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HomeMy WebLinkAboutBuilding Permit #609-15 - 170 ROSEMONT DRIVE 1/20/2015Permit No# Date Issued BUILDING PERMIT TOWN OF NORTH ANDOVER /APPLICATION FOR PLAN EXAMINATION Date Received S p10RT 0.1 N�t�ec ;b1ti0 02 a Om H `� O4_ cocwKwewKw ^`C *� IMPORTANT: Applicant must complete all items on this page PROPERTY_L_IJ f� Print X100 Year Structure yes no MAP V iPAR CEL ZONING DISTRICT Historic District yes � no 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 Septic ❑ Well: ❑Floodpin Ntlan hedDsricf __.0 Water/Sewer OWNER: Name: Address: Contract Address DESCRIPTION OF WORK TO BE PERFORMED: Identifications Please Type or Print Clearly .nine Ph( S;upervisor's Construction License: /��`) /. T rExp.. kDate:f ;Home 1 mprovement.'_License ._..:Exp. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BOLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $4l� FEE: $ .� Check No.: (062/-� 2 `/ Receipt No.: �'� 2 7 NOTE: Persons contracting with un�st ontractors do not have access to the gin nd signature ot Hgent/Uwner_____ signature of contract"or__ - (,, 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 Sianature r COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments e, Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 364 Usgood Street dFIRE DEPARTMENT TempDumpsteron site yes __ no _ . _ Located at 124.Main Street Fire Department signature/dates � m a Dimension Number of Stories Total land area, sq. ft.: Total square feet of floor area, based on Exterior dimensions. ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NU I t5 and UA I A — (I -or cie ❑ Notified for pickup Cal nt use Email No Date Time Contact Name -------._.._........ _..�— - -- -.._.. - -- ----------._..._.._..i_.._.._.... 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 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 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 NOTE: 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 /762 -,74 No. Date A� "P// Check 28427 TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector 3 0 ENO J 2 LL. O OC Q O co C L 0 O LL Q V) 0 u ta/f Z Z 0 d > m C 7 L CL w U LL p W H Z m > d 7 LL O �j a H Z a U lz (�•� W W � U N LIL w O U d Z N Q t 7 C LL Z W °C oQ. W 0 W Cc LL N i' CO �+ iJ N +� Y O Ln Z: ,r h 4• O Z s Zmew: Q L H p co = _W O W C-5 g co H t o O cc O O 2= •a i Q O O �a 0 O N 0 C. m W o�= r 0 L 3 CD c CL Cc J U1 Cc LM�y� W O O .a N rt �E�o ��Z .QW- �yo0 L C ��� w ) Cc.., O = % L � Q � m R .c C rte. 2 .2 O .n o CL 0C) Fa z m co z W w X LLJ0- ti ti v O LL is m 071 � { 00 m -0 M to z r•► ,;,r !�,.�!S2'x� '� R 37 i 1 t r( Oji 2k dI94.2 m> 4 I t 0 R � m CD U� p coi CL C. CL R � m CD U� p M $6, Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor SpecialtN License ROGER A ®VIELIA T 55 STAM ®I� "O"q) ISL028 Expiratio-I r„mrr,�ssiar,e��G��9�©`d6 RwYicted To: CSSd OCA e Onsuh,000n Contractor Failure to possess a currenZ edition of he "185sachusetts 5ga.te Building Code is cause for revocation of this license. For ©PS Ucensing informatoni vidto The Commonwealth o fMassachusetts Department o, f Industrial Accidents ®ice of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2019 www.massogov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual). Next Step LB!/161g Address: 21 ®rydock Ave . Boston, MA 02210 Phone #: (666)667-6729 Are you an employer`/ Check the appropriate bog: 1.0 1 am a employer with 650 4. ® I am a general contractor and I employees (frill and/or part-time).* have hired the sub -contractors 2,E] 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [Ivo workers' comp. insurance comp. msurance.t required.] 5. We are a corporation and its 3. M I am a homeowner doing all work officers have exercised their myself. [Ivo workers' comp. right of exemption per MGL insurance required.] c. 152, § l (4), and we have no employees. [No workers' come. insurance reouired.l Type of project (required): 6. ® New construction 7. ® Remodeling 8. ® Demolition 9. ® Building addition 10.C] Electrical repairs or additions 11. ® Plumbing repairs or additions 12.® Roof repairs 13.[M Other Insulation - *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. t I;omeowners 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 trot tho3e entities have employees. if the sub -contractors have employees, they must provide their workers' comp. policy number. lam an employer that is providing wor/ters' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: A.I.M Mutual Insurance Company Policy # or Self -ins. Lic. #: AWC-400-7030025-2014A Expiration Date: 9/30/15 Job Site Address: City/State/Zip: 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 form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of ifici Investigations of the DIA for insurance coverage v tion. I do hereby certify sander the painsandpin es f er ury that the informsatioaeprovided above is true and correct Si afore: Date: Phone #• o �)397 aq Official use only. Do not write its this area, to be completed by city or town official. City or Town: Permit/License. # Issuing Authority (circle one): 1. Board of health 2. Building (Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone #. NEXTS=1 OP ID: EL CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/01/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CNI y AND CONFER$ NO RIGHTq UPON THII CERTIFIGATr BOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ASTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), 4gTHORIM 0199 PSENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. PMR RTANT: If the gertif8cate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION Iq WAIM, Qgw_q6$ tq the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to �hq certificate holder in Iieuu of such endorsement(s). PRODUCER McLaughlin IypSurance Agency 828 Lynn feels Parkwpy Melrose, MA 02976 john E. McLaughlin Jr. NAMEACT Erin Lyons PHDNE 701=66�=2770 FAX 7191650=oa Arc Nn Ext: Arc Ne E-MAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIC €# INSURER A: Nautilus Insurance INSURED mext Step �Iving, Inc. 21 Drydock Avenue, 2nd Flavor Boston, MA 02210 INSURER B: Commerce Insurance Company 3475 INSURERc:A.I,M. Mutual Insurance Co. INsuRERD:AXIS Insurance Company 1851® INSURER E : INSURER F: .m eso ar2ewaa+iec n-ic��rnwrn-rwnxm eun eeenn•awae^ � lc vu�uum nvumnn m: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY R5RIQP INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T is 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. /NSR LTR TYPE OF INSURANCE S R POLICY NUMBER POLICY EFF MMIDD POLICY EXP MMIDD LIMITS A X COMMERCIAL GEWE)3AL LIABILITY EACH OCCURRENCE $ CLAIMS MADE ®OCCUR ECP2090988=92 08/30/094 00/30/2095 PREMISES (Ea urrence $ 190,000 MED EXP (Any one person) $ 0,000 PERSONAL & ADV INJURY GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $1Q0O/AQIi PRODUCTS - COMPIOP AGG $ ?11410111090 POLICY ❑ JEC LOC COMBINED SINGLE LIMIT Ea accident $ 9,900,0(80 OTHER: AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ BANY AUTO 14MMBOKKOM 09/30/2094 00/30/2095 BODILY INJURY (Per accident) $ ALL OWNED y SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS �° AUTOS PROPERTY DAMAGE $ Per accident $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ �,®00x00 AGGREGATE $ 0.04090 D EXCESS LIAR CLAIMS -MADE El,U783647012014 09/30/2014 09130/2095 DED RETENTION $ $ C WORKERS COMPENSATION AND EMPLOYERS' LIABILITYTO ANY ECUTIVE YEl BE ISSUED BY CARRIER 09130/2094 0 136/2®� 5 STATUTE ER E.L..L. 500,000 ACH ACCIDENT $ E.L. DISEASE - EA EMPLOYEd $ 500,000 OFFICERIMEMBER�EXCLUDED (Mandatory In NH) N I A E.L. DISEASE - POLICY LIMIT 1 $ 500,000 If yes, describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 109, Additional Remarks Schedule, may be attached If more space Is required) FOR ENF°ORNATMON ONLY INFO -01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Information Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE 4 ACORD CORPORATION. All riahts reserved. ACORD 25 (2094191 ) Thif APgftR 9@qn ImOp, are rq%gbgr� s gf AC®R r next step Living,, home energy solutions This agreement is made by and among Eleanor Tipa 170 Rosemont Dr North Andover, MA 01845 Site ID: A703455 DESCRIPTION OF WORK TO BE PERFORMED Next Step Living, Inc. ("NSL") 21 Drydock Avenue, 2nd floor Boston, MA 02210 phone: (866) 867-8729 06 -Dec -14 NSL will perform or cause to be performed the following work on the customer's address above, in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail (the 'Work") which are incorporated herein by reference: vvorK +vocation: Attic Flat • Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 14 $75.00 Hr $1,050.00 Weatherization Recommendations Work Location: Attic Flat Attic Stair Cover Thermal Barrier with Carpentry 1 $237.65 Each $237.65 Vent bath fan to soffit exhaust 2 $118.75 Each $237.50 Propavent 2`r 4' _ -, 67 _2I0 Each 8134-00 Attic Floor Open Blow Cellulose 4" 1,536 $1.08 sgft $1,658.88 Pipe Tenting 91St 4.tg n -r% 1 .,w cdaa Ar; 4• rgYMENT CUSTOMER agrees to pay NSL for the work as follows: Payment #1: .$100.00 Credit Card or E -check deposit is due at the time the Work is scheduled. Required payment information will be collected over the phone by a automerservlce representative at the time of scheduling. Deposit is not to exceed 1/3 of the total retail costs. (Note: Mastercard, Visa, and Discover accepted) Additional Payments and Final Invoice: $1,440.08 -Additional Payments for the Work shall be due upon completion of the Work is �•Q c zcP( Custoj r Signature Date 6 Dec 2014 NSL Signature Date Andrew Carpentier Name of NSL Representative A703 55 The Terms of this Agreement are contained on both sides of this page Next Step Living . 21 Drydock Avenue o 2nd floor o Boston, MA 02210 - (866) 867-8729 o inquiry@nextsteplivinginc.com o www.nextsteplivins.com TERMS OF AGREEMENT A703455 ~� 3. PROPOSED START DATE AND COMPLETION SCHEDULE NSL will contact customer to schedule the Work at a mutually agreeable time, subject to the availability of subcontractors or materials, or to delays attributable to the weather or other events beyond NSL's control. 4. CONTRACTOR REGISTRATION Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to: Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston, MA 02116.617.973.6700. 5. PERMITS NSL will obtain any necessary permits as the Customer's agent. Customers who secure their own permits or deal with an unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law. 6. PERFORMANCE OF THE WORK AND CHANGES 6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer 6.2 This Agreement may be supplemented, amended, or modified only by the mutual agreement of the parties. No supplement, amendment, or modification of this Agreement shall be binding unless it is in writing and signed by all parties. 6.3 At times, our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern for residents. Such concerns can include but are not limited to ventilation, potentially hazardous materials such as mold or asbestos, or structural concerns. In the case of health or safety concerns being identified, NSL reserves the right, per section 9.2 of this contract, to communicate concerns to the Customer and halt work until such concerns have been addressed. 6.4 The rebates and Incentives available from the Mass Save® Home Energy Services Program and amounts due from the Customer are based on the best estimate of the situation in the structure by the NSL home energy advisor. However, at times our weatherization team discovers situations in the home during the course of the Work that impact the availability of rebates and incentives from the Mass Save Program. In such situations, NSL will communicate such changes to the Customer, including any impact on amount the Customer would be expected to pay for the Work. The Customer will have the option to remove from the Contract the work elements that need adjustment, or set up a separate contract for performing the adjusted work. 6.5 NSL represents and warrants to the Customer that (a) the materials and equipment furnished under this Agreement will be of good quality and new, (b) that the Work will be free from defects, and (c) that the Work will conform with the description of the Work described in Paragraph 1. 7. INSURANCE AND REGISTRATION NSL represents and warrants to the Customerthat lt has a valid Home Improvement Contractor Registration (No: 162111) and the necessary insurance required by applicable law and normally maintained by prudent contractors in NSL's field, including, but not limited to, Workers Compensation Insurance for all employees who will perform the Work. 8.9UALITY OF WORK NSL agrees that the Work will be performed in a good and workmanlike manner, and that NSL will repair and replace, at its own expense, and promptly upon Customer's request, any defects in workmanship and materials provided by NSL which appear up to (1) year after completion of the Work or within any longer period as permitted or required under applicable law, provided NSL has received final payment as provided herein. 9. PRE-EXISTING CONDITIONS & PROPERTY PROTECTION 9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions. These conditions include but are not limited to poorly fastened or broken drywall, moisture damage, non -code construction, cracked or fragile siding or shingles, old pipes and fittings, rotting wood, etc. 9.2 NSL reserves the right not to perform Work upon the discovery of asbestos, mold, or any other potential health risk to the Customer. In this event, the Customer is responsible for remedying the at-risk situation, including any necessary removal of hazardous materials and all bills for services to date shall be paid immediately. Work cannot resume until remediation is complete. 9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customer's responsibility to remove or protect, including dust protection, any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property not properly protected prior to the commencement of the Work. 10. GENERAL PROVISIONS. 10.1 NSL reserves the rght, the extent permitted by applicable law, to have, file or maintain a mechanic's or material men's lien, or to file a notice of intention to lien, and to take any other steps to perfect and enforce such a lien, if Customer fails to pay NSL as provided herein. 10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts. 10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this Agreement, they are not relying on any representations, warranties or terms other than as expressly contained herein. This Agreement supersedes all prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties. You may cancel this Agreement if it has been signed at a place other than the NSL's normal place of business, provided you notify NSL in writing at its main office or branch office by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this Agreement. See the attached notice of cancellation form for an explanation of this right. 11. ENERGY BENEFITS. The Sponsoring Utility Company (the Utility) is entitled to 100% of the energy benefits associated with all Energy Conservation Measures, excluding the value of energy cost savings by the Customer, but including all rights to all associated ISO-NE Energy, Capacity and Reserves Products. NSL agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products. 12. NOTICE CONCERNING SPONSORSHIP Customer understands and acknowledges that NSL is not an agent, vendor or sub-vendor of The Sponsoring Utility Company (the Utility) with respect to the installation of an energy efficiency measures. In the event of the failure of an energy conservation device to perform as expected, Customer's sole recourse is to Contractor and not to RISE Engineering (RISE) or to the Utility:The Utility and its operating companies shall not maintain, remove or perform any work whatsoever on the energy conservation measures installed. Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have consented for Contractor to install the proposed energy conservation measures. Customer agrees that it shall not hold RISE, the Utility, their affiliates or operating companies liable for Contractor's to perform its obligations under this agreement, for failure of the energy conservation measures to function, for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 13. LIMITED TIME OFFER. The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy Services Program offers. 14. CONTRACT CANCELLATION Under Massachusetts law, you may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or a branch thereof, provided you notify the seller In writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement Mass Save Planview Diagram Customer r ►Q�,.,��,r j ��na Advisor Name:-��`� Address l`ln-ese.►mow} l Advisor Number: Town nl� Aru(o�ei Any limitations to access by truck? Site ID —4z 3 Y AP NOTES )�►hrs Ali -A4z r xI•zs- T2� �� — 2, k3 1 2 -Doge /rte J (� 7u.-m;►t - LVia Li oG ,z r 3 �,l 3 e e a • flI4 • o 37- 0 D '6 Q it t2 2L -C3) •v • IL n MR K,p V5 vj p 6