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HomeMy WebLinkAboutBuilding Permit #221-2017 - 127 CHESTNUT STREET 8/31/2016 i OF NORT!{ q AaAj(w ,�,,! �tt , . iBUILDING PERMITfi' 'lamIAC TOWN OF NORTH ANDOVER �'2 �� �` 46 0 APPLICATION FOR PLAN EXAMINATION Permit No#: �ikl" '" Date Received ��ss,TE, ACHU I Date Issued: ORTANT:Applicant must complete all items on this page LOCATION 121 CAA$ - yJr- Sk,54Ak Print PROPERTY OWNER 'PAk Print 100 Year Structure yesno MAP 66 PARCEL:ZONING DISTRICT: Historic District yes no Machine Shop Village 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 XRepair, replacement- ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ `L D F oodlam,F ®kUVetl`an'ds _y� _WN e Distract 'Sc -ti A1Nelll - �^ P aLt i D�Water/Sewer, _�......,_����- _ � _�_, - . DESCRIPTION OF WORK TO BE PERFORMED: Q 01a Vunkila �t.4u" ix 1'Ql✓ 6&ms insM.ld paid�earr� inswlaf+r� c�vw �'or t�cisFi� HM6&.hat�w�a.► u Identification- Please Type or Print Clearly OWNER Name: sex Phone: 47 01-3yb7 I t�r� Address: In A-ndoy'xv-, Contractor Name: #4!cJhaL% 'S" Phone: C56A 3382- Zo8 l Email: Address: Tb ]ox t,40, t kms, NK oako8 Supervisor's Construction License: 106035 Exp. Date: W1 Z 2018 Home Improvement License: 1�2'1gZ Exp. Date: �>< Z� 12o1l 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: $/ H, 23(a . 41- FEE: $ � Check No.: ' ('J J Receipt No.: ��� NOTE: Persons contracting with unregistered contractors do not have access to the gualpntp fund 3 r � Location No. f Date • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# )q ' Building Inspector 21 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan 0 Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming pools 11I Tanning/Massage/Body Art ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR. OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF A U FORM PLANNING a DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature OMMENTS I I HEALTH Reviewed ori Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decisionfreceipt submitted yes i'lanning Board Decision:• Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: -Located 384 Osgood Street FI� DEPARMENT ,pTempDump sfier on;sitex,yes_ Located at�124 MainStreet ,FireD�e�artm n � :��, - �:Y,, ar , : .c�•t. •�;,�,.:� � :� ���� � � „ 1. _p�,.. � t-signature/date � .1 �� r .*,..3rsa :'•i•r• a' l�� ; i T '`i.r _ "_ -ttft"t;a;`�-'.�t„a-i :':1r+.J".`�i%�s=fir t�N Y'`'�.,.�eS f 7+�� COMMENTS• _. �r tom:;�.. `��.*�.. _,. , , n � `: � ' fir. ,a�•yy 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) i ❑ Notified for pickup Call Email Date Time Contact Name i 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 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 Building Permit Application i 6 Certified Surveyed Plot Plan 4. 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 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 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 Doe:Building Permit Revised 2014 NORTH q Town of 6 ndover p -. - `" 0 No. Q j_ c?o * oh ver, Mass, I �� COC..ICH.WKA �1' s U BOARD OF HEALTH Food/Kitchen PER I D Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ............ ..�. .. ..... .. .. ....... ....... ......... ................... . �.. ... . ...... . Foundation has permission to erect .......................... buildings on .... ���,,� �� •� Rough to be occupied as .... ..44' 1!.1. . .. . �....... ........ ......... Chimney provided that the person accepting.this peMhit shall in every reC ect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws rel ting to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR N Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONS TIO T Rough Service 9F'.-Vqr!Mv lit:oi ...... Final BUILPAG OR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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 10 0 RISE Engineering Rt Contractor Registration No 8188 RISE 01lAContracior Registration No 120818 A tgvisioo ofThielseh Ergiaeeriag ENGINEERING 60 Shawmat Unit 424 Canton,NIA 02021 33502-65 FAX339-502-6345 CONTRACT PROGRAMeormuerffie�xeoaiweamuemiat� CMA-EU s"9001811MANDIM FORMUMAB g1a70d6R i�,� .