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HomeMy WebLinkAboutBuilding Permit # 2/1/2016 %AO R TIy O&"'90 j6�'V BUILDING PERMIT �� g�;. . `. ° L TOWN OF NORTH ANDOVER ° � APPLICATION FOR PLAN EXAMINATION x Permit NO; Date Received ATE D Date Issued: m� ��` ° ° I PORTANT: A licant must com lete all items on this age I G TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential C New Building �4-ane family C Addition L Two or more family Industrial �,,teration No. of units: F Commercial F- Repair, replacement F Assessory Bldg I- Others: Demolition rOther �/�1,rG irl / 1, ' ��6 1' - Air 0, , Identification Please Type or Print Clearly) OWNER: Name: C ° Phone :; µ ' Address: 5` i ARCHITECT/ENGINEER P o 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. PTotal roject Cost: $�� �.{ 13�� l Check NoReceipt No. J NOTE: Persons contracting with unlegiste►ed contractors do not have access to the ptawnty fund �,,, ,, ,, /,�„,,.�� ,,,«r°�Y/ u/r Gei/�;� r�,� a i ;/r /✓//lj'�/ /�%��.n,;��/ r a moi;���,, ioii//%//iiir/ rn r a, //n „ , a..6w"ro°�w G� �x�,�.,n,`�`' ��:x(`V sc,+ �F�'•a.�".., a' 6��... lw�6,) �^"°�„„s �,� f� jA0RTH Town of i Andover 'z 2.61 T O - lAKE h ver, Mass, COCHICHE WICK �i9 A�R�tTEO PPa`,��5 S U BOARD OF HEALTH Food/Kitchen P R T L D Septic System THIS CERTIFIES THAT ... .. BUILDING INSPECTOR Foundation has permission to erect ................ J2.5b ildings on . it i .. Rough tobe occupied as ............. .. ......•. ..... .....1.!®' .. ...!! .1.............................................. Chimney provided that the person accepting this permitall 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 CONSTRUTION TARTS Rough Service ` ..... .. ..... .... ......................................................... BUILDING INSPECTOR Final GAS INSPECTOR Occupancy Permit Required to 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. ,l i/CO-OP POWER �ON I//1 ''/%�i�� Wcommunity-owned U l�f , , � 'Oi oRUwnedsstainable energy January 26, 2016 To Whom It May Concern: Enclosed is an application for a permit for insulation worIQ at 125 Phillips Commons, North Andover, NIA 01845 and 328 Summer St, North Andover, ISA 01845. We are authorized by the homeowners to obtain this permit — a note of authorization is included. I believe I've included all the necessary paperwork to have these processed, but if there's anything missing, please feel free to call me at the number listed below or send an email. Please send permit in the enclosed stamped addressed envelope or let us Know when the permit is ready at 617-272-3340, ThanIQ you very much! Best Regards, fiVe Knight Office (Manager Co-op Power 1476 River 5t, Hyde Park A 4A o2i36 (617) 272-3340 olive@cooppower.coop Power is a consumer-owned energy cooperative bringing you quality affordable energy efficiency and renewable energy. Co-op Power 15A West Street,West Hatfield,MA 01088 Boston Office: 1476 River Street,Hyde Parlez,MA 02136 phone:413.772.8898 or 877.266.7543.Hyde Pariz:617-272-3340 fax:413.517.0300 Email: info@coopp0wer,cOop Website:www.cooppower.coop RISE 60 Shawmui Road,unit 21 canton,MA 020211339-602-6336 ENGINEERING www.PJSEenglneering.com pffkien cy Energized. OWNER AUTHORIZATION I, C./ ,- (Owner's Name) owner of the property located at: h Ca I'Yr Yli7 S, (Property Address) (Property Address) hereby authorize `3 1j-�2--r (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perforin work on my property.This form Is only valid with a signed contract. Owner's Slgnature 6.y Date -- Federal ID#OS-0405629 RISS Engineering MContractor rRegisraltion No 1x0979 RISE A division afThielsch Engineering ENGINEERING 60Shawmat(]all#2,Canton,MA 02021 CONTT 339-502.6335 FAX 339-502-6343 Page i PROGRAM CMA-"ES MMIReSIUM't0 AND THE CCUSTEUTERED oMER FOR WORK AS DESCRIBED UELOIN CUSTOMER ..... PHARE _.._ DATE CUEM a ._... ViORR ORDER David Ciaccia (503)313-3260 12/21/2015 422895 00002 saRVlee sraaET __ oawuo sTRECT 125 Phillips Commons 125 Phillips Commons SERVICE CITY,STATE ., _. SILUNO CITY,aTATe,?7P North Andover,MA 01845- North Andover,MA 01845- JOB 