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HomeMy WebLinkAboutBuilding Permit # 5/27/2016 taaern K„ .......°.°� BUILDING PERMIT � ��''.;, ...b°�4,�0a. TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION ; Permit NO: Date Received Date Issued: CHU FiFORTA A licant must corn fete all items on this a e �, o ,ly.'r�r��; / ✓ ���,f ./ �, � i- i �';';/ j�✓ifs ✓; /r ��r �- ,jJ-� f of ��"!f �,, �/��,; y r I�, .,l ��� elf' � fi /°// /✓f�� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Li New Building V4Qne family ❑ Addition F-1 Two or more family F-1 Industrial ,F-Alteration No. of units: ❑ Commercial ❑ Repair, replacement 1=1 Assessory Bldg u Others: ❑ Demolition ❑ Other �9 rio r y ' I /✓` ✓ *°'r° fI' g � o.,, ,r 9 / // Gf/ G r,✓/AI�, ,�e/r / ! / � ,� Fr � �l�f�,F�'/'� � � I Identification Please'Type or Print Clearly) 2 OWNER: Name: a” ,, Phone: Ll " �..... � ry �, Address: �� �� �F'S� u' r! l /�f /, 'J �i�f,r /� /l� r �✓�4 I r�''fr� ���/ f i�2✓ v' � /c ref �a i����y �,rri- / / e � dY ,�/i✓ II t ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST EASED ON$125.00 PER S.F. Total Project Cost: $ '-'7,) FEE: $� Check No.: Receipt No.: .: c�* _tb NOTE: Pei-sons contracting with unregistered cont actors do not have access to the guaranty funs' r*� k /r /P.,//,,i, ✓f„ l;,„ - yr'f�.>f„uri /ll,u/fi/,Fir ',l/ri / ii a//, „//i,��i a//f/,:,�/,�/r ;,,.;0/, ,. -/ �/ rb //.r /`/�/r !, � ,'fy / !//r✓,/,,J�✓/lr ',///r ,,,rnfj�/i i✓ r /F fii r /r,ir / ,//„,/in / ���, r,r;/tJb/ /` ','r ,,'(�✓/✓//✓Ji, /1/i//� �f 1/ ,i�d�l///2/icy// 9� {�/��/ „I /11 l!,n,,,n� Ji. ,/f�Ji� �./. �,,,i�riAZ,r?��+w�'F;/ f�,/l ,/ni„r�P'✓�',I,c,�;,✓.,,tri ,!J'ia-,./n rJr/..,✓/,�,./�i/ ,// /,,;,��,�� 8��/li/rr,�� ^!,�`� %. ,//r„/, �i, ;/cf�,cif/,n, r/ tkORTH Town ofIAndover ,. ® ". - L. ® ® - $, h ver, Mass, 2b He OLAME COC MICMQWICK V AoJ;?ATED BOARD OF HEALTH Food/Kitchen PERM T LD Septic System ® BUILDING INSPECTOR THIS CERTIFIES THAT ............................. has permission to erect g Foundation .......................... buildings on . .. ... . .... ................................ ............... ® ® Rough to be occupied as .......... .. .. ... . . . ..... .......... ........ .. .... ..... ..... ........ 14..... ............. 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 PERMITIN 6 MONTHS ELECTRICAL INSPECTOR UNLESS TI TARTS Rough Service ........... ...... . ........ .............. .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display Ina Conspicuous Place on the Premises — Do Not Remove Final No Lathing all To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. I Federal ID 0 05.0405629 n No 8186 RISE Engineering MA Conn Contractor Regis�tratlon No 120979 RISE " A division of Thielsch Engineering ENGINEERING 60 Shawmut Unit#2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 1 PROGRAM THIS CONTRACT is ENTERED INTO BETWEEN Rua CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRISSD BELOW CUSTOMER PHONE DATE CUENTO WORKORDER Kevin WHIM (978)258-6602 12/11/2015 409432 00003 SERVICE STREET BWNG STREET 24 Skyview Terrace 24 Skyview Terrace SERVICE CRY,STATE,ZIP EILUNG cnY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION HAZARD BARRIER:We have identified that there are recessed lights present in your home.unless the recessed lights are certified as IC-rated(Insulation Contact Rated)we will create a 3"clearance space around the fixture by using fiberglass blanket insulation as a damming 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 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 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(8)working hours.A reduction in cubic feet per minute(efin)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 be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 AUDITOR'S NOTES HOUSE BELOW BUILDING AIR FLOW STANDARD. BLOWER DOOR-3359 Q CFM 50 PA. BLDG STANDARD=3788®CFM50 PA. OWNER NEEDS TO INSTALL A BATH VENT FAN TO MAKE UP AIR TO BUILDINR AIR FLOW STANDARD. PANASONIC WHISPER SELECT IS ONE SUCH FAN.CAN FIND AT EFI.ORG. $0.00 A'UDITOR'S NOTES HOUSE BELOW BUILDING AIR FLOW STANDARD. BLOWER DOOR=3359 @ CFM 50 PA. BLDG STANDARD=3788®CFM50 PA. OWNER NEEDS TO INSTALL A BATH VENT FAN TO MAKE UP AIR TO BUILDINR AIR FLOW STANDARD. PANASONIC WHISPER SELECT IS ONE SUCH FAN.CAN FIND AT EFLORG. $0.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass baits to(48)square feet for damming purposes. $98.40 ATTIC FLAT:Provide labor and materials to install a 6"layer of R-21 Class 1 Cellulose added to(1667)square feet of open attic space. $2,100.42 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thermax board.Weatherstrip the perimeter. $60.00 ATTIC ACCESS:Provide labor and materials to insulate(1) back of the kneewall hatch with 2"rigid Thermax board,and seal the edge of the hatch with weatherstripping $60.00 � \ ,l I g Federal ID#05-0405629 9Vd,. )SSE Engineering RI Contractor Reglstratton No 8186 RISE `� � MA Contractor Registration No 120979 A division orThielseh Engineering ENGINEERING 60 Shawmut Unit#2,Canton,MA 02021 RA ^T CONT 339-502-6335 FAX 339-502-6345 CONTRACT 1 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENTO WCRKORDER Kevin Willoe (978)258-6602 12/11/2015 409432 00003 SERVICE SMIEET BILLING STREET 24 Skyview Terrace 24 Skyview Terrace SERVICE CITY,STATE,LP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with soffit mounted flapper vent to exhaust existing bathroom fan(s). $118.75 COMMON WALLS:Provide labor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to(118)square feet of common wall area. THIS IS THE BACK OF MASTER BATH VAULTTO ATTIC! $413.00 RISE 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 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 air flow in your home both before the work is begun,and after the weatherization worts is complete.We will also conduct a full assessment of the combustion safety ofyour heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$3,110. $90.00 Total: $3,620.57 Program Incentive: $2,770.00 Customer Total: $850.57 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Eight Hundred Fifty&57/100 Dollars $850.57 UPON FINAL INSPECTION AND APPROVAL BY RUSE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE W FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER V DAYS.SEE REVERSE FOR IMPQJtTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULUNG,AND S4NTRACTOR REGISTRATION. NOT SIGN THIS CONTRACT IF THERE ARE ANY PLANK SPACES AUTHORM TORE-RISS lnaa C O M ACCIPTAIP NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ~ !J ACCEPTANCE OF CONTRACT-TRE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORISED TO 00 THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE I, OWNER AUTHORIZATION FORM owner of the property located at (Pro Address) At- f? C GA i✓✓ (Property Address) I i x�w M herebyauthorize 4-4-(Subcontracto ' an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. IL w& Jer's Sig ure Date i i I s y i i i L.Pnn11C1tCTt The Commonwealth of 1Mlassachusetts Department of Industrial Accidents zµ ro 14 Office of In 3e I Congress Street, Suite 100 " �t Boston, MA 02114®2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Please Print Le9ib1�L App 1>Icant Information 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: F ype of project(required): 4. I am a general contractor and I ❑ New construction 1.❑✓ I am a emp]oyer with 100 ® have hired the sub-contractorsemployees (full and/orpart-time).* Remodeling listed on the attached sheet. ❑ 2.❑ 1 am a sole proprietor or partner- These sub-contractors have 8. ❑ Demolition ship and have no employees employees and have workers' working for me in any capacity. 9. E] Building addition camp. insurance. [No workers' comp. insurance 5. We are a corporation and its 10.❑ Electrical repairs or additions ® required.] officers have exercised their 11.❑ Plumbing repairs or additions 3.❑ I am a homeowner doing all work myself. [No workers' comp, right of exemption per MGL 12.E] Roof repairs c. 152, §1(4),and we have no Weatherization insurance required.]t 13.Z Other employees. [No workers' camp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: AGE American Insurance Company Policy# or Self-ins. Lie. WLRC 48151553 Expiration Date:6/30/2016 �, Ci /State/Zip: �X 615$ ( Job Site Address: .. . City/State/Zip: �; a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Attach ion 25A of Msecure coverage as required under Sect c. 152 can lead to the imposition of criminal penalties of a Failure a fine up to $1,500.00 and/or ane-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine copy of this statement may be forwarded to the Office of of up to $250.00 a day against the violator. Be advised that a Investigations of the DIA for insurance coverage verification. I do hereby cern under the sins and enalties o er'ur that the information provided above is true and correct. x v Si nature: Phone#:603-324-1974 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 ane): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: 1 I DAT 016/240-01 SYYY) CERTIFICATE OF LIABILITY INSURANCE P�lk CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER_ THIS TIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES OW_ THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSU114G INSURER(S), AUTHORIZED RESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. RTANT:If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBRDGATIO14 IS WAIVED, subject to erms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the °i icate holder in lieu of such endorsement(s). m R VIIIA T -p sk Services Central, Inc. ield n1I Office .Ext): (866) 253-71?? aC.No.p FAX (100) 363-0105 m a own Center E-MAIL o 3000 S: _ ield MT 48075 USA INSURERS)AFFORDING COVERAGE NAIL INSURED A Old Republic Insurance Company 24147 TopBuild Coro- B: ACE American Insurance Company 22667 260 Jimmy Ann Drive Daytona Beach FL 32114 USA c: ACE Fire Underwriters Insurance CD. 20702 DE' 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 TERfvrS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR 'TYPE OF INSURANCE INSD WVD POLICY NUMBER Nat,NDDfYYI'Y I IM1IO/DD/YY) d LIMITS A X COMMERCIAL GENERAL LIABILITY Fiwz Y304634 Ob/3 _ 1� 061301`0161EACH OCCURRENCE 12,000,000 DAMAGE O N ED $2,000,000 CLAIMS-MADE OCCUR. PRELIISES Ea occurrence) MED EXP(Anyone person) 325,ODO PERSONAL S ADV INJURY 12,000,000 0 m GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE 14,000,0001 m X POLICY ❑JE6 ❑LOC PRODUCTS-COMP/OPAGG S-0,000,000 0 OTHER.: o '. n A AUTOMOBILE LIABILITY P1hffB 304535 06/30/2015 06/30/702 61 COIABIIJEDSINGLE LIMIT 55,ODO"Doo (Ea accident) ANYAUTO BODILY INJURY(Perp—ri) I O Z ALL OWNEDSCHEDULED BODILY INJURY(Per a—dent) N AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE � AUTOS Per acutlenp U JANYUMBRELLA UAB OCCUR. EACH OCCURRENCE U E.YCE55[IAB CIAIMS-MADE AGGREGATE '.. DED RETENTION WORKERS COMPENSATION AND WLRc48151553 06/30/2015 06/30/2016 X PER 0TH- MPLOYERS-UABILITY y/N All Other States 57PTUTE ER PP-OPRETOR I PARTNER,I EXECUTIVE E L EACH ACCIDENT Sl,000,DOC) FFICERIMEMBERExcwDEO• NIA SCF: 48151 06/30/2015 06/30/.1016 (Mandatory in NH) Wl Only E L.DISEASE-EA EMPLOYEE S1,000,000 If yes,dcscnbe ander DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LINUT S1,000,000— IENE ss�+ ESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Addrti—A Remarks Schedule.may be attached if morn space¢re gaire d) vidence of Coverage -r RTiFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIP.ATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 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 eservedACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Id CE ARO SCCMIARTZ IIS ttF#I!•C't IMS ST#tR:E'C [4'#:tttc•#tc`crer'NC1 (Ill(#2 QWM201Ei � Sktic,Ft,=.c{ TU. cssL-IC:-Irrstt{affGul Carttrrlrrnr ilure f4#aossE4s a cclrrent edition of i;F1t tifass _husettt atct ficrilrl q We is cause fur rrvor Uan of thm loonse. ............... . X Co s un,e.- r j 3 an s and B zsjne" Regulation 0 Pak Plaza - SL:Ii!i 5 17 0 1�onne ln-T ovenIent Contra'ctol Rcgistral�t,� � Registration: 179141 Type: Supplement Card BUILDER SERVICES GROUP, 11'JC. -xpiration: 6125f2D16 RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 t lxiate Address l:nd return card,Mari,reason for chane. Address Rene%+al Rini)]';Nmell, last ( .ard _--- ----()lfrr of Co nsuner Affair,e Business Rt,-ulation license or reoistriition valid for indii idui use anh :..- ,•, $iGt 9PfiGRDI'EtJiEPtTCDNTFZACTGRbefore the expiration d2',e. ]f found return to: 011ce of Consumer Affairsand Business Rl-�,0atir;n i.egistration: 170-141 Type 11 3 ,; i i'arl;S lazlL s i:tc_ 10 Expiration: 6i2612616 Supplement—ard Boswr,;11A 02116 UILD_R SERVICES GROUP, )NC CHARD SCHV-JARTZ 3()JIMTAY ANN DRIVE A Y T 0 t E C ii. rL 32114y r3 ildi'�+etre liar t Not�'.i 1lG�5t"it}I t)L't SIY•nzIL'rl'