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HomeMy WebLinkAboutBuilding Permit #1079-2016 - 210 GRANVILLE LANE 5/12/2016 BUILDING PERMIT 3? y TOWN OF NORTH ANDOVER ° i APPLICATION FOR PLAN EXAMINATION Permit NO: 1 Date Received �9SSACHUSEt�� Date Issued: IMPORTANT: Ap2licant must complete all items on this page-1 64 ,el , //� �/ LOCATION t�/ !Vr1j7 Prin PROPERTY OWNER !7f Print MAP NO:ICj _C—PARCEL: ONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential t al New Building ❑ae family Addition ❑ Two or more family �J Industrial /Alteration No. of units: ❑ Commercial Repair, replacement ❑Assessory Bldg ❑ Others: Demolition ❑ Other Septic Well Floodplain Wetlands ❑ Watershed District Water/Sewer t 'ca llIdentific ion Please Type or Print Clearly) OWNER: Name: 7 (!� Phone: lC� ' � Address. OU 1AJ r �� CONTRACTOR Name: Phone: Address: Supervisor's Construction License: Exp, Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER IV Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 0!!PFEE: $ Check No.: Receipt No.: '— � — NOTE: Persons ontracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Ower Signature of contracto Y Location No. C 7C a, Date C L1/I -r 1,/' G . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ _ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 3LI 0 Building"Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan-❑; Stamped Plans ❑ TYPE OF SEWER-AGE DISPOSAL x. Public Sewer ❑ Tanning/MassageMody Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpstex 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 ?oning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes -?fanning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/sr�c nature�Date Driveway Permit DPW Town Engineer: Signature: ti .��, Located 84 Osgood 3 od Street F�fRE DLP,�R`TM`ENT ��Ternp ® - " � R-�-� -a-m- umpster'onsite .5yes� �no Located at -1 Main Streets `{• �-� -- F1ire D partmen W40:76, %d Qi ti �C®MMENTS �- x 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.$1oo-$l000 fine NOTES and DATA— (For department case) LJ Notified for pickup Call Email i . } Date Time Contact Name Doc.Bnilding Perin Revised 2014 Building Department The following is a list of the required formas 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 OTE: 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 Department prior to issuance of Bldg Permit products OTE: All dumpster permits require sign off fromp I New Construction (Single and Two Family) j Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses j6 Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 4 2012 IECC Energy code -% Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit T P peals In all cases if a variance or special permit was required the Towrecorded clerks at the Registry of Deedsfice must stamp the cision from.the Board of One copy and proof of recording that the appeal period is over. The applicant must then get this must be submitted with the building application Doe:Building Permit Revised 2014 r -1 V NORT11 w: :. . : �. .c . : ve" **. o - r _ h , ver, Mass, 041 S/ 2.01 cocKic"RWICK 1 P � U BOARD OF HEALTH Food/Kitchen P. ERMIT T D Septic System THIS CERTIFIES THAT ........ '.C''.....S.�..�Y...1..co:t. .s........ ............. BUILDING INSPECTOR .... ................. �� .O. 67r.".v! 1.1.1e....�..f. Foundation has permission to erect .......................... byildinson ..... ... .l.. . ic'.f • Rough to be occupied as ............ :- - . ... . ..&W..1�.+fo.n........................................ 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 VIOLATION of the Zoning or Building Regulations Voids this Permit Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTYSTAR S Rough Service ....... .. . ... .... .................................... Final BUILDIN 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. RISE60 Shawmut Road,Unit 2 Canton,MA 02021 339-502.6335 ENGINEERING www.RISEengineering.com Efficiency Energized. OWNER AUTHORIZATION FORM Peter Simonds (Owner's Name) owner of the property located at: 210 Granville Lane, N. Andover, MA (Property Address) (Property Address) D _ / hereby authorize CU W� (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my grope This fo is only valid with a signed contract. Own ri at re Date RISE