Loading...
HomeMy WebLinkAboutBuilding Permit #130-2017 - 23 CLEVELAND STREET 8/10/2016 NORTy 11 BUILDING PERMIT b46 qo TOWN OF NORTH ANDOVER �2 hEy • APPLICATION FOR PLAN EXAMINATION Permit No#: •lT_�3J— �t7 Date Received y`'�Rrwep"�5 ED • 4 CH Date Issued: e1J=1I IMPORTANT: Applicant must complete all items on this page LOCATION (6a PAQ, 3+7 U,nt PROPERTY OWNER 41A-^ (n �Ui- e-lc— G� Print 100 Year Structure yes no MAP 6 PARCEL:iM� ZONING DISTRICT: Historic District ye no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain D Wetlands ❑ Watershed District, 0 Water-/Sewer DESC IPTION OF WORK TQ BE PERFORMED: Seat c adentification- lease Type or Print Clearly u OWNER: Name: w\ (^, -e � Phone: Address: A- ' Contractor Na e: u&-vJ Phone: 32 L� Email YVI t- . c.- _ a Address: / CQ ,r6, n69 Supervisor's Construction License: --Exp. Date: > (� ( Ll Ex Date: 'If Home Improvement License: p 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.: Rz / Receipt No.: 7/ 7 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Location C�+/ Nec'(P ' J No. A) — ?O/ l Date ` f • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ � Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ~ Check# aw 4 �' Building Inspectoe/ 1 J Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWER-AGE 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS 4 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 r A Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: __. 3 O eFIREDEP`ARdTMENT -'TemWA Dumpst s. _ ,riows Located goo Street � E,Located at er ons " ite �yess� ,,� � 421VIamtStreet _ ___,_ � EFre�sD°epartinenfasignature[datey..�_ _ _ _ �p_ � � Y __,_„ # ;'0 OMME'NITZS_ _ 4 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 J ' 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 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 4 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) rr 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 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 NORTH own of s ndover I)b Z 1 � oh ver, MassLAKE coc"ICKIWKK y1. A04ATED P4�`�.(y S U BOARD OF HEALTH Food/Kitchen PER LD Septic System THIS CERTIFIES THAT .......... ..... .... . ...... .......... ....................................... .......... ..... . BUILDING INSPECTOR has permission to erect ......... build' gs on ..�..r/� � .,,...... Foundation .�IRM. kAdt. 1Z.ma-re^ .rw e. Rough to be occupied as .., 1� .... .................. 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 CONST"10 Rough Service ... .......... ..... ........... Fina BUILDI INS CTOR 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. 1 � Federal IG#08"s629 RISE Engineering Rl contractor Regbtratlon No 8186 01!!! MA Contractor Reglabution No 120979 !� A division of Thielsch Engineering CT Contractor Registration No RI S E 60 Shawmat Unit i12,Canton,MA ENGINEERING CONTRACT (401)784-3700 FAX(401)784-3710 Pago 1 PROGRAM TWS CONTRACT Is ENTERED ORO WTWEM Rise CMA-HES 00MME]WO AND THe CUSTOMER FOR WORK AS OBSCRIBED BELOW CUSTOM PHONE RATE CLUINTS WORK ORDaP Adam Cutler (617)429-4971 07/192016 437438 00002 SERVICE STREET HALM STMT 23 Cleveland Street 23 Cleveland Street SEANCE CITY.STATE,aP 841M CM.STATE,aP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION FIX EXISTING INSULATION:Slash the vapor barrier,flip,or reposition(185)square feet of insulation in the awe area $46.25 KNEEWALLS:Provide labor and materials to install 2" FSK fitecd semi-rigid fiberglass board insulation to(185)square feet of kneewall area $647.50 ATTIC ACCESS:Provide labor and materials to insulate(4) back of the kneewall batch with 2"rigid Thermax board,and seal the edge of the hatch with weatherstripping. $240.00 INCENTIVE:RISE Engineering will apply ail applicable,eligible incentives to this contract. You will only be billed the Net amount Currently,for eligible measures,Columbia Gas offers an incentiveof 750/9,not to exceed$2,000 