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HomeMy WebLinkAboutBuilding Permit #844 - 10 DEWEY STREET 6/13/2011 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:—E�— Date Received eived _ Date Issued: _ 1 3_ /I IMPORTANT:Applicant must complete all items on this pLge LOCATION :­] P-� S - Prii t c PROPERTY OWNER I Unit#� Print MAP NO: 10 PARCEL: o�s ZONING DISTRICT: Historic District yes n ` nit Machine Shop Village yes no \J 00 year-old structure yes no e , TYPE OF IMPROVEMENT PROPOSED USE Residential Nori- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other F, t� -- � WeII FT A DESCRIPTION OF WORK TO BE PERFORMED: 2.3-d (Identification Please Type or Print Clearly) OWNER: Name: E i e Phone: Address: �L� CONTRACTOR Name: �r ���� Phone: 9?9- 7yY-9l t3 Address: H, i 'n 51'`-- Sig Supervisor's Construction License: � ��� � Exp. Date: Home Improvement License: 1 Ya-d Exp. Date: ARCHITECT/ENGINEER Phone: 0 Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 1686. 00 FEE: $ 3 Check No.:_ Receipt No.: 0 1 NOTE: Persons contracting with unregistered contr ctors do not have access to the guaranty fund nature of Agent/Owner` :. _ Signature of contractor �- Location A 6277 No. Date � � i NORTTOWN OF NORTH ANDOVER F?,• 1 • Ly ' f Certificate of Occupancy $ ___6k ITS E��' Building/Frame Permit Fee $ cMus Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # i�•3 24G44 Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools El Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pei-rmanent Durnpster on Site ❑ THE FOLLOWING SECTIONS.F®.9 OFFICE USE-ONLY INTERDEPARTMENTAL SIGWOF'F - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS 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 - Date Doc:.Building Permit Revised 2011 June/mi vrrcPgLLLI_- - I 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 Com Affidavit It ❑ 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 Per Addition or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses �i Copy/ Of Coi-t lck * i-�IGoi-i(�rosseetiolliElevatioi1 Plan Gf1'r'oposea vvorK vvi'M 6prjnll ICI' han Ana 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 Permi 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 q g 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: Doc.Building Permit Revised 2008mi NORT#1 Town ol'I ndover 0 � o . lover, Mass.,0 LAKE /fesCOCMICHE WIC ADRATED S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System BUILDING INSPECTOR, THISCERTIFIES THAT............ ' ..�... .l ................... .. .................................................... Foundation has permission to erect........................................ buildings on .. .......,�� .v�,k.�`r...... ............................. Rough 1 , / Chimney XL.Az.-rXto be occupied as............ .........&..-. �.....1: - --.......................................................... provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 CONSTRUC STARTS Rough - .................. .`............................................ Service BUILDING INSPECTOR Final ermit Required to Occupy Building GAS INSPECTOR Occupancy P 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. SEE REVERSE SIDEJ1 Smoke Det. Atlantic Weatherization, LLC 6 1 R Jefferson Avenue Salem MA 01970 To Whom It May Concern, 1, Enc Palm, owner of Atlantic Weatherization, LLC authorize my employee, to pull permits for my Company. Sincerely, Eric Palm Atlantic Weatherization, LLC Subscribed and sworn to before me This_��h day of 2010. c, --- 1 Notary Pbblic My.Cominission Expires:7�7642010 Restricted to: 00 Massachusetts- Department of Public Safet} 00- Unrestricted p Board of Buildin�o Rei-uiations and Standards 1G-1 2Family Homes Construction Supervisor License License: CS 87977 Restricted to: 00 Failure to possess a current edition of the ERIC W PALM Massachusetts State Building Code 3 HILTON ST J A- is cause for revocation of this license. SALEM, MA 01970 Refer to: WWW.Mass.Gov1DPS • Expiration: 4/23!2012 (' minisi racr Tr#: 22214 m. �� /�c, j License or registration valid for individul use only °\ before the expiration date. If found return to: Office of Consumer Affairs&Business Regulation Office of Consumer Affairs and Business Regulation HOME IMPROVEMENT CONTRACTOR 10 Park Plaza-Suite 5170 4 Registration: 142089 Boston,MA 02116 Expiration: 311212012 Tr# 292174 Type.: Ltd Liabiity Corpor ATLANTIC WEATHERIZATION L.L.C. ERIC PALM ! `yam/ Vit' 61 R JEFFERSON AVE Not valid without signature -SALEM,MA 01970 Undersecretary Job Number 3871 June 1,2011 Client Elizabeth BUturlia address 10 Dewey St 1lfamily city r town No.Andover 878-688.2575 contractor Atlantic t 1.V11EATHERSTRIPPIN13ICAULKING QUANTITY TOTAL AUDITOR_ NOTES Door Kits Q-Lon or Equty. 4 172.00 Door Sweeps(Regular) 2 30.00 ow Sweeps(Autos) 2 44.00 Reglaze Windows M.inch 0 0.00 Window.Weathstr Schlegal per side 0 0.00 Al iwBasement bypass seating man/hr 4 240.00 Attic sealing with 2-part foam marOw 0 0.00 SUBTOTALS 486.00 2A.INFILTRATION!INSULATION AUDITOR NOTES Domestic pipe Hot Water Tank let 6' 1 15.00 Sill Insulation R-19 CF 62 93,00 Sill TWo Part Foam w/Fiberglass Batt 0 0.00 Drape Perimeter R-5 ArrA Sq.ft. 0 0.00 Drape DOOR R-5 Anch. 0 0.00 Tape Joints(Alums Grip only)per hr. 0 0.00 Duct Insulation&Tape In.ft. 0 0.00 Rigid Foam Board Anch. V 0 0.00 Hydrodc pipe insrr to 1-R-6 0 4100 Hydronic pipe ins_7-26'--1.5-R-6 0 0.00 Steampipe Ins.to1.2r iron pipe R-5 0 0.00 Steampipe Ins.1.5-T iron pipe R-5 0 0.00 Steampipe Iris.3-iron pipe R-5 0 0.00 Air Conditioner Meeting Rail 0 0.00 Air Conditioner Cover 0 0.00 n Ait Conditioner Cover Special Order 0 0.00 SUBTOTALS 108.00 i 211 INSULATION AUDFTOR NOTES Open Unrestricted R 49 0 0.00 Open Unrestricted R 38 0 0.00 Open Unrestricted R 30 0 0.00 j Open Unrestricted R 20 0 OJ00 i Open Unrestricted R 10 0 0.00 Restrict FL R 30 972 1370.52 j Restrict FL/Sloped R 20 0 0.00 Restrict FL/Sloped R 10 0 0.00 R-19 FGB open ratterE Aareswaits; 0 0.00 R-11 FGB open rufterShIalIMMeMNaft 0 0.00 Attic Stairs(stairweli&common wall) 0 0.00 Cover Pull Doom Stairs Themradome 0 0.00 Site built pull down stairs 2-foam box 0 0.00 i i- , Page 2 AUDITOR NOTES Attic/KneeNral Floor Transition.Dense pack cellulm 0 0.00 W.S.&bat Hatch R-19 IQ-Lon or= 0 0.00 W.S.