The URL can be used to link to this page

Home My WebLink AboutBuilding Permit #689-15 - 100 GREAT POND ROAD 5/1/2018 BUILDING PERMIT . of N°pT� TOWN OF NORTH ANDOVER•. APPLICATION FOR PLAN EXAMINATkQ.N:`, '- �- c° . . Permit No#: Date:Received: �- 3 -.�'S 4q °q�reo^pe AC US Date Issued: - IMPORTANT:Applicant must complete:'all-items on:this page �L®CAkTIQN pot +PROPER�T.r , 1IVNER` 4 Lam'^ _ - -� T ,inn 10D-YeayStr cine _yes moo• MAP' PARCEL Z®NCN0I®[S�TTRISC.7 - .N.istorit4istnct yes _ _ - FMachmeSh®p Visage• yes = no: TYPE OF IMPROVEMENT PROPOSED USE: Residential Non- Residential ❑ New Building 0 One family ❑Addition ❑Two or more family 0:Industrial ❑Alteration No. of units: 0,Commercial ❑ Repair, replacement 0 AssessorV Bldg 0. Others: ❑ Demolition ❑ Other _ ❑ Septic ❑�11Vel�l ®#Floodplain "Wetla%ds �A q 4UVate.rsh;ed Distract ❑Water/Sewer DES RIPTION OF WOtriK• vT E PERFORMED: 5 I ' S I S J — ) uU - dentification- Please Type or Print Clearly OWNER: Name: d I L ,i Phone: — —ob Address: l 06 G P dw�:J �o - Coritractoo-rfName.n t 2,_C Ad, r-OCSS . _ _ � _ _ Su�ervis®r_'s C°o_nstruction L;ice�nse [') �: v EcDwaten_:, '[ - -? O�;�J p` l 6 Home$ Improvement;License ARCHITECT/ENGINEER Phone:.•;.;;:'° s1 Address: / r ' g Regw No —�_ FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE,TOTAL ES.TIMATED:COST BASED ON$125.00 PER S.F=-- -2 Total Project Cost: $ Oo6 FEE:,:$"' Check No.: Receipt: NOTE: Persons contracting with unregistered contractors.do,not haveaccess to the gty f d Signaturetof Agent/ wner � _-__ �..W :- Signatu�ewof'cantra`etQr� . _�.. . i Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ TypF,OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art ❑ Swimming 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 r I! PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS N HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes l5lanning Board Decision: Comments VI Conservation.Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit bPW Town Engineer: Signature: _Located 384 Osgood Street f REQ DEP�►RTMENT' t Temp M®u`mpsferonssieE dyes% iLocatetl+at 1 24iMarnCStreef m _ Fir�e,D!epartmentsig)nature/date ®IVIIVIENTMS Dimension Number of Stories: Total square feet of floor area,`based--on.Exterior dimensions. Total land area, sq. ft.: 1 I ELECTRICAL: Movement of Meter location, mast or servicedirop requires approval of Electrical Inspector Yes -Noy DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) I I ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 II _ 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 o Building Permit Application ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks o Building Permit Application ❑ Certified Surveyed Plot Plan o 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) o 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 o Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 No. Date . - TOWN OF NORTH ANDOVER i` Certificate of Occupancy $ Building/Frame Permit Fee $3d , " Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1 h C eck# `' Building Inspector NORTH own of s Er,� ndover o ; - :. to No. I doom - "o h ver, Mass, � �1V coc"Ic"IWIC 1' RATED S U BOARD OF HEALTH PERMIT D Food/Kitchen ZOP Septic System THIS CERTIFIES THAT `_ 1.l� BUILDING INSPECTOR ........... ................, ...... ...... .... .. .......... ...... .... ..... ... ft _has permission to erect ..... Foundation p ..................... buildings on Am.......... .. .. . .......... ... ......... to be occupied as ,.,�� ,� , "04S%044116+��/ Rough Chimney provided that the person accepting this permit hall in 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 CONSTRUCTION A S Rough Service ................................ .............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. g Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division ofThieiseh Engineering CT Contractor Registration No 60 5hawmut Unit#2,Canton,N"02021 CONTRACT T Alk %' 339-502-6335 FAX 339-502-6345 Page i PROGRAM TM CONTRACt=EMIRED WTO BETWEEN RISE ENGINEERINGCMA-HES ENOMERIND AND THE COSTOMER FOR WORK AS ... DESCIUSED OELOW ................__ .._ _......._.. CUSTOMER PHONE .. DATE CUENT0 WORM ORDER John Ntceforo, (978)687-0560 12/08/2014 402821 00002 SERVICE STREET rp �'.}',......... -. B11.trN0 STREET- 100 1Ofl Great Pond Ro w= 100 Great Pond Road - .. SERVICE CITY.STATE.ZlP e1r.tJNO CITY.STAT$LP North Andover;MA North Andover,MA 01845 JOB DESCRIPTION BARRIER:A Blower Door Test will not be conducted at your home,due to the.prescnse orasbestos. 50.00 AIR SEALING:Provide labor and materials to seal areas of Sour home against wasteful,excess air leakage. This work will be performed in concert with the use ofspeciat tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,(hams,weatherstripping and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed)(6)working hours. At the completion of the weatheriasttion work,and at no additional cost to the homeowner.a final blowvt door and/or combustion safety analysis will be conducted by the sub-eontmctor to ensure the safety of the indoor air quality_ Sd50.00 CRAIVLSPACE:Provide labor and materials to install (279)square feet of 1140 rigid Thermax insulation to the crawlspace perimeter wall up to the sill and against the band joist. 5982.08 BASEMENT CEILING:Provide labor and materials to install(178)linear feet of R-19 unlaced fiberglass insulation to the perimeter orthe basement ceiling at the house sill. $311.50 BASEMENT DOOR:Provide labor and materials to insulate the back ofthe basement door leading to the bulkhead with 2"rigid board that mects the sections R-316.5.3 mad 316.6 requirements of building code. Seal all edges and seams with CSK tape. $7 .22 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only he billed the Net amount. Currently, For eligible mcasures,Columbia Gas offers 75%incentive,not to exceed 52,000 per calcadaryear,and an incentive of 1001%for the Air Scaling measures up to 5600. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air now in your home both before the work is begun and after the weather'rration work is complete.We will also conduct it full assessment of the combustion safety of your heating system and water heater.This has a value of S90 and is at no cost to you. Total allowable tiveatheriration incentive is$2,690. 590.00 Federal tD# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division nr'rhieisch F,ngineering CT Contractor Registration No 60 Shmmut Unit#2,Canton,MA 02021 p�+� 339-5036335 FAX 334-1112-(x345 CON i CT I � Page a PROGRAM THIS CONTTTACTIS ENTERED UNTO BETWEEN RISE CMA-HES ENGINEERING AMD THE CUSTMAER FOR WORK AS ENGINEERING DESCRIBED BELOW ..................--_................. _...,,,,,_ __._..__.._.....,.__,... . ...,._ _, ....._.....,....._.._..___..._...._...._._ _-..................... CUSTOMER PHONE DATE CLIENTS WORK ORDER John Niceforo (978)687-0560 12/08/2014 402821 00002 SERVICE STREET BILLING STREET 100 Great Pond Road 100 Great Pond Road .. ..... ........... ....... _.. r....... ...__._ ,.. _ _._ _. _. ,.._.. SERVICE CITY,STATE,ZP SICCING CTTY,STATE.?JP North Andover,MA 01845 North Andover,MA 01845 JOB.DESCRIPTION Total; $1,905.80 Program Incentive: $1,564.35 Customer Total: $341,45 WE AGREE HERESY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF **Three Hundred Forty-One 8L 451100 Dollars $341.45 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL..INTEREST OF 1%WILL Be CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER le DAYS.SEE REVERSEPOR IMPORTANT INFORMATION On GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. ....._............... __...._.._... .................. ...._.,..,_......,._._.._._._...,... _.....,._... _..m......,..,.,_......._.,........— .._.»..._.. , ........ _...,._.,.., ._._�. 00 NOT SIGN THIS CONTRACT IF THERE ARE A 13LANK SPACES __ _.. _. _._....... .. ...._.. ... _: _.._,..,_.... ........................................ AUTHO ED SIGNATURE-RIS I O CUSTOMER A CE NOTE,THIS CONTRACT MAY OE WITHDRAWN BY US IF NOT EXEOUTEO WITHIN DATE OF ACC CE __. .................... ..�....�...�._.,�...,_...._......_..__.. ACCEPTANCE OF CONTRACT•THE A90%PRICES.SPECIFI ATIONS AND C014OMNSARE 4..✓t,,! SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORUMD TO OO THE WORK ........__.,..._.__..._....._. DAYS, AS SPECIFIED.PAYMM WILL BE MAD!AS OUTLMD ABOVE OWNER AUTHORIZATION FORM t, L70h Rl i L re (Owner's Name) owner of the property tocated at &Ye4P A014C (Property Address) ,Cty v'-�Lrv�y'f &tq , (Property Address) �11 V hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behatrto o m Ing permit and to perform work on my property owndes Signature Date �a�aT�ancoozcoeu�l/o��a�u�uael� '0"Office of ConsumerAffairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: e9istration: .a04800 Type: Office of Consumer Affairs and Business Regulation piration: VA512016-a Private Corporation 10 Park Plaza-Suite 517.0 HUGH'S ENERGY CORPORATION' Boston,MA 02116 ' DANIEL DRISCOLL 259 MILTON STREET DEDHAM,MA 02026 Undersecretary Not valid without signatu Massach usetts- 3i?eoard or 8u; Partment Of P inn Rei ` ..crion ublic Safiety Loi}5i Ulan License:C"S07g4 _ . ,v.rThor4as.Pj)rl�MitS0 oOeet2Ddbr.. - _ Commissioner Expiration 1012y2016 0 CERTIFICATE OF LIABI(,� INSURANCE SINS-1 OP ID:MR THIS CERT FICATE I$ISSUED AS A NATTER OF INFORMATION ONLY AN DATE pa CERTIFICATE DQEB LVOT AFFtRA►ATIVELY 14 OR AIEGy1TIVlY D CONi:ERS NO RIQIfTS UPON THE CFRTIFiCATE HOLD6EROTHIS BELOW. THIS CER7iFiCATE OF INSURANCE DOES NOT AmwwV l EXTEND OR`O•�THE COVERAGE REPRESENTATNE OR PRODUCER,AND THE CERiiflCNO HO�A CONTRACT BETWEEN THE ISSUINNG 13Y THE POLICIES ]IMPORTANT If the certl]Iioate holder 1s an ADDITIONAL INSURED,the R(% AUTHORIZED the terms and conditions of the pocky, PoIIc]Ies tm1]Icy(Ies)must be endorsed, If SUISIWM ION IS WAIVED.subject to cerWicate holder]In lieu ofsueh endoy"" s, MW MW*e an endorsement. A statement on this cerhficata pRODUCwt does not confer rights to the TYG Insurance qq��envy,Inc. 88 Freeman Sbae� Arltrrgton,MA 4 7$1.6413002 7$1.6413009 UBUR>B1 eA uecovsR pony GE NN09 A:8tansa259 Miton ancem rxsuRee9-An►GuaM tnscr Dedham.INA 02026 rance C2mareuros:c:Ar6e0a Protection Ins Ca RrsuBERa• 41360 E: COVERAGES CERTIFICATE NUMBED F: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED B$OW HAVE BEEN 15SUE0 TQ THE INSURED NA1b1ED A90VE FOR THE POUGY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY REVISION NUMBER: CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE CONTRACT OR OTHER DOCUMENT IXCLUSIONS AND CONDITIONS OF SUCH POUCMS LIMITS SHOWN MAY HAVE BEEN REDUCED 8Y PAID CLAIMS. WITH RESPECT TO WHICH THIS AFFORD®SY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, iia TYpEOFnraURaNCE A X co�tcuu.0>a�u,�y NDMe� LIM OCCUR X X PS20=02 081,t/2014 08/741207850,0001 S 1,000,00 s 50,00 "�O¢' anepeison s 6,0001 GEM AGGREGATELWrappUESpM PERsoNALaADvnwURY s 1,000,00 POLICY❑ Lac �I-AG2%MTE s 2,000,00 AUiOlrOBLLE W91LrrY 't bPAGO S 2,000,00 c ANYAUto 5 G L �( SCNEDUL6� 10200327" 08/t4/2p14 0811 -----fir $ 1,000,00 AVTO34/Z075 BDOILYIKARY(ftomm1) 3 HREDAUIOS AUTOS BODILYINJURY(Paraeftwo S UMBRELLA LIAR J( ° S A EXCESSLKAB R S cWMS-MADEEACHS 1,000,0 DED x RETENTTDNS 90000 Oaa410 10107=14 081412075 ° "'� $ 1, WORKERS coupENSATION O0000 B ANYPROPRI YIN S 0 NIA R2WC513035 STATUTE ER . °A Excwnsm 0812/2014 08112/2015 ELEACHACCioENT d�PM OPOTPErrATTONseero„ S 500,00 EL DISEASE-EAEMPLO $ 500,00 CommerciaiAppllca EL DISEASp_PaucYLtretr s 500,00 Ol Cp1FnONOF°PttrAY[ONSILOCATI°NSIVENICLES(ACORD101,A0d[QOMiRsma,ra ,!„�Y aOsdto�!#mrna rs ro9�1 cERnFICAT!_HOLDER ADa:Rcr{E CANCELLATION SHOUWANYOFTHEABM DESC, BEp POLICIES BE CAN CCORDANCE WRHcauxasuftE THE EIMMATIONMp THEREOF, NOTICE WILL Be D IN 7HePoucYPRovrstoNs: AUTHOREMD ACORD 25(2014101) (�9988.2014 ACORD CORPORATION All rights reserved. TheACORD name and 1090 are regWgrad mwb OfACORD The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 < Boston,'MA 02114-2017 "t www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name(Business/Organization/Individual): �T Address: City/State/Zip: Phone#: 7T/ 6 066 /-3 66 Are you an employer?Check the appropriate box: Type of project(required): _1,Q4-m1a employer with employees(full and/or part-time).* 7. ❑New constriction 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.]t ❑ 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.[:]Roof repairs These sub-contractors tiave employees and have workers'comp.insurance.= 6.❑We are a corporation and its officers have exercised their right of'exemption per MGL c. 152,§1(4),and we have no employees.[No workers'com% p.insurance required.] 2 ` *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. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: y Policy#or Self-ins.Lic.,#: d Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers'compensation 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$1,500.00 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under th ins ,ndpnaltie erjury that the information provided above is true and correct. Si nature: Date: Phone#: 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#: