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Home My WebLink AboutBuilding Permit # 10/12/2016 NORTy BUILDING PERMIT °F TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION * ; Permit No#: !'� 1 Date Received �AnrE° �S SRC F1L15F� Date Issued:_ IMPORTANT Applicant must complete all items on this page rt PROPERTY 011VNER �` E.s `"� F 101 Year'.35tructure `'y �IeS�`� Ito P�t1t Mpp PARCEL ZONING DISTRiCK Hrstorrc Distract yes no ,r ,Machine Shop..Urllage, ..;yes. � rap-. _. ; TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family El Addition El Two or more family L1 Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Se ttc ❑Well ❑ Floodp[ai ❑]Wetlands ❑ Vllatershed�rstnct p ❑1111ater'ISewer . .. .... .,. DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: e, " e Phone: Address: � Confracto Name n one Email AddressAk b. :.'. r: 5uperu�sor's Construction License Exp Date »` Home Improvement„License. ' Exp Date ARCH ITECTIENGINEER 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: $_ 33 �: .FEE: Check No.:.__L 00 Receipt No.- �- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 5ig ature of Agent/Owner' Signature of contractor:, V40RTH Town of t 6Andover 0 �+ a � V.K. h ver, Mass, b 4 coc.ucKC.I.K 1' A�� ATE D U BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System JVM THIS CERTIFIES THAT JA rt, kvBUILDING INSPECTOR has permission to erect .......................... buildings on ......q(..... .. .,.... .f...2.b........... Foundation Rough to be occupied as ...........,�.�. .�w.�Cp. � ` r4 �� S Chimney s . ................................ ....................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application Find 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 IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION Rough .Y. Service .. ..... . ..... ........... . ... Final BUILDING IN CTOR GAS INSPECTOR Occupancy hermit Re uired t® Occupy Buildin Rough Display in a Conspicuous Place on the Premises �- Do Not Remove Final YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. www.ReviseEnergy.com Revise Energy Home Performance Contractor 5 South Summer Street,Bradford,MA 01835 CONTRACT 978-914-2214 FAX(401)784-3710 Page 1 PROGRAM CMA-HPC -- -- - - -- -- ------ - - -- CUSTOMER PHONE DATE CLIENT# WORK ORDER James Holloway (781)962-3973 09/21/2016 440464 00001 - ---- - ...------- -- .. — — SERVICE STREET BILLING STREET 41 Perley Road 41 Perley Road - -- - - SERVICE CITY,STATE,ZIP €r€LLING CITY,STATE,ZIP North Andover,MA 01845 North Andover, MA 01845 JOS DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(1)working hours.A reduction in cubic feet per minute(cfni)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety ofthe indoor air quality. $85.00 WALLS:Furnish and install blown in Class I Cellulose to(1378)square feet ofshingle and/or clapboard exterior walls.The butt of the upper course of your wood siding is cut to drill holes into the wall sheathing behind,The holes are then plugged and the wood siding is reinstalled using stainless steel finish nails.Touch-up painting,if needed,will be the customer's responsibility. Invoicing will occur upon completion of installation.Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure frown the weatherization work to be performed.Your signature is your acknowledgement of receipt and agreement to proceed. $2,549.30 CRAWLSPACE:Provide labor and materials to install(225)square feet of 6 ml polyethylene over open ground in designated crawlspace/earthen basement areas. $173.25 CRAWLSPACE:Provide labor and materials to install (148)square feet of R-10 rigid Thermax insulation to the crawlspace perimeter wall up to the sill and against the band joist. $547.60 0 I r www.RovisoEnergy.com Revise Energy Home Performance Contractor 5 South Summer Street,Bradford,NIA 01835 CONTRACT 975-914-2214 VAX(401)784-3710 Page 2 PROGRAM CMA-HPC CUSTOMER PHONE DATE CLIENT# WORKORDER James Holloway (781)962-3973 09/21/2016 440464 00001 SERVICE STREET MLLING STREET 41 Perley Road 41 Perley Road SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOS DESCRIPTION Total: $3,355.15 Program Incentive: $2,185.00 Customer Total: $1,170.16 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand One Hundred Seventy & 151100 Dollars $1,170.15 -- ... - - - AUTHORIZED SIGNATURE-Revise Energy CUSTOMER ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE - -- - ----- — -- DAYS. I 6 Department of In(lustrialAccidents k9iOffice of Investigations I Congress Street, Suite.100 Boston,MA 02114-2017 ivivmmass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibi Name (Business/Organization/Individual): Building Science & Construction Address:300 Trade Center Suite 3690 City/State/Zip:Woburn, MA 01801 Phone #:781-353-2455 Are you an employer? Check the appropriate box: Type of project(required): I.Al I am a employer with 8 4. E] I am a general contractor and 1 6. F1 New construction employees (full and/or part-time).* have hired the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet. 7, E] Remodeling ship and have no employees These sub-contractors have 8. E] Demolition working for me in any capacity. employees and have workers' 9. n Building addition [No workers' comp. insurance comp. insurance.1 required.] 5. We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their I lj❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.F� Roof repairs insurance required.] t c. 152, §1(4),and we have no Weatherization employees. [No workers' ]AM-1 Other...---- comp. insurance required.] I I *Any applicant that checks box#I must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 tint air employer tliat is providr"rrg worlrers'comlaensrrtion insurruiee far-my employees. Below is the policy acrd job site information. Insurance Company Name: Hartford Underwriters Insurance Inc Policy#or Self-ins. Lic. 11:UB-9F620983-16 Expiration Date:4/11/2017 Job Site Address:40"W City/State/Zip: M%WjWM MA,04"Wr Attach a copy of the workers' compensation policy deciration 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. I elo hereby certify under the pains and penalties ofperjury that the inforination provided above is true and correct. Kyle Martin .............. 9/27/2016 sigly "X11,11=11,11111111"", _ otlreL_ Date: Phone#: 781-353-245 Qjficial 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 Contact Person: Phone#: r r`1fdv.i�i+��aru rri/I h',lunr1ll4ri/s fll�et att�aafaat►er AflkGrr�� mlwtton CC CR EE 912917117 OBA 'QHS CARPENTER PRRNSLL JACKWN 29 CHIPMAN 8T. DORCHISM.MAW24 us&m4fthlry I " , r i