&bat Hatch R-30 10-Lon or= 0 0.00 Kneewall R-12 cell behind Per.Memb 0 0.00 Open Rafter R-20 Cell./w poly 0 0.00 Open Rafter R-30 Cell./W poly 0 0.00 Basement Overhead R-19 fiberglass 0 0.00 Basement Ove ead R-0 fiberglass 0 0.00 CrawEpace Overhead<4'high RIS 0 0.00 CraWlpace Overhead<4 high R30 0 0.00 Garage Gelling cavity filled w/cellulose 0 0.00 Wood,Shake,Clapboard,ShingW Vinyl 1112 1890.40 Asbestos(single nail)/Asphalt 0 a00 Asbestos(doub.Nail)/Aluminum 0 0.00 Brlck/Stucco 0 0.00 Vinyl over Asbestos 0 0.00 Multilayered 3 or more layers 0 0.00 Drill rough plaster or finish wood plug 0 0.00 Drill finish plaster 117 211.77 Test Drill Wait(all 4) 0 0.00 SUBTOTALS 347269 2.INSULATION TOTAL.2A+2B. 3500.69 3.STORM WINDOWS/DEADLITES AUDITOR NOTES Plexiglass up 10 88 u.i. 0 0.00 Additional per UI Over 88' 0 0.00 Other(Negotiated Price) 0 0.00 SUBTOTALS 0.00 5.OTHER MATERIAL AUDITOR NOTES Ridge vent in ft. 0 0.00 Vents Gable rectangular 0 0.00 Varipitch Vent 0 000 Vent Roof 135(1 sq ft NFV)Large 4 380.00 Vent Roof 865(A sq ft NFV)Small 0 0.00 Vent Soffit Round 0 0.00 Vent Soffit Rectangular 0 0.00 i Turbine Vents AN 0 0.00 Shads Vent 0 000 i Propa Vent 0 0.00 Pertnable Nouse Wrap 0 0.00 Vapor barrier 0 0.00 Energy Star R4 Rigid Vinyl Rep[to 73 U.I. 0 0.00 Energy Star R4 Rigid Vinyl Repl 74-84 U.I. 0 0.00 Energy Star R41Rigid Vinyl Rep!84-W U.I. 0 0.00 13 Energy Star R-4 Rigid Vinyl Repl 94-101 U.1. 0 000 SUBTOTALS 380.00 617.E.C.MATERIAULASOR 4446.68 i i I Pa 3 8a. HEALTH&SAFETY AUDITOR NOTES `Vent Bath 1 85.00 Dryer vent w/admuci duct Heartland 0 0.00 Dryer Transition Duct only 0 0.00 Blower Door Test Pre Post 0 0.00 no test Abestos SUBTOTALS 85.00 8b.REPAIR MATERIAIAABOR AUDITOR NOTES Basement outside door only 0 0.00 Basement outside door w/jambs 0 0.00 Door Rep!pre hung 32-"Steel" 0 0.00 Door Rep!Interior solid core 28-32" 0 OAO Door Repl pre hung 32-W wood" 0 0.00 Window Replacement w/SIR less then 1 0 0.00 Basement Window Rept,Awning/Hopper 0 0.00 Basement Window Repl.With a frame 0 0.00 Locksnt(door)Sditp or equal 0 0.00 Repair/Relit Door 0 0.00 Replace Side Stop 0 0.00 Replace Casing 0 0.00 Glass Replacement to 64 u.L 0 0.00 Glass Rrtent per u.l.over 64 0 O.OD Sash Sldelock/Top Replacement 0 0.00 Threshold(Wood) 0 0.00 Threshold(Aluminum) 0 OOD Slide Botts 0 0.00 Plug Plate Cover 0 0.00 Cut/finish attlo-kneewall access 0 0.00 Cut/close attio-Imeearall access 0 0.00 Labor Rate Hours 0 0.00 Permits/Fees(Wap only) 0 0.00 SUBTOTALS 0.00 i TOTAL REPAIR+HEALTH&SAFETY 85.00 i GRAND TOTAL WORK ORDER# (A) 3871 4531.811 I Any alterations or deviations from the above specifications Involving epdre costs must be cleared in writing before lnstalhWon. The Work Order must be complete within 15 woridng days from acceptance date below: f i CONTRACTOR/COWANY: Atlantic ACCE PTANC E:Company/Contractor AUTHORIZED SIGNATURE: Date i AGENCY APPROVALS: CTI Authorized Signature: Date i GLCAC Authorized Signature: Date OW � � 4 i 2011/06/09 17 :48 : 16 2 /3 AC� DATE(MM/DD/Y YY) CERTIFICATE OF LIABILITY INSURANCE 6/9/2011 THIS CERTIFPCATE 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 NAME:CONTACT Construction Eastern Insurance Group LLC AHDNNo,EXt: 1508)651-7700 A C No): 233 West Central Street ADDRESS: PRODUCER 00024397 CUSTOMER ID p: Natick MA 01760 INSURER(S)AFFORDING COVERAGE NAIC s INSURED INSURERA-+rbella Protection Ins. Co. 41360 IN_SURER_B-Arbella Indemnity Ins Co._ 1001_7_ Atlantic Weatherization LLC INSURER C CHARTIS 61 Rear Jefferson Avenue INSURERD:Nautllus Insurance Company INSURER E Salem MA 01970 INSURERF: COVERAGES CERTIFICATE NUMBER:UPDATED MASTER 2011. 