HomeMy WebLinkAboutBuilding Permit # 5/15/2016 BUILDING PERWT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Z' Permit NO: Date Received Date Issued: " SACH IMPORTANT: A)plicant must complete all items on this .7a 2 7V— "0' 100 0,J. 'T q RICT: Hi*ric Distrfct, yes, r,,10 Machine Shop hop Vilf 0 yb's no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building Prie family Addition Two or more family Industrial /, Alteration No. of units:— Commercial Repair, replacement Assessory Bldg _mmOthers: Demolition Other FlOW0,146" i i Wetlands -I Writerv i0tri t 'J' _1-�( � z el", 4""),( Identific;1,�ion Please Type or Print Clearly) OWNER: Name: 42, Phone: .P ..... Address: 0"P An'C1 7(" R, I ' rr Phone: ion I Cense -i ,, Exp, Date-, E(09ixp Date: ('/�'e,h Y ARCH IT'Ec-r/ENGINEER Phone: Add FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000,00 OF THE TOTAL ESTIMATED COSTBASED ON$125.00PER S.F. Total Project Cost: $ FEE: $ Check No.:— No. _ Q NOTE: Peirsonsve Wret g m)ith uni�egyistei-ed conhweloi,s (lo not have access to the gtI(u-,an1V.fiin(1 Signature of Age,'nt/ awn er.,­.—............ Signature of con F FORTH Town of1,. Andover O ti . No. ® Z� ® Mass, LAKE COCHICMEWICK "4A-m) `S U BOARD OF HEALTH P E R M L U Food/Kitchen Septic System THIS CERTIFIES THAT ........ .... .. ..... ........3-i.m... .. .. . ....... ..........A............. BUILDING INSPECTOR has permission to erect ....... buildings on .•• •• V.I.I.C.••••• ••• •••••••••••••• • e Foundation ..... .......... ..... .. ....0 Rough 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS . STAR S Rough Service ....... ...:.. ... .... .................................... Final BUILDIN INSPECTOR GAS INSPECTOR ccupancV Permit Required t® Occupy BuRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or all To Be Done FIRE DEPARTMENT Until Inspected and Approvedby the Building Inspector. Burner Street No. Smoke Det. 60 Shawmut Road,Unit 2 Canton,MA 020211339-502-6335 RISE '- ENGINEERING www.RISEengineering.com Effider.CY E110r9izQd- OWNER AUTHORIZATION FORM Peter Simonds (Owners Name) owner of the property located at: 210 Granville Lane, N. Andover, MA (Property Address) (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my prope This for .s only valid with a signed contract. pe r is only valid with a slunuu CO my pro T' is'OL Own onre ' Federal ID#05-0405629 1114k Aft OW 5,, E Engineering RI contractor Regletrauon No alas MA Contractor Registration No 120979 A division of Thielseb Engineering C7 Contractor Regltrtratlon No 620120 ENGINEERING 60 Shawmut,Canton,MA 02021 CONTRACT 339-SW5197 FAX339-502-6345 Rags 1 PROGRAM TM CONTRACT IS EMERFO INro BaTV1EEN R18E CMA-HES GtGtlWNO AND TKE CUBTOItE�2 FORWORK AS DESCF45 DBELOW CUSTOMER ® CSO PRONE DATE CLUMD WORK ORDER Peter Simonds aJ/fa � (617)622-5228 02/22/2016 429642 00002 SERVICE STREET ass BUNG STREET 210 Granville Lane `v 210 Granville Lane SERVICE CnY,STATE,ZIP W 61111NO CRY,STATE.ZIP North Andover,MA 01845 U_ North Andover,MA 01845 JO B DESCRIPTION WHEN GAS HEATED:This proposal has been prepared to illustrate the incentive value once your home becomes gas-heated.Some measures recommended for your home qualify for an incentive from Columbia Gas. Currently,Columbia Gas will pay 75%of the cost for insulation measures(not to exceed$2,000)for gas-heated homes.The maximum possible allowable incentive for all measures,including air sealing and diagnostics,is$2,900. Prices and program incentives not guaranteed past 30 days. 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 home both before the work is begun,and after the weatherization work is complete.We will also conduct a diagnostic assessment of the combustion fumes in the exhaust flue ofyour heating system and water heater.This has a value of$90 and is at no cost to you. $90.00 AIR SEALING:Provide labor and materials to seal areas of your 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 seat your home can include caulks,foams and other products. Primary area for selling include air leakage 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(cf n)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 mialysis 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 SEALING:Provide labor and materials to install Q-ton weatherstripping and a doorsweep to(2)door(s)to restrict air leakage. $150.00 DAWMNG:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass baits to(80)square feet for damming purposes. $164.00 ATTIC FLAT:Provide labor and materials to install an 8"layer of R-28 Class 1 Cellulose added to(613)square feet of open attic space. $839.81 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. The cover has integral weather-stripping to restrict air leakage. $200.00 VENTILATION:Provide labor and materials to install ventilation chutes in(57)rafter bays to maintain air flow. $114.00 OVERHANG:Provide labor and materials to install 6"R-21 densely packed Class 1 Cellulose insulation to(120)square feet of exterior overhang located below a heated floor area,by drilling holes in the overhang from below. Holes drilled will be plugged. Plugs will be sealed with exterior grade spackle and left in a relatively smooth condition.Finish sanding and touch-up priming/painting will be the customer's responsibility. $460.80 OARAOE CED ANG:Provide labor and materials to install 6"R-2l densely packed Class 1 Cellulose insulation to(600)square feet of garage ceiling located below a heated floor area,by drilling holes in the ceiling from below. Holes drilled will be plugged. Plugs will be sparkled and left in a relatively smooth condition.Finish sanding and touch-up priming/painting will be the customer's responsibility. $1,140.00 RISEN Engineering SE En •nom FRl ederal 109 620 Contractor ntrao �istra8an No 8186 A division of Thleisch EnReglatratlon No 120979 g g CT NIA ctrrContractor Registration No 620120 ENC 4EERING 60 Shaw==Canton,MA 02021 339^502-5197 FAX 339-502-6345, -CONTRACT 9- • Page r .. .. PROGRAM Tres CONTRACT 18 P1ITexEo 4ato B�we�Nttls2 .. CMA-HES - ENGINEERINGANDTHEWBTomPORWORKAS DESCRIBED BELOW . CUSTOM PHONE DATE CLIENT WORKoROER Peter Simonds (617)622-5228 02/22/2016 429642 00002 SP3WtCB BILLING STREET 210 Granville Lane 210 Granville Lane SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $4,008.61 Program Incentive: $2,940.00 Customer Total: $1,068.61 WE AGREE HEREBY TO FURNISH SERVICES.COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE SUM OF ***One Thousand Sixty-Eight&611100 Dollars $1,068.61 UPON FINAI.IEgPWWN AND APPROVAL BY RISS SN0114MU QG,CUSTOMER AGREES To REMIT AMOUNT DUB IN FULL T OF 1 BE CNARGFL MONTTB.Y ON ANY UNP CEAFTER 30 DAYS.WEREVERSE FOR IMPORTANT IRPOREATIe•1 O>:OI:ARSINTEES,RIGHT80F RECISgN, .,ANO NTRACTOR REOISTRATNIA 00 NOT SIGN THIS CONTRACT IF THE A SPAC CFZW .RISE 64uarinD c ANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 30 ACCEPTANCE OF CONTRACT.THE ABOVS PRICER,SPECfftCATKINB AND CONDITIONS ARE DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORMED TO 00 THE WORK AS SPECIFIED.PAYMENT vaLL Be MADS AS OUTLINED ABOVE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston, MA 02111 wwminass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (BLisiness/OrgaiiizatioiilliidividLial): 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.[Z I am a employer with 20 4. El I am a general contractor and 1 6. Fj New Construction employees(full and/or part-time).* have hired the sub-contractors 7. E] Remodeling 2.0 1 arn a sole proprietor or partner- listed on the attached sheet. +T ship and have no employees These sub-contractors have 8. [:] Demolition working for me in any capacity. workers' comp. insurance. 9. E] Building addition [No workers' comp. insurance 5. F1 We are a corporation and its required.] of10.0 Electrical repairs or additions officers have exercised their 3.F-1 I am a homeowner doing all work right of exemption per MGL I Ln Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.n Roof re airs insurance required.] c employees. [No workers' ) �k comp. insurance required.] 