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HomeMy WebLinkAboutBuilding Permit # 11/4/2016 V%O R T}l own oTn ov r .�. e O No. 4ql 6540- ;-I - oMass, ver, ass, folop�4 [OCMIC KE WI[K ATED r �(C3 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..........Q.. J. -. .#1`, ......... ..1 .S ��.'�f SIN BUILDING INSPECTOR ..... ............................... has permission to erect buildings on ... .k..t.......P4 .. . ..' 0�PV Foundation . .. .� ........ .� ..... Rough to be occupied as ............ .N.sy.�. .... .. •,• Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final 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 CONSTRUCTION S ARTWMMM.M Rough Service . .................... ..... ..................... .. BUILDING INSPECTOR- Fina! GAS INSPECTOR Occupancy 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. Federal 10#05-0405629 RISE Engineering Rl Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration No 620120 RISE01)Sbawnmt Road,Canton,MA 02021 ENGINEERING CONTRACT 339-502-5197 FAX 331-502-6345 Page PRO(WAM Was CONTRACT IS CUrWO INTO aVAMN WE "CINU110 GANDTHF CUSTOMMFORWORK AS I I DESCRIM.LOW CUENTO WORK ORDER Megan Glennon (978)699-5779 0911912016 438952 28602 SERVICE STREET MUM STREET 121 Raleigh Tavern Lane 121 Raleigh Tavern Lane ri SlInViCr CoY,37A7E,2JP 04LUNG CITY,STATE,ZIP North Andover,MA 01845 North A ndover,MA 01845 3OB DESCRIPTION AIR SEALING:provide labor and materials to sea)areas of'your horns against wasteful,excess air leakage. 'filis work NN ill lac,pqr(bulned in colicert with the use ofspecial tools and diagnostic tests to assure that your hoine will be left with a Ireaftliffil level of air exchange indoor air quality.Materials to be used to seal your home call include caulks,foams and other products, Prilll!)Tyaircasfor sLatingificlude air leakage to nitics,basements,attached garages and other unhasted areas(windows are no(gencrally oddrcssed.) 11is will require(10) working hours.A reduction in cubic feet per minute(cl'in)of air infiltration will occur,but the actual number of efin is not guaranteed. At the completion of the NNcatlarizatiort work,and at 110 additional cost to the honacownur,a final tjImvLr door and/or Combustion safety analysis,will be conducted by the sub-contractor to ensure the safety of the indoor air quality, $850.04) AIR SEALING:Provide labor and materials to install Q-Ioo wcaftnMripping and a doors Cep to(1)door(s)to restrict air leakage. ATUC FLAT:Provide labor and trilactials to install a 6"layer nil"R-21 Class I Cellulose added to(120)square ficel of floored attic space. $213.60 DAMMING;Providc labor and materials to install it 12"layer or it-38 unfaced fiberglass baits to(148)square feet for damming purposes. $303.40 ATTIC;PLAT;Provide labor and materials to install a I I'layer of R-38 Class I Cellulose added to(836)squaw feet of open attic spaco, 51,262.36 xrrIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access foldhig stair. A small flat will IYC GTCatwCl arland dle OlSeITICag wwnthln the attic. 'I'llis will allow the cover,$inteval weather-stripping to restrict air leakage, $237.65 VENTIUMON:Provide labor and materials to install(2)Insulated exhaust hose to existing bathroom fhnts). SIGOM VENTILMICIN:Provide labor and materials to install vcutihttion cluacs in(72)rafter bays to maiiunin air flow. $144,01) BASEMENT CEILING:Provide labor and materials to install(142)linear reel ol'R-19 unlaced fiberglass;insulation to the perimeter ofilic basement Ceiling tit the house sill, $249.50 OVERHANG':provide labor and materials to install 8'*R-28 densely packed Class I Cellulose insulation to(50)square feet of exterior overhang located below heated floor area,bydrilling holes in the overhang from below, Holes drilled will lie plu8ged. Plugs will be scaled with exterior grade spackle and left in a relatively S1110011%Condition.Finish sanding and touch-up pruning,painting will be tile customer's respollsibility. 