845-JOB DESCRIPTION 1•lA7ARDBARRIER:We have identified that there are recessed lights present in your horne,unless the recessed lights are certified its IC-rated(Insulation Contact Rated)we will create a 3"clearance space around the fixture by using fiberglass blanket insulation its a damming material,no insulation will be installed across the top turd closed cavities which contain ret:essed lights will not be insulated. $0,00 AIR SEALING:Provide labor and materials to scat areas ofyour home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be telt with a healthful level of air exchange and indoor air quality.Materials to be used to sed your home can include caulks,foams and outer products. 11rhnary" areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows an not generally addressed) This will require(8)working hours.A reduction in cubic feed per minute(cfrn)ofair infiltration will occur,bat the actual number of cfm'is not guaranteed. At the completion of the weatheriration work,and at no additional cost to the homeowner,a final blower door and/or combustion surety analysis Will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 DAMMING:Provide labor and materials to install a 12"layer orR-38 unfaced fiberglass hints to(68)square feet for damming purposes. $139,40 ATTIC PLAT:Provide labor mrd materials to install a 4"layerorR-14 Class l Cellulose added to(440)square feet ofopen attic space. 51,062.20 KNEEWALL FLOOR:provide labor and materials to install a 4"layer ofR-14 Class i Cellulose added to(40)square feet of open knecwall flootVERY'fIGl1T SPACI:...CONTRACTOR DISCRESTION//ONLY RECOMMENDING DESIGNATED K.WALL SECTION. $44A0 ATfi1C ACCESS:Provide labor and materials to insulate the back of(l)attic hatch with 2"rigid Tbenuax board.Weatherstrip the perimeter, S60.Op COMMON WALLS:Provide labor and materials to install 2"PSK raced semi-rigid fiberglass board insulation to(108)square rec_t or common wall area. 5378.00 RISE Engineering will apply all applicable,eligible incentives to this contract, You will only be billed the Net amount. Currently, for eligible measures,Columbia rias offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Smiling measures up to the first$680 and an additional$340 ifsavings are justified by the auditor. For the safety and hoalti ofyour home's indoor air quality,we will be conducting a blower door diagnostic of the available airflow in your hotne both before the work is begun,and after the weatherixsttion work is complete.We will also conduct a full assessment of the combustion safety of your beating system and water Water,')*his has a value or$90 and is at no cost to you. 'total allowable weatherim fon incentive is$3,110. $90.00 Federal iD#05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RISE A.division orThiclsch Lo inecring ENGINEERING 61)5lin rout Unit/M Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO DETWEEN RISE CIMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW! CUSTOMER PHONE .__. _._. DATE CUE14T9 _ WORK ORDER David Ciaccio (503)313-3260 12/21/2015 422895 00002 SERVICE STREET NLLINO STREET 125 Phillips Commons 125 Phillips Commons SERVICE CITY,STATE,ZIP ....... B.'LUNO CITY,STATE.ZIP North Andover,MA 01845- North Andover,MA 01845- JOB(DESCRIPTION Total: $2,464.00 Program Incentive: $1,943,00 Customer Total: $611.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE SUM OF ***Five Hundred Eleven&00/100 Dollars $511.00 UPON Fit"INSPECTION AINO APPROVAL DYRISE ENNOINEERINO,CUSTOMER AGREESTO UMITAMOU14T DUE IN FULL.INTEREST OF 1%VALL BE CHMOED MONTHLY ON ANY UNNPAND BALANCE AFTER SS DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON CUARA14TEES,RIGHT'S OF RECISION,SCHEDULINO,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AIITHOJVNAIATURE-RI NOTE:THIS CONTRACT MAY HE WITHDRAWN BY US IF NOT EXECUTED VAnUN DATE OF ACCEPTANtC£ ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONMTIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HERESY ACCEPTED.YOU ABC AUTHORIZED TO 00 THE WORK AS SPECIP".PAYMENT WAIL DE MADE AS OUTLINED ABOVE � Ci The Coninionwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 dw wwminass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Almlicant 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): 1.2 1 am a employer with 20 4. ❑ I am a general contractor and 1 6. F-1 New construction employees(ftill and/or part-time).* have hired the sub-contractors 2.0 1 am a sole proprietor or partner- listed on the attached sheet. t 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9, E] Building addition [No workers' comp. insurance 5. [:1 We are a corporation and its 10.El Electrical repairs or additions 3 E] required.] officers have exercised their -1 Plumbing repairs or additions 1 am a homeowner doing all work right of exemption per MGL 11.F myself. [No workers' comp. c. 152, §1(4),and we have no 12.0 Roof repairs insurance required.] employees. [No workers' 13.[R Other it)5 comp. insurance required.]_ *Any applicant that checks box 41 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. lContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I ant art employer that is providing workers'compensation insurance for my employees. Below is th e policy all djob site information. Insurance Company Naine: HDI Gerling America Insurance Company Policy#or Self-ins.Lic. #: EWGCCO00187715 Expiration Date: 11/08/2016 4 -, J,I /1'14, t � S , �> ) Cvi Job Site Address:, City/State/Zip: k�0 �Adc�l�vlltl 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 verification. I do hereby cei,-I,'ify,;i 'd�'r,the-.ptiiiis and petialtie�;,'o"f—XiFr'juty that the infbrination provided above is true and correct. Si natures Date: 2 5 L) Lionel#" 2 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#: AC RVQCERTIFICATELIABILITY INSURANCED /DD/YYYY) 11/12/2015/12/12/22 015 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: Debbie MacNeal James J. Dowd & Sons Ins PHONE FAX 14 Bobala Road (AIC,No,Ext: 13-538-7444 AIC No: Holyoke MA 01040 ADDRESS: dmacneal@dowd.com PRODUCER CUSTOMER to#:COOP INSURERS)AFFORDING COVERAGE NAIC# INSURED INSURER A:HDI-Gerling America Insurance Compa Co-op Power, Inc. INSURERB:Torus National Insurance Com an 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 S BR POLICY EFF POLICY EXP LIMITS LTR INSR WVD POLICY NUMBER MM/DD/YYYY /Y MM/DDYYY A GENERAL LIABILITY EGGCC000187715 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 !q7CLAIMS-MADE MERCIAL GENERAL LIABILITY DAMAGES(RENTED 100,000 PREMISES Ea occurrence $ILI 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 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY EAGCC000187715 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 X UMBRELLA LIAB OCCUR 70354QI50ALI 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DEDUCTIBLE _ $ X RETENTION $10,000 $ A WORKERS COMPENSATION EPIGCC000187715 11/8/2015 11/8/2016 We OLT ER AND EMPLOYERS'LIABILITY Y/N ORBYLIMITS ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? r 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 $1,000,000 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 Y,I" /h f'. ( ffIc;cX o1 C.,oI a � r �r I`l,.rrr�s rcl Business rc lac <a rl t l rr Boston, Mass(,,)ch usetts 02116 1 Jornc Improvement Contractor Registr,,ilia a Reqistr�ifiow 165217 type: Supplement Card Expiration 1/21/2018 (.._E AH DANIELS WEST* FIAT'FIEL D, MA 01088 I�pdateAddress and return card. Mark reason for change. ;.::A ii.ddress Rcoewal Employment I.,ost Card of r�)ffirc(11' i lsruracr Affairs& 13rrsirre,v kogulratiorr 1 icense or registration valid for individual use only �Wi 1 before the expiration datc. It"found ac°trarrr to: ,4 Office of Consumer,Affairs and l3usinoc Regulation Registration: 165217 'EyIte; III I''arl<lkLara -Suite 5170 Expiration. 1/21/2018 Supplement(;ald Boston,NIA 02110 CO-OF'POWER, INC, LEAH DANIELS S WEST HATFIELD, MA 01088 tlrrdr raccrrrurr�v���� �� Not valid rvitlararat si nattarc k 1 �i ro� iris ,trd a �F a�lrvua ort r>t I rri�l�x r xta `y vd psi l(h'j dk0 ,j ,Ifil Yd ""ata99rjA9 d'r '. CS-097409 LEAH MDANIELS iYml 'y 12 MARC.ELL.A S1 ROXBURY MA 02119 PY r �� 0511812017