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HomeMy WebLinkAboutBuilding Permit #776-2016 - 195 OLYMPIC LANE 1/4/2016Z1�i eNORTH BUILDING PERMIT ctteD -bq�c TOWN OF NORTH ANDOVER h.;,..:.:. °6 APPLICATION FOR PLAN EXAMINATION Permit No#:�'zo Date Received 4 �gSSACHU5���5 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION kCI S- CAMM& L UL�-� Print PROPERTY OWNER t -t %' 0\&<,I (f elf 6 J1^- /} Print 100 Year Structure yesnno MAP �b PARCEL: 00 ZONING DISTRICT: Historic District ye Machine Shop Village ye TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building No(5-e family D 60ition ❑ Two or more family ❑ Industrial CrA eration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: w�n... a%r S-e�tLeA', A-Ain(.;rQ , cr_twl.Uk V1 cx-kh . Identification - Please Type or Print Clearly OWNER: Name: tk' (.k Phone: 'bl 4�1. 5�a(3C) Address: k cls u Contractor Name Email: GAavJ A%% Address' IFS O tw V 4 - l y\% N%44 U I -q 3SID • 3.'83 Supervisor's Construction License: i O V� Z Exp. Date: 5 17s Home Improvement License: �i� �� 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: $ 3 3yS . 1 O FEE: $ 10`1 Check No.: Illiz Receipt No.: 2PLM NOTE: Perso s contracting with unregistered, contractors do not have access to the guaranty fund 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. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e O FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH ,0 COMMENTS Reviewed On Signature. Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planing Board Decision: Commer Conservation Decision: Comme Wafter & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea 5o4 usg000 Street DEPARTMEIVT* , .atmpDumpstyero nsite;:,YeS� Lo ated at 124 MainStce t '' �'",""° 7` fie" Departments graure d ted ,� a t, m- COMMENTS _ z. 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 Mil NNI TiL U11TE10=1901W Komi LJ Notified for pickup Call Emai Date Time Doc.Building Permit Revised 2014 Contact Name Building Departr The following is a list of the required forms to be filled out for the a Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. License: Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products 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) 4. Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products TOTE: 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 No. —710 ' 2,0 Check #A&Z Date t 4 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ "' Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector _v N� N 0 'a O CD m n Z N O Q _� e�F Q �• N O 0 CD Q j S CD CD O Go CD CD CL 0 O y. C• C � v O N n O o CDa CD O c� c c)Z. z c: 0 .ga < 0 0'a O O 2 O y:5 CD -0 VN r I m(D n . m O 0 CL C) Z 0 s N O� 7 N rt (D' O. �7 ,0�0 �0- 0 m c�D cn m W 0 y p N S.m CDCL 2 OS. � o � —DI CQ N rt O 91) O 3 � 0 W rt CD S S. CD - Q.. � O O 0 C to U3 y''� •r CD- -fi p S �D ;CL Q' N CU3 < CQ= U) Q< CD O CD a1 SCD CL N W CD CD U). -l- CO, =0: c� O O =r C O CD )�. cD ov =3r -r aCD CD M 0 �o CL V) 0 ry((D N (p W C M X m 'O m 'z T y W O . C' S C) H vZi n 0 T 3 2L VI O N :;a O S m m A N V fmi 0O T O N ;;o O C V C 3 W m -I 0 j (D S O C S O C O_ p C r- p Z N m m 0 Vl (D "O n �v (D 3 T O O n rrD 07 O D O = m 2 ISI go Federal to4OS 405629 RISE ngineeeriflg RI Contractor RegilitratioNo8186 NIA Contractor lteglstratio» Na 1209751 RiSEw A division ort"hicisch Engmeeriag CT Contractor Registration No 620120 ENGINEERING 60 Shawmut Canton, MA 02021 CONTRACT 339-502-SI97 FAX 339 -502 -&US Page Z PROGRAM TM CMA -HES u TaosTEoSETWOMM arwaotmas DEsantaE»sErow _.. CUSTOM /+DOME DATE cumll WORKORM Michael Crepeau (780439-5600 1011612015 416191 00003 SERV= STREET SILUNG STREET 195 Olympic .Lane 195 Olympic .Lane sww" c1MSTAMzw 8110IG CITY,aTAT8 M North Andover, MA 01845 'North Andover, MA 01845 JOB DESCWTION Alit SEALING: Providc labor and materials to seal areas ofyour home against wasteful, cx=s 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 hcalthful level ofair exchange and indoor air quality. Materials to bc.uscd to seal our home can include caulks, foams and other products. q Y Y p Primary areas for scaling include air /outrage to allies, basements, attached garages and other unheated areas (windows arc not generally addressed,) This will require (8) working hours. A reduction in cubic feet per minute (cf n) of air infiltration will occur, but the actual number of cfm is not guaranteed. At the completion of the weatheriration work, and at no additional cast 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 DAMMING; Provide labor and materials to install a 12" layer of R-38 unlaced fiberglass baits to (92) square reel for damming purposes. $188.60 ATTIC FLAT: Provide labor and materiels to install a 19" layer of R-35 Class I Cellulose added to (540)square feet ofopen attic space. $793.80 ATTIC ACCESS: Provide labor and materials to insulate the back of (1) attic hatch with 2" rigid'lhermax board. Wcwhcrstdp the perimeter, $60.00 ATTIC ACCESS: Provide labor and materials to install (1) new, finished plywood, kneewall space access hatch.Thc hatch will be insulated with code compliant 2' rigid Thermax board, u=dicr-stripped, and held closed by eye hoot`s. (Wood surfaces will be unt`ntished. Prime coat and/or paint is not included.) $120.00 VENTILATION': Provide labor and materials to install (2) insulated exhaust hose with roormounicd #lappa vent to exbaust future bathroom fin(s). $237.50 VENTILATION. Provide labor and materials to install ventilation chutes in (39) rafter bays to maintain air flow. 378.00 COMMON WALLS: Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to (308) square feel of common wall area. $1,076.00 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 75% incentive, not to exceed $2,000 per calendar year, and an incentive of 100°/0 ror the Air Sealing measures up to the first $680 and an additional $340 irsavings arejustified led by the auditor. For the safety and health of yourhome's indoor air quality, we will be conducting a blower door diagnostic orthe available air now 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 sarety of your heating system and water heater. This has a value of $90 and is at no cost to you. Total allowable weatheriration incentive is $3,110. $94,00 OCT 5 No Federal 10 0 (IS- dgS62S - RISE Engineei•iisg Ri ContractorRegistrationRegistration No 8186 i►1A Cotriraetar Regislrstilan No i20sT9 A division nrThieisch Engineering CT Contractor Registration No 620120 RISE"" 60 Shawrrtut; Canton, HA 02021 CONTRACT 339-502-5117 RAX 334-5024445 Page 2 PROGRAM TICS CONTRACT O WnVgM FW CMA-HESA►► c TMMW o as nEacalBEoetaaw CUSTOM .. _ PNONE OATS Curare WORKORO6R Michael Crepeau (781)439-5600 10/16/2015 416191 00003 Stown SIM! Owns armu 195 Olympic Line 195 ©lympic.Lane SERVICE CTTY.$TWMVP SUNG CM STATE ZIP North .Andover, MA 01845 North Andover, MA 01845 JOB DESCRCPTION Total: $3,323.90 Program Incentive: $2,686.93 Customer Total: $638.98 WE AGREE HEREBY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE. SUM OF ""`Six Hundred Thirty -Eight & 981100 Dollars $638.98 UPON AnAYPMACBy=aaf monc#tsunakA@REEs<Tower#t00womiiPALornwniOFi%Vuor,c ARawmo TtR.YONAw UHPAAr AF;8t�0AYS.