Engineering Federal ID#054409W R ' RI Contractor Registration No 8186 S EN A division of Thielseb Engineering TC CC r Registration No 120978 EMG Contractor Registration No 820120 60 Shawmat,Canton,MA 02021 339-So2-5197 PAX 33 5 CONTRACT 1 ?ages 1 PROGRAM CMA-MS a MRwmgc�A9 oAn=. eLa9aro Peter Simonds � yXW� (61 X622-5228 02/22/2016 429642 00002 88134108 arm r SUM araeEr 210 Granville Lane C14210 Granville Lane 9ERM city,8TATE,zip W BILL"CrMSTAMZW North Andover,MA 01845 - North Andover,MA 01845 14 DESCRIPTION WHEN GAS HEATED:This proposal has been prepared to illustrate the incentive value once your home becomes gas-heated.some measures recommended for your home qualify for an incentive from Columbia Gas. Currently,Columbia Go will pay 75%of the cost for insulation measures(not to exceed$2,000)for gas-heated homes.The maximtun possible allowable incentive for all measures,including air scaling;and diagnostics,is$2,900. Prices and program incentives not guaranteed past 30 days. 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 wesibeiza<i combustion fumes in the exhaust flue of your heating system aon work complete We will also conduct a diagnostic assessment of the ad water heater.This has a value of$90 and is at no cost to you. $90.00 AIR SEALING:Provide labor and materials to seal area 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 horse 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(8)working hours. A reduction in cubic feet per minute(efts)of air infiltration will occur,but the actual number of of n is not guaranteed At the completion of the won work,and at no additional cost to the homeowner,a final blower door and/or combustion safety a3talysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. AIR SEALING ADDER: (2)working hours. $680.00 $170.00 AIR SEALING:Provide labor and materials to install Q40n weatherstripping and a doorsweep to(2)door(s)to restrict air leakage. $150.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaoed fiberglass baits to(80)square feet for damming purposes. $164.00 ATTIC FLAT:Provide labor and materials to install an 8"layer of R-28 Class 1 Cellulose added to(613)square feet of open attic space. $839.81 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. The cover has integral weather-stripping to restrict air leakage. $200.00 VENTILATION:Provide labor and materials to install ventilation chutes in(57)rafter bays to maintain air flow. $114.00 OVERHANG:Provide labor and materials to install 6"R-21 densely packed Class I Cellulose insulation to(120)square feet of exterior overhang located below a heated floor area,by drilling holes in the overhang from below. Holes drilled will be plugged. Plugs will be sealed with exterior grade spackle and left in a relatively smooth condition.Finish sanding and touch-up priming/painting will be the customer's responsibility. $460.80 GARAGE CERING:Provide labor and materials to install 6"R-21densely packed Class 1 Cellulose insulation to(600)square feet of garage ceiling located below a heated floor area,by drilling holes in the ceiling from below. Holes drilled will be plugged. Plugs will be speckled and left in a relatively smooth condition.Finish sanding and touch-up priming/painting will be the custoinces responsibility. $1,140.00 RISE Engineering Federal 10 9 OMMSU Ris MA CQ�Re91 fto No 8186 A division oiTblel6cb Engineerin Regiaktradon No 120979 ENGINEERING g CT Contractor RegisMon No 620120 60 Sbawmat,Canton,MA 02021 339r802rS197 FAX t CONTRACT P1tOG1tAM T168eaHrRAcrIB BHTExEo pro BET%VW R{BE CMA-HES s a�erom�Ponrwnu as 1asloMm DATE CUEHTt Peter Simonds PHONE NtO oRoeR (617)622-5228 02122/2016 429642 00002 BERVICE 6TROUT se uuo STREET 210 Granville Lane 210 Granville Lane SERVICE CITY.STATE,EP W-UM CRY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 .TOB DESCRIPTION Total: $4,008,61 Program Incentive: $2,840.00 Customer Total: $1,068.61 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPEMCATMa FOR THE SUNT OF 'One Thousand Sixty-Eight 8161!100 Dollars $1,068.61 UPORRUL e 11OMAMAPPROVALBYRISEEIMMERIMCINTOMAGREESToREIMAtOUMDUEDIFUU.. UWAftUMDEAFTERSOo0.Ye.SEEtLqVIUEFORD+IPORTANTDdFOMTDYIOL'Ol:A0.'U1rcES,RIGHMOFTOF1 BE tltARO®MOMIUYOMANY RECggN, ,ANp WURS RAT101L OO NOT SIGN TMS CONTRACT IF THE SPA ROiEEnpnte,IR6 /WCE /p,, �l1 //� NOTE 1106 CONTRACT MAY BE WITHDRAWN BY US IF NOT EIIEgITED WRWN DATE OF ACCEPTANCE ��LL�!