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Home My WebLink AboutBuilding Permit #690 - 129 COTUIT STREET 5/10/2010 (3) BUILDING PERMIT o�"°oT"qti TOWN OF NORTH ANDOVER Fr APPLICATION FOR PLAN EXAMINATION / h T Permit NO: (U Date ReceivedArED Date Issued: . _ , ��SSACHUS IMPORTANT:Applicant must complete all items on this page LOCATION ('614 tI 1 S' PROPERTY OWNER V't Print t Print MAP 210 c PARCEL: 7 ING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial eration > l No. of units: Commercial Repair, replacemenIJ Assessory Bldg Others: Demolition Other Septic Well Floodplain Wetlands Watershed District Water/Sewer DESCRIPTION OF WORK TO BE PREFORMED: XIC Vol 9- ' Jew - Ce5 Identification Please Type or P . Clearly) OWNER: Name: Phone: Address: ltd LOT tA 7 ` CONTRACTOR Name: t4 Phone: i€ Address: b Supervisor's Construction License: Exp. Date: C Home improvement License: Exp. Date: 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: $ 7e7a FEE: $ a P-r-1 s g Check No.: Receipt No.: ,7 t z f0 _ NOTE: Persons contracting with unregistered contractors do not have accWtoe u fund Signature of Agertt/Owner R Signature of contractor Location No. Date -/V f MORTM'1 TOWN OF NORTH ANDOVER IIS' f 9 Certificate of Occupancy $ s',�'°'E<� Building/Frame Permit Fee $ �CMUS Foundation Permit Fee $ Other Permit Fee $ • TOTAL $ Check # 23166 - Building Inspector The Commonwealth of Massachusetts Department of jndusts-ial_Accidents Office of investigations 600 Washington street Boston, MA 02111 Workers' Compensation Insurance Affidavit guild rs/ CotrctorsElectiAn licant Information cians/Plumbers Please Print Legibly Name (Business/C�mni7-a6on/Individual): '� C Address: _.L�. _ L06 0- . I z4 City/State/Zip: Phone#: Are you an employer?Check the appropriate box: 1•❑ I am a employer with 4. ❑ I am aType of project(required): r,eneral contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. ❑New construction 2 I am a sole proprietor or partner- listed on the attached sheet t 7• ❑Remodeling ship and have no employees These sub-contractors have working for me in any capacity. workers com . 8. Demolition [No workers'comp. � P Insurance. p insurance 5. ❑ We are a corporation and its 9. Building addition required.] officers have exercised their 10•❑Electrical repairs or additions 3.❑ I am a homeownereP frons doing all work right of exemption per MGL 11.7 Plumbing repairs c152or additions myself [No workers' comp, . ,§I(4),and we have no insurance required.] temployees. [No workers' 12-0 Roof repairs Pomp.insurance required.] 13 0 Other ' that checks box�? mus?also fir.out Cce section ceiow comp_ Homeowners who submit this affidavit indicating thy,am do;9 al`.work and then�oxide contractors . 'Contractors that check this box must attached an additional sheet showin;the name of the sductsubmit a new affidavit indicating such. ub contractors and their workerscomp.policy information. I am an employer that is providing workers'compensation information, insurance for my employe Below is the policy and job site C Insurance Company Name: Aed IN 0)) Policy#or Self-ins.Lic.#: b 40 0 Expiration Date: � Job Site Address: n ' Attach a copy of the workers'compensation policy declaration page (showing City/State/Zip: �{— Failure to secure coverage as required under Section 25A of MGL c. 152canlead to impositionolicy number of cin inal matron date).ea fine up to$1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of a STOP WORK ORD penalties of a of up to $250.00 a day against the violator. Be advised that a copy of this statement may forwarded to the Office o f d a fine Investigations of the DIA for insurance coverage verification I do hereby c 1 u de the airs a pe ties of perjury that the information provided abov is tr a and correct Signature: _ Date.:-.. Phone#: Official use only. Do not write in this area, to be completed by city or town offciaL City or Town: Permit/License# Issuing Authority(circle one): I.Board of Health 2.Building Department 3. City/Town 6. Other Clerk 4. Electrical Inspector 5.Plumbing Inspector Contact Person: Phone#: Information an- d Instructions Massachusetts General Laws chapter 152 requires all employers to provide workers'compensation for their employees. Pursuant to this statute,an employee is defined as"...every pi✓rson in the service of another under any contract of hire, express or implied,oral or written." An employer is defined as"an individual,partnership,association, corporation or other legal entity, or any two or more of the foregoing engaged in a joint enterprise,and including the legal representatives of a deceased employer, or the receiver or trustee of an individual,partnership, association ox-other legal entity,employing employees. However the owner of a dwelling house having not more than three apartm eats and who resides therein,or the occupant of the dwelling house of another who employs persons to do maintenance,construction or repair work on such dwelling house or on the grounds or building appurtenant thereto shall not be cause of such,employment be deemed to be an employer." MGL chapter 152, §25C(6)also states that"every state or local licensing agency shall withhold the issuance or renewal of a license or permit to operate a business or to construct buildings in the commonwealth for any applicant who has not produced acceptable evidence of ca>@pliance with the insurance coverage required." Additionally,MGL chapter 152, §25C(7)states"Neither the commonwealth nor any of its political subdivisions shall enter into any contract for the performance of public work um7t l acceptable evidence of compliance with the insurance requirements of this chapter have been presented to the contracting authority." Applicants Please fill out the workers' compensation affidavit completely,by checking the boxes that apply to your situation and,if necessary,supply sub-contractors)name(s),addresses)and