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Home My WebLink AboutBuilding Permit #909-2016 - 110 HIGH STREET 2/23/2016 t%0 R Ty BUILDING PERMIT �S7 ED ,bggo TOWN OF NORTH ANDOVER 2 � '`` c=.� .6 APPLICATION FOR PLAN EXAMINATION h IO� O Permit No#: y I Date Received �gssgcHus��5 Date Issued: 2Z1 IMPORTANT: Applicant must complete all items on this page LOCATION 57"_; Print PROPERTY OWNER ►?a 5 Print 100 Year Structure Yes MAP 063 PARCEL:a� ZONING DISTRICT: Historic District no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units.- ❑ Co mercial ❑ Repair, replacement ❑Assessory Bldg Others: �r ❑ Demolition ❑ Other Septic ❑Well ❑ Floodplain lWetlantls' ❑ Watershed District, _. 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: - Phone: 9 9cZ, 6195) Address: �/c �l; .fir Sl`� /L 1--7 t2dec!' r Contractor Name: ; t v-,soL �,v\ Phone: Email: Address: L36 >4 cue !� f it h /y?>4`7 Supervisor's Construction License: a(19 235' Exp. Date: Home Improvement License: 1y '' � Exp. Date: ? / ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3260 FEE: $ Check No.: 221JI Receipt No.: 41�� ; NOTE: Persons contracting with unregistered c ntractors do not have access to thO fund _ - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL t Public Sewer ❑ Tanning/Massage/Body Art ❑ Swhnnn ng Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Pennanent Diunpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes tPlanning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARtTMENT# ;Temp Durnp§ter on�site�,yesu,, 1� s '1{au,'��: riot' Located_j tf t,24fM" t ri t r ain Stree ,'s Fire D&dittrrient4signature/date, 1". .` .�� 4t.' .. t. � a .t , •y y.,r. {�,.. ♦. .•, t..t`. •tP"q�' �FY n.,,-t,,,. ..�.ps._.� s ,.;�,. <-�`-:.�...m. .. ; 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) Cl Notified for pickup Call Email 3 - 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 4. 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4. Building Permit Application � Certified Surveyed Plot Plan 4. Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 4� 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 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 2012 IECC Energy code 4� 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 Location—1 A 1' -��- '.YJ zx- c Na r � 1j-_ �� Dated • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $I' Other Permit Fee $ TOTAL $ Check# Building Inspector r 1 2 t%ORTIy - _ . w: .. . ilwz . .. .c . ve. . ',i L No. _ RiqW.-O h ver, Mass, �3 O COCNIC Nl WICK V �as R�TEO ►'P�,�,�y _ U BOARD OF HEALTH Food/Kitchen PER I T TLD Septic System 6 THIS CERTIFIES THAT ........... ...... ....... ... s....... ................... ................................ BUILDING INSPECTOR OFoundation has permission to erect ..... buildings on .........................l!* \ its Rough tobe occu led as p ......1.N . ... ..... . .. ! ... ....�... ............................................. Chimney provided that the person accepting this permit shall 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 CONSTRUCTIO ARTS Rough Service ...... . . .. .. +.....'..... ................ ..... Final ........ .... . BUILDIN..G INSPECTO. R 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. Work Order INSULATE ATTIC AND WALLS USINGBLOWNUE LU_LOSE GREATER LAWRENCE COMMUNITY ACTION Job NumQeFZ019OZ62LS COUNCIL,INC. Work Order Date:2/9/2016 305 Essex Street Ownership:Owner Lawrence,MA 01840 Phone:978 681-4956 DANETTI INSULATION CO Auditor:Keith Young 362 EASTERN AVE Email:kyoung@glcac.org LYNN MA 01902 Cell:978 857-7841 Email:danetti0l@yahoo.com Phone:978 681-4955 x4793 Phone:781598-7043 Kimberley Pass Columbia Gas $3,195.52 110 High St Total $3,195.52 North Andover Ma 01845 813-902-8198 Authorized Actual Measure Description Price Total Comments QtY Totai Qry; . Attic.Insulation Kneewalls R-12 cellulose behind 60 $1.94 $116.40 60 $116.40 Gable walls permeable membrane R-30 unrestricted-settled cellulose 208 $1.53 $318.24 208 $318.24 attic flat Reinforced poly/R-20 cellulose open 528 $2.06 $1,087.68 528 1$1,087.68 slopes in knee wall net&blow rafters Basement ansulation Sill two-part foam w/fiberglass batt 87 $2.46 $214.02 87 $214.02 Doors Basementloutside door-door only 1 $412.00 $412.00 1 $412.00 Fixed Sweep 3 $17.64 $52.92 3 $52.92 Fr.ext./rear extJbase.ext. Weatherstrip s/Q-lon or equal 2 $51.00 $102.00 1 $51.00 Fr.ext. Misc Insulation Domestic water pipe wrap 6 $2.95 $17.70 6 1$17.70 Hydronic pipe insulation to i in. 158 $3.82 $003.56 158 1$603.56 8 ft of 1/2 inch and 150 ft.of 3/4 inch copper pipe R-5 Date:2/9/2016 Page 1 I -7- Greater Lawrence Community Action Council,Inc. �f 5D.2 Weatherization Assistance Program 1 L/� 305 Essex Street --- Lawrence,MA 01840 WORK PERMIT I I - ` PASS Ce � _ ' M � CIzL.�y �•tify that_T am the owner/authorized Agent for the property at: aqA 44-6 Nok MA (Address) I further certify that I have given my permission to allow work on the property listed above in accordance with the following provision: 1• Weatherization 2. Heating System Work and such other particulars as may be attached to this agreement. Signed o i Date ' -a Owner/authorized A nt OANETTI INSULATION CO. 362 EASTERN AVE LYNN,MA 01902 DEC 0.1 2014 362 Eastern Avenue Lynn, Massachusetts 01902 781-598-7043 ' • • Memo To:Building Department CC: Date: 02/152016 Re: permission for Neil Moore to pull permits To Whom It May Concern: I, Edward Champigny give Neil Moore permission to submit paperwork and pick up permits on my behalf in order to obtain building permits for Danetti Insulation Company. Thank you Edward Champigny 1 The Commonwealth ofMassachuseas Department of IndustrialAccidents 1 Congress Street,Suite 100 o�Zarz�11� www mass gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Pnnt Lesrtbly Mine(Business/Organiration/IndividuaI}: Address: 3 t e City/State/Zip: L /j7 COOV- Phone#: 7 l-Sf�= 7 61412 ^ Are you an employer?Check the appropriate box: Type of project(required). 1.❑1 am a employer with__ employees(full and/or part-time).* 7. 0 New construction 2.[]l am a sole proprietor or partnership and have no employees working for me in any rapacity.[No workers'comp,insurance required.] 8. F]Remodeling 3.[JI am a homeowner doing all work myself.iNo workers'comp.insurance required]' F. ❑Demolition 4-[]l am a homeowner and will be hiring contractors to conduct all work on m 10 Q Building addition ensure that all contractors either have t+rorkers'compensation insurance or are I will Proprietors with no employees. P.Q Electrical repairs or additions 5.01 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 12.Q Plumbing repairs or additions These subcontractors have employees and have workers'comp.insurance.: 13.❑Roof repairs b.Cj We are a co pon and its olllicers have exercised their right of exemption per MGL c. 14.[frOtherjJ, ,f U l err/U✓� 152,§I(4 Strd we have no employees.lNo workers'comp.insurance required.] •, *Arty applicant that checks box'i must also fill out the section below showing their workers'.compensation policy information +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 a tJre policy and job sae— information. n Insurance Company Name: Z l Qf L �`� � ' Policy#or Self-ins.Lic.#: q ! _�yg C jr / Expiration D�Ie '/�JohSiteAddress: / 2Attach a cv of the wvrke City/State/Zipf�`� � copy Wcompensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. I52,§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. I do hereby c under the pains an inaldes ofperjmy that the information provided above is true and correct Sienature: `G Date: -;2— G Phone#: 7G off cial use only. Do not write in this area,to be completed by city or town officio[ City or.Town: Permit/License# Issuin Authority(circle Issuing my( e one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6.Other Contact Person' Phone#: ORD, CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDD/YYYY) 06/22/2015 IS 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 m?y require an endorsement, A statement on this certificate does not confer rights to the certificate holder in lieu Of such endorsement(s). PRODUCER CONTACT NAME: Duffy Insurance Agency, Inc. AIC NoE,,t.781.593.1200 AIC,N,;781.593.7260 317 Broadway AE-MAILDDRESS: Wyoma Square INSURERS)AFFORDING COVERAGE MAIC# Lynn, MA 01904-2602 INSURERA: Endurance American Insurance Co INSURED Danetti Insulation INSURER B; Pilgrim Insurance Company c/o Edward Champigny INSURER C: National Liability & Fire Ins Co 362 Eastern Avenue INSURERD: Lynn, MA 01902-1626 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:00 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POUCIES 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. LTR TYPE OF INSURANCE INSR" POLICY NUMBER MMID MID LIMITS GENERAL LIABILITY CBC100019940 06/22/2015 06122!2016 EACH OCCURRENCE $ 11000, X COMMERCIAL GENERAL LIABILITY PREMISES ocanrenai $ 100-OW CLAIMS-MADE I A I OCCUR MED EXP(Any one person) $ 51000 A PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2;000.,00 GEN`L AGGREGA LN[T APPLIES PRODUCTS-COMP/OP AGG $ 2 i 0.00,000 X POLICY & JECT LOC $ AUTOMOBILE LIABILITY PRC00001004242 07/08/2044 07/08/2015 $ 1,000,000 ANY AUTO 07/08/2015 07/08/2018 BODILY INJURY(Per person) S ALL OWNED B AUTOS X AUTOS U�D BODILY INJURY(Per accident) S X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE AUTOS (Per accident) $ S UMBRELLA LIAB OCCUR \ EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE 7 AGGREGATE $ DED I I RETENTIONS _ $ WORKERS COMPENSATION V9WC64369 04/24/2015 04/2412016 X AND EMPLOYERS'LIABILITY YIN TORY LIkIITS ER ANY PROPRIETORIPARTNER/IXEC E.LEACHACCIDENT $ 500,000 C OFFINIA A CERIMEtABER IXCLUDEDI (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ S00,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,If more space is required) nsulation contractor CERTIFICATE HOLDER CANCELLATION 1 i SHOULD ANY OF THE ABOVE DESCRIBED POLICIE BE CANCELLED BEFORE E !RATION DATE THEREOF,NOTICE_WI ELIVEREDIN l CCODANCE WITH THE POLICY PROVISIONS i 7 A O ZED REPR Fi;A ACORD 25(2010105) The ACORD name and logo are egis ed marks of ACORD 7hts reserved 2 OKI'ICA AES and B49bless R.cgu�on 10 Pa&P - She 517€3 ` ( 6 Cm c � on R 1&W56 TYPe:. Ye► 113ANE—11I1[SU ' IDEM Ga_EAS-1 ERN A LYN#, MA 01902 }'E`ftitS C3�'Y� - qmtowpAcm OEM ofC er -Seim TTI�.i� MA16 Massachusetts-Department of Public Sa€ety Board of Building Regulations and Standards Cniii£ruction Supemvor Specialty License: CSSL-099738 EDWARD W CHAMP ,r r 362 EASTERN A.. LYNN MA Ol9f lr.xpira#ion Commissioner 04117=16 1