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HomeMy WebLinkAboutBuilding Permit # 2/1/2016 f 00RTM q a`�T 48D X64 /QIa BUILDING PERMIT �� b,.:,. e ay TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ATO $0 Date Issued: �' ',CHU`��� IMPORTANT: A licant must complete all items on this a e r i TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential C_ New Building t°" 7ne family Addition L Two or more family Industrial ,wi,,"Alteration No. of units: - Commercial I- Repair, replacement F-i Assessory Bldg F Others: Demolition F1 Other Room=. r ,. � w Identification Please Type or Print Clearly) � ,. '� OWNER: Name ..� � � w;< �- r,�f �;°.,�°`�� �w.� ;�r� Phone: �.� Address: ��I .., ..� ���.,��-���, �,-�� �� �.� " � � � A l ARCHITECT/EN GINEER A'° � Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost:$ � FEE: $ l , ,1 ..Chec �oRecei tNo.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fu , �,. - - i ,J . • , ,liJ��/�����!✓/���J/f/ �r� �!/� r///J/�//c7 i,/��/l//NJ//ii 0%l/P4i/lir ii, ' / J , M 0 WTVIn of AMIN navvc, O NORTH- .� NO. 000,6 C% h ver, ass, ti" L4 (' CO[HIC HE wICH y1. S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �-- � ... .. .. . .��... . BUILDING INSPECTOR ............... 4 . . .......................................................... . Foundation has permission to erect .......................... buildings on ... ....... � .M..!� . ... ........ ...... Rough tobe occupied as ..... ................................ ....... '....J ray,...... .::.............................. Chimney provided that the person accepting this permit sha I 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIOTS Rough CService ................................................................................ Final BUILDING INSPECTOR 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. z �s RISE , 60 Slwwmut Road,Unit 21 Cenion,BM 020211339-602-6336 ENGINEERING www.R]$Eengineerfng.corn Cffkroa cy Encr�zad, OWNER AUTHORIZATION FORM a & (Owner's Name) owner of the property located at: n� Weil (Property Address) (Property Address) hereby authorize (Subcontracto ) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. �—Z&e Q14t�- Ownees Signature Date FoderaI IO#06-1405629 RISE Engineering RI Contractor Registration No 810G MA Contractor Registration No 120979 A division ofThielseb Emghicerhr„ RISING GO Shawmut Unit#2,Canton,NIA 02021 CONTRACT-p^ 339-501.0335 FAX 339-502-6345 Page 1 PROGRAM Tins CONTRACT 15 ENTERED INTO DETwEEN RISE CLIA-II ES E21NEERINO AND THE CUSTOMER FOR WORK AS DeaCRdRED BELOW CUSTOMER .. _. PHONE DATE CLIENT d WORK ORDER Elise Amendola (617)388-4179 12/17/2015 419976 00003 SERVICE STREET OILUNR STREET 328 Summer Street 328 Stammer Street SERVICE CITY,STATE,21P _ _. _. BILLINO CnY.STATE,TIP North Andover, MA 01815 North Andover, MA 01845 2015 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage, This performed in concert Tvith the use of special tools and diagnostic tests to assure that your home will be tell with it healthful level of air exchange and indoor air quality,Materials to be used to seal your home can include caulks,roams and other products. Primary areas for sealing include air leakage to atlics,basements,attached garages and other unheated areas(%eindows are not gencially addressed) 'This will require(8)working hours.A reduction in cubic rest per minute Win)or air infiltration will occur,but the actual number of Clint is not guaranteed. At the completion of the weatherization work,and tit no additional cost to the homeowner,a final blower door and/or combustion sufcty analysis will be conducted by the sub-contractor to ensure the sutety of the indoor air quality. $680.00 Alit SEALING ADDEIt: (4)working hours. 5340.00 AIR SF.AI_ING ADDER: (2)working hours. $170.00 KNUFWA1..LS:Provide labor and materials to install R-13 faced fiberglass to(237)square feet of kneeNkall, Theft install 2"rigid board insulation.Seal all seams with PSK tape. SSfi5,05 STORAGE l3ARRICR:Homeowner is responsible for the removal of the stored items blocking the installation orweatheriudion wvark in the kneewall areas. Removal must occur prior to Ute scheduled work start. $0.00 KNFEWALL FLOOR:Provide labor and materials to install an 8"layer of dense packed R-30 Class I Cellulose added to(3 10) square feet of kncewall floor, $558,00 A'nw ACOS:Provide labor and materials to insulate(3) back orthe kneewail hatch with 2"rigid Tbermax board,and scat the edge ofthu hatch with%Nvothentripping $150.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible memores.Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Scaling measures tip to the first 5680 and an additional 5340 if savings arc justified by the auditor. For the safety and stealth of your horn&s indoor air quality,we will be conducting a blower door diagnostic of Clic available air Ilow in your home both before the work is begun,and allcr the weatherizbton work is complcte.We will also conduct a full assessment of the combustion safety ofyour heating sysicnt and water linter.This has a value of$90 and is at no coo to you. Total allowable wealberization inecinke is 53,110. 590.00 Fedora IIt)#06 406629 RINE,Engineering RI Contractor Registration No 0186 RISE MA Contractor Registration No 120979 A division orThicisch Engineering ENGINEERING' 60 Shat+mut unit#2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6315 Page 2 PROGRAM CMA-fit"sS ENGICONTRACT NAND7 ENTERED INTO SFOR NO tRK�AS DESCRIBED BELOW M.TOdM9R PHONE DATE CUENT x WORK ORDER Elise Amendola (617)388-4179 12/17%2015 419976 00003 SERVICE STREET RSLLING STREET 328 Summer Street 328 Summer Street SERVICE CITY.STAM ZIP - BELLUQO CITY,STATE,ZIP. .._. . . ._. North Andover,MA 01845 North Andover, MA 01845 .JOB DESCRIPTION Total: $2,883.06 Program incentive: $2,439.79 Customer Total: $443.26 WE AGREE HEREBY TO FURNISH SERVICES.COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF '"Four Hundred Forty-Three&261100 Dollars $443.26 UPON FINAL DISPECTRTN ANO APFROVALBY RISE ENOWURINO.CUSTOMER AGREES TO 110,10AlMOUHT DUE IN FULL.INTEREST OF%%VILL BE CHARGED MONTRLY ON ANY UNPAID BALANCE AFTER 30 DAYS,SEE REVERSE FOR IMPOR INFORMATION ON CUARAMUS,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR RF:OISTRATION. 0 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLAN. ACES AWOORTZ IONATI3RB RMITr #inti CUSTONERACCB TANCE NOTE:THIS CONTRACT MAY BE VATHDRAWN BY US If NOT£X£CUTED WITHIN DATE I)F ACCEPTANCE /J 1-.+" ✓ ,N 1 -- - --- ACCEPTANCE Of CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUT14ORM TO OO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE A0 OUTLINED ABOVE The Commonwealth of'Massachusetts 16 Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 UV wwminass.govIdia Workers' Compensation Insurance Affidavit: Builders/Conti-actors/Electricians/Plumbers ApjRficant Information Please Print Legibly Name (Business/Organization/individual): Co-op Power Address: 15A West Street City/State/Zip: West Hatfield, MA 01088 Phone #: (413)772-8898 Are you an employer? Check the appropriate box: Type of project(required): 1.[9 1 arn a employer with 20 4. 0 1 am a general contractor and 1 6. F-1 New construction employees(full and/or part-time).* have hired the sub-contractors + 7. E] Remodeling 2.0 1 am a sole proprietor or partner- listed on the attached sheet. + ship and have no employees These sub-contractors have 8. ❑ Demolition working for trie in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. F-1 We are a corporation and its 10,E] Electrical repairs or additions required.] officers have exercised their 3.0 1 am a homeowner doing all work right of exemption per MGL 11.n Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.E] Roof repairs insurance required.] t employees. [No workers' 13.[R Othe 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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HDI Gerling America Insurance Company Policy#or Self-ins.Lic.#: EWGCCO00187715 Expiration Date: 11/08/2016 e— c, <.. ........ Job Site Address: 1.1&`Y-Y1 t(YV--Qe City/State/Zip: N A i1i Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verificati iuler,A�pdins,,qndpenalties ofpeijiny thaiffie h'6rination provided above is true and correct. Ida hereby certiku I s Si nature: Date: "2 Phone#: Official 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 Pei-son: Phone#: 0 DATE(MM/DD/YYYY) ACCW" CERTIFICATE F LIABILITY INSURANCE 11/12/2015 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(les) 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: Debbie MacNeal James J. Dowd & Sons Ins PHONE FAX 14 Bobala Road AIc No Ext): -538-7444 AIC,No): Holyoke MA 01040 ADDRESS: dmacneal@dowd.com PRODUCER CUSTOMER ID#:COOP INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:HDI—Gerlinq America Insurance Compa CO-op Power, Inc. INSURERB:Torus National Insurance Company 25496 15A West Street West Hatfield MA 01088 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1503274623 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 SUBR POLICY EFF POLICY EXP LIMITS LTR INSR D POLICY NUMBER MM/DDIYYYY MM/DDIYYYY A GENERAL LIABILITY EGGCC000187715 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100,000 CLAIMS-MADE 7 OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 '.. GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X7 POLICY 7 PRO- LOC $ A AUTOMOBILE LIABILITY F-AGCC000187715 11/8/2015 11/8/2016 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ Comprehensiv $ '.. B g UMBRELLA LIAB HOCCUR 70354QISOALI 11/8/2015 11/8/2016 EACHOCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ A WORKERS COMPENSATIONTO YIN ELIGCC000187715 11/8/2015 11/8/2016 WCSTATU- OTH- AND EMPLOYERS'LIABILITY L IT ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ NIA --- ----- ---- - --- ---- "-- ------ (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1 $2,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder is named as Additional Insured per written contract in regard to general liability only. 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. Thielsch Engineering, Inc. 195 Frances Ave. Cranston RI 02910 AUTHORIZED REPRESENTATIVE � ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD r �ry <rr' d BLISir�rCSS I C'( r,rl;�rtroj) 111w,1911,P1, t)�f'I"iC;C:, r:��I'(.,C>r-r;�rrrC�r �Ilrwri��s" 10 Pai C) Boston, Masscachusetts 02 1 16 I Ionic Improvement Contractor Regisircation RI.,gistrafIon 165217 1.ypo,: Supplement Card Expiration, 1/2112.018C O-CJI:' POWER, INC;. I....EAFI DANIELS 15A WESTST' Wf ST' HATHFI_D, MA 01088 1;pdafe Address arrtf /moan cartf, Mark reason for change. 1�1r1dress ftcncvt arl f;Mrrt7foy�arrt:nt f..ost Card )ktrrriil`(;crnsurncr o� CSMC�:tIV14�FlC�u airs wr tiusos Ixegrrlation (,cease or registration valid fro inriividol Ilse(rtty \If lirµ , w T CONTRACT"LC7f before tile expiration date, If foundra:�trrrn to: Office ofConsumer onsumer Affairs acrd Itusiness Regulaatiorr f fde0i trati rt: 165217Type: li)f'a rk f'Lrza�-4iurtc 9f7f) Expiratiow 1/21/2018 Supplement Card Boston,MA 021 16 CO OP POWER, ING, LEAH 0ANIEt..S 15A WEST SJ WEST NA111E.11), MA 01088 -___. __. _ � t;ndt�r•srrrctary �, raot valid without Signature �}asr F r f ,r N�r �r }� r,i�ry ��t Ot f�itW ,endAv'nscV vcls C -097409 LEAN M DANIELS 12 MARCEL.L.A ST ROXBURY MA 02119 j ''T 09/1812017