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HomeMy WebLinkAboutBuilding Permit #265-2017 - 22 BAY STATE ROAD 9/13/2016 { ,/ �J' of No oT b�� 5 L� BUILDING PERMIT ter. o� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION " - sz Permit NO: �Z l Date Received Date Issued: I MPORTANT:Applicant must complete all items on this page LOCATION 22 Bay State RdNorth Andover,MA 01845 Print PROPERTY OWNER Maureen McKean {Q, Print MAP NO: "1" PARCEL: '� ZONING DISTRICT: Historic District yesnn Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building N One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other d Septic- Ll Well Q Floodplain El-Wetlands ❑-Watershed District 11 Water/Sewer fiberglass insulation in basement Identification Please Type or Print Clearly) OWNER: Name: Maureen McKean Phone: 978-687-0931 Address: 22 Bay State Rd. North Andover, MA 01845 CONTRACTOR Name:Joseph A Ryan, Merrimack Valley Insulation Phone: 978-408-7832 Address 23A Sullivan Rd Billerica, MA 01862 Supervisor's Construction License: cs 075541 Exp. Date: 0204/2017 Home Improvement License: Exp. Date: 180506 11/24/2016 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: $ 1,020.75 FEE- $ �)6 " Check No.: )� e1g Receipt No.: So&-I NOTE: Persons contracting with unregistered contractors do not have access th g ranty fund ignature of Agent/Owner see attached _, ignature of contractor r- p10RTt� �- BUILDING PERMIT Q��"E. ;6q�o TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION T _b Permit No* Date Received �SSAArED CHuSE��� Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION Print 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 ❑ One family ❑Addition ❑Two or more family Li Industrial El Alteration No. of units: El Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ T s - D�Sep�i� UUI ®]�Flootlp'a1 � �W t ani late fed Dis#r�ct L®1Nate)-on wer - -_ DESCRIPTION OF WORK TO BE PERFORMED: o Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone- Email: Address: Supervisor's Construction License- - Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the- ;uarr.-' fund Location— No.7(0' ' 6 C t t Date • • TOWN OF NORTH ANDOVER .. • Certificate of Occupancy $ Building/Frame Permit Fee $ao Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# Building Inspector II Jti .'.i � c G 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 Dmnpster 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 4 - Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water cos Sewer Connection/Signature&Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp,Dumpsterpn site ;yes.- rio._. � wi � c t. zt Located at 124,1616 Street r COMMENTS 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 LITi ERATURE: lies 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 Pennit Revised 2014 1 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 4 Building Permit Application 4 Workers Comp Affidavit 4, 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 products IS 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 OTE: 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 q own of NORTH ? _ s ndover O TO No. ; 114L � C% ver, Mass, c0c.1c Nl WKK V A�R�TED pPP��S S U BOARD OF HEALTH Food/Kitchen PER Septic System 11 BUILDING INSPECTOR 1,�' ,PJ �i t 6►.N THIS CERTIFIES THAT ...... .................::.............................. ...... .............. `` Foundation has permission toe re ............... buildings on ,rJ ... `............... Rough � �. ...... .. Chimney to be occupied as ..... Iva "".."""'... provided that the person accep 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 PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST 10 T Rough Service ... ..... .. .... ... ................. Final BUILD NG 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. i Federal 10 0 05.0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 �� A division of'Ihelsch Engineering RINEERE Company.Address,City,MA 00000 CONTRACT 401-123-1234 FA\401-123-1234 V RAC page i PROGRAM CMA-HHS E aNEEmNaAMWECs ICIRETNEUMSE FOR WORK AS oEscRmEo BELOW COStMER PHONE OAM CUMN woBaoll" Maureen Mckean (978)687-0931 07/06/2016 436853 00002 OE=SKEET sumo SWUM 22 Bay State Road 22 Bay State Road sr.W=crW.sVtE.LP aaLm aur.81RF—BP North Andover,MA 01845 North Andover,MA 01345 JOB DESCRIP't'ION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This%wrk will be performed in concert with the use of spccial tools and diagnostic tests to asstre that your home will be Ielt with a healthful level of air cxchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for staling include air ieakage to attics,basements attached garages and other unheated areas(+iindov+s are not generally addressed,)This will require(4)working hours.A reduction in cubic feet per minute(efm)ofair infiltration will occur,but the actual number ofcfm is not guaranteed At the completion of the v%eatherization work,and at no additional cost to the homeowner,a final bloncr door andlor combustion safety analysis will be conducted by the sulrcontmctor to ensure the safety of the indoor air gw[ity.RIM JOIST. $340.00 ATTIC ACCEsw Provide tabor and materials to insudate the back of(I)attic hatch with 2'rigid Thermax board.Weatherstrip the perimctcr. 560.00 BASEMENT CEILING:Provide labor and materials to install(109)linear feet of R-19 unlaced fiberglass insulation to the perimeter ofthc basement ceiling at the house sill. $190.75 INCENT,IVE:RiSE Engineering will apply all applicable,eligible incentives to this contract. You wilt only be billed the Net amount. Currently,for eligible measures.Columbia Gas offers an inccntiveof 75% not to exceed S2.00D per calendar year.and an incentive of 100%for the Air Sealing meastaes tip to the first$680 and an additional$340 if savings arc justified try the auditor. FORA LIMITED TIME:Columbia Gas%%ill also offer an additional S 100 incentive to%%ards the%watherization%wrk outlined in this proposal.This special Summer Incentive is available to homcov%ncrs rho have had their Columbia Gas home energy audit before July 31.2016. A signsd proposal for v%eatherization needs to be submitted by August S.2016 and%wrk mast be completed by Septcmbcr 30.2016. For the safety and health of your home's indoor air quality,%%e will be conducting a blo+%cr door diagnostic of the available air now in your home both before the vwrk is began,and after the w atherization%wrk is complete.We will also conduct a full assessment of the combustion safety of yotr hentingsystem and rater heater.This has value ofS90 and is at no cost to you The maximum allowable incentive for all measures,including air sealing,is 53,210 The 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%wrk. $90.00 D IE 00 IE 0 V 0' JUL - 7 2016 Federal 109054405629 RISE Engineering RI Contractor Registration No 8166 MAContractor Registration No 120979 R� AdhisionofThielscbEngineer•ing RISE ENGINEERING Company Address,Cit},MA 00000 COWR A^r 401-123-1234 FA.4401-123-123+4 1► �V'14 Page 2 PROGRAM IMSCOMCNIA-HES r OAANimIMwes�FORs"RWORKAS OBSCR UMOBELOW CUSTO ER PNORE DATE CUHNTS YMM ORDER Maureen Mckean (978)697-0931 0710612016 436853 00002 SERVICE 31IE0 SUIM 8TREET 22 Say State Road 22 Bay State Road somm arc.sP.E,DP BUM car,sw aP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRWnON Total: $680.76 Program Incentive: $718.06 Customer Total: WEAGIREE HEIMYTO FURNMH SMMES-COMPLETEM ACtOROAXCE W TTTR ABOVESPEC1R=TW&FOR THE SUM OF .31 Dollars UPORAWALRISPECTONANDAPPROVALOY RISE ERN.INEERB.VR CM P"AGREES DREWTAtAIMXO0fJRL eMRESTOFj%WRLB£CHA="wMLYONANY URPAW BALANCE:AFER 30 DAYS_EEEAEVOMERORMURIONRt WARANEES.RMMCFfMCMJ N,SCREBUL nANDOWIPAC1ORRE=TtAIM. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPMCI S A SIGNATaRE- E noseaoseamtAerrmraEwmcRAtvNerosrPRRoT£x culmwvmm WEOFACCEMPICE AOCEPTANWE OF CQ'T RACT-W ABOVE PRICES,SP.EGW"1iM A90 CONUM NS ARE 30 DAYS. AAS SSPE AYMEMWRAM�if�E ASQUWNEOOAAewVE AUMORIIEo wno IRE waa so��d� JUL _ � 20 16 CASE# "'/J Cr?S 3 SIDING WS/CB 1NY ALUM/ASB I BRICK I ROOF ARCH 3-TAB I COLOR VENTS BATH FLAPPER x alpRIDGE ROOF xA PGABLE x_ SIZES OK FOR WO& Y/N SOFFIT: NONE/WOOD/ALUM#IR4 DEPTH 10' COLOR WA i- QSTYLE Pel ,. wilt. :.! 14 i f I I i I I 1 I I s • � 1 � } E Y k # iS � {{E l {� ( i _ _ 1 1 t ! t I i f t Z� I � Ir41 # , 1 f : Ij LL da 1 FLAT f7 KNEEWALL Q WALLS FIAIR SEALING HADD VENTS SLOPE F-�KW FLOOR Q KW SLOPE f-7 SILLS O MAKE ACCESS ❑EXISTING ACCESS RISE 60 Shawmut Road,Unit 21 Canton,MA 02021 339-502-6335 ENGINEERING www•RISEengineering.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: Property Address) 11,1q. (Property Address) hereby authorize (Subcontractor) 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. Ownees Signature Date 7 2016 G The Commonwealth of Massachusetts DelsarLment of Indt-istrial Accidents Cats'lice of Invesdgat op-s 600 Washington St. Bostoall TV---{z 02111 sn:-1:}.mass.zo wdia Work-ees Compensation Insurance 4fff davit: builders/Contractorsi lectriciar:s/Plumners A,ppilcation Iuforut-nation-Please Prin t Legi bly l\'acme(.EnsinessiOrganizai?oni ndividuni/Oiti'ner:,C. j.;Ace-VA I/e ' CLie+luw CO3 Sddress: a� A &—i4IvAIJ' 2;� - Citvlstate"Zip:-R)IIIE CI CA L-4-3 Gi?(-z- Rhone-: 479-19S*R- 31415 i ire you as employer? Are you the hoineoWner? Check the approplate amnber: � 1. v1 I am an employer with emplovees(full and/or Hart time. 3_ I ane a sole propri_caw or partnership hasa ao employes worldng for rye in any capaciy_ 3. I a:n a homeowner doing aII:mrk rn seI. (ryo workers compensation insurance required.) ti 4. =am$aener2l contractor spm x have hired the sub-cunr-actors listed on the attached sheet } (Theze contractors have workers Loop•insurance and I nate attached a coDy gar their ins.) ' We are a corporation and its officers have exercised their richt of exemption per.IC-L C.10-sl (4j,and.ve bare no employees.( o Yforkers comp.insurance required.) t c n appiicint ti:at checi�hos�i must also i.'il out the se:aoa beton:showir,-E th:ir F:orier'comp.polity information. � I =o_mco- re=:wao,suomit this 06tw it in UmfiRg tit*v are di:tr_r die roriC 9_i:?ftea hare v_.e3.u...0:..�..s.,_a.uu.�:.�'."........... s affidavit indican ag such. i o Contractor--that ci eco this hoz must at.aca as additiasai sheet showing the umm of the sole conirmcbrs a^d ticcir.rorheContractor-- compensation policy in€onration_ Type of Droject(required}: Chec.:appropriate- j 16. Ne-vv Constrniction �._Remocdehng s._.Demolition 9. Building caddition ! j 1Q_ Electric: 11. Plumb.12. {coof 33_]-�/Other Ts00 '.' I am an employer that is pre-widin,:corkers'eomnensation iusurzncc fur my cmplpyees. Below is the colic,&job sic ir.fo. Jnsur-- +ce company-iame: Policj.•r or self-ins.Lic.