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Home My WebLink AboutBuilding Permit #481-15 - 1 Morkeski Drive 11/18/2014Permit NO: I, Date Issued: lill BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received RTANT: A-DDlicant must complete all items on this MR. NORTH TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Cl New Building F1 One family 1-1 Addition F1 Two or more family Li Industrial D Alteration No. of units: D Commercial Ei Repair, replacement tj Assessory Bldg X Others: [-I Demolition IJ Other A � GOW4 (A &t"Ub-0C W50-nC-710a 6CL't Identification Please Type or Print Clearly) OWNER: Name: Address ARCHITECT/EN (NEERPhone: a&-- - — Address:— NA. Reg. No. KLA - FEE SCHEDULE: BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ +11 sue - -zo FEE: $ 5�- d Check No.: 17) '0 2r - aRe.ceiCpt No.: 2 NOTE: Persons contraefingith unregistered contractors do not have access TtoZtheUg uara. ntyfund Signature of Agent/0wherlht to!of itractdr 0 X "W-II7L.P-1 b- Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swiumning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comm r Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes= Located at 124 Main Street Fire Department sigmpture/date COMMENTS Located 364 Usgood Street no Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Mass check Energy Compliance Report (If Applicable) ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ Building Permit Application ❑ Certified Proposed Plot Plan ❑ Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc: Building Permit Revised 2014 Location 01 &4 4 No. Check # . - �r- I e: 1, Z V U Date TOWN OF NORTH ANDOVER s Certificate of Occupancy $ Building/Frame Permit Fee $, Foundation Permit Fee $ Other Permit Fee $ TOTAL $ z Building Inspector 0 HI Z IL9 * O cu Cc O C.). •�Cc gx a� ca �a co 1 Q E cn Q• •�: 2 E C O / 0 i °D en CD O O � _ = U Q H d t t E '~ O CL 0 _ O O (S+: •CO _ 3 _0 L C0 CD �Z_ 0 m F- vha;O = O v CL m N Cc d m ujW = O O N CL N C W O v E Cl) d •> _ N O H CL t CL 00 Z m co Z CO w x LLJC W CL �V N w N SIV w 0 CD N i O Q ai Q Cc J -0 O ) za N r- -W C J0 oC Z W W O Q W CL CW W d Ln H U C x zZ LU LL Q Z Z U N W m D Q W J I- CO =n N v C d W ? N z _ L _ N O Y O O_ 3 � 3 @ = > r 0 m i O 0 :Ec C C c v LO (n LL W U LL w LL K Ln LL K LL O cu Cc O C.). •�Cc gx a� ca �a co 1 Q E cn Q• •�: 2 E C O / 0 i °D en CD O O � _ = U Q H d t t E '~ O CL 0 _ O O (S+: •CO _ 3 _0 L C0 CD �Z_ 0 m F- vha;O = O v CL m N Cc d m ujW = O O N CL N C W O v E Cl) d •> _ N O H CL t CL 00 Z m co Z CO w x LLJC W CL �V N w N SIV w 0 CD N i O Q ai Q Cc J -0 O ) za N r- -W C Name / Address Energy Services 4th Floor ABCD 178 Tremont Street Boston MA 02111 Air -Tight Weatherization LLC 9 Story Ave Beverly, MA 01915 Phone: 978-998-4684 Job Location Morkeski Meadows I Waverly Rd. North Andover MA Estimate Date Estimate # 10/1/2014 210 Project Description Qty Rate Total Attic sealing with two-part foam 120 84.00 10,080.00 R-30 unrestricted - settled cellulose 17,768 1.65 29,317.20 Duct insulation R-5 500 3.47 1,735.00 Site Built Therma Dome 12 140.00 1,680.00 Building Permits 1 516.00 516.00 Total $43,328.20 To Whom It May Concern: I, James Fortin, do authorize Douglas Cranford to act as my agent in the process of applying for building permits and other necessary documentation pursuant to the conduct of business by Air -Tight Weatherization LLC. \r J ,S- Sign ture Date State of Massachusetts County 35l On this N day of M" I a, before me personally appeared JCOfS. n J f004-4 , to me known to be the person (or persons) described in and who executed the foregoing instrument, and acknowledged that he/she/they executed the same as his/her/their free act and deed. Notary Public - - l-� pap 0 Print Name: ---- My commission expires: HUM Iq, 202 1 D0 Notary Public COMMONWEALTH