$$REYER98PORt1EPORTALiTO&BR�TtOet�1 G11ARMlTP.Eb,RM'iNT80P REfitStOtt;SCNEDWRO,ARO CONTStAATORaEti�'CFIAtk1N. DQ_ NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHOR!1�DSiGNATTRae-ARSSngi>barinp CUSTOMER A J/ I'MM' THIS CONTRACT MAY RE WITHDRAWN BY US IFWTEXECUM WIftRN OATS OFACCEPTMICE 7 �' ACCEPTANCE OF CONTRACT-TTSS ABOYE PFW=, SPECW=TWM ARD CONMONSARE 30 DAY& SATISFACTORY TO US AND ARS HM MACCMM. YOUAREAUTftORM'I'DOOTIM YYORH AS SPECWM. PAYMWW U. $EMJU%AS OUTiAW A8M No N OWNER AUTHORIZATION FORM Michael Crepeau (Ownees Name) owner of the property located at 19,t Olympic Lane, North Andover MA 01845 (Property Address) lgOlympic Lane, North Andover MA 01845 (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. owner"s Sig t� Date The Cominoawealth ofMassachusetts Deparbnent of Industfial Accidents Office of Ingest; gadons I Congress Streo, Suite 100 fioston,JMA 02114-2017 U1W wvwxIassgovidia Workers' Compensation Insurance Affidavit- Builders/Contractors/ElectritiansMiumbers Apybeant, Information Please Print Uaft Name (Brift msnizatiortlindivi4w]): Gwb��Yr lavAlk 0-t— Addrcss: 00 Sox 344 City/State/Zio: 1vvtW;(.h M A- Oil 3 6 Phone, #: 11 --YV I T'U - 341 3 Are you an emplo.--vO Check the appropriate bum, '4pe Of prujeCt (required): 1, a I am a employer with S 4. []] am a general contractor and I employees (full andforpart-time).* have hiredthe sub -contractors 6. New constraction 1 U I am asoic prooctor or partner- listed on the anached sheet 7. Remodeting ship and have no employees Thew sins -contractors have 8. Demolition working for the in any capacity. employees and have workers' 9. Building addition [No workas' wtnp. ins"ce comp- insurance,' regsti 5, We are a Corporation and Its 10.[) Electrical repairs or additions 3. r]1 am a homeowner doing all work- officers have exercised their 11, [) Plumbing repairs oT additions tight of exemption per MGL myself [No worUrs' comp, 12,C] Roof repairs 0. 152, §1 (4), and we have no insurance w4uired.] t entployees- [No workers* 1-1 Other com, insurance rquired.] *Any app6=V1h9;hcc4box#J niogalso fail out the policy information, Honmmmm who adbznitthigaffidavitindicate ig they are doing all %,o(K=dd,,m 'Cmtractm that check this box M1a9*r4C4V4 an wkjtional,sheet sh�r'n n# the mOne ofthz and state whether or not 4mccnUticshave employm. If the sub-contmors have stip lq„om, 41tcy numpmvidr. them %vtktrss' coftv. policy nttrriber ............. I am an em;� p; lqj'yr that ispmidiog my employees. Below is thepwficy andjob site Instirance ConVany Natne'. Policy- or Self -ins. Lic; 9- Expimfion Date; V Job Site, Addtess:..L LES awstateizAp, n ot Attach a copy of the worken' carapensation polity declaration page (showing the policy number and expiration date). 'L e, 152 can lead to the inVosition of criminal n lb of a Failure to secure coverage as required under Section 25A ofMG pe a es fine -up to $1,500.00 aadfor one-year imprisormumt, as well as civil perialties in the form of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be aeeviscd that a copy of thiN statement may be forwarded to.the Office of Investigations of the DIA for insurance coverage verification. I do hereby rerlify underthe pains and penakies ofpejyury that the informajion provided above is trae andearrect Sinature- tXV4_1 �­ �Ck� Date,. Official we only. Do not write in this arm, to be comp irted by city or town offieW, City or Town: Perntit/License 9 Issuing Authority (circle onc�-. 