HomeMy WebLinkAboutBuilding Permit # 11/4/2016 BUILDING PERMIT 16
TOWN OF NORTH ANDOVER ® ;
APPLICATION FOR PLAN EXAMINATION
Permit No#: q 7 4 - i 2 Date Received I 1 20 1 L01
ENO
Date Issued: It- (4
IMP011TANT: Applicant must complete all items on this page
LOCATION '-A ck,s)
rent
PROPERTY OWNER
.1 Print 100 Year Structure yes no
MAP --Historic District yes no
—,- PARCEL: _CZ3,. ZONING DISTRICT: Machine Shop Village yes no
_TY__PEOF_1MPR_ ___ PROPOSED USE
Residential Non- Residential
L New Building )n-Qne family 0 Industrial
(] Addition P Two or more family Ll Commercial
)4-Alteration No. of units:
[.1 Repair, replacement [I Assessory Bldg 0 Others:
11 Demolition 0 Other
5
DE�CRIIPTION OF WORK TO BE PER!FrME D:
'je
Identification- PI e YPI or Print Clearly
70
OWNER: Name: Phone:Allcx-
Address. '2(-,tC) U6163
C
Phone:
ConwContractor N me:
mom "
tractor
ail:: iz),,e
r(I
Address.
11 J
ddress:
Supervisor's
D ate. ezl�)
upervisor's Construction License: Exp.
Exp. Date:
Home Improvement License.
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: $_ �-) FEE: $
Check No.: I Fz Receipt No.: 3
hC
NOTE: Persons contracting with unr-egistered contractors do not have access to the guaranty funtl
..........
.........
%AORTH
own of
,�. 6 ndover
O .�.-
No.
h ver, Mass •� •
o 1 �l CN/0
•pq COCMIC FI[w1tR
�{q ORATED P'4a,t�5
S U
BOARD OF HEALTH
Food/Kitchen
PERMIT -T LD Septic System
THIS CERTIFIES THAT ..,......t. �I, os.rt .&. ........ .......... BUILDING INSPECTOR
=
has permission to erect .......................... buildings on ..P I�.......W.00b........,...1v................... YFoundation
Rough
to be occupied as ........ 01411...... 4.ft s6%.....V.NP&L......../.....jP .. 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 CONSTRUCP...
TART Rough
....... .� ......................................... Service
BUILDING INSPECTOR Fina]
GAS INSPECTOR
Occupancy .Permit Reguired to Occupy 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.
r`
RISE RnghteerintgRISE ' att��aastae
,-`r,� !WA C�tRogtatraPloa tato 19l�`tf
n. A dlvWo of Tbktstb Rughmaing
ENGINEMING 60 st mva tU. Unit i%Canton,IdA 02021 CONTRACT
3"-60""s PAX 3304024345
page 1
PROGRAM
.... ,u a CNA-HES
nrro aaa at
Cfr (!
Vona= ONO(978)979-2070 01/28/1016 4115 {gym
)WI&121Y:011 Roche �,..p;
maim Vau xe aTRW
340 Wood LAW 340 Wood Lane
OEM=C*%8YAMZP ! y =L=aW.07AMW
North;Andover,MA 01� :, ; North Andover,MA 01845
JOB DESCRMION
PfLUB TWO-Praposa!for tiW yaaf'awosthatizm m pmjmt.Prints and program inaatives not guaramod.
54.04
BAR,R MR:A Blow floor Teat will not bt tonduttad at your burnt,dao to the proms of t4ett(m
80.00
BARER;We have dis+ammv4 what appaara to be a mold/mlk1a4*9kcmbjft=la you bomo.This is being brought to ywr
atttation to idwAHl it m a pmeacLatirrg oandhlon to the insaladm and air stallag work plamtod for your hoatc.Your signature is
your txknnwdodgattndtt of Wan cwtdititws and aptanent to proceed.
50.40
WAU.S:Fumfah and htstall bkwm to Class l Calbdoao to(1664)squaw fad of thin and/or ctapboW axtaiar walls.Tho bum of
pp
tho uorcoarso ofymr wood aiding bout to drill holaa into tha wnll ahaotblog Tbo holaa aro than plugged and tho woad
sfdhag la raladalbtd ue#og eta W ars areal Ilatsh halls 1Caitb ftp paiatiag,tf t octad,will lea thn cuatamat"s ty. lavoiting wiU
ooeur upon compktion of fastalladan.Subsequa it to your payment,as an added savlce,RI58 lingWating w,71 tckm wht a wtcnthcr
pertnits to chock fen arty voles with an Inlinved scamter.Any nm*voids that may be found will be Niel at no additional oast.
