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HomeMy WebLinkAboutBuilding Permit #688-15 - 196 ANDOVER STREET 5/1/2018 NORTH � BUILDING PERMIT:" TOWN OF NORTH ANDOVER- APPLICATION FOR PLAN EXANIINATQN , Permit No#: Date«Received �� ZED SSACHUSE -Date Issued: IMPORTANT:Applicant must complete.all-items on-,Ihis-page _ Pnnt s m PR 0 PERTY OWNEaR � _ * 1 Riot1®,i 1Stuctur MAP= -PARCELZONLNG ®ISTRICTHisto �c ®tstnct yes• n© Machir"ie Shop Village YeS in.o: 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 ❑Assessor)(Bldg ❑ Others: ❑ Demolition _ ❑ Other ❑ Septic ❑{V�/e�h T ❑ Floodplain ❑"Wetlandsk q; tiWatershed i®tstnct ❑01Nater/Sewet D1�IE�S IPTIO�N NOF S W�O <T E PERFORMED: RA ... J v tJU Identification- PleaseType or Print CIearly OWNER: Name: 1-�� y to 0 Pfione: io ?'rAddress: s tC®ntractorfNa e,: Address: _ fil T _ L&A—fitL Su F ervls®r's;Gonsfrtictlon,Licegse. � I?} _.. - 2. _ _ _ 'H a - � . Phone` ARCHITECT/ENGINEER .. - - Re Address: 9 . FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED:COS,TBASED ON$125.00 PER S_I=— Total Project Cost: $ L 660 Check No.: Receipt;No ` NOTE: Persons contractink with unregistered contractors;do nothave=cessto the g _ of�e_oritr, 'Y r tyd wner turegnSigneAget/® Location No. Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ ,.F � Building/Frame_Permit Fee $ ;.fi , Foundation Permit Fee $ Other Permit Fee $ TOTAL $' Check# 2b528 ? Building Inspector i .ri. Plans Submitted El Waived ❑ Certified,,Plot Plan ❑ Stamped Plans El -Y 6F 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 I COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 0 Planning Board Decision: Comments Conservation.Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: F ft-PATmp f®umpstere®n��site �ocated 38 sgood Street ted atFX1240--pi �S `reef lDepa.rtmentsignature%date _ L �C;®M11/IENTS Dimension Number of Stories: Total square:feet_of floor area, based ort Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location,,,m' or service drop requires approval of Electrical Inspector ,Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$TOOO.fine--' NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Co'ntact:.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. I 4 Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application o Workers Comp Affidavit ❑ Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract ❑ Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit i Addition Or Decks o Building Permit Application a Certified Surveyed Plot Plan o Workers Comp Affidavit a 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) o 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) o Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses ❑ Workers Comp Affidavit o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract o Mass check Energy Compliance Report o Engineering Affidavits for Engineered products VOTE: 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 t%O R T#1 E Town of ndover 0 - r h ver, Mass, COC NIC Nt WIC I{ p0 Areo S U BOARD OF HEALTH Food/Kitchen PER Septic System THIS CERTIFIES THAT taa� BUILDING INSPECTOR ...................................... .................................................................................... �. �....... Foundation has permission to erect .......................... buildingson ... .............. ........ ,.,,,,. . • . • Rough to be occupied as ......AIR..... r..�. ... ....�.N S1�!�o. !h............................................ Chimney provided that the person accepting this permit all in every respect conform to the terms of thea Iication pp 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 CONSTRUCT ARTS Rough Service ................................................................................ Final BUILDING INSPECTOR 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 Contractor Registration No MA Contractor Registration No A division ofThielsch Engineering CT Contractor Registration No 60 Shawmut Unit#2,Canton,MA 0202CONTRACT 17 1 IST 339-5026335 PAX 339-502-6345 iii R1 7Page 4 PROGRAM CMA-HES £Not THIS CONTRACT OMEER BMW UITIDFDR WORK TWEEN AS ENGINEERING rrrsscnuameEtow cusaaMtEa PHONE DATE CUENTO YYORKO TUER Jennifer Vautour (860)402-0865 12/31/2014 40466 SERVICE STREET Oft"NG STaEEr � i, 201 Andover Street 201 Andover Strvet SERVICE CITY.STATE..ZIP ...•�_.�.�_ _ SULrNG CrrY STATE ZfP North Andover,MA 01845 North Andover,MA 018)k� JOS DESCRIMON PHASE ONE Proposal for this calendar year. $0.00 AIR SEALING:Provide labor and materials to seat 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,weatherstripping and other products. Primary arcas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not gencrally addressed.)(8)worsting bouts. 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-cantractor to ensure the safety of the indoor air quality. $600.00 ATTIC FLAT:Provide labor and materials to install a 4"layer of R-I4 Class I Cellulose added to(16)square feet of floored attic Spam $27.04 LAMMING:Provide labor and materials to install a 12"layer ofR 38 unlaced fiberglass baits to(16)square feet for damming purposes. $32.80 ATTIC FLAT:Provide labor and materials to install a 12"layer of R42 Class i Cellulose added to(614)square feet of open attic space. $933.28 SLOPES:Provide labor and materials to install a 6"layer of R-21 Class]Cellulose added to(185)square feet of slope area. Wherever possible baffles will be installed to the entire length of each bay to maintain ventilation space. $344.10 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic batch with 2"rigid Thermae board.Weatherstrip the perimeter. $60.00 VENTILATION:Provide labor and materials to install(4)12"X i8"aluminum gable end attic veal 5494.00 VENTILA11ON:Provide labor and materials to install ventilation chutes in(40)ratter bays to maintain air flaw. $80.00 RISE Engineering will apply all applicable,eligible incertinres to this Contract. You will only be billed the Net amount Cum mdy, for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to$600. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your home both before the wort:is begun,and after the vmatherization work is complete.We%ill also conduct a full assessment of the combustion safety of your beating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$2,690. $90.00 Federal ID S RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thielseh Engineering CT Contractor Registration No 60 Shawmut Unit#2,Canton,MA 02021 CONT Vr1 "W= 339-502 6335 FAX 339-502-6345 RX !V SPage 2 PROG1tAM THIS CONTRACT 13 ENTERED INTO BETWEEN RISE ENGINEERING CMA-HES DESCRIBED OEI�OWN CUSTOMER FOR WORK as _PHONE DATE CLIENTS WORK ORDER Jennifer Vautour (860)402-0865 12/31/2014 404610 - 00004 SERVICE STREET BILLING*STREET 201 Andover Street 201 Andover Street SERVICE CnY.STATE.LP �_. __. BILLING CnY.STAMZP ._— North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $2,661.22 Program Incentive: $2,168.41 Customer Total: $482.81 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WrtH ABOVE SPECIFICATIONS,FOR THE SUM OF 'Four Hundred Ninety-Two&811100 Dollars $492.81 UPON FINN.INSPECTION AMC)APPROVAL BY RISE ER _CUSTYIiSER AGREES TO REMIT AMOUNT DUE Rd FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER J6 DAYS.SEE E NPORTANT INFORM11TtON On GUARANTEES,RIGHTS OF RECURMSCKEDIAING,AND CONTRACTOR RE=TRATIDN. 00 NOT SIGN THIS CONTRACT IF THERE ARE;ANYBLANK jc ,�CUS CE NOTE:THIS CONTRACT MAY BE WITHDRAYINBY US V NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICEO.S EC[ACATIONS AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBYACCEPTED.YOU AREAUTHORIZED TO OO THBWORK AS SPECIREO.PAYMENrIN1 1.BE.MADE AS OUTLINED ABOVE /_ � l i OWNER AUTHORIZATION FORM Jennifer Vautour I, - (Owner's Name) owner of the property located at 201 Andover Street, North Andover, MA 01845 (Property Address) 201 Andover Street, 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. wne s Signature Date �a t{anrntaortuerr�l�o��a��e�nsell3 • Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 494800 Type: Office of Consumer Affairs and Business Regulation pitetion: 1512Q16a Private Corporation 10 Park Plaza.Suite 517.0 HUGH'S ENERGY CO :PORATfOW.: Boston,MA 02116 DANIEL DRISCOLI. 259 MILTON STREET DEDHAM,MA 02026 Underseeretary Not valid without sfgnatu Massachusetts Board of Departrnent of Public i Su"diry ae. , Safec Col3stryciif,=j illyulations and 5tard2rd Y License:CS40S0 j_.r.. ',8¢ P�- . . 25OANtoll $� � m$o9re treet ara AM Tt _ COmrmissioner Ex ir� ' A anon 10/2212016 o 'tDINS- ' �. CERTIFICATE OF LIABILITY INSURANCE 1 OP ID:MR �THis CERflFICATE Is ISSUED AS A AIATTFR OF INFORMATIo cAm '1 CERTIFICATE DOES;NOT AFFHWATIVELY OR NWdITIVELY N ONLY AND 10/0612044 81:I.OY{I THIS CERTIFICATE OF INSURANCE ODES ROT CO CONFERS NO RtGJfT;s UPON THE C EXTEND OR ALTER THE COVERAGE >:RTIF/CATE HOLDER.THIS REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER E�TE A CONTRACT BETWEEN THE AGEISSUAF ORDR By THE POLICIES IMPORTANT: if the certifleate holder is an ADDRI (bi,AUTHORIZED the terms and conditions of the"gal Corbin policiesOff-wWSUREd Y ,the poflay(Ies)must!�endorsed, ff SUBROpATiON IS WANED,subject to CeftitiCate holder in lieu of such endont quite alt ertd°iSemenL A statan(ent on this does not coMer fights to the PROOUCt9t TYG tnsura>tce AA��tutcy,Ina. +� 88 Freeman Sttee� Adtttgton,MA 0247q•6g14 781$413002 No.781.641.3009 AFADRDpVB COYSRAGE INSURED i D tnsutation, nc. uA:Sl;oftsdale Insurance CoIllpanv NAloe 259 Milton StreettNsuR�te-AmGumd Insurance Com Dedham,MA 02026 u+aunoec:Arbalia P ratectton Ins Co. 41360 txsuaeea: E• COVERAGES CERTIFICATE NUMBER: tNSORERFe THIS I5 TO CERiiFY THAT TME POLICIES OF INSURANCE REVISION NUMBER: INDICATED. N071NITF(STANDING ANY REQUIREMENT UStED BELOW HAVE ii ! 1 ISSU®TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD CERTIFICATE MAY BE ISSUED OR MAY PERTAIN. OR COMMON OF ANY CONTRACT OR OTHER DOCUMENT EXCLUSIONS AND CONDITIONS OF SUCH POUCIES LIMITS S RAN MAY HAVE BEEN REDUCED CI PAID SCRIMS. NTH RESPECT TO WHICH THIS INSURANCE AFFORDED D N THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, iii T�OFINSURANCE A X COMMERM,ONORMIJaeRm flu UNITS CLnmIs*pM Q OCCUR X X PS2021l 08114/2014 08H4i ib FACH RICE S 1,000,00 3 50,00 WHEW eneaenon $ 5100 C-SMAGGREMTEUNirAPPUt:$PEM PERSONALaA(VOMURY s 11000,00 PDucY 0 WT ❑LOC cENEsuLAcar:�+Is s 2,000,00 aaoDuCTS- Lu'ml'AGO S 2,000,00 AttrOlHOeILE LIABILtt1r C $ ANYAUrO 10200327" � 5 AA .OVOV ltm X � ( uLEo 08/14/2014 + "t 1,000,00 08/14/Z0t5 YRJURYPerpa>,on} S H(RWAU S AUTO$ SODRYfN M(perxetda, S t) G S UUMELLAUM X OCCUR 3 A EXCESS UAB Ct oUms-MADE EACH DED X 044490 10107=14 08114!2015 � s 11000,0 WORKeel oNs 10000 s 1,000,00 ANDEMPLOYaWLMSUM B AWPROYE E od YarN d � A R2WC5135 Itm-desaftAiaer 08HZt2014 082EL STATUTE S ER SAM AMENT s 500,00 OescOPOPERAMNsbel ELDISSUE-Fi1EMPLOY S 500,00 CommerdalApplica Et_DISEASE-PDUcruMrr s 500,00 DESCiUPIIONOROPfEtAi(ONg/I�CAT(ONS/t1ElRCLE5(ACOROtOT.ApdIQpeNR¢, N � ra4uiisul I CERTIFICATE HOLDER CANCELLATION ADRRCHE SHOULDANY OFTHEABOVB I)25M W p0UCMS THEREOF THE EBE CANCELLED BEFORE ACCORDEXPIRATION DATE , NOTICE WILL BE DEINERW IN ANCEVII17H7Ii6POUCYPROVISIONS: AIJiHaTnYfD H+n'AiNE ACORD 25(2014101) 1988.2014 ACORD CORPORATI THe ACORDON. All>ig} reserved. name and logo are 1110tered marks efACORD The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,M4 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lepibly Name (Business/Organization/Individual): Address: 151 AllGU`1 City/State/Zip: Phone#: `��� o Are you an employer?Check the appropriate box: Type Of project(required): _j,Q 'Pia employer with employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp,insurance required.] 9. Demolition 3.0 I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑ 10 E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.0 Electrical repairs or additions proprietors with no employees. 12.EJ Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13Roof repairs These sub-contractors Have em .employees and have workers'comp.insurance.; 6.Q We are a corporation and its officers have exercised their right of exemption per MGL.c. 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 2 ` *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. 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 of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is pioviding workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Namey / Policy#or Self-ins.Lic.#: k W r z j-,3,0 Expiration Date: 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 MGL c. 152,§25A is a criminal violation punishable by 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.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 th ins nd p naltie erjury that the information provided above is true and correct. Signature: Date: _'I 17 Phone#: Official 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#: