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HomeMy WebLinkAboutBuilding Permit # 11/28/2016 itAORTN BUILDING PERMIT u� TOWN OF NORTH ,ANDOVER ,�� y�,.'• vb APPLICATION FOR PLAN EXAMINATION Permit No#: 57 U Date Received 1 1 �iR`��„rED �SSACHtI`�E� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Q'4 Pri t PROPERTY OWNER -� Print loo Year Structure yes Sno MAP PARCEL: f ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ,KQne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial PKI�epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Se tri ❑�11lell x ❑ Fled lain ' 1 WetlarXds Yrr `Wafeised Dasnct -'.fi' 'r�' DEItCRIPTION.0117,VVORK TO BE, PERFORMED: Id tification- Please pe or Print Clearly OWNER: Name: =` Phone: Address: Contractor N me: g �, jV� Phone: r Email: 4-nap, Address- 7(7_",dqL-Za Supervisor's Construction License: [� Exp. Date: Home Improvement License: i Exp. Date: _ ARCHITECT/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. $� ?7 _FEE: $ Check No.: Receipt No.: 3 1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �®RT�y own o zAndover 0 "'��' •yam •E � ' No. Its --JA 11 - _ LAK! h A", ver, Mass, ► LOC K�CKI'WKK �' �i9 Aa"'RTE0 A4p�4,(5 S U R BOARD OF HEALTH Food/Kitchen PERMIT T LD a� Septic System THIS CERTIFIES THAT ... 111-St „ ,.L,, �I,�, � /' ;I„ ,�.� ” BUILDING INSPECTOR ' ' has permission to erect .......................... buildings on .!! ., .. ...... .. . , ,./..`I. .......s:r Foundation • Rough to be occupied as ...,... Iq L h 1f I(r �� 1�''f�! y .......................................... .............. .. ......................................................... 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 CONSTRUCTIONATARTS Rough ........ ... . �... ... ..............,.,.............. Service ....... .... Final BUILDING INSPECTOR GAS INSPECTOR Occu anc Permit Required to Occupy By 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. T-T. ooR Federal M 0105440M RISE Eagineedug JU Camusdai ItagIstratloin No 84$0 MAC011tracw Realstno"Ma 12C9lG A division of Thlelseb FAglueeiing RISE60 shalmal Unit AZ,Canton,MA 010211 ENGINEERINGCONTRACT 339402-633S FAX339402404S Page 11 PROGRAM COMMMMI CMA-HES 1M nor GAVA &Am# turoattowan Randy Tibbetts (617M3-2103 05/16/2016 415351 00002 Met"zvd= OVAM MAO 245 Chestnut Street 245 Chestnut Street "Mince em,SAW tp North Andover,MA OF ' North Andover,MA 01843 JOB DESCRIPTION AIR SlIMANG:provide IaMr sad mnterinis to ad areas of your home against vautfw.excess air leakage. This work W be performed in concert with the use of special tools and dispostic legs to asom that your home affil be left with a halthfW level of air exchange and indoor air quality,Materials to be used to seat your home can include GUL&G,foams and other prOdUCIf. Primary area for scaling lachult:air leakage to allies,b=mentk attached SuVp and other unheated area (windows are trot generally adikeued.) This will mqjke(10)iwrking hours.A redilctiou in e*c feet per tninine(cfm)of&infiltration will occur,tad the actual number or trin is not guaranteed At the completion of the wcat hrriwian work,and at no additional cost to the horneovAl cr,4 final blow door and;or combustion safety analysis will be conducted by the sab-contractor to C11990 the gddY of the indoor air quality. MOM DAMMM(k Provide labor and MdefiAlS to install a 12"layer of R-33 unrated fiberglass buts to(186)square feet rar diunming Ptn"NeL MIJO ATT FC FLAT;Provide tabor and mawiata to install an 8'layer of R-28 Class I Cellulose added to(1000)square CCU of open attic space, $1,370,00 ATT IC ACCM Provide labor and nuteriAk to in"I(1) easily moved,insulating cover for t he attic access folding stair. A small flat ice of plywood will be created around the opening within the attic. This will allow the cover's integral weather-stripping to restrict air leakage. $237.65 VENTILATION.Provide labor and materials to inusli(2)Wmalated cxhzm hose Uitb roof motmted flapper vent to exhaust ex isting bathroom fan(s). $239.30 VENTILATION:Provide labor and materials to install ventilation chutes in(104)rafter boys to maintain air flow, $208,00 RISE EaOecrinovAll apply all applitzb1c,eligUie incentives to this contract. You WW only be Med the Not amomt. Cwmtly, for eligible mcwircs,Columbia Cox offers 75%inewtive,not to exceed$2.000 per calendar year,andan incentive of 100%for the Air Seafing mcuwa up to the first$680 and an additional$340 if saving&at justified by the at4ior. For the safety and health ofyour home's indoor air quality,ac will be conduct iriga Nov=door diWouic of the avallabie sit flow in your home both before the vmrk is begua,and after i he meatherization work is complete.We will Ww coadact a M assessment of the combustion safely of your heating system and water hewer.This has a value of 590 and is at no oast to yott Total allowable 590.00 Pederst ID s 06oe06M ` RISE Eagineeltng R)cenbaetot"Istrrtlen No arse YAe:oerre.1 PA00dton Ito l2m R' A dtvtaten of7bleredr f►gtneering RISE ENGINEERING 6o S>xavatat ante a:,e:Nlle00,MA ata:t CONTRACT 339-SU 4335 FAX33"02-U45 Page 2 PICOGRAM CMA4US arsaeR atoms win 149 a Nrmeem6R Randy Tibbetts (617)233-2103 05/1"16 435351 00002 lams @T=T eeasie lg ar 245 Chestnut Street 245 Chstaut Street erg cm.avls BUM mr.*Vmxp North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Towl: $3,374.45' pmemm Inoerd": $217US4 Ctt8'EQrtmer Total. $&$1 � ws��vroar��erret�•eorsoasrnrr AeeatmrwcswnM�awewarawacaRn�surr as "lx Hundred®girt&611100 Dollars $808.8'1 my aim "� .aM",9 `e ea�aaxmew`a"?IIF 0o rtoR etoir tR IMM M wtratatttt LE > a il F. CtMENA90P91Md I #pQtErlGe rUVASMAMMar1Af►il0rtllsaf awrNlw mN1ra�ACapoYt� D 1 Z"', 30 CAM 9 d ti V I i Ij The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 t _ L : Boston, MA 02114-2011 www.mass.gov/dia ensation Insurance Affidavit: Builders/Contractors/Electrician /Pl mb bl Workers Comp Please Print p, licant Information I�iaiTle (Business/Organization/Individual}: Builders Services Group dlbla Quality Insulation Address: 1 10 Perimeter Rd City/State/Zip: Nashua NH 03063 Picone #: 603-3x4-1974 Type of project(required): Are you an employer? Check the appropriate box:rrt a general contractor and f 6 New construction I.0 I p a employer with r part-.____ have hired the sub-contractors 7 ❑ Remodeling employees(full and/or part-time).* listed on the attached sheet. 2.[] 1 am a sole proprietor or partner- These sub-contractors have S. Q Demolition ship and have no employees employees and have workers' 9 ❑ Building addition working for me in any capacity. mp insurance.{ co [No workers' comp. insurance 5 co are a corporation and its 10•❑ Electrical repairs or additions required.] officers have exercised their 11,0 Plumbing repairs or additions [] I am a homeowner doing all work right of exemption per MGL 1 Roof repairs myself. [No workers' comp. c. 152, §](4),and we have no 13.FV_1 Othe r Weathe rizati on insurance required.] t employees. [No workers' comp. insurance required.] asation icy *Any applicant that checks hox Al must andieatiout t'he hey are section below showing and then hire outside contracor,must submit ne v at�davit indicating such. T Homeowners who submit this affidavit g ;Contractors that check this box must attached an additional sheet showing the name of the psuDjCOnnumher and State whether or not those entities have employees. I f the sulrccrntractors have employees.they must provide their work ers' co policy em Laver that is providing workers'compensation insurance for my employees Below is the pvlicV and job site I am an p information. Insurance Company Name: ACE American Insurance Company i Expiration Date:6/30/2011 WLRC 48151553 Policy # or Self--ins. Lic.#: �}��] Ql� City/State/Zip-s' —&k,r `T A- L Job Site Address: L 57 licy er and iration i� Attach a copy c. of the workers' compensation pfl1►c�dec1 frMGLion a1g5(can cad t showing hthe�mpositionbof criminal penalties a Failure to secure coverage as required under Section..SA o K fine up to $1,500.00 and/or one-year imprisonment,as well as civil ofthipenalsistaternent may b forwarded to the ffice of es in the forin ofa STOP WORK ORDER d a fine of up to $250.00 a day against the violator. Be advised thatCOPY Investigations of the DIA for insurance coverage verification. cerci V under the Pains and enalties of erjurV that the informative provided above is true and correct. I do hereby f Date Si nature: Phone#:603-324-1974 official use only. Do not write in this area,to be completed bV city or toren officio! Permit/License# City or Town: Issuing Authority(circle one): 5.Plumbing Inspector X.