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HomeMy WebLinkAboutBuilding Permit #805-2017 - 127 KARA DRIVE 2/28/2017 r NORTy BUILDING PERMIT `tCP bq1' � � TOWN OF NORTH ANDOVER X�A i� APPLICATION FOR PLAN EXAMINATION Permit NO:_4RO Date Received_ ^� '^ 1 '� �o •� " Date Issued: 9SSgcNus�� Il"ORTANT A hcant must complete all items on this a3,e LbCht AT ION :_ a RROPERTY dV1IN1=1 11 AP NO 'PAF ZONING-DISTRICT f istorc�istnct " � Maahrne Slop Village x yes no. TYPE OF IMPROVEMENT PROPOSED USE 11 New Building Resid tial Non- Residential ne family El ❑Two or more family ❑ Industrial Iteration ev,1 No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic i UVetl i 1 Food Iain , - �... P - Wetlands Il WateFstied District ,Water/Sewer y - f lahoo u Identification Please Type or Print Clearly) OWNER: Name: ���'�" Phoh! Address: (�,� rI vIC, CONACTC)1 Narne Phone TR T Addr'es's. - 14 Suen/isor'sConstruction cense 4 exp:Y T ate 3 Home Improvement license - LZ�� te - - i , Exp :Da . ' ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULD/NG PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ n o a D FEE: Check No.: t5 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acce �.-� try fund Signature:of Agent%bwner i Q__. Signature of contractor f Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ F WERAGE DISPOSAL ❑ Tanning/MassageBody Art ❑ SwimmingPools❑ 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 Y Planning Board Decision: Comments ` Conservation Decision: Comments Water & Sewer Connection/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 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 ®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 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 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/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 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 act ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products 40TE: 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 ,..ate--, �.. ,�-,•,F..�.,..-m--r ..-,- , � :___ _ - s- eo r Location ►Z J/Z Na Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ r� Other Permit Fee $ • TOTAL $ Check#3A- Building Inspector 3157 i I i I I ,�� � a i i � o -- -- pORTI1 Town of t 1� sAndover O - 0 No. 865 _220 �o h ver, Mass, OI A_ coc"Ic"awmN 7,9 q�RATE9) S V BOARD OF HEALTH Food/Kitchen P "ERMIT T LD Septic System THIS CERTIFIES THAT ......r4bb. ...... 1t.1m.cr...... .........e.e&.,o.4... .... .............. BUILDING INSPECTOR .. .........I.. .....7.......904_40... has permission to erect buildings on 0. Foundation Rough to be occupied as ...AAA 0 A.4IIIIII&.......*........O..of j..AdAt P..I.Ov. ...... 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 T RT Rough Service ............ ... ..... ..... . .... ............ Final BUIL `IP CTOR 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. Federal ID#05.0405629 RISE Engineering RI Contractor on No 8186 MA Contractor Registration No 120979 t t fes' CT Contractor Registration No620120 RISE60 Shawmut Road,Canton,nt.A 02021 ENGINEERING' COINTRACT 339-502-6335 FAX 339-5024345 Page 2 PROGRAM THIS CONTRACT ID ENTERED INTO BETWEEN RIDE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER - _ PHONE _ DATE CLIENT t WORK ORDER Peter Bennett (978)975-7602 02/12/2017 444149 23902 SERVICE STREET BILLNG STREET 127 Kara Drive 127 Kara Drive SERVICE CITY,STATE,LP DILUNG CITY,STATE,ZIP North Andover,MA 01845- North Andover,MA 01845- JOB DESCRIPTION VENTILA'170N:Provide labor and materials to install(1)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s).Broan model#636 or equivalent. $118.75 VENTILATION:Provide tabor and materials to install ventilation chutes in(86)roller bays to maintain air 11ow. $215.00 COMMON WALLS:Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to(156) square reef of common Wall area. $600.60 Rl3Z CoPwaft BACattteeborRt ftbllO6Rtl RISE,B - vioNmew ' ' �tt ,ceo,e�►a CONTRACT 73�8L6,1J6 FAX 1z9�NS iia s PROGRAM weaosnu+atosas mvgftlowm CMA w OFAUM asa�iea.oasa earorIt r.._._._._�._._...