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HomeMy WebLinkAboutBuilding Permit # 3/30/2016 BUILDING PERMITo��a d'S�,�gL�'d TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received wcsaUS Date Issued: 6", IMPORTANT: Applicant must complete all items on this page LOCATION - '' aft ; Print PROPERTY OWNER Print 100 Year Structure yes no MAP '" PARCEL: ZONING DISTRICT:`_. Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building "Qne family 11 Addition 11 Two or more family 11 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other //r/�i/,t ri rr r/,,./lIlifl�r,i////r iS'r",,.T�e!rr1,,/�rr�arl�rrdit,M,rrcyr„/�„,�,/Sr10 r>�l/../,e,r❑�rU,„,r!U�/e_,.rG.,/irri i t ///�r✓rr,/r/,/,,(//,,�l,/,,,,�,�,i i/.,�//r��ir,ir/t/�,�/i//,ir///,/////�/.,/,,./,r.r,./�/a//�///%,/lr,ri,., /Fr.r:.//I1o-ir,,iiiv,or,/�te�/Id,r,,,�/I lrJa/,�/,,/�/,r,�1/,�f/,irf,/,�,,l11��,/,,m,,,/,,,W/rr/r,ie/i//t�,tl,a,,�-/�n�/�:�„Id�s/�r/r��//��//./�r1ri,<,/.,///,%./r„�///!ir//,i/,//,r/i,G///f,r,,(r r/ ./,.Mill / � ,. .. wDESCRIPTION OF WORK TO DE PERFORMED: denti�ic tion ease ype or Print Clearly OWNER: NamePhone. Address: . Contractor Name A �� �,a�� �� i Phone Email: °°; i Address: Supervisor's Construction License:_ / Exp. Date: Home Improvement License Exp.Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� ,..„� FEE: $ Check No.: -2-1-2-_75 Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty.fr1n d i�ign'at_Ir�of Anent/CO�nlner _�.i�r�.att�rQ�r'��onir��tor , NORTH Town '' ver O �'�+• �N• Ft 0 No. T .1t. T ver, ass COCMICMl WICK � �d A0 ATE 1) P` 5 S U BOARD OF HEALTH PERI - IT T ( LD Food/Kitchen Septic System 4 THIS CERTIFIES THAT ......................... .................... .N .......................... ........ ..... ... BUILDING INSPECTOR ........ ......W . ..... .... % has permission to erect......... . buildings on . Foundation ® ............. ® .. .'. ..!�.. ._ .... Rough to be 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,Alt ration and Construction of Buildings in the Town of North Andover. ! PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR CONSTRUCTIONUNLESS ST S .. .... Rough Service .......................:...... .. ... ....................... Final UILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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# RISE, ]Gngitter ring RI Contractor Registration No MA Contractor Registration No A division of Ttdelsch EllgiuceritIg C7 Contractor Registration No R I ENGINEERING- 60 Sbnwmut Unit 172,Conlon,NU CONTRACT (401)784-3700 FAX(401)784-3710 Page 1 PROGRAM THIS CONTRACT 14 ENTERED INTO BETWEEN RISE { CMA-HES ENOINS KIND AND THE CUSTOMER Poo WORK AS Itt7 V PHONE DATE CLIENT WORK ORD ER CUSTOMER Robert Lundy (978)807-3432 02/1612016 428272 00002 SERVICE SmEETT DILUNO STREET 1 18 Williams Street 8 Williams Street SERVICE CITY,STATE,21P BIlUNO CITU,STATE,21P North Andover,MA 0 North Andover,MA 01845 JOB DESCRIPTION i AIR SEALING:Provide labor and inaterlais t0 seal areas of your home against wnstefid,excess air leakage. This work iviil performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a ltealthfhl nit 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 areas(windows are not generally addressed)This will require(1)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 cast to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $85.00 BASEMENT'FLOOR CEMENT MUST BE POURED BEFORE INSULATION $0.00 DUCT SEALING:Provide labor mid materials to seal heating and/or cooling ducts within designated unheated areas. This work will be performed at the rate of$75 per man per hour,which includes materials. (3)working hours. $225.00 SLOPES:Provide tabor and materials to install a 6"layer of R-21 Class I Cellulose added to(14)square feet of slope area.Wherever possible baffles wili be installed to the entire length of each bay to maintain ventilation space. $26.04 KNEEWALLS:Provide labor and materials to install R-13 faced fiberglass to(137)square feet of kneewall. Then install 2"rigid board insulation.Seal all seams will%FSK tape. $500.05 1 14EBWALL FLOOR:Provide labor and materials to install a 14"layer of R-49 Class 1 Cellulose added to(15)square feet of open kneewail floor. $22.90 ATTiC ACCESS:Provide labor and materials to install(1) new,finished plywood,kreewall space access hatch.The hatch will be insulated with code compliant 2"rigid Tlcrnax board,weather-stripped,and held closed by eye hooks. (Wood surfaces will be unfinished. Prime coat and/or paint is not included) $120.00 ATTIC ACCESS:Provide labor and materials to insulate(1) back of the kneewall batch with 2"rigid Thermox board,and seat the edge of the hatch with weatherstripping. $60.00 i RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, lj 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 if savings 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 nit flow in your home 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 heating system and water healer.This lifts a value of$90 and is at no cost to you. Total allowable wcatherization incentive is$3,110. $90.00 i t Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No RISE A division Of Thictsch Engineering CT Contractor Registration No ENGINEERING` 60 Shawmut Unit 02,Canton,MA CONTRACT (401)784.3700 FAX(401)784.3710 Page 2 PROGRAM THIS CONTRACT 13 ENTIREDINTO69TWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CUENTN WORK ORDER Robert Lundy (978)807-3432 02/16/2016 428272 00002 SERVICE STREET BILLING STREET 18 Williams Street 18 Williams Street SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $1,128.89 Program Incentive: $946.67 i Customer Total: $182.22 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Hundred Eighty-Two&221100 Dollars $182.22 t UPON FINAL INSPECTION AND APPROVAL BY RISS ENGINESRING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER SS GAYS.SEE REVERSEFOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCNEOULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE AR ANY BLANK SPA S ,l _ i AUTHORIZED SIGNATURE-ROSE EngMsal" C OM ACCEPTANCE ',. �.. NOTE;THIS CONTRACT MAY OE WITHDRAWN BY Us IF NOT EI(ECUT£D WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIFIED.PAYMENT WILL BE LNAOE AS OUTLINED ABOVE i y {{-,� r(-p G 16 i t I ., The Commonwealth of Massachusetts Print Form � Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA ozII4-zal7 � wwmivass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legit' Name (Business/Organization/Individual): 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? Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 100 4. ❑ I am a general contractor and 1 6 ❑ New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8, ❑ Demolition and have workers' working for me in any capacity. employees9. ❑ Building addition [No workers' comp. insurance comp. insurance.' required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] T c. 152, §1(4), and we have no Weatherization employees. [No workers' 1�.® Other comp. insurance required.] *Any applicant that checks box#1 must also fill out the section belo\v showing their workers'compensation policy information. I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must stibmit 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. Il'the sub-contractors have employees.they must provide their workers'comp.policy number. I ani,an employer that is providing wor%ers'eompensation insurance for nrh ernplo�j�ees. Below is the policy crud job site information. Insurance Company Name: ACE American Insurance Company Policy 4 or Self-ins. Lic. 9:WLRC48151553 — Expiration Date:6/30/2016 — 1f" `"" Cit /State/Zip: f. Job Site Address:_ ll 11 t y 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 oi'criminal penalties of 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 certift under the pains and penalties of reriur r that the r'nfornurtion provided above is tare and correct. Si mature: - Date: r Phone 9: 603-324-1974 Oficial use only. Do not write in this area, to be completed tri'trip 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 Person: Phone#: DATE(MMIDD/YYYY) LIY INSURANCE 06124/2015TLIAB F HIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON'THE CERTIFICATE HOLDER- THIS ERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES ELOW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BEMIEEN THE ISSUING INSURER(S), AUTHORIZED EPRESENTATIVE 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. (NCINo.Ext). (866) 253-71?2 FAX No). (800) 363-0105 Southfield MI office — 3000 Town Center E-MAIL o Suite 3000 ADDRESS: _ Southfield r II a8075 uSA INSURER(S)AFFORDING COVERAGE IN INSURED INSURER A old Republic insurance Company 124147 TOOBUild COrD. INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann Drive ACE Fire underwriters Insurancz Co. 20702 Daytona Beach FL 32114 USA INSURER C. INSURER D INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER: 570058348882 REVISION NUMBER: THIS 1S 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 INBD WVD UBRI POLICY NUM 9ER. MI CY O C 7 LlldnS Mh1/DOIYYYY I(rc)DD ).'YI AX COMMERCIAL GENERAL LIABILITY P4 2Y304834 LID, 1� 201b EACH OCCURRENCE 52,000,000 CLAWS-MADEX❑OCCUP. DAMAGE PREMISES OEi,ccuvDence) 52,000,000 MED EXP(Any one person) S25,000 PERSONAL S ADV INJURY 52,000,000 ©� GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGP.EGATE 54,OOO,OOO v X POLICY ❑JE O- ❑LOC PRODUCTS-COMP/OPAGG S4,000,000 0 OTHER. m A AUTOMOBILE LIABIIJTY MIjB 304835 06/30/2015106/30/2016 COMBINED SINGLE LIMIT ,55,000,1000 (Ea acedent _- ANY AUTO BODILY INJURY(Per person) C) ALL OWNED SCHEDULED BODILY IN JURY(Per a cadent) O ALTTOS AUTOS PROPERTY DAMAGE � X HIRED ALJTOS X NON-OWNED (Per acodent - AUTOS dJ UMBRELLA ILLAu HOCCUP. EACH OCCURRENCE C7 EXCE 55 LABCLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND I v✓LRC48251553 06/30/2015 06/30/2016 X PER OTH- EPLOYERS-LIABILITY yIN All other SLatBS STAT MUTE ER ANY PP.OPF.IETOR/PARTNEP./EXECUTIVE E L EACH ACCIDE N7 11,000,000 C oFFICEP✓MEMBER EraUDED, N/A SCFC4815190 06/30/2015 06/30/'016 tory in NI-Q Uil Only E L DISEASE-EA EMPLOYEE S1,000,000 (Manda If yes,d—be under DESCRIPTION OF OPERATIONS below E LDISEASE-POLICY LIMIT S1,000,000— -T- ESCRIPT ION OF OPERATIONS f LOCATIONS/VEHICLES(ACORD 101,Add,v-1 Remarks Schedule,may be attached if more space are quve d) oidence of coverage _ R-J RTIFICATE HOLDER CANCELLATION _ SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH POLICY PROVISIONS. Builder ServiCe5 Group, Inc. AUTHORIZED REPRESENTATIVE A TopBuild Company y Timmy Ann Drive Daytona tona Beach FL 32114 USA � ©1988-2014 ACORD CORPORATION.All rights reserved. %CORD 25(2014101) The ACORD name and logo are registered marks of ACORD f 'f rd € .; s f.` iia' ( s t Office o7 Coy sumer A?_L hIrshncr: .Busi fess Regulation f: lU ' 3�iaza - Suite 5170 i oStCii= .�\�aS C�'iU��I S 02116 Home Improv emient Contractor Registration Regi imbon: 179141 Type: Supplement Card Expiration: 6/25/20 16 BUILDER SERVICES GROUP, INC. RICHARD SCI- WARTZ 110 PERIMETER RD NASHUA., NH 03063 l }dMe Addaw and return carr;. 1,aK reasan for chant. Ad<lresti Ete,�es:a1 En,nlcjmNu l.osi (and _- ----{ i ci:f t',;asnnrr.4fi'AW� BuAnrss Rtguis;iva 1_icens r,r rrs�istr anion valid for indie icul use ar,3 010E MAPROVEMENT CONTRAC T Or hLfore the e it€ra�liar a t. ,f found return to: 01 ice of Consumer Affairs and Business Ru ulaliml "r egWation: 17n141 Type ' s 1 ;t'arl:Plaza -suai.c 5170 Expiration: 6992016 5upplemem Land Bost„r„,MA 00 16 UILDER SERVICES GROUP. l'NC. ICH)L.FD SCH'jJt-.RTZ 30 ji%lib,4Y AN"N'-DRIVE AYTONA BEACH, FL 32114 ` Not��,?IIL�lwithout SIY•^a lt:rf � it,�II it i.I,,H �IIIR'1�Gln, °sl•i �f!!� �S:j, •- ., . GS::TI.-1(}541112 � rK" `� Ftl t: iAR U SCHWART! k 15 EfFlf!'t'[tlstiti "IRE, F.'E MAnchivUer NEI tf310'2 �(:Stritat.'.Ct 7a. CSSLAC Insulafictn CUrNrtutcrr ifurE to passes a current edition of tttc MEassachuslaYtti Grr.e fadiiiirng Code is Ouse for myaeatian rrf this;(icerrst�- ___._.............