OF MASSACHUSETTS My Commission Expires March 19, $021 7X, e Y()O)yj 0 y 4 M11161611 A 7 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor :Registration Reqistration: 165640 Type: LLC Expiration: 3/15/2016 Tr# 248557 AIR - TIGHT LLC. WEATHERAZATION JAMES FORTIN 10 PINE KNOLL DR. - BEVERLY, MA 01915 SCA 1 0 20M-0.5/11 X11f. Y' (,III pt, I; ef�'Jlllj f/ Orrice of Consumer Affairs & Business Regulation :HOME IMPROVEMENT CONTRACTOR �')egistration: 165640 Type: P Expiration: 3115/2016 LLC AIR - TIGHT LLC, WEATHERAZATION JAMES FORTIN 10 PINE KNOLL DR. BEVERLY, MA 01915 Undersecretary Update Address and return card. Nlirk reason for change. Address Renewal Employment Lost Card License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, INIA 02116 loot va id without signature I 11% MassichusclUr of 010-)kf: �VSto (jar,.�, Ba�lrfj ()f auljdj�jy R# % So pC rt I Ir' 4409% L,CCIISO CS -052576 .WNIES F FOR -11N, III PINI-,1KN0I,I- 61? 13ctcrlv NIA 11191'N 10/03/2015 The Commonwealth of Massachusetts Department of Industrial.Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 wwwinass.govldia Workers' Compensation Insurance Affidavit: General Businesses Al2plicant Information Please Print Legibly Business/Organization Name: Address:— Q-\ City/State/Zip: % 1,4:' Phone#: --- Are you an employer? Check tittle e appropriate box: 1. I am a employer with employees (full and/ or part-time).* 2.E1 1 am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' corp. insurance required] 3,0 We are a corporation and its officers have exercised their right of exemption per c. 152, § 1(4), and we have 4 0 no employees. [No workers' comp. insurance r,cquircd]**l We are a non-profit organization, stafTcd by volunteers, with 110 employees. [No workers' comp, insurance r Business Type (required): 5. EJ Retail 6. Restaurant/Bar/1---ating F.stablishnicnt 7. ❑ Office and/or Sales (incl. real estate, auto, etc.) 8. ❑ Non-profit 9. El Entertainment 10.0 Manufacturing I LEJ 11calth Care 12.R Other 1111Y "IIIP 1cdflttnitt UflCCKS00X Ff I must also Iffl out he section below showing their workers' c0l"Pen-1-ation policy information, . * If the corporate officers have exempted themselves, but the corporation has other crnployccs, a workers' compensation policy is required mid such an organizzition should check box V 1. I am an employer that is providing svorkers'comp rrsation insurance forrimy employees. Bele);Visthe polio itif(irniation. Insurance Company Name:-- Insurer's Address: City/State/lip: VA Policy fi or Scifins. I..,ic. # I U- .-1) 1"'xpiration Date: —Clls,— Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MG1, c. 152 can lead to the imposition of criminal penalties ot'a fine up to S1,500.00 and/or one-year Imprisonment, as well as civil penalties in the form of STOP W(MK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be tbrwarded to the Off cc of Investigations of the DIA for insurance coverage verification. I do hereby certify, under the pains and penalties ofperjur information provided I wided ahove is true and correct. U. � that the 11�1�- - Phone #: Q-1 - K-1— (—� I Cl 1� L. It cA Ll Official use only. Do not write its 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. Licensing Board S. Selectmen's Office 6. Other -- -1 I I (--N I I � Contact Person: Phone ACOORL)i� CERTIFICATE OF LIABILITY INSURANCE DAT 11/17/2014 YY) 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. 