HomeMy WebLinkAboutBuilding Permit # 8/2/2016 %40RTFI 4
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BUILDING PERMIT ,�� �..;, OZ.
TOWN OF NORTH ANDOVER o N o
Permit NO: � APPLICATION FOR PLAN EXAMINATION -
t Date Received
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Date Issued: '� '��
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IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENTPROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition N.Two or more family ❑ Industrial
Ti Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
7To puri l Uytss ❑ /aershed Dpsict
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Identification. Please Type or Print Clearly)
OWNER: Name: Phone: - 1
Address:
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ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ . �'5 2. FEE: $
Check No,: 1 Receipt No.. I " '
NOTE: Persons contracting with unregistered contractors do not have access to tl a u ty f d
Signature of Agent/Owner 41py Signature of contractor ell
� FI.
ORT
Town ... sndover
0
1 '
No.
LAKE h ver, Mass,
OR 0 ZW 16
Ik COCKICMEWICK y�-
J�Q�R^TE P 0
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BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT .... .I..�!! r....., ........ ... ..�.'�
BUILDING INSPECTOR
W
has permission to erect .......................... buildings on ...... .,��.. .,. . ,�......;r..,,,,,,,,,,,,, Foundation
Rough
to be occupied as ,. !�c/ppting
.........�,1W.T.. ............................. Chimney
provided that the person this rmit 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 16 MONTHS ELECTRICAL INSPECTOR
UNLESS CONEITRIJIVIO Rough
Service
.. ... ..... Final
BUILDING 1 ECT
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 __hall To Be Done . FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
Work Order
GREATER LAWRENCE COMMUNITY ACTION Job Number: 20092154
COUNCIL,INC. Work Order Date:7/15/2016
305 Essex Street Ownership:Owner
Lawrence,MA 01840
Phone:978 681-4956
AMERICAN BUILDING TECHNOLOGIES Auditor:Keith Young
263 Western Ave Email:kyoung@glcac.org
Lynn MA 01904 Cell:978 857-7841
Email:jobs@americanbuildingtechnologies.corn Phone:978 681-4955 x4793
Phone:781598-7125
Cell: 617 233-8704
Madeline Fontaine Columbia Gas $7,752.76
58 May St Apt 1 Total $7,752.76
North Andover Ma 01845-2328
978-258-1231
Safety Issue(s): Lead Paint Possible
Authutazed Actu�I
hie�sure Descriptroti, Comi>tents
Qty Prcce,_ Total Qty Total
A#titc,Insula#14
aon
R-49 unrestricted-settled cellulose 136 $1.80 $244.80 136 $244.80 for front porch flat
Atf,e Ventilation
Rectangular gable vent 1 $103.00 $103.00 1 $103.00 112 x 16 gable vent
$a�etnent Insulation: -
Basement overhead insulation R19 136 $1.77 $240.72 136 $240.72 under front porch
Fiberglass
Doors = -
Fixed Sweep triple flange 6 1$17.64 $105.84 6 1$105.84 Fr.ext./2 rear ext./2 base.int,/door to attic
Weatherstrip s/Q-Ion or equal 6 1$51.00 $306.00 6 1$306.00 Fr.ext./2 rear ext,/2 base.int,/door to attic
Mise Insulation
Rigid Foam Board 1 inch RFB PER 136 $2.63 $357.68 136 1$357.68 1 136 sq.ft.foam board under front porch
SHEET
Date:7/15/2016 Page I
Work Order: Job Number: 20092154
'> M�scMeas'�res .
Attic/basement blower door guided 3 $70.00 1$210.00 3 1$210,00 Seal under sinks,cliimney,plumbing,electrical
sealing with one-part foam and all air penetrations to the living space,
Replace Clothes Dryer Transition 2 $45.00 $90.00 2 $90.00
Duct only
YFet mrt
Other 1 $0.00 $0.00 1 $0.00
Wall Insulation _ ''' -
Drill rough plaster patch or finish 468 $2.04 $954.72 468 1$954.72
wood plug(dense pack)
Wood clapboard/shakes/shings or 2570 $2.00 $5,140.00 2570 $5,140.00
vinyl{dense pack}
Total $7,752.76 $7,752.76
Contractor Instructions:
Before Starting the Job. Duringthe e Job:
1.Please notify us 24 hours before starting or scheduling a job. 1.This residence was built before 1978.Lead-safe ractices are
2.Obtain required building permit. required.
2.Total for Heath&Safety and Repairs cannot exceed$2500.00.
Additional Contractor Instructions:
Attic Inspection form attached? Yes NIA (Circe One)
Certificate of Insulation posted? Yes No (Circle One)
AMERICAN BUILDING TECHNOLOGIES hereby certifies that this.job was supervised and completed in compliance with all
Department of Labor Standards and Lead RRP regulations.
Cl a e a�/15r/ftature: Date: RRP License#: Page e 2
Wore Order: Job Number: 20092154
1 hereby acknowlege that all work has been completed and inspected.
Customer Signature: Date:
Energy Director: Date: Fiscal Officer: Date:
FOR AGENCY_U E�NLY
Pre Post Language Other than English needed? Yes No (Circle One)
Dryer CO 0.000 if Yes,indicate language;
Stove CO 0.000 Occupany change in last 18 months? Yes No (Circle One)
H2O Tank CO 0.000 Comments:
Heating System CO 16.000 Number of windows
Ambient CO 0.000 Number of rooms
Blower Door 0.00
Date:7/15/2016 Page 3
Contract for Products/Service Work
This Agreement is made by and among
Madeline Fontaine
58 May St
North Andover, MA 01845
American Building Technologies(ABT)
2 Neptune Rd, Suite 439
Boston, MA 02128
I. DESCRIPTION OF WORK TO BE PERFORMED
1-Attic,basement&wall insulation
2-Door sweeps&weatherstrips
3-Ventilation
Total: $7,752.76
Customer Signature:
——z,6111111
Customer Name: Date:
Contractor Signature:
Contractor Name: Date: C),71jk3l:ZP116
-,11
merice n Bul hig "Tewchnologles
Energy Savings Is Our Specialty
263 Western Avenue.. Lynn-MA 01904
Phone - 781-598-7125/Fax-781-479-0727
wmiw.arriericanbuildirigteci,in( logies.corn
Authorization Letter
1,Jose Santos, HIC 163106 and CS-101378 holder hereby give my authorization to Stephanie DeTornasi
to act on my behalf regarding the Building Permit Application
58 May St. North Andover, MA 01845
VJ e Santos
/28/16
28 16
The Commonwealth of Massachusetts
Department of Industrial Accidents
Office of Investigations
600 Washington Street
Boston,MA 02111
IN jvww.tnass.gov1dia
Workers'Compensation Insurance Affidavit: Builders/Contracto rs/F(,Ie ctricians/1"I umbers
Applicant Information Please Print Legibly
Name(Business/Organization/individual):American Building Technologies – Jose Santos
Address: 2 Neptune RD #4 3 9
City/State/Zip:Boston MA 02128 Phone!#: 617 233 8704
Are you an employer?Check the appropriate box: Type of project(required):
1.[3 I am a employer with 5 4. ❑ 1 am a general contractor and 1 6. EJ New construction
"'Mployees(full and/or part-time),* have hired the sub-contractors 7. E]Remodeling
I am a sole proprietor or partner- listed on the attached sheet.I
ship and have no employees These sub-contractors have 8. []Demolition
working for me in any capacity. workers'cornp. insurance, 9. E]Building addition
[No workers' comp.insurance 5. We are a corporation and its 10.El Electrical repairs or additions
required,] officers have exercised their
3.El I am a homeowner doing all work right of exemption per MOL 11.®Plumbing repairs or additions
myself. [No workers' comp. c.152,§1(4),and we have no 12.R Roof repairs
insurance required.]t employees, [No workers' 13.EkOtlierLinsulat
comp.insurance required.] I EE�
*Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information,
I Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such,
teontractors that check this box must attached an additional sheet showing the n3nic offlic sub-contractors and their workers'comp.policy information.
lam an employer tliatisproviding)vorkerslcompensation insurancefor myeinployees. Below is the policy and job site
infonnado'n. Ace American Insurance
Insurance Company Name:--
Policy##or Self-ins,Lie.#:— 2E918445 Expiration Date:_ 10/2 0/16
<Z, WA
Job Site Address:_;r,–10 WA City/State/Lip:Mf Apawy–A Ar 0 105
Attach a copy of the workers'colpensation 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 tip 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 ryerase Nification
I do hereby certify under the ainsat d enaltiqs 01perjury that the information provided above 19 true and correct.
,Signature: Date. WOW
617 233 8704
Official use only. Do nite in eis are to be completed by city or town offlelal.
City or Town: Pernilt/License#
Issuing Authority(circle one):
.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person. Phone#:
c., . vu , ov MM Yliun G/ vv/_ rax ney'ver
CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYYI
TkIiSdWRICIFICATE 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
IMPORTANT:If the certificate holder Is an ADDITIONAL INSURED,the polley(les)must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to
the certlflcate holder In lieu of such endorsement(s).