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 6.other Phone#: �,' Contact Person: I *ffice o onsumers (d%u mess a u g ra t 04h 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home lmprovem���antractor Registration Registration. 179141 Type. Supplement Card 1' Expiration. 512512018 BUILDER SERVICES GROUP, INC M- RICHARD SCHWARTZ ro Asa JIMMY ANN DRIVE id DAYTONA BEACH, FL 32114 K(} rr��Ir ,.~ Update Address and return card.Mark reason for change. S SCF t 0 MW,05111 � Address 1D Renewal ❑ Employment Lost Card �io�or�Lnu-rrusxrx�l�a�'C�/�t'acursc�irael� ice"Consumcr Affxim&Business Regulation License or registration valid for individual use only E IMPROV r=Nlr CONTRACTOR before the expiration date.. If found return to: R$glstraOffice of Consumer Affairs and Business Regulation Type: 114 Park Plaza-Suite$170 )rxPiTa 8>, Supplement Card Boston,MA 02116 BUILDER SERLIICES�G !ty : ! RICHARD SC1-1VYRR 110 PEf2itJII fER fZ© r� tJRSfi1JA,NH 03t}63 Undrmcretary Not valid without signature I - I B a 1: I �AAII� DATE OM 51DDffYYY) CERTIFICATE OF LIABILITY INSURANCE 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 policy(les)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 CONTACT 'a Aon Risk Services Central, Inc. PHONE (866) FAX Southfield MI Office (A1C.No.Ext): 283-7122 (AM No.): (800) 363-0105 3000 Town Center E-MAIL o suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Old Republic Insurance Company 24147 TruTeam Builder Services Group, Inc. INSURER B: ACE American Insurance Company 22667 d/b/a Quality insulation A TOpRUild Company INSURER C: 110 Perimeter Rd INSURER D: Nashua NH 03063 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570064230317 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. Limits shown are as requested LLI TR TYPE OF INSURANCE '�P yMyfD POLICY NUMBER MMlDDIY MMID© LIMITS '4 X COMMERCIAL GENERAL LIABILITY MWZY307 18 16 0 30 1 EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR D O RENTED $2,000,000 PREMISES lEa occurrence MED EXP(Anyone person) $25,000 PERSONAL B ADV INJURY $2,000,000 ,"- I GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 N X POLICY ❑PRO- POLICY F-1PRODU LOC CTS-COMPfOP AGO $4,000,000 I OTHER: 3 � I mkm 307519 06/30/2016 06/30/2017 COMBINED SINGLE LIMIT A AUTOMOBILE LIABILITY $5,000,000 i Ea accldenl I X ANY AUTO BODILY INJURY(Per person) OWNED SCHEDULED BODILY INJURY(Per accldenl) W i] AUTOS ONI-Y AUTOS PROPERTY INV 11 HIREDAUTOS X NON-OWNED (Peraw ent) GE V ONLY AUTOS ONLY PeraCCidenl 4_ v UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE i DEO RETENTION t B WORKERS COMPENSATION AND WLRC47860180 06/30/207.6 06/30/2017 X STATUTEORH EMPLOYERS'LIABILITY YIN All Other States B ANY PROPRIETOR IPARTNERIEXECUTIVEE.L.EACH ACCIDENT $1,000,000 OrrICEWMEMBER EXCLUDED? N NIA SCFC47860209 06/30/,2016 06/30/2017 (Mandatory in NH) WI Only E.L.OISEASE-EA EMPLOYEE $1,01)0,000 If yes,describe under DESCRIPTION OF OPERATIONS belovi E.L.OISEA5E-POLICY LIMIT $1,000,000...-- i. DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES(ACORD 101,Addlllonal Remarks Schedule,may be altached if more space Is required) i. t I' t i E; CERTIFICATE HOLDER 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, ToWn Of North Andover AUTHORIZED REPRESENTATIVE Building Department Attn: Donald Belanger 1600 osgood street, Suite 2035 „ North Andover MA 01845 USA 01988-2015 ACORD CORPORATION.A I rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-105992 Construction Supervisor Specialty RICHARD SCHWARTZ 260 JIMMY ANN DRIVE DAYTONA BEACH FL.,32144 Cr CA,.�-.. Expiration: ofnmissioner 012612018 Construction Supervisor Specialty Restricted to: CSSL-IC-Insulation Contractor Failure to.possess a.current edillon of th;Massachusetts Statin B01 ding Cotte Is cause for revocation of this lice rise. DPS L lronsing Information visit: WLWW_MASS.GOV/DPS i 0 i Q i o-