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HomeMy WebLinkAboutBuilding Permit #247-14 - 12 STONINGTON STREET 9/10/2014 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page _.:`. LOCATION YC`72 Print. w :- PROPERTY OWNER 16:-( r � l� Print` ` 100 Year Old structure yes nCno MAP NQ: i PARCEL:bb\q ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT. PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: 0 Commercial " Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic 0 Well 0 Floodplain 0 Wetlands 0 Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Add)A/T y 13(&w/v X)f!S U LA-A#i l �D g4tnu $6-- Identification Please Type or Print Clearly) OWNER: Name: Ns c-L tl ell_AvA A-� Phone:92P/ Address: st /L6 c(oyc CONTRACTOR Name: U1 Pc-&O CIL C,+Nc- Phone: '?)B W-763 y Address:, rden.s D2. AeE-e` LJLN� X* OtBro b Supervisor's Construction License: Exp. Date: /-30.4/ Home Improvement License: lot?,A 6 Exp. Date.- 7 'a'/6 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. � OI�J Total Project Cost: $ � o���I.0b FEE: Check No.: Sad.S Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Qwner �—Aigenaturo of contractor , Plans Submitted L.j Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ 'E Plans Submitted ❑ Plans=Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ - ,TMPE OF:;SEWERACTEDIS-P:OSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑. . Swimming Pools ❑ Well ❑ Tobacco.Sales 0 - Food_Packaging/Sales ❑ Private(septic tank,ete._ permanent Umpster on-SiteEl THE.FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM -- _ DATE REJECTED DATE.APPROVED PLANNING & DEVELOPMENT ❑ ❑ 1 COMMENTS .CONSERVATION Reviewed on Si`nature 1 COMMENTS HEALTH Reviewed on Signature COMMENTS t €; Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: :Comments Water & Sewer ConnectioniSignature& Date Driveway Permit DPW'To` x! Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMr NT Tern_ p Dumpster on site . yes no Located at.124�MairStreet :� a w�inkl-+:vi '9 f 4 Fire epartmeJat si `nature/date , CWM`ENTS ' r Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions._ ! Total land area; sq. ft.: ELECTRICAL: Movement of.Nieter.locatso i, rust 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-$1000fine NOTand DATA— (For department use ® Notified for pickup - Date Do .Building c Building Permit Revised 2010 11 I Building Department " X 'the fol;-)wing is`=a=list of the req` uired.forms to befilled outforthe appropriate permit to be obtained. {I Roofii g, Siding, Interior Rehabilitation Permits ❑ ' Building Permit Application 9 o Workers Comp Affid-avit ❑ Photo Copy Of H.I.C. And/OrC.S.L Licenses ❑ Copy of Contract o 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 Permit Addition Or Decks ❑ Building Permit Application ❑ Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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 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 ❑ 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 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 apw•al period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be subm.+ted with the building application Doc: Doc.Builling permit Revised 2012 L s Location �2— No. t ! Date • - TOWN OF NORTH ANDOVER. Certificate of Occupancy $ Building/Frame,Permit Fee sap Foundation Permit Fee $ Other Permit Fee TOTAL $ Check# .� i 28000 ,. Building Inspector r -1 V NORTH - W" ' � � t : �. .c : ver No. -t _ O C ver, Mass, COC -XI-) K1C4 41W.CK �'►- S RATED l3 BOARD OF HEALTH Food/Kitchen Septic System PEFIT T LD THIS CERTIFIES THAT .'�.0..... 1. A'!:�...... .................. BUILDING INSPECTOR .... ..... . .... .............................. . .. � Foundation - has permission to erect .......................... buildings on . .�N�.I4... 6!!�........................... , Rough to be occupied as ....M.O.94...l.1i!...�. .. �le's"pect �.�... ............................. chimney provided that the person accepting this permit shall in every 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 STARTS Rough ............ ..... . rj�.. ............................... 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. I G Federal ID# ' RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thlelsch Engineering CT Contractor Registration No 60 Shawmut Unit#2;Canton,MA 02021 Y CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 MOM S PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT 9 WORK ORDER Daniel Tiernan (978)828-2641 08/08/2014 400396 00002 SERVICE STREET BILLING STREET 12 Stonington Street 12 Stoning ton Street SERVICE CITY.STATE.LP BILLING CITY.STATE.LP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $2,319.12 Program Incentive: $1,889.34 Customer Total: $429.78 VIE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF 'Four Hundred Twenty-Nine 8L 781100 Dollars $429.78 UPON FINAL INSPECTIQB AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE tN FULL INTEREST OP 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE 30 DAYS.SEE REVERSE FOR IMPORTANT 1. MATION ON GUARANTEES.RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO SIGN THIS CONTRACT IF THERE ARE A K SPACES 1 1 ` A 0 SIGNATURE-RISE EN INV C FA&WCEPTANCE Np- NOTE-THIS CONTRACT MAYBE-WITHDRAWNSYUSIF NOT EXECUTED W"IN .. DATE OF.ACCEPTANCE -- /pO ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE t/p SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE i Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thielscb Engineering CT Contractor Registration No 60 Shawmut Unit#2,Canton,INLA 02021 CONTRACT CT v N 1 Rt'► 339-502-6335 FAX 339-502-6345 • Page 1 S E PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CLIA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE CIJENT6 WORK ORDER Daniel Tiernan (978)828-26 08/08/2014 400396 00002 SERVICE STREET B 12 Stonington Street eet SERVICE CITv,STATE,zip BaJJNG C ,ST North Andover,MA 01845 �V d r A 01845 EION AIR SEALING:Provide labor and materials to seal ar f e ul,excess air leakage. This work will be performed in concert with the use of special tools and di osttc 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,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows arc not generally addressed.) (8)working hours. At the completion of the w•eatherization work,and at no additional cost 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. .. $600.00 ATTIC FLAT:Provide labor and materials to install a 10"layer of R-35 Class I Cellulose added to(168)square feet of open attic space. $235.20 ATTIC FLAT:Provide labor and materials to install a 14"layer of R-49 Class I Cellulose added to(366)square feet of open attic space. 5589.26 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thermax board.Weatherstrip the perimeter. $60.00 KNEEWALLS:Provide labor and materials to install 3.5"R-13 faced fiberglass batt insulation to(123)square feet of kneewall area. $162.36 ATTIC ACCESS:Provide labor and materials to install(2) now,finished plywood,with 2"rigid Thermax board,weatherstripped attic space access hatch. Prime coat and/or paint is not included. $230.00 VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with gable wail mounted flapper vent to exhaust existing bathroom fan_ (s). $237.50 VENTILATION:Provide labor and materials to install ventilation chutes in(40)rafter bays to maintain air flow. $80.00 BASEMENT CEILING:Provide labor and materials to install(78)linear feet of R-19 unlaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $124.80 GINNER AUTHORIZATION FORM I, ri P-. J Cth (Owner's Narrs3) owner of the property located at (Prope4 Address) (Property Address) hereby auftfize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. s Signage Date_ _ A� CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 05/13/2014 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 CONTACT NAME: Automatic Data Processing Insurance Agency,Inc. a CoNE N Ext). ac,No 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIL# INSURER A: NorGUARD Insurance Company 31470 INSURED POLAR BEAR INSULATION CO INC INSURER B Po Box 958 INSURER C Andover,MA 01810 INSURER D: INSURER E: INSURER F: COVERAGES - CERTIFICATE NUMBER: 231099 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. ITRR ADDLI TYPE OF INSURANCE INS POLICY NUMBER �hULIDD EFF POLICY LIMBS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RE PREMISES Ea occurrence $ CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ _— — PERSONAL&ADV INJURY $ GENERALAGGREGATE $ ` GEWL AGGREGATE'LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JEFPRO- LOC AUTOMOBILE LIABILITYO T $ e acti E ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per person) $ AUTOS AUTOS - BODILY INJURY(Per accident) $ HIRED AUTOS NON-OWNED PROPERTY DAMAGE— AUTOS $ PeracddeM S UMBRELLA UAB OCCUR EACH OCCURRENCE $ EXCESS LAS CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION WC STI-'- OTH AND EMPLOYERS'LIABILITY Y'l N X TRY LI S ER A ANY OFFICER/MEMBEREX UDEEPROPRIETORIPARTNER/EXD ECUTIVE N/A N POWC550065 01/01/2014 01/01/201$ E.L.EACH ACCIDENT $ 1,000,000 (Mandatory In If yes,describe under er E.E.L.DISEASE-EA EMPLOYE $ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 11000,000 i DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,U more space is required) MASSAVE/RISE R CERTIFICATE HOLDER CANCELLATION r j SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Columbia Gas of Massachusetts ACCORDANCE WITH THE POLICY PROVISIONS. 