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HomeMy WebLinkAboutBuilding Permit # 3/30/2016 ------------— OORTH BUILDING PERMIT 1.1 4-1- C TOWN OF NORTH ANDOVER #0 APPLICATION FOR PLAN EXAMINATION Perm!tNo#: Date Received &S 5 Date Issued: IPORTANT:Applicant must complete all items on this page .... .m:: LOCATION P int PROPERTY OWNER PrIA 100 Year Structure yes no MAP PARCEL: Z NING DISTRICT:-Historic District yes nO Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Ll New Building IM-One family [I Addition L]Two or more family El Industrial El Alteration No. of units: El Commercial 0 Repair, replacement 11 Assessory Bldg El Others: D Demolition D Other DESCRIPTION F WORK BE PIERFORMEf: s. Idenfirication- Please Type or Print Clearly OWNER: Name: Phone. Address: Contractor N?me: r Phone: e -7 (L- Email -4,, 1 A J111", Address: q- b4, a :..... Supervisor's Construction License: Exp. Date: 1 10 4 Exp. Date=. (5 Home Improvement License: Exp. Date: 5 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. Total Project Cost: e2l FEE: $ 4 1 Receipt No.: Check No.: farad NOTE: Persons contracting with unregistered contractors do not have access to the guaranty f - ------------ ---------- gnat 4 6-6f Aqebt/ natur&--of-rx ...........................-0 1-v-,n-- -- e'--r 05i, RTiyAL town of Ancmtover ® Iblia- 2bl - _ h ver ass, 50. 2A(p A" * 0 /.ANE COCMICHCWIC 0RgteD J'p�,�'�� LU) BOARD OF HEALTH P E R1W-_ I LD Food/Kitchen Septic System THIS CERTIFIES THAT ............. ... ... ...... .... :.................. BUILDING INSPECTOR ..�. .................. ............................. Foundation has permission to erect.......................... buildings on JR5....... �t. .. .��r.. . .. .... ............. pRough to be occupied as ..... .. ........ ...... a..vs. . ... ..�. . . . ............ .. .... . ....... Chimney provided that the person accepting this permit shall in every respect conform to the terms o applica Ion 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRESIN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TS 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 Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. fI 6 0 Federal to 11105-0405629 RISE Engineering RI Contractor Registration No 0106 MA Contractor Registration No 120979 R I %S4 E A division of'I'lliclsch Engineering ENGINEERING' 60 Shnwmut Unit f12,Canino,NIA 02021 CONTRACT ONTNACT 339-502-0335 FAX 339-502-6345 Page 1 PROGRAM TRIS CONTRACT IS EMTEREO WTO DETWEE11 1113E CMA-HES ENOINMRINO AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER - PHONE DATE CUE14T# WORKORDER Timothy Mcguire (978)314-3987 02/05/2016 419480 00003 SERVICE STREET _.... ...._ GILLOR;STREET 25 Colgate Drive 25 Colgate Drive SMVICE CITY,STATE,DP BILLING CITY,STATE,ZIP "y '• 7 North Andover,MA 01845 North Andover,MA 01845 Y j _ , JOB DESCRIPTION `r HAZARD BARRIER:We have identified that there are recessed lights present in your home,unless the recessed lights are certified as iC-rated(insulation Conlnet Rated)we will create a 3"cfearanec space around the fixture by using nbcrblass blanket In'iii1ifi6iiii9 A'"' damming material,no insulation Will be installed across the tap and closed Cavities Which contain recessed lights will not be insulated. $0.00 Alit SEALING:Provide labor and nnderials to seal areas ofyour home against wasteful,immss air leakage. This work will be performed in concert with the use of spccial 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,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated amass(windows are not generally addressed.) This will require(8)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but die actual number of Clio is not guaranteed. At the,completion of the wcallierization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the subcontractor to ensure the safety Bribe indoor air quality, $680.00 AIR S1 ALING: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 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 areas(windows am not generally addressed.) This will require(2)working hours.A reduction in cubic feet per minute(cfm)ofair infiltration will occur,but the actual number of cfm is not guaranteed. At the complotion of tic wealheri-ration work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the sali ty of itic indoor air quality. $170.00 AIR SEALING ADDER: (4)working hours. $340.00 DAMMiNG:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass baits to(100)square feet for damming purposes, 5205.00 ATTIC FLAT:Provide labor and materials to install a 4"layer of R-14 Class I Cellulose added to(192)square feet of open attic space. $216.96 ATI'IC FLA`(':Provide labor and materials to install on 8"layer of R-28 Class 1 Cellulose added to(12 10)square feet ofopcn attic space. S1,657,70 FIX rxiSTiNG INSULATION:Slash die vapor barrier,flip,or re-position(192)square feet of insulation in the attic urea. $48.