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HomeMy WebLinkAboutBuilding Permit # 11/28/2016 ............................... .... .... VAORT11 BUILDING PERMIT DFSTLEP ,6gHo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '' `dQ00 p Permit No#: �iia 9` c i 7 Date Receivedj4¢`�5 �SSAC Date issued: IMPORT//) >I: Applicant must complete all items on this page LOCATION A �e_oLn -S-f— Print PROPERTY OWNER Print 100 Year Structure yes Ono MAP � PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building d'.One family ❑Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial 7�<RRepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other E ��C�S�`t�c y ❑Vllelll � ���4' ���Floo`dp�a�r�� (�Wetlands"4f^ ,�� ^ ❑�U11a�ershed D`estr�� ,.�.c^°, ` gyp,r��.,..lr `.. . � wF"may ',: ✓`�` r ,,,-! �' .!„ � �"kf� ^ ,�w�TMf�i., �',:6���..� � ����P,,,��a,,�c��� �- r. �111F'CZt�i'r��e•�e� ; ;'`f.,;. ,..� � .�" ",��.."s�.c"r�" ��.�s.,�.,..,..,...�.��.,.;;5':-.�' �a5^i.1. -€ 'r°.u.o�'`:'.. � �.-ai�w.�..f.,.. ,�,: > ,,?! DESCRIPTIO OF WORK TO BE PERFORMED: dentification- Please Type or Print Clearly j g OWNER: Name: vV)CAPhone: Address: 3��� Contractor ame: Edon —Phone-.,,,(g 0-S r Email: Mrce_ cx,� se,O _cow Address: 7�Ljt,n-`.4 ®f� Supervisor's Construction License: Exp. Date: Home Improvement License: -7cl f t—( ( Exp. Date: ARCH ITECTIENGINEER Prone: Address: Reg. No. FEE SCHEDULE:SULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $_ `'� FEE: $ 7 Check No.: t `t Receipt No.: ' -- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ............ ........... ... ............................ ............... ..................................... N°RTS Town o n over 0 qa I- .90i -n No. _ �i h ver, Mass, • d?4p t.A 64 01. ATFg) ILI BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........ wm 1.4+1 64�Al BUILDING INSPECTOR has permission to erect .......................... buildings on ....X.!fl...... Foundation to be occupied as l!... A..�.4.. us C Rough person accepting this -.�all in every respect conform ....................................... Chimney p provided that the s pern t s 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 CONSTRUCTIO STARTS Rough .......... ..... Service BUILDING INSPECTOR Final GAS INSPECTOR Occupaner.hermit Required to QccupE Building 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. Fadoral to 3 05.0406629 RISE Engineering RI contractor lzeaharotion No 8186 ?MA.GontraetorRe9istradon No 12.0979 C7 Contractor Reglatratlon No020120 60 5hawinut!load,Conlon,MA 0202( �A1TC1 R g,�" R INEERING 6.d11�}ii ISI F' AC 339.502-6335 1.,1X 339-502-6345 Page 2 PROGRAM CMA-111 NL°asoieERINNnGANDIRCIZ�o£�FORWORK OEaORN)EI)ltEIDW CU$VMR PHONE OA1S CUENT9 VACRMOR"It Robin Boevwn (781)858-7279 1(V2W2016 412532 23902 SERVICE SSIEET RiLt1NO 3'MEET 349 Appleton Street 349 Appleton Street 01tivi a CITY,avr'm muino cm.Sum,ZIP. North Andover,MA 01945 North Andover,MA 01845 JOR DESCRHMON VENT ILATION:Provide iatxtr and materials to install(11) 6"X 16"rectongalar al=inwu-A)f it vents Its incrcasc:V01tilatint)in attic areas. Specify color:White or Gray. M)TE:VENTED DRIP EME EMMUS R R'IS ALL CRV,9 WO AND NO C:(TfTtIROUGII IN SPOTS, $275.90 R18E Engittccring will apply all applicable,eligible inccitt ivcs to this contract. You will wily be billed the Net amount. Ciurcntly, for eligible nivaswes,coltaribia Gras of€ccs 75%inceat im.liot to exceed$2,000 per calendar year,and on incetativc of NO%for I he Air&crating tncusttres up Io the fust 5680 and an adtlitionul$340 if savings tire jwiil wit by the auditor. For Ilie safety and heahh of your home's indoor air yu.ility,lw%till Ix.