this 5 page agreement. Power Home odeliho, roup Buyer( )15 �ioilo)1; Signa" ,RernotlefingCoPsuitant Signet r Ni""ck Sahwertschlag :; Robert H ar YOU,THE eUYER(S),MAX CANCEL THIS TRANSACTION AT ANY TIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY Al`iER TttE DATE OF THIS TRANSACTION SEE THE ATTACHED NOTICE OF CANCEI,t.AnON FORM FOR AN EXPLANATION OF THIS Rte4F , - '' ctober 10 Page 1 of 5 <i 1 of 1 11/7/2015 10:45 AM NATIONAL HEADQUARTERS Robert Hajjar 31-72297 October 10,2015 2501 Sea MA HIC# 1686'16 Project Specifications Windows: Living room 1 101.0"x50.5" WINDOWS: Models SL 2700 Styles Bay Types None Configs Double Hung Ends a r OPTIONS: Color White/White: Grid Pattern: None I Removal Wood I Upgrade Head,Seat and Jambs Pine I Additional Details None W"+Jr4r", %M"o'.�o I 1 is q4 N' Q3ctoberI0,20.5 14:26 4 :J t IIIIIIIIIIIIIIIIIIIIIIIIIILIIIIIIIIIIIIIIIIIIIIIII � . Way , , t . , Page 2 of 2 „a r"".a�tPa rt rA14 .- ,a , .. ..r. l... -'.S NATIONAL HEADQUARTERS . Robert Hajjar p Dnve Chester PA 19013 31-72297 2501 Sea ort October 10 2015 CUOatI-g9Ca#d1taF96'Y(r PRODUCT SPECIFICATIONS Buyer(s)'Information and Description of the Property: Project Number: 31-72297 October 10,2015 Robert Hajjar DateotAgreement (978)685-0513(Nome) 20 Mablin Ave North Andover,MA,01845 County:Essex Township: Buyer(s)listed above hereby jointly and severally agrees to purchase the goods and/or services listed on the accompanying specification sheets,in accordance with the prices and terms described in the Custom Remodeling and Improvement and the Product Specifications (collectively,this"Agreement"). Pre Installation Inspection Date:Your pre installation inspection is tentatively scheduled for Mon 10/26 between 1:00p and 2:00p. Windows-SL 2700 Inclusions: Includes metal reinforced meeting rails and nighttime safety locks on double hung windows only,welded corners,foam injected frames,Sashlite technology, Heatshield,Duraglass,exterior custom capping, installation,clean up and haul away of all job related debris. II 1 It is agreed and understood by and between the parties that the Product Specifications,along with the Custom Remodeling and Improvement Agreement,constitutes the entire understanding between the parties,and replace any and all prior negotiations, representations,or agreements,either written or oral. The Product Specifications may not be changed,modified,or varied in any way unless such changes are in writing and signed by both Buyer(s)and Contractor. Buyer(s)hereby acknowledge that Buyer(s)has read the Product Specifications. have read and received each page of this 2 page agreement. Power Home Remodeling Group Buyer(s) /10/10/15 /10/10/15 Signature of Remodeling Consultant Signature i Nick SchWertschlaq Robert Haijar YOU,THE BUYERS_),MAY CANCEL.THIS TRANSACTION AT ANYTIME PRIOR TO MIDNIGHT OF THE THIRD BUSINESS DAY OF CANCELLATION FORM FOR AN EXPLANATION OF I THIS RIGHT- AFTER'jt-IE DATE,OF THIS TRANSACTION.SEE THE ATTACHED NOTICE October 10,2015.1.4:26' IIII II IIIIIIIIIIII�IIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIII) Page 1,Of 2 t ,-r•- 1>1: t c' ai':.tit - — 1 FEZ "•':lis f-op,f�z r r. "e-` 7.j 1 f1°'G. ,..• ' 0 _ `W:;f"a'M1I.R.�3m:'si�.cs.•..v^=S�.i{G tiiM1•� :-;: 4�-,zy- .'+' _ t Z• fir C`.tr,;�=.'X^;��,t ',.. .lam :^+- _:•1M1.._ii3! i S�z'�' - �.f•,h..,�h.,�-.-_ ',.. i- DA - �� �"�'�""��� ��'d,y "ydc�` �'��r�'�^d, +1�� �uz ���F, 3'�c,�,s�, r• ,rte-,,x ;�,�,�r;.,�-�.,M1,,,,.�*✓.mk f �3 b,�.LX "� � � ������� � t➢�,.^ G 4w �'°°�� t 7"x,1 " e. a c+r/ �,�� 1 &�, +A'""�R�� �V�,r �yiA �F�a��"�C'.: G`/. u7 �u��l Cux F`�s �,.•� g r I �g , POWER-1 OP ID:EL DATE(MMDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 01 9111/2016 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: Lacher&Associates Ins AgencyPHONE FAX Lacher Insurance Group A/C No Ell:215-723-4378 A/c No: 215-723-8604 632 E Broad St P O Box 64398 E-MAIL Souderton,PA 18964 ADDRESS: Chad Lacher INSURER(S)AFFORDING COVERAGE NAIC N INSURER A:Harleysville Preferred Ins.Co 35696 INSURED Power Home Remodeling Group, INSURER B:Harleysville Worcester Ins Co 26182 - LLC INSURER C:Nationwide Mutual Ins Company 23787 2501 Seaport Drive Ste B110 Chester, PA 19013 INSURER D:Pennsylvania Manufacturers 12262 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR 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 TYPE OF INSURANCE ADDL SUB POLICPOLICY NUMBER MM/DDYEFF POLICY EXP/YYYY MM DD/YYYY LIMITS