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 CONTACT ONNT CT Jacqueline Marie Melanson, CLCS MassPay Insurance Seruces, LLC PHONE FAX Et(978) 7744338 x105 No): (978) 7741318 27 Garden Street, Unit 1B('C.No Damers, MA 01923 l: (AIC, ADDRESS: jaclde@philrichardinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: AmGUARD Insurance Company 42390 INSURED Air -Tight Weatherization, LLC INSURER B: INSURER C: 9 Story Ave Beverly MA 01915 INSURER D: 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. IICYEFF TR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER MMIDD/YYYY POLICY EXP MM/DDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE ( RENTED PREMISES Ea occurrence) $ MED EXP (Any one person) $ CLAIMS -MADE F-1 OCCUR PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS - COMP/OP AGG $ PRO LOC POLICY JECT $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY IWURY (Per accident) $ NON -OWNED HIREDAUTOS AUTOS FIR arEciden DAMAGE $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ AGGREGATE $ EXCESS LIAB CLAIMS -MADE DED RETENTION $ $ A WORKERS COMPENSATION AIWC576437 07/01/2014 07/01/2015 ✓ WC STATU- OTH- TOR AND EMPLOYERS' LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECLMVE OFFICER/MEMBER EXCLUDED? N (Mandatory in NH) N I A E. L. EACH ACCIDENT $ 1,000,000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 If yes, describe under DESCRIPTION OF OPERATIONS below E. L. DISEASE -POLICY LIMIT $ 1,000,0 DESCRIPTION OF OPERATIONS I LOCATIONS/ VEHICLES (Attach ACORD 101, Additional Remarks Schedule, ff more space is required) Proof of Workers Compensation Morkesld Meadows 1 Waverly Rd North Andover. MA 01845 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE WCL4Vx*k... @ 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD AIRTIA OP ID: JD CERTIFICATE OF LIABILITY INSURANCE 711/14/14 YY) 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(ies) 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 781-914-1000 CONTACT TGA Cross Insurance, Inc. NAME: Jill DeHetre 401 Edgewater Place, Suite 220 (A/H_c°; No, Ext): 781-914-1000 FAX No); 781-246-2601 Wakefield, MA 01880 EMAIL John Scanlon ADDRESS: dehetre t across.com g INSURER(S) AFFORDING COVERAGE NAIC # INSURER A: Arbella Protection Ins. Co. 41360 INSURED Air -Tight WeatherlZation, LLC INSURER B : Arbella Mutual Ins. Co. 17000 9 Story Ave. Beverly, MA 01915 INSURER C : INSURER D : INSURER E: INSURER F: COVERAGES CERTIFICATE NUMRFR- NIIMRFR- 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. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1ICY EXP �TR TYPE OF INSURANCE NSRADDLSUBRA POLICY NUMBER MM DDIYYYY MMPOLICY EFF - LDDIYYYY LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A • X COMMERCIAL GENERAL LIABILITY 8500046432 03/08/14 03/08/15 DAMAGE ETO aoccu RENTEante) , $ 100,000 CLAIMS -MADE X OCCUR MED EXP (Anyone person) $ 5,000 _ PERSONAL & ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS -COMP/OP AGG $ 2,000,000 POLICY X JPEC - LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT 1,000,000 (Ea accident) $ A ANY AUTO 27088400004 03/08/14 03/08/15 BODILY INJURY (Per person) $ ALL OWNED XI SCHEDULED AUTOS AUTOS BODILY INJURY ( Per accident $ ) , X HIRED AUTOS X NON -OWNED AUTOS PROPERTY DAMAGE • $ (Per accident) S X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 2,000,000 B EXCESS LIAB X . CLAIMS -MADE, 4600052930 03/05/14 03/05/15 AGGREGATE $ 2,000,000 DED X RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS' LIABILITY Y / N '. . TORY LIMITS . ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L. EACH ACCIDENT $ . OFFICER/MEMBER EXCLUDED? N / A (Mandatory in NH) E.L. DISEASE - EA EMPLOYEE $ If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS/ LOCATIONS /VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space is required) CFRTIFICATF Hf]I nF-R f Ap1/`CI I ATIll Al MORKESK SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Morkeski Meadows THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1 Waverly, Rd North Andover, MA 01810 AUTHORIZED REPRESENTATIVE �� U 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25 (2010/05) The ACORD name and logo are registered marks of ACORD