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HomeMy WebLinkAboutBuilding Permit #697-2017 - 18 CHESTNUT COURT 1/6/2017�I1 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION'-- Date Received TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building )(One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial YRepair, replacement 0 Assessory Bldg ❑ Others: ❑ Demolition 0 Other ❑ Septic ' 0 Well D Floodplain Wetlands. Watershed ®strict ❑_Water/Sewer, DESCRIPTION OF WORK TO BE PERFORMED: i SuAa td "h"P hose- 4 exish• b An'; WWI ymblahski ehu f^cs M r4&4'- 10�5 Identification - Please Type or Print Clearly OWNER: Name: 5WIMftr Folling Phone: (q74 687 -1663 Address: Contractor Name �tdcl�a Jo Phone= i3$Z—ar7 Address:,: FO fax -.641(1Hula4.3-6+— -NH-6316$ Supervisor's Construction L'icense__ (..POOH (.._ .Exp. Date: _ -$ 17 L`2o1 1). _ Hom0.1hn, ,, ent License -x E-Date l ARCHITECT/ENGINEER Address: Phone: FEE SCHEDULE: BULDING PERMIT. $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COSTBASED ON $125.00 PER S.F. ;Total Project Cost: $ "T &–I. 21 FEE: t — Check No.: 2 2-1 Receipt No.:- NOTE: o. NOTE: Persons contracting widt unregistered contractors do not have: access to the Yvan fund 5ignatu�e_of^AgenI , wrier -- Signature of contractor; i Check # aol ounuing/rrame rermit I-ee $ }c Foundation Permit Fee $ Other Permit Fee $ TOTAL $ :..: - � Bui 'ng Inspe Building Inspector r 31411;. r Y -, rev'.... . ... .. .. . ... -:.. .,.. .._ ..- .- _ .,. .. - t Plans Subimitted ❑ Plans Waived El Certified Plot Plan ❑ Stamped Plans ❑ .-TypF 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 COMMENTS CONSERVATION COMMENTS HEALTH COMMENTS Signature Reviewed on Signature Reviewed on Signature Zc'hing 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: Located M4 Usgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate COMM€NT,--=�a. -imension I 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 lies No - DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine 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. r 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 aC L -- - o Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: 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 L rA rA cl I O = O O fn t Y a O 0 LL E ��+ y Q cu N N ? C7 Z m C 7 LCL z 0 d' E :EC U LL O N Z J a CL' LL O N Z a V W W 3 d' U > L/) m LL D: 0 a Z •�' CC LL Z ui a W LL ` CO Z v N O N E L 4) CL MA U) 0 C cm d an m O cn C ._ O N d t O Z O Q J 0 O LU V z 0 0 ncc Z a� ma m z L o = O@ (� L Q' J d _ > 0 yaD o=_mo ti 0 "a 0 0 V Q m 6 0 Z -O �• CL _ N C A.2 �• 0 'QC.a, Cc> r- 0 r C • Q ai � Ny0, R d •2 uj W_ IL .0 -0 o O O N C Ae .2 W U V V CJ 0 = i 010 N Q. N m �. O • — N -0 0 "= _ E L 4) CL MA U) 0 C cm d an m O cn C ._ O N d t O Z O Q J 0 W az W 0 _U) Lu LU a z `IV 2 E z .E L i C d U m w O LU z Z m z W az W 0 _U) Lu LU a z `IV 2 E z .E L i C d U m w I r_� L f 6 7th Federal ID # 05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 R A division of Thielsch Engineering CT Contractor Registration No 620120 ENGINEERING 60 Shawmut, Canton, MA 02021 CONTRACT 339-502-5197 FAX 339-502-6345 Page 1 PROGRAM ... WTO 8ET%VM FUS CMA -HES EEM �TIMCU ToOMERFORWOMAAs DESCRIM SEIOW CUSTOMER PHONE DATE CUENTA WORK ORDER Jennifer Pollina-+'\t�} (978)687-1063 01/19/2016 427962 00002 SERVICE STREET &WNG STREET 18 Chestnut Court r__1 18 Chestnut Court N SERVICE CnY, STATE, ZIP a� SIWNG CITY, STATE, ZIP North Andover, MA 01845 North Andover, MA 01845 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 (8) working hours. A reduction in cubic feet per minute (cfm) of air infiltration will occur, but the 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. $680.00 AIR SEALING ADDER: (4) working hours. $340.00 AIR SEALING: Provide labor and materials to install Q -Ion weatherstripping and a doorswecp to (3) door(s) to restrict air leakage. $225.00 DAMMING: Provide labor and materials to install a 12" layer of R-38 unfaced fiberglass baits to (42) square feet for damming purposes. $86.10 ATTIC FLAT: Provide labor and materials to install a 10" layer of R-35 Class 1 Cellulose added to (1040) square feet of open attic space. $1,528.80 ATTIC FLAT: Provide labor and materials to install a 13" layer of R45 Class 1 Cellulose added to(184) square feet of open attic space. $299.92 ATTIC FLAT: Provide labor and materials to install a 14" layer of R49 Class 1 Cellulose added to (96) square feet of open attic space. $162.24 ATTIC ACCESS: Provide labor and materials to 'install (1) easily moved, insulating cover for the attic access folding stair. A small flat surface of plywood will be created around the opening within the attic. This will allow the cover's integral weather-stripping to restrict air leakage. $237.65 VENTILATION: Provide labor and materials to install (2) insulated exhaust hose with roof mounted flapper vent to exhaust future bathroom fan(s). $237.50 VENTILATION: Provide labor and materials to install ventilation chutes in (I 11) rafter bays to maintain air flow. $222.00 COMMON WALLS: Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to (I I8) square feet of common wall area $413.00 BASEMENT CEILING: Provide labor and materials to install (140) linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $245.00 Federal 10 # 05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RISE A division of Thieisch Engineering CT Contractor Registration No 620120 ENGINEERING 60 Shawmut, Canton, MA 02021 CONTRACT 339-502-5197 FAX 339-502-6345 v v Page 2 PROGRAM THIS CONTRACT CMA-HES OE9WMANDp CUSTOMER INTaF•e OR WORKAS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT r WORK ORDER Jennifer Pollina (978)687-1063 01/19/2016 427962 00002 SERVICE STREET BSAJUG STREET 18 Chestnut Court 18 Chestnut Court SERVICE CITY, STATE, ZIP sl uNG erTY, STATE, ZIP North Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION 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 1001/o for the Air Scaling measures up to the first $680 and an additional $340 if savings are justified by the auditor. For the safety and health of your homes 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. $90.00 D - OCT 2 4 2016 Total: $4,767.21 Program Incentive: $3,110.00 Customer Total: $1,657.21 WE AGREE HEREBY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE SUM OF ***One Thousand Six Hundred Fifty -Seven & 211100 Dollars $1,657.21 UPON FOAL INSPECTION AND APPROVAL BY RISE ENGINEEFUNG. CUSTOMER AGREES TO REMIT AMOUNT DUE O FULL INTEREST OF 1% Wal BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFVA,30 DAYS. SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES, RIGHTS OF RECISION, SCHEDULING, AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BANK SPACES AUTHORED SIGNATURE -RISE Engkrri�p ACCEPT NOTE: THIS CONTRACT MAY BE WRHDRAWN BY US IF NOT EXECUTED WTTHO DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT -THE ABOVE PRICES. SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. SAMFACTORY TO US AND ARE HEREBY ACCEPTED. YOU ARE AUTHOR2ED TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED ABOVE RISS60 Shawmut Road, Unit 2 j Canton, MA 02021 (339-502.6335 ENGINEERING www.MSEengineering.com ro N C7 G7'3 OWNER AUTHORIZATION FORM 1 Jennifer Pollina (Owner's Name) owner of the property located at: 18 Chestnut Court, North Andover, MA (Property Address) (Property Address) hereby authorize an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. 0 ner's Sig tore /0// Dat The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street, Suite 100 Boston, MA 02114-2017 'r www mass.govldia Workers' Compensation Insurance Affidavit: General Businesses. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Business/Organization Name:.Mill City Energy Address: PO Box 6411 City/State/Zip: Manchester, NH 0310$ Phone #. 603-391-7923 Are you an employer? Check the appropriate box: Business Type (required): I -El I am a employer with 12 employees (full and/ 5. 0 Retail or part-time).* 6. E]Restaurant/BarlEating Establishment 2.0 I am a sole proprietor or partnership and have no 7. E] Office and/or Sales (incl. real estate, auto, etc.) employees working for me in any capacity. [No workers' comp. insurance required] �• Nan -profit 3.0 We are a corporation and its officers have exercised 9. 0 Entertainment their right of exemption per c. 152, § 1(4), and we have 10.0 Manufacturing no employees. [No workers' comp. insurance required]* 4. E] We are a non-profit organization, staffed by volunteers, 1 I.0 Health Care L with no employees. [No workers' comp. insurance req.] 12.0 Other 'Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. "If the corporate officers havc exempted themselves, but the corporation has other employccs, a workers' compensation policy is required and such an organization should check box 91. I am an employer that is providing workers' compensation Insurance for my employees. Below is the policy information. Insurance Company Name: Clark Insurance Insurer's Address: One Sundial Avenue Suite 302N City/StatetZip: 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 tine up to $1,500.00 and/or one-year imprisonment, as well as civil penalties in the form of 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 Itereby certify, u0#14roins and penalties of perjury that the infomration provided above is true and correct. 603-396-7520 Official use only. Do not write in this area, to be completed by city or town of ciaL City or Town: PermitiLicense # 1- U410-11 Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. CityfTown Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact www.mass.gov/dia Phone#: MILLCITY-1 AGOULD ACORO® CERTIFICATE OF LIABILITY INSURANCE DAT YY) 7//191201619/2016 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 Clark Insurance One Sundial Ave Suite 302N Manchester, NH 03102 CONTACT NAME: PHONE 603 622-2855 ac Nc : 603 622-2854 A/c No Edl.. ( ) ) E-MADDRESS: agould@clarkinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # 04/29/2016 INSURER A: Arbeila Mutual Insurance Co 17000 EACH OCCURRENCE $ 1,000,000 INSURED INSURER 8: AmGuard Ins co 43290 Mill City Energy 106 Joseph St PO Box 6411 INSURER C : INSURER D: INSURER E: Manchester, NH 03102 INSURER F: A 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 CONTRACTOR 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, INTR TYPE OF INSURANCE IN U SR POLICY NUMBER POLICY D EFF PWDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE OCCUR 8500065735 04/29/2016 04/29/2017 EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTEff__ PREMISES Ea ocWrrence $ 300,000 MED EXP (Any one person) $ 5,00 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY 7 PJECTRO• ❑ LOC OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS -COMP/OPAGG $ 2,000,000 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS X NON -OWNED HIRED AUTOS AUTOS 1020050919 04/29/2016 04/29/2017 COMBINED SINGLE LIMIT Ea accident $ 1,000,00 _ BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PeOaccidentDAMAGE $ $ A X UMBRELLA LIAB EXCESS LIAB X OCCUR CLAIMS -MADE 4600065736 04/29/2016 04/2912017 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DED I X I RETENTION $ 10,000 $ B WORKERS COMPENSATION AND EMPLOYERS' LIMILITY YIN ANY PROPRIETORIPARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N❑ (Mandatory In NH) If es, describe under DESCRIPTION OF OPERATIONS below N / A MIWC791896 04/29/2016 04129/2017 X PER OTH- STATUTE ER E.L. EACH ACCIDENT $ 500,000 E.L. DISEASE - EA EMPLOYE $ 500,00 E.L. DISEASE - POLICY LIMIT 1 $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION ACORD 26 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 ACORD 26 (2014/01) ©1988-2014 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS410041 Construction Supervisor MICHAEL JOY 106 JOSEPH STREET MANCHESTER NH 03102 �-JZOK Commissioner Construction Supervisor Restricted to: Unrestricted - Buildings of any use group which contain less than 35,000 cubic feet (991 cubic meters) of enclosed space. Failure to possess a current edition of the Massachusetts State Buildirg Code is cause for revocation of this license. DPS Licensing information visit: WINKMASS.GOVIM ,�. Y , AN ...,.:...1r/ . f/ ^`�,» v Atl, Leese or dixidut t)fi'ite or t"nosamer Aftnirs & Basebess lie�mtatloa registration vAlid for lause on t, rOME iMARt3VEMENT CONTRACTOR betore the expiration date if found return to: egistration. 182-`62 Type. Office of Consumer Affairs a a d Business Regula lion Expiration: Tt27=17 LLC 10 Pant Pizza -Supe 5170 + , ." Bosten—MA 82116 MILC Y ENERGY, LLC. MICHAEL JOY 106 JOSEPH STREET MANCHESTER, NH 03102 t.'nder�eremry NXots