7,Irls *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy int'orniation. 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 trip an employer that is providing workers'compensation insurance far niy employees. Below is the policy anti job site in formation. Insurance Company Name: HDI Gerling America Insurance Company Policy 4 or Self-ins. Lic. EWGCCO001 87715, Expiration Date: 11/08/2016 Job Site Address:'­ Two,—r) �dxV City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration(late). 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 certirins-and 7 71desofpeijurythat the in inationprovidedabove rtrueandcorrect.for Sivnature:') Pho4e::#�:2 LV-' Official use only. Do not write in this area,to be completed by city or tosvil 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 9: =DATEyyy (MMIDD 01 AC" & CERTIFICATE 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 IS 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(les)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 NAP TDebbie MacNeal James J. Dowd & Sons Iris PHONE FAX A1C No Ext): - - 4 AIC No 14 Bobala Road EMAIL Holyoke MA 01040 ADDRESS: dmacneal@dowd.com PRODUCER CUSTOMER ID#:COOP INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:HDI-Gerl in America Insurance Com a Co-op Power, Inc. INSURERB:Torus National Insurance Com an 25496 15A West Street INSURERC: West Hatfield MA 01088 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 THS O ALL THIE TERMS,IEXCLUSIONS EAND CONDITIONS OFRSUCH POLICIESN,THE .LIMITS SHOWN MAY HAVE NCE AFFORDED BY THE PBE N(REDUCEDES BY SUBJECT ISSUED OR BY PAD CLAIMS. ADDL SUBR POLICY EFF POLICY EXP LIMITS ILTRTYPE OF INSURANCE 1111 WVD POLICY NUMBER MMIDDIYYYY MM/DDIYYYY A GENERAL LIABILITY EGGCC000187715 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 DA A ET RE TED 00 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $100,0 X OCCUR MED EXP(Any one person) $5,000 CLAIMS-MADE PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $21,000,000 PRODUCTS-COMP/OPAGG $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ X POLICY PRO- 71 LOC A AUTOMOBILE LIABILITY EAGCC000187715 11/8/2015 11/8/2016 (aaccident)INGLELIMIT $1,000,000 ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) S X SCHEDULED AUTOS PROPERTY DAMAGE $ (Per accident) X HIRED AUTOS S X NON-OWNED AUTOS $ Comprehensiv B X UMBRELLA LIABOCCUR 70354Q150ALI 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 EXCESS LIABCLAIMS-MADE AGGREGATE $1,000,000 S DEDUCTIBLE $ X RETENTION $10,000 WC STATU- OTH- p WORKERS COMPENSATION EPIGCC000187715 11/8/2015 11/8/2016 TORY LIMITS ER AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N I A OFFICER/MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYE $1,000,000 (Mandatory in NH) If yes,describeunder E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I 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 IN ACCORDANCE WITH THE POLICY PROVISIONS. CLEAResult Attn: Contractor Services Dept. 50 Washington St. 'AUTHORIZED REPRESENTATIVE Westborough MA 01581 )f*,�. ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 26(2009/09) The ACORD name and logo are registered marks of ACORD �3lti til ; t�n�iimer Affairs "111 I3u�lne�� Park 1"Ll/a - 5110r 1 (� ton, 'tlassacht mitts 0? 1 l ct 1111provement COW'- ctor I�e��istr atit�n Registration ;65217 ?20'. , ;1_,�;= ,'OWEF`\. INC. �vV4=- ST M A ` .�( Ei. � Fi .i_1.J. :�.��.' ,., 1, plate ;lddres;;nuf <turn card. �Ln i. rcan�>n fur'ch:an�e. Address lfcne .ii t:mplocnit nt f.ost Card >c -()III, �I ,i� ,,,,;ci stt>�in Z i3u•iur,• ItrCulatvut License or registr 1rii��n valid fot indi,itft I u>e onh before the espirttion date. If f{xnui return In: IMPROVE CONTRAGTOR Office of( Affairs and I3nsines� Re��ulahon Type: 10 Pari Play", Suite 6f7f) ?-r— }2i fif'itl0 its' a.s. , itvnt d f3nstnn,1'L\ Ulf!h `0 s r�iYdtip Tt'. 2 ...Uel ... - r Cit)-OP i LEAN i _.. .._. 15A VV`= _ — got valid tis ithout signature WEST I _- l ndcrvcrrC�!"� aft GS-097409 ` . LEAH M DANIELS 12 MARCELLA ST ROX13URY MA 02119 050812017