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. INSIR L POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE I SR WVD POLICY NUMBER MMIDDIYYYY MMIDDIYYYY GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 L)AMAUL 10 HIEN I ED50 000 X C:OMMEP(aAl GENERAL LIABILITY PREMISES Ea occurrence) $ � A CLAIMS-MADE I X]OCCUR 8500042816 /20/2011 /20/2012 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 E:EITL Gi:E:-,�.TELIt1ll'a,F'F'LIE�.F'EF. PRODUCTS-COMP/OPAGG $ 2,000,000 POLICY ZI ILOC AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ $ vL ,,.. - 93827400003 /20/2011 /20/2012 -- ----- -- BODILY INJURY(Per accident) $ X �CHFFp II IF Al IT PROPERTY DAMAGE $ X HIRED AUTOS (Per accident) X NON-iJVMIED AI(TOS Uninsured motorist BI split Ilmit $ 20,000 Undennsured motorist BI split $ 20,000 }{ UMBRELLA LtAB X OCCUR EACH OCCURRENCE _ $_ 1,000.,000 I EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 Uc=DI-iC TIBLE $ A RETENTION $ 600047820 /20/2011 /20/2012 $ r. WORKERS COMPENSATION X �STATU- OTH- ArJO Efv1F,0(ERS'_iABILli'r arJ✓ Pr.'OF'c'IETOR/PAP.TNERIEXECUTIVE YIN E L.EACH ACCIDENT $ 500,000 OPPICEF'/MFMFER ExCI JPED� N I A (Mandatory in NH) 1616071 /20/2011 /20/2012 111DISEASE-EA EMPLOYEE $ 500,000 if Yes.descnbe under r r;.;;'-r:rmw �r �pFPc.=InNS t+elow EL DISEASE-POLICY LIMIT $ 500,000 DTPOLLUTION LIABILITY �PLO152189210 0/01/2010 0/01/2011 GENERAL AGGREGATE $1,000,000 EA POLLUTION CONDITION $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule.If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER 1600 OSGOOD STREET AUTHORIZED REPRESENTATIVE ANDOVER, MA Rosemary Fulham/PMA ACORD 25(2009/09) ©1988-2009 ACORD CORPORATION. All rights reserved. INS0251zrloan4l The ACORD name and logo are registered marks of ACORD Print Form The Commonwealth of Massachusetts _ -- ? Department of Industrial Accidents W. Office of Investigations I Congress Street Suite 100 Irq�, , * Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Atlantic Weatherization, LLC Address:61 R Jefferson Ave C ity/State/Zip:Salem, MAO 1970 Phone #:978-744-8143 Are you an employer? Check the appropriate box: Type of project(required): 1.0 1 am a employer with 26 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. F-1 New construction 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. EJ Building addition [No workers' comp. insurance comp.insurance.$ required.] S. We are a corporation and its 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 1.52, §1(4), and we have no employees. [No workers' 13.0 Other comp. insurance required.] *Any applicant that checks box#1 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. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: Chartis Policy#or Self-ins. Lic. #: WC1616071 Expiration Date:3/20/2012 Job Site Address: /0 V A", 'e--y City/State/Zip:iv- 4,q aVL W$- 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 MGL c. 152 can lead to the imposition of criminal penalties of a tine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under the pains andpenalties qfpeUM that the in ormation provided above is true and correct Si ature: ",oi Date 4 Phone#:978-744-8143 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 Contact Person: Phone#: