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Home My WebLink AboutBuilding Permit # 2/22/2016 TH BUILDING PERMIT OOR "",ED ,, t' 1, 6 D ,p TOWN OF NORTH ANDOVER e�_ 0 APPLICATION FOR PLAN EXAMINATION # Permit No#: Date Received ATED Date Issued: �Ml�01RTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Q L/2 t A Print 100 Year Structure yes no MAP I . PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ' '.One family El e� El Addition El Two or more family El Industrial PF-Alteration No. of units: El Commercial El Repair, replacement [I Asse;sory Bldg Li Others: El Demolition El Other i"W" 1,'---1/.......... SCRIPTION OF W, IRK TO BT PERFORM Id tification- PI ase Type or Print Clearly Phone OWNER: Name: v'l")(4, el-7 Address: Contractor Narne:1( Phone: 'A Email Address: 111 rA '24 A 42A -s Supervisor's Construction License: �21 42 Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDII PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Pro oject Cst. FEE: $ , Check No.: Receipt No.: Lk) Zl 1�5 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund lgnat6r6' 6i6: � NORTH ftdover 2 ? _E �', town ot ® � . 0 _ LAKE h ver, ass, K co«MicHewsc« 1.. ATED RMQ UP BOARD OF HEALTH Food/Kitchen F= R IT T L =U=ft' Septic System AWEVA THIS CERTIFIES THAT BUILDING INSPECTOR ................ .. ........ ........... ..... ............................... ........ ........... ...... ....... ... ...,.'... . Foundation has permission to erect .......................... building on ... . .....LoltA..C.wAjk..r Rough tobe occupied as ........... . .. ............... ..... .. ... A.... .............................................. Chimney provided that the person accepting this permit shall in every respect conformm o 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 PERM IT EXPIRESIN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIr TARTS Rough �j Service ........ . ....... � `• � -!----- ----............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Displayin a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal ID A RISE,Fngineering RlConhactorR2eglstmtionNo MA contractor Reglstratlon No A division ofThiNlsch Engineering CT contractor Regftirafion No 60 Shawmut Unit 02,Canton,MA 02021 r CONTRACT 339.502 6335FAX 339-502-6345 Page 4 PROGRAM Th?3 CONTRA"13 EMT=11C1r0 aL WEIEPr AM NGiNEE INii� �6-I� S r?aa TTCEc rcrnxranvraracka CUSTOMER PNONC GATT? CLOWTV WOnK OADM Debbie Schmidt (978)502-8311 05/1 414583 0000 130 Laconia Circle 130 Laconia Circle !JERVICE P,rTY.sTA'rf,7J"i -� _v --- ------- ---aiY.=cm.STAT,22P Nonh Andover,MA 011545 North Andover, MA 01845 MAY 9 JOB DESCRIPTION AIR SEALING.,Provide labor and raalerisls to seal areas of your home against wasteful,cams air lcakagc. This work will be performed in concert with the use ofspecial tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,faanr,and other products. Primary auras for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addrcssed.) (8)working hours. At the completion of the weatherization wotk and at no additional cast to the horneoetimcr,a final blower door and/or combustion safety analysis will be conducted by the sult-contractor to ensure the safety of the indoorair quality. $680.00 Alit SEALING ADDER: (4)working hours. $340.00 AUDITOR'S NOTES DRYER VENTS TO ATTIC...DRYER MUST BE VENTR-D OUT!!! $0.00 DAMMING:Provide labor and metcrials to install a 12"layer of R-38 unfaced fiberglass batt to(40)square feet for damming purposes. $82.00 ATTIC FLAT:Provide labor and materials to install a 4"layer of R-14 Class I Cellulose added to(1080)square feet of open attic space. $1,220.40 AMC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small flat surface of plywood will be created around the opening within the attic. This will allow the covci s integral weather-stripping to restrict air leakage. $237.65 VER11LA11ON:Provide labor anti materials to install(3)8"diameter roof v rrt(s)io htarca e v�atfiation in attic scans. The vent carr be supplied in(circle color)black,brown,gray or mill finish. 5256.50 VENTII,.ATION:Provide labor and materials to install(1)insu!nted exhaust hose with roofmounted flapper vent to exhaust existing bathroom fan(s).AUDiTOR'S NOTES DRYER VENTS TO ATTIC...DRYFR MUST BE VENTED OUT!11 $118.75 VENTILATION:Provide labor and materials to install(l)exhaust hose with wall mormled flapper vent to exhaust existing clothes dtycr(s)_ $147.00 RiSE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for Ute Air Seating measures up to Ole first$680 and an additional$340 ifsavings are justified by the auditor. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your(tome both before the work,;is begun,and after the weathcrization work is complete.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you, Total allowable wcatherizatfon incentive is$3,110. $90.00 Federal 11) JSid Engineeting RI Contractor Registration No A division OfMA Contractor Registration NoThielsch FOgineering CTContradorRegistration No 60 Shawrnut Unit€t2,Canton,MA 02021 CONTRACT r _ 339502-6335 FAX 339-502-6345 Page z PROGRAM ENTERED FTWESIS KARAGlAd��!�G CMA-HES ENOWEITHIS MIND CONTRACT IS CUSTOMER FOR W=K DESGRIe�Il£LWY CUMM132 —"- --_--- PHONE -" — DATE CUENTD WOR}TORDER Debbie Schmidt (978)502-3311 05/14/2015 414583 00002 SERVICE STREET BALING STREET _— 130 Laconia Circle 130 Laconia Circle SERVICE CITU,STATE,ZIP SILLMO CTTY,STATE,ZIP North Andover,N4A 01845 North Amdover,MA 01845 MAY 1 9 2015 li JOB DESCRIPTION `total: $3,172.30 Program Incentive: $2,556.72 Customer Total: $515.58 WE AGREE HEREBY To FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH A@OVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Fifteen&581100 Dollars $515.58 UPON FINAL.INSPECTION AND APPROVAL BY RISFF�eOMEERING.CUSTOMER AGREES TO REMR AMOUNT DUE IN FULL INTEREST OF 1%WILL DE CHARGED MONTHLY ON ANY UNPAID EIAUW 90 DAYS.SEE C'bR--7; ANY INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDUUNG,AND CONTRACTOR RE"TRATOIL DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AIMM SIG N4 �c�T.giT,c'artg ACCEPTANCE NOTE:7115 CO HAY DE WITHDRAWN BY US IF NOT EXECUTED VMIN DATE OF ACCEPTANCE 3O ACCEPTANCE OF CONTRACT'THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE DAYS, AS ISFAi mFl PTo US A ABBEHERMY OUTLINED YU ARE ABOVE AUTNORIBED TO DO M WORK 4 Tite Commonwealth of Massachusetts Print For Department of Industrial Accidents J Qffice ofInvestigations .1 Congress Street, Suite 100 Boston, MA 02114-2017 W W W.n1lCSS.gOVIl11 a Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leiibly Name (Business/Organization/Individual): guilders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #:603-32.4-1974 Are you an employer? Check the appropriate box: Type of project(required): I.❑✓ I am a employer with 100 4. ❑ I am a general contractor and I employees (full and/or part-time)." have hired the sub-contractors 6. F-1 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 8. ❑ Demolition working for nue in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp, insurance.'+ required.] 5. F-] We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I I. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] c. 152, §1(4), and we have no Weatherizatian employees. [No workers' 13.❑✓ Other comp. insurance required.] *Any applicant that checks box#1 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 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 employees,they must provide their workers'comp.policy number. Z am an employer that is providing workers'compensation insurance for my employees. Below is thepo/icy andjob site in f or'rnation. Insurance Company Name: ACE American Insurance Company Policy# or Self=ins. Lic. #:WLRC 48151553 Expiration Date:6/30/2016 .lob Site Address: � C,.. ��t"� ` °' C ��.� � CitylStatelZip: 1/ft, � /`" �, �� " 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. 1.52 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 $250.00 a day against the violator. Be advised that a copy of this statement+nay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I da lrereFiy cern y under the pains a d1 enrlt' s of perjury that the information provided above is true and correct. 0,, Signature: Date Phone#:603-324-1974 Official use only. Do not write in this area,to be completed by city,or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Cleric 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: CERTIFICATE LIABILITY INSURANCE q ]]� y�j� DATE(MNIW/YYYY) THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the pohcy(ies)must be endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT ro PRODUCER NAME: Aon Risk Service$ Central, Inc. P ONE (866) 283-7122 FAX (800) 363-0105 Southfield MI office INC.No.Ext: AIC, No,: 3000 ToWn Center o aboRess: � Suite 3000 Southfield MI 48075 USA INSUREP4$)AFFORDING COVERAGE NAIL# INSURED INSURER A: Old Republic insurance Company 24147 TOPBuiid Corp. INSURER B; ACE American Insurance Company 22667 260 Timmy Ann Drive INSURER C; ACE Fire Ondertariters Insurance Co. 20702 Daytona Beach FL 32114 USA INSURER D: INSURER E: INSURER F; i COVERAGES CERTIFICATE NUMBER:570068348882 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 L R TYPE OF INSURANCE INSD WVD POLICY NUMBER M D LIMITS X COMMERCIAL GENERALLIABILn'Y MWZY EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR PREMISES 1Ea occurrence _,..S2,000,000 MED EXP(Any one person) $2S,000 PERSONAL 8 ADV INJURY 52,000,000 GENERAL AGGREGATE $4,000,500 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑ PRO- M LOC PRODUCTS-COMP,'OP AGG $4,000,000uD 0 OTHER: D i A AUTOMOBILE LIABILITY mwa 304835 06/30 2015 06/30/2016 COMBINED SINGLE LIMIT $5,000,000 IF BODILY INJURY(Per person) X ANYAUTtl ALL OWNED SCHEDULED BODILY INJURY(Per accdeM) AUTOS AUTOS PROPERTY DAMAGE U ER X HIRED AUTOS X NON-OWNEO (Par accident) AUTOS d EACH OCCURRENCE UMBRELLA LIAR OCCUR F__ AGGREGATE EXCESS LIAR CLAIMS-MADE DED RETENTION EI WORKERS COMPENSATION AND WLRC48151SS3 06/30/2015 06 311 2016 X STATUTE OTN EMPLOYERS'LIABILITY YIN All Other States E.L.EACH ACCIDENT 51,000,000 ANY PROPRIETOR IPARTNeR,EXECUTIVE o SCFC4$15190 06/30/2015 06/310/2016 _--. C (Mandatory in ER EXCLUDED? NIA WI Only E.L.DISEASE-EA EMPLOYEE 51,000,000 (Mandatory i»NH) Y Itas,describe under E.L,DISEASE-POLICY LIMIT 11,000,000--- DESCRIPTION OF OPERATIONS below I '—' DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Sehedule,may be attacbed it more space Is required) Evidence of coverage CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVIS(ONS. I Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TOI)BUild Company a 260 Jimmy Ann Drive Daytona Beach FL 32114 USA �+ 01988-2094 ACORD CORPORATION.All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD P i.%rL�'l,Jf 3s''/�7�� '��P 1.,y�•�?�J f�f.f ,y Y��3';,� { bffice of Co Sumter Affairsand Business Psi gLdation � a_ 3 'ark 'laza - ui4e -5170 Boston' MassadfflSettS 02116 Home Improvement Contractor Registration Registratlon: 17914, Type: Supplement Card BUILDER SERVICES GROUP, INC, Expiration 6/2512016 RICHARD SCF-iWARTZ 110 PERIMETER RD NASHUA, ISN 03063 Cpdate Addres,,and return card.Mark reason for chnnge. '!drew Renoal vniployment Losi Card _Office'of Consumer Af'fdn'8: Business Regul.,aaion License or rcgistr:aii an v21it3 for irtdi+ dui USc tJ t!ti 14OME IMPROVEMENT CONTRACTOR before the expiration date, If found return to: i ,.' Office of Cousunier Affairs and Business kegulatirar. -Registration: 179`141; Type ltlf'ark Plaza `ya:atc-:"I-(j Expiration: 61e5/2016 Supplement -ard Rostur3.NIA 02116 BUILDER SERVICES GROUP,W0. 1ti0,.Y7FiR D S CHWAPT2 260 j1MM1Y At-IN DRiVE DAYTONA BEACH,Fl- 321 I"ndcr cerciery 'Not valid iihont signature CSSL-'tf353�� RCf"E'ARDSCEr SRTt 19,5 tiuwrRESS STRE ET Manchecter`JI (8102 € E "� -4W— t� t2ff2f1 f�i Restrfcted To CSSLIC, iacte)r F E € i t Failure tq f,-ditiCr of the MassachuseM st;tt:�Building 10,