Loading...
HomeMy WebLinkAboutBuilding Permit # 6/27/2016 t%oRT#1 BUILDING PERMIT 0 C TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 7,110 Date Received A ED S CHIJS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNER Pnn Print 100 Year Structure yes MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Li New Building Li One family F1 Addition Two or more family 11 Industrial 11 Alteration No. of units: Li Commercial ,N-Repair, replacement 0 Assessory Bldg 11 Others: Ll Demolition 11 Other DESCRIPTION OF WRK TO J�PERFORffl,PD: 7Kwma ,44--- o - Ident*fi atio —,,-Ple -- " e Type or Print Clearly 7� Phone: 26 77- OWNER: Name: rwM Address: Contractor Nare- Phone: L e,5f 4D Email: q (tV, Address: e — Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 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.: NOTE: Persons contracting witli unregistered contractors do not have;access to the guaran#fund ttORTH Town of Andover ® _ % LANA h ver, aSS' Jt46'x('-'A2A(1 ID q COC NICNQWICK C � U BOARD OF HEALTH PEFXMIT U Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ......... ...... ....... ....... ..... ................... ........................... ................ ..... ... Foundation has permission to erect ............. b 'Idin s on • ® Rough 11 to be occupied as .... ..... .. ........ ....... .. ............... ..J;��.......... Chimney provided that the person accepting this perm) 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, Iteration 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 ELECTRICAL INSPECTOR UNLESS CONS Rough Service ... . .. ..®...... Final i BUIL G INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Bulldzn Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be Done FIRE DEPARTMENT Until s ecte and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal ID q 060406629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 A division of nicisch Friginecring CT Contractor Registration No 620120 60 Shawntut.Canton.b1A 03021 IT9 339.502-5CONTRACT tl 197 FAX 339-502-6345 Page 1 PROGRAM tKI9 eoHiRACr is EgTFutEOlaro t38iYlEEN R19a CMA-HES a► nenr�ret0euaro+OMMMittroaxa5 onsaasw BELOW fi a we Ft Frank Fodcra (617)877-1311 12/14."2015 422459 00002 300 Pleasant Street 1 300 Pleasant Street I SERVIca CM.UTATU,M1 North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against%vasteftd.excess air leakage. This work will be performed iii concert with the use of special toots and diagnostic tests to assure that your home will he felt with a licafthful level of airexchangc and indoor air quality.Materials to he used to seal your home can include caulks.foams and other products. Primary unit%rur scaling include air leakage to attics.basemeou,nttachcd garages and other unheated areas(windows an not ycnerdly addressed.) This will require(6)working hourb. A reduction in cubic feel per minute(cfnr)ofair infilimtion will occur,but lln actual number of cfin is not guaranteed. At the completion of clic weatherimlion work.and at no additional cost to the homeowner,it rout blowcrdoor andror combustion surety analysis will be conducicd by the suh-contractor to ensure the safety of the indoor air quality. SS 10.110 ATTIC FLAT:Provide labor and materials to install u 9"layer dr R-32 Class I Cellulose added to 0851 square feet of open allic space. SS36.S5 ATTIC ACCESS:Provide latxtr and materials to install t 1) easily moved.insulating cover for the attic acce.Ls folding stair. The cover has integral weather-stripping to restrict air leakage. S200.00 VENTILATION:Provide labor and materials to install ventilation chutes in(30)roller buys to maintain air flow. Sfi0mil COMMON U'ALLS:Provide labor and materials to install 2"FSK faced 8mui-rigid fiherghw%hoard insulation to 1323)square feet of common wall area. S1,137,50 BASEMENT CEILING-Provide labur and materinis to install(43)linear tixt of R-it)unraced liberglanss