5196,50 Fedarail ID 0 06.0405629 RISE E,rigineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration No$20120 RISE00 Shaivraut Road,Cmiton,'INIA 02021 ENGINEERINC; COINITRACT 339-5112-5197 FAX 339-502-6345 Page 2 PROGRAM TRIS CONTRAC r 13 ENTERED INTO UCTIN401 RISE CMA-IIES ENGINEERINO AND TUC CUSTOMER Foil WORK AS O"CRIDEOVELOIN CUSTOMER PHONE DATE CLIENT 0 WORK ORDER Megan Glennon (978)689-5779 09/19/2016 439952 28602 SERVICE STREET Bi[LUNG STREET 121 Raleigh Tavern Line 121 Raleigh Tavern Lane SERVICET"7YSTA-W7zjP MIXING CITY.STATF,ZIP North Andover,MA 01845 North Andover,MA 01845 ,JOB DESCRIPTION RISE Engineering At apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently,for eligible measures,Columbia Gas offers 75%incentive,not to exceed 52,000 per calendar year,all(]at)incentive of 100%for the Air Scaling mcasums up to the first 5680 and un additional$340 if savings are justificil by the auditor. For the safety and health of your)ionic's indoor air quality,we will be Conducting a blower door diagnosde of the available air IlO%V in Your buille both before flic)"Votk is begun,laid after the-wealheri7ation work is Complete_We will atso,conducts full assessment of the combustion safety oryour beating System and water heater,111is has-,I value ol'S90 unit is at tit)cost to you. Total allowable weathcrization inecluive is S3,I I0. S9100 \V/ LIE Total: $3,721.01 Program Incentive: $3,015.00 Customer Total: $706.01 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF '"Seven Hundred Six&01/100 Dollars $706.01 UPONPrL INSPECTION AND APPROVAL.13Y RISE EROINEERING,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF VA VALL RE CHAROED MOUTHLY 03ANY UNPAID ALANCE AFTER SD DAYS,$Efi REVERSE FOR IMPORTANT INFORMATION DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK //PACE$ AUTHORIZED MNATURE-RISE VOPIO.*14.0 CUSTOMER ACCEPtANCIE M/ //6.9 nore."ruts ccemiFty MAY aeYATHORAym uY 0 IF nor ExEcLrrEo VaT)RN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-7119 ADOYI!PRICES,SPECIFICATIONS AID CONDITIONS ARE 30DAYS. AS SATISFACTORY TUSA US ANDEOJTV41LL ARE HEIIEGY AS OACCEPTED,YOU ARE AUTHORIZED 10 00 THE' ORK SPECIFIED.PAYMBit 0,tAOF UTUN50ABOV9 RiSE60 Shawrnut Road,Unit 21 Canton,MA 020211339-602-6336 ENGINEERING www.PJSEongineering.com OWNER AUTHORIZATION FORM Megan Glennon (Owner's Name) owner of the properly located at, 121 Raleigh Tavern Ln, North Andover, MA (Property Address) (Property Address) i I V/ RE, hereby authorize (Subcontractor) V"OH"; an authorized subcontractor for RISE Engineering,to act on my behalf too permit and to perform work on my property.This form Is only valid with a�Igned-contract-,-_._ Owner' Signature gate The Commonwealth of IVtassucrr ����� ,Department of Industrial Accidents Office of investigations Irl 1 Congress Street, Suite 100 Boston, MA 02114-2017 M1 www.mass•gov/dia ers Wo rl{ers' Compensation Insurance Affidavit: Builders/Contractors[El ctrice Print Eek bl licailZt Information Builders Services Group d/b/a Qualityk�t1°�? jr,jarne (Business/organization/Individual): -- Address: 110 Perimeter Rd city/State/Zi Nashua NH 03063^� Phone #/:603-324-1974 -- _ Type of project(required): Are you an employer? Check the appropriate bo4. x 1.0 I am a employer with 100 I am a generale contractor and 1 New construction D have hired the sub-contractors Remodeling employees(full and/or part-time).' fisted on the attached sheet. 2.❑ 1 am a sole proprietor or partner- These sub-contractors have 8. 0 Demolition ship and have no employees employees and have workers' 9 n Building addition working for me in any capacity_ comp. insurance. Electrical repairs or additions We workers' comp. insurance IO•� 5, �] e are a corporation and its required.) officers have exercised their 1 1,F] Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL 12.0 Roof repairs myself [No workers' comp. c. 152, §1(4), and we have no13 Q Other Weatherization insurance required.]t employees. [No workers" comp. insurance required.] :Any applicant that checks box#1 must also fill out the section below showing their workers`compensation policy informa new ation. Homeowners who submit this affidavit indicating td'ational doing show thall work e name othen �i"the sub-contractors and state whether or nioutside contractors must submit otahose�entities havech. Contractors that check this box must attached an ad policynumber. ;mployees. If the sub-contractors have employees.they must provide their workerscomp. or my employees. Below is the policy andlab site I am an employer That is providing workers'compensation insurance f Fnformation_ - — ACE American Insurance Company ------- Insurance Company Name: -----~--- 6/30/201-7 WI_RC 48151553 Expiration Date: Policy 4 or Self-ins. Lic. 4. ,� � ��" � — I t � City/State/Zip: - Job Site Address: tn Attach a copy of the workers' compD& ation policy declaration Page tcanwlead t ing hthecimpositio nofcrim nal ipenalties 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 his ain the may be forwOa WORK he Office of d a foe of up to $250.00 a day against the violator. Be advised that a copy o Investigations of the DIA for insurance coverage verification, provided above is true and correct. ]do hereby cern t�under the sins acrd enaJties of erjurt%that fJre information Date' Signature-. - Phone 4:603-324-1974 area, to be completed by city or town official. Official use only. Do rrat write in this Permit/License# City or Town: Issuing Authority(circle one): tment 3. City/Town Clerk 4. Electrical Inspector 5. plumbing Inspector 1, Board of Health 2. Building Depar 6. Other phone#- Contact Person: { OATE(MMIDDmvY) q CERTIFICATE OF LIABILITY INSURANCE Ia�f�4�zD�6 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 INSUREII AUTHORIZED N REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ? ° IMPORTANT:!f the certificate holder is .....aADDITIONAL INSURED,the I'D icy(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 c this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). CONTACT PRODUCER NAME: Aon Risk Services Central, Inc. PHON (S66) 283-7122 aJXc,No.: (800) 363-0105 m INC.No.Ext): Southfield MI Office E-MAIL o 3000 Town Center ADDRESS: Z Suite 3000 Southfield MI 48075 USA INSURER(Si AFFORDING COVERAGE NAEC N INSURER.4 old Republic insurance Company 24147 INSURED22667 TruTeam Builder services Group, Inc. INSURER B: ACE American Insurance Company d/b/a Quality insulation INSURER C: Lloyd's Syndicate NO; 1969 AA1120106 A TopRuild Company 110 Perimeter Rd INSURER D: Nashua NH 03063 USA INSURER E: INSURER P: COVERAGES CERTIFICATE NUMBER:570062471987 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF)NSURANCE 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 Or SUCH POLICIES,LWITS SHOWN#NAY HAVE BEEN REDUCED BY PAID CLAIMS. Limits shown are as requested LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMlDD MMlI.1DfYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY KVZY 1 EACH(ICCURRENCE S2,000,0 AG D S2,000,000 CLAIMs-MADE ❑X OCCUR PREMISES Ea ouurmnoe MED EXP(Any one person) $2S,000 PERSONAL B ADV INJURY $2,000,000 m rn GENEP.ALAGGREGATE $4,000,000 ti GEWL AGGREGATE LIMIT APPLIES PER: X POLICY ❑PRO PRODUCTS-COMPIOP AGG $4,000,000 UD JECT LOG OTHER: MlYT6 307519 06/30/2016 06/30/2017 COMBINED SINGLE LIMB S5,000,000 A IEa aeciden4 AUTOMOBILE LIABILITY .. BODIL)INJURY(Per person) Z ;( ANYAUTO BODILY'INJURY(Per accident} d1 $ALTOS WNED a. ONLY AUTOS LED PROPERTY DAMAGE U RED AUTOS X NON-OWNED Per a�cJdentLY AUTOS ONLYTH16000Z705/30/201506/30/207.7 EACH OCCURRENCe $2,000,000 vC MBRELLA LIAR X OCCURSIR applies per policy ter s & condi ions AGGREGATE $2,000,000 XCESS LIAR CLAIMS-MADED X RETENTION B WORRIERS COMPENSATION AND WLRC47860190 06/30/2016 06/30/2017 X STATUTE ER EMPLOYERS'LIABILITY YIN All Other States E.L,EACH ACCIDENT $1,000,000 B ANY PROPRIETORIPARTNERIEXECUTIVE SCFC47860209 06/30/2016 06/30/2017 pFFICERIMEMBER NIA EXCLUDED? E.L.DISEASE-EA EMPLOYEE (Mandatory in NHWI only ) u (lyes,descri4e under E.L,OISEASE-POLICY LIMIT $l,000,000--- I DESCRIPTION OF OPERATIONS below I [ACORD 105,Additional Remarks Schedule,may be attached if more space is requ"sred) DESCRIPTION OF OPERATIONS 1 LOCATIONS i VEHICLES Evidence of insurance. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCR1aE0 POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE NTH THE POLICY PROVISIONS. Builder services Group, Inc. AUTHORI2E0 REPRESENTATIVE 7� dba Quality Insulation L A TopRuild Company Nashua NH 03063 USA V N' ©1988-2015 ACORD CORPORATION.All rights reserved. s i' ACORD 25(2076103) The ACORD name and logo are registered marks of ACORD ffice W nsumer ..airs acid Ausm6e�s�sVewgufatlon 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Dome rmprove-M&entractor Registration Registration. 179141 Type: Supplement Card { Expiration: 512512018 BUILDER SERVICES GROUP, INC RICHARD SCHWARTZ 260 JIMMY ANN DRIVE DAYTONA BEACH, FL 32114 ' Update Address and return card.Mark reason for change S SCR t a fit (� Address D Renewal L] Employment J Yost Card c.��ic Lrraizncrmrrte.�rll�n�C�/i!�nssrrc.�iiraella ice of Consumer Affzirs&Business Reguixtion License or registration valid for individual use only a- E IMPROVW NT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation RoglstratfonT_= Type,yP 10 Park Plaza-Suite 5170 EXP lra 8 i Supplement Card ,z Y Boston,MA 02116 BUILDER SERVICI MCHARD SC!flA1AR y 110 PERIM R ,s- NASHUA,NH 03053 Undersecretary Not valid without signature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-145992 Construction Supervisor Specialty RICHAfW SC14WART2 250 JIMMY ANN DRIVE DAYTONASEACH FL.32114 ' Expiration: Co mmissioner OWW2018 Construction Supervisor Specialty Restricted to: CSSL•IC-lnsulatiion Contractor Failure to possess a curront.edition of the Massaehusotts State Building Code Is rause for revocation of this license. DPS Licensing Information visit: W1MW.MASS.GOV;DPS