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HomeMy WebLinkAboutBuilding Permit #346-2017 - 18 STEVENS STREET 9/30/2016 BUILDING PERMIT �^ of NORry q I .fit LED b TOWN OF NORTH ANDOVER =a APPLICATION FOR PLAN EXAMINATION A K 1� Permit No#: D/� Date Received �� l �R 0 \TED (5 gSS•gcHus�•c Date Issued: a ` 3 (r IMPORTANT: Applicant must complete all items on this page LOCATION 1% sk- WEAS sk-r -k Print PROPERTY OWNER 120n CI UsS Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village 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 _ �❑ Floo�dp�lainn �®'�Wefl'an - `�i �`�Water,•sf e �is ric„�- , � s R . _, DESCRIPTION OF WORK TO BE PERFORMED: '� it1 0�l- ba Celli ba o� o�hL oo In �nAaft6 .c,,c h WalinqA4A b Identification- Please Type or Print Clearly OWNER: Name: Donald R-oSs Phone: ((o11)(Pq'7 -99 1 ., Address: I$ OVtx- HA QMS'S Contractor Name: NkbJlQUA S" Phone: (MV) 382- 2081 Email: comti Address: 90 SOx (e� 1 F Manc tkeske r IJK o3toss Supervisor's Construction License: i i 00tA t Exp. Date: ZoA R Home Improvement License: M-100— Exp. Date: '712-11 t ARCHITECT/ENGINEER Phone: i a Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 14%. us FEE: $ Check No.: �L® C) Receipt No.: 3 0!9 —7 NOTE: Persons contracting with unregistered contractors do not have access to the ara fund Mans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped flans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanaing/Massage/Body Art ❑ Swinn ing pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank, etc. ❑ Permanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING a DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS .. a HEALTH , : w; Reviewed onSignature COMMENTS r � ' Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes P,�anning Board Decision:' Comments ,t° I Conservation Decision: Comments Water & Sewer Connection/s►gnafiure Date Driveway Permit DPW Town Engineer: Signature: Located' 384 Osgood Street FIS DEPARoT'MEN ;�empjDum ,stet onsite : Locate12it .4 IVIa Strx ' �, ' ' A r . . g tiS.�-n; � o r ; ., - FirelDepartmentasignature/date . `r. t M fwv�-fr�.l ..r -�y:. _ i�r," N•.. 1 �':��r...` ` .� ;�,t 3 �.i wrt'S t .a-�.e.- •:4�� �'.�q�:t:��: �'t+i ^s�R�.',,a`�t+ '. ,. .' '3�,' ` r NTS COMIVIE I 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) LI 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 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 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 46 2012 IECC Energy code 4 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 Location Cf 3 Q (9- No. 90/6No. 34 /( 0/ 7 Date "7 `-3d - gal • • TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee - l Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#a O 0 30976 Building Inspector Town ofndover No. Zb h ver, Mass, 0 30M COCHIC041WIC � V as RATEO A'P�,�'(5 U BOARD OF HEALTH Food/Kitchen . PERMIT T D Septic System THIS CERTIFIES THAT I.C.. *. r.....................� .... ..................... BUILDING INSPECTOR .. . ............................... ............. .. Foundation has permission to erect .......................... buildings on ......�.T..... �.v .�.......'.•.ST Rough . ..t. # `. to be occupied as ................ .......... . ........... .................................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final .PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TA Rough CService ........... . ............... . ... ................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough t 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. The Commonwealth ofMassaehusetts .hep arttnent of Industrial Accidents I Congress Street,Suite 100 4 Boston,MA 02114-2017 www.mass go 1di a Workers'Compensation Insurance Affidavit:General Businesses. TO BE TILED NviTo TaE f'ERmrrnNG.AUTHORITY. Applicant Information Please Print Legibly. BusinesstOrganizatiort Name:Mill City Energy Address:PO Box 6411 City/State/Zip:Manchester,NH 03108 Phone#.,603-391-'792.3 Are you an,employer?Check the appropriate.box: Business Type(required): 110 I am a employer with i2` employees(frill and/ 5. ❑Keta l or part-time)-* 6. n Pestaurant/BarlEatina Establishinent 2.0 1 am a sole proprietor or partnership and:have no 7. Offtce.and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] S. Non-profit 3.[2 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*' Il Health Gare 4.n We are a non-profit organization,staffed by volunteers, with:no employees.[[co workers'comp.insurance req.) I2. Other_ W W4"!A oy\ #Any applicant that checks box 41 must also fill out the section bolo-A twt ng their workers'compensation policy information. "If the corporate officers have exempted thernscives,but the corporation has'other employees_a workers'compensation policy is required and such an organization should check boxttl. I am an employer that is Prov&ng workerscompensation insurance far my, employees, ,Below is the policy hiformation. Insurance Company Name:Clark Insurance Insurer's Address One Sundial Avenue Suite 302N City/StatManchester,NH 03102 Policy#or Self-ins.Lic.#MI=791896 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 ane-year imprisonment,as v epi 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-maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification., I do hereby certify,it ins andpenalfies of perjury.tligt the information provider(above is true and carred Si ature: Date: :Phone#:603-396-7520 Official use only. IM not write in this area,to be completed by city or tmvn official City or Town: Permit/License# Issuing Authority(circle one): t.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office b.Other Contact'Person: Phone#: w%vw.mass.gavtdia i MILLCITY-1 AGOULD ACORO' DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 7/19/2016 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(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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). NTACT PRODUCER License#AGR8150 NAME: Clark Insurance PHONE 603 622-2855 AX No; 603 622-2854 One Sundial Ave Suite 302N LAIC,No Etl: ) ( ) Manchester,NH 03102 E-MAIL ADDRESS:agould@clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Mutual Insurance Co 17000 INSURED INSURER B:AITIGUard Ins co 43290 Mill City Energy INSURERC: 106 Joseph St PO BOX 6411 INSURER D 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 TYPE OF INSURANCE AD L S BR POLICY EFF POLICY EXP LIMBS LTR INSR MND POLICY NUMBER MM/DD M/DD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE �OCCUR 8500065735 04/29/2016 04/29/2017 DAMAGE O RENTED-PREMISES E T D occu300,000 PREMISES Ea—mance) $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident , A X ANY AUTO 1020050919 04129/2016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS X X NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION X PER AND EMPLOYERS'LIABILITY STATUTE I I ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N MIWC791896 04/2912016 04/2912017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N❑ N/A (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 I VEHICLES (ACORD 101,Additional Remarks Schedule,may be 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(2014101) The ACORD name and logo are registered marks of ACORD 51 N- RISE 60 S -502-6335 hawmut Road,Unit 2.j Canton,MAl2l21 (33s ENGINEERING www.-RISEengineering.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: 6D rR [E (Property Address) =EO 'v (Property Address)) hereby authorize., (Subcontracto 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. Ther Permit will be secpred 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. Owners Signature Date 62016 Rco I q6 Federal 10 it 05-0405629 86 RISE Engineering MA ContraRl car Reglag'sst ar R tlo'onn lio 1 0979 CT Contractor Registration No RISE� - 00 in (toad.Canton.NIAENGINEEMCONTRACT Cr (401)7S4J700 ';tX(401)7$d-3710 Page 1 PROGRAM TH:CONTRACT C3 ENTERED INTO BETWEEN ME -' CMA-11ES EWINEERINGAND THE CUSTOMERFOR WORK As t DESCRtaEO BELOW PHONE .. _. .._ .DATE' - CLIENT! WORK ORDER CDSTOMER Donaid Ross 4t � � c��i� � (617)697-998F 09/2012016 439014 35002 SERVICE STREET ... i } �.}i •- BIWNG STREET ... ,s 18 Stevens Street ` 18'Stevens Street vu -SERVICE crtr,sTATE.ZIP.. T 81LLiN0'CITY,STATE,ZIP North Andover,MAO 1 45- North Andover,MA 0 1845- JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home aeainst wasteful.excess air leakage: This work will be performed in concertwith the use of special tools and diagnostic tests to.assure that your home will be left with a healthful level of air exehange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for soiling include air leakage to attics,basements,attached garages and other unheated areas twindows are not gencrully addressed.) ?Itis will require(2)working hours.A reduction in cubic