Loading...
HomeMy WebLinkAboutBuilding Permit # 8/10/2016 Z-%AORTfi 0 BUILDING PERMIT ! LE 0 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 7 Date Received to Ari Permit NOS: SAC14U Efi Date Issued: �1>Z_ PORTANT: Applicant must complete all items on this page LOCATION r (94- L PROPERTY OWNER Print 100 Year Structure yes(no MAP PARCEL: ZONING DISTRICT:---Historic District ye no I Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building [I One family 11 Addition Li Two or more family E Industrial Li Alteration No. of units: 11 Commercial ------ El Repair, replacement El Assessory Bldg Li Others: D Demolition 0 Other DESCON OF WURK 1' BE PEF�FtIN1E OWNER: Name tdentification-T_�Iease Type or Print Clearly OWNER: 7—cl,�q Lf� Address: L 7S - Contractor Na AZ,' e: (9 LV`1 1.., Phone: S,I Email: �! ;-, vi , ej V i,'� "Ll" Address: //C -'e'-c-t q&-it S Supervisor's Construction License: 2 Exp. Date: L Exp. Date: ARCHITECT/ENGINEER Phone-. Address: Reg. No. FEB 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 , 7/ 7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund - NORTH q own of = :, 6 ndover O ,� - ti 0 �� �;KE h ver, Mass [4[Ntt.t..K 41' �,�p�RA7ER #61P ,CC2 S U BOARD OF HEALTH Food/Kitchen PER LD Septic System THIS CERTIFIES THAT .......... ..... . ... ...... ..... BUILDING INSPECTOR /1� Foundation has permission to erect .......................... build' gs on�j..clev r., .. .......... . . .......,. e Rough to be occupied as ..../.ItC.X 0/0j,e.....i ) ..4 e..k 0 V Lve.. ................... 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 ® TS ELECTRICAL INSPECTOR UNLESS CONST Rough Service .. ,....... .. .......... inai BUILDI INS CTOR GAS INSPECTOR OccupancyPermit RE uired to ®ecu BuLlding Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 1 , . FadBrat m#0&-OAOSBZ9 RISE Engineering Rt Contractor Reg%tratlan NO 8186 MA Contrac:W Re$"ation No 120979 1 A division of Thielsch Engineering Or Contractor Reglatratton No R!S E 60$bawmut Unit 42,Cantors,MA ENGINEERING CONTRACT (401)784-3700 FAX(40E)784-3710 Page 4 PROGRAM TM CONTRACT 19 ENTERED WTO BETWEEN RUSE CMA-HES ENOWERwOANOTHOCUSTOMER FOR WORXAS DeMiSEO CCLOW CUSTOMER PHM RATE CLUMI WOPXOR= Adam Cutler (617)424.4471 47/15/2016 437438 00002 SERV=SIRE" BEING STREET 23 Cleveland Street 23 Cleveland Street SERVICE erTY.STATE,ZP WWNG ermaTAmZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION FIX EXISTWG INSULATION:Slash the vapor barrier,flip,or reposition(185)square feet of insulation in the attic area. $46.25 KNEEWAILLS:Provide labor and materials to install 2" FSIs faced semi-rigid fiberglass board insulation to(185)square feet of kneewall area $647.50 ATTIC ACCESS:Provide labor and materials to insulate(4) back of the kneewall hatch with 2"rigid Thermax board,and seal the edge of the hatch with weatherstripping. $240.00 INCENTIVE:RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently,for eligible measures,Columbia ON of brs an incentiveaf 75'/16,not to exceed$2,000 per calendar year,and an incentive of 1000/6 for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. FOR A LI WITED TIME:Columbia Gas will also offer an additional$100 incentive towards the weatherization work:outlined in this proposal.This special Summer Incentive is available to homeowners who have had their Columbia Gas home energy audit before July 31,2016. A signed proposal for weatherization needs to be submitted by August 8,2016 and work must be completed by September 30,2016. Por the safely and health of your homes 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 full assessment of the cornbustion safety ofyour beating system and wafer heater.This has a value of$90 and is at no cost to you. The maximum allowable incentive for all measures,Including air sealing,is$3,210 The Permit will be secured by the insulation contractor,at no additional