PRODUCER CONTACT
NAME:
AMBROSC INS AGCY INC PHONE FAX
70 MI)NROE ST ST'E 5 (A/C,No,Ext): (A/C,No):
E-MAIL
LYNN, MA 02101 ADDRESS:
237LY INSURER(S)AFFORDING COVERAGE NAIC q
INSURED INSURER A: ACE AMER[CAN-INSURANCE COMPANY
AMERICAN BUILDINGTECHNOLOGIFS INC INSURER B:
INSURER C:
INSURER D:
263 wF.ST'ERN AVE
INSURER E:
LYNN, MA 01904 INSURER F;
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS ISTO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEER ISS ED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWrIHSTAN0ING
ANY REDUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T1418 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE
AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,EXCLUSIONS AND CON DrrIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY
PAID CLAIMS,
INSR ADD SUB POLICY EFF DATE POLICY EXP DATE
LTR TYPE OF INSURANCE L R POLICY NUMBER (MMMMYYYYI (MI AtDD1YYYY) LIMO'S
GENERAL LIABILITY EACH OCCURRENCE $
COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $
CLAIMS MADE OCCUR. PREMISES(Ea occurrence)
ED EXP(Any one person) $
PERSONAL A ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY 1'RO.IECT LOC PRODUCTS-COMPIOP AGG $
AUTOMOBILE LIABILITY COMBINED SINGLE $
ANY AUTO LIMIT(Ea accident)
ALL OWNED AUTOS BODILY INJURY $
SCHE DOLE AUTOS (Per person)
HIRED AUTOS BODILY INJURY $
NON•OWNEb AUTOS
(Per accident)
PROPERTY DAMAGE $
(Per accident)
UMBRELLALIAB OCCUR EACH OCCURRENCE $
EXCESS LIAR CLAIMS-MADE AGGREGATE $
DEDUCTIBLE $
RETENTION $ $
A WORKER'S COMPENSATION AND X WC STATUTOHY OTHER
EMPLOYER'S LIABILITY YIN UB-2ED1R445-15 10/201201.5 10/20/2016 LIMITS
ANYPROPERITORrPART'NEWEXECUTIVE M NIA E.L.EACH ACCIDENT $ 1,000 000
OFFIGER/MEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00()
It yon,doscrlbn w4or E,L.DISEASE-POLICY LIMIT $ 1,000,000
DE SCR I PTf CMI OF OPERAT IONS holow
DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLESIRESTRICTION5ISPECIAL ITEMS
'RES REPLACES ANY PRIOR CER'IITTCATE ISSUPI)TOTHE GERM-M-CATE HOLDER AFFECTING WORKERS COMP COVERAGE;.
CE=RTIFICATE-HpDER CANCELLATION
f' GLCAC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED
' WF..A'TIfE RI2ATTON ASSISTANCE PROGRAM BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B DELIV D
IN ACCORDANCE WITH THE POLICY PRO
305 ESSEX ST '
AUTHORIZED REPRESENTATIVE
LAWRFNCF,MA 01840
ACORD Z5(2040I85).,,The pCgQBD..namLi"and logo are registered marks of ACORD 1988-20110 ACORD CORP R r ghts reserved.
,, r`=%�n ll'rea�rt�re>rlr+eri�(✓r n�C?r%��rJlcrc�r�Sctfi
Office of Consumer Affairs&Business Regulation
E ' HOME IMPROVEMENT CONTRACTOR
Registration: 183105 Type:
Expiration: 5/1'1/2017 Corporation
� r
AMERICAN BUILDING TCHNQ1„O0IES,INC,
License or registration valid for individual use only
JOSE= SANTOS � before the expiration date. If found return to:
2 NEPTUNE RD.SUITE 430 Office of Consumer Affairs and Business Regulation
10 Park Plaza-Suite 5170
BOSTON,MA 02128 -" ------
Boston,MA'02116
Undersecretary
Not v 'd wi ou ignature
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CS-101378
Ccmstrucflon Supervisor y� f
• Construction Supervisor
Restricted to:
NOSE A SANTOS ® i �� Unrestricted-Buildings of any use group which contain
37 W.MILTON STREET APT��I y ���s less than 35,000 cubic feet(991 cubic meters)of
HYDE PARK MA 02136. ' o-' '1 enclosed space.
r—jZ;Z;K- Com._.._- Expiration:
Commissioner 11/27/2017
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocation of this license.
DPS Licensing information visit: WWW.MASS.GOVIDPS