Loading...
HomeMy WebLinkAboutBuilding Permit #661-2017 - 163 LACONIA CIRCLE 12/21/2016 BUILDING PERMIT o1 NoRry q TOWN OF NORTH ANDOVER 3� 5: APPLICATION FOR PLAN EXAMINATION nO ey Permit No#: Date Received �qs q^TED SACHUS Date Issued: LV IMPORTANT: Applicant must complete all items on this page LOCATION IbLS Laeon,io-- Cirou- Print PROPERTY OWNER Sharp Woalru ! Print100 Year Structure yesCno MAP�_PARCEL: �ZONING DISTRICT: -Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial XRepair, replacement - ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑:Well © Floodplain ❑Wetlands Watershed District D Water/Sewer _ DESCRIPTION OF WORK TO BE PERFORMED: air SCQ4inA insWah- &.4kc Commm WA* &ll insul •exhaust host. 4o W&I �an Identification- Please Type or Print Clearly OWNER: Name: SVIa Wood ba±E Phone: 631—Z-7 Address: IL4 La Cir vt it HA 0 I Ns Contractor Name: .ic,�gtA Sou Phone: (56�-nt—208 Email: '160 nil Address: ?o sox 104l w 03108 Supervisor's. Construction License: 110041 Exp. Date: I uuh Home Improvement License: I g 2192 Exp. Date: `i 2. 201 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: $ ��� G'I S. �o FEE: $ 41 .0 L) Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund I Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL f Public Sewer ❑ Tanning/Massage/Body.Art ❑ Swiluming 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' m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Si qnature COMMENTS HEALTH Reviewed on Signature COMMENTS 1 ' k- Zoning Board of Appeals, Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: ' Comments Conservation Decision: Comments Wafter& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: E De t _ _ Located 384 Osgood Street ,FIREPAR�TMEIdiTTernp, Dumpseron site- 3Located at124 fP� l �ain¢St" .R_ ;Fire Dep�artment�gnatur�e/date'. r `� �, r- �C.®M"�MEN1TtS i Dinnension 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 i NOTES and DATA— (For department use) ® Notified for pickup Call Email E [ Date Time Contact Name Doc.Building Pennit Revised 2014 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 Building Permit Application 4.. 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 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 I and Two Family) New Construction (Single y) 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 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 Doc:Building Permit Revised 2014 i Location l U No. (n — 2-0 Date • • TOWN OF NORTH ANDOVER ' • �� Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 31367 Buildirig Inspector tAORTH Town of . No. * .T h ver, Mass . o > > COC 1. 0 ATeD 'kPa���S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .S .. BUILDING INSPECTOR .... .. ....... ...... .. .... ... L Foundation has permission to erect .......................... buildings on .1( ..... .... 9� -. . Rough to be occupied as .......... . . ... t►..... . ....... ..... ...... ......................................... Chimney provided that the person accepting this permit s II in every respect conform to the terms of the application Final on file in this office, and to the provisions of the odes 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 CONSTRU F A Rough 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. 1 fi(t CEJ E f 60 Shawmut Road,Unit 2 j Canton,MA 02021 339-502-6`35` ENGINEERING' www.RISEengineering.com y� OWNER AUTHORIZATION FORM I, Shane Woodruff t (Owner's Name) owner of the property located at: 163 Laconia Court, N. Andover MA (Property Address) ' (Property Address) hereby authorize , (Subcontractor i j 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. I Owner's Signature I i -,LIZ ld � Date I M 0 Federal to#06-0405629 RISE Engineering RI Contractor Registration No 8186 t MA Contractor Registration No 120979 CT Contractor Registration No 620120 ROSIN � Sha �A ENGINEERING 60 . t�ara Ci•- '616 r"_' ? ONTf`!1C1 339-507" 39-50 �g l I r1X33 �50Z 345, �l� �I Page 1 II.I PROGRAM §; (�- (� } I i THIS CONTRACT IS ENTERED INTO BETWEEN RISE t1 U l d 1 CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS I. (t-1,,.1y.,.