per calendar year,and an incentive of I00%for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. FOR A LIMITED T&M Columbia Gas will also offer an additional$100 incentive towards the weatherization work outlined in this proposal.This special Summer Incentive is available to homeowners who have had their Columbia Gas home energy audit before July 31,2016. A signed proposal for weatherization needs to be submitted by August S.2016 and work must be completed by September 30,2016. For the safety and haft of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air How 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 beating system and water heater.This has a value of$90 and is at no cost to you. The maximum allowable incentive for all measures,including air sealing,is$3,210 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 work. $90.00 C DOVE D j U L 1 9 2016 1 i Federal ID#054405629 RISE Engineering RI contractor Registration No 8166 MA Contractor Iehation No 120979 .- A division orThidsch Engineering �_ °� g CT Contractor Registration No RI S� �� 60 Shawmut Unit#2,Canton,MA ENGINEERING (401)784-3700 FAX(401)784-3710 CONTRACT Page 2 PROGRAM THIS CONTRACT IS ENTERED MTO BETWEEN RISE CMA-HES ENGWOUNG AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOM PHONE DATE CLIENT N WORK ORDER Adam Cutler (617)429-4971 07/15/2016 437438 00002 SERVICE S'TRINT BILLING STREET 23 Cleveland Street 23 Cleveland Street SERVICE CRY,STATE,aP BIUMO CrTY,STATE,IIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $1,023.75 Program Incentive: $885,63 Customer Total: $168.13 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "*One Hundred Sixty-Eight 8131100 Dollars $168.13 UPON FOUL WSPECTION AND APPROVAL BY RISE ENOSNEERUIO.CUSTOM AGREES TO FEW.AMOUNT DUE W FULL INTEREST OF 1%WML BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER W DAYS.SW REVERSE FOR DWORTANT M"RMATION ON GUARANTEES,RIGHTS OF REM LM SCHEMAI NG,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTIWAIiFD SIGNATURE-RISE WSIOtnaeAnp CUSTOMER ACCEPT ICE I / NOTE:THIS CONTRACT MAY BE w1THDRAwN BY us IF NOT E%ECUTEO wnHCN OATE OF ACCEPTANCE �6 ACCEPTANCE OF CONTRACT.THE ABOVE PRUms aPECIFICATU NS AND COXMTWNS ARE GAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORMED TO DO THE WORK AS SPECUM.PAYMENT WILL BE MADE AS OUTLINED ABOVE D JUL 1 9 2016 i + 60 Shawmut Road,Unit 2 Canton MA 02021 339-502 RISE I I -6335 ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM (k Her (Owner's Name) owner of the property located at: 79 Oe"w S f (Property Address) (Property Address) ' hereby authorize a CA601 J�L (Subcontract ' 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. Owner's Signature Date --�ra D 1 9 2p16 ,AUL �AM, The Commonwealth of Massachusetts - -- -- ----- Department of Industrial Accidents 9.1 _ '} 'Office of Investigations Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers bl A licant Information Name (Business/Organization/Individual): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #:603-324-1974 Are you an employer? Check the appropriate box: Type of project(required): I. ✓❑ I am a employer with 100 4. ❑ I am a general contractor and 1 6 ❑ New construction employees(full and/or part-time).* have hired the sub-contractors ❑listed on the attached sheet. 7, Remodeling 2.❑ I am a sole proprietor or partner- These sub-contractors have g. F-1 Demolition ship and have no employees working for me in any capacity. employees and have workers' q EJBuilding addition insurance.+ [No workers' comp. insurance comp. 10.❑ Electrical repairs or additions required.] 5. ❑ We are a corporation and its 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no 13 0 Other Weatherization employees. [No workers' 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 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. 