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HomeMy WebLinkAboutBuilding Permit #1027-2016 - 157 LANCASTER ROAD 3/30/2016 I/[/ I LG BUILDING PERMIT ,,ORTN / � O LED TOWN OF NORTH ANDOVER a2 h��t- ` '.6.°��L o i APPLICATION FOR PLAN EXAMINATION Permit No#• ��� Date Received aQR � q�RwreD�Pa •(9 �SSACHUS�� Date Issued: I ORTANT:Applicant must complete all items on this page LOCa�TI'QN i �_rTY-OWN .� PR,�PER _ _ ¢ _ NER " ' ,r 100 Year Str,�,ct�e yes no- TYPE PA`RCEL:_�''� zONING�R�DISTRICT: _,Histo;i� ®istnct yes Macf�ine Shop Village yes, 4 OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 4 ®'"ne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg 0 Others: ❑ Demolition ❑ Other _ P E,p i]Wetlands �f Wate_,rshed'Distnet5 ❑ e tic �Q,'WeIU` ❑ Flood lain � Water"/S ewer DESC IPTION OF WORK TO B RFO D: i Ide tification- Please T e or P int Clearly OWNER: Name: �U,� zin<� Phone: Address: _L!T�7 L-A&inas-L-ez Contractor!Name: ` _- Z � AddressIr - _a Supe�vis 's C:®nsfruction 'License. 4 ' Home Impro�ementLicense: _ - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$12500 PER S.F. Total Project Cost: $ L-1 77 FEE: Check No.: 1 Z23 Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ,°_ ignature of Ag�ent/O:wner_w-- , _ tSignat'ure of�3contractor;_'�___�__ F I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ 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 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit ,DPW Town Engineer: Signature: ` , 384 A'R�TMENT =1Tem �FIREIDEP, g ®ump terto,tq ite _ Located Osgood Street i CLocatedE,aY{124'(Mgam�St,�eetk � y fFrDepartnents'r'gnatur�eda`te 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) ❑ Notified for pickup Call Email Date 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 VOTE: 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 DOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products COTE: 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 NORTH own of 0 ..�. - 21 h ver, Mass, �/" 2AI� O �Q COCNIc Ne WIC.t y�' q�R'�TED S V - BOARD OF HEALTH Food/Kitchen PERMISeptic System , L D THIS CERTIFIES THAT 1A.C.... iM� ............................................... BUILDING INSPECTOR .......... ..... ... Foundation has permission to erect ......... ............... buildings on .�. 1.....L . . ...... .. ............ .. ...... r ....% Rough to be occupied as ...61L'4elift AD.. .... ,� .�.... .. ........... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION START Rough Service .............................. ...... ..����::�..................... .. Final BUIL ING 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. - . " Federal ID#050405629 RISE Engineering RI Contractor Registration No 8186 INA Contractor Registration No 120979 RISE A division ofThielseh Engineering ENGINEERING 60 Shawmut Unit 42,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-302-63445 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENCINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW ._........ ............ __. _... _...__._._ . CUSTOMER PHONE DATE CUENTO WORKORDER Barbara Tomkins (978)689-0688 02/05/2016 427523 00002 ................. ......... . SER=S STREET BRLM STR-EET'..__ .. .._.. .„,... 157 Lancaster Road 157 Lancaster Road ....SERVICE CITY,STATE,ZIP ........ ............. ........... .BILLING CITY.STATE.ZIP ...... ........ j i.l.! _ North Andover,MA 01845 North _.._._. Andover,MA 01845 206... It ift,1i IJ JOS DESCRIPTION i HA?.ARD BARRIER;We have identified that dwre are recessed lights present in your home.utniM. lite rccessed lights celtifrod . 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 be-installed across the top and closed cavities which contain recessed lights will not he insulated. $0.00 AIR SEALING:Provide labor and materials to seal areas of your home against vmslcful,excess air leakage. 11tis work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be fell with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows arc not-generally addressed.) This will require(8)working hours.A reduction in cubit:feet per minute(cfrn)of air infiltration will occur,but the actual number ofcfm is not guaranteed. At the completion of the wcathcri72tion work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by tate sub-contractor to ensure the safety of die indoor air quality. $680.00 AIR SEALING ADDER: (4)working hours. $340.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass bans to(96)square feet for damming purposes. $196.80 ATTIC FLAT:Provide labor and materials to install a 4"layer of R-14 Class I Cellulose added to(2514)square feet atopen attic space. $2,840.82 ATTIC ACCESS:Provide labor and materials to insulate the hack of the attic door with 2"rigid Thermax board and seal the door's edge with weatherstripping to restrict air leakage. $73.91 VENTILA71ON:Provide labor and materials to install(2)insulated exhaust host:to existing bathroom tan(s). $100.00 COMMON WALLS:Provide labor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to(158)square feet of common wall area. $553.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be bilicd the Net amount. Currently, for eligible measures.Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year.and an incentive of 100%for the Air Scaling measures up to die first$680 and an additional$340 ifsavings are justified by the auditor. For the safety 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 before the work is begun,and after the weatherization 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 or s90 and is at no cost to your. Total allowshlc ww~tttierirntion incentive is$3,110. 590.00 Federal ID#05-0406629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120978 RISE µ A division or'rhieisch Engineering ENGINEERING- 60 Shuwmut Unit N2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING Alto TOIL CUSTOMER FOR WORK AS OESCAIBEC BELOW ... CUSTOMER PHONE DATE CLMENTr WORK ORDER Barbara Tomkins (978)684-0688 02/05/2016 427523 00002 . ........ _ ............_. . r SERVICE STREET BAAM STREET 157 Lancaster Road 157 Lancaster Road `" 1c; - SERVICE CITY STATE.ZIP BILLING CITY.STATE,ZIP Z North Andover,MA 01845 North Andover MA 01845 FES 8 2% j _ __ _ ..___._ _ C z'_. .__ ... ..... I JOB DESCRIPTION Total: $4,874.53 Program Incentive: $3,109.99 Customer Total: $1,764.54 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ""`One Thousand Seven Hundred Sixty-Four&541100 Dollars $1,764.54 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGWRERING.CUSTOMER AGREES TO REMITAMOUNT OVEIN FURL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER JY DAYS. REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.DENTS OF RECISION,SCHEOULINO,AND CONTRACTOR REGISTRATION. ..........................__............................................._...._._.__.._.,......,._._..�__._._... _ ._..___........,.___.�........___ ..__...._.w_.._.,_ __._....Y........,_..__._..._,,..,,,,.�._...__.__`__"'__'........ ...__.... DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES SKRA - E fq CUSTOMER ACCEPTANCE ' r NOTE:THIS CONTRACT MAY BE WTHORAWN BY UIS IF ROT EKECUTEO WITHIN DATE OF ACCEPTANCE •. sJv.. ......- ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORRED TO DO THE WORK DAYS. AS SPECKED.PAYMENT WILL OF MADE AS OUTLINED ABOVE The Commonwealth of Massachusetts Print Form # Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lezibly Name (Business/Organization/Individual): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #:603-324-1974 Are you an employer? Check the appropriate box: Type of project(required): 1. ✓❑ I am a employer with 100 4. ❑ 1 am a general contractor and 1 6 ❑ New construction eirtployees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition working for ine in any capacity. employees and have workers' 9 E] Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.F1 1 am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. 12.E] Roof repairs insurance required.] T c. 152, §1(4), and we have no Weatherization employees. [No workers' 13.n.1 Other comp. insurance required.] Any applicant that checks box#1 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. *Contractors 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. Ifthe sub-contractors have employees.they must provide their workers'comp.policy number. I am an emplover that is providing workers'compensation insurance.for n?v employees. Below is the policv and job site information. Insurance Company Name: ACE American Insurance Company Policy #or Self-ins. Lic. #:WLRC 48151553 Expiration Date:6/30/2016 Job Site Address: 15-7 C...�J neez City/State/Zip: d�f Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of 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. Be advised that 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 pains and.......................