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HomeMy WebLinkAboutBuilding Permit #819-2016 - 120 OSGOOD STREET 1/20/2016 NORTH BUILDING PERMIT 32Oy�tLEo 6�('O TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION PoRq N y�^yry�t Permit No#. u 1� Date Received �qs L,A�ea�c5 i SACHUS� Date Issued: t IMPORTANT: Applicant must complete all items on this page LaCJ &TION �PR®PERTY '�' "r '' " g ''%""` ""- ,*q•.'x f"' s.'S -c .er.`x ;� PClflt piss. .�0� e.8 ELIC Llf2' <�, <° 85 s e�[�O MAPS PACED _ ZONING DISTRICh Histort District es 'no ^r a a.TM� -t�r z^+s,: � �� 'Machine Shop�Vi�lage � ye no 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 ❑ Septic Well ❑ Floodplain ❑Wetlands ❑ Watershed D ;7 . fl 1Nater/Sewer � DESq.qIPTION OF O K O BE PERFORMED: N CIVVI Eta Identification- PI Type or Print Clearly OWNER: Name: Phone: �7�^( —37 7 Address: Contractor Name. Phon : �' �' m_ stJ Email 74 Address _.. P. Su e isorsCons ruction License71 t .: Exp Datek r Hon e,lmproue ne t License ' s Exp Date, Y; ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �(? - FEE: $ '. Check No.: /� / Receipt No.: I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of'AgentlOvvner__ Signature of contracto Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE 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 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 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIf3EDEPART MENT Tremp{4®`umpster on cite yes Locatetlhata124MaintiStr.,eet , Fire Departmentsignaturol-d,#te 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) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit 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 ❑ Building Permit Application ❑ Workers Comp Affidavit a Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract ❑ Floor Plan Or Proposed Interior Work L3 Engineering Affidavits for Engineered products VOTE: 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 ❑ 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 DOTE: 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 o 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 o Engineering Affidavits for Engineered products COTE: 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. IC�' 1 Date O . - TOWN OF NORTH ANDOVER ED 16 . Certificate of Occupancy $ '- Building/Frame Permit Fee $ Foundation Permit Fee $ } Other Permit Fee $ TOTAL $ Check# Building Inspector I NORT1y w: :. . : :. .� . : ver �h ver, Mass,LT,&4^" A%JAIJ6 coc NIc"awtCM ot• A- 7�AERATED S U BOARD OF HEALTH Food/Kitchen PER .. ITT LD Septic System THIS CERTIFIES THAT Ila BUILDING INSPECTOR 0Foundation has permission to erect .......................... bu' dings o .... ..... .... ��;a ........... Rough to be occupied as ........... .. ..... ..... ..: ... . .Ci�..41 ...... ... s Chimney provided that the person accepting this permit shall in every respect conform to the terms-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 STM 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. Federal W1t RISE, Engineering RI Contractor Regid", ton Na MA Contractor Registration No A division offideljels Engineering CT contractor Registration No 60 Slinwinut Unit 42.Canton,MA 02021 CONTRACT AX 339 A -5024 -$02 34S 339 WS Page 1 5 E PROGRAM VIV.COUTRACIM CUMOD MM BETIAME41MI! CNO"MORM0 A"TICCUSTOMPR FDRWORK Aa ENGINEERING CMA-HES MCM110 BELOW est To+aex ou*no naTn CUDIr a WORK 046CA Scot Freda (978)688-3773 11120/2014 4064S7 00003 nsav"MEET n[LUNO zttitcet 120 Osgood Street 120 Osgood Strect f-MVCE CaV.STATE.VP StLUU0 CITY,CTAMZtP North Andover.IMA 01845 North Andover.MA 01845 JOB DE SCRMION PHASE ONE-Proposal for this calendar year. AIR SCAUNG:Provide lohnr and materials to scat Armi nfyour haute anintl Wllftful.cxttqq air leakage. This%wk will be performed in conccn with the use orsistclill Imis and ditignmmc ttts to assure that your home will he left with a healthW1 levet of air=change and indoor air quality.MatcrioU to he used to sal voirr home can include caulks,foams.sx-cathmtripping and other praduct,z. Primary areas for stMing include air leakage to attics,bascroctsts,attached garages and dthtr unhealed areas(windows ore not generally RdsIrmed.) (20)wonting hours, At the tmnWinn n F the vventherization work,and at no additional cost to the homeowtser,a Pmol blower door ondlo;combustion safety analysis will btconducied by the cub-contractor to ensure the safety of tile indoor air quality. BASEMENT CEFING:Provide labor and mpterini.%to install(198)linear fW of R-19 sin(aced fihcrgIv;r insulation to the perimeter of the hawnerst Ceiling 41 die house silt $346.50 BASEMNj 1'DOOR-Provide lobos and materials To insulate the back or the basentcrit door leading to tit;bulklicad with 2'rigid board That m=the sections R-116.5.4 and 316.6 requirements of building code. "ittil all cde:r-4 and scams with FSK tapc. S72.22 RISE F'psgimeeting will RPPIY all lisplicalsic,eligible incentives to this contract. You wilt only be hijW the Net ivniwnt. Currently. for digNe measures.Columbia Gas offers 75%inccotim not to exceed S2.000 per calendar year.and an incentive of I OVIo for the Air Senlinf,-mcwurcs up in SM0. Pot the saildy and health oryout hatnes indoor air quality,we will he conducting a blower door diagnostic of the availpblc air flow in your home both before the work in begun.and offer tile weatlicrizotion work is complete.We will also conduct a full assessment of thc combustion m(ety ot')oisr hem ing ,system Lind water heater.This has n vninc of-WO and is at nn ctrl to you. Total allowable weathetizatioll incentive is$1690. S90.00 NIS 61 r i � - ,��� it j#� USE Engineering PJ CorWWW P-Igft""No MA Coftaftr ReqW04A We A division of TbIrbeb RagNtering CTCOMW rRejIW*0*ftNo 60 ftwmitt Unit 42,Conton,MA 02021. CONTRACT PAX W4024W Page 2 RISE PROGRAM MCOWW"85MMMOUNMUMMM omommumNamostwWwwwmAs CMA-HES MOW ScotFredo (978)688-3773 11/20/2014 406457 00003 some 8TRW MR" 120 Osgood Sheet 120 Osgood Street Sawmamaumvp Math Andover,MA 01845 North Andover,MA 01845 ITOB DESCRMION Total: $2,06,72 Program Incentive., $1,6711.04 Cut mer Total: $=.68 ***Three Hundred Twenty-Nine&691100 Dollare $329.68 UMMUD" moo AL OVMmw4x =CUm= q4oA=T*WFA9DMWAVIAA4.DW- ku on o00 NOT SIGN THIS CONTRACT IF TW.-M ARE ANY SLANKSPACBS o"""N T"'3 Ift UIS W WW"EIMMMM-MMM cown*m Ant i The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #: 603-324-1974 Are you an employer? Check the appropriate box: Type of project(required): 1.0 I am a employer with 100 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E] New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] ' c. 152, §1(4), and we have no Weatherization employees. [No workers' 13.❑✓ Other comp. insurance required.] *Any applicant that checks box#I 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. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ACE American Insurance Company Policy #or Self-ins. Lic. #:WLRC 48151553 Expiration Date:6/30/2016 Job Site Address: City/State/Zip: , AdowcX� DINS— Attach a copy of the workers' co nsation 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 for insurance coverage verification. Ido hereby certi under the ains and enalties o er'ur that the in ormation provided above is true and correct. Si nat re: J Date: Phone#:603-324-1974 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#: ti DATE(MM/DDNYYY) ACRD CERTIFICATE OF LIABILITY INSURANCE I 06!24/2015 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 'a6 Aon Risk Services Central, Inc. PHONEFAX Southfield Mi Office (AIC.No.Ext): (866) 283-7122 AIC.No.l: (800) 363-0105 a 3000 Town Center E-MAIL 0 Suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A Old Republic Insurance Company 24147 TODBUi l d Coro. INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER C: ACE Fire Underwriters Insurance Co. 20702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570058348882 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. Limits shown are as requested LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MM/DDM'YY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304$ 4 - / EACH OCCURRENCE $2,000,000 CLAIMS-MADE X❑OCCUR DAMAGEO N $2,000,000 PREMISES Ea occurrence MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $2,000,000 io m m GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $4,000,000 � X POLICY ❑PECT F1LOC PRODUCTS-COMPIOP AGG $4,000,000 co 0 OTHER: I I o r A MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY $5,000,000Ea accident X ANY AUTO BODILY INJURY(Per person) 0 ALL OWNED SCHEDULED BODILY INJURY(Per acindent) d1 AUTOS AUTOS NON-OWNED PROPERTY DAMAGE M X HIREDAUTOS X AUTOS Per accident t= d UMBRELLA LIAROCCUR EACH OCCURRENCE U EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X PERoTH- EMPLOYERS'LIABILITY YIN All Other States STATUTE R ANY PROPRIETOR I PARTNER I EXECUTIVE E.L.EACH ACCIDENT S1,000,000 C OFFICF-RIMEMSER EXCLUDED? N/A SCFC4815190 06/30/2015 06/30/2016 (Mandatory in NH) wi only E.L.DISEASE-EA EMPLOYEE S1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000- DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H morn space is required) Evidence of Coverage 414 YJ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. a�a Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE air+7 A TopBuild Company 260 Jimmy Ann Drive @�. Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ho .. ' O ee oCosurner Aa�rs n Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration:: 179141 Type: Supplement Card Expiration: 6125121;16 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03083 t'ndate,address and return card.Mark reasun for change. Addre>t Ren-Aal Empinymert Liw Card -- Office of Consumer Affair;8 Business Rtgulaiion License or re-isiratian s'alid for individul use unk i - 40ME IMPROVEMENT CONTRAC 3 OR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 17141 T-pe i(}?ar Plaza-Su to 5_iU -xpiraii�n: si�5/2G1g Supplement -ard f�eston, ti1A 021 15 JILDER SERVICES GROUP;INC. CHARD SCH',A'ARTZ0 j1MTv1Y ANN DRIVE •" _ ' ^'11 ❑dtrsccrttzrti �otYaivOr, without si-n2ture ittOutci-n2ture . ^- rH t t . CSSL-105992 RICkIAIZD SCII'v'F'ARTL 117 HUNTRESS S'EKEET Manchester NH 03102 09/2612016 Restricted To CSSL IC insulation Contractor f a{lure to posses, -rent ed,tion of the?Massachusetts State Building Cot ause for revocation of this I cense