-condt"ing a Homer boor diagnostic of I lie avadabli air flow in your home bot It kforc the Mark is bebtar.and after tltc%watheriz ation work is complctc.Wc'sill also conttucl a full usmssment of the conlhtstion safety of yotw hent inns system and seater .her{tor.This has a valise of S90 land is at no cast to you. Total allouablCs�£tlterizution incentive is$3,110. The Permit sill be-secured by the insulation contractor,,it no additional cost.It is t3£e homeowices rt spoasibility to close out this permit by contacting their municipality at the completion of thisssurlc. $90.00 1r'"a ,4 Tota l: $3,486.65 Program Incentive: $2,849.91 Customer Total: $636.64 W E AGREE HERMY To FURNISH$f;RViCES•COMPLM IN ACCORDANCE w€rH ABOVE SPECIFICATIONS,FOR THE 3Uih Of "*Six Hundred Thirty-SiX &641100 Dollars $636.64 UtiPAFWALrO hAtA1 EA1pi ANO AYO R> EHHVE BU £tACRTAnT IFatXiNLVr�# Vd� BE CHARGED NONIOLY ON T� CM GUAARANEIGNIS OF RSGIOMGCHEWUNO.AIo) OmACWRCCSAAaR tao NOT SIGN n-tis coNrt7xr IF T1EERE eta pct:s A VIDSknagnll14=1'No CC711iA4RAWN BY UE IF NOTEXECUED tY£S£VI OA&OFACCEPTANCE --•- 31) ACCEPTANCE OP COACT-SIE ABOVE PRICED,DPECIMAMNS AND CONAIXOkia ARE DAYS= AS SPECIFIED.PPAYM NNtWiLlt,BE NiOR ASCOUTJJR2D AAD IEGYOU W£AU'MiORI7.EO�00 INE 1YdiM 1 3 i The Commonwealth of Massachusetts Department of Industrial Accidents Office of In Congress Street, Suite 100 Boston, MA 02114-2017 Ix"����z., www.mass.gov/dia Workers' Compensation Inlsurance Affidavit= BuilclerslContractors/El bers Please print Legibly A licant Information '', Builders Services Group d/b/a Quality Insulation Name (gassiness/Organizationilndividual): Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #:603-324-1974 Type of project (required): ,ire you an employer? Cheek.the approp 4. box: a general contractor and l 6, [� New construction 1.0 1 ain a employer with 100.__......_ � have hired the sub-contractors employees(full and/or part-time). 7. Remodeling listed on the attached sheet. 2.[ 1 am a sole proprietor or partner- These sub-contractors have 8. [] Demolition ship and have no employees employees and have workers' 9 F� Building addition working for me in any capacity_ insurance.; [No workers' comp. insurance 5 comp.are a corporation and its 10.❑ Electrical repairs or additions required.] officers have exercised their l l.❑ Plumbing repairs or additions ;.❑ I am a homeowner doing all wort: right of exemption per MGL 12.E Roof repairs myself. [No workers' comp. c 152 §](4),and we have no Weatherization insurance required.] � 13.0 Other _....__..—.....�-- employees. [No workers' comp. insurance required.] *Any applicant that checks box#I must also Jill out the section below showing their workers'compensation policy information. and then ' Homeowners who submit this affidavit must attached an additional sheet showiing,they are doing all ng the name orth e suit-contractors and state whether or noutside contractors must submit a new ot ties haveeh 'Contractors that check this boy n u p, olio number. employees. If the sub-contractors have employees.they must provide their workers com policy I am an employer that is providing workers'compensation insurance for my emplovees. Below is the polies and job site information_ insurance Company Name: ACE American Insurance Company Expiration Date:6/30/201-7 48151553 " Policy # or Self-ins. Lic. #- city/ CitylState/Zip: fl_,��W_ Job Site Address: Attach a copy of the workers' compensation policy declaration Page(can ad t winahthe�impositionbof criminal penalties of a Failure to secure coverage as required under Section 25A of MGL c fine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties this tatement ay be forwe form of a Oa dedOta the ffice of d a fine of up to$250.00 a day against the violator. Be advised that a copthy Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of erjury that the information provided above is true and correct. Si nature: Phone#:603-324-1974 Official use only. Do not write in this area,to be completed by city or town official. Perm it/Lieense## City or Town- issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector a 6. Other Phone#: sContact Person: i All %ff,YTorosumer airs a(d%Ausuon g faet 0 10 Park Plaza - Suite 5170 Boston, Masachusetts 02116 rs&4Hone Improveontractor Registration Registration: 179141 Type: Supplement Card i apiration: 6/25/2018 BUILDER SERVICES GROUP, INC RICHARD SCHWARTZ # 260 JIMMY ANN DRIVE DAYTGNA BEACH, FL 32114 j Update Address and return card.Mark reason for change. SCA 1 0 ODM-05111 Address E, ] Renewal [ Employment host Card �i��-aayanumr�re,�x�l�a�C/��rrz:rralrrraelG gee of Cansumcr Affstrs&Busiam Regulltion License or registration valid for individual use only lE IMPRQV�ENT CONTRACTOR before the expiration date. If found return to.- Office of Consumer Affsirs and Business Regulation R$glstratt _*7 Type: 10 Park Plaza-Suite 5170 1 xpirntl — - 8,, Supplement Card y� ,,,_ AA Basion,NLA 02116 BUILDER SERVICI=S�G -. i RICHARD SCHtA�AR� - 110 PERIMETER RO NASHUA,NH 63/763 Underweretary Not valid without signature I I I I i Ate, DATEion!510016 Y) 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 u) REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. � IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(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 yE this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT a NAME: Aon Risk Services central, Inc. PHONE (g66) 283-7122 FAX (600) 363-0105 N Southfield MI office {A1C.No.Ext): AIC.No.: 3000 Town center E-MAIL 'p suite 3000 ADDRESS: Southfield MI 48075 USA INSURERiS)AFFORDING COVERAGE NAIL q I, INSURED INSURER A: old Republic insurance company 24147 TruTeam Builder Services Group, Inc. INSURER 8: ACE Allierican Insurance Company 22667 d/b/a quality Insulation INSURER c: A TopBuild company 110 Perimeter Rd INSURER D: Nashua NH 03063 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570064230347 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 TYPEOF INSURANCE POLICY NUMBER PO C E P LIMITS LTR 1N50 WVD MM100 MMfDD A X COMMERCIAL GENERAL LIABILITY MIVZY307518 EACH OCCURRENCE $2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $2,000,000 PREMISES Fa nccuuence MED EXP{Any one person) $25,000 PERSONAL&ADV INJURY $2,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,000 M X POLICY L]PR0 El LOC PRODUCTS-COMPIOP AGO $4,000,000 It 0 OTHER', AMWTR 307519 06/30/2016 06/30/2017 COMBINED SINGLE LIMIT � AUTOMOBILE LIABILITY $5,000'000 Ea accldeni BODILY INJURY(Pet person) O )[ ANY AUTO Z OWNED SCHEDULED BODILY INJURY(Per accident) AUTOS ONLY AUTOS tp X HIREDAUTOS IX NON-OWNED PROPERTY DAMAGE f] ONLY AUTOS ONLY Perr aaccident Ir: W UMBRELLALIAB HOCCUR EACH OCCURRENCE EXCESS LEAS CLAIMS-MADE AGGREGATE DED RETENTION B WORXERS COMPENSATION AND WL.RC47860180 06/30/2016 06/30/2017 X STATUTE °RH EMPLOY ERS'LIABILITY YIN All Other States ANY PROPRIET0R1PARTNrRIEXECUTIVE E.L.EACH ACCIDENT $1,000,000 B al'FICEwM MaERExc uDEo? � NIA SCFC47860209 06/30/20I6 06/30/2017 (Mandatory In NH) WI Only E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $1,000,000...�� DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 1 Of.Additional Remarks Schedule,may be attached if more space is required) 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 Deartment ' Attn: Donald Belanger 1600 Osgood Street, Suite 2035 � t North Andover MA 01845 USA ©1988-2095 ACORD CORPORATION.Ail rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety ^ Board of Building Regulations and Standards Licansa:CSSL-1195992 Construction Supervisor Specialty `J RICHARD SCHWAFM 260 JIMMY AIYN DR DAYTONAt BEAOH I .u� .t Expiration:�o sslonar 0912612098 ,.. Construction Supervisor Specialty Restricted to; CSSL-IC-Insulation Contractor Fatlum to possess a current#dM*n of the Massachusetts State Witting Code Is cause for revocation of Ws Ilmnse. DPS Licensing Information visit:M1WW.MASS.GOVIDP8 I 3 I