___._..�..... ......__ oao� -----...__. am.._.__...r_aaea, sae<anme pdwsumw (978j97S-7b0'd MM 17 444149 23M maea.aeger __. _.. MAA 127 Kms Drive 127 Kms Drive om. _... ._._...___.._......._.......__.._ ase,ia wi __ ___.......�._____..__... vavw North Aadow+sr.MA 01843- Nordt Aodow.MA 01845- JOB DESCRZPT[ON Rl� wigegp�raUd laiaam othboolm Yovw06*batdflod9wNamw f Ctimaotiy. for t79�6b10 aotto=ooad#.000ParMmadao' 11Yed16096tbr d cA rSafta as oplodofst3MaadaoaddMmd$Mif =JmW dbyd ftdkw. Fatd�e�r aad bodt6 of goer bome�tadoa eh goalttp.we sift bo aoadoo�g a biovar door dEa�Osde afd�e able sir floe ioyour[maoobadai�naWo viakis bepaaaodaRxrim weeoa aark isaomptxe WowHiab000adneta fldl vffto uftofyvimmitW&=andwatubmftMhbnavdwd=aadsetmmattopw 71g Elsapit4rtq baeoaaad by We i�aa aoaaaetaz'Ihis bee a wzsoatt75 aad it at aa,oet a,�tt is tba tMnmos�a"e iaom8yakiet3.1i83*by do* exd000mptaboaoflt�bxwk.'mei NUN do, ft6S:00 Taft s3,8 m pigs=lumrt n.. Custottmr Tdd: $P"3 ataw�eieResrroaownota�+oes-aoe�ealwrtxaeoaes ►tioue�ron�aiwoa --'86t Hwidred 8twenty-Sltt S MOO Doftm $87M aeoN�oaaeoaaaie® a. aeroaaeae�saaewruaeeaoataww�raresaaaaaoawaao�raraa ■orowws aaseaa oaaaatoaaa ma�tsaaortaas wsooeaaeeeaaemaanoa. twsaawmearaeraaeeamasrae+ras anaa — aoaaexor.ea�mortt roac�a�osiraaammasae 30amaea saemm�ia � as o e �soansnoiac Federal to#05.0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration No620120 RISE ENGINEERING' hu 5baw•mut-Rand,Canton,.M11r10202i q 339-502-6335 _i FAX 339-502-(1345 CONTRACT Page 1 PROGRAM t THIS CONTRACT IS ENTERED INTO OETWEER RISE OCMA-FIGS EHOINEERINO AND THE CUSTOMER FOR WORK AS C1• DESCRIBED BEIAW CUSTOMER PHONE DATE CUENTS WORN ORDER Peter Bennett (978)975-7602 02/12/2017 444149 23902 SERVICE STREET — [f-- W DILUM STREET 127 Kara Drive 127 Kara Drive SERVICE CITY,STATE,LP - BIUJNO CITY,STATE,LP North Andover,MA 01845- North Andover,MA 01845- - -- JOB DESCRIPTION 14AZARD BARRIER:We have identified that there are recessed lights present in your home.unless the recessed lights are certified as IC-rated(Insulation Contact Rated)we will create a 3"clearance space around the fixture by using fiberglass blanket insulation as a damming material,no insulation will he installed across the top and closed cavities which contain recessed lights will not be insulated. $0.00 Alit SEALING:Provide labor and materials to seal areas of your home against wastcli 1,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure(fiat your home will be Icn with a health rid level 01, sur exchange and isidoor air quality.Materials to he used to seal your home con include Caulks,foams and other products. Primary arca;for scaling include air leakage to attics,basements,attached garages Ind other unheated areas(windows are not generally addressed.) This will require(8)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a finnl blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaccd fitxvglass baits to(60)square feet for damming purposes. $123.00 A'ITIC CAN"r-ADD-CANNOT ADD ATTIC INSULATION $0.00 ATTIC FLAT:Provide labor and materials to install a 5"layer of It-19 Class 1 Cellulose added to(176)square