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HomeMy WebLinkAboutBuilding Permit # 2/15/2017 BUILDING PERMITof "aF D TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: (7 Date Received 1TED A e i• . �SSACHLIS�'C Date Issued: 1 IWORTANT: Applicant must complete all items on this page LOCATION n_. . M. PROPERTY OWNER i t 'nnt 1 t}0 Year Str"ucture yes no MAP _:' PARCEL. ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial ]teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic D Wel] ❑ floodplain ❑Wetlaricls " C) 'Watershed District WaterlSevver DESCRIPTION OF WOR TO BEP RFORMED' Identification- Please Type or Print Clearly { OWNER: Name: � � Pho e: 7` 77_ �! Address: LQ — Contractor Name: ra Phol'ie ��. l Address:: SUperviso. Construction License. -_ Exp: Date —C . ( i 'l Hcime Im rovement License: Exp:' Date". P _ (Vj, ARCHITECT/ENGINEER Phone: Address.- Reg. No. FEE SCHEDULE.13ULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. ,notal Projeot Cost: FEE: $ Check No.: ��¢ Receipt No,_ NO'T'E: Persons contracting with unregistered contractors do not have.access to the guaranty fund 5,igr�ature ofAgeWOwner Signature of corttracta : - %AO R TN Towe. ofndover .; = 6 ® T to '71 hA ver, Mass,-..... j C ► SOO / 7 ,9 Q° Are S tl BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT .......&VAIA0.!.j.7...........I.O. so(o .►.eA..... ...................... BUILDING INSPECTOR has permission to erect .......................... buildings on .......... .� ...... ... ,I , �'/.� Foundation Rough ���► r tobe OCCLIpled as ..............I A S.......,......,�...,.. ........�... ... ...�...........,.,.........,.................. Chimney provided that the person accepting this permit shat n 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 C® STRCI S ARTS Rough ... Service .......... .. . ,. ....... Fina[ BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. The Commonwealth of Massachusetts x Department of Industrial Accidents 1 Congress Street,suite 100 r a Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Leeibl Name(Nosiness/Organizationllndividual): Builder Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03060 Phone#: 603-324-1984 Are you an employer?Check the appropriate box: Type of project(required): 1.®1 am a employer with 100 employees(full and/or part-time).' 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]f 10❑Building addition y4,❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 3 ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions gi proprietors with no employees. 12.❑Plumbing repairs or additions N 5.�I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These subcontractors have employees and have workers'comp.insurance-1 14.®Other Weatherization 6.❑We are a corporation and its officers have exercised their right of exemption per MGI,C. 152,§1(4),and we have no employees.[No workers'camp.insurance required.] 'Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: E eri Insu nce m a Policy#or Self-ins.Lic.#, WLRC 48151553 Expiration Date: 6/30/2017 Sob Site Address: iYCi CitylState/Zip: �e_f (� lv �� Attach a copy of the workers'compens tion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.40 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$254.04 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the sins ar enalties of per' ry that the information provided above is true and correct. Signature:_ Date: Phone#: 603-324-1984 Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone#: Contact Person: DATE(MMIDDfYYYY) -°� CERTIFICATE OF LIABILITY INSURANCE 1012512016 �. 