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thcrmax board.Weatherstrip the perimeter. $60.00 t Federal ID 9 05-0405629 RISE.Engineering RI Contractor Registration No$185 MA Contractor Registration No 120979 A division DCThiclsdn Engineering Kom" IS'E ENGINEERING' 60 Showinut Unit 42,Canton,INIA 02021 CONTRACT 339-502-6335 FAX 339-502.6345 Page 2 PROGRAM THIS CONTRACT IS ENTERED UITO BETWEEN RISE CMA-HUS DMINEERIaG AM THE CUSTOMER FOR WORK AS DESCRIBED MOW CUSTOMER PHONE DATE CLIEUT9 WORK ORDER `timothy Mcguire (978)314-3987 02/05/2016 419480 00003 SEnvIC£STREET ._.... BIWNG STREET ...... y r r .. 25 Colgate Drive 25 Colgate Drive j t� r a 1 4 SERVICE CITY STATE,ZIP _. ON.UNO CITY,STATE.LP - ) ./ Y _. •� .�.._ North Andover,MA 01845 North Andover MA 01845 - I FEB 8 2016 .JOB DESCRIPTION VF:N'rft.ATIGN:Provide labor and materials to install ventilation chutes in(46)rafter buys to mnintain air flow. $92.00 BASEMENT CEILING:Provide labor and materials to install(116)linear feet of It-19 unfaced fiberglass insulation to the perimeter ofthe basement ceiling at the house sill. $255.50 RISE Etlginecring 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 the Air Scaling measures up to the first$680 and an additional$340 ifsavings are justifled by the nuditnr. For the safety and health ofyour home's indoor air quality,we will be conducting a blower door diagnostic orlhe available air flow in your hone both before the work is begun,and after the weatherization work is complete.We will also conduct a fill assessment of the combustion safety of your hunting system and water heater.*['his has a value orS90 and is at no cost to you. 'rotas allowable weatherization incentive is$3,110. $90.00 (9 � tom- Total: $3,815.16 Qkw ( lr y Program Incentive: $3,110.01 1 Customer Total: $705.15 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Seven:Hundred Five&151100 Dollars $705.15 UPON FRML INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL OE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT UIFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND COJITRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE AK SPACES ORIZ£p SIGNAN ngin<*Nng CUSTOMER ACCEPTANCE NOTE:THIS CONTRACT MAY DE WITHDRAWN DY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE �.. .. �.�... ACCEPTANCE OF CONTRACT.THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE 30 DAYS, SATISFACTORY TO US ANDARe HEREBY ACCEPTED,YOU ARE AUTHORIZED TO OO THE WORK AS SPECIFIED.PAYMENT WRL BE MADE AS OUTLINED ABOVE � The Commonwealth of Massachusetts Print Form k Depaa-tment of Industr icrl Accidents Office of Investigations € 7777 1 Congress Skeet, Suite 100 Foston, MA 02114-2017 rd - +, wwrv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Ap>�licant Information Please Print Le i 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. ✓❑ 1 am a employer with 100 4. ❑ 1 am a general contractor and 1 6 ❑ New construction employees (full and/or part-tuneyhave hired the sub-contractors 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 employees and have workers' working for me in any capacity. 9. ❑ Building addition No workers' com comp, insurance. [ p insurance 10.0 Electrical repairs or additions required.] 5. F-] We are a corporation and its 3.❑ I am a homeowner doing all wort: officers have exercised their 11.0 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 11 0 Other Weatherization employees. [No workers" camp, insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy inlbrmation. 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 checl:this box most attached all additional sheet showing the name of the sub-contractors and state whether rn not those entities have employees. I f the sub-contractors have eiilployees.they must provide their workers'comp.policy number. 11 I am an employer that is providing workers'eornperrsation insurance fcrr-nz)'emplgyees. Below is the poMi v and job site information. Insurance Company Name: ACE American Insurance Company WLRC 48151 Policy # or Self-ins. Lie, # 3 Expiration Date:6/30/2016— — � t t^. .�ry _ City/State/Zip: , � DC Job Site Address. Attach a copy of the workers' cont"ensation 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 fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form ofa 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 herebcertify under the pains and penalties of perjur,Ir that the utfornaation provider)above is true and correct. r _ ... Si 7r�ature. Date Phone#: 603-324-1974 LLOt only. Do not write in this area, to be completed Ill,city or toxrrr official. wn: Permit/License# thority(circle one): Health 2. Building Department 3. City/Town Cleric 4. Electrical Inspector S. Plumbing Inspector rson: Phone#: 7TE(M%11DDNYYY) 0512412015 CERTIFICATE OF LIABILITY INSURA14CE 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 BE-R,%IEEN 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)- m PRODUCER TIN a NAME- Aon Risk Services Central, Inc. FAX Southfield MZ Office )- (866) 263-71?? (A/c No). (600) 363-0105 m 3000 Town Center o suite 3000 3-- Southfield Southfield MZ 48075 USA INSURER(S)AFFORDING COVERAGE NAIC r INSURED Old Republic Insurance Company 24147 TOPBUi Id Corp- INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann Drive '.. Daytona Beach FL 32114 USA INSURER C. ACE Fire Underwriters Insurance Co. 2070_ 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 LTSUBRI Po CY EX R TYPE OF INSURANCE lNBD WVD POLICY NUA99ER A1ttiDDfYYYY I IAIM/DD/1'Yl'Y1 LJM175 A X COMMERCIAL GENERAL LIABILITY IwzY304834 Ub 1 1J UbljO120161EACH OCCURRENCE 52,000,000 CLAIMS-MADE X❑OCCUR. DAMAGE�fO REN EO 52,000,000 PREMISES Ez occurrence) MED EXP(Any ane person) S25,ODO PERSONAL E ADV INJURY S2,000,ODO p GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 54,000,000 X POLICY ❑JPRO- ❑LOC PRODUCTS-COMPIOPAGG S4,000,000 0 OTHER,: o r A AUTOMOBILE LIABILITY U,LiB 304835 06/30/?015 06 30/20261 COINBINEDSINGLELIMIT 55,000,000 iEe accuden0 '.. ANY AUTO BODILY INJURY(Per person) Z ALL OWNED SCHEDULED BODILY INJURY(Peracudenl) o1 AUTOS AUTOS X HIRED AUTOS X NON-OWNED PP.OPEP.TY DAMAGE U AUTOS (Per amdent O UIFBRELLA LIAB OCCUR, EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WLRC48151553 06i 3Gj2015 G6/3O/7616 X PER 0TH- EMPLOYERS'LIABILITY STATUTE ER Eff ANY PROPF.IETOR I PARTNER I EXECUTIVE YIN All Other SCaL25 EL EACH ACCIDENT 51,OGO,000 C OFFICER/MEMBEREXCLUDED-, NIA SCF 4815290 06/30/2015 06/30/2016 (Mandatory m NM wl Only E L DISEASE-EA EMPLOYEE S1,000,000 If yes,dcscnbe vn der DESCRIPTION OF OPERATIONS below E I.DISEASE-POLICY LIMIT 12,000,00()- ESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule.may be attached if more space rs re auire d) ti-� vidence of Coverage a_ RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE y✓ILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. ¢.mac Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBuild Company 260 Jimmy Ann Drive ����� 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 Office of Consunmer ' sine Reaa_aLlon 4e 5170 10 Park Plaza B o s t o n- INA a s-s a cli u se i t s 0-2 11 16 Hon-le In-Troven,,em Contra(-'toii Registra"1011 Registration: 179141 Type: Supplement Card Expiration 6/2512D16 BUILDER SERVICES GROUP, INC, RICHARD SCHVVARTZ 110 PERIMETER RD NASHUA, NH 03063 1 pdnie Address',Ind return C:Ird.Nlarl' reason for chlin"It. Address Runex a 1 Fi-liplo)n1em Lost and -isun -s B L fion idol 01'fj cc of Coz ger Affin sijitss Rt,-,uh� License or rtgistr�ition valid for iiid;N I use onh 'ore -n nd return to: b-I--I thi!expij,tion d2le- If fuu -HDIO.- IMPROVEMENTCONTRACTOR of("onsw al mer Affiim irid Business Relud i ion: 179141 -i�5� t�egISTrati Type F1,111 azL-S U; 170 Expiration: 6/25/2016 Supplement ard Bostop-NIA 02 116 UJI-DER SERVICES GROUP, INC. ICHARD SCHY-JARTZ JjMM'�ANN' DRIVE AY T 0 N A BEACH, FL 3_11 4 ender. cr:.xrtiNot vnlid!'ti-�!thout signnwrc 16 CUAR U SCf{WAR i"l.. IDS E[flfl'f't ESS STREET Git�f' f41.,[ttcEtc�stet'N[i (I�ilff} C19(2aw i Fi 2c Stfic:Qk:d TO. CSSL.-IC InsulafiC[n CUrtf["actor HMO W pmw"a current edition of tF,c t4tass,cF,usettt aW f.}tlllCfiN CWC IS CaUSP_ for i't?V(1Ci#Cf0i1 of 06