/�+ M�7 30 ACCEPTANCE OF CONTRACT.TIIE ABOVE PRIM.6PEC0�0AT10116 AND COIIDITIONB ARE DAYS SATISFACTORY TO US AHD ARE ICY ACC�TEp.YOU ARE AUT1ORMED TO DO THE WORK ASBPECffOb PAYMENT WILL BE MADE ASOUTUNEDABOVE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 S� www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Co-op Power Address: 15A West Street City/State/Zip: West Hatfield, MA 01088 Phone #: (413)772-8898 Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with 20 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. + E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp. insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their 10.F] Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑ Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.❑ Roofre airs insurance required.] t employees. [No workers' 13.® Other (CALO comp. insurance required.] *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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: HDI Gerling America Insurance Company Policy#or Self-ins. Lic.#: EWGCC000Ile 187715 /� Expiration Date: 11/08/2016 Job Site Address:CQ/bq,017?yt C... 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 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 certij ri enalties of perjury that the information provided a ve 's true and correct Si nature: Date: Ph o e#: 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#: A C4 o CERTIFICATE OF LIABILITY INSURANCE Fil/12/2015ATE(MNM) 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: Debbie MacNeal James J. Dowd & Sons Iris PHONE FAX 14 Bobala Road A/C No Ext):4 13-538-7444 A/C No): Holyoke MA 01040 ADDRESS: dmacnealQdowd.com 'PRODUCER CUSTOMER ID#:COOP INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A:HDI-Gerling America Insurance Compa Co-op Power, Inc. INSURERB:Tcrus National Insurance Company 25496 15A West Street West Hatfield MA 01088 INSURERC: INSURER D: INSURER E: A INSURER F: COVERAGES CERTIFICATE NUMBER:254565888 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 TYPE OF INSURANCE ADDL UBR POLICY EFF POLICY EXP LIMITS INSR D POLICY NUMBER MM/DD/YYYY MM/DD/YYYY A GENERAL LIABILITY EGGCC000187715 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence) ccurrence $100,000 CLAIMS-MADE Fx_]OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PRO LOC $ A AUTOMOBILE LIABILITY EAGCC000187715 11/8/2015 11/8/2016 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULEDAUTOS X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ Comprehensiv $ g X UMBRELLA LIAB HOCCUR 70354Q150ALI 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ A WORKERS COMPENSATION EWGCCO00187715 11/8/2015 11/8/2016 WCSTIT ER AND EMPLOYERS'LIABILITY y/N R IMT R ANY PROPRIETOR/PARTNER/EXECUTIVE❑ N/A E.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 i T � 7 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder, Eversource, and National Grid are Additional Insureds on a primary and non-contributory basis per written contract CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. CLEAResult Attn: Contractor Services Dept. 50 Washington St. 'AUTHORIZED REPRESENTATIVE Westborough MA 01581 <i�q *� ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD F 1 a l�t�j1cc o `� msumer �, fclli"S L1S1�7i'`� Rc'�?llicill(�?� 10 Park Plaza - SLI"Ite, 5170 Boston, lVlassachusctts 02110 t�i1't Improvement Contractor Re��istrat o?1. Registratior 16521 ...apt'.. Si.pplef?1en', Card Expii'a t-onr2�i°' ,�O-OF' POWER. INC. l._LA--i [)ANIELS A VVEST ST A' .S.?.. ti.tiiFIELL). MA i plate.address and return Bard. Nbl- zea>on 1or cl�an�e. :Address Renvwv d EAnI loyment Lost Card & License or registration valid for iudividtd m c onk t befw c the expiration date. If found return to: 3 #OME.IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Re<,ulation -F Rer+.sttation. ._. Type 10 faro:}'laza-quite 5170 Expiration: i'20'8 5uo.r!enlent C", Boston.MA 021 Ib CO-OP LEAH DAN` 15A tN E WES.. t nticr. crer.,> " ' Not valid N,ithout signature .......................... _ _ ---... of PuukC :safety, 1tGe . .,;: -�:;ufattons and S,,ar+rsards = CS-097409 f`ortsirssctmy) supervisor LEAH M DANIELS g 12 MARCELLA ST t ;' ROXBURY MA 02119 05%18!2017