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HomeMy WebLinkAboutBuilding Permit #743-2017 - 110 LACONIA CIRCLE 1/30/2017 BUILDING PERMIT of No oT �1 AA W TOWN OF NORTH ANDOVER �� y�'' .-• APPLICATION FOR PLAN EXAMINATION _ n0� K �, Permit No#: 7q.3 vo!? Date Received 3 Q I (� °�R,,,.Ep,ea` VSs acus�� Date Issued: IWORTANT:Applicant must complete all items on this page .i. I. "t k t %tom` }.*r r S� ' , pxe � } 1 4s� n:. y� ` N"_ +:a��Xr -tYt► yS ` �`-fix r',}'+C `y,�t M �.�.,t.?'`.c'. ,c .,u;,t. i, tMtC`` 4A Dew, aLrua �, . �wd„ t'^ ik'.�' ..r- '.. ,��� nnt' .•»"�k-.r. •';,'. i v` �., '.�`_°- t�nno .t`' ti'�YJF. '`'��►.1 -1..?Yb -i� :fir a, .C.. . w RROPERT�Y ®WNER .� a •,�=Kits. 0 DDeB rAP i� ? PARCEL-'( ZONING DISTRIac ine op_ it age TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial I Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic Well ` Floodplain 0 Wetlands 9 Watershed District ❑.,Water/Sewer `4 DESCRIPTION OF WORK TO BE PERFORMED: a i r seaUA A a isaU& 1rAc k oP A&Ik kyaAf~ t Common wM 13 ; k"inset iafed UkAMI- hose. A) All kia AAA, 71 Identification- Please Type or Print Clearly OWNER: Name: J6SZol� euLIS Phone: (4 qs -&1q& Address: 110 LQcoru &eotc over MA 011'y Contractor' Name° _k(.+c,�ae.�_ Jif Phone_ 382.77?081 Address ..�0 _$ox :.Gylt_r MAm4- fw,. . .IJH _09(6f Supervisor's Construction License . Date .$I :., Home;liiprovement License• -_. (fS27q►2 . . ' . .._ Exp Date 7 2� Zo_�� _ ._ � - _ JL ARCHITECT/ENGINEER Phone: 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: $ 2, 16 . 'd5 FEE: $ 3 3 Check No.: a' Receipt No,, jy� DOTE: Persons contractingwith unregistered contractors do not have.access*thhemarantyfund g Signature_of^Agert/Owner-' Signature of contractor' r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ _ f- TYPE-OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ SWiDlMi g Pools ❑ Well ❑ Tobacco Sales ❑ 4 Food Packaging/Sales ❑ I Private(septic tank, etc. ❑ permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR,OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature -%.4 COMMENTS ` HEALTH; Reviewed on Siqnature COMMENTS . . ; . . , . • • . . , � _ , ::_ ,:_..a c . . : • Zoning Board, gf Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ,Planning Board Decision: Comments ' f T Conservation Decision: Comments Wafer & Sewer Connec#ion/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 a COMM EN-T,S• *--.. � ' limension 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 lies No ®ANGER 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 ate Time Contact Name Doc.Building Permit Revised 2014 Building Department artment The following is a list of the required forms to be filled out for the appropriate permit to be obtained. r Roofing, Siding, Interior Rehabilitation Permits ❑ Building Permit Application r ❑ Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ 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 ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses o 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) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit o Two Sets of BuildingPlans One To Be Returned to Include Sprinkler Plan And ( ) p Hydraulic Calculations (If Applicable) o Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for .Engineered products DOTE: 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 thea appeal period is over. The applicant must then et this recorded at theRegistrye din PP P pp g of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Location //0 ��(-O Av 1►"9 014. No. !�3 f Date (j�s4 f�}4 17 • - TOWN OF NORTH ANDOVER • 00"41 ,• ` Certificate of Occupancy $ Building/Frame Permit Fee $_ Foundation Permit Fee $ Other Permit Fee $ i TOTAL $ I Check# 1�' 0 14 8 2 Building Inspector NORTH Town o 3� _ 1, Andover o � z h ver, Mass 0/ COCNIC"t ICK y1. RATED U BOARD OF HEALTH Food/Kitchen PERMIT. T LD Septic System THIS CERTIFIES THAT .....M!.4k A.4..!Ie....... .%4.....................................................+............ BUILDING INSPECTOR .... Foundation has permission to erect .......:.................. buildings on ....0. 9.......� :101111 ......44 .1. . c Rough to be occupied as .......kq�.. ...... 'Q. �!.�.K... ....... ...........� .