1 f the sub-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for rrry emplovees. Below is the policy and job site information. Insurance Company Name: ACE American Insurance Company Policy # or Self-ins. Lic. #: WLRC48151553 Expiration Date:6/30/201 ' Job Site Address: LlejelLj 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 herehy certi_v under the sins and penalties of erjury that the information provided above is trueandcorrect. Date Si nature: zi Phone#:603-324-1974 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#: DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE F 06/14/2016 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 have ADDITIONAL INSURED provisions or be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement.A statement on w this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 al Southfield MI office (A1C.No.Ext): ac.No.: o 3000 Town Center E-MAIL Suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Old Republic Insurance Company 24147 TrUTeam Builder Services Group, Inc. INSURER B: ACE American Insurance Company 22667 d/b/a Quality Insulation A TopBuild Company INSURER C: Lloyd's Syndicate No. 1969 AA1120106 110 Perimeter Rd INSURER D: Nashua NH 03063 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570062471987 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 LTR TYPE OF INSURANCE INS WVD POLICY NUMBER MMIDD/YYYY MMIDDIYYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY mwzY307518 77/76/='06/30/2017 EACH OCCURRENCE $2,000,000 CLAIMS-MADE ❑OCCUR DAMAG O $2,000,000 PREMISES Ea occuce rren MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $2,000,000 MGFN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 POLICY ❑PEr T LOC PRODUCTS-COMP/OP AGG $4,000,000 m OTHER: p t` A AUTOMOBILE LIABILITY MWTB 307519 06/30/2016 06/30/2017 COMBINED SINGLE LIMIT $5,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) Z OWNED SCHEDULED BODILY INJURY(Per accident) d7 AUTOS ONLY AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE v ONLY AUTOS ONLY Per accident ;�- 1= d1 C X UMBRELLA LIAB X OCCUR TH1600027 06/30/2016 06/30/2017 EACH OCCURRENCE $2,000,000 U SIR applies per policy terns & conditions AGGREGATE $2,000,000 EXCESS LIAB CLAIMS-MADE DED I X RETENTION B WORKERS COMPENSATION AND WLRC47860180 06/30/2016 06/30/2017X PER OTH- EMPLOYERS'LIABILITY Y/N All other States STATUTE ER ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 B OFFICERIMEMBEREXCLUDED? NIA SCFC47860209 06/30/2016 06/30/2017 (Mandatory in NH) WI Only E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000- DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Insurance. 2% 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. Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE �+ dba Quality Insulation A TOpBUild Company Nashua NH 03063 USA ©1988-2015 ACORD CORPORATION.All rights reserved. ACORD 25(2016/03) The ACORD name and logo are registered marks of ACORD YToro nsumer �us i h e�ss eguA n 10 Park Plaza - Suite 5170 Boston') M sachusetts 02116 Home Improvem contractor Registration Registration: 179141 Type: Supplement Card Z BUILDER SERVICES GROUP, INC Expiration: 6125/2018 RICHARD SCHWARTZ 260 JIMMY ANN DRIVE .............. DAYTONA BEACH, FL 32114 Update Address and return card.Mark reason for change. r, SCAT 0 2OU-Mil I LJ Address Renewal FL-1 Employment Lost Card cee of .,un,r Affairs 8,Business R19-1-tion License or registration valid for individual use only WINE IMPROV ENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Regtstratlon ,fit 41, Type, 10 Park Plaza-Suite 5170 ExpIrat1W4--0b"§. Supplement card Boston,MA 02116 BUILDER SERVICE61' RtcHARD SCHWA I10 PERIMETER R NASHUA,NH 03063 Undersecretary Not valid without signature CSSt.-105992 RICHARD SC:ttWA1d.1_ 195 HUIN C KESS S"t-RELT !lanchOtcr ''FC (131(12 09/26/2016 estfic-ted, 'C) CSSL. i:.. lnt u`olofl Colntr?t:to, i 1E[ E :t 1;zrc to posses, rent O".b iLvi of tEi iJiass t:.h!uSf?rtc tate Building,Co, ..dUS�for revocation of S iff-PMse