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HomeMy WebLinkAboutBuilding Permit # 9/22/2016 BUILDING PERMIT of °Or 6�H TOWN OF NORTH ANDOVER �'= g�'''<- .6 4 0 t eti APPLICATION FOR PLAN EXAMINATION �o Permit Na#:0. Date Received4'�R�rEo �SSac�usEt Date Issued:Lq IMPORTANT: Applicant must complete all items on this page LOCATION - _ P n PROPERTY OWNER. FLae- Print, 100 Year Structure yes no MAP PARCEL: /-5�,-" ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ;� ne family ❑Addition ❑ Two or more family ❑ Industrial 4-�3;Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .�✓'����" r MEOW D SCRIPTION OF WO K TO BE PERFORMED: cn_ Ide tificat'on- aseTe ype or Print Clearly OWNER: Name: CCI&l.I �. C_ Phone: Address: _41-W- C Contractor N rne:. 4 LPhone: EmaEl: a- r �c(D Address: Supervisor's Construction License: Exp: Date:_��6&, Home Improvement License` 1-7q tH Exp Date: (,Q/Q 57J t ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 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 with unregistered contractors do not have access to the guaranty fund ,77 ... . . . ..... ............................................... r10RTH q owe. of �� a ndover roh ver, Mass, ZZ [aeet r Co „ w� .c I. h' Z Z R o � 0 ATED )`'7 �(5 S V BOARD OF HEALTH Food/Kitchen PERMIT _T LD Septic System THIS CERTIFIES THAT 5Foundation BUILDING INSPECTOR has permission to erect .......................... buildin son ... C#44 ....... ....V.. ...., ......,.. Rough to be occupied as / IR. ` ......... 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, 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 MONTHS ELECTRICAL INSPECTOR UNLESS CONST "I® Rough Service ' Fina( BUIL INSP TOR GAS INSPECTOR Occupancy Permit#e uired to ®ccu BuRough 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. J. it Federal Ih U 96Q/0t!019 RM Englaeft R1 Coat actor ReakeWom No 0186 MACcaftclor ReglaWan No 4!0979 A division of Iblelsel;ftineering Company Address,Cl ty,MA MOD CONTRACT 401-123.1234 FAX401-123-1234 Pap I PROGRAM CMA-MM CONNOM am CUB" wMaram C= MichactFuller (791)953.M 06/21/2016 436460 00002 alumm aim 5 Rosedale Avenue 5 Rosedale Avenue 62"as 4maulg.2w CD Cw.ffawar North Andover,MA 01 North Andover,MA 0180 JOB DESCRWnON HAZARD BARRIElt We have idMN(Wthat there are messed lighta present in your home.unless the mcmd 110ts an cartir" as IC-rded(InsuiationContact Rated)vie QI wwa a 31 clearancospace aroundthe fixture by using fiberembi frtuadstion as a &mmingzatafal,to inst1lation WE]he fiWallod==the top md closed cavities which contain recessed lights will not be insulated. $0.00 ATTIC FIAT-Provide labor and materials to install a 91 layer ofR-30 unfttced fiberglass buts to(80)uWa,fiat ofaft sp=. $133.60 ATTIC RAT.Provide labor and materials to EnatW1 a 61 layer of R-21 Cless I Cellulose added to(894)square(bet ofopw attic $1,126.44 WHOLE HOUSE FAN.,Provide labor and materials to fiorkae and Eost&U a rigid bm iosu]atiog cover for the vkolo house fan. $209.21 ATTIC ACCEM Provide labor and materiels toftwtall(l) easily moved,insulating cover for the attic access f6ftl;stair. Asmall Ad sm*=of plymad will.be created amund the opcob*Wthin the attic, This wig allowtho cover's integral weather-stripping to restrict air takeso, $237.65 VENTILATION:Provide labor admacriahto install(2)inn WW exthaust hose with roof mounted flapper vent to exhaw existingbwwoom&a(s). $237.50 VENTILATION:Provide labor and materials to install ventilation chutes in(63)rafter bap to maintain air flow. $126.00 INCENTIVE:RISE Engineering vvdl apply all apPlica63G diglhtc bttxntivrsto thigoontruat. You will only be billodtheNat amount. Cwm*-for ft19omeasure,Columbkbas offersaft hicantivc075%not to exceed$2,000 per oWm&year.and an inocaft of 100%for the Air Sealing mean up to the that$W and an additional$340 if savings are justified by the auditor. FORA LWTED TIME:Columbia On vill also offeran additional$100 incentive towards the weethubmion work cWhied in this proposal.This special&mmer Inventive is avaMdb to homeowere who have hadtheir Colunbla Gas home energy audit before July 3L,2016. A signed proposal for wwbaizatiDn needs to be sibmittod by AugaL 9,2016 and viark must be completed by September 30,2016. For the safety and health of your homes indoor air quality,vie viii!be conbetiogn,blower door dkrostic of the avalbWe air flow in your home both before the vork is b*m,and after the wdheritation work is OOMPICIL We VIM"CGR&d&fW assessment of the combustion safety of your heating system and vater hater.This has a value of$90 and is at no cost to you The maximum allowable incentive for all mess urea,including air sealing,is$3,210 $90-00 A' _i L FsdwO In 110640" MSE Eqghwe}jng RI Coa&wwr Raplat won No 8108 MAC*nb=or"h tra on No IMM 5 A divtiion or7l!€elach Fng€neerigg RI �' Campaay Ad4reas,City,MA OW CONTRACT 1 ENGINEER[PIG 401-113-[234 FAX402-123-1234 Page 2 PROGRAM Qac Mim BAS CUMrn wfawoRaall Mich"IFUller CnIW5.3-6m 062U2016 436460 x(102 dFRVM$RMT OILMQ WKMT 5 Rosedele Avenue S Rosedale Avenue VMV=cnv.alxvLzr RUM crff.9 1I%MP North Andover,MA 01845 Nari1L Andover,MA 01845 JOB DFSCRIP'I.TON Total: $2,160.40 Program Incentive: $1,742.80 CusbDrner Total: $417.60 WBA hWaBVToFUR%MHs9tI M-00AWLEM NACCORMCOWMAH631ESPS.MATM%F0RDM8 MOP '*`Four Hundred Sevendaen 8s80190fl Dollars $417.60 ratAr.I�7290rANOAPPRavAiaKama seoaa�t�3n rra�autr�wrOINwLLar�aLw- roux ewu�aon kom - Aa>r;uAt�ne a�ra.amH waaNrt�olawt�wr aaRurt�a.RaMaPwLxsa�uLa� asltas�u DO Nfff 9(QL1 MM 00MR/CT IF MUMS SLANAC It /V 7��gym. ,�:.� ► aear�� Ef{IEOFANHPBUIC6 .._...... ACCEF AG60P0wFA6T-VMAWMPw=aFilIF10=GAW0M F W PM 30DAM E11' K1.1�F bY�R.YWARAAYIMMEDIDUU 1�[ti1f1 AaaF6gRaa.PA 88WIa8A30U&M=ABM i A i i i j RISEBD Shawntut Road, unit 21 Canton, MA 020211339-502-6335 ENGINEERING www.PJSEengineering.com OWNER AUTHORIZATION FORM qe f (Owner's Name) owner of the property located at: 1'<V06C 46 dG (Property Address) (Property Address) hereby authorize ( ubcantractor) , 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� K�- a OW-Ker's Signa ure 6u I � V ©ate i i The Commonwealth of Massachusetts 9 - Department of• industrial Accidents Office of Investigations 1 Congress Street, Suite 1110 r Boston, MA 02114-2017 www.mass.gov/dia m ber s uilders/Contractors/Electricians/Plu Insurance Affidavit: B PensationLegiblyt rkers Com Please FrinWo Applicant Information Builders Services Name (Business/Organization/individual): Group d/b/a Quality insulation Address: 1 10 Perimeter Rd city/State/Zip: Nashua NH 03063 Phone #:603-324-1974 s" Type of project(required): Are you an employer`.' Check the appropriate box: 4. l am a general contractor and 1 6 ❑ New construction I.Q 1 am a employer with 100 * ❑ have hired the sub-contractors f employees(full and/or part-time). 7. Remodeling listed on the attached sheet. ❑ 2.❑ 1 am a sole proprietor or partner- These sub-contractors have $. ❑ Demolition ship and have no employees employees and have workers' 9. ❑ Building addition working for me in any capacity. comp insurance. [No workers' comp. insurance 5 ❑ We are a corporation and its 10.Q Electrical repairs or additions required.] officers have exercised their 11.❑ Plumbing repairs or additions ;,❑ er doing all work I am a homeownright of exemption er MGL myself. [No workers' camp. g p p 12.E] Roof repairs c. 152, §1(4),and we have no 13.171 Other Weatherization insurance required.] employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also 1,111 out the section below showing their workers'compensation policy inibrmation. outside con t Homeowners who submit this afTidavit indicating they are doing how nrkthe name of d thert hire he sub--contractors and tractors must tate wheth r or nattlhoscavit'entities havech. +Contractors that check this box must attached an additional sheetg otic number• I rthe sub-contractors have employe employees. es.they mast provide their workers comp.p Y 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 Expiration Date:6/30/201'7 Policy #or Self-ins. Lic• #:Wl BC 4&1'1553 Job Site Address: - L) City/State/Zip: ' � Attach a copy of the workers' compensation policy declaration page(showing the polcynumber f criminal penalties of a Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to theimposition fine u to he form Of $1.500.00 and/or one-year imprisonment,as well as civil penalties intent a be forwarded dedOto h office of d a fine p y of up to $250.00 a day against the violator. Be advised that a copy of thts statetn Investigations of the DIA for insurance coverage verification. 1 do hereby cern_y under the ains and enalties of erjury that the in ormation provided above is true and correct. Date• 5i nature: Phone#:fiO3-324-1974 Official use only. Do not write in this area, to be completed by city or town official City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3.City/Town Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Phone#: Contact Person: I I i CATE(MMIDDAYYYY) A CERTIFICATE OF LIABILITY INSURANC 061141201 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED n REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ° IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)must have ADDITIONAL IN UREA provisions or be endorsed. if SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may repair an endorsement A statement on 9 this certificate does not confer rights to the certificate holder in flea of such endorsement(s). CONTACT PRODUCER NAME' Aon Risk Services Central, Inc. P ONE (866) 283-7122 FAX (800) 363-0105 (AIC.Na.Ext): AlG.No. Southfield M1 Office EMAn. O 3000 Town center ADDRESS: suite 3000 Southfield M1 48075 USA INSURER(S)AFFORDING cOVERAGE NAIC N i INSURED INSURER a Old Republic insurance Company 24147 ACE American Insurance Company 22667 TruTeam Builder services Group, Inc. INSURER AA1120106 d/b/a Quality insulation INSURER C: Lloyd's syndicate NO 1969 A Top$uild Company 110 Perimeter Rd INSURERD: Nashua NH 03063 OSA INSURER E: I � 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 NA EDA E FOR',THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCU ENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER IN 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 SUBRTYPE OF INSURANCE !NSD -- POLICY NUMBER MMIDD fDD1YYYY I-PbUCY EFF P43UCY EXP LIMITS ' LTR MWZY 1 #EACHCOURRENCE52,000,000 X COMMERCIAL GENERALLIABlUTYD $2,000,000 LA(MS•MADE X❑OCCUR Ea occurrenceAny one person) '1, $25,000 9 PERS NAL&ADV INJURY $2,000,000 ' GENE ALAGGREGATE 54,000,000 I GEN'L AGGREGATE LIMIT APPLIES PER: X PR'TPROD CTS-CDMPlOP AGda $4,000,000 JECT LOC ti OTHER: n MWTB 307519 06 30/2016 06/30/2017 (Ea a NED SINGLE LIMIT $5,000,000 A AUTOMOBILE LIABILITY EaIden, '. •. $ODIC I INJURY(Per person) C B X ANY AUTO i=t I INJURY(Per accident) DINNED SCHEDULED Gden AUTOS ONLY AUTOS PROPERTY t DAMAGE v u X HIRED AUTOS FX NON-OWNED Pere ONLY AUTOS ONLY C X UMBRELLA LlAB X OCCUR TH1fi00027 06/30 2016 06/30/2017 EACH CCURRENCE $2,000,000 ti SIR applies per policy terns & condi ions AGGR GATE 12,000,000 EXCESS LIAR CLAIMS-MADE DED M RETENTION 06/30 20 6 06/ 0 2017 P R oYH- B WORKERS COMPENSATION AND WLRC47$60180 X ATUTE EMPLOYERS'LIABILITY YIN All Other States E,L.E CH ACCIDENT $1,000,000 B ANY PROPRIETOR IPARTNER IEXENIA CUTIVE sCPC47860209 06/30/2016 06/30/2017 OFFICERIMEMSER EXCLUDED? WI Onl E.L.OS EASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) Y 11g,descn6e under E.L.C EASE-POLICY LIMIT'. 51,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTiON OF OPERATIONS r LOCATIONS I VEHICLES(ACORD 161,Additional Remar"Schedule,may he attached if more space Is required) Evidence of Insurance. CERTIFICATE BOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Builder Services Group, In AUTHORIZED REPRESENTATIVE dba Quality insulation A TauiCompany — NashuhuINK a 03063 USA e i u: 01988-2015 ACOR CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD i 3 3 3 1 mfikiii �. ffiGe o onsumer i s r �d usmess e u t n g a.xo 10 park plaza - Suite 5170 Boston, Massachusetts 02116 j Home Irnprovem. § ontractor Registration Reglstmtlon: 179141 Type: Supplement Card BUILDER SERVICES GROUP, INC M J � Expiration: s12sr2a�s RICHARD SCHWARTZ 260JIMMY ANN DRIVE DAYTONA BEACH, FL 32114 h< �t°h 16 Update Address and return card.Mark reason for change. SCAIt5 zo rn ❑ Address [I Renewal El Employment [D Lost Card s i �ie Sir w tic err/ o�'vF2aest d,,, A ee of Consumer Af uirs&business Regulation License or registration valid for individual use only E IMPROVLENT COHTRAGTOFt Before the expiration date. If found return to; Oflire.ofConsumer Affairs and Basiness-Regtilatlan R$glasrType, 10 EXPI t -W supplement card Boston, Plaza-Suite 5170 , ,MA 02116 BUILDER SERVICE j— RICHARD SCHWA 110 PERIMETER RQ — NASHUA,NH 03463 Undersecretary Not valid without-signature 3 i - B B i I 3 CSSL-105992 RICHARD SCI-CW RTZ 19:r HUNTRESS STREET ytanc6ester:kH 03102 09/2612016 RestgcCed To CSSL-IC-insulatior'Contractor 1 railure to posses rren edition of the Massachusetts State Buiiding Cc: cause tor revocation of tNs license.