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HomeMy WebLinkAboutBuilding Permit # 1/30/2017 BUILDING PERMIT r�OR7N TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: L-3 - 016C2 Date Received SSACµl15�Jt pate iSSUGCI: _ IMl'ORTANT:Applicant must complete all items on this page LOCATIDN - Print PROPERTY - Pnnt :; 1 Oi}.Year 5f�ucture yes o MAP PARCEL: _ ZONING- DIST RICT. His or�c Dty Machin Sh:_oAVi[]ae es no . - -gam__---Y._.� - TYPI✓ OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial I Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic D Well ❑ Floodplain 1�VVetlancl ❑ Watershed l r'str ict ❑.1Nater/8 wer DESCRIPTION OF WORK TO BE PERFORMED: �- hast.- � �x� �' 6�•� n Identification- ]Please Type or]Print Clearly' OWNER: Name: Phone: G!7 a Address: 110 LACakt;q aeolc ovor MA (318''! -17 Contractor Name.: .. Rhone . Sa . 38.2_- c 6111 M�nc.G4es e.,� 631(( Address: � . Supervisor's Construction License ._.. _ 110041 --.-- Exp. Date: _. ]Z_12014. . Home ImprOvemerit License: isL-742 -. _ Exp. Date=:' ? ARCHITECTIENG[NEER Phone: Address: Reg. leo. FEE SCHEDULE:BULDING A.RRMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125,00 AER S.F. -- Total Projeot C®St: $ Z,l1b . �5 FEE: '33 - Check No.: Receipt Not !MOTE: Persons contracting with unregistered contractors do not have.access to the quarantyfund Signattare of AgenlOwner r,K,� Signature afi con tracor NORT#1 Town of r Andover O 0 her, /*10/ 7v 9 MaSs7 I 2C0CNICHEWICK h' I V ,4 A3. S t! . BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .....M!. .A.!#..�.......1�1..M....... BUILDING INSPECTOR has permission to erect .......:.................. buildings on ....A1.Q.......L. I .ol . . ...... ..� t..... Foundation c s Rough to be occupied as ....... :�..�..�1........ ..... '4.�. . ....................T. . .T.� .................... Chimney provided that the person accepting this permit shall in a ery respect conform to the terms of thea application pp 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 C®NSTRUCTI® TARTS Rough Service ......... . ................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occu Buildin 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 ID#05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration No RISE 60 Shawniul Road,Canton,NIA ENGINEERING CONTRACT 339.502-6335 FAX 339-502-6345 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-FIES ENGINEERING AND THE CUSTOMER FOR WORK AS 0SC"I"00 artlow ........... CUSTOMER PHONE DATE CLIENT 0 WORK ORDER Jospeh Kukas (617)593-6290 12/09/2016 431895 35004 SERVICE STREET UILLINO STREET 110 Laconia Circle 110 Laconia Circle ---------- ------- --------------- SERVICE CnV.STATE,ZiP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover, MA 01945 JOB DESCRIPTION HEALTH&SAM'Y: Have your heating system tuned up and retested to be sure that the undiluted flue gasses do not exceed 100 parts per million(ppm)carbon monoxide.Weatherization work cannot proceed until this is fixed. Alit SEALING:Provide labor and materials to Seal amlN ol'your(tome against wasteful,excess air leakage, this work will be performcd $1,020.00 in concert with the use of special tools and diagnostic WNIS to assure that your home will he left with a healthful level of air exchange and indoor air duality.NIaLerials to be Used to seal your[ionic can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,hAsumerivs,allached garages and other unheated arews,(wiridow5 are not generally addressed.) This will require(12)working hours.A reduction in cubic feet per minute krnl)[)fair infiltration Will occur,but the actual number ol'chn is not g0;m'I0WCd. At the completion of the weafficrization work,and III tio additional cost it)[lie homeowner,a final blower door andhor combustion safety analysis will be conducted by Lite sub-contractor to ensure the safety of the indoor air quality, AIR SEALING ADDER: (2)working hours. S170.00 AIR SEALING:Provide labor and materials to install Q-Ion weatherstripping and doorsweep to(4)door(s)to restrict air leakage. S320.00 ATTIC ACCESS:Provide labor and maturiak to insulate the back of(I)mite hatch with rigid board at R-10 or greater With the required S60,00 Fire rating,Weatherstrip the perimeter. VENTILATION:Provide labmand materials to insiall(I€insulated exhaust hose with roor niountud flapper vent it)exhaust existing S1[8,75 bathroom fan(s).Broan model It 636 or equivaleni. CONINION WALLS:Provide labor anal materials to install rigid board a(R-10 or greater with[lie required fire rating