= ExprItion dace: _ job Site Address: -�iiacb a cop}of warker's coMnensation policy declaratior.Pa_e(showing La epolicy I um erarcie piration date railtara i7 sacr-rB coverage as -Qu!aid order Section 25A of M1.7-c,I5'_'c-tm lead to the.'imosition ofCri i?Da{ cenait:es a a fine UG to SI-500-00 and/or one year i[T_iprisoa nZ5 a.L'us viell as civil pen-di tics in the form of a 3TOP 4iJ0 K ORDER and a fine of up to 5350.00 a day against the viola-den- Be advised that a cap.;of this iaiernent rna;;be forwarded to to OfTca of investicatn oris of the DIA for insurance coverage verification. do herab v ce-ni under the pans aad peaalies of perjun tha>.the info rmedon aro'ided abme is true and coriect Pone Off, use o:1?�J: �G i1Gt+��to iii..this area-to be comyleted by,cit r or tovwn G�ciar. fI n To min: P� 'Tice se i issuing, utlioritty(ckec1Co:?e) 1. Board of ffeal`th ?_Building DepL 3_`C.i'1wTv-w9 Cieek 4. Electricai hasp. f Plurnb&Gas o. Other Contact Person: (print) Plione f / 1 m������r��-vv 164 , Ro= CERTIFICATE OF LIABILITY INSURANCE DAT1D/YYY1�v` 6/13/213/2016 CHIS 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 ertificate holder in lieu of such endorsement(s). ODUCER CONTACT NAME: tomatic Data Processing Insurance Agency,Inc PHONE FAX .DP Boulevard ac No Ext: ac No: E-MAIL seland,NJ 07068 ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:5Star V3 AAIC American Alternative Insuran LURED Merrimack Valley Insulation Corp INSURER B: 23a Sullivan Rd INSURERC: North Billerica,MA 01862 INSURER D: INSURER E: INSURER F: )VERAGES 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. 2 TYPE OF INSURANCE ADSL WVDR POLICY NUMBER MMIUDD EFF POLICY M UD EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ CLAIMS-MADE F—I OCCUR MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COII AGG $ —1 7POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED $id (Per accent) AUTOS AUTOS BODILY INJURY I NON-OWNED PROPERTYDAMAGE $ HIREDAUTOS AUTOS Peraccident $ UMBRELLA Ll" OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X I WC STATU- OTH- AND EMPLOYERS'LIABILITY TORY LIMITS ER ANY PROPRIETORIPARTNER/EXECUTIVE Y/N 9WC749118 611812016 6/1812017 E.L.EACH ACCIDENT $ 1,000,0D OFFICERIMEMBER EXCLUDED? 1 N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,00 lips describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,00 SCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,H more space is required) °RTIFICATE 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. AUTHORIZED REPRESENTATIVE ©1988-2010 ACORD CORPORATION. All rights reserved. CORD 25(2010105) The ACORD name and logo are registered marks of ACORD j office of COf1SUmler-A- airs and Biuiness Regulation 10 Park Pl=-Suite 5170 Boston;Massachusetts 02116 Mome improT3ement Collar r Rejistration Registr25on_ U0506 TYPe: CainoraSon MERRI IACK VALL L=Y INSULATION!CORD Expiration: 11324!2016 Tr,- 2BR524 JOSEPH RYAN -- -. 23 A SULLIVAN P.] - - SILLERICA, IMA 011862 Update Address and return card.hark reason foreusope ._.. _.r•± :;i Address ' ' RC[ICK9I - Cmployment LostCard "r�' =e tip:::JtC;r.}-`-i•'°p- %'.:_r:::nt...::`, - _ ... -=OJLce:o:Corssuncr_�rfaics E SMW-Re,'utatic 0 License or—.k"-tion ti-alid for indiridul use only FOC IMPROVEMENT COPtr'i R4CTORbefore L8e e^piratian dais Iffound returmLo: T _ S,rTsgistra8on_ te050o Typz rJ ice of Consumer_Affairs and Business Regulation `-piztion_ '-i24:2aL6 Corpoiauan 14PnrkPiae_Svi'M5170 MEMMACKVALt,EYWISULAT10hCOR? Boron.3i�02JI& XSEPH RYrii 25 a SULUVA?;Ro ^\ l�x �3G_ r Stt.LERICR,td<101So'? -- i ��i Vatitj{tiI�0UE 53onaLUlt - s arm 5�•�:.,�� ; ?s�:CS 07547 JOSFPRARYALV 200 Mn-a RMI Dr-:Apt 201 Lynnfieid M4 01340 Cc-iss:_r r 02!0412017 E -