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HomeMy WebLinkAboutBuilding Permit #776-2017 - 137 WEYLAND CIRCLE 2/15/2017 Aiii ° � 4t,� S10RTy BUILDING PERMIT oF�zLEo 6'�ti TOWN OF NORTH ANDOVER 32 ��'''- 0 APPLICATION FOR PLAN EXAMINATION " _ Permit No#• 77� '�-0 (7 Date Received • �SSACHUS�� Date Issued: 'a�0 1 - LMTORTANT:Applicant must complete all items on this page !�..v—0--;�r'7H." ,jf...,, .a s SRR ERTY ®WNER: 1 - - �• -. -- .�4-4., �. . �101Yearr�StMUFF �; ryes no AMAP' ._1RARCEL� ZONING�DISTRICT; ,4F�' lstorlcRDistnct eye ono �t - } t , .*+.�w NR-r-i t3 '� `."'2 •—�rw. r r r .-j . ��. t.�".-. r a w, iF,'Y —'s - ... r ro' 'T - _ �f 4 Mach�ne�ShoVlllage' yes .no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building KQne family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic Weil-� ❑ Floodplain Wetla`nd`s 0 UVatershed District ❑.Wate_r/Sewer 7 _.. 1.- DESCRIPTION OF WOR TO BEP RFORMED' Identification- Please Type or Print Clearly' /OWNER: Name: Pho e: _ _ Ylco Address: CA). ec l C Contractor Name: Phone:, A a��a i. y.... ;Address y se n,M= �.w� Lt �. ,.... .,5. i+. ., 'r- ^c.T-_ r p rE- ._ -. ..—.. j. T_•+cr>-Y:, .. ._ w.rte---'."'_` {.r:""-i. 'Pr t-^.' Supervisor'stConstructiorFL•icense �� .'; Exp Date t i y Home;ImprovementrLicenSe ._ t _ l ' t , .s •' Exp: ate ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.,BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Coit: Na—(_10 e ' FEE: $ � Check No.: g Receipt No,. NOTE: Persons contracting with unregistered contractors do not have:access to the guaranty fund S_igratu�e of Agerit/Owner Signature of coritracto 1 Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ F WERAGE DISPOSAL ❑ Tanning/MassageBody Art ❑ Swimming Pools❑ Tobacco Sales ❑ Food Packaging/Sales :0 i Private(septic tank, etc. ❑ permanent DumP ster on Site i I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Siqnature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes r ' D P.Ianiiing Board Decision: Comments A Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT' - Terno Dumpster on site yes no Located at 124 Main Street , Fire Department signature/date COMMENTS limension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land areas . ft.: ELECTRICAL: Movement of Meter location mast or service dro p,re `vires approval i p.� q pp al of Electrical Inspector Yes Ido ®ANGER ZONE LITERATURE: Yes Ido MGL Chapter 166 Section 21A—F and G min.$10041000 fine NOTES and DATA— (For department use) i i I i ❑ Notified for pickup Call Email ate Time Contact Name Doc.Building Permit 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 P P _ 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 Application I g Permit pp ❑ 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 o CContract ❑ 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 Location 117 VC-'-1 CAA/0 Ct !� No. '77to' 2 d17 Date 2 ' l S - d 0 /-7 • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ 30 Foundation Permit Fee $ Other Permit Fee $�.:_ 'z TOTAL $ Check# b s Building Inspector NORTH q Town of sAndover No. 1 = - o h ver, Mass, / r ' 490t 7 COCMICMl.rca y1. ADRATE D Ppa,`�(y � S u BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT .......I � BUILDING INSPECTOR .. .M1.`.�.`.�.. ...........�.N. .1�1. ./�. .11.11 ................................�... Foundation has permission to erect .......................... buildings on ............1.3.7...... ..... Ao^........Cl.in Rough to be occupied as p' ...............��..�V��....�...... ........��.�...� .�.......................................... Chimney provided that the person accepting this permit shat n 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 S ARTS Rough 0 .......... 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. The Commonwealth of Massachusetts Department of Industrial Accidents s 1 Congress Street,Suite 100 Boston,MA 02114-2017 w, www.mass.gov/dia .r Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Aipmlicant Information Please Print Leeibly Name(Business/Organization/Individual): Builder Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03060 Phone#: 603-324-1984 Are you an employer?Check the appropriate box: Type of project(required): 1.®1 am a employer with 100 employees(full and/or part-time).* 7. E]New construction 2,M I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required.] 9. Demolition 3.[J I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑ 0 4.❑lam a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and 1 have hired the sub-contractors listed on the attached sheet. 13.F-]Roof repairs These sub-contractors have employees and have workers'comp.insurance.: 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.®Other Weatherizatlon 152,§1(4),and we have no employees.[No workers'comp.insurance required.) *Any applicant that checks box 91 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 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 thepolicy and job site information. Insurance Company Name: ACE American Insurance Company Policy#or Self-ins.Lic.#: WLRC 48151553 Expiration Date: 6/30/2017 / � Job Site Address: t City/State/Zip: Al7kesi- ©r (I S Attach a copy of the workers'compens tion policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the ains an enalties of per' ry that the information provided above is true and correct. Si ature: Date: 9 A, Phone#: 603-324-1984 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#: I I AC R® DATE(MM/DD/YYYY) `...� CERTIFICATE OF LIABILITY INSURANCE 10/25/2016 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 have ADDITIONAL INSURED provisions or 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 0) Aon Risk Services Central, Inc. NAME. D Southfield MI office (A/CO.NNo.Ext): (866) 283-7122 (AIC No.): (800) 363-0105 3000 Town center E-MAIL c Suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Old Republic insurance Company 24147 TruTeam Builder Services Group, Inc. INSURERS: ACE American Insurance company 22667 d/b/a Quality Insulation A TOpBUild Company INSURER C: 110 Perimeter Rd INSURER D: Nashua NH 03063 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570064230317 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 INSR A POLICY EFF POLICY EXP LTRTYPE OF INSURANCE INS. WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 1 1 EACH OCCURRENCE $2,000,000 CLAIMS-MADE ❑X OCCUR -DAMSO RENTED $2,000,000 PREMIES Ea occurrence MED EXP(Any one person) $25,000 PERSONAL 8 ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,0100 co X POLICY ❑PRO- JECT LOC PRODUCTS-COMP/OP AGG $4,000,000 OTHER: 0o r A AUTOMOBILE LIABILITY MWTB 307519 06/30/2016 06/30/2017 COMBINED SINGLE LIMIT $5,000,000 Ea accident IX ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED AUTOS ONLY AUTOS BODILY INJURY(Per accident) O) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE V ONLY AUTOS ONLY Per accident d UMBRELLA LIAB OCCUR EACH OCCURRENCE L) EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION H I B WORKERS COMPENSATION AND WLRC47860180 06/30/2016 06/30/2017 X PER OTH- EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETOR/PARTNERI EXECUTIVE Y/N All Other States B OFFICER/MEMBEREXCLUDED? NIA SCFC47860209 06/30/2016 06/30/2017 E.L.EACH ACCIDENT $1,000,000 (Mandatory In NH) WI Only E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000- 17 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached ff more space is required) III CERTIFICATE HOLDER CANCELLATION I SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town Of North Andover AUTHORIZED REPRESENTATIVE Building Department Attn: Donald Belanger 1600 Osgood Street, Suite 2035 North Andover MA 01845 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD I i YOTMO=~er �s (dVu mess e"at 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home lmprovem�M LVvontractor Registration Registration: 179141 1 Type: Supplement Card BUILDER SERVICES GROUP, INC+M;�' l ; Expiration: 6/25_._/2.._0_1.-8 RICHARD SCHNARTZ - --.._.._......__..._.-___...._.__...-----...._ 260 JIMMY ANN DRIVE DAYTONA BEACH, fL 32114 ' Update Address and return card.Mark reason for change. SCAII 6 zoos os+tt ;,-1 Address. E] Renewal F-1 Employment � Lost Card CCJO,.� C:criLncrrru a�CyC%lc�uGt�� Lee"Consumer Affairs&Business Regulation License or registration valid for individual use only SE IMPROV BAST CONTRACTOR before the expiration date. If found return to: Registration:, Uff ce of Consumer Affairs and Business Regulation L47c6Type' Exp10 Park Plaza-Suite 5170 $'' Boston,MA 02116 N���__-��_.��� ,,, BUILDER SERN[CESI Supplement Card RICHARD SCHfNAR 110 PERIMETER RD m'r NAS}iUA,NH 03f}63 `r•V y J' ����� Undersecretary Not valid without signature VIC ' II Y Massachusetts Department of Public Safety Board of Building Regulations and standards f License:CSSL-105932 i Construction Supervisor Specialty 260 JEMMY ANN DR9 o• . . Expiration: Mmissioner 0912612018 7,777, C .�C tructicn Supervisor Specialty Restricted to: CSSL-!C-Insulation Contractor Falture to possess a current edition of the Massachusetts, State Building Code is cause for revocation of this license. DPS Licensing information visit:HWX4.M ASS.GO!VI PS I i G ti V{/"t Paxserat 10 tt 08440SF>ali 3E Engi nelizlg q0 MA c� n No i2ern Co*uwr Reeletre N NOW120 RISE 60Shnwmut Road,COMA,MA 02021 ENGINEERINta CONTRACT 339-902-b333 FAX 339,5026345 Page 1 PROGRAM T►at QORTRACTw"TERM WTO Mvtm RISE CMA-NES BRAMNlaRiNOAWOTHECUP010EAFOR WORK At oeaMBEn89LOW cWOMBR PMOM CAT£ Ct'"Ta VIMORM Chris Conway (617)877-4128 41/26/2017 444334' 23906 DOM STREET 6a t♦fiREMT 137 Wayland Circle 137 Weyland Circle #eWME cm."Are,rip "AM am.STATS,W North Andover,MA 01845 North Andover,MA 01845 JOB DESCRUTION HAZARD BARRIER We have Identified that there are recessed lights present in your home.unless the recessed lights are certified U lC-rated(Insulation Contact Rated)we will arcate a 3"clearance space around the fixture by using fiberglass blanket insulation as a damming material,no insulation will be installed across the top and closed cavities which Contain recessed lights will not be insulated. $0,00 DAMMING:Provide labor and materials to Instatt a I2"layer of R-38 unfaCed fiberglass batte to(198)square feet for damming WPM, 3405.90 A171C FLAT:Provide labor end materials to Install a 5'layer of R-19 Class I Cellulose added to(976)square feet of open attic space. $1,229,76 ATTIC ACCESS:Provide tabor and matatiais to Insulate the back of(1)ardc hatch with rigid board at R-1 0 or greater with the required fire rating.Weatherstrip the perimeter. $60.00 ATTIC ACCESS:Provide labor and materials to make(1) ae=opening from are attic area to another by cutting a passage through sheathing. 11h19 access will be left open as It is between two common unbeeted non 8rewMed attto areas. $35.00 VENTILATION.provide labor and materials to install(2)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s).Broan model#636 or equivalent, $237.50 VENTILATION:provide labor and materials to install ventilation chutes in(148)raflw bays to maintain air Dow, 5270.00 i bt l 61?LL-b99-9L6 VVY 6u1p88H uUON -SdSft Wtf 6Q;1,1,:9 LLazio:tue Federal ID N 064400828 1ISE Xngineelling RI Cotttteetm Reglafretlon No 0186 ,:1 e,, MA contractor ReplatreNon No 120979 CT CoMnebor Rptetradon No020130 RIS RINEBRING 60SbawtnutRoad,Canton,MA02MI CONTRACT 339.102.6335 FAX 339.902.6345 Pogo 2 PROORAM CMA-HES wa�nC°NTRA°viaaro° PaeworatAs oeacaiem eE�ow VAMIN PMOMa DATE crura s WM Daae++ Chris Conway (617)8774128 Ol/2612017 444334 23906 Bova eTRaaT Ulm an= - -- 137 W land Circle eY 137 W eylartd Circle aaavroa^STAMMP Sum 4".e1ATLOP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION RISE Erineoring will apply ell applicable,eligible incentives to this omtnM You will only be billed the Net amount Currently, for eligible messurn,Columbia Gas offers 75%Incentive,not to vwcod 32,000 per calendar year,and an Ifteative of 100%far the Air Selling measures up to the first$680 and an additional$340 if savings are justified by the auditor. For the sally and health of your home's indoor air quality,we will be conducting a blower door diagnostio of the available sic flow in your home both belre the work Is begun,and after the weatherization work is complete.We will also conduct a lith assessment Of the combustion safety of your heating system and water heater.This has a value of S90 and is at no cunt to you. The Permit will be seoured by the Insulation contractor.This has a value of$75 end is at no cost to you.It is the homeowner's responsibility to close out this permit by eontaodrtg their municipality at the=npletton of this work.Total allowable woathorization Incentive Is$3,185. 5165.00 Total: $2,403.16 Program Incentive: $1,843.62 Customer Total: $559.64 WE AOREE MERM TO FURMISM SERMCES•COMPLIM Ill ACCOROM M ABOvo BMIROATIOUL MR TME suns of '~Five Hundred Fifty-Nine&541100 Dollars $SS9,64 aPOgIIkAi aL91IPmEEIYO/6UWG-OUST&=A6ReefAM TORaMITDWOuselaau.areRE"CW'1%MLDEQ==M XMY0MApr IpParoeAuwcF moA eEERFRReEXIMPDRTAMrDHoaMff"oN nteNrs ewwaa�xae,ANDwNiRAer�REeiBTpATpt, 19 CONTRACT IF THM AN ANY LANK 8PA Tuaa.RMaanarw.nRo Aaet: rMCGWrrRDTMAVBgWPHORAw„arLIDtF*Drt e,Cl CAM OFMOMAM!a —j-La� b 7 Aoo�PTAI[Ca a eowTaAcr.TNaA80Ya PA ,aPao�crcAT+wm npoeowomoro30 �aE onro "saPea PAMM"UeENMEAsNERSM BEVA�sovfa �ot000TMEwowc t►/Z 6bLL-099-9L6 VW Buipeaa WIJON-Sdsn INV 60'.6 V9 LLOZ/osiuvr