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), AUTHORIZEDto r— REPRESENTATWE OR PRODUCER,AND THE CERTIFICATE HOLDER, IMPORTANT:If the certificate holder is an ADDITIONAL INSURED,the policy(les)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 w this certificate does not confer rights to the certificate holder in lieu of such endorsement(s), m CONTACT PRODUCER NAME: Aon Risk Services Central, Inc, {!uON No.f=xt}: (866) z83-77.22 F -Na,): ($00) 363-0105 Southfield Mi office o E-MAIL 3000 Town center = ADDRESS: suite 3000 Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: old Republic Insurance company 24147 TruTeam Builder ServiCes Group, Inc. INSURER B: ACE American Insurance company 22667 d/b/a Quality Insulation INSURER C: A TopBuild Company 110 Perimeter Rd INSURER D: 9 Nashua NH 03063 USA INSURER E: INSURER F: u COVERAGES CERTIFICATE NUMBER:570064230317 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 _F0_Clc7TFF_ POLICY INSR' TYPE OF INSURANCEAD SUBIR POLICY NUMBER MMlDDM' MMIDD P LIMITS LTR INSD WVD A X COMMERCIAL GENERAL LIABILITY MWZY 518 30 11MD2 0 11EACH OCCURRENCE $2,000,000 DAM Gr O REN ED CLAIMS-MADE X❑OCCUR $2,000,000 PREMISES Ea occurrence MED EXP(Anyone person) $25,000 PERSONAL&ADV INJURY $2,000,000 r` m GENERAL AGGREGATE $4,000,000 ay GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY ❑PRO ❑LOC PRODUCTS-COMPlOP AGG $4,000,000 JECT Q n OTHER: 4] A AUTOMOBILE LIABILITY MWTB 307519 06/30/20166/30/2017 COMBINEDtSINGLEtIMIT $5,000,000 Ea acciden BODILY INJURY(Per person) O 1( ANY AUTO OWNED SCHEDULED BODILY INJURY(Per accident) Orsi„ AUTOS ONLY AUTOS PROPERTY DAMAGE U _ X HIRED AUTOS X NON-OWNED Per accident) ONLY AUTOS ONLY Gl EACH OCCURRENCE V UMBRELLA LIAB OCCUR AGGREGATE EXCESS LIAB CLAIMS-MADE DED RETENTION B WORKERS COMPENSATION AND WLRC47860180 06/30/2016 06/30/2017 X STATPERUTE EOR EMPLOYERS'LIASILITY YIN All Other States E.L.EACH ACCIDENT $1,000,000 ANY PROPRIETOR I PARTNER I EXECUTIVE SCFC47860209 06/30/2016 06/30/2017 B N OFFIGERIMSMSER EXCLUDED? f A E.L.DISEASE-EA EMPLOYEE $1,000,000 (Mandatory in NH) WI only If yes,describe under E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS belay DESCRIPTION OF OPERATIONS f LOCATIONS)VEHICLES(ACORO 10i,Additional Remarks schedule,maybe attached If more space is required) i 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 Ruilding Deartment Attn: Donald Belanger 1600 Osgood street, Suite 2035 North Andover MA 01845 USA o 91988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD ff FoW4ornt'22er airs a(d%Aus F 10 Park Plaza - Supe 5170 Boston, Massachusetts 02 116 ontractor Registration Home Irnprovem". Registmtion: 175141 Op Type: Supplement Card BUILDER SERVICES GROUP, INC Expiration: 6/2512018 RICHARD SCHWARTZ r; F 260 JIMMY ANN DRIVE DAYTONA BEACH, FL 32114 Update Address and return csrd.Mark reason for change. ; 11 Address Renewal Employment Yost Card 0 2M �se (:��ita7ur�ir��f�,n�s��az:rrc.FtiaelL. i' Ire of Consumcr Affairs&Business Regulation License or re-gistration valid for individual use only i tE IMPRO1lFjl+€T CONTRACTOR OR before the expiration elate. 1f found return to: Office of Consumer Affairs and Business Regulation Rt isfratlptf;. T�3f?47.:. Type, 10 Park Plaza-Suite 5170 EE, pir $7. Supplemeni Caret 7x �..„ Boston,MA 02116 BUILDER SERVICES rlf;I� 4- =_ R€CHARD SCHYVAR�E���f. ##0 PERIMETER Rd NASHUA, NH 03053 undersecretary Not valid without signature i A Massachusetts}department of Public Safety 5 Board of Building Regulations and Standards Licenser: CSSL-105992 Construction Supervisor Specialty `. RICHARD SC6tWATM 764 JIMMY ANI1IlRl DAYTONA SEAOFt ='A- CA—. Expiration. P commissioner 69i��12t�l� R „ Construction Supervisor Specialty Restricted to: CSSL-1C-Insulation Contractor is i Failure to possess a current edition of the Massachusetts &tate Building Cote to cause for revocation of tills tlranse C)pS UrAnsing tnfot-mation visdt:'I WW.fdASS.COV1DPS �� �ti�{�n Federal ID is CtE-4dC5826 RISE Englr►eerin Rt Contractor Regietralson No 9106 { '{ (� MA Contraotor Reglatratioorl No 120979 C1 Contractor Raglatrrtlon N0820129 ' �. 