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HomeMy WebLinkAboutBuilding Permit # 4/15/2016 OORTH BUILDING PERMIT TOWN OF NORTH ANDOVER to it APPLICATION FOR PLAN EXAMINATI Q, Permit NO: Date Received T LI-LL Irg Date Issued: CH IMPORTANT: Applicant must complete all items on this page r r/ �i �r / /�/ / � /,,, �/ // /i,,,,iii/r ,, / /io ���i/i�///// , r/ / r�>� r ��/, /. /ii,,// „��/��r./i//�����r%�ir/,rii////��/// //it/ �/ �lfi/��r /% it a.a�i- r��1� „�;r/.fir ;��I r /��,0%(�i�i�/�////��/rl�/;/��/�, ����j�i,. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential j New Building D, bne family Addition ❑ Two or more family I I Industrial L�-Alieration No, of units: 0 Commercial Repair, replacement il Assessory Bldg 11 Others: L i Demolition El Other 'rti,r11/1 offill", e 'I K S(94"L CA, �Al- VA U, Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: garg", g M . ..... 10 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: $ FEE: $ o 'Check No.: Receipt No.: NOTE: Persons contracting with uni-egistei-ed contractors(Io not have uaranty.ftind SignatuWaf-A h r ign ttare of,b6h rA',ft �Kl SAO TH Town of '_ : ` _ Andover O to ® _ h , ver, Mass, 0 14 1 .5 La of I. COC LAK WICK -�• y ��p0R^TED � U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT Kcv(.11Vi�L BUILDING INSPECTOR..........-V..f.......... Foundation has permission to erect ................ buildings on 1..� pf f V. .. .......... g .... ... ... .. . .. ....... Rough to be occupied as .....Al+.f ...... ... .. ..S. �.+. .1.0.n......................................... 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .............. Service �t. ..................... Final BUILDING 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. b RISE60 Shawmut Road,Unit 21 Canton,MA 02021 [339m502m6336 ENGINEERING SEengineering.com Efririer.�y E;ie;gized, OWNER AUTHORIZATION FORM I, Kevin (Owner's Name) owner of the property located at: 97 Appleton Street, North Andover, MA 01845 (Property Address) (Property Address) � r hereby authorize '^ ° (Subcon dor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. Owner's Signature gate Federal ID 4 054056* RI CmRog tractor latrAon No 89B6 RISE Engineering MA Contractor Rogisiration No 9209-74 A division of'ThiflsCh EdglueeAtlg C-l'Contractor Registration No 620120 IR I GIN (%` 60 Shawrout,Canton,rVIA OM) CONTRACT 339 197 FAX 339502-6345 Page Tm cowmAel,is Farre turn UEMUN War PROGRAM CNA-HES ". "WdW=TW CUSTOMM POR WORK AS oesrAvaw 8"W FRORP OAT6 CUM if WORK ORDER Kevin Lundy (617)259-5493 01/20/2016 428877 00002 L MUM SIRM 97 Appleton Street 97 Appleton Strect 0".ma c8iy.817dTE,lip NoTth Andover,MA 011145 North, Andover,MA 01845 ['".-SCRISON -- — A6 SEEMO:Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage. This work will be Wbm�ied i n conceit with thew of special tools and diagnostic test to assure that your home will be ten with a heWtinul love]of air exchange and indoor air quality.Materials to be used to seal your home m include caulks,foams and other product, P6tnary arm for scaling include air leakage to attics,basements; attached garages and other unheated areas(windows are not generally addressed.) This will require(9)working hours. A reduction in cubic feet per minute(01m)of air infiltration will occur,but the actual munbcr of of N 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 be conducted by the sub-contractor to ensure the safety of the indoor air quality, $680.00 AIR SEALING ADDER! (2)working hours. $170.00 AIR SEMANG:Provide labor and materials to install Q4on weathemiripping and a doorsweep to(1)door(s)to restrict air leakage. $75.00 DAMMING:Provide labor and materials to instil a 120 layer of 12-3$unfoed fiberglass baits to 32)square feet for damming pwposes, 'er "Il a AM a' and W matert Provide $270.60 AT'171C FLAT:Provide labor and materials to install a 10"layer or R-35 Clam I Cellulose added to(1380)square feet ofolleff attic spare, $2,028.60 AT IT hU-'ESS,Provide labor and materials to insulate the back of attic hatch with 2"rigid Thermax board.ti cal the perimebm $60.00 VENTILA*nON:Provide labor and ntaterials to install(1)insulated exhaust hose with roof mounted flapper vent to exb"st future bothroolit fan(s). $118,75 VFNTTT-.A'nON:Provide labor and materials to install ventilation chutes in(63)rafter bays to maint;9in air flow. $12&00 -AS" CEILING:Provide labor and materials to install(120)linear feet ofR-1 9 unlaced fibeIPJass insulation to the pesimeley Of the it" "erColumbiang�the house� basemerit coiling at the house sill, $210.00 RISE Engineering will apply all applicable,elioWble-in:t=tives to this contract. You will only be billed the Net amount. Cwrtoft,for eligible incentive, neen 'n.tto 75/ apply if at, measumi, Gam ofts 75%incentive,riot to exceed$2,000 per Wendar year,and an inwritiveot'100%for the Air Sealing measures 1 .0 up to thee first$680 and an additional$340 ifsavings are Justified by the auditor. For jhe safety and htaid,ofyour house's indoor air quality,we will be conducting blower door diagnostic of available air now in Your home both before the work is began,and after the weathetirAon work is complete.We will also conduct a full assessment Ofthe combustion safety of your heating system and water heater.'This has a value of$90 and is at no cost to you. Total allowable weatherizati(al incentive is$3,110- $90.00 M H 45-0405629 RI Contractor R istrat3on No 8165 RISE Engineering MA Contratior RegiStntlon No M97$) F. `_ A diviSion Of Thiet9th Fagineering CT Coptrartnr R on NO 6213120 0 S6awmut,Canton,'.MA 02021 CONTRACT 339-502-5197 FAX 334-502-6345 Page 2 PROGRAM Trus couraA.cr Is ExreRID wxo WTw'Wa tusc CMA-HES EUMEMWG Atm IM CUSTOWER FOR WOW AS DP.BCRtHEO UE2.M ---- ctrSTOW"R PHONE DATP WENT 0 Y ORO Ormp3't Kevin Lundy (617t)259-5493 0111012016 428877 00002 -----.----__. SERVEC;F.3TkE: i BSl,l..4ldt5 SYRF_ET 91 Appleton Street: 97 Appleton Street SOME t TY,STAM BP 6UIM Cm" STATE;,ZIP 'North Andover, MA 01145 North Andover,MA 01$45 JOB DESCRIFFION Total: $3,828.9 Programa Incentive. $2,940.00 u tom r`Total: &96 WE AGREE HERFOY TO FURNISH SERVIO .G4?tPLETE W ACCOMANi E WITH ABOVE SPEcti-ICA)ID"4-,> 6 OXY THE SUM OF "'Eight Hundred Eighty-Eight&95M00 Dollars $889,9 UPOW FUde1.. 1�,3Pd", 014 An APPMVAL BY RL511 EPi6i1tiEMN0.rUSTOMM Af,REZS TO MW AMOUNT DUE EN PULL.INTOMST OF 1%WILL U`k CEIAR6ED MOWMLY OV ANY UFtPa JL# yC AFT`E�iR M OAM RM MME FOR i POWART INVOWATLON ON GUANAHTFI.+Rk3RM of 1tEf t3 ott,6UKE<'DULttdt3,AR.CtL�tt4'rf+hYW tL —� 4ti9 DLJ NOT SIGN THIS CONMCT IF THERE ARE ANY BLANK SPACES n� qq - ACFNAUTRO 81 E riglrwti g CMOMMCE !A M4 Tfi;S COMPACT MAY RPS MWO,R"M by US IF NOT LXIV M—f)VMWN DATE OF ACCE TANM ACCEPTANCE OF MINTRACT-TNEABOVC PR(CZ3.SMOF1CATIOUS XU 21onrnOm ARE ,31a DAYS, SATISFACTORY TO US AUD ARC HIMUBY ACCEPT ,YOU ARE AMMOM M TO DO THE WORX .. .___._.....�...�... AS spE cine].pAYM.tMT ftL BE MWV A.9 OUTONE1)ADOVE I ' LIABILITY INSURANCE DATE(MM/DD/YYYY) 11/12/2015 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 James J. Dowd & Sons Ins NAME: Debbie MacNeal PHONE F 14 Bobala Road ac No Ext: - - A/C No): Holyoke MA 01040 ADDRESS: dmacneal@dowd,com PRODUCER CUSTOMER ID#:COOP INSURED INSURER(S)AFFORDING COVERAGE NAIC# Co-op Power, Inc. INSURERA:HDI-Gerling America Insurance Compa 15A West Street INSURERB:Torus National Insurance Company, 25496 West Hatfield MA 01088 INSURER C; INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:254565888 