$3,478.40
BASPMEbI"1'1)00R;Ptavido labra and mawsWs to haulatc the back oftba basrmcnt door Wding to the bsdldnaad with 2"tigld
board that mods the mations R-316-SA and 316.6 tnquhaotnis of bulldlag coda. Scat all edgas and mtuns with FSK taps.
$72.22
RISS Braginceri n8 wrill apply all appllcAble,eligible incentives to this fit. You will onl y bo blued the Nd amount. Wrattly,
for digl le nuamm,Utunbis Gas ofrm 7$96 inccrafve,not to ccutad 52,000 per cakadu ymr,and an hu=tivt of 100%for the
Air Sealing mawes up to tlra that 8684 and an additlemal$344 if savings ase justified by the m litwr.
For the safety and hWtb of your bomds indoor aft quality,we will be conducting a blower door diagnostic of tbaa available air flow in
your homo both befaaa the work is btsg a4 and after deo watitaization work is"lett.Wo will also conduct a full amsuacal of
the combalim safety ofyour hedwa system and water h+tater."mb has a valua of890 and is at no cost to you.Tata!allawable
wCat muftom humative to 53.110. p//�}{ryy�/�/�
s".00
a
RISC Engineering 0006M
M CwWftWEt"MWU"No
OMVUW" No
A divbina oMidtch Bapinttrlag CT Caftba nr�No
60 Shl lut VnIt 42,(:Qatar#,MA'0021 CONTRACT
334-aQ2a533!1 i:AJ(334-St12.d�•i5
R i S E PROGRAM pogo 2
'00 CONTPACt FA
�i11GiFi2QlirAd�
CMA-HES On==R*0so
WLTptill vuvre arra cow* wwaamp
Ma€ireen Roche (978)974.2070 0610212015 41611S 00004
GVRMR aTRf6T R4iio0tl iTRtST
340 Wood Lana 340 Wood Lane
A4NVi6f tYtV,OTATt OA IRl.t.gla Ctn,6TAi�7SP
Nomh Andover,MA 01845 Norlb Andover,MA 01845
JOB DESCRIPTION
Total: 63,U0.62
Program Incentive, $2,089.99
Customer Total: Si.160.83
WE AGM HOMY TO FURNM SEW=•Ct11EpiAMM ACOROAMCt:PATH Abram ht•E?w"T*k&MR THY sun ac
*"Ons Tho nand One Hundred Flay&631100 Dollars $1,150.03
UVMFVMMt[:TM*MMD3WftErii4sElkRtlEt#wnruETOWAAGRMY*2MTMMWt0MMML+1tnMTOf'Y;VALL {CMlItM**TMLY06#0
wrouDw►NCS+tr�maawac�aroawroatT�arTr�samuTw�or au�uvrers.ao�rTrarar�s�ou,er�rxaan��uasraawrae+a4�uarTUT�ar.
04 NOT 816N TM CONTAACt IF IMIEAfM ANY BLANK SPAMIR .
Tlpi! �IGIifM.Wp AtlG{7Na,p4 �j_
>vOTR;riatLOHTwt�ruFwa€YAi�tdlWn�eTua�caore¢Cuttnx�t�cN erR��rtx�Tu�e;a �f Yom`^'. � !� . . .. .,.
►aarr�T�ca er cwm�r.TTaaOreif+�neos.lt�taryc�smts�woa iR!
so 04Ta� �Ct1Ttt�lMwltir�i�tlllDe�jJt�tp�MIfTT alRlraRAEaTntfaTWAoItK
To 39va 66ESZ898G5 D :S� 9CAi�l8�lE0
The Commonwealth of
Department of Industrial Accidents
0 e of Investigations
ff I C o-
e
I Congress Siret, Suite 100
Boston, MA 42114-2011
www.mass.govldia
ffidavit: Builders/ContractorsfElectricians/Plumbers
Workers" Compensation insurance A bly
Please PrintlMiL_
A licant Information
AP���,C_a_n__��_Inform;fiolftion
Narne (Business/orgariization/Individual): Builders Services Group d/b/a Quality Insulation
Address:____ Perimeter Rd
Phone #.603-324-1974
City/State/Zip: Nashua NH 03063 - Type of project (required):
Are You an employer? Clieck the appropriate box;
4, 1 am a general contractor and 1 6, F1 New construction
I.Z I am a employer with 100 have hired the sub-contractors 7. n Remodeling
employees(full and/or part-time).* listed on the attached sheet.
2.0 1 am a sole proprietor or partner- These sub-contractors have 8. F] Demolition
ship and have no employees employees and have workers' 9- n Building addition
working for me in any capacity.
[No workers' cornp. insurance comp, insurance. 10.[:] Electrical repairs or additions
5, E] We are a corporation and its I I.n plumbing repairs or additions
required.) officers have exercised their
3.El I am a homeowner doing al I work right of exemption per MGL. 12,R Roof repairs
myself [No workers' comp, c. 152. §1(4),and we have no 13.Z Other Weatherization-
insurance required.] employees. [No workers'
comp. insurance required.] j
low showing,b
#1 must also fill out the section below their workers'compensation policy,iniormatiort.
'Any applicant that checks box 11 work and then hire outside contractors must submit a new affidavit indicating such�
Homeowners\vho submit this affidavit indicating they are doing a the name oi*the sul)-contractors and state whether or not those entities have
:Contractors that check this box must attached an additional sheet showing comp.policy number�
sub-contractors have employees.they must provide their workers-
lovees. Below is
,mPloyees, If Lhes the polieZv and jab site
f am an employer that providing workers'compensation insurance far my emp
.information- e: ACE American Insurance Company
insurance Company Nam -6/30/2011
.WLRC 48151553 Expiration Date
Policy g or Self-ins. Lic. #.---
City/State/Zip:
Job Site AdcIress:___i::, oneaofa
py of the workers' compensation Policy declaration page( ilpobAttach 2 cO 52can lead totheimposition ofcriminal penalti
as required Linder Section 25A of MGL, ORK ORDER and a fine
Failure to secure coverage -year imprisonment,as well as civil penalties in the form of a STOP W
fine up to S 1,500.00 and/or one t may be forwarded to the Office of
of up to $250.00 a day against the violator. Be advised that a copy of this state'rien
investigations of the DIA for insurance coverage verification. re information provided above is true and correct.
I do hereby certify is and penalties of perjurr that 11
,J.v under the pail
Si,nature.
Phone 4: 603-324-1974
official use only. Do not write in this area, to be completed kv city or town official
Permit/License#----------------------
City or Town:
Issuing Authority(circle One): /Town Clerk 4. Electrical Inspector 5. plumbing Inspector
I. Board of Health 2. Building Department 3. City
6. Other Phone#c
Contact Person:
DAT E(MM)DDlYYYY)
CERTIFICATE OF LIABILITY INSURANCE D611412816
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 Il licy(ies)must have ADDITIONAL INSURED provisions or be endorsed.
it 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 a
PRODUCER SME'
Aon Risk services Central, Inc. PHONE {866) 263-7122 PAX{AIC,l (800) 363-0105
[AIC.No.Ext): �' '17
Southfield MI office a-MAIL I o
3000 Town Center ADDRESS:
Suite 3000
Southfield MI 48075 USA INSURERS)AFFORDING COVERAGE NAIL
INSURE
Old Republic Insurance company 24147
INSURED22667
Trull Builder Services Group, Inc. WSURERe: ACE Ameri[an Insurance Company
d/b/a Quality Insulation wsuRERc: LlGyd`s Syndicate No'- 1969 AA1120106
A Topsuild Company
110 Perimeter Rd INSURER D:
Nashua NH 03063 USA INSURERE:
INSURER F:
COVERAGES CERTIFICATE NUMBER:570062471987 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAfylEb 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
Il WVQ
POLICY NUMBER O LIMITS
LTR TYPE OF INSURANCE MM1DOf!'YYY MMfDQlYY1'Y
A X COMMERCIAL GENERALLLaB€U7Y F•7lYZY 1 EACH OCCURRENCE $2,000,000
MAG O $2,000,000
CLAIMS-MADE OCCUR PREMISES Ea uEmrence
MED EXP(Any one person) 52 s,000
PERSONAL&ADV INJURY 12,000,000
m
GENERAL AGGREGATE $4,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: 00
N
X POLICY ❑PRO ❑LOC PRODUCTS-COMPIOP AGG $4,000,0
JECT
OTHER:
MWTs 307519 06/3°/201606/30/2017 COMBiNEDSINGLELIMIr 55,000,000
A AUTOMOBILE LIABILITY Ea accident
BODILY INJURY(Per person) O
z
X ANYAUTO BOQ€LY INJURY(Per acadenl) Y
OWNED SCHEDULED cc
AUTOS ONLY AUTOS PROPERTY DAMAGE 0
X HIRED AUTOS X NON-OWNED Per adcidenl
ONLY AUTOS ONLY 1
TH16000Z7 06/30/2016 06/30/2017 EACH OCCURRENCE $2,000,000 V
C X UMBRELLA lJAB X OCCUR
SIR applies per policy terns & Condi ions AGGREGATE 52,000,000
EXCESS LIAB CLAIMS-MADE f
OED X RETENTION _
WOR
B KERS COMPENSATION AND WLRC47860180 06/34/ 016 05/30/2017 X STATUTE ERH
EMPLOYERS'UABILITY YIN All Other States E.L.EACH ACCIDENT $1,000,000
B ANY PROPRIETOR I PARTNE=R IEXECUTIVE NIA SCFC47860209 06/30/2015 06/30/2017
CFFICER/MEMBER EXCLUDED,
WF only E.L.DISEASE-EA EMPLOYEE $1,000,000
(Mandatory in NII) y
If yes,describe under E.L.DP5FASE-POLICY LIMIT S1,000,000-
DESCRIPTION OF OPERATIONS below
T�-
DESCRIPTION OF OPERATIONS€LOCATIONS I VEHICLES(ACORO 161,Additional Remarks Schede€e,may be attached if more space is regui[ed}
Evidence of Insurance.
U
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.
Builder Ser Vi Ces GCOUpr Inc. AUTHORIZED REPRESENTATIVE
dba Quality Insulation
A Topsuild company
Nashua NH 03063 USA
01988-2015 ACORD CORPORATION.All rights reserved.
AC IRD 26(2016/03) The ACORD name and logo are registered marks of ACORD
qffiYTorosumer airs (dVu i"neg u farson
10 Park Plaza - Suite 5170
Boston, Massachusetts 0211.6
.Home lmprovem&entractor Registration
Registration: 179141
�
) Type: Supplement Card
/- Expiration: 6125/2018
BUILDER SERVICES GROUP, INC
RICHARD SCHWARTz ; ___ _ --___-.__....__.------_.---_.
260 JIMMY ANN DRIVE
DAYTONA BEACH, FL 32114
5
Update Address and return card.Mark reason for change-
L]
hange.❑ Address E] Renewal ❑ Employment �E] Lost Card
�re�n9nnunsrae.�1 a�v�as:ar�rraetG
ice of Consumer At'fxirs&Business Rcgulxtion License or registration valid for individuSI use only
E IMPROV Efiif CONTRACTOR before the expiration date. It found return to:
Office of Consumer Affairs and Business Regulation
Registration;< qType: 10 Park Plaza-Suite 5170
Expl -r, 5oppfement Card Boston MA 02116
BUILDER SERVICES11
RICHARD SCH1lsIRR, `zY ,r --=:
910 PERIIi+Ifi RQ ��--
NASHUA,N 03063 N
I)ndersrereixry Not valid without signature
B
it ,
Massachusetts Department of Public Safety
Board of Building Regulations and Standards
License: CSSL-105992
Construction Supervisor Specialty
260 JIMMY ANN DRIVE..
DAYTONA BEACH FL 32144 �
_ Expiration:
Coi"nmissioner b5126f2oi8
Construction Supervisor Specialty
Restricted to:
CSSL-IC-Insulation Contractor
Failure to possess a current edilion.of.the Massachusetts
Stata Building Code Is cause for revocatlon of this license.
OPS t.Icansing information visit:WWW.MASS.GOV/DPS