feet or open attic space. $221.76 A'rnc I'LAT:Provide labor and materials to install an 8"layer or R-30 Class 1 Cellulose added to(344)square feet of open attic space, $495.36 KNEEWALLS:Provide labor and materials to install rigid board at R-10 or greater with the required fire rating to(148)square feet of kneewall area. $569.80 KNEEWALL FLOOR:Provide labor and materials to install a 5"layer ol•R-19 Class I Cellulose added to(176)square rect of open kneewall floor.. $221.76 ATTIC ACCESS:Provide labor and materials to insulate the back of the attic door with rigid board at R-10 or greater with the required lire rating and suit the door's edge with weatherstripping to restrict air leakage. $110.00 RISE60 Shawmut Road,Unit 2Canton MA 020211339-502-6335 ENGINEERING' www.PJSEengineering.com Ef idtwv Erargize6 OWNER AUTHORIZATION FORM (Owner's Name) ' owner of the property located at: ! T /.,< q ✓ct l�Y (Property Address) A/ 64`t'lkoo Veleal-iq_ p t (Property Address) hereby authorize . I allC Subcontractor) 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. 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. Owneei Signature 2 � y yo /- Date ' 6.2010 „ 2a.\ The Conw1onWea1t1i of Al,,assacllusetts Departtitent of Intlicstrial Accidents Office ofIii vestigations 604 Was/tington Street Boston,AIA 02111 )i'►i'ii:massgoi/dia Workers' Compensation Insurance Affidavit: Builders!Contractors/Electricians/Plumbers AQDJiC2nt information 8usincssr Please Print Nape Le ibly ( Organization/individual): FG D�41�/tom ud�f! Address: 37o uX ervi7 � Cii f'/SiateJ7ip: 7T/C13or[o Photic#: L101- Are you an employer?Check the appropriate box: --------------- F- • l ant a employer with, 1 4. [] 1 am a general contractor and 1 Type of project(required): I Lmptopces(hull ane!./or part-time).' have hired the sub-contractors G• []New cotlstructiolt 2. Ian}a sole proprietor or partner- listed on the attached sheet. 7. (�Remodeling j zlilp and have t1U employees These sub -contrdctors have ! Working for tt,e in any capacity. employees and hay a workers' ' Demolition (No workers'comp.insurance comp.insurance.1 9. ❑Building addition Inrequired.] �. [] We are a corporation and its 1.0_[] Electrical repairs or additions r am a homeoiNmer doing all work officers have,exercised their myself. [Nd workers'comp, right of exemption per MGL l 1 0 Plumbing repairs or additions insurance required.]_t c. 152,§1(4),and we have no 12 0 Roof repairs employees. [No workers' 13.0 Other Lv `1 i -rXo v comp. insurance required.] *An applicant that checks box#l must also fill out the section below showing their workers'compensation policy infomrttio1. ”limine+,>rcncts oho submit this affidavit indicating they are doing all work and then hire outside contractors must submit a nejeaffidavit indicating such.. sContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not thuse entities ernployces, if the sub-contractors have emplo,.yees,they must provide their-•orkers'comp.policy nu -r have i'ant an eniplot*er that is providing workers'compensation insurance for mv emplaTees. Mow is the policy acid fob site in(ornrutiurr. Insurance Company Name: Policy it or Self-ins. Lic. #: 0 3o Expiration Date: Jt�hfiite Address: r�. ��� CitylState/Zip: f )XK Attach a copy of the workers'compensation police declaration page(showing file police 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 S1,500.00 andtor 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 cope of this statement may be forwarded to the Office of lnvestis ations of the DIA for insurance-coverap ge verification. 