it)(242)square feet 5931,70 orcomnion Wall-area, j: JAH 017 ij Federal 10 N 05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration No I#S 611 Mamma Read,Canton,NIA FNGINFERING CONTRACT 339-502.6335 FAX 339-502.6345 Page 2 PROGRAM Tit IS CONTRACT IS ENTERED INTO BETWEEN RIS[ CMA-HES EN1.119RINO AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLrENr9 WORK ORDER Jospeh Kukas (617)593-6290 12/09/2016 431895 35004 SERVICE STREET BILLIIIO STREET 110 Laconia Circle 110 Laconia Circle - --_ - - - �_.. ----- __ _. SENVtCE CITY.STATE,ZIP etLLINO CIFY,STATE,ZiP Nortli Andover,IMA 01845 North Andover,MA 01845 .TOB DESCRIPTION RISE Engineering will apply.ill applicable,eligible incentives to this contract. You Will only be billed the Net amount. Currently,for 590.00 eligible measures,Columbia Gas offers 7551,incentive,trot to meed$2,000 per calendar year,and an'incentive of 100%for the Air Sealing measures up to the first$690 and an additional$340 if savings arc juslified by the auditor. For the safety and health of your hatne's indoor air duality,we will be conducting a blower door diagnostic of the avaitahle air flow is your home both before the Wort(rR begun,and after the weatherization work is complete.We will also conduct it full aSWNSnlellt 111 the combustion safety of your heating systartl and water heaterAllis bas a value of 190 and i5 al 110 cost to you. "Thud allowable weallrerization inccruive is S3,1 10. `tale Perron Will be Sccurcd by the insulation contractor,at no additional Cost.It i.c the IlonleOWner's responsibility to close out this permit by colitaeting their municipality at the completion of this Work. Total: $2,710.45 Program Incentive: $2,278.46 Customer Total; $431.99 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ""*Four Hundred Thirty-One&99/100 Dollars $431.99 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMrT AMOUNT DUE IN FULL INTEREST OF I%WILL DE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS,SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. E-SIGNED by Nathan Weiss E-SIGNED by Joe Kukas _. — _..___._..__....._..._ _... . _.-- --------. _..__---_.._.....__._._._. AUTHORIZEDSIONATURE•RISEEnglnmtlnq CUSTOMER ACCEPTANCE December 12, 2016 NOTE:THIS CONTRACT MAY BE WRHORAWN BY US W NOT EXECUTED WITHRI DATE OF ACCEPTANCE _- ,___..�.��............._.__... {{�� ACCEPTANCE OF CONTRACT.THE ABOVE PRICES,SPECIFICATIONS AND COHORIONS ARE 3" GAYS. SATFSFACTORY To US AND ARE HERESY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIRED.PAYMENT WILL DE MAGE AS OUTLINED ABOVE RAS E 60 Shawmut Road,unit 2 I canton,MA 020211339.502.6335 ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM I, Joe Kukas , (Owner's Name) owner of the property located at: 110 Laconia Circle _ (Property Address) North Andover, MA 01845 , (Property Address) hereby authorize � vi.Q� (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. E-SIGNED by Joe Kukas Owner's Signature December 12, 2016 Date 1 The Conimorwealllt ojWassacltffsefts Z3epartmerftof•lndustehil.9ccfflents .1 coplAwess Std eel,sidle 100 f`1 Boston, NA 02114-2017 WorkLys' Compensation Insurance Affidavit:General Businesses. O IIE FILE 1)WITbt'iHE 11t,[2M TTING AUTHORITY. Please Pript Lg :i BUS'inuss/Organization Njljje:dill City Energy Address:PO Cox 6411 City/State/Zip:Manchester, NH 03108 603-391-7923 Are you in employer?Check tate appropriate box: Hasiness Type(required): 1.0 1 ani a employer with..1-2_.__.____._employees(Rill rend/ 5. ®Retail or part-Berl(~).* G. Q Restate aut/l3ar/Eating.P.stablishnient 2.0 1 am a sole proprietor or partnership and have no 7, Q Office and/or Sales(incl.real estate,auto,etc.) einployees working for ore in any capaeity. [No workers' comp, insorancc required] 9, ❑Non-profit 3.El 1we ars;a carl)Oration and its officers have exercised 9. ❑ Entertainment their right.of exenjption per c. 152,y t(=t),and we have 10.F] Manufacturing no employees. [No workers'comp.insurance required] ' 1].� Health Care 4.® Wo ere a non-prohl organization;staffed Ery volunteers, with no ornployees.[No Nvorkers' comp. insurance req.) 12.Q0 Other , �yj.��G►1_.____._...__.__ 'Any applican€that chct:ks box i#] nwst aho fill Out t1w.section betnw showing Ihcir workers'compewation policy informalion. 'if fhe corporate of ems have exel-Apled 1hQn1s0ves,13111 the corpointion leas other employe-;a-4-s'compensation policy k ragcsircd and well an m1pnir'ttion should check box it 1. l rasa art carrplayer flaaal is provirlira rr�orker;l'coaaaperasatiou laasrrraaarce fva rray eraapdr�pees. Below is tete policy inforrawflon. Insurance Company Name:Clark Insurance Insurer's Address:One Sundial Avenue Suite 3021 City/5tatei7.ip Manchester,_NH 03102 Policy 9 or Self-ins. Lit:.I hllllltlC791896 1 xpiration Date,:4/2912097 Attach a copy of the workers'cornpensation policy declaration page(showhig the policy ntanher and expiration date). Failure to secure coverage as required tinder Section 25A of A4GL c. 152 can lead to the imposition of'criminal pcnaltics of a nine up to$1,500.00 and/or one-year imprisournent,as tivetl as civil penalties in She form of a STOP L oRk OR DFA and a fino of up to$250.00 a day against the violator. Be advised that a copy of this staternent may be Forwarded to the Office of hivestigations oftlte DIA for insurance coverage verification. I ala hereby Certdfy,ria ada'ts an d pearalfdes of perjary that the iPtformation prop,irlerj above is fr iie and correct, _-- Dat�_I.'. !'/tone:r:603-396-7620 Official rase only. Do not write in this area,to be completed fip city or te)-tv"of vial, City or Town: _ _ Permit/License Issuing Authority(Oil cle one): . Boat, of Ilealtlr 2.I3oHding Depar•tr:renk 3.C,'ityfl'own Clerk 4.Licensing Board 5.Selectmen's Office 0.Other Contact l'�rson.._W... ___------._ _. V.W_. .._....._..---_._._.__. PlaorEe#:_- -� MILLCITY-1 AGOULD FACORL7 DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 711912016 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 an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#AGR8150 NAME CT Clark Insurance PHONE 2 One Sundial Ave Suite 302N M&INQ,,E t)_(603)622-2855 iAc,No): (603)622-2854 E-MAL _....._- Manchester,NH 03102 ADDRESS:agould@clarkinsurance.com INSURER'S)AFFORDING COVERAGE -_„ , MAIC N INSURER Mutual Insurance Co 17000 ._....-----_ �.._._._...___-- _.._..._..._ INSURED INSURER B:AmGuard Ins co 43290 INSURER C: Mill City Energy __........ - 106 Joseph St _ __.._.._� ____..........._..._.____..___.� PO Box 6411 INSURER D_c__._ Manchester,NH 08102 INSURER E: 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, !NSR _.,.... - Ab—r)L S 3alan ---._...._.__PpLICY EFF POLICY EXP LTR TYPE OF INSURANCE D POLICY NUMBER MMIODfYYYY MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $_ 1,000,000 DAMAGE TOE - -..._..._,._..._._ CLAIMS-MADE OCCUR 8500065735 0412912016 0412912017 PREMISES EaR ar.T=D nce $ 300,000 MED EXP(Any one person) $ 6,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PFR: GENERAL AGGREGATE $ 2,000,000 POLICY L� JECT � LOC PRODUCTS-COMPIOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea acciden,0,,,, A X ANY AUTO 1020059919 04/2912016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED W SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED X PROPERTY DAMAGE $X HIRED AUTOAUTOS Pr ) X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIA9 CLAIMS-MADE 4600065736 04129/2016 0412912017 AGGREGATE $ 1,000,000 _.. DEO X RETENTION$ 10,000 $ WORKERS COMPENSATIONX AND EMPLOYERS'LIABILITY STATUTE ER B ANYPROPR€ETORIPARTNER/EXECUTIVE YIN MIWC791896 0412912016 04/2912017 E,L EACH ACCIDENT $ 500,00 OFFICER/MEMBEREXCLUDED? FIN] N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 Ii es,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS f VEHICLES (ACORD 161,AddlUonal 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 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORN name and logo are registered marks of ACORD & fir.¢ i.d adorn sand St;aaarta.arc Depaktda ont of q ubkc Safety t Oa trur:tion Supervisor , Massachusetts � is f2etrirtecl to , �aaceoal t>i E1uooEcteurs LJowshicledy Buildtigs of any eme roup which contain L.ir;r„nse: CS-110041 lass thin til5,000 cubic feet(991 cubic;oie teas)of C,onstructiory enclosed space MICHAEL JOY 106 JOSEPH STREET MANCHESTER NH 03102 e 08/0712019 E allurato aos sos acurrent edition of the Massachusetts i- raon State u lrqCodo is cause for revocation of this li:eaas . Ct ni >m r r CPa Lircr1 irairarutaatiora vi%W WM.ftflASS.GOV)DPS ii �wstr a460"�valid for irh�tk Out nw ostly Cai0r�arri 1 n��atwcevra r M1,Riiapa?�k!r tSw���r^ quar,uataatdaa�� vevir cYr rr�� t1t"1C E IW66I�M�t"V M H1 OWRAt� 100 6�arNtarr the a=ai rr npir r("late, It(mindresor�t R�u: l fCau0��trp"ua5�a, tYtndrpt fyPv: tlfiitwraltomowara°rAfkdrG mal1farsilwW ttrrgldlfriMl f a frir cdrwra' "1„ti ark k1'r” k..:..r� ltt f°nd,k"iro .�- �aitr 5170 0nrtorM.NIA 02110 WA a kr t 0414 t AE Ptrd � x r 01 �, I E1' TrdL f 6 r tirrat t mklwrM`t tlw2d NW.;aPCar,tdfk03V,t'�;�i t��a�ia��e4«a4�r hir a,alp v' l �v