Loading...
HomeMy WebLinkAboutBuilding Permit #121-15 - 20 MILL ROAD 8/4/2014 f 0RTH BUILDING PERMIT O�tpA eD q4.0.L TOWN OF NORTH ANDOVER �� 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �gSSACHUs���� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION' Print -- PROPERTY OWNER Print 1o0'Year Structure LL yes no MAP -PARCEL: r 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 ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain 0 Wetlands ❑ WatershedDistrict ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: _ Phone: a Address: Supervisor's Construction License: Exp. Date: Home Improvement License: _ z. 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: $ FEE: $ Check No.: Receipt No.: NOTE, Persons contracting with unregistered contractors do not have access to the guaranty fund - Si ;nature of Agent/Owner Signature of contractor �__ r i 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 NOTE: 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 t NOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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 s 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 Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes _no._ Located at 124 Main Street Fire Department signature/date COMMENTS r 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 NOTES and DATA — (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 Location No. _ Date e - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ L Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#-- 27849 B 1I ing Inspector NORTf-� • - W. . . . E ; :. .c . . ve q' R� O cn% h ver, Mass, Coy«.c„ewrcK �'►• TEO S U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT •••, �K„�1.� BUILDING INSPECTOR ........... ..r�. .......... .... .. .•••�T.............................. • Foundation has permission to erect .......................... buildings on .. .0...... .. �,.�. ......... .. ................. Rough to be occupied as ........... tt. '�1i►l�Ir.�,....�..,. :,.�,�•� :.. ..... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI T S Rough Service ...... .......... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. r Job Number 4958 DATE 712312014 Client Maria Murphy(978)794-1980 address 20 MITI Rd city IWwn North Andover,MA 01845 contractor Carbonneau Insulation 1.WEATHERSTRIPPING/CAULKING QUANTITY TOTAL AUDITOR NOTES Door Kits Q-Lon or Equiv. 5 255.00 Door Sweeps(Regular) 0.00 Door Sweeps(Automatic) 5 130.00 Reglaze Windows/ln.inch 0.00 Window.Weathstr Schlegel per side 0.00 Recessed light cover per SWS.Not a tenmat cover 0.00 attic sealing 2 part foam 0.00 attic sealing 1 part foam 0.5 35.00 Chimney basement and living space air sealing 1 part 0.5 35.00 minimal to no air sealing needed SUBTOTALS 455.00 2A.INFILTRATION!INSULATION AUDITOR NOTES Domestic pipe Hot Water Tank 1st 6' 1 17.70 Sill Two Part Foam w/Fiberglass Batt 0.00 -- 1"T-max only foam board Perimeter per IECC&SWS sq.ft. 0.00 2"T-max only foam boardPerimeter per IECC&SWS sq.ft. 0.00 Drape DOOR R-5 or T-max only 0.00 Tape Joints(Aluma Grip only)per hr. 0.00 Duct Ins w/Tape sq.ft.R-5 conditioned space 0.00 Duct Ins w/Tape sq.ft.R-8 unconditioned crawl/garage/attic 0.00 Hydronic pipe insulation to 1"R-5 0.00 Hydronic pipe ins.1.25"-2"R-5 0.00 Steampipe Ins. 1.25"-2"iron pipe R-5 0.00 Steampipe ins.2.5"-3"iron pipe R-5 0.00 Air Conditioner Meeting Rail 0.00 Air Conditioner Cover 0.00 Air Conditioner Cover Special Order 0.00 SUBTOTALS 17.70 2B.INSULATION AUDITOR NOTES Open Unrestricted R 49 0.00 Open Unrestricted R 38 0.00 Open Unrestricted R 30 1176 1799.28 1176 minus floored area,extra goes to sloped R20 Open Unrestricted R 20 0.00 Open Unrestricted R 10 0.00 Restrict FL/Sloped R 38 0.00 Restrict/Sloped R 30 0.00 Restricted FUSloped R 20 0.00 Restrict FUSloped R 10 0.00 R-19 FGB open rafters/walls/kneewalls 0.00 R-11 FGB open rafters/walls/kneewells 0.00 Attic Stairs(stairwell&common wall) 1 151.00 Cover Pull Down Stairs Thermadome up to R49 per SWS 0.00 Site built pull down stairs 2"foam box 0.00 AUDITOR NOTES Attic/Kneewal Floor Transition. Dense pack cellulose 0.00 W.S.Hatch Q-Lon or equal 0.00 W.S.&bat Hatch,dam around etc.complete to attic R value 0.00 Kneewall R-12 cell behind Per.Memb 0.00 Open Rafter R-20 Cell./w poly 0.00 Open Rafter R-30 Cell./w poly 0.00 Basement Overhead R-19 fiberglass 0.00 Basement Overhead R-30 fiberglass 0.00 Crawlpace Overhead<4'high R19 0.00 Crawlpace Overhead<4'high R30 0.00 Garage Ceiling cavity filled w/cellulose 560 1316.00 28'x 20'test drill to see whats in there Wood,Shake,Clapboard,Shingles Vinyl 0.00 2100 if empty Asbestos(single nail)/Asphalt 0.00 Asbestos(daub.Nail)/Aluminum 0.00 Brick/Stucco 2 hole 0.00 Vinyl over Asbestos 0.00 Multi-layered 3 or more layers 0.00 Drill rough plaster or finish wood plug 0.00 Drill finish plaster 0.00 Test Drill Walls(all 4) 1 67-00 - SUBTOTALS 3333.28 2.INSULATION TOTAL 2A.+2B. 3350.98 3.STORM WINDOWS I DEADLITES AUDITOR NOTES Plexiglass up to 88 u.i. 0.00 Additional per UI over 88" 0.00 Dead light 0.00 SUBTOTALS 0.00 5.OTHER MATERIAL AUDITOR NOTES Ridge vent In ft. 0.00 Gable Vent rectangular 0.00 Varipitch Vent 0.00 Roof Vent 135(1 sq ft NFV)Large 0.00 Roof Vent 865(.4 sq ft NFV)Small 0.00 Soffit Vent Rectangular - 0.00 Turbine Vents All 0.00 Stack Vent 0.00 Acuvent proper(Must be this product)available @ HomeDepot 0.00 Permable House Wrap 0.00 6 mil poly on ground 0.00 Energy Star R-4 Rigid Vinyl Repl 94-101 U.I. 0.00 SUBTOTALS 0.00 6.17.E.C.MATERIAULABOR 3805.98 Page 3 8a. HEALTH&SAFETY AUDITOR NOTES CO detector 0.00 Vent Bath/ Fan 0.00 make sure all fans are vented Dryer vent w/exhaust duct Heartland 1 100.00 out rear of house above dryer Dryer Transition Duct only 0.00 Bath fan 50 CFM(replace exsisitng)fan only 0.00 Bath fan 50 CFM(new install)with timer 0.00 Bath fan Smart timer 0.00 Blower Door Test Pre Post 1 45,00 SUBTOTALS 145.00 8b.REPAIR MATERIAL/LABOR AUDITOR NOTES Basement outside door solild core inc all hardware 0.00 Basement outside door w/jambs inc all hardware 0.00 Basement outside door site built per SWS inc all hardware 0.00 Door Repl pre hung 32-36"Steel*"w/Lite 0.00 Door Repl interior solid core 28-32" 0.00 Door Repl pre hung 32-36"wood""w I Lite 0.00 Window Replacement w/SIR less than 1 0.00 Basement Window Repl.Awning/Hopper 0.00 Basement Window Repl.With a frame 0.00 Lockset(door)Schlage or equal 0.00 Repair/Refit Door 0.00 Replace Side Stop 0.00 Replace Casing 0.00 Glass Replacement to 64 W. 0.00 Glass Replacement per u.i.over 64 0.00 Thermo pane Glass replacement 0.00 Sash Sidelock ITop Replacement 0.00 Threshold(Wood) 0.00 Threshold(Aluminum) 0.00 Slide Bolts/pull handle 0.00 Cut/finish attiakneewall access 0.00 Cut/close attiakneewall access 0.00 Labor Rate Hours 2 134.00 consilidate plywood in attic for storage. Labor Rate Hours 0.00 Labor Rate Hours 0.00 Labor Rate Hours 0.00 Labor Rate Hours 0.00 Permits I Fees(Wap only) 0.00 SUBTOTALS 134.00 TOTAL REPAIR+HEALTH&SAFETY 279.00 GRAND TOTAL WORK ORDER# (A) 4958 4084.98 Any alterations or deviations from the above specifications involving extra costs must be cleared in writing before installation. The Work Order must be complete within 15 working days from acceptance date below: CONTRACTORICOMPANY: Carbonneau Insulation ACCEPTANCE: Contractor AUTHORIZED SIGNATURE: im Date AGENCY APPROVALS: CTI Authorized Signature: Date GLCAC Authorized Signature: Date ' err-r�rilitrue�r�l�a�C � License or registration valid for individul use only ice of Consumer Affairs&Busin C?ME ess Regulation IMPROVEMENT CONTRACTOR �( ;., before the expiration date. If found return to: _. Office of Consumer Affairs and Business Regulation ' egtstrati°n 1.62729 ; e _ Type.Park Plaza-Suite 5170 II LLP i; • Boston,MA Q2116 ti't CARBONNEAU INSULA'T MICHAEL i BONNEAU # 2LENNY LANE t j HUDSON,NH 03051 Not valid without signature ^�~ ` Undersecretary ,# i% Restricted To: CSSL IC Insulation Contractor Massachusetts -Department of Public Safety Board of Building Regulations.and Standards Construction Supervisor Specialtx License: CSSL-102168 itis ¢ r ! MICHEAL S CAR80NNEAU 21 LENNY LANE= ' HUDSON NH 03051 � Failure to possess a current edition of the Massachusetts i State Building Code is cause for revocation of this license. Expiration For DPS Licensing information visit: www.Mass.Gov/DPS 11/10/2014 Commissioner i Unrestricted -Build' sof any use rou «$ich f Massachusetts p Board of Building of Public Safety contain less than 35.000 cubic feet(991m')of ing Regula#ions and Standards enclosed space. f C ontitruction Superi kor License: CS-097614 " NORMAN CARBO, ,r NNEAjJ r 4 CARRIER ST v Londonderry N Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. 954— For DPS Licensing information visit: www.Mass.Gov/DPS Expiration Cammissioner " 01/19/2015 Restricted To: CSSL-IC-Insulation Contractor Massachusetts -Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialt. License: CSSL-102166 ALBERT S CARB(JNNEA.0 � 21 B LENNY LADE }} Failure to possess a current edition of the Massachusetts HUDSON NH 03051 s State Building Code is cause for revocation of this license. r 1 For DPS Licensing information visit: www.Mass.Gov/DPS Expiration Commissioner 06/18/2014 Cw DATE(MMIDD/YYW) A "R" CERTIFICATE OF LIABILITY INSURANCE 6i5i14 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: Appletree Insurance PHONE (60 3) 881-9900 AX No: (603) 594-9840 33 Indian Rock Road E-MAIL ADDRESS: Bldg. 5 Ste. 3 INSURER(S)AFFORDI_N_GC_OVERAG_E_ MAIC#__ Windham, NH 03087 INSURER A:NAUTILUS INS INSURED INSURER B:SAFETY CARBONNEAU INSULATION LLC. INSURERC:WESCO INS. 21 LENNY LANE INSURER D:WESTCO INS. CO. HUDSON, NH 03051 INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER: 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. INSR — -- — ADDLSUBR -_— --- POLICY EFF POUCY EXP - - ---- - LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MMIDD/Y MM/DD/YYYY LIMITS B GENERAL LIABILITY ! NN124116 I 6/2/14 6/2/1.51 EACH OCCURRENCE S 1 000,000 I DAMAGE TO RENTED}� S 300,000 COMMERCIAL j _PREMI ES1Eaoccurrence�. .;,-_ .. - CLAIMS-MADE �z OCCUR MED_EXP(Arty one person) S 5 000 PERSONAL&ADVINJURY S 1,000 000 GENERAL AGGREGATE S 21000,000 GEN'LAGGREGATE LIMIT APPLIES PER PRODUCTS-OOMP/OPAGG S 2 000,000 POLICY! I PRO- LOC i S I ECT A AUTOMOBILE LIABILITY ICNHOO81187 6/9/14 6/9/151 COMBINED SINGLE L IMIT OBIEemSINGLELIMIT S — X ANY AUTO BODILY INJURY(Per person) S ALLOWNED SCHEDULED BODILY INJURY(Per accident). S AUTOS AUTOS PROPERTY D NON-OWNED AMAGE S ' HIREDAUTOS _AUTOS 1.(I5 raccide� S i A UMBRELLA LIAB OCCUR EACH OCCURRENCE 5 ! EXCESS LIAB �_..---------- - -------- CLAIMS-MADE ! AGGREGATES —_ DED RETENTION S i S D WORKERS COMPENSATION i �WWC3093137 6/2/14 6/2/15 4CSTAITs: X.IOER _ AND EMPLOYERS'LIABILITY YIN I ANY PROPRIETOR/PARTNER/EXECUTIVE _5OO,000E.L.EACH ACC GE V S OFFICERIMEMBER EXCLUDED? NIAI (Mandatory in NH) E.L.DISEASE_EA EMPLOYEE�j S 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below i E.L.DISEASE-POLICY LIMI1 ! S 500,000 I I i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN FOR THE BENEFIT OF THE INSURED ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE PATRICK J. CONWAY ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: operations@carbonneauinsulation.com 4, The Commonwealth of Massachusett, .Department of Industrial Accidents �' Office of Investigations !i � 600 Washington Street 1 Boston, MA 0211.1 www,mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant: Information _ _ _ Please.brant legibly Name Busine,s.'Or anization/Individuai : Ad(tress: Ci t v,State/Zi Phone ; : " / x Are you an employer? Check the appropriate box: Typo 4rg project +;rec}uirecl): 1.LLe"l"atn a ennpioyer with _.. ..._..__. a. ❑ 1.am a general contractor and 1 Ti . employees ;full and/or part-time) have hired the sub-contractors 6. New c onstt;t t.,r: 2. am�, state proprietor or partner— ship and have no employees These sub-contractors have g. ❑ Demolition working for me in an capacity. employees and have workers' =� Y p t 9. U Building addition No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.7 Electrical.repairs or additions 3.❑ i am a homeowner doing all work officers have exercised their 1 l.❑ r Plumbing epairs or additions myself. [No workers' comp. right of exemption per MGL 1 t c152 1(4),and we have no 12.,,7 Roof repairs insurance tree aired,j .employees. [No workers' 13.❑ Other 1 comp, insurance required. .................._.__ __.._ __ .......... *Any applicant that checks box#1 must also till 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 of idavi:iticlicatirig,such. tContractors that chuck this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities hr.ve employee:. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policv and job,site information. �--� J _ Insurance Company Name: C .-......... G s ( � �� _ - _ Policy#or Self-iris. Lie. #: Expiration Date:0�.� p _____moi._:�.�_._-_1�? Job Site Address: Cit /State//:� 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 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: 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 DTA for insurance coverage verification. I do hereby certify it der t e ai d enalties ofperjury that the information provided above is true and correct, Si>;nature;�... _ — 4 't � --bate:._ ...-..... . Phone_ ,---_._._.........._ _ � ��_ _ ....-__-__._.---._..__...._._.__.—........__. Official use only. Do not write in this area, to be completed by city or town official City or Towne 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#: