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HomeMy WebLinkAboutBuilding Permit # 2/22/2016 FORTH BUILDING PERMIT LED TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#. Date Received 0A C2 A U5 Date Issued: ,E IWORTANT: Applicant must complete all items on this page LOCATION print PROPERTY OWNER .......... Print 100 Year Structure yesn MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes r,no TYPE OF IMPROVEMENT PROPOSED Lf8E Residential Non- Residential El New Building ane family [I Addition El Two or more family E1 Industrial Alteration No. of units: El Commercial ri Repair, replacement El Assessory Bldg El Dthers: ❑ Demolition El Other a/ ............ VNINAlffilIN NN"151 VS. OR/ "00 F + DESCRIPTION F WOR�JO BE PERFORM Tcl_ Identificon Plea�e Typeor Print Clearly 27 ' OWNER: Name: ]_�5;,A,�ce% tic, 0 4�CJJ Phone: Address: Contractor Ngme:..., K7 (c, 11M./I Ph.one;' Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER 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. FEE: $ Total Project Cost: $ Check No.: Receipt No.: NOTE: Persons coniracting with unregistered contractors do not have access to the guaranpfu ir�L "00, ------ F tA®RTH own of .� L Anc'lover ® ver, Mass, 2 COC MIC �.11 �r �qS RareT E P ® UBOARD OF HEALTH Food/Kitchen 11F Septic System M L &WO Off-MRM THIS CERTIFIES THATC-610.4-S BUILDING INSPECTOR ............. ................................................ ......�.................. ......................... AA .......... Foundation has permission to erect.......................... uildin s on -Al.... .. of.... .. ...... .. . .......... . • Rough tobe occupied as ....... ... . . .. .. ....... .. ..... ...... ................................................................ Chimney provided that the person accepting 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 ®NTS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough Service ............ ..... .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Einal No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected rove the Building Inspector. Burner Street No. Smoke Det. Federal ID 110"405629 RISS, Engineering R1 Contractor Registration No 8186 MA Contractor Registration No 120979 RISE A division orThielscb Engineering ENGINEERING60 Shnennit unit 82,Canton,NIA 02021 CONTRACT 339-502-0335 FAX 339-502.6345 Page 1 PROGRAM TNII CO2nRACT r,ENTERED INTO nETYrMI RISE CMA-IIr:S EtIGINEERIIGANOTIIECUSTOMER FORWORK AS OEICRIREO BELOW CUSTOMER PHONE OATS CLIENTS Woo ORDER Tara Mchards-1-teinl (978)637-7182 01/14/2016 426557 00002 SERVICE-STREET fol LINO STREET 41 Brewster Street 41 Brewster Street SERVICE CITY,STATE,ZIP SILLIRG CITY,STATE,ZIP ` North Andover, MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to scat areas of your home against wastef il,excess air leakage. This work will be pertormad in concert with ilia use of special tools and diognostic tests to agsorc that your home will he left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated a rcahs(windows are not generally addressed.) This will require(8)%working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,fill(the actual number of cf n is not guaranteed. At the completion of the ivcaltori»tion work,and al nu additional cost to lite homeowner,a final blower door and/or combustion safety analysis will be conducted by tiro sub-contractor to ensure,the safety of the indoor air quality. 5G80.00 DAMMING:Provide labor and materials to install a 12"layer of R-3S unfaced fiberglass butts to(50)square feel 1br damming purposes. $102.50 ATTIC FLAT:Provide labor and materials to install a G°Layer of R-21 Class I Cellulose added to(300)square feet of open attic Space. s.37x.0(1 STORAGE BARRIER:Homeowner is responsible for the renlovul ofihe slorvd items blocking the installation ofweadiwizaniun work in the attic. Removal must occur prior to the scheduled work start, $0.110 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. The cover has integral weather-strippin•;to restrict air leakn;e. ,52011.00 VENTILATION:Provide labor and materials to install(I)insuluted exhaust hose with gable wall mounted flapper vent to exhaust existing bathroom fuut(s). $118.75 VFMILATION:Provide labor and tim rials to install ventilation chutes in(1 S)roller bay,to maintain air flow. S3G.0(> STORAGE BARRIER:Homeowner is responsible for the removal of tiro stored itenhs blocking ilia installation ol'weatherirntion work in the basement. Removal must occur prior to the scheduled work start. $0.00 CRAWLS PACE:Provide labor and materials to install (224)square feet ol'R-10 rigid Themuu insulation to the crawispace perimeter wall up to the sill and against Uhc band joist.THUS ISACTUALLY A CRAWL SPACU CEILING IN CONVI RTED GARAGE.30°HEADROOM CONTRACTOR DISCREC ION. $828.80 RISE Engineering will apply all applicable,eligible incentives to this contract. )'nu will only be billed ilia Net onuuau. Currently, for eligible measures,Columbia Gas offers 75'%incentive,not to exceed 52,000 per calendar year,and an incentive of 10011.firr Ilia Air Scaling measures up to the first$680 and In additional S3d0 Irsuvings are justified by the auditor. For the safety and health ofyour home's indoor air quality,we hvill he conducting,a blower door diagnostic oi'the available air flow in your home both bel`ore the work is begun,and after the weuthcrization work is complete.We will also conduct It till a ssessnhenl of the combustion safety ofyour licating system and water heater.'(this has a value of$90 and is at ao cost to you. Total allowable Federal ID#05-9405629 RISE Engineering RI Contractor 114stration No 0106 13 MA,Contractor Raglstretion No 120979 RISE A division of•1'hiclsch[Engincuhig ENGINEERING- 60 Shatvtnitt[blit 112,Canton,MA 92021 CONTRACT 33'9-59'!-6335 FAX 339-502-6345 CONTRACT 4/i� 6 L r Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE C�f A-d i LfJ ENkINHIRING AND THE CUSTOMER FOR WORK AS DE3GRISEO BELOW CUSTOMER PHONE DATE CLIENt WORI<ORDER Tara Richards-Heins (978)687-7182 01/14/2016 4261557 00002 SERVICE STREET DILUNG STREET 41 Brewster Street 41 Brewster Street SERVICE CITY,STATE.XIP DIU-ING CITY,STATE,XIP North Andover, MA 01845 North Andover,MA 01845 3DB DESCRIPTION 6veathcri7ition incentive is 53,110, $90.00 Total: $2,434.05 Program incentive: $2,018,04 Customer Total: $416.01 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE V41TH ABOVE SPECIFICATIONS.FOR THE SUM OF '. "*Four Hundred Sixteen&01/100 Dollars $416.01 UPON FINAL It ECTIOt{{ t10 APPAOVAL DY ENGINICIII..CUSTOMER AGREES TO REI r AMOUNT DUE in FULL.INTEREST OF 5 WILL BE C14ARCED MONTHLY ON A11Y UNPAID ICE ni+t t GAYS.SEE E FOR IMPORTANT INFORMATION OH OUARAUTEES,RIGHTS OF RECI5IGN,SCIIEODUtt(.,AND CONTRACTOR REGISTRATION. f' —po-No-SIGN THIS CONTRACT IF THERE ARE ANY 13LANK SPACES A x1010 12E0 SIGNATUE E00144 ttk CUSTOGIER ACCEPrA.Ncr r4 \l4 NOTE:THIS CONTF64CT MAY GE WITHDRAWN DY U5 tF f4DT EXECUTED 671 tIRN DATE OF ACCEPTANCE `- - - - - - ACCEPTANCE OF CONTRACT•THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE �� DAYS 5 SFACTORY TO US A?;D ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED 10 OO THE WORK AS SPECIFIED,PAYMENT VIILL DE MADE AS OUTUNED ABOVE °wP The Commonwealth of Massachusetts Print Farm Department of Industrial Accidents �u4v, f�� i�r`�``' Office of Investigations a 1 Congress Street, Suite 100 i Boston, MA 02114-2017 wwrv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): guilders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #:603-324-1974 Are you an employer? Check the appropriate box: Type of project(required): 1. ✓V I am a employer with 100 4. ❑ 1 am a general contractor and 1 employees (full and/or part-time).* have hired the sub-contractors h El New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees "These sub-contractors have g• ❑ Demolition working for me in any capacity. employees and have workers' 9. F-] Building addition [No workers' comp. insurance comp. insurance.- required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their I I.❑ Plumbing repairs or additions myself. [No workers' camp. tight of exemption per MGI, 12.❑ Roof repairs insurance required.] c. 152, §1(4), and we have no Weatherization employees. [No workers' 13. ✓❑ Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. 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 most 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. Z am an employer°that i,v providr'ng workers'compensation insurance for•rny�einplgvees. Below is the policy and job site information. Insurance Company Name: ACE American Insurance Company Policy #or Self-ins. Lie. #:WLRC 48151553 Expiration Date:6/30/2016 .lob Site Address: � c a��� ... City/State/Zip: �� �� C�(�� 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. Z do hereby certify under the pains tn7d penalties of perjury tltirt the inforrnatiorr provided above istrueand correct. Si nature: ` Date: Phone#:603-324-1974 Official itse 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 Cleric 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: DATE0612412nV5, ) CERTIFICATE OF LIABILITY INSURANCE 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 -a NAME: Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 d Southfield MI office (AIC.No.Ext): (A1C.No.): v 3000 Town Center E-MAIL o suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A Old Republic Insurance Company 24147 TopBUild Corp. INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER C; ACE Fire Underwriters Insurance Co. 20702 INSURER D: INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER:570058348882 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. Limits shown are as requested LTR TYPE OF INSURANCE INSD VD POLICY NUMBER MMIDDIYYYY MM WIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY3048 4 EACH OCCURRENCE S2,000,000 CLAIMS-MADEX❑OCCUR DAMAGE O RENTED S2,000,000 PREMISES Ea occurrence MED EXP(Any one person) $2 S,000 '..... PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 '.. X POLICY ❑JE Q ❑LOC PRODUCTS-COMPlOP AGG ;4,000,OOO m 0 0 OTHER: I II' A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT $5,000,000 `n Ea accident Ix ANY AUTO BODILY INJURY(Per person) O Z ALL OWNED SCHEDULED BODILY INJURY(Per accident) Gf AUTOS AUTOS NON OWNED PROPERTY DAMAGE U HIRED AUTOS X AUTOS Per accident .r d) UMBRELLA LIAB OCCUR EACH OCCURRENCE V EXCESS LIAR CLAIMS-MAGE AGGREGATE DED RETENTION 8 WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE I oRH EMPLOYERS'LIABILITY YIN All Other States ANY PROPRIETOR I PARTNER I EXECUTIVE E.L.EACH ACCIDENT $1,000,000 C OFFICEWMEMBEREXCLUDED? M NIA SCFC4915190 06/30/2015 06/30/2016 (Mandatory in NH) WI Only E.L.DISEASE-EA EMPLOYEE S1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 '.. DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) '.. Evidence of Coverage AA d..l 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. A c�a Builder services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBuild Company 260 Jimmy Ann Drive Q Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD OI' ice oCosurner Aitairs n Business Regulation << I Park Plaza - Suite i 7� -= Boston, massachusetts 02116 Home I111provement Contractor Registration Registration: 179141 Type: Supplement Card Expiration 6125/2016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASH UA, NH 03063 t ,;date Address and return card.Mark reason for chane. ddre>s Renewal Eniploymer:t Last Card t:c n s u mer A ff a i r s cl Business Regulation License or registration valid for individul use unIN -== - before the expiration date. If found return to: '3ME IMPROVEldiE12T CONTRACTOR pli,cc of C:onsunter A;:mirs and Business Regulation "r°Z2gi5iratior.: 1791411 Tbpeto p -f laza-Suite 5170 Ex iratlon, 6i25/2G16 Supplement-ard Boston,MA 021 H6 11LDER SERVICES GROUP:INC. CHARD SCHWARTZ �. G Jin f�h1�1', ANN s .YTONA BEACH. FL 3_211, i'nderscrretzn NOt vali ,without sirn21ure CSSL-105992 RICIIARD S(,RWARTZ 195 HUNTRESS STREET Manchester NH 113102 09126/2016 Restricted To CSSLAC•Imuli)TIOr,Cc)ntra'10' Fatlure to posses, rent edition of the Massachusetts State Building Cot atjsf'for revocation of tt)i=-,license