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. INSR 'ADDL SUER LTR TYPE OF INSURANCE IN WVD POLICY NUMBER POLICY EFF POLICY EXP MM/DDlYYYY MM/DD/YYYY LIMITS A GENERAL LIABILITY EGGCC000187715 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY D E E TE6---— CLAIMS-MADE OCCUR PREMISES Ea occurrence $100,000 MED EXP(Any one person) PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'LAGGREGATE LIMIT APPLIES PER,7POLICY PRO- XPRODUCTS-COMP/OPAGG $2,000,000 JECT LOC A AUTOMOBILE LIABILITYEAGCC000187715 11/8/2015 11/8/2016 COMBINED SINGLE LIMIT ANY AUTO � (Ea accident) $1,000,000 ALL OWNED AUTOS BODILY INJURY(Per person) $ X SCHEDULED AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS PROPERTY DAMAGE $ (Per accident) X NON-OWNED AUTOS Comprehensiv UMBRE B X EXCESS LAB OCCUR 70354Q150ALI 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 EXCESS LIAR CLAIMS-MADE DEDUCTIBLE AGGREGATE $1,000,000 X RETENTION $10,000 �$ A WORKERS EMPLOY RS'LI A ILITION E4TGCC000187715 11/8/2015 11/8/2016 T CY LATT OE H- ANDEMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N OFFICERIMEMBER EXCLUDED? ❑ N/A E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYE $1,000,000 DESCRIPTION OF OPERATIONS below E.LDISEASE-POLICY LIMIT I $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder, Eversource, and National Grid are Additional Insureds on a primary and non-contributory basis per written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED CLEAResult IN ACCORDANCE WITH THE POLICY PROVISIONS. Attn: Contractor Services Dept. 50 Washington St. AUTHORIZED REPRESENTATIVE Westborough MA 01581 ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street y` Boston, MA 02111 a� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Co-op Power Address: 15A West Street City/State/Zip: West Hatfield, MA 01088 Phone #: (413) 772-8898 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 20 4. ❑ I am a general contractor and I 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. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roof repairs insurance required.]? employees. [No workers' comp.insurance required.] 13.® Other S G� *Any applicant that checks box#I 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 their workers'comp.policy information. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HDI Gerling America Insurance Company Policy#or Self-ins. Lic.#: EWGCC000187715 (� Expiration Date: 11/08/2016 ] . Job Site Address: % `L J City/State/Zip: Vi 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. I do hereby certify under mins and penalties of perjury that the information provided above is true and correct. Si nature: Date: ^� Pho 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 Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: 6 i I0 Dark Plaza - `=uite 5170 Boston, Masa(,,-usJcgtts 02116 11c}mix ImprovementConti-actor Revyistral ion Registration: 165217 I ype: Supplement Card Expiration 1/21/2018Cd2)_0[D 'POWER, INC. E.-.EA i--f DA N I C I_S 15A WEST ST VVEST HATFIELD, MA 01088 d:pdate Address and return card. Mark reason for change. Addy s fteneNN Irmplo�urent lost Card I)d'fwc of,( Itusinrss Rt ul:riion I,icense or registration valid for individol use orliv '(JIVIE IMPRt7VEMFt�T CONI"RAC'fC�iZ before the expiration elate. If found return to: Office of Consumer Affairs' and Business Reut dation Registration: 165217 Type: 10 3'ark Plaza- Suite 5170 Expiration: 1/2112018 Supplement Card Boston._MA 02116 CO-OP PCUVE_F2 INC. LEAH DANJFI_;.� f 15A WES1 ,T WEST -Vi FRELD, MA 01088 ( ndcr,cecrcrar) Not valid without signature 1 SS r, n 0 � r P- equlwionq p" CS-097409 f LEAH M DANIELS 12 MARC ELLA ST ROXBURY MA 02119 . 05/18/2017