4 Technology Drive,Suite 250 Westborough,MA 01581 AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION.All rights reserved. ACORD 26(2010/05) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washi.ngfon Street i Boston, MA 02111 ,M wmv.mass.ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ?a &R ttjul LAGIM C.. t NC. Address: O vy 158 City/State/Zip: l'�'y1� Ove Oiplo - Phone M 4? (o S�-5/ 9.S Are you an employer? Check the-appropriate box: Type of project(required): 1.tig I am a employer with_1 4. ❑ I am a general contractor and I 6 # have hired the sub-contractors ❑ New construction employees(full and/or part-time). Remodel 7. RdelMi 2.❑ I am a sole proprietor or partner- listed on the attached sheet t g ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers'.comp. insurance 5. ❑ We are a corporation and its • required.] officers have exercised their 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.E] Plumbing repairs or additions myself. (No workers' comp.' c. 152,§1(4), and we have.no 12:❑Roof repairs- LL insurance requued.] t employees. [No workers' 13.� Other Z t�S ll 1 q-T L a N comp.insurance required.] 'Any applicant that checks box#1 must also fill out the section below showingtheir workers'compensation policy information f Homeowners who submit this affidavit indicating they are doing all work and then hire outside.contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that isproviding workers"compensation insurance for my employees. Below is the.policy and job site information. Insurance Company Name: D Q U A-1 A _ Policy#or Self-ins. Lie. M O W C 5 5 DO is 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 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 fdr insurance cover4gq.verification. I do hereby ertify under thepains andpenalties ofpe jury that the information provided above is true and correct �. Si ature: Date: Phone#: oy1cial 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/Toivn Clerk 4. Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations . a 600 Washington Street Boston, MA 02111 ^. b. wmv.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): ,4-12 &&J2 N S(/rL,h" Address: lam• O• 4�W !58 ; City/State/Zip: l i� ovF K- l ot9lo " Phone #: Are you an employer? Check the appropriate box: Type of project(required): 1. I am a employer with 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet i 7.'E] Remodeling: ship and have no employees These sub-contractors have 8. ❑ Demolition workin for me in an capacity- workers' comp. insurance. g Y P tY• 9. E] Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its officers have exercised their 10.El Electrical repairs or additions required.] 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers'comp: c. 152, §1(4), and-we have no 12:❑ Roof repairs insurance required.] t employees. [No workers' 13.[) 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 tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp,policy inforTnation. I am an employer that is providing workers°compensation insurance for my employees. Below is the.policy and job site information. I Insurance Company Name: U A MI Policy#or Self-ins.Lic: #: p O w C S S DO(oS.. Expiration Date: Job Site Address: - �- fl U City/State/Zip: �IBYy 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$1,500.00 and/or one-year imprisonment, as well as civil penalties.in the form of a STOP WORK ORDER and a fine 0 25-.00 a da amsi'he violator---Be advised that a co f u to$ a of this statement maybe forwarded to the Office of P A _ Y g PY Y Investigations of the DIA for insurance cover�gq.verification. I do herebyertify wider the pains and penalties ofpe►jury that the information provided above is true and correct Si,enature: —2/0Date: 9 � Y Phone#: OrIcial 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#: ✓21 & / �.` 0'!774) G �/(GQ.iJC6Csif4f8a`b Office of Consumer Affairs&Business Regulation �wOME IMPROVEMENT CONTRACTOR = — License a registration valid for individu!use only t i=• Registration:- 9 tration: 102726 before the expiration date. If found return to: r EXpiratlon 7/2/20.16 Type: Office of Consumer Affairs and Business Regulation DBA POLAR BEAR INSULATION Q. _ 10 park Plaza-Suite 5170 g tton Boston,HA 02I16 Vincent LeBlanc 51 SO.CANAL ST #5A ` LAWRENCE,MA 01$41- Undersecretan• -- -___ -__ Not valid without signature 9� Massachuset s -Dapartrneni Of PuiJiic Sa;ezv Board c;Buiidin ' g =gut= sons and ,.'011structil,n. Sr!perciss,, Sl�eci:1)t� _ :anse: CSSL-105924 VINCENT E LEBIANC - 24,1-4"ING DR: METHUEN MA W44 - f-ommissioner 01/30/2016 DRIVER'S LICENSE -- ISS .. 4d HUMBER - 03 20.2013 �4G - NONE 7 S090639.33- o� 4os -30 494 , !. _rasSsC - . NONE 15 SEX M tc xcT 5.09 z VINCENT EtiZ 24 '� s METTHHUEN LANG OAR enS6 gel 5 0007.21.2017Revoms.2o09 s '