HomeMy WebLinkAboutBuilding Permit # 12/28/2016 BUILDING PERMITNoaTy
TOWN OF NORTH ANDOVER �� y�''"5 -A 7,6
APPLICATION FOR PLAN EXAMINATION w
Permit Nod: [0� '� / Date Received- ® �, " R�
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Date Issued: t
LMTORT.ANT:Applicant must complete all items on this'page
Print
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RTY OWNER
Prrnt 1a ,YearStructure yes rio
MAP PARCEL..=ZONING D1STRIGT His#orEc Drstrict yes no
--Machine Shop Village _y _
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building )(One family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
XRepair, replacement 0 Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Septic riNVe€] . 0 Floodplain 0 Wetlands.. ` E V.Vaferslieci )district
awaterlsewer_
-
DESCRIPTION OF WORK TO DE PERFORMED:
94 Kr"W s v Ca mart wa l r�,y�7ov t w[a do
a�tls i t �,wl� ah' s
Identification- Please Type or Print Clearly'
OWNER. Wt Ca v�.r Phone: 273 �-7ZY
Address: Vond Oe oVt OIM
Contractor Name:� � T,N Pi�orie: �5b$ 3 Z-zo�7
Address. V x '-t t l C)lite � __... 03 Og_
Supervisor's Con'struetion License: - 4ti�t�-�� Exp. Date_
Home Irnprovernerit License,, . . �.82.� 2 . Exp_: Dater
ARCHITECT/ENGINEER Phone:
Address: Reg. leo,
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL.ESTIMATED COST BASED ON.$125.00 PER S.R
135,1 , a+' FEE: $ 0
Check No.: - �- � Receipt Na,, S i s
DOTE: Persons contracting with unregistered contractors do not have:access to the gu ar a fora
5igr�ature,of AgeritlQwner "' Signature of coritractar�
'T
SORT
own of
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No.
p - �^- h ver, Mass,
coc Oki
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U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
CTHIS CERTIFIES THAT ... .r.".4.a,4Le... ,.. .................A&,Y ..,......,. BUILDING INSPECTOR
® ..............�......... Foundation
has permission to erect .......f.................. buildings on ..,...... .. ......... .... .,.
.0..1.4......S , . .' ....�.. Rough
to be occupied as ,...... .. ......... ..... ........................... chimney
provided that the person accepting this permit shall in ev 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 CONSTRUCTION TS Rough
.............. .. ... . ..................................... Service
Final
BUILDING INSPECTOR
GAS INSPECTOR
q o ilding u'gh
ccupancyPermit Required Occupy BuRo
„t,
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.
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Faders!it3 tsQ6010t�9
RW itl$iktt3Btiqg R1 Contractor W*aftn Wo NO
VACoabuftr"Iskaden ito 1Stf0
CT Contraamf Rsgistng"Reamla
RISE
69 shaemat Road,Canton,M,►aunt CONTRACT
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96Mill Pond , 96Mi11laond
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North Andover.MA 01845 North Andover,MA 01845
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JOB DLSCRWnON
AIRSEALINO Pmvbk Mbar and materials to sial areas of yourhamO ArhW WXeK awesair tokw This work will be
perfiarmed to concert vrsth them of special tools sad dlegeordc tats to assure that your home wl0 to tot Oka htehMW level of
air eachani o and ladoor air vnlity.Moterialsto be u sedto seat your home can h nude caulks,foams and other products Prbmsry
areas for sealing include rtir leakep to attics,basements;attached garages and other unto tedareas(wtrudora we not gemaelly
edhessed)This sill requirc(x)vorktaghoum A reductlon in aft fart per mloute(dm)of air lnfiltraifon will occur.bA the
matted number of ai'm is not guaranteed.
At tho completion of the vicalhetixation work,andai no afdittanal cost to the homeowner,a that blower door and/or oombustton
safhty ams(ysIS O1 he eoodrated by the sub eonitaelor to aurae the safety of the f adder air duality.
$170.00
KNF.SWALL SLOPE.Provide labor end materials to install a 9'layer of R 30 fiberglass baits to(78)square feat of tatter slaps
area behind a knee%M.
NDTE:TMS IS THEE SLOPE OF THF.MACANICAL ROOM WHICH IS IN THE 3EER FLOOR LOFT.
$157.56
KNERWALL SLOPE Provide tabor and materials to install 2'M Mead seetl-r*fibcrgtars board Wittlon to(78)supnuo fat
ofknawall rafteratea.
NOTE:TINS ISTHFH SLOPE OF THE MACANICAL ROOM WfUCH ISM THE 38ERFLOOR LOFT.
$273.00
REMOVAL: Remove(78)squire fiat of batt style h9letion from the knwWl arca.
NOTE:TWSISTHEE SLOPE OFTHE3 MACANICAL ROOM WMCH IS IN THE 3EER FLOOR LOFT.
$38.50
MWILATION:Provide labor and materials to install ventilation chutes in(IS)rafter bays to mafataia air-flow
NOTE:T W SISI HEE SLOPS OFTHR MACANICAL ROOM WMCH ISIN THE SEER FLOOR LOFT.
$36.00
COMMON WALLS:Provide laborand materials to install$lawn hn Cuss 1 Wdosna to(40)sgoaro(W af4*common will
thmq t an interior surface drflM andpleag method Plgp will be epaekled And left In a relatively smooth condition.ROM soodtng
andleach-up prfming/psintf vYW be the ou stomar+s mpmAhlifty.Homeowner harsreaivW a copy of the EPXoReuovate Right
Lead-We information VA cxplainingthe potential risk of the(mdhamtd exposure from the%whcrf:atlon work to be
perfamsad.Your sWadLn is ycuracknoweftyrncnt ofrccdpt and sWaamcol to proceed
STAIR WELL TO QAMW-
$74.00
RIM ft8=&8V4lApply AD Applicable,014ftiacrntivcstothNountract. You vAI only be Wed the Net amount. Currently.
for etlg'ble mauaacs,ColumbfaGa%ofibrs 75%incentive,not to exceed$2.tltt0 pax calendar year,andan i=t Wo of 100%fbr
the Air tl% tg mvu=up to the first 1680 andan additional$340 Ifsavhagaare,justiTed by the auditor.
For the saftty and heath of you'homtls indoor art gaeltly,we wll be conducting a Mort door diagnostic of tho avalleble air Ilow
r
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96MM land 96Mm ftw
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Nm6 Andover,MA 0186 North AmbMMA 011113
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ft�Mw Windnad Mm*-Thr"&"100 DORM NOW
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RISE00 Shawrnut Road,Unit 21 Canton,ARA 024271389.6024WS
ENGINEERING' wwwAftengineerirrg.eom
OWNER AUTHORIZATION FORA
I, hCgte-
(Owner's Nems)
owner of the pmpeirlI►located at:
G M • // }'
(Property Address)
(Property Addresa)
hereby authorize
(Subcontractor)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property.This form Is only valid with a signed contract.
JJf A A h -AL11 (112A j A/h
Owner's Signature
Date
3
a
I
N a The Co,rrrmomvetalth of P �t P�chtssc�
1=11 >. f Depen'lttreN of��dusfr ial AccideWs
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�L �t
X Cori, r E, S11-eet,smHe 1110
_ J Boston, A 02.114-2{17
WWIt%maSS,govf(lla
WorNer'.i' Cornpcalsatjt)a instrt'an o Affidavit'General BUSillesses.
'1'0 1311,FILED WI'f11'IH I'ERMI'I'TINC,4 A I1O11M'.
Al!>}ali 111f111f()1111 .On Please Print Legibly
13uSitaess/01_natairttti0ll N�alj1e:Mill City Energy
Address:PO Box 6411
Citylfittate/zip:Manchester, NH 0310€3 Phone fiI:603-391-7923
Are you an employer?Check the appropriate box: Business Type(required):
1.0 1 ant a employer with 12 employees(full ands 5• El Retail
or part-time).` ... _ .., 6. ReStaeiraPlt/Bill'/iiltill." L;stablishment
2,0 1 am a solo proprietor or par'tilerShlp 1931d have 310 7 Office Find/or Sales(incl.real e'slate,auto,etc_)
employees working for me in any capacity.
[,No workers' comp. insurance required]
$. ❑Nen-profit
3.0 We,are a corporation and its officers have exercised 9. E] Lnte;rtainl1wrlt
their right of exemption per c. 152,§1(4),and we:have I O.E] manufacturing
110cinployecs. [Nay workers'comp.insurance rcquircdl`., I I.[] I ImIth Care
1. with
aro,Xemployees.
p to ees o workers'corn 3ns13ranco req.]]
on-prolit�imization,staffed by volontce s,
ti•V1th 1117 c;rn -----
`
Ally'1tllilivallt Il71at Owck',hox Y 11111ist alml 1,01 nut 11w.sectiml below stim'Ji P,their worl:i:rl•coltlpensiilE011 j)0 i - inc(i4l71Fil16YS.
*i i the cmimmtc O ficc•rs have exempted fhclInd yes,hilt Sho corporation has Other employo.es,a ib Ts e3s'(,f)mj)vmminll policy is regiiwe l ami mich un
csr�i�niz.r3tiolt shpuld cfleck i7Os�i.
f fdP7F Ld7P CP771}iflyL'1"ttdfdt i.4 f9r't)aJifiir7i,�lig{I F''t'-r9 Cf7PFF�7L'14.FfdPi{}l1 tPT ti7PP'fd77Ge fE}r'f1Ry�('lPdj7ltt) ee,V'. .Below is the palicy injimnaflon.
T11s1.arance C:"c1r11pa11yo-1111e:Clerk I€15Ufrt+✓e
Insurer's Address:One Sundial Avenue Suite 302-N
C"sty/titateiTip Manchester, NH 03102
l'c}lia;y iI e71.Self=ills.Lic.#MIVVC791696 _ }3xpiration Date:4/29/2017
Attach an copy of the Workers'colllllietl'is ioa policy declaration Usage(showing the policy number and expiraltialrr date).
Failm-e to secure coverage:as required miter Section 25th of NIGL c. 152 can lead to fhe imposition ot'criminal penalties of a
'rine up to$1,500.00 and/or one-year imprisonment,as xvell as civil pellallties in the form of a STOP WORK ORDF`R arid a tine
oi'up to$250.00 a day against the violatae. Be advised that a copy of this staiernurll may be Ibrwarded to the Office of
Investigations of 4he DIA for insurance coverage raeriticadwi.
I{if)here I7 certif j!,Ut r lifts aridii)e17Aities t}_f f}erjur t,that the informatim provitte!(d bone ifi+ttris({{.'anit rtljr'eet,
Date:_
Sit�s3attarc� ! f
1'llrnle"1:603-396.7520 - ----
qf vial lase only. Do not write in this avea,to be completedl by city or town of¢irritJ
City or Towr;- lies°¢aitll.icensr #�
Issuing Avithority(circle erne.):
1.Board of 1-leal€11 2.Building Depilr•tment I Ci€yfl'oWl,Clerk 4.Licensing Board S.Selectmen's Office
6.01 her
Contact Person: Phone t#:
wwm m ass-tgovldia
i
3
II
MILLCITY-1 AGOULD
1:1119/2016
(MMlDAlYYYY)
CERTIFICATE OF LIABILITY INSURANCE (PAMI
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 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 License#AGR8150 COONTE CT
Clark Insurance - _..._ .One Sundial Ave Suite 302N AIC t o.Ext): 603)622-2855 we No:(603)622-2854
_._. .._. _.. . .
E-MAIL agouid@clarkinsurance.com
NH 03102 -ADDRESS: ouldclarkinsurance.com g @ ._..._..._ _.-.__ __.....__.
INSURERfS)AFFORDING,COVERAGE NAIC It
INSURER A:Arbella Mutual Insurance Co 17000
INSURED INSURER 0:AmGuard Ins Co 43290
Mill City Energy INSURERC: _.
106 Joseph St --.._. �._.
INSURER D
PO BOX 6411
Manchester,NH 03102 ANSURER
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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.
LTR TYPE OF INSURANCE INSD WVD m_ POLICY NUMBER MM UCO EPF MMIUUY( NYYYI
AXP LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ '1,000,00
DA TUR NTEO _,_,......
_ CLAIMS•MADE OCCUR 8500065735 0412912016 04/29/2017 pREMISE5 Ea accumence $ 300,00
MED EXP(Any one person) _ $ 51066
PERSONAL&ADV INJURY $ 1,000,006
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
POLICY PELT F7LOC PRODUCTS-COMPIOP AGG $ '0
OTHER:
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
(Ea
A XANY AUTO 1020050919 04/29/2016 04/29/2017 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
_ AUTOS AUTOS
X_'
PROPER
HIRED AUTOS X AUTOSNON-OWNEO (P rraccdeatDAMAOE $
X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS LIAS CLAIMS-MADE 4600065736 0412912016 0412912017 AGGREGATE $ 1,000,000
DEO X RETENTION$ 10,000 �..� $-.._...
WORKERS COMPENSATION
AND EMPLOYERS'LIABILITY STATUTE ER
13 ANY PROPRIETORlPARTNER/EXECUTIVE Y� X NIA
A MIWC791896 0412912016 04/29/2017 E.L.EACH ACCIDENT — $ 500,00
ER
OFFICIMEMBER EXCLUDED? _
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ __ 500,000
It yyes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
1600 Osgood St.
North Andover,MA 01845
AUTHORIZED REPRESENTATIVE
E
O 1988-2014 ACORD CORPORATION. All rights reserved.
(` ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
I:
0
Pb«1acu mc:huce@ts Department of PUblra S afcty �Constr(s:htan supervrm�
Board of Building h ecfrahaadk)ns and Sfmwra,hards R trictod to
Umestfictecl Buiktuap of any use group which contain
L4:e;dnse: CS-110041 Ins than 35,000 cubic feet(901 cubic meters)of
t:onstruch ern 13upser isor erncnlcsrd"Pace,
MICHAEL JOY
106JOSEPH STREET
MANCHESTER PJH 03102
Failure to possess a current edition of the Massachusetts
� ._..w._ 'xpnrr,aathcn: S(alea Huilctirct Code is cause for revocation of this hcense.
Commissioner 08/0712019 OPS Liceansino intomi ation visit:VWVV.MASS.G OVtOPS
C)nirm^«nt<rrwarrarraer�8tean~M,� nac;as�me«rtaa,w,aga'wrtraar t,fa�raaee,wreaatrrutieuran3hmtfua°furlraadaaler�e4u6y
tftlMt:NNbtFIrv:)Vr,'MLNtf(,ON TR CTOf1 prr^f avw the V%,lrie aMirra(tteie. if fraunat r eturn ter:
� r(Nr+grstraatta)ra: W792 office rai Cowsuuna r Affair's tanrt tlraainess lta p,ulnuiuu.
ciAn¢ tt_ 110 Part 1"lax t Suite 5170
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