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HomeMy WebLinkAboutBuilding Permit # 11/9/2016 %%0R*J1 Contact: Phil Morris 978-880-7088 ,so " phil@air-tightweatherization.com BUILDING PERMIT 16 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIOV Permit NO: Date Received 45vi Arco Date Issued: arkrf d'" CHU IMPORTANT: icant must com fete all items on this a e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential F1 New Building N One family El Addition Insulation Two or more family El Industrial r---i Alteration No. of units: 1.7 Commercial D Repair, replacement it Assessory Bldg I--] Others: [I Demolition 0 Other Air sealing, blown in cellulose to attic floor, install door sweeps and weather stripping. Install bath fan roof flaspper Identification Please Type or Print Clearly) OWNER: Name: Mary Ronan Phone: (978) 794-3052 Address: 97 Sawmill Rd, North Andover, MA 01845 ARCH ITECT/ENGINEER 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: $,3,158.18 FEE: $ Check No.: ( 3(0 '-� Receipt No.: 3 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund YR.,. ,0j,\Andover own o yr. No. 48i, >11 �p UAK, h ver, Mass, _j s, q ' ;L 01 (i COCNIC"lwr[x `y '7,f�s R�17Eo PpIV (5 l3 BOARD OF HEALTH Food/Kitchen PERMIT ' T LD Septic System THIS CERTIFIES THAT ....gAJK9A....... ......... .�......rN. ,�.y. , ... O.N. .. BUILDING INSPECTOR has permission to erect ...... buildings on .....� 7 . .F.L.►: Foundation .......... .... �..�.A..�. ..... ........ Rough to be occupied as .:�..��..��. .�.................. 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. . Rough Fina[ PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRU ON S TS Rough ... .. .. .�. .. ................................ Service BUILDING INSPECTOR Final GAS INSPECTOR OccupancyOccupanfy Permit Required to OccuM Buildin Roan 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. CONTRACTOR WORD ORDER 50 Washington St.Suite 3000 Printed: 10/24/2016 Westborough,MA 01581 Work Order Id: S24789P57547C271 Air-Tight Weatherization Mary Honan Email:mhonanCtormarketingmatters.co 50 Rundlett Way 97 Sawmill Fid Phone(Eve): 978-794-3052 Phone(Day): 978.794-3052 Middleton, MA 01949 North Andover,MA 01845-1435 Site ID: 500050224789 Location Description Quantity Unit$ Total $ Living Space Perform Air Sealing at Estimated 62.5 CFM50 8 $84.32 $674.56 Door Sweep 3 $23.18 $69.54 Exterior Door Weather Stripping 3 $27.59 $82.77 Living Space Hatch:Thermal Barrier Polyiso 2 inch (Attic) 1 $41,71 $41.71 Living Space Attic Floor Open Blow Cellulose 7" 952 $1.53 $1,456.56 Attic Propavent 2'or 4' 102 $3.83 $390.66 Damming 84 $2.19 $183.96 Attic Vent bath fan to roof flapper 2 $129.21 $258.42 ------------- Installed Measures Total $3,158.18 �/i /'//NM% Incentive Payments Weatherization Incentive $1,748.48 Air Sealing Incentive $826.87 Total Incentive Payments $2,575.35 Customer Share Total Customer Share $582.83 Less Deposit Of $194.00 Customer Share Balance(Due Contractor) $388.83 L Air-Tight Weatherization / ' A■ 50 Rundlett Way Middleton,MA 01949 978.998.4684 77-- CONTRACT • OWNER AUTHORIZATIONFOR CONTRACTOR TO PERFORM WORK as owner/authorized agent of the subject property,hereby authorize James Fortin to act on my behalf,in all matters relative to work authorized by the building permit. Owner/Authorized Agent(Print): Mary Honai1 Date. Nov 7, 2016 eb N Owner/Authorized Agent Signature: ly Contractor Signature: Contractor:James Fortin Construction Supervisor License:CS-052576 Exp:10/03/2017 The Commonwealth of Massachusetts Department of Industrial Accidents .1 Congress Street,Suite 100 Boston, MA 02114-2017 ivivwmass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Armlicant Information Please Print Le2ibly Name (Business/Organization/Individual):Air-Tight Weatherization, LLC Address:50 Rundlett Way City/State/Zip: Middleton, MA 01949 Phone#:978-998-4684 Are you an employer?Check the appropriate box: Type of project(required): 1.E]I am a employer with 20 employees(full and/or part-time).