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HomeMy WebLinkAboutBuilding Permit #1026-2016 - 18 WILLIAM STREET 3/30/2016 NORTH BUILDING PERMIT OF�tLeo b�'1p TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION � 1 e Permit No#: �b Uo 2-C,t/ Date Received Date Issued: O� I� SgACHUSf IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 1 100 Year Structure yes no MAP C) �O PARCEL: W4t ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Buildingne family ❑Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other -Septic ❑1Nell ❑ Floodplain KI`Weti n;ds ❑ Watershed ®�stnctf. DESCRIPTION OF WORK TO BE PERFORMED: Identilic tion- Please ype or Print Clearly OWNER: Name: Phone:�7 Address: FE ontractor Name: Phone:mail:416 I Address: 116 Supervisor's Construction License:_=�`j c'C�~t , Exp. Date: Home Improvement License: Exp. Date: 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: $ 11/R&,. �)'�( _ FEE: $ 136 — Check 36 "—Check No.: �ZZ-15 Receipt No.: -5�) NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund K=ature -_ _ F 4 fi J 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 Gonservation Decision: Comments Water& Sewer Connection/SDriveway Permit DPW Town Engineer: Signature: n cy t -• } rv. Located 384 Osgood Street FIRE DEPAR=TMEN{T j Fern aFW , � �_ .� ,� TempDumpster on,tear,yes� tom : n dziNted at"l 4�MaintStreet} �--Y_•;5,� c. µ�, �' rR 1 i w'°; �r",r sti, Fire Department si a t � Fs�r gnture/date�,,� �t �♦ f �{' +,�k.1 rl � .� ���. �-�'� � i u�+ +`t•° + '.t�'v`1t`.F_;" 'Ey-r�.r "" r-`_ n.. .,r7j} f � } ..� r /:tri . I < , < i� {[ •i'1 COMMENTS'' A" Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$1oo-$1000 fine NOTES and DATA.-- (For department use) Ll Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit Revised 2014 r 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 4. Building Permit Application 4. 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) i6 Building Permit Application 4 Certified Proposed Plot Plan 4. 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) iLCopy 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 Doe:Building Permit Revised 2014 r Location No.J 'L • r • • TOWN OF NORTH ANDOVER '! A Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ r TOTAL $ Check# L Building Inspector r 1 NORT1j . W. .. . E ic . . ve, O No. A0 C, h ver, Mass, �( , > I T o LAN. .�. A- COCNICHI WICK 7,45 RATED U BOARD OF HEALTH Food/Kitchen PERN11T D Septic System THIS CERTIFIES THAT ........ N d 1 BUILDING INSPECTOR ............ . Foundation has permission to erect .......................... buildings on .I. ....U.'o A..R.AR�s.............................. t.......*........ e Rough to be occupied as ... .. ... ...awvsftA,...Loftlko�. .... ........ 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 CONSTRUCTION ST S Rough Service .............................. .. ..... ........................... UILDING INSPECTOR Final 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 10# RISE Engineering RI ContractorRegtstratlon No 906'ISE MA Contractor Registration No A division of Thieisch Engineering CT Contractor Registration No ENGINEERING 60 Shawmat Unit#2,Canton,MA CONTRACT TT (401)784-3700 i•AX(401)784-3710 Page 9 PROGRAM 77� CM-HES �earseaeaoaron�ecvareM¢areawo+ncA9 � ohaOM=SIEcow ctuTOMea _ IsdorE cLeNTr woax omaRobert Lundyrrr, i � (978)80?-3432 02116/2016 428272 00002 saawcE sTrWEr ... ertuNo eraser 18 Williams Street 18 Williams Street j ' SERVICE CITY,STATE,VP SWUNG CITY,STATE,ZIP Notch Andover,MA 0LNorth Andover,MA 01845 JOB DESCRIPTION F AIR SEALING:Provide labor and materials to seal areas of your home against wasteftd,excess air leakage. This work willhe performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a heaithibl air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary area for sealing include air leakage to attics,basements,attached garages and other unhealed arms(windows are not generally addressed.)This will require(1)working hours.A reduction in cubic feet per minute(efm)of air infiltration will occur,but the actual number of cfm is not guaranteed. j At the completion of the wweatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-ctmtractar to ensure the safety of the indoor air quality. $85.00 BASEMENT FLOOR CEMENT MUST BE POURED BEFORE 1NSULAMON S0.00 DUCT SEALING:Provide labor and materials to seal heating and/or coding ducts within designated unheated arra. This work will be performed at the rate ofS75 per man per hour,which includes materials. (3)working hours. $225.00 SLOPES:Provide tabor and materials to install a 6"layer of R-21 Class I Cellulose added to(14)square feet of slope area Wberever possible baffles will be installed to the entire length of each bay to maintain ventilation space. $26.04 KNEEWALLS:Provide labor and materials to install R-13 faced fiberglass to(137)square feet of knetwali.Then install 2"rigid board insulation.Seal all scams with FSK tape. $500.05 KNEEWALL FLOOR:Provide labor and materials to install a 14"layer of R-49 Class I Cellulose added to(I5)square/bet ofopen kneewall floor. $22..80 ATTIC ACCESS:Provide labor and materials to install(1) new,finished plywood,kneewall space access hatch.The hatch will be insulated with code compliant 2"rigid TThennax board,weather-stripped,and held closed by eye books. (Wood surfaces will be ) unfinished. Prime cost and/or paint is not included.) $120.00 ATTIC ACCESS:Provide labor and materials to insulate(1) back of the knecivail hatch with 2"rigid TThermax board,and seal the edge of the hatch with weatherstripping. $60.00 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 75eA incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to the first$010 and an additional$340 ifsavings arejustified 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 foil assessment of the combustion safety of your heating system and water beater.This has a value of$90 and is at no cost to you. Total allowable weatherizaton incentive is 53,110. 590.00 tl i i I jl Federal 10# RISE Engineering RI Contractor Registration No NIA Registration NoRIS A division ofThicisch Enginering CT Contractor Registration f No # ENGINEERING 60 Shawtnut Unit#2,Canton,AtA CONTRACT (401)784-3700 FAX(401)784-3710 Page 2 PROGRAM 710 wEN NSECMA'HES EM(QDCROENRTWRANTwMpOMER6WaRR AS OESCIUM MOW CUSTOMER PHONE PHONE DATE CLIENTS WORK ORDER Robert Lundy (978)807-3432 02/16/2016 428272 00002 SERVICE STREET BR.LE7G atREET 18 Williams Street 18 Williams Street a SERVICE CITY,STATE.ZIP MUM CITY,STATE,LP _,... North Andover,NIA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $1,128.89 d Program Incentive: $946.67 Customer Total: $182.22 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS FOR THE SUM OF j z ***One Hundred Eighty Two&221100 Dollars $182.22 i UPON FINAL NOMCTION AND APPROVAL 6Y RISE ENGUMMUNG.CUSTOMER AGREES TO REMIT MOUNT DUE IN VU"—INTEREST OF t%V AL BE CHARGED MONTHLY ON ANY UNPAW"LANCE AFTER SS DAYS.SIE 963410RSErtOR UWORTAMT RIFORMATION ON OUNWMES,RIGHTS OF RECUPON.SCHEDULING,AND CONTRACTOR REMYRATNON. 00 NOT SIGN THIS CONTRACT IF THERE ANY BLANK SPAI;qS AUTHORMRO SIGNATURE.RIFE&W"#t rg CIA 1 (0NOTE:TARS CONTRACT MAY eE WITHDRNYN BY US IF NOT EXECUTED WRMN DATE OF ACCEPTANCE i 3 ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AM CONDITIONS ARE DAYS. SATMACTOAY TO US AND ARE HEREBY ACCEPTEM YOU ARE AUTHORREO TO aO THE WORK I AS SPECIFIED.PAYMENT WLL BE MADE AS OVnAEO ABOVE 3 £pI F S I V VU 1 91 I { i The Commonwealth of Massachusetts Print Form �_.._._......._.........................__._.__..._ " - Department of Industrial Accidents Office of Investigations 1 ' ' 1 Congress Street, Suite 100 —' Boston MA 02114-2017 = <- www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 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. ❑ I am a general contractor and I employees (full and/or part-time). * have hired the sub-contractors 7. New construction ❑ 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition and have workers' working for me in any capacity. employees9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 1011 Electrical repairs or additions ,.❑ I am a homeowner doing all work ofhave exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] t c. 152, §§'1(4), and we have no Weatherization employees. [No workers' 1�• ✓❑ Other comp. insurance required.] Any applicant that checks box#I must also fill out the section below showing their workers*compensation policy infiormation. 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 ol'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 employer that is providing workers'compensation insurance for my emph vees. Below is the policy and job site information. Insurance Company Name: ACE American Insurance Company Policy #or Self-ins. Lic. #:WLRC 48151553 Expiration Date:6/30/2016 / L/ Job Site Address: �_�W ��'� 1 Q�l(YL�_ � City/State/Zip:x�l 4 A/ `� 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 Investigations of the DIA for insurance coverage verification. I do hereby certify under the pains and penalties of erjury that the information provided above is true and correct. Si nature: Date: Phone#:603-324-1974 Oficial use only. Do not write in 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#: A DATE(Mil9/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE 06/242015 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 BETINEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER- IMPORTANT,— If the certificate holder is an ADDITIONAL TNSURED, 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 CONTACTm NAME' a Aon Risk Services central, Inc. Southfield MI Office acNno.Ex,). (866) 763-7122 FAx (S00) 363-0105 3000 Town Center lac.Ne.): — E-MAIL Suite 3000 ADDRESS: -FSouthfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC:. INSURED INSURER A Old Republic Insurance Company 241,7 0Build Corn- 260 Jimmy ann Drive INSURER ACE American Insurance Company 72667 6 Daytona Beach FL 32114 USA INSURER ACE Fire underwriters Insurance Co. 20702 INSURER O' INSURER E. INSURER F: COVERAGES CERTIFICATE NUMBER: 570058348882 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 S I OL CYc I O C cX LTR IVSD 1MVD POLICY NUMBER MrtvDD/YV1'Y (R9 h7/DDlYY1'YI LIMITS A X COM.MERCIALGENERAL LIABILITY M1,127304834 06/3 1 1J I Ub/3U/201bjEACH OCCURRENCE $2,000,000 CLAIMS-MADE X❑OCCUP. DAMAGE O N D $2,ODO,000 PRE MISc5 Ea occurtence) MED EXP(Any one person) 375,000 PERSONAL S ADV INJURY S2,000,0001 ©� GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE S4,000,0001m X POLICY ❑JECT PR0. E]101PRODUCTS-COMP/OPAGG $4,OOD,000 m OTHER.: 0 A AUTON.OBILE LIABILJTY MIT1B 304835 06/30/20151?6/30/20261 COMBINED SINGLE LIMIT (Ea a—denn 55,00D,0001 ANY AUTO BODILY INJURY(Per person) O Z ALL OWNED SCHEDULc'D BODILY INJURY(Per amdent) d AUTOS AUTOS X HIRE[)AUTOS X NON-OWNED PROPERTY DAMAGE U AUTOS Per acndenl) — 4UMS,RELLA LIAB OCC UP, EACH OCCURrENCE CJLIAR CLAIMS-MADE AGGREGATE P.ETENTION B WORKERS COMPENSATION AND WLRC48251553 06/30/2015 06/30/2016 PER OTH- EMPLOYERS'LIABILITY IN � All Other states � BTATUTF ER O ANY PROPRIETOR/PARTNER r EXECUTIVE ACCIDENT NT N H. � S1,000,000 OFFICEPJMENIBEREXCLUDEO> ❑ N/A SCFC4835290 06/30/2015 06/30/7016 E L EACH. (Mandatory in NH) WI Onl If yes,descnoe E L.DISEASE-EA EMPLOYEE 51,000,000 under y DESCRIPTION OF OPERA71ONS below E L.DISEASE-POLICY LIMIT 11,000,000— I ESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORO 101,Additional P.,—k,Schedule,may be attached d morn space is repuued) vidence Of Coverage .T JJ RTIFICATE HOLDER CANCELLATION SHOULD ANY OF�IEOIN RIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE WILL BE DELIVERED IN ACCORDANCE WITH THEPOIICY PROVISIONS ¢tea Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE a.r� A TopBuild Company 260 _jimmy Ann Drive Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD _!s ft e o Cors-inner rv_'airs the Business f�eLr fation 10 Park ' in 5170 ruS10-n Tv'j ssanc usetts 021116 211v Regisiraiion: 179141 Type: Supplement Card Expiration 6/2512D16 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 I:l dwe Address;and return carr!.1larh reason for change. �dci.*ess Eteeaes+a, Ernp ;)mm IOU ( ard >3'11cr cif('o nsumer APNA cti Business Rt'--u121ivn I_icrnse or r eristrution valid for intiividul use onlj HOPAE IMPROVEMENT CCNTR.ACTOR hefure the expiration date. If found return to: Office of Consumer AfTairs and Business RegLlaiitm registration: 17 141 Type r PlazL c Expiration: 61,5/2016 Supplement Lard Foston.NIA 02 116 UILDER SERVICES CROUP, INC. IC!.k.RD SCH,,tJARTZ � 0 JNMY .T• Jt!!VE L: y— —41 r , ' A,YTON+.BEACH. FL 321 - �,. :'ntic°r:zcr:;ar Not vnr_n;thnm signature i i ((! 1 ,Q,11.1,.1;��n ',u ii�•n li,,, `its, �,!f� `si, i bulcttecfc•r NII (1310). 0.412612016 I 1!`Sttir,Qr:ct T�. C:55L-tC-InsulalitFn Cantractnr ilttrt to possess a current edition of tFle f�tassachusettt ace flilduig,Cade is cause fot'irvocatinn of tttl5 licrrlstt. ..__..........