fast Per minute(cfm)of air infiltration will occur;but the acetal number of cfm is not guaranteed: At the completion of the weathcrizmion Avork,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis still be conducted by the sub-contractor to ensure the safety of the indoor air quality. $170.00 ATTIC ACCESS:Provide labor and materials to insulate the back of the attic door with 2"rigid Thermax board and seal the door's edge with%veadtetsttippine to restrict air leakage. $73.91 tiEN-MM ION:Provide labor and materials to install t 1)insulated exhaust hose with gable wall mounted flapper vent to exhaust existing bathroom fan(s). $118.75 VENTil-ATION:Provide labor and materials to install(1)insulated c-,baust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). 5118.75 BASEM, r\T CEILING:Pax•idc labor and materials to install(60)linear feet of R-19 unfaced f turglass insulation to the perimeter of tate basement ceiling at the house sill S105.00 BAS I EENT 1700RAIrovide labor and materials to insulate the back ofthe basement door leading to the bulkhead with 2"rigid board that meets the sections R-316.5.E and 316.6 requirements of huilding code. Seal all edges and scams with FSK tape. 572.22 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only:tn:billed the Net amount C'urruntiv. for eligible measures,Columbia Cas offers 7S°lo incentive.not to exceed 52000 per calendar year,and an incentive of 100%for the Air Scalina measures up to the tint$680 and an additional$340 if savings are justified by the auditor. For the safety and health of your homes indoor air quality,tvc will be conducting:a blower door diagnostic of the available air tlott in your home both before the work is begun,and after the weatheriaation work is complete.We%vial also c«nduct a full assessment of the combustion safety of your heating system and gate,heater.This has a value of S90 and is at no cost to♦ou. Total allowable weatherizalion incentive is 53,110. SWAG 1 i I Federal ID 0 05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 CT Contractor Registration No RISIN60 Shminut!fond.Cal►t►m.11\ING CONTRACT (401)784-3"+00 1-'AX(401)71141-3710 Page 2 PROGRAM TNtS CONTRACT IS ENTERED IMO BETWEEN RISE CMA-Ii ES SWINEERWO AND THE CUSTOMER FOR WORK AS DLSCRIOED OELOW CUSTOMER ... _ 'PHONE' DATE- WENT.9 YIORK ORDER Donald Ross (617)697-9981 09/20%016 439014 35002 SERVICE STREET .._ _ ... 0.111N6 STREET 18 Stevens Street 18 Stevens Street SERVICE CITY.OTATE,ZIP DIUJNO CRY.STAMZU' North Andover;MA 01845- North Andover.MA 01845- JOB DESCRIPTION Total: $748.63 Program Incentive: $626.47 Customer Total: $122.46 WE AGREE HEREBY TO FURNISH SERVICES-COMPLEM IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "*One Hundred Twenty-Two&16/100;Dollars $122.16 UPON FRNAL TNSPEC7ION AND APPROVAL BY RISE ENGINEERING.:CUSTOMER AGREES TO RUVTAMOUM DUE IN FULL INTEREST OF n VALL BE CHARGED MONMY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEEREVERSE FOR PAPORTANT INFORMATION ON GUARANTM,ft!ON_B OF REGSION.Sd1EDUUNO,AND CONTRACTOR REGCJTRATRNR. - Do NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES ~� AUTriO�f3EDSKIIJATURE-RISE EnpneeAnS [USTOtmm ACCT$TA`ci NOTE:THIS CONTRACT MAY BE V=HCRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE- f\ C/• f o) ACCEPTANCE OF CONTRACT..THE ABOVE PRICES.SPECIFICATIONS AND CON121IOUS ARE 3 SAMfACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORMW TO 00 THE(YORK DAYS, AS SPECIFIED,PAYMEUT WALL BE MADE AS OUTLINED ABOVE cu X016 4 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:CS410041 less thart 35,000 cubic feet(991 cubic meters)of Construction Supervisor enclosed space. MICHAEL JOY . 106 JOSEPH STREET MANCHESTER NH 03102 �`.. Fallure tv possess a current edition of the Massachusetts �'J^ Expiration: State Buildirg Corte is cause for revocation of this license. Commissioner. 08/07/2019. DPS licensing information visit:WWW.M1 SS.00VIDPS 1 r,OwMelPfeN*MAli r ;? `�•ruac r#sc' !<leense or registration t olid fit for n "rvtti s use a Ofric+trrrCnaramerAfPitfirst#1# etsR Istiaaidt, OME tMPROVEMENT CONTRACTOR before the expiration date- If found return to: Collin of Consumer Affairs and Rusinfts Regulation i egistrafian; t8Z7fi2 Typo: x<ptrtition: 7&U21317 LLC .40 Park Plaza-Suite 5170 Roston,;f A 02116 MILL 61Y ENERG ,LLC; MV iAEL JOY 106 JOSEPH STREET, MANCHESTER,UK 03102 AYl\.� —N' tlttdcr+�crrtar}� vat tits,vafhaisrc