� .................... Chimney provided that the person accepting this permit shall finery 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 TARTS Rough Service .............. ... .. ... .�.. ... .... ................... Final BUILDING INSPECTOR 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. I Federal 1D#05.0405629 RISE Engineering RI Contractor Registration No 8186 CT Contractor Registrationis ration No 120979 CT Contractor Registration No RI S L 60 Shawmut Road,Canton,MA /� ENGINEERING' CONTRACT 339-502-6335 FAX 339.502.6345 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CUENTs WORK ORDER Jospeh Kukas (617)593-6290 12/09/2016 431895 35004 II SERVICE STREET BILLING STREET 110 Laconia Circle 110 Laconia Circle i SERVICE CRY.STATE,TIP BILLING CRY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION HEALTH&SAFETY: Have your heating system tuned up and retested to be sure that the undiluted flue gasses do not exceed 100 puns per million(ppm)carbon monoxide.Weatherization work cannot proceed until this is fixed. AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed 51,020.00 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.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(12)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of efm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,afinal blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. AIR SEALING ADDER: (2)working hours. $17000 AIR SEALING:Provide labor and materials to install Q-Ion weatherstripping and a doorsweep to(4)door(s)to restrict air leakage. $320.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(])attic hatch with rigid board at R-10 or greater with the required S60.00 firc rating.Weatherstrip the perimeter. VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with roof mounted flapper vent to exhaust existing $118.75 bathroom fan(s).Broan model#636 or equivalent. COMMON WALLS:Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to(242)square feet 5931.70 of common wall area. L/ 1 1 s JAh 2 4 2017 3 Federal ID III 05-MS629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration No 60 Sbawmut Road,Canton,MA RISEA ENGINEERING CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT WORK ORDER Jospeh Kukas (617)593-6290 12/09/2016 431895 35004 SERVICE STREET BILLING STREET 110 Laconia Circle 110 Laconia Circle SERVICE-CITY,STATE,ZIP .BILLING CRY,STATE,ZIP. North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the net amount. Currently,for S90.00 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 5340 if savings arejustified 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 after the weatheriration work is complete.We will also conduct a 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 weatherization incentive is 53.110. The Permit will be secured by the insulation contractor,at no additional cost.It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion of this work. Total: $2,710.45 Program Incentive: $2,278.46 Customer Total: $431.99 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WrrH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Thirty-One&99/100 Dollars $431.99 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 70 DAYS,SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. E-SIGNED by Nathan Weiss E-SIGNED by Joe Kukas AUTHORIZED SIGNATURE-RISE Engineering CUSTOMER ACCEPTANCE y December 12, 2016 NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE 30 DAYS, SATISFACTORY TO US AND ARE HERESY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE V RI S E 60 Shawnwt Road,Unit 21 Canton,MA 02021 1339.5024WS ENGINEERING wwwAISEWWneerin9.aom OWNER AUTHORIZATION FORM 1, Joe Kukas (owner's Name) owner of the property located at: 110 Laconia Circle (Property Address) North Andover, MA 01845 (Property Address) hereby authorize E (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behaff to obtain a building permit and to perform work on my property.This form Is only valid with a signed contract. E-SIGNED by Joe Kukas Owner's Signature December 12, 2016 Date The Commonwealth of Alassachuselts Department o,f IndustriatAcc dents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass gov/dia Workers'Compensation.Insurance Affidavit:General Businesses. TO BE PILED WIM THE PERMTMNG AUTHORI'it'Y. Applicant Information Please Print Legibly I Business/Organization Name:Mill City Energy Address:PO Box 6411 City/State/Zip:Manchester,NH 0310$ Phone#:603-391-2923 Are you an employer?Check the appropriate box: Business Type(required); 1.0 I am a em to er wt#h 12 employees uand/ 5. 0 Retail or part-time).* 6. Q Restaurant/Bar/Eating Establishment 2.El T am a sole proprietor or partnership and have no 7. E]Office and/or Sales(incl.real estate,auto,etc.) employees working for mein any capacity. [No workers'comp.insurance required] S. Non-profit 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]* I I.0 Health Care 4.Il We are a non-profit organization,staffed by volunteers, with no employees.[No workers'comp.insurance req.] 12.14 Other. )tA* of 'ovx "Any applicant that cheeks box 91 must also fill out the section below showine their workers'compensation policy information. "If the corporate officers have exempted themselves,but the corporation leas other employces,a workers'compensation policy is required and such an organisation should check box 91. I am an employer that is provir#ng workers'compensadon;insurance for my employees. Below is the policy information. Insurance Company Nance:'Claris insurance :Insurer's Address:One Sundial Avenue Suite 302N City/State/Zip: Manchester,NH 03102 Policy#or Self-ins.L c.#MIWC791896 Expiration Daw4/29/2017 .Attach a copy of the workers'compensation policy declaration page(showing the,policy number and expiration slate). 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 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. I do hereby rerdfy,zr ins and penalties of perjury that the it formation provides(above is true and correct Signature: Date: I 30 201.7 Phone#:603-396-7520 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) I.Board of Health 2.Building Department 3.CityfTowo Clerk 4.Licensing Board S.Selectmen's Office 6.Other Contact Person: Phone#: wwwtmass.govfdia I MILLCITY-1 AGOULD CERTIFICATE OF LIABILITY INSURANCE DAT /YYIY) 7//19/2019/2016 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(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 License#AGR8150 CONTACT Clark InsurancePHONE FAX One Sundial Ave Suite 302N A/c No Ext:(603)622-2855 ac No: (603)622-2854 Manchester,NH 03102 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 INSURER C: 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. LTR TYPE OF INSURANCE N D WVD POLICY NUMBER POLICY M DD EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTIED- CLAIMS-MADE Al OCCUR 6500065735 04/29/2016 04129/2077 pREMISEs a occurrence $ 300,000 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRO ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A X ANY AUTO 1020050919 04/29/2016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAS CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION _ AND EMPLOYERS'LIABILITY Y/N X STATUTE ERH B ANY OFFICEOPRIET R PARTNER/E ECUTIVE N/A MIWC791896 04/29/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,00 EXCLUDED(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 It yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If 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 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Construction'Supervisor Board of Building Regulations and Standards Restricted to: Unrestricted-Buildings of any use group which contain. License:-CS410041 less than 35:000 cubic feet(391 cubic meters)of Construction Supervisor enclosed space: MICHAEL JOY 106 JOSEPHSTREET MANCHESTER NH 03102 _ Failure to possess a current edition of the Massachusetts ✓ Expiration: State BuildirgCode iscause forrevocationcfthis license. Commissioner 08107/2019 DPS Licensing inforrnation visit:vAMM.htASS.GOVAt pS I I « 42�++emt r«€«wrGs rff'tfi1S+/t+ r3tel hnic or Cosasamer AtYolYs Fi Basifiess Reehtionca5e or' Lr anon rand for indincidut use trniy MGY' IMPROVEMENT CONTRACTOR Wore the expiration date- tf found return ton rati ol. "182702 Type: OfRre of Consumer Affairs and,Business ttegtilatlon tion. ,7`127=17 LLO 10 Park PI*zA-Suite 5170 Roston.A1A 02116 LLC,. MICHAEL JOY 106 JOSEPH STREET MANCHESTER,NH 03102 1,=ndxrrtrrrrtirc to slthotual S ur'e I