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Home My WebLink AboutBuilding Permit #622-2017 - 20 HAWTHORNE PLACE 12/8/2016BUILDING PERMIT 4�j,jjy,(J, ej 4t. TOWN OF NORTH ANDOVER T "` APPLICATION FOR PLAN EXAMINATION Permit No#: (9 a -a- —a01-7 Date Received I Date Issued: / F- " 2-01 & IMPORTANT: Applicant must complete all items on this page LOCATION 20 1-i0.4v:�l:orn� P1ac�e- - Print 1 Ty PROPERTY OWNER 'Richard I "TOY -1 Print 100 Year Structure yes no MAP _PARCEL: 00 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 11 Industrial ❑ Alteration No. of units: El Commercial V Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑ Well ❑ Floodplain ❑Wetlands ❑Watershed District ❑ Water/Sewer _ -- -- - - DESGRIP I IUN UF- VVL)KtX I U tsr: rt:mrvmmw. Identification - Please Type or Print Clearly OWNER: Name: Richard Lars 6h Phone: �GI�)yGl-y1�8 Address: 20 Naw�Morrt� YI �lovkk Andevur MA o184fi j Contractor Name: JA4J4AaA ;fw Phone: iSD� 382-Zofl7 Email: • co Ad( ki 0310� Supervisor's Construction License: 1100 -II Exp. Date: 8'-112-01 Ot Home Improvement License 2 Exp. Date: T ARCH ITECT/ENGINEE Address: Reg No. Phone: FEE SCHEDULE: BULDING PERMIT: $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: $ 1510o • 11 FEE: $ 3 t/ �— Check No.: / � / Receipt No.: 31 :9 NOTE: Persons contracting with unregistered contractors do not have access to the ,*q3q!�Kty fund �-; F Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ElSwimmin g Pools ❑ Well ❑ Tobacco Sales ElFood Packaging/Sales ElPrivate (septic tank, eta ❑ lPennanent Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HEALTH < COMMENTS 1P Reviewed On Signature Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Wafter & Sewer Connection/signature &Date Driveway Permit DPW Town Engineer: Signature: -- Located 384 Osgood Street FIREaDEPAl HMENtT - Temp.:Dumps_ter.on�s,ite yes_ Locatediat -124im inrSt�eet - - ;Ilok F1`re'D;0P9ffinent Signature/d'a"te. COMMENTS 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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine 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 :rF 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 ;rF 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 IOTE: 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 ;a< Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ;aF Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products TE: 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 Location P 0 fbqt,47�04N-V at - No. (92 ) -'D 0 '1 Date I.,; - d- .101(o TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee $—a -o Foundation Permit Fee $— Other Permit Fee $— TOTAL Check# t Building'Ins'pector Toy No. (0u—Zo11 P RM T TO S_U E I I THIS CERTIFIES THAT MCA 44A ........ ��.Y ................................................. has permission to erect .......................... buildings on .. .... .... ... be occupied as . .� . ...sp.&&.111..� �� to p..................................................................................... provided that the person accepting this permit s all in every respect conform to the terms of the application 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. VIOLATION of the Zoning or Building Regulations Voids this Permit. PERMIT EXPIRES IN 6 MONTHS UNLESS CONSTRUCTIO TARTS Y / __ ............ ....................................... BUILDING INSPECTOR Occupancy Permit Required to Occupy Building Display in a Conspicuous Place on the Premises — Do Not Remove No Lathing or Dry Wall To Be Done Until Inspected and Approved by the Building Inspector. lover N s • 1? • 01-4 BOARD OF HEALTH Food/Kitchen Septic System BUILDING INSPECTOR Foundation Rough Chimney Final PLUMBING INSPECTOR Rough Final ELECTRICAL INSPECTOR Rough Service Final GAS INSPECTOR Rough Final FIRE DEPARTMENT Burner Street No. Smoke Det. Federal ID # 05-0405629 RISE Engineering RI Contractor Registration No 6166 MA Contractor Registration No 120979 CT Contractor Registrallon No RISE 60 Sbawmut Road, Canton, MA ENGINEERING' CONTRACT 401 t1� 7&4-370� 3710 E E Q V Page 1 V L PROGRAM THIS CONTRACT IS ENTERED WTO BETWEEN RISE CMA -HES ENOINEERINO AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW IRSEf---.7 gni CUSTOMER tG- PHONE DATE CLIENTS WORK ORDER Richard Larson0 (617)461-4168 09/02/2016 439208 35002 SERVICE STREET BILLING STREET 20 Hawthorne P1 20 Hawthorne Pl SERVICE CITY, STATE, ZIP BILLING arf, STATE, ZIP North Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION HEALTH & SAFETY: Weatherization work cannot proceed until mechanical ventilation that will provide (1) efm (cubic feet per minute) of continuous air flow has been installed in your home. SD $0.00 AIR SEALING: Provide labor and materials to seal 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 and other products. Primary areas for sealing include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed.) This will require (4) working hours. A reduction in cubic feet per minute (cfm) of air infiltration will occur, but the actual number of efm is not guaranteed. 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 subcontractor to ensure the safety of the indoor air quality. $340.00 DAMMING: Provide labor and materials to install a 12" layer of R-38 unfaced fiberglass batts to (20) square feet for damming purposes. $41.00 ATTIC FLAT: Provide labor and materials to install a 6" layer of R-21 Class 1 Cellulose added to (670) square feet of open attic space. $844.20 STORAGE BARRIER: Homeowner is responsible for the removal of the stored items blocking the installation of wcatherization work in the attic. Removal must occur prior to the scheduled work start. (initials) $0.00 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 weatherstripping to restrict air leakage. $73.91 Provide tabor and materials to install R-8 faced fiberglass insulation to the exposed heating and/or cooling ducts in certain non - conditioned areas. Total to be installed is (60) square feet. $171.00 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% for the Air Sealing measures up to the first $680 and an additional $340 if savings aro justified by the auditor. 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 work is begun, and after the weatherization work is complete. We will also conduct a full assessment of the combustion safety of your heating system and water heater. This has a value of $90 and is at no cost to you. Total allowable weatherization incentive is $3,110. 590.00 Federal ID # 05-0405629 RISE Engineering RIn Contractor RegisMA tration ReNo 818S gistrationNo 120979 CT Contractor Registration No RISE F 60 Shawmnt Road, Canton, MA ENGINEERING'ONTMCT (401) 784-3700 FAX (401) 784-3710 Page 2 PROGRAM THIS CONTRACT 18 ENTERED INTO BETWEEN RISE CMA-HES ENf#INEERIHO AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENTM WORK ORDER Richard Larson (617)461-4168 09/02/2016 439208 35002 SERVICE STREET BILLING STREET 20 Hawthorne PI 20 Hawthorne P1 SERVICE CITY, STATE, ZIP SILLING CITY, STATE. ZIP North Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION Total: $1,560.11 Program Incentive: $1,277.68 Customer Total: $282.53 WE AGREE HEREBY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE SUM OF 'Two Hundred Eighty-Two & 53/100 Dollars $282.53 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING. CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL. INTEREST OF i% WILL BE CHARGED MONTHLY ON ANY UNPAID_ BALANCE AFTER 30 DAYS. SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES, RIGHTS OF RECISION, SCHEDULING, AND CONTRACTOR REGISTRATION. DONOTSIGN THIS CONTRACT IF THERE ARE ANY BLANK SP AUTHORIZED SIGNATURE - RISE Engineed" CUSTOMER ACCEPT NOTE: THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED xWITHIN DATE OF ACCEPTANCE 0111-2-11 ACCEPTANCE OF CONTRACT -THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO 00 THE WORK WILL AS SPECIFIED. PAYMENT LL BE MADE AS OUTLINED ABOVE sem–... VV SEP 9 2016 .i RISE60 Shawmut Road, Unit 2 1 Canton, MA 020211339-502-6335 ENGINEERING` www.RISEengineering.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: 2,1110 (Property Address) Al Nver M A D / $ q� (Property Address) hereby authorize W (Sub 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 secured 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. Owner's Signa r 7i � � Le Date 6.2016 The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street, Suite 100 y Boston, MA 02114-2017 www,mass.gov/dia Workers' Compensation Insurance Affidavit: General Businesses. TO BE FILED WMI THE PERMffTfNG AUTHORfT'Y. AgE!licant Information Please Print Lwibly Business/Organization Name: Mill City Energy Address: PO Box 6411 City/State/Zip: Manchester, NH 03108 Are you an employer? Check the appropriate box: 1. [✓ I am a employer with 12 employees (full and/ or part-time).* 2.0 1 am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required] 3. Q We are a corporation and its officers have exercised their right of exemption per c. 152, §1(4), and we have no employees. [No workers' comp. insurance required]" 4. [] We are anon -profit organization, staffed by volunteers; with no employees. [No workers' comp. insurance req.] Phone #: 603-391-7923 Business Type (required): 5. Q Retail 6. Restaurant/Bar/Eating Establishment 7. Q Office and/or Sales (incl. real estate, auto, etc.) 8. Q Non-profit 9. Q Entertainment 10.0 Manufacturing I I.0 Health Care Other�tYu-t[ t] *Any applicant that checks box #1 must also SFII out the section below showing their workers' compensation policy information. "If the corporate officers have exempted themselves, but the corporation has other employees; a workers' compensation policy is required and such an organization should check box # 1. I am an employer that is providing workers' compensation insurance for my employees. Below is the policy information. Insurance Company Name: Clark Insurance Insurer's Address: One Sundial Avenue Suite 302N City/StateiZip: Manchester, NH 03102 Policy 9 or Self -ins. Lic. # MIWC791896 Expiration Date: 4/2912017 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, ug*- J fiins and penalties of perjury that the information provide4 above is true and correct 603-396-7520 Official use only. Do not write in this area, to be completed by city or town off dal. City or Town: Permit/License # I [_qj.0A Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. Cityfrown Clerk 4. Licensing Board 5. Selectmen's Office 6. Other Contact Person: wwrv.mass.govldia Phone MILLCITY-1 AGOULD R CERTIFICATE OF LIABILITY INSURANCE . lk.—� `016 DAT/19/2 16YY) 7 /19/2 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 License # AGR8150 Clark Insurance One Sundial Ave Suite 302N Manchester, NH 03102 CONTACT NAME: PHONE FAX A/c No Extl: (603) 622-2855 AC No): (603) 622-2854 E -M -ADDRESS. agould@clarkinsurance.com INSURER(S) AFFORDING COVERAGE NAIC # 04/29/2016 INSURER A:Arbella Mutual Insurance Co 17000 EACH OCCURRENCE $ 1,000,000 INSURED INSURER 8: AMGuard Ins co 43290 Mill City Energy 106 Joseph St PO Box 6411 INSURERC: INSURER D : INSURER E : Manchester, NH 03102 INSURER F : A COVERAGES CERTIFICATE NUMBER: RFVISInN 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. INSR LTR TYPE OF INSURANCE D INSD S D POLICY NUMBER POLICY EFF MM/DD POLICY EXP MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE X OCCUR 8500065735 04/29/2016 04/2912017GE EACH OCCURRENCE $ 1,000,000 O RENTED PREMISES Ea occurrence $ 300,00 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ PRO - ❑ LOC OTHER: OTHER: GENERAL AGGREGATE $ 2,000,00 PRODUCTS -COMP/OP AGG $ 2,000,00 $ A AUTOMOBILE X X LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS HIRED AUTOS X NON -OWNED AUTOS 1020050919 04/2912016 04/2912017 COMBINEDSINGLE LIMIT $ 1,000,00 BODILY INJURY (Per person) $ BODILY INJURY Per accident ( ) $ PROPERTY DAMAGE $ Per accident A X UMBRELLALIAB EXCESS LIAB X OCCUR CLAIMS -MADE 4600065736 04/29/2016 04/29/2017 EACH OCCURRENCE $ 1,000,00 AGGREGATE $ 1,000,00 DED I X I RETENTION $ 10,000 B WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY YIN N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' FN ] (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A MIWC791896 04/29/2016 04/2912017 OTH- X STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space Is required) Town of North Andover MA 1600 Osgood St. North Andover, MA 01845 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 U 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS -110041 Construction Supervisor MICHAEL JOY 106 JOSEPH STREET* MANCHESTER NH 03102 �—^^ C&-- Expiration ' Commissioner 0810712019 Construction Supervisor Restricted to: Unrestrided - Buildings of any use group which contain less than 35,400 cubic feet (991 cubic meters) of enclosed space. Failure to possess a current edition of the Massachusetts State Buildirg Code is cruse for revocation of this license. DPS Licensing Information visit: WWW.MASS.CiO\rtDPS —j4r`t°rr«,,./Gig�1 "lir*,4x.rf1«y f,jnsrortrmtion�ai[dforindividuluseont office of co"Umer Affairs B�t!tt6ess fitt6ulsHom Y -HOME wpROvEmEta CONTRACTOR before the expiration date. if found return to: ration. 1U762iY{ta: Office of Consumer Affairs and Business Regulation i ! J "Expiration. 7127120t7 LLC 10 Park Plaza - Suite $170 fir, Boston—VIA 02116 MU CITY ENERGY, LLC MICHAEL JOY 106 JOSEPH STREET MANCHESTER. NH 03102 t'apc,acrcrart f va. -ithontu 3 core