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HomeMy WebLinkAboutBuilding Permit #771-2016 - 200 COACHMANS LANE 1/4/2016BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION n;itp Rprpivpri TYPE OF,IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building One family 0 Addition 0 Two or more family 0 Industrial No. of units: 0 Commercial —�NIteration 0 Repair, replacement 0 Assessory Bldg 9�Other 11 Demolition 11 Other - WOW "'"0* _0 9 F2 I Identification Please Type or Print Clearly) ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE ,SCHEDULE MVLDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost.: (e0_ FEE: $ QU Check No.`. Receipt No.: a - NOTE: Persons contActing with unregistered contractors do not have access to the guaranty fund It A BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print O' , PROPERTY OWNER Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building El One family El Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic _ �zlNell ❑ Flood lain ❑ Wetlands . WatershedLDistnct; Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Address: Contractor' Name: Phone: Email: Address: Supervisor's Construction License: Home Improvement License: Phone: Exp. Date: Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: BULDING PERMIT.- $92.00 PER $9000.00 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 Location 2G Q C o o t vV A ^r -s L3 No. Date ► 1 Check # Z.,Q/ 2 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ x TOTAL $I_ f Binding Inspector Plaits- Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL F Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic lank, etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m U FORM PLANNING & DEVELOPMENT Reviewed On Signature, COMMENT'S - .-CONSERVATION - Reviewed on _ - - - - Signature - - - COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board f Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes Planning Board Decision: Comments Colnservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit ]DPW Town Engineer: Signature: Located 384 Osgood Street g. ,�., �e.w...-..ra.-. ... �.9 (g1-Zf .' 3i •t i R •. '' `+ ! -'' ""' :: ;I x7-147.'.`+ JEIRE DEPARTME IT �Ternp ®umpster on site � yes, ,: " w, no I Lo�cated.at 124 Main'Street'' 361 ,.:7..:'�•i'w�^.. Via` �Ie✓^4.c..Crf 1`.i.r- � �-c� fit s .ii�'"�". � 1 }'�,�, E Alf, ire I F.,"`I.! -, it." V. .AtF��3_..ti .�`y+�yyi t �r. C®MIVIENT`S'� t t,,��� k= �•�., , `, , •�'�,,, ;�' �': ,�`{ `� �, �� �,3 • Dimensions 1 A Number of Stories: Total square feet of floor area, based on Exterior dimensions. J 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 3 Doc.Bi lding 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 Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4 Copy of Contract Floor Plan Or Proposed Interior Work 'Engineering Affidavits for Engineered products TOTE: 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) i 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 m 0. Z Cp O CLr CL �. �O 0v CD CLc CD O CD —'v CL O SCD CD .�f O �WJ 0 N C. C °I CD CD C. U) im- c� Z m m ic X v y Z m Z 2 < 0 0 10 C -i o v O < CD N 0 CD 0 z o =r =r Z C _?' � vi' � O O N fuCDN• TI =-ILr O O =r = m CD W CD N ' "� N N c, CD 0 CD CD C to y. CL O � rt � CD a c� 0 ' p S CCD O N S �, .� z CD U) D N n S P •� O O� _ bJ RL<Q-rO. CD CD O� O W O CD O CD CL C N �"o CU MCDr N � C CD 0 N OO+, DCD m ".00 su O O rt w O � O CLC3 , N y a� T PO OCD pp 1 r T w T r) w T N T (n N � C CD 0 N OO+, DCD m ".00 su O O rt w O � O CLC3 , N W T PO T V1 pp T w T r) w T N T (n N OU F �p r+ S S CO S cm 7 o- Z 7 ro S it v cn LA \ 0 N n p 3 h S =� m C C 3 W N v v W M a Z v M z O ccl y H r O v+ _ v M m m m O m Z 70 rl r 0 s e.l'\ #00M) RISE Engineering10Coribactor RealsbUtIOU No eeA ConhVIdW Reglairatlon No A dNrisloa of TbWwh Fqtne ft mconfsaemr 0O "D 60 ShimmutUmhS,Cut^UAMW CONTRACT 339-SU4MS FAX3-902.06 Pop 7 tarcuro o tete PROGRAMneeooxraactattaeare MA-HESraegewncromtaa CDESCRIND -CLMS PROM -=a Vlowafanw— Julia RoacheIc (617)894-4076 08/23/2015 413171 '*Q I 00003 200 Coachman Lace 6 200 Coachman Lane North Andover, MA 0184 0 N North Andover MA 01845 tB DESCPJMON PHASE ONE -Proposal for $0.00 HEALTH & sAPETY: Weathmivatim work cannot proceed uohl dre irisofficieat draft issue is axed El rwATM SPIE IS FLUE GAstll $0.00 AQt SEAU Na Provide labor and materials to seal areas of yourhome again wItcK excess air lealmilk lois work wUl be performed in concert with Via use of spccW tools and diagaostietoo to assure thatymahomawill be left with a ha ddM level of sir oxcbanga and indoor afr ghality. Materiels to be used to seal your ham can include canft %m and other Products. Primary areas for seeliug include an lealoige to eltas, basentohib, attached garages and atur unheated areas (windows are notY addressed.) (8)wohimtghmua I Atdre rmmpkton ofthe weatde rah work, and atno additional costto ho hom or mer, a final blower door and/or combustion ser ty analysis will be conducted by the subaw� to enema dre safety of the iadoarair quality. $680.00 AIR SEAUNG, Provide labor and materials to seri areas of your home against wadcK excess air lealage. This work will be pgdormed in oo cW VAth fire use of q>e W tools and dis prostctests to own that your home will be left with a heft id level of air excbmge and indoor air quality. Materials to be used toad your home cm include caulk, foams and other Pmxluim. Primary meas for sealing mduda air 1ee&age to shear baa=cm ettarLed gattsg- and other unhaded areas (windows am not gemm ly eddresm&) (4)vwarldtbotas. Atrho completion oftlm wea&minden wade, dad atm addit wd costto the ha wwnw. afmai bimmdoormWOr combustion safely anahysis will be conducted by the subaroatrector to ensure the safety of dre indoorair gaality. $340.00 APR SBALQ3Q AME[t (4) wwkWg Bourn $340.00 DAMMG * Provide l dw m d materials to install a 1r layer ofR 38 unfaoed fiber&m bath to (M sgme fact fordaahmiag I $5330 ATTIC FLAT. Provide labor sad materials to mosU a T taper of R 25 Class 1 CeUtdose added to (1948) square fed of aper site SPWL $2.532.40 SPORA(IB BARRIER Homeowner b respohtsible for the removal of the aimed m= blocking the msWWhm of weadrerizaton wink in dre attic. Removal tmat ocean Puiertu fhe schrrduted wmk stazt. $0.00 KNESWALIA. Provide lem aodmd aida to mstaU 2° F31t. faced semi-rrgrd 5ber0ass board bmdaoa to (110) sgrmre sed of kaeawail area $385.00 Y" a 0001h\ Eedetal m 0 RISE EngMeertngc mAc8flbec t m0 A ftfdm dTtrhdseb E CT Cor&sctor Regbtra9on Ho 60 Ommatudt A Gamboa, m 08021 CONTRACT 33SL602b336 FA%339902." Pap 2 PROGRAM eseeeereAcraaomawesrfaae CMA4ES �tEmoosraasewawefecAe Julia Roache (617)894-4076 08232015 413171 00003 mown= mumomm 200 Coachmms Lane 200 Coad mass Lane Noir Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION AMC ACCM, Provide tabor mrd mecaiels to ioaalam the back of(i) attic hdchwith2- rigid Themoeo: board Weathers* the 1• $60.00 VENTIIAATTON, Ravi& Mm and materiels to in" (2) imvleted c&mmt hose with soffit mwmtad 8appervmt m a> I wdsbns bathroom Nm(s} ' $z37so VE MAMOK PmvWc labor ad mdtuids to install veoblation in (22)raft bays to mufnm air Now. $44.00 1tiSB Eagineaiag wrll apply�eII epplimble, eligible is tivas to this co�seG You wfll only be bMW theNet amount cm en#y, for eligible meamum ColumbmGss cars 75% mceative, not to aweed 52.000 per cymr, and as laxative of IwA Nor the AirSealingmmun up to fhelust $680 and an additional5340 if savings aro jaslificdby theauditor. Fortbesafetyand heft ofywhomesiadoordrgadity.wewdlbeemi&w gablowerdoordbgmos&oftheavailableairfiowin yourhome both beforethe work is beM and aNathe wedh=mdm wmkis complah Wewill ohmandrcta Hill assessmaftof theoombustionsafeiyofycurbmtmgsystemand vim heatex.' ibbiksavdaeof$80aadzatn000sttnymL Tatalallowable west udution Wcmtive is $3,110. $90.00 Total: $46762.20 Program Incentive: $3,140.00 Customer Total: $1,6522D WEAORFFHt3t®Y-tAeEPl.EtHRIACODRDAefMVMWaeavt: CATtot &FMTl SWOF "*One Thousen ! bt Hund Two & 20H00 Dollars $1,662.20 uwwwuv emaivaoawaawu aaemvo rmcFjma 3CU�rwtswateaex+�ao>aaoxanraxMnr aravm vaaffi oaf woxrawfos�oxsa.M 0wimacroaaeamw►voon. THIS fiRACT ff THERE ARE 7.,"17a eorrstwscaarwicraaraE+asreoAAwieroa ear varsmf DAiewAeewaeee AorEPraneeweoafaacr-Teaf►aave evaw+c+ MAf®ooeomoesAaa 30 a� AcwTOi m� raaea AaeAvfxota:EaT000rnEwowt i The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 ' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individua,,. Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #: 603-578-9275 Are you an employer? Check the appropriate box: I . ✓❑ I am a employer with 100 4. EJI am a general contractor and employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] required.] 3. ❑ I am a homeowner doing all work myself [No workers' comp. insurance required.] t have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.+ 5. ❑ 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.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.✓❑ Other Insulation "Any applicant that checks box 41 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 providing workers' compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: 'Indemnity Insurance Co of North America Policy # or Self -ins. Lic. #.V0--��-`Jl kS 1 J5�, Expiration Date: 6/30/201 Job Site Address: 90 cnnr N fY1ri in Lie 0 < City/State/Zip: &Iue-r 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 under thepains and penalties of perjury Ilia, the information provided above is true and correct. ane #: 603-324-1974 Official use only. Do City or Town: write in this area, to be completed by city or town officiaL 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 #: �_1 ® A�Ro CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 06124/2015 I 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 Aon Risk Services Central, Inc. Southfield MI Office CONTACT PHONEFAX (AIC. No. Ext): (866) 283-7122 F . No.): (800) 363-0105 EMAIL ADDRESS: 3000 Town Center suite 3000 INSURER(S) AFFORDING COVERAGE NAIC # Southfield MI 48075 USA INSURED INSURER A: Old Republic Insurance Company 24147 TODBUild Coro. 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER B: ACE American insurance Company 22667 INSURER C: ACE Fire Underwriters Insurance Co. 20702 INSURER D: INSURER E: INSURER F: COVERAGES I CERTIFICATE NUMBER: 570058348882 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. Limits shown are as requested S LTR I TYPE OF INSURANCE INSD WVO POLICY NUMBERMN/DDIYYYY POLICY EFF MMIDDlYY1'Y LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY3O48 4 'D67RVZDH EACH OCCURRENCE CLAIMS -MADE X❑ OCCUR DAMAGEO N $2,000,000 PREMISES Ea occurrence MED EXP (Any one person) $25,000 PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,000 X POLICY ❑ PRO. O. ❑ LOC PRODUCTS - COMPIOP AGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT $5,000,000 Ea accident BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per acddenl) ALL OWNED SCHEDULED AUTOS AUTOS PROPERTYDAMAGE Per accident X HIREDAUTOS X NON -OWNED AUTOS UMBRELLA LIABOCCUR EACH OCCURRENCE AGGREGATE EXCESS LIAB CLAIMS -MADE DED RETENTION B WORKERS ION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE ORH EMPLOYERCOMPENSAS'LlABILITY YIN All Other States E.L. EACH ACCIDENT $1,000,000 C ANY PROPRIETOR I PARTNER /EXECUTIVE [N] SCFC4815190 06/30/2015 06/30/2016 OFFICERIA1EMBER EXCLUDED? (Mandatory in NH) NIA WI Only E.L. DISEASE -EA EMPLOYEE $1,000,000 If yes, describe under E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) 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 M ACCORDANCE WITH THE POLICY PROVISIONS. Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A Topeuild Company 260 Jimmy Ann Drive Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD n ss OEM— sine Regulation Airf�irs opfice'of Consumer 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 Officr ofConsLmcrAffairs .&- BusinessRegulationME IMPROVEMENT CONTRACTOR -579141 Type Supplement JILDP-R SERVICES GROUP, !NC. Registration: 179141 . Type: Supplement Card Expiration: 6!2512016 V. -)date, Address and return card. Mark reason for change. Address Renewal Fmolovnient Lost Card I.icense or registration valid for individul use unh before the expiration date. If found return to: ()ffice of Consumer Affairs and Business Regulation IO par- -1 pl;an . u: it 5 Bov�on. MA 0211' ) :,HARD SCHWARTZ 0 JIMMY ANN DRIVE -'21144 .YTONIA SE CH. P, Not vaiid,;�A-ithout signature 0