LTRINSD A X COMMERCIAL GENERAL LIABILITY _ EACH OCCURRENCE $ 1,000,000 TX MPA00000089793N 10/01/2015 10/01/2016 DAMAGES t RENTED 1,000,000 CLAIMS-MADE OCCUR� PREMISES Ea occurrence $ '. MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,00 '... GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICYFX]PRO-LOC PRODUCTS-COMP/OP AGG $ 2,000,000 '.. OTHER: $ '''...... AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 B X ANY AUTO BA 00000089796N 10/01/2015 10/01/2016 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED - PROPERTY DAMAGE $ HIREDAUTOS AUTOS Per accident $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,000 C X EXCESS LIAB CLAIMS-MADE CMB00000089794N 10/01/2015 10/01/2016 AGGREGATE $ 5,000,000 DED RETENTION$ $ WORKERS COMPENSATION -( '.. AND EMPLOYERS'LIABILITY STATUTE EOR H D ANY PROPRIETOR/PARTNER/EXECUTIVE YIN 201500-66-20-96-7 10/01/2015 10/01/2016 E.L.EACH ACCIDENT I $ 1,000,000 OFFICERIMEMBER EXCLUDED? Y❑ N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $ 1,000,000 B Mass Auto BA 00000018227P 10/01/2015 10/01/2016 Auto Liab 1,000,000 B NY Auto BA 00000074849R 10/01/2015 10/01/2016 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION NANDOVE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 120 Main.Street AUTHORIZED REPRESENTATIVE North Andover,MA 01845 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD C-Taiga ess Street,sw&100 B0stcsrtis M402114-2077 Wol•kers'Compensation hasurance Affldavat::Builders/Contractors/4lectricians/Flumbers. A licant Inforrnafion Please hint I,e `bl Name (Business/Organizationdual): s )� ����°j�(��� / �� t �? < Address: �� I V pity/StatelZip:_ ff0'(- 61' Phone t: 508- z8,6- 015,6 Are you an employer?Cheek the appropriate boa: Type of project(required): 7. I am a employer with �� employees(full andlor parttime). 2.0 I am a sole proprietor or partnership and have no employees worlring for me in 7. 0 New construction. any capacity.[No workers'comp,insurance rrquired] 8. 91emodeling 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 9• Demolition 4.0 I WE a homeowner and will be hiring contractors to conduct all work on m 10❑Binding addition ensure that all contractors either have workers'compensation insurance or arsole oey. I will proprietors with no employees. 11.0 Electrical repairs or additions 5.0 I am a general coMtractor and I have hired the sub-contractors listed on the attached sheet. 12'❑Plumbing repairs or additions These sub-contractors have employees and have workers'comp.insurance.] 13.®Roof repairs 6.0 We are a corporation and its officers have exercised their right of exemption per MGL c. 14.0 Other 152,§1(4),and we have no employees.[No workers'comp.insurance required.] `Any applicant that cheeks box#1 most also fill out the section below showing their workers' compensation t y information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must ysubmit anew affidavit indicating such tContcactors 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 emth ployees, ey must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. lnsIHMCe Company Name: �YL i LC(5 _r /A/FIM A" Policy#or Self-ins.Lie.#•_ ii�)�j,,ti�'�br-V1)- �Zt�' V- Expiration Date Job Site Address: ®_ . I sK (, M 1,IVe City/Statelzip:_ Attach a copy of the workers'compensation policy declaration page(shoeing 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 lnvestigations of the DIA for insurance coverage v 1 do hen eby r' tthCpalns and penalties ofperjrcry that the information provided above is trae and correct Si ature: A Phone#: 8 'e)15,6 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License It Issuing Authority(circle one): 1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical hnspeetor S.Plumbing Inspector 6.Other Contact Person: Phone#: Of C(l)-limer Affairs&Business plgulgliou Licenscor registration valid foy indi-vidul use only DOMIE 110PROVEMENT CCVTRIACTOR before ille eypir26ion date If found return to: RegistraZion, 16861-6Mcc OfCOBsumcr Affairs and Business Reg-0,12tin Typ" 10 Par P127,2-Suite 5170 Expiration: 3/18120117 Supplemenl "ard Bo on,6 --'q 116 POWER HOME REMOOELING GROUP LLC. MARK IVIORDINI 2501 SEAPORT DRIVE STE BI 10 CHESTER,PA 19013 VIDdersecretary of Valid without sigmatuye assacbuSefts Department of Public Safe4, Board of Building Regulations and Standards LiMnse.CS457645 MARK E MORDINI Mf IS NEWELL DR N ATTLEBORO 10A Expiratipm, COMMissioner 0 198/26117 to A D& fl 85