insulation to the perimeter ofthe basement ceiling at the house sill $7S.2i RISF.Fngincering will apply all applicable.eligible incentives to this contract. You will only he billed the Net amount.Currently.fur eligible measures.Columbia Cas ofPetx 75%incentive,not to exceed 52.000 per calendar year,and an incentive of 100%fair the Air Scaling measures up to the Gest$680 and an additiorml S340 if bavings are justified by the auditor. For the safciy and health of your homes indoor air quality.we will beaunducting a blower door diugnostic of the available air flow in your home both before the work is begun,and after tic weatherization work is complete.We will also conduct a full assessment of the combustion safety of your licating system and water heater.11tis has a vnluc of S9n and is at no cost to you. Total allowable weatherization incentive is 53.110. 590.(in y FedDrat ID 5 050405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 A dhision orThieisch Engineering CT Contractor Registration No 620120 60 Showmut.Canton,MA 02021 �P�NA� fl a`S A&% 9 339-502-5197 FAX 339-502-6345 Page 2 PROGRAM =8 CONTRACT aWEREDDnOIUMNSMRWe CMA-HES MEtwer"0 C U S T CM I IR I R R VX AS mm e Frank Fodera (617)877-1311 12/14!2015 422459 7700002 300 Pleasant Street 1 300 Pleasant Street I North Andover,MA 01845 north Andover,MA 01845 JOB DESCRIPTION Total: $2,909.30 Program Incentive: $2,331.97 Customer Total: $577.33 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF 'Five OH,undred Seventy-Seven&331100 EDST $577.33 U�!lVAIDDBALI EAFTER30DAYYSP.RSEE LSRTi ER888FORIMPORTANTINFORRMATIONOONN OVARANNTTEHAB,RIGHTDSOFREpWOH 6c4HEGUUFUH0 ANDCCONTRAORREaISSTRA IOAN. OD GN THIS CONTRACT IF THERE AREA PACES a NOTE:THIS CONTRACT MAY DEWITHDRAwN BY US IF NOT EXECUTED WITHIN DATEOFACCEPTANCE 1Z.1 Z0110 ACCEPTANCE OFCONTRACT-THE•AB10VEPRICSB SPEgRCATIONSAND CONDITIIONSARS 3O DAY6 SATISFACTORY Tp US AND ARE HERESY A0CEP11'�.YOnAREAUTHO'U—T000THEWRORN AS ePegRED.PAYMENTWILL8ENAOEAeOUTLINED ABOVE 4JL ISE t 60 3hawrnut Road,Unit 2 Canton,MA 02021 1339®502-6335 ESI INEERING www.RISEenglneering.com Efitelc�:'�i'>:rnCEizp�. OWNER AUTHORIZATION FORM I, Frankr (Owner's Name) ' owner of the property located at: 300 Pleasant Street, North 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 property.This form is only valid with a signed contract. jeie'Vsnat—ure I GI Date wrtntr corm The Commonwealth of Massachusetts Department of Industrial Accidents Off ice of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant:Information Please Print Legibly 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): I am a employer with 100 4. ❑ 1 am a general contractor and 1 6. F1 New construction have hired the sub-contractors employees(full and/or art-time). listed on the attached sheet 7. E] Remodeling 2.F-1 I am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. n Demolition working for me in any capacity. employees and have workers' 9. F-1 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 I I.❑ Plumbing repairs or additions myself. [No workerscomp. right of exemption per MGL 12.[:] Roof repairs insurance required.] tc. 152, §1(4), and we have no 131,71 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 far my employees. Below is the policy and job site information. Insurance Company Name: ACE American Insurance Company Policy# or Self-ins. Lic. #:WLRC 48151553 Expiration Date:6/30/2016 ? Job Site Address: i1e; eoc,111 k11 I City/State/Zip:.41 Z V 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. Idohereby cern y under the paitis.and l!enalties qfeerjurZ that the information provided above is true and correct. Si10e iF,ritur Date Phone 4. 