--- i Peucrn DAM canon worst aimnnt Peter Ayer r= N E (978)682-3467 06102(2016 435811 00002 wwace aged r C) I sum arrear 127 Chestnut Street )27 Chestnut Street I sgtveee enr.aaw.aP = muuw omr.smVrP North Andover,MA 01945 -cm North Andover,MA 01845 Pori It i: C...._... . JOB DESCRRMON AIR SEALING:Provide labor and materials to seal areas of your home against viastefid,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home wig be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include walks,foams and other products. Primary areas for sealing include air leakage to attics,beseatents,attached ywages and other unheated arras(windows are not generally addressed.) This will require(12)working hours.A reduction in cubic feet per minute(cfm)of air infiltration wvli ocaa,but the actual number of efm is not guamoteed. At the completion of the ueatherizatan work,and at no additional cost to the homeowner,a final blower door andfor combustion safety analysis will be conducted by the subcontractor to ensure the safety of the hndoor air quality. $1.020.00 AIR SEALING:Provide labor and materials to install Q-ton weal herstripping and a doorsweep to(2)door(s)to restrict air leakage. $150.00 ATT IC FLAT:Provide labor and materials to install a 4"layer of R-14 Class l Cellulose added to(280)square fed of floored attic space. $473.20 DAMMING:Provide labor and materials to[install a 12"layer of R-38 unfaced fiberglass baits to(100)square feet for damming Purposes. $205.00 ATTIC FLAT:Provide labor and materials to install a 10'layer of RAS Class I Cellulose added to(860)square fret of open attic space- $1,26410 STORAGE BARRIER:Homeowner is responsible for the removal of the stored items Mocking the installation of wsatherization work in the attic. Removal must occur prior to the scheduled work start. CONSOLIDATE STORAGE TO DESIGNATED 14x20 AREA.IN ALL OTHER AREAS,REMOVE FLOORING AND STORAGE (NOTE:FLOORBOARDS CAN BE STACKED IN THE STORAGE AREA) $0.00 KNEEWALLS Provide labor and materials to install R-13 faced Margins to(70)square feet of kneewail. Thin install 2"rigid board imsrdation.Seal all seems with FSK tape. $2SS.50 KNEEWALL FLOOR Provide labor and materials to install a 12"layer of R-42 Cutis 1 Cellulose added to(40)square feet of open kneewell floor. Si8.40 WHOLE HOUSE FAN:Provide labor and materials to fabricate and WWI a rigid foam insulating oover for the vibole house fan. $209.21 ATTIC ACCESS Provide labor and materials to install(1) estsrly moved,insulating cover for the attic arae folding stair. A small fiat surface of plywood will be created around the opening within the attic. This will allow the covers integral weather-stripping to restrict air leakage. $237.65 I i Federal to s os.040sw RISE En&eeft In Contractor Registration No 8186 A division of'lhielsch Engineering EOAContmetor Registration No 120M RISE60 Showmut Unit 42,Canton,MA 02021ENG ® �CONTRACT A^AC� 339-502-6335 FAX339-502.6345 C s� Page 2 PROGRAM CMA-HES nm CU31MRRWMM oasmaR wwm oam a.uexrs wtsuaomcart Peter Ayer (978)682-3467 06I0W016 435811 00002 sumac cum ewes gamer 127 Chestnut SUW 127 Chestnut Street SERVICE UM m>e.av 601810 crn.SaXap North Andover,MA 01845 North Andover.MA 01845 JOB IDESCREMON ATT IC ACCESS:Provide labor and materials to make(1) temporary access to an attic aces. The opening will be closed with materials simller to those existing. Finish sandingand painting is not included. $85.00 VENTILATION:Provide labor and materials to install ventilation chutes in(60)rafter bays to maintain air flow. $120.00 BASEMENT CEILING: Provide labor and materials to install(43)square feet of R-19 faked riberglass insulation to the basement exiling. $68.80 INCENTIVE:RISE Engineering will apply all applicable,eligible incentives to this contract. YouwiiI only be billed the Net amount. Currently,for eligible measures,Columbia Gas offers an incentiveof 7W*.not to exceed$2,000 per calendar year,and an incentive of 100%for the Ar Sealing measures up to the first 5680 and an additional$340 if savings are justified by the auditor. FOR A LIMITED TIME:Columbia Gas will also offer an additional$100 incentive toward the Weatherization wort outlined in this proposal.This special Summer inoentive is available to homeowners who have had their Columbia Gas home energy audit before July 31,2016. A signed proposal for weatherization needs to be submitted by August 8,2016 and work must be completed by September 30,2016. For the satbty 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 bcfbre the work is bo®m,and after the vxatherization ewrk 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$90 and is at no cost to you. The maximum allowable incentive for all measures,Mudiog air sealing,is$3,210 590.00 II Federal ID 0 0"405= RISE Engineering RI Contractor Regialra0on No 8188 A division orThielac6 Engineering IY%convactcrRegime"No 120979 ROSE 60 Shawmat Unit#2,Canton,MA 02021 �+opaT�a�►'�' ENGINEERING V N RA 339.502.633$ FAX339-502-6345 Page 3 PROGRAM "CONWAMCMA-EIS WOO ns sum us CUM$ WOR CRUER Peter Ayer (918)M-3467 06!OZ016 435811 00002 BMW=SWZT Be.