1 rto i'terebs'cerhfj'under the pains and penalties of pedury that tiler information provided above is trice and correct. Si nature: .... � pi_ Date: Phone gffcivt use only. Do not write in this area,to be completed Fy e^itior town official City or Town, Permit/License 9 Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Tomvn Cleric 4.Electrical Inspector S.Plumbing Inspector G.Other Contact Person: Phone#! T i► ACORO® CERTIFICATE OF LIABILITY INSURANCE D/27/201IDDIY 1/27/ 7 `--� 7 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(iss) 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 NAME CT Steve Moran Loiselle Insurance Agency PHONE (401)723-8510'MAIFAC (aoi)Tze-iezo 279 Dexter Street L stave@loiselleinsurance.com AINo): P. 0. BOX 1148 INSURERS AFFORDING COVERAGE NAIC A Pawtucket RI 02862-1148 INSURER to ers Mutual Casualty Co 21415 INSURED INSURERB Beacon Mutual Insurance Co 0035 AFFORDABLE BUILDING & WEATHERIZATION, INC INSURER C;Ar onaut Insurance Co ARGO 92 SUN VALLEY DR INSURER D: INSURER E CUMBERLAND RI 02864-3241 INSURER F: COVERAGES CERTIFICATE NUMBER.-Update 16/17 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. INSR ADDLSUBR POLICY EFF POLICY EXP LTRTYPE OF INSURANCE POLICY NUMBER MMIDD/YYYY MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) $ 100,000 A CLAIMS•MADE EZ OCCUR X 5D28935 /8/2016 /8/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X POLICYF-IJFCT F-1 PRO LOC $ AUTOMOBILE LIABILITY COMBINED eESINGLE LIMIT E 11000,000 A ANY AUTO BODILY INJURY(Per person) $ ALL OWNED X SCHEDULEDX E28935 /8/2016 /8/2017 AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTYDAMAGE AUTOS Per acciden $ Uninsured motorist combined $ 11000,000 X UMBRELLA LIABOCCUR EACH OCCURRENCE $ 2,000,000 A EXCESS LIAB HCLAIMS-MADE AGGREGATE $ 2,000,000 DED I I RETENTION J28935 /8/2016 /8/2017 $ B WORKERS COMPENSATIONWC STATU- OTH- AND EMPLOYERS'LIABILITY Y I N 1 ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ 500 OQO OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) 0308 9/17/2016 /17/2017 E.L.DISEASE-EA EMPLOYEE $ 500,000 If Dyes, IPTIOe under E.L.DISEASE-POLICY LIMIT $ 500 000 DESCRIPTION OF OPERATIONS below C MA Work Comp WC928068403534 /17/2016 /17/2017 $500,0001$500,001$500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,If more space Is required) National Grid is named as an additional insured on the general and business auto policies as required by signed written contract. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN National Grid ACCORDANCE WITH THE POLICY PROVISIONS. 50 Washington Street AUTHORIZED REPRESENTATIVE Westborough, MA 01581 Steve Moran/STEVE ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INW125 rgninmi m Thg%Arnpn nnma anri Innn arc ranieforari mark*of Arnpn Mass achuse;is-Deczz tm_-nz�^.e Putt,'a..3,%N!-" 4ourd of Buildi,nn Regulavons and t:mda.cls fi:izaYi•uct W.Saite.w jwr Spue1.!i" License:CSSL-106019 TODD LEDUC - 95 QUEENS STREET#3 East Greenwich M M8 18 ��,a.�asSaar,er 0212812018 Restricted To:CSSLAC-insulation Contractor • Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For DPS Licensing information visit. www.Mass.Gov/DPS License or registration valid for individual use only Office of Consumer Affairs&Business Regulation before the expiration date. If found return to: HOME IMPROVEMENT CONTRACTOR Registration: 179572 Type: Office of Consumer Affairs and Business Regulation s Expiration: . 8/18/2018 Corporation 10 Park Plaza-Suite 5170 Boston,MA 02116 AFF(SRDABLE BUILDING&WEAiHERI7ATION INC TODD LEDUC 330 VICTOR RD.SUITE,A :5 �.,_",.,.,,.. _ ATTLEBORO,MA 02703'% Undersecretary Not valid without signature