cost.It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. $90.00 .011VE fl JUL 9 2016 • r. ,1 r' •1 Federal ID 9 0840405829 RISE Engineering RI Contractor Registration No 8486 IM Contractor Registration No 124979 / A division ofThielsch Engineering CT Contractor Registration No RISE 60 Shawmnt Unit#2,Canton,HA G ENGINEERINCONTRACT (401)784-3700 FAX(491)784-3710 Page 2 PROGRAM THIS CONTRACT IS ENTEPIM INTO BETWEEN RISE CMA-HES MINEERINGANDTHECUSTOMMFOR WORK AS DESCRIBED BELOW CUSTOMER PRONE DATE CLLWO WORKOROER Adam Cutler (617)429-4971 47/15/2016 437438 00002 SERVICE URIEST BILUNO STREET 23 Cleveland Street 23 Cleveland Street owmea cay,STATE,ZIP BILLWO WN,STATE.ZW North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $1,023.75 Program Incentive: $855.63 Customer Total: $168,13 WE AGREE HEREBY TO FURNISH SFAWCES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE SUM OF ***One Hundred Sixty-Eight 8T 131100 Dollars $158.13 UPON FWAL.INSPECTION AND APPROVAL BY RME ENOWE MO,CUSTOMM AGREES TO REIWAMOUNT DUB IN FULL WrEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE APTER W DAYS.BIP REVERSE FOR WOITTANT WOFMATION ON GU MMEES,RIGHTS OF RECISION.SCHEDULNO,AND COMACTOR REGSSTRATiON. AO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHOF=DSIGNATURE-FUSE Enalimling CIS MERACCEPT CE NOM THIS CONTRWT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OP ACCEPTANCE �6 ACCTB'TARCE OF CONTRACT•THE ABOVE PRICFl.SPECIRCATTONB AND CONDITIONS ARE DAYS. SATISFAGWAY TO LIS AND ARE HEREBY ACCEP M YOU ARE AUTHORM TO OO THE WORK AS SPECIFIED.PAYMMIT WILL DE MADE AS OUTUREG ABOVE F�V 6 JUL 1 9 2016 F 60 Shawmut Road, Unit 2 Canton,� MA 02021339-502-6335� 1 ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM hflex- (Owner's Name) owner of the property located at: ve (Property Address) X44 (Property Address) hereby authorize JJ (Subcontractq 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. V Owner's Signature Date 1 1111 . �..•• The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations J I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/ContractorslElectricians/Plumbers ARpjicant Information Please Print Le ibl 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): 4. I am a general contractor and l 6 E] New construction employees(full and/or part-t] 1.❑ I am a employer with 100 � ❑ have hired the sub-contractors trte). 7, Remodeling listed on the attached sheet. ❑ 2.El am a sole proprietor or partner- These sub-contractors have g. Demolition ship and have no employees employees and have workers' working for me in any capacity. comp. insurance.+ 9. ❑ Building addition [No workers' comp. insurance 10.❑ Electrical repairs or additions required.] 5• ❑ We are a corporation and its 3.El I am a homeowner doing all work officers]lave exercised their 11.❑ Plumbing repairs or additions ', right of exemption per MGL 12T] Roof repairs myself. [No workers' comp. insurance required.] c. 152, §1(4), and we have no 13.21 Other Weatherization employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below slowing their workers'compensation policy intornlation. 7 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 nante 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. lam an emplover that is providing workers'compensation insurance for my emplovees. Below is the policv and job site information. Insurance Company Name: ACE American Insurance Company Policy 4 or Self-ins. Lic. 9: WLRC 48151553 Expiration Date:6/30/201 ' City/State/Zip: �L Job Site Address: + 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-yearviolator. i tl tors Be advised that a conment, as well opy of tlalties in the forrn of a s statement may be for O dedOo h oOfDfice of ER d a fine of up to $250.00 a day against the a Investigations of the DIA for insurance coverage verification. X do herehy certify under the pains and penalties of erjury that the information provided above is true and correct. Date: Si nature: 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# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Other Contact Person: Phone#: �� ¢a OAT OBMi ID2D YYYY) �.. CERTIFICATE OF 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 POLICIES 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(ies)must have ADDITIONAL INSURED provisions or 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 CONTACT 'O NAME: _ Aon Risk services Central, Inc. HO _____.