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HomeMy WebLinkAboutBuilding Permit #220-2017 - 1044 SALEM STREET 8/31/2016 i /{A� BUILDING PERMIT NORrr .' • ♦� � Ob�•tLED »! TOWN OF NORTH ANDOVER o� APPLICATION FOR PLAN EXAMINATION * C1 Permit No#: ®� Date Received TED �SSACH►15�� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 10yy ro0,UJ n 54rLuk Print PROPERTY OWNER p00.}� C1 N JAox-S)onoAd Print 100 Year Structure yes (noMAP j�/ PARCEL: ZONINGDISTRICT: Historic District yeso Machine.Shop Village yeso TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement-- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other t�S p1Nelli s� rs� Floodpla n� ®1Netl`anrs ®. 1Nater�shed I_Water/Sew_er> DESCRIPTION OF WORK TO BE PERFORMED: _air sta tin a 1wi Ins"44- -G 4AC Rooecp k4semz4^AEins4a,11 ins / Y J I auk hose- 0 445 n l r &n; ins f VAA11��A M a u -t-zs n Identification- Please Type or Print Clearly OWNER: Name: QQ�nrici.o. MOIC,S�bnaAd Phone: Address: IoLkq S Sh- MA =145 Contractor Name: Phone: .5b g2.-2oan Email: \\ Address: k s Supervisor's Construction License: 106OS5 Exp. Date:_0 -7 2-o It Home Improvement License: l$Z"lg2 Exp. Date: -7 [Z-712-on ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 2 1 qKS •'b FEE: $ 3 & Check No.: f S0 Receipt No.: �6&24!/ NOTE: Persons contracting with unregistered contractors do not have access to a gu anty fund 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 f OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application 46 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) � Building Permit Application 4� Certified Proposed Plot Plan � Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit 46 Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) 4, Copy of Contract 4, 2012 I ECC Energy code Engineering Affidavits for Engineered products OTE: 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 Plans Submitted ❑ Plans Waived ❑ `Certified Plot Plan ❑ Stamped Plans,[] G � , TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Mg eBod assa Art El Swimming Pools ❑ Y Well ❑ Tobacco Sales ❑ Food Packaging/Sales II Private(septic tank, etc. ❑ permanent Dumpster on Site ❑ 'i THE FOLLOWING SECTIONS FOR.OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING a DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Siqnature �Irj":��" '.� . .S• ,i � -- . ,. �. . ..r. . ' . � be . ,_ - . s t.. f ...�.,. _ �, I e COMMENTS z r' 3 HEALTH . .• ; , `. Reviewed on Siqnature COMMENTS r Zoning Board of Appeals:Variance, Petition No: Zoning Decisionfreceipt submitted yes Planning Board Decision; Comments ► Conservation Decision: Comments I Water& Sewer Connection/ Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street MEFV , e p xump ntsite FIRE DEPARtT m D §ter o ' r Located amt 124 Maea 18treet °Fire ®e r partment signature/date�s�: 4 . s # +tY *4,� : :..� th-t. .,e ;,`1.w". ♦3r ��;,,,i'Y vr_t "` fs!}``'( DJI r9'" iy •t +'"x` ` :e'�'1'3'�,`"_�}''�,, r}.7f::glp ^. +`..t#�f C' .'i.:. 3 s;4.f is •C ,{.-a.,"31N3 ' _: -. � y�-,.;.. I I 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.$1oo-$1oo0 fine NOTES and DATA-- For department p ment use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 r— I G Location /f,e5r,0r 7 No.�Z Datezn • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ -3, Foundation Permit Fee $ Other Permit.Fee $ TOTAL $ Check# �7 v y 30820 Building Insp for �` OORTF/ q Town of s ndover O _ No. as = ti r Mass oh ver, COC"'A'"ICNIw CK AERATED S U BOARD OF HEALTH Food/Kitchen PER LT• Septic System THIS CERTIFIES THAT Ci.. ,41,... ............. , .............................. BUILDING INSPECTOR Foundation has permission to erect ..... buildings on ....I .... .................... . A;�-- for. A. g• Rou h to be occupied as ... .. .. �!� ..��� .. .�r.....�4. ........................... Chimney provided that the person accepting this p mit shall in every pect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and -L ws relating to the Inspeq 'on, Alteration and Construction of Buildings in the Town of North Andover. C�f PLUMBING INSPECTOR �j • Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. �� 1 w.!�IAW _A e pp y pp C Final PERMIT EXPIRES IN 6 MONVELECTRICAL INSPECTOR UNLESS CONST CTI Rough Service Final BU GIN PECTOR GAS INSPECTOR Occupancy Permit Required to 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. f Federal ID 0 0$44056 RISE EngineeringM coon mon No 8186 SE '� A division of Thielat Eugineeniog KA Contractor Registration No 120879 CT Contractor Reglstraton No UMM ENGINEERING 60 Shawmut,Canton,NA 02021 FAX 339402-6345 CONTRACT Page 1 PROGRAM THIS OOKrRACT is t�rrEaED Baro eEtrrEEx tu9E CMA-HES encaauroarmniaeusraweaaaewowcas CESS UM MOW cuffroma Rim DACE dAra # wowoorOM Patricia Macdonald (978)618.6780 02/03/2016 427010 00002 SMMCE arrow C:1 BRAM r 91REEr 1044 Salem Street ® 1044 Salem Street SERVICE MY.STAMM 07 UMHO C"ARAW.W North Andover,MA 01845 North Andover,MA 01845 DESCRIPTION AR SEALING:Provide labor and materials to seal anis of your home against wasteful.excess air leakage. This work will be perforat d in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.MaterialsAo be used to seat your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements;attached garages and other unheated auras(windows are not generally addressed.) This will require(8)working hours. A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cast to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 AIR SEALING:Provide labor and materials to install Q-Ion weabuerstripping and a doorsweep to(2)door(s)to restrict air leakage. $150.00 ATTIC FLAT:Provide labor and materials to install a 6"layer of R 21 Class 1 Cellulose added to(240)square:feet of floored attic space. $427.20 DAMMING:Provide labor and materials to install a 12"layer of R 38 unfaced fibeiglaas Batts to(84)square feet for damming purposes. $172.20 ATTIC FLAT:Provide labor and materials to install a 13"layer of R45 Class 1 Cellulose added*440)square feet of open attic space. $717.20 ATTIC ACCESS:Provide labor and materials to install(1)easily moved,insulating cover for the attic access folding stair. A small flat sofplywood will be created around the opening within the attic. This will allow the coves integral weather-stripping to restrict air leakW $237.65 VENTU ATION:Provide labor and materials to infill(1)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fitn(s). $118.75 VENTILATION:Provide labor and materials to install ventilation chutes in(51)rafter bays to maintain air tow. $102.00 BASEMENT CEILMG:Provide labor and materials to install(142)linear feta of R-19 unfsced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $248.50 RISE Engineering will apply all applicable,eligible incentives to this conmam You will only be billed the Net amount. Currently,for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and atter the weatherh ation work is complete.We will also conduct a fdl assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weathe ization incentive is$3,110. $90.00 Ok/ RISE Engineering CoaaactDran No 8186 RISE 'EFMA COnb=W a�11 No,2087A dWen of Tbielac6 EDglunflug Cr Cw*aCkw RBgRsE 26ou No U"U ENGINEERING . 60 Sbaw[004 COMM4 MA OMI CO NTRACT 339 502-5197 FAX 339-502-fiM pap 2 PROGRAM moaC=MueT3r 121pDWTowmMRNA CMA-HES 51MUMMOSAIMTHSCUBWMFORWORKAS DESDeeoW CUSTOM PNONE OATS MEW# WORKORDER Patricia Macdonald (978)618.6780 021032016 427010 00002 BBKv�cE attu�T aniDco BTREET 1044 Salem Street 1044 Salem Stet ` 8E1W=CRY,WAMSP BALM CRY.STAW-ZP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $2,943.80 Program incentive: $2,400.93 Customer Total: $843.38 WE AGM HEREBY TO FURNW SERWCES-COMPLETE W ACCORDANCE WITH ABOVE VECMATMW FOR THE SW OF "'"Five Hundred Forty Three&381900 Dollars $843,38 WON ECTNNIAMAPPROVALBYNEEStMWEIMLOIBTONERMONTOWWAMOLWDWR1RLLINIBID:BTOFIS%% BEQWtQW=W LY ON ANY UNPAID AF 30DATS.SEREWMPORWFORTANTWFORBAIMCUauARANroos,RI0Ni8WRSq BCNEDWIND,ARDCON�RAG70RRaWBTRA190R OO NOT SM TIRIS CONTRACT iF THM�Rr IE�1�6}A�p!gFA ES _ AU1/10RQEO8TONAmB1E- B�OealoB ApCE `-� NOTE TMCONMWTMAYBE WU$w=TMMCO=WffRW OATEOFACCEPTANCE ACWTANCEOFCONWRACT-TNSABOYEMC BP MMADOWSAND CON==ARE 30 SATNiFACTORYTOUSAWARENERWAqERE VOUAREAUTHORMTODoTWWOW AS WPBCWW.PAYMENTVALMUM ASOUItAEDABOVE ' I � O • ' RISE"" :- 60 Shawrnut Road,Unit 21 Canton,MA 020211339-502-SM ENGINEERING www.RMEengineedng.com OWNER AUTHORIZATION FORM 1. Patricia Macdonald (Owner's Name) owner of the property located at 1444 Salem Street, North Andover, MA (Property Address) (Property Address) hereby authorize SicnMi t (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. i Owner's Signature Date The Commonwealth of Massaekuselts Department of Industrial Accidents I Congress,S'treet,Suite 100 Boston,MA 02114-2017 www. ass govIdia Workers'Compensation Insurance Affidavit:General Businesses. TO RE PILED WITH THE PER IITT[ G.AUTHORITY. Alp Information Please Print�LgRibb Business tanization Name:iMill City Energy .Address:PO Box 64.11 City/State/Zip:Manchester,NH 03108 Phow#..60M91-7923 Are you on employer?Check the appropriate.box: Business Type(required): 1. ✓M I am a employer with 1.2 employees(full and/ 5. O Retail or part-time). 6. '[]Restaurant/Bar/Eating Establishment 2.0 1 am a sole proprietor or partnership and have.no 7. E]Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. 8. Non-profit [No workers'comp.insurance.required) 3.0 We are a corporation and its officers have exercised 9. Q Entertainment their right of exemption per c.152,§1(4),and we have 10.0 Manufacturing no employees.(No workers'comp.insurance required]* 11 ❑Health Care 4.Q We are anon-profit organization,staffed by volunteers, .t� with no employees._[No workers'comp,insurance req.) 12.0 Other *Any applicant that checks boa 41,must also fill out the section below showing their w orkcre compensation,policy information. "If the corporate officers have exempted themselves,$ut the corp rittionbe:otberemployees a workers'compensation policy is required and such an organization should check box.#t. law an employer drat is providing workers'cotnpet{satiou ins1114110e far my employees. Below is the policy ttforntatiorl. Insurance Company Nance:G16rk Insurance Insurer's Address:One Sundial Avenue Suite 302N City/State/Zip: Manchester, NH 03102 Policy f#or.Self-ins.Lie.#MIWC791896 Expiration Date:4129/2017 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 .fine.up to$1,500.00 and/or one-year unprisoninent,.as we11 as civilpenalties in the form of a S 1 OP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that acopy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification_ I do hereby certify,a ins rand penalties of perjury that the information provider(above is trite and correct Si ature: bate: 30 Ol(• y: Phone#:603-396-7520 Official use only. err not write in this area,to be completed by city or town off ciaZ City or Town; Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other {Contact Person: Phone#: wm,,,;mass.gov/dia I MILLCITY-1 AGOULD '4���• CERTIFICATE OF LIABILITY INSURANCE DAT DIYYYY) 7//19/219/2016 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 License#AGR8150 CONTACT Clark Insurance PHONEFAX One Sundial Ave Suite 302N (AIC.No, c Ell:(603)622-2855 Alc No):(603)622-2854 Manchester,NH 03102 E-MAIL ADDRESS:agould@clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Mutual Insurance Co 17000 INSURED INSURER B:AMGUard Ins Co 43290 Mill City Energy INSURERC: 106 Joseph St INSURER D PO Box 6411 Manchester,NH 03102 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. ILTR TYPE OF INSURANCE INSD S POLICY NUMBER POLICY EFF MM/LIDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEU-- CLAIMS-MADE T OCCUR 8500065735 04129/2016 04/29/2017 PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY PRO- JECT D LOC PRODUCTS-COMP/OP AGG $ 2,000,00 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A X ANY AUTO 1020050919 04/2912016 04/2912017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ( AUTOS AUTOS INJURY BODILY Per accident) $ NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY X STATUTE J I ER B ANY PROPRIETORIPARTNER/EXECUTIVE YIN MIWC791896 04/29/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? FN_1 N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached H 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 1600 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORUED REPRESENTATIVE .� ©199888-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License:CSSL-106035 Construction Su pervisor.Specialty t, MICHAEL:JOY 106:JOSEPH STREEIJ C1 j MANCHESTER NH 0314?� Expiration: Commissioner 08107/2018' . rrAffai�i�rr.�tBiii ss-Re slab License or re istration valid for individul use only r Office of Consumer Affairs&Busi�ess Regulation ': g Y OME.IMPROVEMENT CONTRACTOR before the expiration date. If found return to: r egistration A182792 Type: Office of Consumer Affairs and Business Regulation `" 10 Park Plaza-Suite 5170 xpiration 7/2 /2017. LLC . ,f Boston,_'MA 0211G MILL CITY ENERGY LLCC �!, V j MICHAEL JOY 106 JOSEPH STREETS MANCHESTER,,NH 03102 �a Uudersceretary 1Ncfva&d4ithout si tore I I