-­-­Z111rrr Ipenalties of pe jury that the in formation provided above is true and correct. Signature Date:- Phone#: 603-324-1974 Official use onll'. Do not write in this area, to be completed by city or town of ficial. 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#: DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 06124/2015 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 r30OOTown W- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BE'RkEEN THE ISSUING INSURER(S), AUTHORIZED ESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. RTANT:If the certificate holder is an ADDITIONAL INSURED, the policy(ies)must be endorsed. If SUBROGATION IS WAIVED, subject to rms and conditions of the policy,certain policies may require an endorsement A statement on this certificate does not confer rights to the icate holder in lieu of such endorsement(s). R CONTACT m k Services Central, Inc. NAME. TJ ield MI Office AGNNo.Ext): 1866) 763-71?? Fax (S00) 363-01DS m wn Center (AJc.No.): E-MAIL p 000 ADDRESS: _eld MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIL» INSURED INSURER A Old Republic Insurance Company 24147 TODBUi Id Corp. INS URER B: ACE American Insurance Company 22667 260 Timmy Ann Drive Daytona Beach FL 32114 USA INSURER C: ACE Fire underwriters Insurance Co. 20702 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE-NUMBER: 57 4 00583 8882 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 S TYPE OF INSURANCE LTR INSD WVD POLICY NUMBER MMIDSYfYYYY I fMnOIID�NYw1 LIMITS A X COMMERCIAL GENERAL LIABILITY Mk2Y304834 Oo/3U/201J106/30/20161 EACH OCCURRENCE 12,000,000 CLAIMS-MADE OCCUR. 5AMAGE ASE 10 RENTED ncl 12,000'000PRE . MED EXP(Any one person) 125,0D0 PERSONAL d ADV INJURY 12,000,000 q GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGP.EGAiE 14,000,000 m X POLICY ❑PR0.JECT ❑LOC PP.ODUCTS-COMP/DP AGG 14,000,000 m OTHER: o0 An AUTOMOBILE LIABILITY Mh7B 30483S 06/30/201506/30/2016 COMBINED SINGLE LIMIT 55,000,000 (-a ccidenl X ANYAUTO BODILY ItJJURY(Per person) O ALL D'WNED SCHEDULED Z EODILYINJURY(P AUTOS AUTOS er acadenl) m X HIRED AUT OS X NON-OWNED PROPERTY DAMAGE U AUTOS (Pe—odent) — - d UMBRELLA LIAR H,)CCUp EACH OCCURRENCE 0 EXCESS LIAR CLAIMS-MADE ACGREGATE DED P.t TENTION B WORKERS COMPENSATION AND WLRC48251553 06/3Dj2015 D6/50/2016 PER OTH- EMPLOYERS*LIABILITY YIN �` STATUTE ER ANYPP.OPP.IETOR I PARTNER I EXECUTIVc •411 Other States _ C - OFFICERIMEMSEREXCLUDED' N/A - - SCFC4815190 06/_30/7015 06/3D/?D16 EL EACHACCIDENT 11,000,GOO (Mandatory in NI-I) Wi Only E L DISEASE-EA EMPLOYEE 51,QOO,ODD If ycs,dasc be ander DESCRIPTION OF OPERATIONS below E L.DISEASE-POLICY LIMIT 11,000,000— ESCRIPTION OF OPtR 11ON51 LOCATIONS I VEHICLES tACORD 101,Additional P•emarks Schedule.maybe attached if more space is regwred) vidence of Coverage A r-E -J RTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE f� POLICY PROVISIONS. Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBuild Company 260 Jimmy Ann Drive Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved- %CORD 25(2014/01) The ACORD name and logo are registered marks of ACORD f f t• ,F f fi f'f{a'.>,fIQ'>e`t :i'�� e`' > �.',d, .„°l� :E f . airs f .1tSlnnJSOffku oCo1Julei IT ReacLL?t'' ? o, 3e fimiprovei e�t Contracts Registrali�, � Repisiration: 179141 Type: Supplement Card Expiration 6/25/2016 BUILDER SERVICES GROUP, INC. RICHARD SCHVv/ARTZ 110 PERIMETER RD NASHUA, NH 03063 1:pdate Address and return card. Marl,re2san for Address Rene)+al Fniploymeni Losi (and _._^,'_-.-_:Office of t'nnsumer Affairs Q Busintss Rt;_uh ion License_. tin registration valid for or Int!)'lGul llie Ui3I $3Gtti�= 9PfiFRnVErriENT CONTRACTOR h=fere the expiraiiiar date. 5f found return to: ,.,f (3lticc of('011, Afiains and Business Reoulatic:n r e istration: 1791E1 Type lei Park}'lnz::- -..� U ,7 Exp ra3 on: 6P25/2016 Supplement Postor:.NtA 03 116 UILDER SERVICES GROUP, INC. ICHA.RD SCr-"• IARTZ 5011kriimY AIN'N )P!vE —._--- AYTGNEEA,Ci. -L '11-, A(ler:>[f rt;a rr �f�t�2l1Ltr Y1"itl'3 t1 L'1 Shr:,naiL're 19S HUNIVESS STREET MuchvUer NH M IU-1 OW260016 �c StricF(act J(). c;51.IC EnsuiaNan Cc)ntr,�ctor Hurt to f u"Ms a current edalon of then E4 amachusett5 dt.f".f5lill(Ilh6 Lf)tIF".IS C')USp lot'i't VI)C iTff)il(Yf tf11S IEC((i5f.'.. y ! Location 1 No. Zit Date r • - TOWN OF NORTH ANDOVER ' Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1 Check# J LjBuilding Inspector