60ShawmutRoad,Cnown,MA02021 CONTRACT ENGINHR NG 339-90x�33g CAX 3394"2-6345 Page t PROGRAM TM!!COUT RT ta 006RED two ek7WfEN R'SE CMA-HES RNOM N»Ga atrw a CUSTOMER"WORM AD CU8'rikheR NONE DATE CLIW6 WORK OR*" Chris Conway (617)877-4128 01/26/2017 444334' 23906 aERvice 8TAW MU,0 i MINT 137 Wayland Chale 137 Wayland Circle eaRv10E CnY.BTATR,rip aR.uke any,tTA1Tl.by North Andover,lu1A 01845 North Andover,MA 01845 JOB DESCRIPTION HAZARD BARRIER:we have Identified that there art recessed fights present in your home.unless the recessed lights are certified as IC-rated(Insulation Contact Rated)we will oleate a 3"ofearanot space around the fixture by using fiberglass blanket insulation as a damming rn6terlal,rte insulation will ba installed across rho top and closed cavities whloh oontaln recessed 110hla will not be insulated, is 5t1,Ot1 3, DAMMINO7 Provide labor and materials to Install e 12"layer of IL-38 un#hocd fibtxglass batty to(198)square feet for damming purposc5. $405.911 ATTIC FLAT:Provide labor and matcrlatS to tnstalt a 5"layer of R-t 9 Class 1 Cellulose added to(976)square feet of open attic $Paco. $1,229.76 ATTIC ACCESS;Provide labor and materials to insulate the baoic of(I}actio hatch with rigid board at R•10 or greater with the required fire tating.Weatherstrip the pertrutcr. 560,00 ATTIC ACCESS;Provide labor and materints to make(1) access opening fmm ane attic area to Rnottter by cutting a passage through sheathing. This access ivlll be left open 0$it is between two common unheated non Orewallod attio areas. $35.00 VENTILATION!Provide tabor and materials to install(2)instttated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s).Broan modal 4 636 or equivalent. $237.50 VENTILATION;Provide labor and materials to install ventilation chutes in(108)rafter bays to maintain(Mir flow, 527©.00 L„ h� s�isn 1-t,taa-ojR xw l3utoeaH WI�ON W�1 so; �,g c azralJ�uer SfE tagineering RI ConUmWr Ragta"Von No 51N 1U MA Conbutor Rogtatratfon No 1209n CT C*nUNWP RM"on N08201:10 RISE60 Shawrout Road,Canton,NA OMI ENGINEERING! CONTRACT 3394"2.ms PAX 339-302-4345 Pop 2 PROGRAM C014111ACT 19 DOPM WO 66TWM RM CMA-RES V4TM AM10101111116 TW CUV"Wffl"WM AIII oeacaiasoeeLow Chris Conway (617)8774128 01/26/2017 444334 23906 1113111146 61MINT BLU0 6"Wr 137 Weylimd Circle 137 Wayland Circle StWell OnVo 4TAlt 1W 9KAM MWATATUP North Andover,MA 01845 North Andover,MA 01645 JOB DESCRnMON RISE Wnooring will apply all applicable,411siblo hicanfives In this contram You wig orAy be billed the Not amount Cunady. thr ellSibEe measures.Columbia Gas offin 75%Incentive,not to cxciecd 52,000 pot calendar year,and an Ifteentivo of 100%far the Air Sealing measures up to the first$680 and an additional$340 if savings are juMcd by the auditor. Por the spAty and health of your home's indoor air quality,we will be conducting a blower door di%ratio of ft available air flow in your hams both befta the work Is kg^and oftr the weatherintlan work it complete.We will also conduct of assessment of the combustion safety of your hoadq system and wets heater.This has a value of$90 and Is at no cost to you, The Pamic will be seoured by the insulation contractor.This has a value of$71 and is at no cost to you.it is the homeowner's i=pcoeitillity to close outthis pmlt by contactIMS their MUfliVipality At the iximplation of this work.Total allowable woWarizadon incentive Is$3,18S. Total: $2,403-16 Program Incentive: $1,043.82 Customer Total: $569.64 WE AMC HaRMY11`0 FURNISH SGIRMES-COMPILLF111 IN ACCOROMON VM AS=SMIPMAVOK&MR TME SUM Or *"Five Hundred Fifty-Nine&641100 Dollars $059." UPOfiF* WPM UNIPMRMAUVOMAUM TDAVAItAIIAW.WOUNIN PULL IUMMOPAW"860WROW IRIMMY ON AW 9 CONTRACT IF THERE ARE ANYWLANK SPA 9YU9 IF*DT EX99MVOM OA141OPACU"LWO ANDTAKIIII OF COUTRW-V`W MWO PAW%3I`IWW=YIQM Win GUNIPF106 ME 30 AS SPOWLED,PAYMM VOLL 06 MAN AD OUMED AMU A i_-nn-en l6 vim Ai i i no2,.j i n inks o-jL%ri IAIW mn,i i'a 11 n71n0)LIQf1