1. Board of Health 2. Building Departownt 3. Chytrown Clerk A. Electrical Inspector S.Plumbing Imilmdor 6. Other Contact Person: Phone ACOR CERTIFICATE OF LIABILITY INSURANCE r TWIS CEATIFCAMPS ISSf9E OF IN&O"ATIONtesty 0 rjFE ray a r T3VE " a € r : THIS CERTIFICATE D r MATWELY CA NE"rV Y AM00, OnNO OR ALTER THE C0WV.P4k APPOPO BY THE POLICES SELOW THIS CERTIFICATE OF INSUR&NCE 00 NOTCOW57TMrrt A CONMcT SETwEm THE I55 Ans NSURERt51< AvrffaRIZED REPRESMATIVE OR PRODUCK AND THE CER"FICATE HOLM" IMPORTANT, It IS; t fasate €s an D— CNAL MSURED, V* Y ) must be endor . t MaOM 0DIS WAIVED, Soled. tothe tells and oondiftU ofthe pwKy recta n pag€ may requ",, an ettasRwnt, A statement on #d$M-tftvt ftftby la tis the € "Wcate hidcter in ku of t�tls). i 1649 #hwW pt0n Si Pig Box 989 r, Rte; 634-460 _ T t��5t a1 ltll NN*Oke MA 01"4 9 s 4`s*uthior lasNtsftaTfix a: PO ftx 3" Ipswict MA Q8ii38 teras u 14T WnH REFECT TO WKbGH Piz is SUW-= a TO AU TK TERMS, zsro rl aylrc:c ,�� scx '.a;xllzls 9lwxt6 Clearest GoenlrMor $ve$ sQ wwftswon Strom wow0wousk MA ailsl ON DATE TIWEOV. ME'&l SE OW41ERED ave ACMD 25 f 2010)0 3139 NSUAMCt _7 5 +:3^�ec� '_rm+tee tAl b 0 Vv r,xxraA- zsro rl aylrc:c ,�� scx '.a;xllzls 9lwxt6 Clearest GoenlrMor $ve$ sQ wwftswon Strom wow0wousk MA ailsl ON DATE TIWEOV. ME'&l SE OW41ERED ave ACMD 25 f 2010)0 3139 '4CIOR o® CERTIFICATE OF LIABILITY INSURANCE DATE MMIDDNY T/(7/20 5YY) 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 CONTACT Nancy Usher PA1C HONEo (413)536-0804 FAX IC No): (413)534-7874 NExt : AIC. Martin J Clayton Insurance Agency, Inc. 1649 Northampton Street E-MAIL ADDRESS, INSURERS AFFORDING COVERAGE NAIC # P. 0. BOX 989 INSURERA:Nationwide Mutual -Harleysville NATIO Holyoke MA 01041-0989 INSURED INSURERB:Allied World Natl Assurance Co CLAIMS -MADE X OCCUR INSURERC: Gauthier Insulation 44 ESSEX ROAD INSURERD: DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 INSURER E INSURER F: IPSWICH MA 01938 COVERAGES CERTIFICATE NUMBER-CL157701379 RFVISIAN NIIMRFR- 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. ILTR TYPE OF INSURANCE nign ADDL Swvn UER POLICY NUMBER MPOLD2 EFF MMIDD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE X OCCUR DAMAGE TO RENTED PREMISES (Ea occurrence) $ 50,000 MED EXP (Any one person) $ 5,000 X GL43487F 7/6/2015 7/6/2016 PERSONAL &ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X JECT POLICY ❑ PRO ❑ LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS P i BODILY INJURY (Per accdent ( ) $ NON -OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE $ (Per accident) X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1 , 000, 000 B EXCESS LIAB CLAIMS -MADE AGGREGATE $____11_00 0,000 DED RETENTION $ BE020792125-194985 10/18/2014 10/18/2015 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? N I A PER OTH- STATUTE ER E.L. EACH ACCIDENT $ E.L. DISEASE - EA EMPLOYE $ (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) TEI, AND ANYONE ELSE REQUIRED ARE NAMED AS ADDITIONAL INSUREDS) ON A PRIMARY AND NON-CONTRIBUTORY BASIS TO ANY OTHER INSURANCE CARRIED BY TEI, UNDER THE SUBCONTRACTORS GENERAL LIABILITY AND UMBRELLA COVERAGE. 30 DAYS NOTICE OF CANCELLATION CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Mr1drdStbd with pdfFactory trial version www.pdffacto[y.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THIELSCH ENGINEERING, INC. 195 FRANCIS AVENUE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CRANSTON, RI 02910 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Mr1drdStbd with pdfFactory trial version www.pdffacto[y.com c ATX c� ;-94` 0 = p D z x x v s o� �'. -�-0A7 ;mo1 Amp cbbGC n ©� OOC)G) ON mcs e R3 a a` o mill f co CL m d 'T N e C) 107 Z �m4 h off' 54 ens. 4 as � p m � Q O � a � �f �+ m a ON R3 a f CD d 'T N o. c CD C fl