Loading...
HomeMy WebLinkAboutBuilding Permit #1087-15 - 150 SALEM STREET 6/23/2015 NORTy L Ii AAA BUILDING PERMIT °�-t,T%-FO 1616 �-L AAA4, TOWN OF NORTH ANDOVER ~o APPLICATION FOR PLAN EXAMINATION _ : IN614� Permit No# Date Received �gssarED cHusE��S Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �1 Pct Print �PROPERTY OWNER OSePA rC Print 100 Year Structure yes no . MAP D�PARCEL:nL< ZONING DISTRICT: Historic District yes no Machine Shop Village yes o 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 ® �I®®tl iain 4®Wetlands Wate""r,,shed Dist `ictn. a ® Sept` 101Ne'I _ ��P .. , V�% terr/S�„�' ve er' 4 DESCRIPTION OF WORK TO BE PERFORMED: TT C At i 5;eg It'079 �1Sv / t� �� � `� Identificatio - Please Type or Print Clearly OWNER: Name: TO S e p c' r Phone: Address: rt�d✓�f Contractor Name: �c?�r' I -eb('%,LAc- Phone: Y2F-- 38 Email: Address •�- ��� �P 5i f4�T5 -aL� /I•,�5� Supervisor's Construction License: -Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: 4. Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. d� �a Total Project Cost: $ Y FEE: $ I Check No.: Receipt No.:__ 1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund I I 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 -u 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 46 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) a, Building Permit Application dr 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 Location <— WIN No. Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ IF F. . Building/Frame Permit Fee $ "' Foundation Permit Fee $ ,' Other Permit Fee $_ TOTAL $ Check 28959 Building Inspector Town of s a ndover O - `" 0 ]� h , ver, Mass, L&oe, 7A T O "'Ke COCNICN!WIC/( '_,�5 s � BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ..................J.� .............. -.. ........... ... . ....................... has permission to erect................. buildings on A%. ..� Foundation ....... . ..... .... Rough to be occupied as ........... .. ` ......*r.'A l. .. ...... ...�.N . ' �n Chimney provided that the person accepting this permit shall in eaa 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 MO"i ELECTRICAL INSPECTOR UNLESS CONSTRUCT STS Rough ..................... Service .............. .1..... ..... BUILDING INSPECTOR Final 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. A4C a 3'6 y Aa Federal 10# �. RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thiclsch Engineering CT Contractor Registration No 60 Shawmut Unit#2,Canton,MA 02021 _ a 339-502-6335 FAX 339-502-6345 CONTRACT C R I J E PROGRAM Page 1 THIS CONTRACT Is ENTERED INTO BETWEEN RISE EIVGINE1tRING CMA-HES ENGIN EERIIN9 AND TTHE CUSTOMER FOR WORK AS CUSTOMER OW PHONE DATE CUENTR WORKOROER Joseph Pace (978)975-1686 05/13/2015 403156 00005 SERVICE STREET BILLING STREET 150 Salem Street I50 Salem Street v SERVICE CRY,STATE,ZJPBILLING CRY,STATE,DP North Andover,MA 01845-3013 North Andover,MA 01845-301 MAY 1 0 2015 1 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work w 11 he performed in concert with the use ofspecial tools and diagnostic tests to assure that your home will be Icft with a healthful level of air exchange and indoor air quality.Materials to he used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,.attached garagcs and other unheated area.-,(windows are not generally addressed.) (4)working hours. At the completion of the weatherization work,and at no additional cost to the homeowocr,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure die safely of the indoor air quality.THIS IS WHERE ISL Fl- BATH VAULT MEETS 2ND.FL.BEDROOM....EVEIDENCE OF AIR SEALING DONE! $340.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unficed fiberglass baits to(76)square feet for damming purposes. $155.80 ATTIC FIAT:Provide labor and materials to install a 6"layer of R-21 Class 1 Cellulose added to(720)square feet of open attic space. $907.20 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(252)square feet of kneewall arca.THIS IS WHERE IST.FL.BATH VAULT MEETS 2ND.FL.BEDROOM....EVEIDENCE OF AIR SEALING DONE! $882.00 ATTIC ACCESS:Provide labor and materials to weatherslip the perimeter of(1)attic hatch with Q-Ion. 525.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Columbia Gas Offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of i00%for the Air Scaling measures up to the first$680 and anadditional 5340 if savings arc justified by the auditor. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic orthe available air flow in your home both before the work is begun,and alter the%ventherization work 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 ID you. Total allowable hvcatherization incentive is$3,110. $90.00 � Federal ID RISE Engineering Rt Contractor Registration No MA Contractor Registration No A division of'1'hiclsch Engineering CT Contractor Registration No 60 Shmvmul Unit k2,Canton.MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 R I SPage 2 PROGRAM CMA-1.1 ES ENGINEERTHIS ING AND THE CT IS USTOMRED ER Fort WORM as ENGINEERING DESCRIBED BELOW CUSTOMER PHONE _-- DATE CLIENT 0 Y10RK ORDER Joseph Pace (978)975-1686 05/13/2015 403156 00005 SERVICE STREET BR1JN0 STREET 150 Salem Street 150 Salem Street SERVICE CITY,STATE,ZIP BRJ.ING CITY,STATE,ZIP i� i`.is � North Andover,MA 01845-3013 North Andover,MA 01845-301 } ; L—a ��JJ JOB DESCRIPTION U MAY 1 9 2015 Total: $2,400.00 Program ncen Ive: V1,607.50 Customer Total: $492.50 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUTA OF :"'Four Hundred Ninety-Two&501100 Dollars $492.50 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE iN FULL INTEREST OF I It WILL BE CHARGED MONTHLY ON ANY -UNPAID BALANCE AFTER 90 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTO REGISTRATION, 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES _ A __~MATURE-RISE Ertpineerin0 C OMER Aniiw C � NOTE:THIS CONTRACT MAY BE WRHORAWN BY US IF NOT EXECUTED VATHIt DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED To 00 THE WORK AS SPECIFIED.PAYMENT PALL BE MADE AS OUTLINED ABOVE e I t - OWNER AUTHORIZATION FORM � (Owner's Name) owner of the property located at o-r - Y 1 15 2015 7yr (Property Address) 1419 0 © zI'L�-. (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. Ovifn is Signature 11 �4 Date Me Conzinoinvealtir of*1 assarlprrsetis Department of IndustrialAccidents Office of Investigations 604 H'aslrinaton Street �Cr., ti a r. Boston MA ()2111 i - ivivmmass gou/dia WOrkeW Compensation Insurance Affidavit: BuRders/Conti-actors/I;Iectricians/Plu3mbers Attplicarit information Please Print Legibly 'Name(Business./oTanizationrindividual): PO Igtr A t&r ringy m Address: p. AM ode 041StatefZi '0.AO Phone 4-. Q1 �6-/'ffr S"'- Are you an employer?Check the appropriate box: Type of project(required): L ►I am a employer with 4-❑ 18M a_general contractor and I etnploi ees(full andlorr pa * have hired the sub-contractors 6_ F1\ ye econstruction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. ?. ❑Remodeling ship and have no employees These sub-contractors have S. [l Demolition %c=orking for me in any capacih. employees and have�rorkers g ❑Building addition [No%%orlcets-comp.insurance comp.insurance_; required_] 5.❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all Am& officers have exercised their I I.❑Plumbing repairs or additions myself.(Na%workers'comp- right of exemption per MGL p c_15_ 12-❑Roofrepairs insurance required_]' 51(4),and-,z>e have no 13.Rother 'het p 1�c7 employees. :' «orl:e& P _ �o - comp.insurance required.] :Any applicant that checks box=1 must also fit eta the section below shouLina their workers compensation polin infvrntation. Hontem mem who submit this ai5dmit indicating they ane doing all t%vrk-and then hire outside ennitactom must submit a neer affi'da%it indicating such. �Conuactors that check this bog must attached an additional sheet sho'%ing the name of the sub-contractors and state.%-$ether or not those entities have emptorees. irthe stab-contractors have emplgvm.they must prmtide their worker--comp.polin-numbtr. I am an employer that is pro PhYng workers'compensation insurance for mJ!emplo}.-ees Below is tfte polio'at d job site information. Insurance n Com an. p . dame: ��,���lJ� PolicN #or Self ins_Lic_Y-. ® tAIG & F-xpimtion Date- if f& Job Site Address w , - /S�' levvi5 CitwstatetZip: n- IR hd�A tern Attach a copy of tate workers'compensation policy declaration page(sho%vtng tare policymember and expiration date). Failure to secure coverage as required under Section 25A of NIGL c_152 can lead to the imposition of criminal penalties of a fine up to S1-500-00 and/or one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to S?50.00 a day against the violator. Be advised that a copy of this statement mat>be fontwded to the Office of Investigations of the DIA for insurance coverage verification_ I do hereby certij•trader the pains and penalties afpedmn- Marta the information provided above is true and correct. Signatilre: Date. Phone Official use ants. Do not terite in tkt s area,to be completed 6r citl•or town o -ciat Citi or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health ?Building Department 3.CRY/Town Cleric -I. Electrical Inspector- 5.Plumbing Inspector 6.Other Contact Person- Phone#.- ®P W.99 Imums TM CITE 6 ISSUED AS A=T TER OF 8tlF11>S3RMM Of&V AND CONIES HO H=M UPON TFIE 6MMWE Fit WEFL THIS CEFB'W=lrE DOES%OT AFFWMTWELV OR UMTWMY ASD, BMW OR ALTER THE COVEMM AFFORDED By THE PGUCM f BJM. TM CERTG WSATE OF lid GIM WF COED A CCB'SEMEN'IRE UMM 99WRER4 AVTHOAj= FtEFAESEt18FATWE OR PRODUCER,AND THE CEIRTYWATE HOLIML H WPCWANr• OttoCeM1toNiar bs 20 ADDYftOI11IB.�llFttDl, p�{€esj auu�bo U SIiBBOCA7���f/AF1fEq tq &iteZE�19&Rd Com[ O?1fiE3 ,j,OPD �E�&8811 A ®11�C�fiE�tFn�i�ttESY�'tiU➢�1D� cobfudderin Int ofsucb eldweemeWs 19310 d3.4aako�aiciA��IiiS� tbMAn0ow,WAW8G Durso Rc�i[ri&. P POLAR-1 oDtrelac� tic u P CA. cra- AHI�E�I:£d P03=958 Andover,MA 04890 mac_ COY+ERAO� ATE I4 1�: THIS IS TO CERTIFY THAT THE POLICIES OF IIMPAWX UMED BELOW HAVE BEEN 0=0 TO THE NStJ[M Wmw ABOVE FOR THE POUCY PERIOD INDICATED. NOTYiRiHS'fAMMS MY REQUHIBMT.TEM OR COUMT1014 OF AW CONTRWr OR 07M DaC Na f SAlfifi RST TO WHICH THIS EF[CATE CERiUAY OF I WED OR MAY PERTAK THE gFSIJRA XE AFFORDED BY THE POISCIE S DESCMED HEREIN IS SIH3IWr TO ALL THE TERMS EXCLWONSAMD COMMONS OFGUCH POLICM&LEMS;SHOWN AW HAVE BERN RWIMW BYPA D CLO AM T1I DFE E umm atttaettsssr EArH g $,QgOa� Gi SL co sstcsas of Att LaY PA tfi IXi 46 s fi0, mAlI� aAm 51-1 ac R � S &Gia o s , sGBMAta ATEUMAPPMPat PF DUC[5-CQSProPAGG S �affl�Dsoa ,cv $ AU{OZOWEF.FAM" s T,Op0,000 3 ANYAUTO I t iFi GVBQ 8816 eoEALY aunitnr I� 7 s ALLOVOMAMS $Qn(LYgiURY(PBtStdAeM} S X SCMWMAUM PHOPSIFYMAWS X mono GVmmm S 5 tlm9i�L4ti81a8 X GCWR FAM Km A PAcesmim r7tcl LrRs tS GM==6 AG past s DEDlICiME S s s �sraR�sesa�a vtc nr- AHAEEVLOYEW UffiRW via mm mm? A EL Z4=ACC9Wr S �—j E,L MSEM-EAN 5 INF FHiAiION3 ELD1SlASE-PDitCYIE�f'r 3 �A W r FOR ' to sucom ' ears`�° ��ss�rFc�tlfof O IEbs ' DV2 M" CERTIRCATE BdOLDER CA1+I TION S?TEEI=At WrIMAMmu gcLw=RLCA%6EL=BarmpR MM MtPMTM DATE TuMmov, Nc ftiE WIL = DI LIi arab IN CWumWD��� A4r6QRDEII1ICEti9ixilTHSIr�OLEC7I'AEbVEt'I0� 195 FranrJ3 Ave AUTHDMM rATnee Crandon,Ra G40 ®i89 ACOS i�'I�II1. AIt cYSlds . ACOFiDFS{ 1139) TmACM ame and tne are eoglftmd amft ofACOFD C� n deuness Oaf Office of Consumes Affairs S to 5170 IOP Boston,Massachusetts 02116 Home Improvement Contractor Registration - Registratton= 102726 Type. DBA Tr# 252249 -_ Expiration_ 71yy016 POLAR BEAR INSULATION CO- — Vincent LeBlanc - - p.O. BOX 958 ANDOVER, MA 01810 Update Address and return d'Mark`mop for change. EE Address v Rene,,,, �EmP�Ornent C4 ��Card OPS-CA1 a 50m404-001215 1 � j11�SSS�zC=?US2i:S-�,o;�-t 'v`?` •• L!Crls Find...-c":.�o(�`.c5 ' {•ttii5iiiiiietti3 32i fit'ni�:ii'S7L'Cl.iit� - _ CrsL406017 PETER A LEBW C 2 EAST PINE SMET = piaistow NH 03865 0412812018