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HomeMy WebLinkAboutBuilding Permit # 6/27/2016 (2) t%ORr#q BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION -V _ Permit No#: � ( � � �, �� Date Received ssco-eu5'� Date Issued:=�4I „ IM R' ANINTI Applicant must complete all items on this page LOCATION Or, t Print PROPERTY OWNER Print 100 Year Structure yesno MAP PARCEL: ZONING DISTRICT:— Historic District yes no Machine Shop Village yes yes ( no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential __ ❑ New Building ❑ One family ❑ Addition k'9Two or more family ❑ Industrial ❑Alteration Na of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other /, /.,,//////% ,/, ,,. /,ri</,q/..,,,/r / rl o /o// ., , iii / ,. ..,✓r ,, / / i/. - l�/1/�6rr„ Elter��.3„��IU�1',���/i� Pf DESCRIPTION OF WO K TOD ERFORMED 0 11 AC _ Pleas Type or]Print Clearly Identification- y OWNER: Name: � � � r,. `� Phone: Address: l Contractor Name: � � ���� ..� m�� . ��� Phone: ".��._ 52 '"TA Email: /V1 i,,r- (, r Address: ( Ex Date: Supervisor's Construction License: p Home Improvement License: Ex Date:p 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: $ Check No. � ���` Receipt No. 4' NOTE: Persons contracting with unregistered contractors do not have access to the guarani fund 7 S Ir of A;g int/Owner it .i4i : na 6)r6- . Town ofr '�. ndover i� h ve1i"' aSSy �2�( o LMKE COCHICNEWICK 1 U BOARD OF HEALTH PEINfAIT T LD Food/Kitchen Septic System h THIS CERTIFIES THAT .......... ........ ........ ..... ........ ...... ..............................................1h...................... BUILDING INSPECTOR Foundation has permission to erect.......................... buildings on ................ ..... . .. ... ...... . . ..... ......... ® Rough ......... to be occupied as ........... ............... .. ...... .. ... .. . .... .. ... ................. ........... 'I... chimney provided that the person accepting this permit shall In eve respect conform to the terms of the app ication 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 EXPIRESPERMIT IN 6 MON ELECTRICAL INSPECTOR Rough r l Service ... ... ti ....... .. ........ . ....... Final } BUILDIN PEC R GAS INSPECTOR ccu2ancy Permit Required to Occupy Building Rough Display i a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. ti Federal ID 0 0"405629 RISE Engineering RI Contractor Registration No 6166 MA Contractor Registration No 120979 A division of Thietsch Fngincering CT Contractor Registration No 620120 60 Shsvmul.Canton,DTA 02011 �®!1•Agl`®A�'� 334-502-5197 FAX 334-502-6345 !!m"V UU tf PA Page 1 PROGRAM t'MccirntaclisewaxioatrotteTty almse CLIA-HES o 00"WOTIMCusToueAMwowcrS Emir a atmaR Leslie Thyne (617)966-4514 12/14/2015 427357 00002 300 Pleasant St 2 300 Pleasant St 2 Nonh Andover,MA 01845 North Andover.MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to beat areas of your home against wasteful.excess air leakage. This work will be performed in concert with the use of special tools and diagnostie tests to assure that your home Will he Icfl with o healthful level of air exchange and indoor air quality.Materials to lie used to seal your home can include caulks.I'oanms and other produoi. Primary areas fur scaling include air k rikage to attics.basements.attached garages and other unheated areas(windows are not generally addres<cd.) This will require(71 working hours. A reduction in cubic feet per minute Win)of air infiltration will occur.but the actual number of chin is not guaranteed. At lite completion of the wcatherization work,and at no additional cost to time homeowner.a final blower dour andor combustion safety iutnlsis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. S593.0U i)ANIMING:Pmvide lalaor and materials to install a 12"layer of R-38 unlaced liherglass baits to(131 capture feel for hamming purposes. S24.6(I ATTIC FLAT:Provide labor and materials to install a 12"layer of R-42 Class t Cellulose added to 18401 square feet of open attic sp tec. S 1.344.01) ATTIC:ACCESS:Provide labor and materials to install 1 l i easily moved.insulating cover for the attic access ridding stair. The cover has inicgral wenther-stripping to restrict air leakage. 5200.00 VENTILATION:Provide Inhor and materials to install I I)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom('ants). $119.75 vENTILATION:Provide labor and materials to install ventilutiun chutes in(45)Taller buys to maintain air now. 590.00 UARAGE CEILING:Provide labor and materials to install 10"R-35 densely packed Class 1(*eIIuIose insulation to 525 square feet orgarage coiling located below a heated floor area.by drilling holes in the ceiling from below. Holes drilled will be plugged. Plugs will be shackled and left in a relatively smooth condition.Finish smiding and touch-up priming1pointing will he the customer's responsibility. 51.02.96 RISE Engineering%gill apply all applicable.eligible incentives to thin contract. You will only be billed the Vet amount. Currently.fur eligible measures.Columbia Gas offers 73%utcentive.not to exceed 52.000 per ealmular year.and an incentive of I W.0 for the Air Soiling uteasun:.s up to the first S61t0 am)nn ndditional 5340 if savings arejustifaLd by the auditor. For the safety and health of your home's indoor air quality.we will he conducting u blower dour diagnostic of tlme available air flow in your home both Merlon:the work is began,and aflcr the w•catherization work is complete.We will also conduct a full aacessment of the combustinn surety of your heating system and water heater.This has a voluc of S91i and is at no cost to you. Total allowable weatherizution incentive is 53.110. $90.00 1 RISE Engineering Federal 1D005-0405629 RI Contractor Registration No BIBS A dicistnn Df Thicisch F,n inecrin MA Contractor Registration No 120979 ti g CT Contractor Registration No 620120 60 ShO%VMUI.COntun,W 02021 �o ®®pp/°► 339-502.5197 FAX 3.19-1502-6.445 CONTRACT Page 2 raoc,xnaa EWO0AEE ��OFOR �C►G\-HFti aNARINGI �TCf 01FAWOK49 EBB CUSTOAMS DAYS R R i-eslic ThyTM (617)966-4544 12/143015 4273570000_2 IN 300 Pleasant St 2 300 Pleasant"A2 SIMMIN C177.8 . Norih Anduvcr.MA 01845 North Andover.MA 0194.5 JOB DESCRIPTION Total: $3,555.31 Program Incentive: $2,685.00 Customer Total: $870.31 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF '*`Eight Hundred Seventy&31/100 Dollars $870.31 M;E L By RISE ENOWEEFUNG,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 11.WILL BE CHAROED MONTHLY ON ANY EVERSE FOR IMPORTANT NFORMATTON ON GUARANTEES.RIGHTS OF RECISION•SCHEOULNO,AND CONTRACTOR REGIBTRATTON. OT SIGN TR15 CONTRACT IF THERE PACES ft0 �V•. '\� NOTE*THIS CONTRACT MAYBE WITHDRAWN BY US IF NOT EXECUTED MICH - GATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT•THE Ae Y8 PRICES.SPECTRCATIONSANO COMMONS ARE 30 DAYS. As 5PEACIITIED PAYMENT�W0.gE HEREBY ADE A50UTUNNEO YOU AUTFIOWZEb TO 00 THE WORN RIS * 60 Shawrnut Road,Unit 2 1 canton,MA 02021 339®5026335 ENGINEERING www.RISEengineering.com E€ri'.;arcy Energized. OWNER AUTHORIZATION FORM Frank Fodera (Owners Name) owner of the property located at: 300 Pleasant tr t, North Andover, MA (Property Address) (Property Address) hereby authorize ,. - .._, �. ubcontractor) 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. Weesure Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 wivw.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please PEjRLLtgjh!Y Name (13 usiness/OrganizationJI ndivi dual): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone 9:603-324-1974 Are you an employer? Check the appropriate box: Type of project(required): FD I am a employer with 100 4. F-1 I am a general contractor and 1 6. F-] New construction _�a_ have hired the sub-contractors employees(full and/or part-time).* listed on the attached sheet. 7. ❑ Remodeling 2.El I am a sole proprietor or partner- These sub-contractors have 8. F1 Demolition ship and have no employees employees and have workers' working for me in any capacity. comp. insurance.'+ 9. F-1 Building addition [No workers' comp. insurance 5� E] We are a corporation and its 10.0 Electrical repairs or additions required.] 3.F_1 I am a homeowner doing all work officers have exercised their I I.Fj Plumbing repairs or additions myself. [No workerscomp. right of exemption per MGL 12.El Roof repairs insurance required.] t c. 152, §1(4), and we have no 13.R1 Other Weatherization employees. [No workers' comp, insurance required.] I *Any applicant that checks box 41 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 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: ACE American Insurance Company Policy 4 or Self-ins. Lic. 4:WLRC 48151553 Expiration Date:6/30/2016 City/State/Zip: a-, w m. Job Site Address: WS 0 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 for-warded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certi under the pains and penalties of C!:�u2 that the information provided abre is true and correct. "Y EZ7��3 � fi SiS1 Date: tur Si ature: Phone#. 603-324-1974 Official use only. Do not write in this area, to be completed by city or town offlicial 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( Mi.1!DDcI'YYY) CERTIFICATE OF LIABILITY INSURANCE 06!?428,6 THIS CERTIFICATE 15 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 BEL01A. THIS CERTIFICATE OF INSURANCE DOES N07 CONSTITUTE A CONTRACT BETYNEEN 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). c PRODUCER CONTACT N MME T3 AOn klSk 52 Services Central, Inc. PHONE (866) �8+-:1"'� FA% (800) 363-010, m Southfield el d Ml office (AIC.No.Ext-) (AIC.NQ.) 3000 Town Center E-MAIL Suite 3000 ADDREs Southfield r-11 48075 USA INSURER(S)AFFORDING COVERAGE NAIC INSURED INS UP A Old Republic insurance Company _414; 70DBUild Corn_ INS URER6 ACF American Insurance Company 22667 260 )immy Ann Drive Daytona Beach FL 32114 USA INSURER ACE Fire Und&rV✓r1TerS insurance CO. 2070' INSURER D I INSLIRER E INSURER F-: COVERAGES CERTIFICATE NUMBER.: 570058348882 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 70 THE INSURED NAMED ABOVE FOR 71-IE POLICY PERIOD INDICATED. NOTWITHSTANDING A14Y REQUIREMENT,TERM OR CONDITIO14 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 7ERNil EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED B'i PAID CLAIMS Limits shown are as requested S' TYPE OF INSURANCE S POUC1'NUMBER OL CY c I O C1' l:'I Uto7I75 -TP, lNSD v✓vD Mt.VDGII'Y'YYI fca ntlDDlYY1Y1 A I X c'.ON.NIERCIAL GENERAL LLAeILIT-Y NW2Y304834 Uo," f_' 1� 6%iU!'(12 bl EACH OCCURRE nCE S!,ODD,ODO CLAIMS-MgDE ❑X OCCUR. DAh1AGE OREF,' ED $� PZAISES(Fa Pc urtenccl -'ODD'ODD MED EXP(Any one person) S25,ODO PERSONAL d ADV I111U11 52,000,ODD '.. GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGP.E G ATE S4,OOD,000 rA X POLICY PRO- n JECT ❑LOC PRODUCTS-COMP/OP AGG S4,000,000 m OTHER � 0 AUTOMOBILE LIABILITY rn,,FB 304835 06/30/2015106,'30/?0161 COMBINED sIr,,GLE LIMIT 55,000,000 IEa acadenil ANY AUTO BODILY INJURY(Per person) I O ALL O'.NK'ED Z SCHEDULED BODILY INJURY(Per acudeml m AUTOS AUTOS '. x HIPEDAUTOS NNON-OPP.OFEP.TYDArnYGEX HIPEDAUTOS WNED v AUTOS Per a dent)HJ - � I " �RFLL-A LIAB OCCUR. EACHOCCUr.P,ENCE XCESS LIAH CLAIMS-MADE AG GF.EGAT: DDPc TENTION WORKER-'COMPEIJSAiION AND LJLFC4 5151553 06;301/110151061150/2016 PEF 0TH- EMPLOYEP.S'LIABILITY YIN �` SiPTUiE I ER ANY PP.OPPIE rOR I PARTIJEF./EXECUTIVE All Other Slates OFFICEPJMEMSEP EXCLUDED' NIA SCFC481S190 06/30,110151061'30,'.016 `L EACH ACCIDE NT $1,000,GOG (Mandatorym NFfl WI Only EL DISEASE-EA EMPLOYEE S1,ODo,000 If yca.do nbe vn der DESCRIPTION OF OPERATIONS below E L DISEASE-POLICY LIMIT $1.000,LIDO— RIPTION OF OPERATIONS I LOCATIOris/VEHICLES tACOP.D 901,Addn—A P-1,Schedul,may be anachad,f mnm sPnce is re Qu-6) ence OT Coverage K� FIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THF—JT-_-w EXPIP.ATION DATC THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Builder 5erviCFS Group, Inc. AUTHORIZED PEPRESENTATIVE �^F� A TOPBui Id Company , -rte 260 )immy Ann Drive Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION-All rights reserved- )RD 25(2014101) The ACORD name and logo are registered marks of ACORD i j I I i s ' . . „�tniCtt�l}„tt ':tt lti•t't u.�r 4l�r��;c!!1 +fit, 7JN � RRC HARD SCI€WAR Z t .111tclw"er NEE €E3€02 0912612015 Restricted To: C:SSL-IC-frzsulation Contra ttfr Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this liceme. ��:" �9`����?r:,�"tom'/�/,d�'%' ' Office of Consumer AffairsL nd� Business Regulation f 10 Park Plaza - Suite 5170 Boston, .Massachusetts 02116 Home Improvement Contractor Registration Registration: 179141 Type: Supplement Card BUILDER SERVICES GROUP, INC. Expiration: 6/25/2016 RICHARD SCHWARIZ 110 PERIMETER RD NASHUA, NH 03003 Update Address and return card.'hark reason for change. Address Renewal Employment Lost Card Office of Consumer Affairs cSc Business Regulation License or registration valid for individul use only tbME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: i Office of Consumer Affairs and Business Regulation R gistration: 179141 Type: IO Park Play-Suite 5 170 Expiration: 6/2512016 Supplement Card Boston,?VIA 02116 BUILDER SERVICES GROUP, INC, RICHARD SCHINART2 260 JIMMY ANN DRIVE DAYTONA BEACH,FL 32114 i.'adersccresary Not valid without signature