* 7. New construction 2.[:]1 am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3,01 am a homeowner doing all work myself. [No workers'comp,insurance required.]t 10 Building addition 4.R I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I LR Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.rl 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F_1 Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 14.[Z]Other Insulation 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box#1 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. tContractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is file policy and job site information. Insurance Company Name: Guard Insurance Companies Policy#or Self-ins.Lic.#:AIWC781370 Expiration Date:7/1/2017 ------- Job Site Address:97 Sawmill Rd City/State/Zip: North Andover, Ma C5,Vq5 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct Sip-nature: - Date: 10/31/16 Phone#:978-998-4684 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.City/Town Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: 2016-11 -09 09:11 air 19789692161 >> P 2/2 Act r CERTIFICATE 4F LIABILITY INSURANCE DATE{MM1YI oe/19J2016o1s THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder i i an ADDITIONAL INSURED,tho pollcy(lon)must have ADDITIONAL INSURED provislons or be endorsed, If SUBROGATION IS WAIVED,subject to the terms and conditions of tho policy, certain policies may require an endorsement. A Statement on this certificate does not confer rights to the certlflcate holder in Hou of such endorsement(s). PRODUCER JacquelinQ Marie Montes MassPay Insurance Services,LLC NAME: 27 Garden Street,Unit IS PHONE (87$)774-4338 x105 I[c.—Nor 1978)774-1318 Danvers,MA01923 e-MAJL ADDRESS: 18okiegP cehilrichardinsuran .onm INSURER(s)AFIfORDINO COVERAGE MAIC N INSURERA:: A_mGVARD Insurance Gomptiny Company42390 INSURED Air-Tight Wealherization,LLC INSURER B! - 50 Rundle"Way rasuRERC; Middleton,MA 01$49 04URER D I INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: REVISION NUMBER; THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMF;NT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THI$ 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. IN5R ADOL sUBR .. POLICY EFF POLIG EKp - LTR TYPE OF INSURANCE POLICY tlUM0EN MM)DD1yYYY) (MIYVDDNYYYI LIMITS COMMERCIAL GENERAL LIARILITY EACH OCCURRENCE 5 DAMAGETO- OLAIMS•MADE OCCUR P EMISES fEa oecunvncz S _ ..• MED EXP iAn one eraon _. 5 ,• PERSONAL&AOV INJURY S GEN'L AGGREGATE LIMIT APPLICS PER: GCNrRAL AGGRF,GATE S POLICY ❑JECCT" n LOC PRODUCTS-COMPIOP AGG 6 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE I, $ Rn y )_, ANY AUTO BOOILY INJURY(Pet person) $ OWNED $GI-IC;OULEt) 80pILY INJURY(Per accidcn!) $ AUTOS ONLY AUTOS HIRED NDN-OWNED PROP M Y DAMAGE 5 AUTOS ONLY AUTOS ONLY �,[atotdenl •„ 5 UMBRELLALIAB OCCUR EACMOCCUR RENCE $ EXCESS LIAB CLAIMS_-MADE AGGRE=C�AT_F $ pRp RETENTION S S A WORKERSCOMPEMSATION AIWC725282 07/01/2016 07/01/2017 PER 0TH' AND EMPLOYERS'LIABILITY YIN STA7UTC F ANY PROPRIETOR /PARTNERlEXECUTIVE NIA E.L.EACH ACCIDENT $ 1,000,000 CFFiCERiMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-FJ1_EMPLOYEE 5 1,000.000 Ryes,deaWbe under 1,OOp DESCRIPTION OF OPERATION$bolow 51,DISI=ASE_POLICY LIMIT 5 ObO DESCRIPTION OF OPERATIONS!LOCATIONS I VFHICLEB(ACORO 1439,Additional RamANs Schedule,may be attached H more space 16 requleM) Proof of Workers Compensation CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES 6E CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 120 Main Street ACCORDANCE WITH THE POLICY PROVISIONS- North Andover,MA 01845 AUTHORISED REPRESENTATIVE O 1968-2015 ACORD CORPORATION- All rights reserved, ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD i 0 DATE(MMIDDIYYYY) A'►LR o CERTIFICATE OF LIABILITY INSURANCE 3/9/2016 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 polley(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 TGA Cross Insurance, Inc. NAMEACT TGA Crass Insurance Inc. 401 Edgewater Place, Suite 220 PHONE 781-914-1000 w No: 781-246-2601 Wakefield, MA 01880 EMAIL ADDRESS: switchboard Ot across.com INSURER(S)AFFORDING COVERAGE NAIC# www.tgacross.com INSURER A: Arbella Protection 41360 INSURED INSURER B: Air-Tight Weatherization, LLC 50 Rundlett Way iN5URERC: Middleton MA 01949 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 28899058 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. ADDL BR POLICY EFF POLICY EXP ILTR TYPE OF INSURANCE POLICYNUMBER MMIDDIYYYYI (MM1DDrYYYY1 LIMITS A ✓ COMMERCIAL GENERAL LIABILITY 8500046432 3/5/2016 3/5/2017 EACH OCCURRENCE $ 1,000,000 DAmAGE TO RENTED CLAIMS-MADE 1_/1OCCUR PREMISES Ea on $ 100,000 MED EXP(Any ane person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,004 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PEO LOC PRODUCTS-COMPIOP AGO $ 2,000,000 POLICY❑✓ OTHER: BNED A AUTOMOBILE LIABILITY 1020015286 3/8/2016 3/8/2017 (CEA'acc,d..tSINGLE LIMIT $ 1 000 000 ANY AUTO BODILY INJURY(Per person) $ AOWNED UTOS ONLY ✓ SCHEDULED BODILY INJURY(Per accident) $ AUTOS HIRED NON-OWNED PROPERTYDAMAGE $ ✓ AUTOS ONLY ✓ AUTOS ONLY Per accident B 1/ UMBRELLA LIAB OCCUR 4600052930 3/5/2016 3/55/2017 EACH OCCURRENCE $ 4,000,000 EXCESS LIAR ✓ CLAIMS-MADE AGGREGATE $ 4,000,000 DED ✓ ION 10,000 $ WORKERS COMPENSATION STATUTE I PRH- AND EMPLOYERS'LIABILITY Y ANYPROPRIETORIPARTNER/EXEGUTIVE ❑ NIA E.L.EACH ACCIDENT $ OFFICERIMEMEEREXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS/LOCATIONS f VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. Buildingg0, Suite 2035 North Kndover MA 01845 AUTHORIZED REPRESENTATIVE J) Thomas I Gre o ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD 28899058 1 223720 1 16-17 GG, AUTO, UM13 I Jill DeHetre 1 3/9/2016 8:32:51 AN (HST) I page 1 of 1 Of*fICC of'C 011SLIme;i At"fairs and Business lt+✓gulation l arl� Plaza - Suite 5170 w 1.0 Boston, Massachusetts 02116 I lome Improvement Contractor Registration. Registration: 165640 Type: LLC Expiration: 311512018 Tr# 419291 AIR TIGHT WEATH ;RIZATION, LLC JAMES FORTIN 50 RUNDLFTT WAY MIDDLETON, MA 01949 Uladsrtc A(Idress>and return card. Mark reason for ciaaange. I �1 Address Renewal i.,rrst('31A SCA i �'WA w,'1 t Massachusetts Department of Public Safety Stan ;NOME IMPROVEMENT CONTRACTOR hrticaa is Rt Nasinesw tdc Board of Building Regulations and License: 05-05 � aol cfarc� � g Re, ulatio� k rW Rration: 165640 Type: i 2576 egistrrar&„�d,°,�Y��at@4��Ct..h&�.5t"V n��.d N�.'"r Expiration: 311512016 LLC MIR TIGHT WEATHERIZATION,LLC JAMES E FORTIN. 50 RUN DLETT WAY, MIDDLETON MAP01$ JAMES FORTIN or 50 RUNDLETT WAY a 1 MIDDLETON,MA 01940 � Undersecretary ( t . Expiration: raaissioner 1010312017