No preview available
HomeMy WebLinkAboutBuilding Permit # 10/6/2016 tkoRTH B RMIT UILDING PE TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received AO 40/ aLk Date lssqed-. f IMPORT ant must comply to alI Mems on this page TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential D New Building )Kbne family I.1 Addition 0 Two or more family D Industrial Alteration No. of units: Li Commercial e eve pair, replacement El Assessory Bldg E Others: El Demolition El Other eti7 77 "' %P Water ed Dstrct; ;,r redsd ®ESC P-rIC N OF RKERF Rr- el 23 elle, 4,.5 6,z,4rv, ok Ixel Cie W Identification - Please Type or Print Clearly OWNER: Name: Phone: Address: Ph'"" 7 '11,, 0/1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PE MIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. e- Total Project Cost: $ FEE: T7 -3&97 Check No.: -Rec NOTE: Persons contracting with unregistered c nfrav rs v ess to the guaran(yfund I$ign I a I tur I e 11 of 11 Agent/Owner ctor NORTH 'q Town of � � _� �. � ndover o No. _ - xb C, h ver, Mass, O� coc.nc Kt WICK ti S' U 4ATIED C> BOARD OF HEALTH P. ERMIT T LD Food/Kitchen Septic System THIS 4040".11CERTLFIES THAT ........... .V.&.............. BUILDING INSPECTOR ! ��44 ` � S r Foundation has permission to erect .......................... buildings on ...... .... ................................ ...............,.............. . Rough to be occupied as ......9�.Sv 1�At........ .f..........k..111 ................................................. Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Fine 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 COSTRUCTIO START Rough Service ......... . ....... ........... .......................... ............. Final BUILDING INSPECTOR GAS INSPECTOR OccupancyOceupancy Permit Required to QccupE Buildan 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 wilding Inspector. Burner Street No. Smoke Det. Work Order GREATER LAWRENCE COMMUNITY ACTION Job Number:20093975 COUNCIL,INC. Work Order Date:6/24/2016 305 Essex Street Ownership:Owner Lawrence,MA 01840 Phone:978 681-4956 HEAT QUEST INSULATIONS COMPANY LLC Auditor:Keith Young 142 HALE ST UNIT 2 Email:kyoung@glcac.org HAVERHILL MA 01830 Cell:978 857-7841 Email:heatquest@aol.com Phone:978 681.-4955 x4793 Phone:978 361-6091 David Lieciardi Columbia Gas $6,425.22 20 Harold St Total $6,425.22 North Andover Ma 01845-3411 978-337-3724 Safety Issue(s):Lead Paint Possible Autlior�zed - Actual Measure Descr�phonCommezits71 Qty Price U.A Qty Total Attic InsuXahon mamma - Kneewalls R-12 cellulose behind 80 1$2.04 $163.20 80 $163.20 gable end walls in knee wall permeable membrane R-18-20 restricted-slopes/floored 366 $1.63 $596.58 366 $596.58 slopes fill wlcellulose R-20 behind membrane cellulose 644 $2.16 $1,391.04 644 $1,391.04 Net&blow slopes in knee wall open ratter R49 unrestricted-settled cellulose 270 $1.89 $510.30 270 $510.30 1VI�sc Measures Attic/basement blower door guided 1.5 $73.50 $110.25 1.5 $110.25 Seal under sinks,chimney,plumbing,electrical sealing with one-part foam and all air penetrations to the living space. Blower door set-up with pre&post 1 $45.00 $45.00 1 $45.00 tests Cuticlose attic-kneewall access 2 $92.40 $184.80 2 $184.80 in front of house speak with client Recessed Light Enclosure 1 $34.65 $34.65 1 $34.65 1 in bathroom Permit t Other 1 $0.00 $0.00 1 $0.00 Date:6/24/2016 Page 1 Work Order: Job Number: 20093975 Walllnsulatton Wood clapboardlshakestshings or 1614 1$2-10 $3,389.44 1614 1$3,389.40 vinyl(dense pack) Total $6,425.22 $6,425.22 Contractor Instructions: Before Startiniz theJ b: During the Job: 1.Please notify us 24 hours before starting or scheduling a job. 1.This residence was built before 1978.Lead safe practices 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) HEAT QUEST INSULATIONS COMPANY LLC hereby certifies that this job was supervised and completed in compliance with all Department of Labor Standards and Lead RRP regulations. Contractor Signature; Date: RRP License#: 9 j 1 hereby acknawlege that all work has been completed and inspected. Customer Signature: Date: Energy Director: Date: Fiscal Officer: Date: Page 2 Date:6/24/2016 �i I Work Order: Job Number: 20093975 FOR AGENCY USE QjNLY 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 55.000 Number of windows Ambient CO 0,000 Number of rooms Blower Door 0.00 Date:6/24/2016 Page 3 9661 Pr U Q Greater Lawrence Community Action Council,Inc. Weatherization Assistance Program 305 Essex Street Lawrence,MA 01840 WORK PERMIT I, L � Certify that I am the owner/authorized Agent for the proper at: (Address) T further certify that I have given my permission to allow work on the property listed above in accordance with the following provision- 1. Weatherization 2. Heating System Work 3. I will allow GLCAC.Inc. and the Contractor access to the property to install weatherization measures, system repairs and inspect the quality of work completed. GLCAC will give the client a one hour window for the purposes of scheduling inspections.If you do not allow access you will be required to reimburse the contractor for all work performed in your house. I certify that I do not owe any property taxes,water or sewer taxes to the municipality that the property is located in: 4. and such other particulars as may be attached to this agreement. Signed: Date: Owner/Authorized Agent Greater Lawrence Community Action ,ditor: Keith Young Phone: 978-857-7841 rob#: 5519 Date: 6/13/2016 Client ` First Name: David Last Name: Lucciardi Address: 20 Harold St. city N.Andover,Ma. Zip Code: 01845 Phone 1: 978-337-3724 Phone 2 House Type: YCapeJ Ranch Split 1 fam 2 fam 3 fam duplex 4 famil Victorian Colonial Tenement Sidin T e Woo Vinyl Iumn Asb Single Asb Dble ConditionGaod Fair Poor Vin 1 overAsb T111 Brick/Stucco Asphalt Comments: RoofTyp e Gable Hi tFt Gambrel sphalt Slate Rubber Tar& Gravel Condition ' Fair Poor Age of House., T940 Heating System, Manufacturer: NTP Print Out CAZ Base Reading : Pre-;tL Post: Oxygen 4.6 CAZ Worst after zeroing out : Pre Post: CO 55 No subtraction needed Efficiency 89.2 CO 2 House Draft limit in Pascals according to CAZ depressure limit Stack temp 132 Draft needed in Pascals vs acceptable draft range per temp Air temp 70.9 Draft INWC = in Pascals Excess Atr o Free alr FHW Steam FHA Space Heater Flame Color Oil Gas Electric Wood Pellet ge Treated Ducts: Yes No Pipes: Yes No Ambient Smoke Heading Domestic Hot Water Tank Referred to HWAP yes no Gas Oil Electric Tank less Date re erre Gallons Temp Sie-ffi—ngSpillage .DraftSpillage es o ra Amb ac Add ee o pipe wrap YES NO CO detectors: Yes/No Locations: Comments: Number of occupants `-I Number of smokers O Number of pets Ambient CO Readings : Stove U Oven Broiler D Dryer_ ****** House draft limit is based on System type Draft needed in Pascals is based on outside temp. **' "* #REF! 20 Harold St. Doors Sweeps f%F Location Kits Auto Reg Caulk Caulk Repairs Replace Dra a Solid Hollow Comments � IN OUTFront to out 9st fir Front to Hall Rear to out side to out To attic To Basement Basement to out rear to hall to front porch 1&2 to rear porch 2&3 Location Condition Damper Yes/No Fire place damper closed Space Heaters Asbestos �o:wer Door Pre Post by contracforMulti Family (!one cs of readings needed. Vermiculite Knob and Tube Yes (NO) Locations Date inspector called Blower Door Air Sealing Se c Make sure bath fan is vented Fans Bath 7 wJ ht w/o light Cfms _ /.0 = L Bath 2 w/light w/o light Cfms CO detector yes no Vie Commonwealth of Massachusetts Department ofind,ustrialAccidents A ; _ I Congress,Sheet,State 100 02114 20. 7 Boston,MA. •^ -�•qWK www mass.govfdia *,,kers' Cornpensatiox►bsuran.ce Affidavit-Builders/ConftactorslElectriciaus/Plumbers. TO BU ME]D WITE1 PERK TTING AU><HO Y. lease F Le 'Tol A ' licaut Information U l Name(Businesslorgansza, anlltadi�dual): V Address: p 6f0 l -/ 0j/ 0 � � City/state/.Zip: : Type ofproject(require); Areyou auernptoyex?C$ecltlie propriatebox: I, am aemployerwitlt employees(Hill andlo art time). ], NEVd6l]stractton 2, ant a sole proprietor or partnership andhave no omployees working forme in $. Re]7to delag any capacity.[No comp.insurance required.] g, ❑Demolition 3.[]i am a homeowner doing all work myself[No workers'comp.insurance required.]' 10 Building addltlan r},Q I am a homeowner and will be hiring contractors to conduct all work ori my prop' zty- I will [�t L 1 11.�Eleorical repaits or additions ensur,that all contractors eithorhave workers'compensation insurance or are,solo .pt �ing repairs or additions Proprietors with no erriployees. E—1 13'.[�Ttoof repairs 5,0 S ant a genazal contractor and Thavehicedthesub-contractors listed uraneontheattachod sheet. G 'these sub-contractors have employces and have workers'comp.insurance.t l4 Zther e�J 6.❑We azo a corporation and.its,officers have exercised thais tight of exomQtion per MGL c. I52,§1(4},andvle Have no empldyees.[No workexa'no insuranco zegt�ired.] (/_ S rthiro outs *Any applicantthat checks fox#1 piust elan fdo Contra, ill.out the sention below showing theirwarkers'compensatoall-work, rg must submit information'.' i Homeowners wha submit this aM� vtt i dibhed�dditi nal.sheg bowing the namaudthe e oftl o sub contractors and state whsthr oz gpot fhoseentit}es have h #Contractors that checkthis box m omployan ernces. If the sub-contractors have'MIA.),-3,they must pro=vide their workers'comp.policy number. IOYeP that is ppopidingwor ke)lsI coin ensation insurance far'my employees Below is the policy and-lob site lam P information. v �("v 4f e, Insurance Company Name: / 'V 00 b Expixation.Datc' Policy##or Self ins.Lie. I CitylstatclZip: lob Site Address: r +vim' ng the Policy number and expiration Attach a copy of the•workers' compensation policy declaration page eintinal-violation pimisbaba by a fine up to$7.,500 00 ' Failure to secux•e coverage as required under MGT.,G. 152,§25A as a x fox irasuranco and/or one-Year imprisobnaent,as 11 as civ` nalties in the form of a STOP WORK ORDER attd tifLne of up to $250.00 a day against a I ox o of e nt may be forwarded to the Office of Investigations of the DTA. coverage vert a xdo lierel�y ert nd rite ai a penalties ofperjury tlaattlie inforrrzationprovidedal�a�is�/ and correct . Date: Si atur : -P one 4: official use only. Do not write in this area,to he completed by city or totPn official permit/License# City or Tovvn- issning.A.uthority(circle onze): ' ector 5.Plumbinglnspector 1,l3oard of ffealth 2•Bnildxug➢epartment 3.CitylTo-evn Clerk 4.L+lectritcal)asp 6.Other Phone contactPerson: ................... . DATE ' CERTIFICATE F LIABILITY INSURANCE 09/19/21016) ACCRA, PRODUCER (978)373-5623 FAX (978)521-,2751 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ANTHONY MALCOLM INSURANCE AGCY. , INC. ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AMEND,EXTEND OR 3 SO. CENTRAL ST. ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. BRADFORD, MA 01835 INSURERS AFFORDING COVERAGE NAIC# INSURED Adan Vei I Ieux, ]r. d/b/a INSURERA: Phenix Insurance CO. Heat Quest Insulation Company LLC INSURERS: Safety Insurance 142 Hale 5t. unit 2 INsuRERC: The Hartford Haverhill , MA 01830 INSURER D: INSURER E: COVERAGE 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.AGGREGATE LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. DATE !NSR DD' TYPE OF INSURANCE POLECY NUMBER POLICY EFFECTIVE POLICY EXPIRATION LIMITS GENERAL LIABILITY CPP0713253 12/27/2015 12/27/2016 EACH OCCURRENCE S 11000,000 COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED $ 50,000 CLAIMS MADE a OCCUR MED EXP(Any one Person) S S,000 PERSONAL&ADV INJURY S 11000,000 A GENERAL AGGREGATE $ 2,000,000 G£N'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOP AGG $ 2,000,000 POLICY JECPRO7 LOC AUTOMOBILE LIABILITY 5021421 12/26/2015 12/26/2016 COMBINED SINGLE LIMIT $ ANY AUTO (Ea accident) 11000,000 ALL OWNED AUTOS BODILY INJURY $ X SCHEDULED AUTOS (Per person) B X HIRED AUTOS BODILY INJURY $ X NON-OWNED AUTOS (Per eccidenty PROPERTY DAMAGE $ (Per accident) GARAGE LIABILITY AUTO ONLY-EA ACCIDENT $ ANY AUTO OTHER THAN Fla ACC $ AUTO ONLY: AGG S EXCESSIUMBRELLA LIABILITY EACH OCCURRENCE $ OCCUR CLAIMS MADE AGGREGATE $ $ DEDUCTIBLE S RETENTION $ 5 WORKERS COMPENSATION AND 6S60UB9609L39015 11/08/2015 11/08/2016 WC sTATu- I I OTH- EMPLOYERS'LIABILITY E.L,EACH ACCIDENT S 1,000,000 C ANY PROPRIETOR)PARTNERIEXECUTIVE OFFICER(MEMBER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 11000,000 Ii yas,describe under E.L.DISEASE-POLICY LIMIT $ 11000,000 SPECIAL PROVISIONS below OTHER DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES I EXCLUSIONS ADDED BY ENDORSEMENT(SPECIAL PROVISIONS insulation work - eneral liability code #96410 orkers' compensation code #5479 CERTIFICATE HQL CANPELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,THE ISSUING INSURER WILL ENDEAVOR TO MAIL Town of North Andover 10 DAYS WRITTEN NOTICE TO THE CERTIFICATE HOLDER NAMED TO THE LEFT, Inspectional Services BUT FAILURE TO MAIL SUCH NOTICE SHALL IMPOSE NO OBLIGATION OR LIABILITY 1600 Osgood St. Bldg. 20 Suite 2/36 OF ANY KIND UPON THE INSURER,ITS AGENTS OR RI PRE5ENTATIVES. North Andover, MA 01845 AUTHORIZEDREPRESENTATWE Frederick Malcolm 3r. dA OACORD CORPORATION 1988 ACORD 26(2001108) FAX: (97$)688-9542 IMPORTANT If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). DISCLAIMER The Certificate of Insurance on the reverse side of this form does not constitute a contract between the issuing insurer(s),authorized representative or producer, and the certificate holder, nor does it affirmatively or negatively amend,extend or alter the coverage afforded by the policies listed thereon. ACORD 26(2001108) Massachusetts Department of Public Safety , 3 Board of Building Regulations and Standards License: CSSL-099295 Construction Supervisor Specialty ALLAN M.VEILLEUX,JR � 142 HALE ST UNT-2 HAVERHILL MA 01834, �M . . Expiration: Commissioner , 08/99/2078 " r {' t,i"YTg.li�.lGP.!#1 f saf,' r 1�r3 �. ; dice orCo r r" Itastn 1Zcgut � r . ME Imp— V pI=AtT'Gt3NTRAMF� : . ,eg�stratfon a36S0 ,, � s _ r .xplrafion 9212 E12p1$.' pgq x HEAT QUEST INSIJI A rib. CD LLC'' At l qN V1=11 LEU?( g J 5 SHAWSHEI;N LAWRENCE;M>401843 i- � � - Undersecrery