�� p DESCRIBED BELOW CUSTOMER PHiGNE DATE CLIENT O WORK ORDER Shane Woodruff (508)631-2767 11/14/2016 441984 28602 SERVICE STREET aS.UNG STREET 163 Laconia Court. 163 Laconia Court SERVICE CITY,STATE,ZIP BILUNG CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 i JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left 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 sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(12) working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but die actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $1,020.00 ATTIC FLAT:Provide labor and materials to install an 8"layer of R-25 Class 1 Cellulose added to(1140)square feet of floored attic space. I $2;052.00 ATTIC ACCESS:Provide labor and materials to insulate the back of the attic door with 2"rigid insulation board and seal the door's edge with weatherstripping to restrict air leakage. $73,91 VENTILATION: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 COMMON WALLS:Provide labor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to(156)square feet of common wall area. $546.00 STAIRWELL:Provide labor and materials to install Class I Cellulose insulation to the sheetrock or plaster ceiling and/or walls of a stairwell which are common to heated space,through a surface drill and plug method. The holes are plugged with styrofoam plugs,and spackled to a rough finish. Any sanding and painting required are the customer's responsibility. Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatheri7ation work to be performed.Your signature is your acknowedgement of receipt and agreement to proceed. $175.00 I i RISE Engineering Federal ID#05.0405629 RI Contractor Registration Noel 86 Q .,t MA Contractor Registration No 120979 CT Contractor Registration No 620120 ENGINEERING 60 Shawmut Road,Canton,MA 02021 (� a p�+T 339-502-5197 FAX 339-502-6345 "'O N T"V 1 Page 2 PROGRAM CMA-HES THIS CONTRACT IS ENTERED INTO SE ENGINEERING AND THE CUSTOMER OR WORKEN IAS DESCRIBED BELOW CUSTOMER DATE CLIENTS Shane Woodruff PHONE WORK ORDER SERVICE STREET (508)631-2767 11/14/2016 441984 28502 BILLING STREET 163 Laconia Court 163 Laconia Court SERVICE CITY,STATE,LP BILLING CITY North Andover,MA 01845 STATE,LP North Andover,MA 01845 JOB DESCRIPTION RISE Engineering will apply all applicable,eligible incentives to this contract. You tivill 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 100%for the Air Scaling measures up to the first$680 and an additional$340 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 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 of$90 and is at no cost to you. Total allowable weatherization incentive is$3,110. The Permit will he 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. $90.00 +I{I f m d� f• tri! i t Total: 4 075. $ , 66 Program Incentive: $3,110.00 Customer Total: $965.66 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Nine Hundred Sixty-Five&661100 Dollars $965.66 J:D,, CTION ND APPROVAL BYRIBE ENGINEERDIG.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF T%WILL BE CHARGED MONTHLY ON ANY D DAYS.SEE REVERSE FOR IMPORTANT..FORMATION ON GUARANTEES,RIGHTS OF RECISION,S..ULI'%AND CONTRACTOR MONTHLY ON N. I i AUTHORIZED SIGNATURE•RISE Enginmring ' C.igj �ACCEP7ANCE NOTE:THIS CONTRACT MAY at WITHDRAWN BY US IF NOT EXECUTED WT HIM DATE OF ACCEPTANCE I , 30 ACCEPTANCE OF CONTRACT.THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED To DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE I The Commonwealth of Massachusetts .Department oflndusirkd Accidents 1 Congress Street,Suite 100 Boston,AL4 02114-2017 www.mass.govfdia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PEW41TTING AUTHORITV. Applicant Information Please Print Legibly Business/Organization Name:Mill City Energy Address:PO Box 8411 City/State/Zip:Manchester,NH 03108 phone#:603-391-7923 Are you an.employer?Check the.appropriate box. Business Type(required): j I.0 I am a employer with 12 employees(;full and/ 5- Q Retail or part-time).* 6. DRestaurantlBar/Eating Establishment. 2.El i am a sole proprietor or partnership and have no 7. Q Office and/or Sales(incl..real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] • Noir-profit 3.0 We are a corporation and its officers have exercised 9. [1 Entertainment their right of exemption per c. 152,§1(4).and we have 10.0 Manufacturing no employees.No workers comp.insurance required]. 1 l:[�Health Care 4.r_1 We are a non-profit organization,staffed by volunteers, with no employees.[No workers,comp,insurance req.) 12. Other VJ *Any applicant that checks box 01 must also fill outthe section below showing their workers'coanpensation policy information. •'orf the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organization should check box N'1. I am an employer that is proviNng workers'compensation insurance for my employees. Below is lire policy information. Insurance Company Name:Clark Insurance Usurer's Address:One Sundial Avenue Suite 302N City/State/Zip: Manchester, NH 03102 Policy#or Self-ins.Lic.#MIWC791896 Expiration Date:4/29/2017 Attach a copy of the workers'compensation policy declaration page(showing the policy 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$1,500.00 and/or one-year imprisonment,as well as civil penalties in the forin 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,tt ins and penalties of perrjury that the information proviiW above is ante and carred Signature: Date: Phone#:603-396-75520 ' Official use only. Do not;write in this area,to be completed by city or toren official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of health Z,Building Department 3.City/Town Clerk 4.Licensing_ Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.govidia i MILLCITY-1 AGOULD CERTIFICATE OF LIABILITY INSURANCE DAT /YYYY) 7/119/2019/2016 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 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 License#AGR8150 NCONTACT AME: Clark Insurance PHONE FAX One Sundial Ave Suite 302N arc No Ext:(603)622.2855 ac N.J:(603)622-2854 Manchester,NH 03102 E-MAIL 9 ADDRESS:a ould clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Arbella Mutual Insurance Co 17000 INSURED INSURERB:AMGUard Ins c0 43290 Mill City Energy INSURER C: 106 Joseph St PO BOX 6411 INSURER 0: Manchester,NH 03102 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 LTR TYPE OF INSURANCE IND SWVD UB POLICY NUMBER MM/LDI DY EFF MMM EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE 0 CLAIMS-MADE a OCCUR 8500065735 04129/2016 04/29/2017 PREM SES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY JE� [�]LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ 1,000,000 A X ANY AUTO 1020050919 04129/2016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,000 DED TX I RETENTION$ 10,000 $ WORKERS COMPENSATIONPER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN N MIWCT91896 04129/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N❑ NIA _ (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD I Massachusetts Department of Public Safety Construction Supervisor Board of Building Regulations and Standards Restricted to. Unrestricted-Buildings of any use group which contain License:CS-190444 less than 35,004 cubic feet(991 cubic meters)of Construction Supervisor ` enclosed space. MICHAEL JOY 106 JOSEPH STREET MANCHESTER NH 03102 _ f Failure to possess a current edition of the Massachusetts 4✓-Expiration: State Buildirg Code is cause for revocation of this license. Commissioner . 08!0712015 DPS Licensing Informationvisit:t.www:n ASS.COVlDPS �— `!err rrn iysrrir�lf�i+ rr�:r r:se✓1; rt Umnse or tratiosn valid for individul use nn ;. Oft'iirt,ofConsumerAff rsal So%, est Regulation " _ # OMI:iMPRt}tliwMEf1Y CONTRACTOR befare lite is expiration ctatr. if found rct4trn to: egistratlon: #82782 Typ@: OMetofConsunterAffairs and Business Rt utation xpiration: 7.t�?{�i17 LLC IQ Pork P147A-Suitt 5170 Bostont.VA 02116 fAli,l.�TY EttERGY,.6.L�, , MICHAEL JOY 106 JOSEPH STREET MANCHESTER,NH 03102 - _ _ ._� _-.� •: _� a _ ts`aderserrctiet 3 tR itbeat are I I I