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 4 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#: CERTIFICATE OF LIABUTY IKISURAHCCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS CERTIFIC=ATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES 6EL01h_ 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 rnay require an endorsement-A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s)- PRODUCER CONTACT r.AME a Aon Risk Services Central, Inc. Southfield MI Office (A/C No.ExrJ L666j ?83-%1'! IF c No) (600) 363-0105 a 3000 Town Center v E-MAIL o Suite 3000 ADDRESS _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC INSURED INSURE1.A old Republic Insurance Company ?ql TODBuild COFD_ 260 Dimmy Ann Drive INSURERB ACF American insurance Company 22667 Daytona Beach FL 3211-1 USA INSURER ACE Fire UndervJriters Insurance Co. 20701 INSURE F.D ' INSURER E ' INSURER F: COVERAGES CERTIFICATE NUMBER.:570058'148882 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO lHE 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 MAYBE 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 SHOVJN MAY HAVE BEEN REDUCED aY PAID CLAIMS Limit;shown are as requested S'" TYPE OF INSURANCE S OL Cf c O C1 S _TP. INSD V✓VD POUCY NUMBER hl r.!/DDM"YYI I fr.1n!IDDNYIYI LIMITS A —,,=-IAL GENERAL LIABILITI' rAw2V304834 Ub1 iU 201� 6j�U 2016 EACH OCCURRENCE 3!,DOD,000 G Lh(MS-MA.DE OCCUR, II PRE t.!ISESo a occurrenccl �2,DDO,ODO '.. MED EXP(Any one person) S25,ODO '.. PERSONAL E A.DV INJURY 52,ODD,000 1. '.. GEN'L AGGREGATE LIMIT APPLIES PERGENEP.AL AGGREGATE S",ODO,000 m PR0. X7HER ❑JECT ❑LOC PRODUCTS ACG S4'000,000 07 HE R a AU7oM.OB)LE LIAHIUTY P11,76 304835 06!30j20]S 06/.0/'016 COt4i3UNEDSIr,'GLEUhnl1 S5,000,000 (Ea aamdenn ANYAUTO BODILY INJURY(Per person) I O Z ALLO'J✓tdEDSCHEDULcD BODILY INJUrR (Peramtlem) pJ AUTOS AU705 ''.. X HIRED AUTOS X NON-OWNEDPP.OP ETY DAIAA.GE � AUTOS Per anadenp HU—F,FLLA L1ABOCCUR. EACH OCCURR ENC. H EXCESS LIAB CLAIMS-MADE AGGFE GATE DED F?ETENTION WORKERS COMPE NSAi1ON AND VJLRC48152553 06330!2015 G6:30/2016 PER OTH- EMPLOYEP.c'LIABILITY YIN X STATUTE_ ER ANY PP.OPFE—TOF 1PAF.T NEE.I EXECUTIVE All Other States OFFICEFWEMSEF.E XCLUDED7 D NIA SCFC4815190 06,,30,1'01 5 06/30,M5 `L EACH ACCIDENT $1,O(1D,DDO '.,,... (Mandatory.n NI-f) Wi Only EL DISEASFEa EnSPL O'*EE 51,000,000 It ycs,dcscnbe under DESCRIPTION OF OPERATIONS be low EL DISEASE-POL ICY LIMIT S1.DD0,000 :cue FIPiION OF OPE PJ TIONS I LOCATIONS I VEHICLES(AC OP.D'IDT,Addm onal P,rmerl,s Schedulr,rray br attached.l mnrr space is re al��re d) AL1 encs OT Coverage e+F.J FIFICATE HOLDER CANCELLATION SHOULD ANY OF THE AEOVE DESCRIBED POLICIES BE CANCELLED ECFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TOpBU1 Id Company -,r 260 Timmy Ann Drive �•F Daytona Beach FL 32114 USA � _ ©1988-2014 ACORD CORPORATION.All rights reserved- )RD 25(2014101) The ACORD name and logo are registered marks of ACORD f ! ! i t t �C1 - . . i "F,+lttl.iivn 4ilhet'�li;; `+l•r ;r!!� .���`I: .S RICRARD SCI{Vdlt);TZ M EEUR't RE'SS STi2k,f'E' e� Nl.lmclwI;ter N11 0102 RC$tfif ted To: CSSL•tC-Insulation Contractor railure to possess a current edition of ttte Massachusetts State Building Code is cause for revocation of thFs license, -at'3/1 Office of Consumer Affairs rid Business Regul ion 10 Park Plaza - Supe 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 179141 Type: Supplement Card BUILDER SERVICES GROUP, INC. Expiration: 6/25/2016 RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 Update Address and return cart].Mark reason for change. SCAAddress Renewal Employment lost Card t ,:� Zi3�J:�iia-" - f)ffice of Consumer Affairs&Business Regulation License or registration valid for individul use only � i?ME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: 7 Office of Consumer Affairs and Business Regulation ' 2egistration: 179141 Type: 10 Park Plaza-Suite 5170 Expiration: 6/2512016Supplement Card Boston,MA 02116 BUILDER SERVICES GROUP,INC. RICHARD SCl-iWARTZ ,�,„ f ' 260 JIMMY ANN DRIVE ,✓,, ��'� DAYTONA SEACH,FL 32114 t'ndersecrciar7 \ot validt�i'ithout signature