HomeMy WebLinkAboutBuilding Permit # 11/29/2016 TOWN OF NORTH ANDOVER „or�rN
APPLICATION FOR PLAN EXAMINATION
Permit NO: L ® � Date Received /I )- o
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Date Issued: — ',)-
IMPORTANT: Applicant must com fete all items on this 2age
LOCATION S f `f` �z"'°'N- f-
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PROPERTY OWNER -It 3) i 6 o --'-T-$ Q 0
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MAP NO.: t 0 (-t PARCEL: ZONING DISTRICT:
TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non-Residential
❑New Building Imine family
❑ ddition ❑ Two or more family ElIndustrial
Alteration
No. of units:
❑Repair,replacement ❑Assessory Bldg ❑ Commercial
❑Demolition
Moving relocation ❑ Other ❑ Others:
Foundation only
DESCRIPTION OF WORK TO BE PREFORMED
Identification Please Type or Print Clearly)
OWNER: Name: ` i Phone:
Address:
CONTRACTOR Name: Phone:
Address: ,. -, fi G OIJ I'll #1 c1�1
Supervisor's Construction License: 6`� Q'2-0 Ex_ _� p• Date: �..�
Home Improvement License: s j _Exp. Dater 1
ARCHITECT/ENGINEER �J Name: Phone:
Address: Reg. No.
FEE SCHEDULE.,BULDING PERMIT.$12.0 ER$1000.00 OF THE TOTAL ESTIMATED COST BASF ON$.125.00 PER S.F.
Total Project Cost :$ - _ q I _ x12.00=FEE:$
Check No.: l J Receipt No.:
Page lof 4
�ORTry
own of
T, Andover
No. 14L -
n� : h ver, Mass,
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U BOARD OF HEALTH
PERMIT T D
Food/Kitchen
Septic System
THIS CERTIFIES THAT ... ## ! _bft!*.', .,., ,�, � ,� BUILDING INSPECTOR
has permission to erect . buildings on ® � Foundation
p ........ ...Y.,`.. � ... .� ....�.�...............��..®®.... •�UV
Rough
t0 be occupied as ........ .......... .... ........ .,........Rlf. ... 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
Final
PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIOI.*SEART Rough
'.. Service
............... .......,... .... ,.....................................
... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit RE uired to Occupy Buil.din 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.
Purview Diagram
rAddress
mer �� � �p ", 0 Advisor Name:
9 ly �3oS`
Advisor Phone #;_ a
�lti �vYtAny limitations to access by truck?
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NOTES Any work scoped outside of Best Practice
4 Approved by:
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Revise Ener y
11°tic i'erformauee Contractor
S S,Dubs Summer Street,Bradford,NIA 01 Os CONTRACT„
978-914-2214 FAX(401)784-3710 CONtRAC r�„
Pago 1
PROGRAM
CNIA-HPC
Eg{a�la We .... CUMTA WORK Moth
Melt Degostino (978)681-3617 10/18/2016 441999 00001
OWN"MTRaer
54 Coventrylyttne 9 aILLtHb aFR%TS 4 Coventry brine 9
BUM UTY,aTATC,MP
North Andover,MA 01845 Nortb Andover,MA 01845
,TOB DESCRIPTION
AIR SISALI1+(Q:PTOVIdC labor and m 1iL`rials In seal ureas of your home 110119t wasleRll,cxcm air leakage. TILLS wort:will be
pertkrrmM in orrrieart with die use of special tools and d104110stie 10419 to assure that your home will be lett with n healthful level of
air exchange and indoor air quality.Materials to be used to seal your!Ionic can include caulks,foams and other products. Primary
meas for sealing include air h:akage to auks,basements,alloched garap trod other unheated areas(windows are not generally
addressed) This will require(4)working hours.A reduction In cubic feet per nlloute(01m)ofair infiltration will occur,but the
actual number of efnl is not guaranteed.
At the completion of tate weadicriY9thnl tvork,said at no additional cost to the homeowner,a final blower door andlor combustion
safety analysis will be conducted by the sub-contractor to casure die surety of the indoor air quality.
$340.00
KNEUVALL SLOPE:Provide labor and materials to install 2"PSK fhoed semi-rigid fiberglass board insulation to(103)square foci
of Iulccwa)l rafter arca,
$367.50
KNt"MALM Provide;labor and materials to install r FSK Faced semi-rigid fuberglau bored Insulation to(20)square fiat of
kneewall WC&
$70.00
ATTIC ACCESS:Provide labor and materials to insulate tho back of the affic door with 2"rigid Themtax board and seal the door's
edge wide weatherstripping to restrict air IeAW.
j $73,91
VENTILA11ON:Provide labor and materials to install ventilation chutes in(22)rifler bays to mointnin air flow,
$44.00
0ARAGE,CEILING:Provide labor and materials to install IV R-35 densely packed Class l f elluloso insulation to$00 square feet
of garage coiling located below a[tested Runt arra,by drilling holes In die ceiling from below. I felts drilled will be plugged. Phrgs
will be spackled and loft in a relatively stnooth condition.Finish sanding and touch-up primirtglpaittting will be the customer's
rospnusibility.°
�
$1,035,00
CRA11'ISPACE;Provide labor And materials to insfull (75)square feet of R-10 rigid Tficrmax InsuIntion to the crawlspace
perimeter—,&At up to the sill and against the band joist.
$277,30
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Pere"".rc("uvsrnctor
-Snath Simmer Street,Bradford,MA 01835 CONTRACT
ED A
979.914-2313 rtX(401)784-3710
Pago 2
PROGRAM
CMA-HPC
P>tDNfi DATE GLEEftr Y RtORII ORDERMatt Dagostino (978)681-5617 10/1812016 441999 00001
54 Coventry Lane 9 54 Coventry Lane 9
wi-M aw."O'W'Vp O W N0 CITY,IITAT2,W,
North Andover MA 01945 North Andover,MA 01845
JOB DESCRIPTION
Total: $2,207.91
Program incentive; $1,740,93
Custorrler Total: $466.98
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCARVANCE WITH MOVE SPECIFICATIONS.FOR THE SUM OF
**`Four hundred Sixty-Six&981100 Dollars $466.98
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Worker's Compensation and Employer's Liability Policy
National Liability & Fire Insurance Company - A Stock
Company
Policy Number V9WC600604
Renewal of NEW
Policy Information Page
-----------
[1]Named Insured and Mailing Address Agency
Environmental Abatement Inc V3 INSURANCE PARTNERS LLC
1200 Bennington St 115 Pheasant Run
East Boston, MA 02128 Suite 218
Newtown, PA 18940
Agency Code: PAVTHR20
Federal Employer's ID 27-5382735 Insured is Corporation
Policy Period
From December 19, 2015 to December 19, 2016, 12:01 AM, standard time at the insured's mailing
address.
..............--...............
[3] Coverage
A. Workers' Compensation Insurance - Part One of this policy applies to the Workers' Compensation
Law of the following states. Massachusetts
B. Employer's Liability Insurance - Part Two of this policy applies to work in each of the states listed
in item [3]A. The limits of our liability under Part Two are:
Bodily Injury by Accident - each accident $500,000
Bodily Injury by Disease - each employee $500,000
Bodily Injury by Disease - policy limit $500,000
C. Other States Insurance - Part Three of this policy applies to all states, except any state listed in
item [3]A, and the states of North Dakota, Ohio, Washington, and Wyoming.
D. This policy includes these endorsements and schedules:
See Extension of Information Page - Schedule of Forms
............
[41 Premium
The Premium Basis and, therefore, the premium will be determined by our Manual of Rules,
Classifications, Rates, and Rating Plans. All required information is subject to verification and change by
audit. (Continued on another page)
Total Estimated Policy Premium $ 17,777
Total Surcharges/Assessments $ 1,026.00
Total Estimated Cost 18,803.00
INTERNAL USE BM Page- I - Information Page
MGA .V9WC600604 WC 000001A
Date : 12/22/2015
MANOTE To Report a Loss
'Dial toll-free 41 (844)777-8323 or visit our
Issuing Office: 100 First Stamford Place, P.O. Box 113247,Stamford,CT
RPSCHIC/SC/2016.01.05 -Contact Insurer directly(see policy section)
The Coninionivealth of Massachusetts
Depm'tntent oflndustrialAccidents
Office of investigations
J
I� Congress Street, Suite .100
Boston,MA 02114-20.17
www.mass.gov/ilia
Workers' Compensation Insurance Affidavit: Builders/Contractors/1Clectricians/Plumbers
Applicant Information Please Print Legibly
Name (Business/Organization/individual): kz:,,N1j't
� .
Address: U
City/State/Zip: t ( ,,`�.. �<" � .Phone#: `� = UT,ID
Are you an employer? Check the appropriate box; Type of project(requited):
1. I am a employer with 4. I am a general contractor and I
employees(fit!l and/or part-time).*
have hired the sub-contractors 6. New construction
2. I ani a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees Tktesc sub-contractors have 8, Demolition
working for me in any capacity, employees and have workers' 9 Building addition
No workers' comp, insurance comp, insurance,l
required.] 5. We are a corporation and its 10. Electrical repairs or additions
3. I am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions
myself [No workers' comp, right of exemption per MGL 12. Roof repairs
Utsurance required,]t c. 152, §1(4),and we have no /
employees. [No workersOther '. @ Id
comp, insurance required,]
*Any applicant that checks box#1 mast also fell 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 anew affidavit indicating such,
#Contractors that check this box must attached an additional street showing the name of the sub-contractors and state whether or not those entilics have
employees, If the subcontractors have employees,they must provide their workers'comp.policy number.
I ant an einplgyer that Is providing workers'compensation Insurance far my employees. Below Is the polley rind job site
irtforntatlon.
Insurance Company Name. `.}d ? Af5i!—j f� t F - ,l `S 1,4 ? t C L
Policy#or Self-ins.Lie,#: 6-6111X)'2 J ' Expiration Date: la1 i,- i c,-
- F
LJob Site Address; cp City/State/zip:
Attach a copy of the workers' compensation pol ey declaration page(showing the policy number and expiration dte).
Failure to secure coverage as requited 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$250,00 a day against the violator, Be advised that a copy of this statement may be,forwarded to the Office of
Investigations of the DIA for insurance coverage verification,
I do hereby cerllf p under the pains and penalties of perjwy that the itrforntatlon provided abov Is true atul correct.
Si natures= _........ . ....�om—
Phone#:
Date: . Z
Official rise only. Do not write/it this area, to be cotnpleted by city or town official.
City or Town: Permit/License 0
Issuing Authority(circle one):
1.Board of Health 2.Building Department 3. City/Town Clerk 4, Electrical Inspector 5.Plumbing Inspector
6, Other
Contact Person; Phone#:
��.� �a���n�i'c��✓t'it�c%✓Ut/��C/ Lf'�✓�� r��'./S/�C�Z/�/.�'✓L%✓✓(��•
Office of Consumer Affairs and Business Regulation
-, 10 Parr Plaza -- Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 177555
Type: Corporation
Expiration: 1/212018 Trt1 273986
ENVIROMENTAL ABATEMENT, INC.
GEORGE WATTENDORF III
1200 BENNINGTON ST
EAST BOSTON, MA 02128
Update Address and return card.Mark reason for change.
SCA 1 4: 2C]M•05151
Address ❑ Renewal D )employment ❑ Lost Card
�llrr.• r(orrurrurnae�rl(�a/C•l�rrJlac�rr.�c/(s
Office of Consumer Affairs R Business Regulation License or registration valid for individul use only
IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
eglstration, 177555 Type: Office of Consumer Affairs and Business Regulation
Expiration: 1/2/2018 Corporation 10 Parc Plaza-Suite 51.70
Boston,MA 02115
ENVIROMENTAL ABATEMENT, INC.
GEORGE WATTENDORF III f
1200 BENNINGTON 5T
EAST BOSTON, MA 02128 Clndersecrcinry Mot vat without signature
l� )Ssarint,setts Department of Public Safety.
Board of Building Requiations aild Standards
c'u 3 f.rp3?
GEORGE II WATI'ENpO1;tF
14 MILLETT LANE.
SWAMPSCOTT PAA 01907
• h
C::>n)missioner 03115l�01$