phone numbers)along with their cerdficate(s)of insurance. Limited Liability Companies(LLC) or Limited Liability Partnerships(LLP)with no employees other than the members or partners,.are not required to carry workers'comp enation insurance. If an LLC or LLP does have employees,a policy is required_ Be advised that this affidavit may be submitted to the Department of Industrial Accidents for confirmation of insurance coverage. Also be sure to sign and date the affidavit:. The affidavit should be returned to the city or town that the ai3Jltcauon for the p�iit or license rS U. .req�seSF.ed BC2t the Department.rt.OI Industrial Accidents. Should you have any questions regarding the law or if you are re�;rired to obtain a workers' compensation policy,please call the Department at the numbe;I listed below. Self-insured companies should enter their self-insurance license number on the appropriate line. Cite or Town Officials Please be sure that the affidavit is complete and printed legibly. The Department has provided a space at the bottom of the affidavit for you to fill out in the event the Office of Investigations has to contact you regarding the applicant Please be sure to BE in the permit/license number which will be used as a reference number. In addition.an applicant that must submit multiple permit/license applications in any given year,need only submit one affidavit indicating current policy information(if necessary) and under"Job Site Address"the applicant should write"all locations in (city or town)."A copy of the affidavit that has been officially stamped or marked by the city or town may be provided to the applicant as proof that a valid affidavit is on file for future permits or licenses. A new affidavit must be filled out each year.Where a home owner or citizen is obtaining a license or permit not related to any business or commercial venture (i.e.a dog license or permit to bum leaves etc.) said person is NOT required to complete this affidavit. The Office of Investigations would like to thank you in advance for your cooperation and should you have any questions, please do not hesitate to give us a call The Department's address,telephone and.fax.number.._ The Commonwealth of Massachusetts. I>ePartment of Industrial Accidents Office of InVestisations 600 Washington Street Boston,MA 0.2111 Tel. itt' 617-72.7-4900 ej,1406 or 1-977-M-kSSAFE Revised 5-26-05 Fax'617-72.7-7749 vry v,.mass._aov/dia. ®RTH Town of 4 Andov No. = LA = dover, Mass., COCMICMEWICK 1' \ADRATED AQ S � Foc PERMIT T D Sep THIS CERTIFIES THAT.......v.� 0 .....,,. . OV has permission to erect......... buildings on ...f&.....CA..�,,,,%TT ou to be occupied as ...................................... ............5. t ........................... chi provided that the person accepting this permit shall in every respect conform to the tees of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Fins Buildings in the Town of North Andover. VIOLATION of the Zoning or Building Regulations Voids this Permit. Rou PERMIT EXPIRES IN 6 MONTHS Fina UNLESS CONSTRU STARTS Roup ......... ............................................................................................... Sery BUILDING INSPECTOR Fina Occupancy Permit Required to Occupy Building Display in a Conspicuous Place on the Premises — Do Not Remove Rou€ Final No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. Burn. Streei SEE REVERSE SIDE Srnok z GEOTHERMAL U.S.A Robert Pauline Contractor/Installer IGSHPA Certified (508) 801-6466 This Proposal Contract for: The installation and Sales of Goods is made on ....4, �,L4 � E' BETWEEN: Geothermal USA, an independent company organized and existing under the laws of Massachusetts,with its office located at: 15 Dr. Braley Road Rochester,MA 02770 AND: Vito and Meghan lacoviello 131 Cotuit Street N. Andover, Ma DESCRIPTION OF SERVICES: Geothermal USA agrees to install a heating and cooling system to the above person and addressed mentioned. The installation will be done using a vertical closed loop. Duct work will be installed in the basement for best possible comfort. A 4 ton Geo-Unit will be installed in the basement, which will feed the two air handlers for the entire house. All mechanical aspects will be completed and installed for best possible results. The room over the garage will have returns moved for better air flow and heat. The house will be split into three or four different heating and cooling zones for best comfort. Services will be rendered in a time frame of approximately five to six weeks. The warranty for Geo-Unit will be 10 years, and 50 years for the actual pipe and loop. The parties have executed this agreement at The day and year first above written. SELLER BUYER kju�zl rMRIZED SIGNATURE AUTHORIZED SIGNATURE .7/r PRINT NAME PRINT NAME www.geocomfort.com Unit Performance: ISO 13256-2 Data - Single & Dual Compressor Units Ground Loop Hent Pump Water-to-Water Models Single Compressor Ground Loop Heat Pump Model Capacity Cooling Heating BTUH EER BTUH COP 026 Part Load 21,700 21.9 16,200 3.2 Full Load 25,800 16.1 26,400 3.1 034 Part Load 31,400 22.1 25,500 3.3 Full Load 40,500 16.5 33,100 3.0 046 Part Load 43,700 21.5 36,800 3.2 Full Load 53,600 16.0 45,100 2.9 058 Part Load 40,500 19.7 37,200 3.2 � Full Load 56,100 16.7 50,500 3.2 070 Part Load 47,000 17.1 44,500 3.1 Full Load 68,700 16.3 61,800 3.1 Water-to-Water Models Dual Compressor 092 Part Load 87,400 21.5 73,600 3.2 Full Load 107,200 1 16.0 90,200 2.9 Notes: Rated in accordance with ISO Standard 13256-2 which includes Pump Penalties. Heating capacities based on 32°F EST&104°F ELT. Cooling capacities based on 77°F EST&53.6°F ELT. Entering load temperature over 120°F heating and under 45°F Cooling is not permissible. Floor heating is most generally designed for 85°F entering load temperature. F GeoComfort F41 GWT Series Catalog - 24 Feb 201 OD