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HomeMy WebLinkAboutBuilding Permit # 3/30/2016 NORTH ' irown otEAndover 0 h ver, Ma *L rue �' O� LAKE ' ' COC MCHTM..CK �1. 0 � .4r4 � DRATE D C> S lI BOARD OF HEALTH PERM-IT T LINIF Food/Kitchen Septic System THIS CERTIFIES THAT ..... .......�, ... BUILDING INSPECTOR ............ .......... ......................... .......................................... . Foundation has permission to erect ......... ............... buildings on . .. .. ...... ...... .. ............ .. .... ...... ® ® � Rough c., 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMITI MONTHS ELECTRICAL INSPECTOR CONSTRUCTIONUNLESS STARTRough l Service .............................. ...... ...��:�:: ..................... Final BUILG INSPECTOR GAS INSPECTOR Occupancy Permit Reg ired 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. Federal ID 4 06.0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 R 1 E A division ofThiclsch Engineering ENGINEERING' 60 Shawntut Unit 112,Canton,NIA 02021 CONTRACT 339-1+02-6335 FAX 339-502-6345 Page 1 PROGRAMTIMS INTO _ I RISE CMA-HES ENGINEERn INOCT 15 AND THCUSTOMER FOR WORK A5 059CRIBFD BELOW CUSTOMER PHOt4E DATE CLIENT Y WORK ORDER Barbara Tomkins (978)689-0688 02/05/2016 427523 00002 SERVIC£STREET ._.. DtLLD1G STREET 157 Lancaster Road 157 Lancaster Road } � I SERVICE CITY,STATP,ZIP _ BILLING CITY,STATE-LP !t North Andover,MA 01845 North Andover,MA 01845 I FEB 8 2016 JOB DESCRIPTION HAZARD BARRIER;We have identified that therearc recessed lights present in your home.unless Due recessed as IC-rated(Insulation Contact Rated)we will create a 3"clearance space around the fixture by using fiberglass blanket insulation as a danmina material,no insulation will be installed across the top and closed cavities which contain recessed lights will not be insulated. $0.00 AIR SEALING:Provide labor and materials to seal areas ol'your home against wasteful,excess air leakage. lluis work will be peribrnted in concert with the use of special tools and diagnostic tests to assure that your home will be 1cR 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 leakanc to attics,basements,attached garages and other unheated areas(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 the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will he conducted by the sub-contractor to ensure the salety ol'the indoor air quality. $650.00 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(96)square feet for damming purposes. $196.80 KrI lC PLAT:Provide labor and materials to install a 4"layer of R-14 Class I Cellulose added to(2514)square feet ofopen attic space. $2,840.52 A'171C ACCESS:Providc labor and materials to institute the back of the attic door with 2"rigid•fhemuLe board and seal the door's edge with weatherstripping to restrict air leakage. $73.91 V13N'I-tLxn0N:Provide labor and materials to install(2)insulated exhaust hose to existing bathroom fart(s). $100.00 COMMON WALLS:Provide labor and materials to insiall 2"FSK faced semi-rigid fiberglass board insulation to(158)square W of common wall area. S553.00 RISK 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 the Air Sealing measures up in the First$680 and an additional$340 ifsavings ate justified by the auditor. For the sufety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air Row in your borne both before the work is begun,and after the wealhcri7ation wort:is complete.We will also conduct a fill 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. "rota!allowable weatherivntion incentive is 53,110. 590.00 Federal ID#05-0405629 121SE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RI S4 A division oi"I'hicisch I.'ngincering ENGINEERING- 60 slutwTnut Unit 92,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 I'ROGR.AM THIS CONTRACT 15 ENTERED INTO EETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIDED SELOW CUENTM ORDER _..._.. _.._.. PHONE GATE CUSTOMER (978)689-0688 02105l2016_ 427523 00002 Barbara Tomkins r DIwNG STREET ..SERVICE STREET 157 Lancaster Road 157 Lancaster Road {'. I OILLIPIG CnY.STATE,ZIP I G L 8 SERVICE CITY,STATE,ZIP k FES 2016 !` North Andover,MA 01845 ! ; , North Andover,MA 01845 C JOB DESCRIPTION 71 $474.53 Program In09.99 Custom64.54 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR T**`One Thousand Seven Hundred Sixty-Four&54!100 Dollars64.54UPON fINAL INSPECTION AND APPROVAL DY RISE ENGINEERING.CUSTOMER AGREES TO TH REMIT E3 RK,nofRECISIONUNT DUE IN FULL TSCHEDUUNO,AND CONTRACTOR REGEREST OF 1%VALL at CHARGED MONTHLY _..."'�-.....-._.. UNPAID eAIRNCE AFTER 330AY3.3Ea REVERSE FOR IMPORTANT INFORMATION ON GU _ _..___._.....- ___ _...._,_ DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES _. ...._ _.. CUSTOMER ACCEPTANCE AUTH O SX3NA E• SEE. neatfnq NOTE:THIS CONTRACT MAY DE WnNGRAWN DY Us IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICER SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. AS SATISFACTORY SPECIFIED.TOR TO US AYILLDE MAGE ORE ACCEPTED. YOU AUTHORIZED TO DO THE WORK The Commonwealth of Massachusetts Print Farm Department of Industrial Accidents Office of In vestrgations 1 Congress Street Suite 100 Boston, Mid 02114-2017 ° www.rnass.govAlia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Inclividual): Builders 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? Checli the appropriate box: Type of project(required): l.0 I am a employer with 100 4. 1 am a general contractor and 1 6. ❑ New construction employees (full and/or part-time).' have 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 8. F-] Demolition working for me in any capacity. employees and have workers' 9. ❑ 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 wort: officers have exercised their 1 l.❑ Plumbing repairs or additions myself. No workers' com right of exemption per MGL Y [ P� 12.❑ Roof repairs insurance required.] c. 152, §I(4), and we have no employees. [No workers' 13.0 Other Weatherization comp. insurance required.] *Any applicant that checks box 41 must also sill 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 allidavil 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. T air an ernplwer that is providing workers'compensation insurance for nzy emplolrees. Below is the policy turd jab site in formatiom Insurance Company Name: ACE American Insurance Company Policy #or Self-ins. Lic. #:WLRC 48151553 _ Expiration Date:6/30/2016 .��. �..,.,.. z — :.. �t Job Site Address: y tt 'i �t ��.r � � �� - �. Cit /State/Zi 7• � �^ " 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 ftp to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of S"rOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement nnay be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify urrrler the pains acrd penalties of pe•jury that the iuformatiou pro►�ided above is tare mrd correct. ,�- 2 ZZ Sr mature: --late-1 e" e� Phone#:603-324-1974 Official use oulb'• Do not write in this area, to be completed by cvtp or town offreial. 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 Person: Phone#: �, t k �242075YYY) 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). rINSURER N PRODUCER 'O Aon Risk Services Central, Inc. g66) 263-71?? 00) 363-0105Southfield MI office 3000 Town Center o Suite 3000 Southfield MI 48075 USAINSURERS)AFFORDING COVERAGE NAICINSURED ld Republic Insurance Company 24147 TOOBUIld COAD. INSURER e: ACE American Insurance Company 22667 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER 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 AI4Y 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 S" TYPE OF INSURANCE S sp POLCY NUMBER POLI I O C Y. LIMITS LTR INBD V"D MM/DO/YYYY (MRI/DD/YYYY1 A X COMMERCIAL GENERAL LIABILITY r4wzY304834 UO 3 L 1J b!3 /2 0161 EACH OCCURRENCE 12,000,000 C LAIR4S-MADE X❑OCCUR. DAMAGE O R ENTED 52,000,0001 PREMISES Ee occunenee) MED EXP(Any one person) S25,000 PERSONAL S ADV INJURY 52,000,000 o, '.. x H'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 54,000,000 POLICY ❑JE T ❑LOC PRODUCTS-COMP/OP AGG S4,000,000 m u OTHER. o n A AUTOMOBILE LIABILITY M,713 304835 06/30/2015 106/30/20261 COMBINED SINGLE LIMIT $ (Ea.—dem) 5,000,000 ANY AUTO BODILY INJURY(Per person) O Z ALL OWNED SCHEDULEDBODILY INJURY(Perawdent) AUTOS AUTOS X HIRED AUTOS X NONN-OWNED PP.OPEP.TY DAMAGE AUTOS Per acndent d UMBRELLA LIAROCCUR. EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION 8 WORKERS COMPENSATION AND VILRC48251553Obi 30)2015 06!30!2016 PER OTH- ' EMPLOYERS'LIABILITY YIN All Other States STATUTE ER '., ANY PROPRFE TOR r PARTNERI EXECUTIVc E L EACH ACCIDENT 51,000,000 C OFFICERMIFMBEREXCLUDED-, � NIA SCFC4825190 06/30/2015 06/30/1016 '... (Mandatory in NH) W1 Only E L.DISEASE-EA EMPLOYEE S1,000,000 '.. If yes,des—be under DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIA41T S1,000,000— E SCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Adorn onal R—rhs Schedul,may be attached if more<pace¢req—rd) vidence o-F coverage RTIFICATE HOLDER CANCELLATION SHOULDANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE �f POLICY PROVISIONS. L�n 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 9CORD 25(2014101) The ACORD name and logo are registered marks of ACORD �;'�r=;:t�l .�,tt ��jj��,;I{'��C�f�'t` _ i�ff?ce 07 Consumer Regulaticoll DO Park Plaza - SuI e >1 ( Bostoini, Massachusetts 021, 16 Hc),m.e III-1pi-ovemient Conti-actor Registration ReplSimbon: 179141 Type: Supplement Card Expiration: 6/25/2D16 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 63063 1 pdate Adduss and return card. Alan,reason for change. Address RencN%n! Falplo: niers, l.osi( and -----f3i'fre cf Co nsumer Aftaars a Business Re^uhi on l-icense or re,istra6on valid for indilidul use unl I ofOE IMPROVEMENT CONTRACTOR before the txpiraitivr,saie- if fauna return to: 1 Office of Consumer A€ieirs and Business Regulatifmn egi�iraiion: 17941 ` p Type ? ,part,Ph=- O,A i Expiration: 612-512016 Supplement%ard Boswn.MA 02116 UILDER SERVICES GROUP, !NC. IC`~A.RG SC".'TJ/-.RTZ 50 JlMMY AN"N'JR?VE v 1i ✓ � " � r','!TGNJi-,oE'.C'-i. FL 02?14 :'ntttr:.ecr;;a: Not ti'BiiLi N ithot t Ji noii re •ir,•I l i.i;�,u 'grl�r�-�rig;: `iI•, ,;:� `'f,'. - .- ., . C;S?'cit.-1C159Ft2 ••�ti^ �`�� 16C:FLAlt!`:tiCHMr(tft'f! , tM Muttclwt (et•Nfl fCilElx Ci9(26l2f)'IEi 4-'Stficft�cf 70. C:SSt.-IC utsul�ficrn Ct>nEr;;ttar '111"'to PuSSE5ti;t current etlilitm of the Massachusertt G'Le Building Co(i(^IS Ouse for fE?V(3(:hffCfil of Lf11ti