___ FAX _ Southfield MI Office (A, No.Ext): (8667 2&3-7122 (APC.No.)_ (800) 3€3-OTOS 3000 Town Center E-MAIL q suite 3000 ADDRESS: 2 Southfield MT 48075 USA INSURER(5)AFFORDING COVERAGE NAIL# INSURED INSURER A: old Republic Insurance Company 241.47 TrUTeam Builder Services Group, Inc. INSURER B: ACE American Insurance Company 22667 d/b/a Quality Insulation 1969 AA1 N t S d' Ll010 INSURER C: Lloyd's Syndicate o. .126 A Topsuild Company 12 7.1.0 Peri meter Rd INSURER b: Nashua NH 03063 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570062471987 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 TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested ADD LTR Y EXP INSR TYPE OF INSURANCE INSb WVD SUBRI POLICY NUMBER MMIDOlYYYY MMIDDIYYYY Y EFF LIMITS A X COMMERCIAL GENERAL LIABILITY mw-zy EACH OCCURRENCE $2,000,000 DAMAGETO RENTED CLAIMS-MADE FX]OCCUR $2,000,0'00 PREMISES Ea occvffence ... MED EXP(Arty one person) $25,000 PERSONAL AAOVINJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 n X POLICY ❑ PRO- LOC PRODUCTS-COMPIOP AGG $4,000,000 JE0 OTHER: ti A MWT6 30751.9 06/30/2016 06/30/2017 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $S,000,0 00 Ea accident X ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) �y AUTOS ONLY AUTOS HIRED AUTOS PROPERTY DAMAGE @ X X NON-OWNED ONLY AUTOS ONLY Per accident . 4Y c X UMBRELLALIAB x OCCUR TH1600027 06/30 201606/30/2017 EACHaCaI1RRENaE $2,000,000 V EXCESS LIAB CLAIMS-MADE SIR applies per policy terns & conditions AGGREGATE $2,000,000 DED I X RETENTION B WORKERS COMPENSATION AND wLRC478601,80 06/30 2016 6 30 2017 X PER o7H- EMPLOYERS'LIABILITY YIN All Other States STATUTE ER _ ANY PROPRIETOR I PARTNER I EXECUTIVE E.L.EACH ACCIDENT $1,OOU,000 B OFFICERIMEMBEREXCLUDED? NIA SCFC47860209 06/30/2016 06/30/2017 (Mandatory in NH) wi only E.L.DISEASE-EA EMPLOYEE $1,000,000 Dyes, Oeunder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of insurance, _ h=.I 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. Builder Service!; Group, Inc. AUTHORIZED REPRESENTATIVE air—, dba Quality Insulation A shuauid Company � � Nashua NHH03063 USA. r'r t=�J .y.• � ©1888-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I q&YToronsumer #a i r s idVuinesse u at ion 10 Park Plaza - Suite 5170 Boston, MeLssachusetts 02116 Homemprovem 'tcontractor Registration Registration; 179149 Type: Supplement Card Expiration: 6/25/2018 BUILDER SERVICES GROUP, INC 5 RICHARD SCHWARTZ t ---- - --___-_- -- __-_-- 260 JIMMY ANN DRIVE DAYTONA BEACH, FL 32114 t _ J�Nn " Update Address and return card.Mark reason for change. SCA 1 0 20M-Wil [-] Address ❑ Itenewai ❑ Employment Lost Card Ccs n»r.i���»u.�tr�l�v�'Cs/��raur�ttac��s mQla(lice of Consumer Aftairs&Business Regula don License or registration valid for individual use only ME iMPROV�MENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation WRegistration: : Typo: 10 park plaza-Suite 5170 _.: ExpiratiAS{ S_t_2t1:8,3 Supplement Card Boston,MA 02116 BUILDER SERVICES)GI7LI �IElC , ' RICHARD SCHWAR? 11 Q PERIMETER RO ;,.17 NASHUA,NH 03063 Undersecretary Not valid without signature SSL-105992 RICHARD SCHWARIZ ' Nk" Al M HUNTRESS STREET sand"wrNH (W 02 ResvidedTo SSL K'. mEmiauz } | � � � . � I . Qu»m Sae, .e wem a the e)swhuse"S | to Bwwmg. nue Or meas»of emBenv ... . . . .. }