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Home My WebLink AboutBuilding Permit #886-15 - 20 ANVIL CIRCLE 5/6/2015Permit No#: als- BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received Date Issued: 6I LP I I---) IMPORTANT: Applicant must complete all items on this LOCATION 9-v A h V i� Print PROPERTY OWNER A, re Sh m% h Print 100 Year Structure MAP %(� ZPARCEL: �� ZONING DISTRICT: Historic District Machine Shop Village yes D�yt LHU A �6 0 TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition El Two or more family El Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: Demolition ❑ Other -TvtSv/4?1ot� --- _❑ ------0 ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands Watershed District ❑ Water/Sewer DE, GRIPTIUN UI- VVUKK i U tst rtrr-um1vir-u: r Ai Koq (-^R � ro'9e re."I ung -P lNFdlg�-� OWNER: Name Identification - lease Type or Print Clearly n 1 IeFk Hrvlf h I Address: Xof Contractor Name: Qf Y� �a�c Phone: -1> Email: Address: 2 «ST i rn,6 bF/,-20fP Supervisor's Construction License: 10 6 Qt % Exp. Date: til _ Home Improvement License: 10 -2 2A Ce Exp. Date: ?0 1-4 ARCHITECT/ENGINEER Phone: F Address: Reg. No. e FEE SCHEDULE. BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $925.00 PER S.F. Total Project Cost: $ 33? / - av FEE: $ t t) — Receipt Check No.: t No.: p NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund . - r Location 2--o A-,,jv,�� No. �A� Iq Check#r�uk-z— Date 4 11,5 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Building Inspector 0 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ SwinUning Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ permanent Dwnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed Sianature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments a Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street i _ a +. EPAR�TtMEI11 Ternn f�i �mn tarinnr[cifia- _ ?S ual� uq lltl'�x AIVICiII 1=711"C,4C L", 0Dep_ rrents g natu re/date 6 1AMMENiTS, - 1 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 Doc.Buildinb Permit Revised 2014 Ad 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 )TE: 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 2012 IECC Energy code Engineering Affidavits for Engineered products 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 cl LLI LL o cc0 O co O N y O LCL E a) V) Q (n U a Z Z m O (O O LL � w N G U C LL U w H Z z m J d L � W C LL O u w 4A Z U c u W J w LU K N i V) C LL O u a Z Q C7 txoO 3 O cr C LL Z W Q w 0 w LL i O m N + y V) >r�wn Vl 0 5 cc o 2 i•� a a) cc= a> Q t � o E o N V rE aD C YZ It. O � W � JO Q 0 N' �Nco��P' °_' 0 N J i CD 2! m - 0) cn cn CD o =c -o0 > .VQ r_ _tom o �. � Eo o ca Q N Z 0 N C C j ISM CL c = c c Q ii ccO a) Q „ N H o m W = 'a m m C O .0 Li •2 � .f/� C C Ln •= � Z LUfY LU �E O • C) m o �+ Q � Q � �-j (n -= o O_ F—� H Z C. O C) > •N N L- Ol rM7 c O O O CL� 0) Q Cc Cc J -0 O d Z N r_ O a Z Z m 1) Cl) Cfl Z V W ILZ w 0 N W CL Z •N N L- Ol rM7 c O O O CL� 0) Q Cc Cc J -0 O d Z N r_ CONTRACT FOR Conner atlon PRODUCTS I SERVICE WORK Services Group This service is brought to you through support from your local utility This Agreement is made by and among Nilesh Amin 20 Anvil Cir North Andover, MA 01845-3366 Site ID: S00002274584 Project ID: P00000280369 Customer ID: C00000284680 Contract ID: 20141208 WORK and Conservation Services Group (CSG) Attn: RCS 50 Washington Street, Suite 3000 Westborough, MA 01581 Reg. No. 173484 Federal ID No. 222457170 (Mail completed contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these "Premises" m a professional manner and in accordance with the terms of this Contract, including the attached reconunendations/work order describing the work in detail (the "Work') which are incorporated herein by reference: Description Quantity location 56 N/A $122.64 Attic Floor Open Blow Cellulose 4" _^ _— _ _ 1,218 _Living Space __ — — $1,632.12 _ Dense Pack 12" Cellulose In Garage Ceiling _ _ _ ._ — 484 Living Space _-_- _ ._ _ _— _ $1,616.56__ Sub Total: $3,371.32 Utility Incentive Share $2,000.00 Customer Contribution $1,371.32 af�o a For office use only Printed: 12/812014 Page 2 of 2 II. PAYMENT Customer agrees to pay Contractor for the Work, the Customer Share of the Contract Price as follows: Payment #1: $ 457.10 as a Deposit payable to CSG upon signing the Contract (not to a 1/3 of the total retail costs). Mail check & contract to CSG, Attn: RCS, 60 Washington St., Ste. 3000, Westborough, MA 01651. Final Payment: $ 9y1' as the final payment for the work shall be payable to the Independent Installation Contractor ("IIC") upon satisfa �o,�{�x pletion of the Work. Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of g 1U(Il7� Changes to Individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. 111. DISPUTE RESOLUTION 'lire IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract, the TIC may submit such dispute to a private arbitration service which has been approved by the Office of Const uner Attain; and Businm- Regulation and Customer shaft be required to subn-dt to such arbitration as piovided in M.G.L c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business. ay follow' the signing of this agreemennjt,. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Customer Signature Date Indicate your selected 11C here, if applicable (011) Initial here if you want iteven ll ecci 12/8/14 Steven Pecci the Program to assign a CSG Signature Date Name of CSG Representative (Printed) Participating Contractor TERMS AND CONDITIONS APPEAR ON THE REVERSE. 3/14 40 1 mass save„ Sey"'ng.s ttuout*1 enrt }v r,.Przlenr,y PERMIT AUTHORIZATION FORM I, Nilesh Amin , owner of the property located at: (owner's Name, printed) 20 Anvil Cir North Andover (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X Owner's Signature Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: i>� �2-1--r L C, < J 5'1' 7-") c 115m "�' -,-sc_ (2I T-1 r 4 - Participating Contractor Rev. 12132011 Date Di For Office Use Only z\ The Commonwealth of Massachusetts _ j7- : Department of Industrial Accidents Office Of Investigations 1, `.' 604 Washington Street Boston, MA 02111 �`�' `•= Wwminass.gOv/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers N anne (Business!Oreanization/Individual): YO qf- Aea V r4 rj�(7 in e D T, Address: V, Ci Phone #: G Are you an employer? Check the appropriate box: l . (�.I am a employer with -` . ❑ I am a General contractor and I employees Mll and/or part-time).* have hired the sub -contractors 2. ❑ I ata a sole proprietor or partner- listed on the attached. sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [\o workers' comp. insurance comp. insurance.! required.] 5. ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [\o workers' comp. right of exemption per, MGL insurance required.] c. 152• S 1(4). and we have no employees. [No workers' comp. insurance reguired.l Type of project (required): 6. ❑ \ew construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 1 l.❑ Plumbing repairs or additions 12.❑ Roof repairs 13. b&0ther 'I,A'5-JAip2h 'Any applicant that checks box =1 must also till out the section heiow showing their workers' compensation police information. v Homeowners who submit this affidavit indicating they a 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. police number. I tun an employer that is providing workers' compensation insurance for ntF enhplo;�ees. Below is the polio' curd job site information. Insurance Company game: Police P or Self -ins. Lie. ;:: J! p ujG T-'""[��j & S7—Expiration Date: I//I&o Job Site Address: City/State/"Lip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required tinder Section 25A of MGL c_ 152 can lead to the imposition of criminal penalties of a fine up to S 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 S250.00 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 perfrity ilial the information provided above is true and correct. n ��12P2�� Official use 011/1: Do not write in this area, to be completed bi' city or town official. City or Town: 11'ermit/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 #: ACoREP CERTIFICATE 4F LIABILITY INSURANCE X0°115"' 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 pollcy(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 NAME PHONE INC Edy No Automatic Data Processing insurance Agency, Inc. 1 Adp Boulevard E -MAI ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC d Roseland, NJ 07068 INSURERA: NorGUARD Insurance Company 31470 INSURED INSURER B: INSURERC: POLAR BEAR INSULATION CO INC PO BOX 956 Andover, MA 01810 INSURER D. i GENERAL AGGREGATE $ INSURERE: INSURER F: VV �•.Il/1V�V 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. LTR TYPE OF INSURANCE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICE GROUP5 POLICY NUMBER MMID MMIDDIYM LIMITS Westborough, MA 01581 COMMERCIAL GENERAL LIABILITY CMS -MADE M OCCUR EACH OCCURRENCE $ ET PREMISES Eaocarter�ceCLAIMS-MADE$ MED EXP (Arty one person) $ PERSONAL & ADV INJURY $ GElfL AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECTT LOC OTHER: GENERAL AGGREGATE $ PRODUCTS - COMPIOP AGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALS ED SCHEDULED OS NON -OWNED HIRED AUTOS AUTOS ED SIRMr=T Ea Mc COMBIdem = BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PERTY DAMAGE $ Per accident $ UMBRELLA LIA8 EXCESS LIAO OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DEO I I RETENTIONS $ A WORKERS COMPENSATION AND EMPLOYERS' UABRM ANY PROPRIETORIPARTNERIEXECUTNE YIN N OFFICERIMEMBER EXCLUDED? Y (Mandatory In NH) If yes describe under DESCRIPTION OF OPERATIONS below N I A N POWC660990 01/01/2015 01/01/2016 STATUTE ER EL EACH ACCIDENT $ 1,000,000 EL DISEASE - EA EMPLOYE $ 1,000,000 EL DISEASE -POLICY LIMIT $ 1,000,000 DESCWPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, AddNonai Remarks Schedule, maybe allndied If more space is required) f1=EMCII ATF WAI rICR CANCELLATION MV IV00-LVI-i NVVRU VVRPVIV'I I IVIS. nu, sumo I coal vau. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICE GROUP5 ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET AUTHORIZED REPRESENTATIVE Westborough, MA 01581 MV IV00-LVI-i NVVRU VVRPVIV'I I IVIS. nu, sumo I coal vau. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD 1 40 CERTIFICATE OF LIABILITY INSURANCE DATf)AO 0412812015� 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 NAME: Automatic Data Processing Insurance Agency, Inc. 1 Adp Boulevard PHONE AIC No Ertl: A1C No): ADDRESS: INSURER(S) AFFORDING COVERAGE NAIC # Roseland, NJ 07065 EACH OCCURRENCE $ INSURERA: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC PO BOX 958 INSURER C: PRODUCTS -COMP/OPAGG $ Andover, MA 01810 INSURER D: INSURER E: LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS INSURER F: COVERAGES CERTIFICATE NUMBER: 336194 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. LTR TYPE OF INSURANCE ISD WVD POLICY NUMBER MMIOD Y MM/1D LIMITS COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FIOCCUR EACH OCCURRENCE $ PREMISES Ea oacunence$ MED EXP (Any one person) $ PERSONAL & ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: HPOLICY ❑ JET LOC OTHER: GENERAL AGGREGATE $ PRODUCTS -COMP/OPAGG $ $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS NON -OWNED AUTOS COMBINED INGL LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per acci$ dent UMBRELLA LU113 EXCESS LIAB OCCUR CLAIMS -MADE EACH OCCURRENCE $ AGGREGATE $ DED J I RETENTION $ $ A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY YIN ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED? a (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N I A N POWC660990 01/01/2015 01/01/2016 XR T - STATUTE ER E.L. EACH ACCIDENT $ 'Ir00�r000 E.L. DISEASE - EA EMPLOYEE $ 1,000,000 E.L. DISEASE - POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) L4�ilII1\�fL�■ 1i1�1��1� LIC17-iZ�41�\�1 C. CONSERVATION SERVICE GROUPS 50 WASHINGTON STREET Westborough, MA 01581 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE All riahts ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD tow usiness Regulation 1:55Office of Consumer Aff s Suite 5170 10 Park Plaza Boston, Massachusetts 02116 Home ImprovRegistratioement Contractor Registration _ n: 102726 Type: DBA T 252249 Expiration: 7/212016 POLAR BEAR INSULATION CO. _ Vincent LeBlanc _ P.O. BOX 958 ANDOVER, MA 0181 Update Address and return card • Mark reason for change- Update Address Renewal EmPIOY°1ent (] Card OPS-cA1 is SOM44/p -13101216 t Massachusetts =Department of Pubic Safety Board of Building Regulations and Standards Construction Supervisor Specialt} License: C..wSL-106017 Y, PETER A LEBI.AK, 2 EAST PINE STREET Plaistow NH 03845 Expiration 04128/2018 Commissioner