=am= 127 Chestnut Street 127 Chestnut Street SERVIcecM6IKV.XP In, cm.81maP North Andover,MA 01845 North Andover,MA 01845 JOB 1DESCRII''d'ION Total: $4,236.96 Program Incentive: $3,110.00 Customer Total: $1,126.96 WE HOMYTO FII MH$Mr=M-COMPLMIN ACCORWS=W nH MOM OPBCtPICA M&FOR DM alae CF **''One Thousand One Hundred Twenty-Six&861100 Dollars $1,126.96 UPC a�mR A ALaraisa asU&RaCitaeS VNEWAMMMOOEMPALaIINWTOM INA UCHA MEOam MGNAW NROR'0<r ITEIION OIIARANEEB,RaNne0Fa�18WN, Aa0CMaRAON7Ra A7aN. DO NOT SIGN iN18 CONTRACT IF ARB ANT,$UINKjA ACID Ott �/� �; -; RISE a nA=WIAat ROOT:ma YaEWINWRAWI1av e8lFNOfE%&dIIEDWININ nAIROPACCIiWNCE 30 OFOONNIACT-IMASUM PRWae 6P TX1DI8 atmoNlmmclat ARP DAYS. ASSP PAVIBUUTWU MWasc tlAaa�eauNiaR¢eowoosieWNRa KISE 60 Shawmut Road, Unit 2 Canton,MA 02029 339-502.6335 ENGINEERING www•RISEengineering.com OWNER AUTHORIZATION FORM (Own s Name) owner of the property located at: C kL j.�-r ,a v-1" (Property Address) (Property ddress) I 1A hereby authorize Rz (Subcontra r) 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. 'Y+ Owner's Signature Date The Commonwealth of Massachusetts Department of IndustrialAccidents J, 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.govfdia Workers'Compensation insurance Affidavit:General Businesses. 1'O BE FILED WITH THE PERMT-11ING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name:Miff City Energy Address:PO Box 6411 City/State/Zip:Manchester, NH 03108 Phone#:603-391-7923 Are you an employer?Check the appropriate box: Business Type(required): 1.'Q 1 am a employer with 12 employees(full and/ 5. 0 Retail or part-time).* 6. Q Restaurant/Bar/Eating Establishment 2. 1 am a sole proprietor or partnership and have no 7. Office and/or Sales(incl.real estate,auto,etc) employees working for me in any capacity. [No workers'comp.insurance required] S. Non-profit 3.❑ 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.[Q Manufacturing no employees.(No workers'comp.insurance required]* 14 4.0 We are a non-profit organization,staffed by volunteers, l I.0 Health Care with no employees.[No workers'comp.insurance req.] 12.E Other��. ZA�lbn #Any applicant that checks box k1 must also fill out the section below showine their workers'compensation policy information. "'rif the corporate officers have exempted themselves,but the corporation has other employees;,a workers°compensation policy is required and such an organisation should check box 91. I ani an employer that is providing workers'compensation insurance for my employees. Below is lite police information. Insurance Company Dame:Clark Insurance Insurer's Address:One Sundial Avenue Suite 302N C'tty/StatefZip: Manchester, NH 03102 Policy#or Self-ins.Lic.#MIWC791896 Expiration.Date:4/2912017 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 tine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forth 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 fonvarded to the Office of Investigations of the DIA for insurance coverage verification. d h i u i d enaX o er'u that the information provided above is true and correct I a hereby certify, 1ns an p es fp ! t3' .f p � Si ature: bate: Q� 20110 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)- .Board of Health 2.Building Department .3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: wwwmass.gov/dia MILLCITY-1 AGOULD CERTIFICATE OF LIABILITY INSURANCE DATD/YYYY) 7/119/219/2016 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(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 Insurance PHONE FAX One Sundial Ave Suite 302N (Adc.No EtI:(603)622-2855 AIC No):(603)622-2854 Manchester,NH 03102 nnDRESS:agouid@clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER k Arbella Mutual Insurance Co 17000 INSURED INSURERB:AmGuard Ins co 43290 Mill City Energy INSURER C: 106 Joseph St PO Box 6411 INSURER D: 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 WVD POLICY NUMBER ADDLSUBR MMND EFF POLICY M DD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE 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- OTHER: LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea .d.nt3 $ 1,000,000 A X ANY AUTO 1020050919 04/29/2016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per ac idem $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAB CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER B ANY PROPRIETORIPARTNER/EXECUTIVE YIN MIWC791896 04/29/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDE07 FN—] N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 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,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 F Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-106035 Construction Supervisor Specialty MICHAEL JOY ►� 106 JOSEPH STREETI s ' MANCHESTER NH 103 F Expiration: Commissioner 08/07/2018 __ e rurnas rzfcr�/�l, fraJrrc/..jellsTM License or registration valid for individul use only Office of Consumer Affairs&Bnsi6ess Regulation g Y OME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistratton. 1'82792 Type: Office of Consumer Affairs and Business Regulation g xpiration 7/27(2017. LLC 10 Park Plaza-Suite 5170 Boston,]VIA 02116 MILL CITY ENERGY LLC MICHAEL JOY 106 JOSEPH STREET MANCHESTER,NH 03102,'- Undersecretary NofvaFfAithout s tore y •