HomeMy WebLinkAboutBuilding Permit #1041-15 - 23 MIDDLESEX STREET 4/11/2015 1.
, '\ f NORTH
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`VVV i v1 BUILDING PERMIT
TOWN OF NORTH ANDOVER ° p
r APPLICATION FOR PLAN EXAMINATION
Permit N0J Date Received
Date Issued:
/ sac►+uSE��h
/IMPORTANT: AEEIicant must complete all items on this page
LOCATION C _
Pri
PROPERTY OWNER
rint ,
MAP N0: PARCEL: ZONING DISTRICT Historic:District ryes na
Machine Shop Villa e
p 9 yes no.
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building oCOne family
Addition Two or more family Industrial
KAlteration No. of units: Commercial
pGRepair, replacement Assessory Bldg i Others:
Demolition Other
-D Septic` 0 Well Floodplain €� Wetlands ❑ Watershed District
t
Water/Sewer
Identification Please Type or Print Clearly)
OWNER: Name: ��� Phone: – _ 7o'l
Address: Ine
CONTRACTOR Name: t.. . .
Phone`,_ , ~� 74,1
AddQj arv��
ress: y
C,4 -
z W.r
Superviso,r's :Construction License Exp Dater
1Ho me.Improvemen# License* 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: $ — � q'W - t"� FEE: $
Check No.: aa 3 Receipt No.: oZ
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
Signature of Agent/Owner - Signature of contractor r
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■
°�- NORTH
BUILDING PERMIT 0(,_f°
TOWN OF NORTH ANDOVER - A
APPLICATION FOR PLAN EXAMINATIONcoc
R .
Date Received '�RA°RATED
Permit No#:
�SSACIiUS��
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION
'I 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
El Addition El Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg_ ❑ Others:
❑ Demolition ❑ Other a __ -
0 Septrc ❑1Nell ❑'FloodplainWetlantls:
�� p Watershed -istncf
C7YWate�/Sewer -
DESCRIPTION OF WORK TO BE PERFORMED:
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$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
t - -
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
aCopy 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
OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
4- Building Permit Application
4� 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
Doe:Building Permit Revised 2014
Plans Submitted L1 y Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑
TYPE OF SEWERAGE DISPOSAL
Public Sewer ❑ Tanning/Massage/Body Art I
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
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH Reviewed on Signature
COMMENTS
Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes
Pleinning Board Decision: Comments
Conservation Decision: Comments
Water& Sewer Connection/Signature&Date Driveway Permit
DPW Town Engineer: Signature:
tFIREDEPART Located 384 Osgood Street
IBBENTh Temp Dum xster�ori;'sife � es x
0Located at`1F24 MainStreet
x f . . ., r ry«+F� t43r *+•�,y� r,�. y a� +, ,w• •,Yr, 1 `r
.F�irk{e Depa meny ig�natu�re/date . ,
C=4 •d efi-.w•wK4�#q
fiT(i`+'f`a`t
�.y ♦., 'c. r..t '.t t 1. $ t t f � N k+�•^ a♦ � � .kms '�t.�
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-$1000 fine
NOTES and DATA,— (For department use)
i
® Notified for pickup Call Email
D =
ate Time Contact Name
Oc.B
uildinb Permit Revised sed 2014
Location ( � ��/!
No. Date
i
. - TOWN OF NORTH ANDOVER
` Certificate of Occupancy $
Building/Frame Permit Fee $
Foundation Permit Fee $
�' Other Permit Fee $
TOTAL
Check
" Building Inspector
r -911 NORTH
� � � E 1, : . ve -
o
No. ®_ A-7-ft
�`y ? ' h ver, Mass
T O LAI(0
COCMICHEWICK V
A0RATEO
S V
BOARD OF HEALTH
PERMIT T Food/Kitchen
Septic System
THIS CERTIFIES THAT BUILDING INSPECTOR
............... �lN��.......... ......� ... .. .tom,..
Foundation
has permission to erect ....... buildings on we..... ..�,.� ... ..
.............. .... Rough
to be occupied as ::I>A j. .6VW"1 .4%.TWA... ... ............. 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 M NTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTIQOSS Rough
-
M. od
Service
. ................................... Final
BUILDING 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.
1.
t
1,14110 5`4
Federal ID#
RISE Engineering fuCott+ectorRegtstratt"No
SNA coft"Wr Rosistnation No
A dlvtsioa of Tbieksch Eogioeerlog CT Contractor It"latratim No
60 tsMW=t Unit A Cauton,MA OMI CONTRACT
33%sn-.m VAX 3394102-018
Page i
PROGRAM r�ascoeraacrme+mxcooroeanrreea
CMA-HES u�sonauamroctitFeuxonauie
CUSTOMER- PROW us 6=3 Maw
Jeanne Madden (508)9542722 05!0412015 409460 00002
antVa RAW 813=Kau
23 Middlesex Street 23 Middlesex Street
MR=WV�ZTATFW nun erMUNUF nn VE
U1
North Andover,MA 01845 North Andover,MA 01845
JOB DESCRIPTION
AIR SEALING:Provide labor and materials to seal areas of your home against wastefW,access air leakage. This walk Will be
performed in concert with the use of special tools and diagnostic tens to assure that your home will be left with a
air exchamga and indoor air quality.Mataiials to be used to sash your hottre can ietade caulks,foatrts anti ether product$.Primary
arras for seating include air leakage to attics,basemerda onschod garages and other unheated arras(windows are not generally
addressed.)(8)working boom
At the completion of the weatheriradon work,and at noadditional cost to the h omrowmer,a final blower door andtor combustion
salary ametysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality.
$680.00
AIR SEALING ADDER (4)worsting hours,
$340.00
DAMMING:Provide labor and materials to install a 12'layer of R-38 unlaced tibergless hatts to(S6)square foci for damming
$114.80
ATTIC FLAT;Provide labor and materials to install an 8'layer of R-28 Class i Cellulose added to(744)square fed of open a*
Space-
$1,019.28
STORAGE DARRIM Homeovmar is responsible for the removal of the stored items blacking the installation of weatheftdon
work in the attic. Removal must occur prior to the scheduled work start.
$0.00
KNEEWALLS:Provide labor and materials to install 1"FSK faced semi-rigid fiberglass orshnllar rigid board insulation to(304)
sgtmre feet of kneawatl area
$866.40
VENTILATION:Provide tabor and materials to install ventilation chutes in(16)ratter bays to maintain air flow.
$32.00
BASEMENT CEILING:Provide labor and materials to install(144)titear feet of R-19 unlaced fiberglass insulation to the perimeter
of One basement ceiling at the house sill.
$moo
RISE Engineering will apply all applicable,eligible incanivcs to this contract.You will only be billed the Net amount. Currently.
for eligible rmxsures,Columbia On offers 75%ircend".not to exceed 52:000 per calendar year,and an incentive of 100%for the
Air Sealing meastum up to the first$680 and an additional$340 if sevings aro jwtiffed by the auditor.
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
year home both before the work is begun,wW ager the weetherbation wok is complete,We will also conduct a full assasuent of
the combustion sali:ty ofyour heating system and water heater.This las a value of 590 and is at no coat to you,Total allowable
w eatherizatiot incentive is 53.110.
$90.00
1
Fedora!ID
RISE Engineering Ri contraotorft"WTaaan No
SIA contractor.Rogistratten.No
A division orThietsch Engineering CT Contractor Registration No
64 ShawTnnt Unit 42,Canton,MA 02021 CONTRACT
339-."2-6333 FAX 339.4112-6e345
Page 2
PROGRAM TnMCOfr CTIsMEMO woRETWUNRGE
CMA-HES ENOMMMANOMCWTOMMMAXAS
oesepim BELOW
Jeanne Madden (508)954-2722 05/0412015 4.09460 00002
VICE 61WEV MM STREET
23 Middlesex Street 23 Middlesex Street
6ERVrA Cff.STATCzw �nf) MP
North Andover.MA 01845 North Andover,MA 01N 11AV
.IUB DESCRIPTION
. Total: $3,394A
Program Incentive: $2,833.36
Customer Total: $571.92
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR nW SUM OF
***Five Hundred Seventy-One S 121940 Dollars $571.92
VPONrMLWWtCTMANO ALBYRISEEAlD1tiEET>I37D.CUST'OMER AOREES TO REMR ANOtRIT OUE U7 FULL UnEREST OF f%WAl BECMAAOEO MON'(HLY�AD%
WAR) 30 DA SEE RiYERSE FOR IMPORTANT BSDRVATION ON GUARANTEES.WWS na W'ftWW Xr"Md W.AM MWVA"nQ ARAR3M&WW
DO NOT SIGN THISCONTRACTIFTHi Signature- xcaa_.& /_Y. Y &iAtz
k-hMno M.Madrary Way, j'20IV)
Email: imadden9@verizon.net
bMIUMEM ACCEPTANCE
NOTE:THM CONIRACt MAY eE WMIORAWN BY US W NOT EXECUTED WHIM DATE OF ACCEPTANCE
ACCEPTANCE OF CONTRACT•THE ASOYE PRICES,SPECIFICATWX AND CONVITIOM ARE
30 DAYS. AS SWIM. AYMENTWILLD MADE AS OUTUNED
AU}f>�R7�♦DTO OO THE WSIIiK
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CERTIFICATE OF LIABILITY Y INSURAN"�
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THIS CERTIFICATE 15 ISSUED ASA MATTER 01 INFORMATION S TiVt\ V�YLY AND COFFERS NO RIGHTS UPON, HE CEPTiFjCL.?c HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATiVE.LY AMEND: EXTE140 OR ALTER THE COVERAGE A.=;O tDED £Y THE POLICIES
BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETV:'EEN THE ISSUING INSUREP?Sl. R.OTHORIZED JI
REPRESENTATIVE OR PRODUC£P,,AND THE CERTIFICATE HOLDER.
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the terms and conditions of the policy,Certain policies may require an endorsernenL A Statement on this certificate does not confer rights to the
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'_�98E8-20194 ACORD CORPOPA.TION.AJI rights reserved.
ACORD 25(2094101) The ACORD name and logo are registered marks of ACORD
AGENC'CLISTOWER ID: 570000027887
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See Cc-rti fi tate 1�um3er: j700540032 b- ! 1
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See CertifiCatE Number: S70GS4003261
ADtD1710NAL REMARKS
THIS.ADDITIONAL REMARKS FORK, IS A SCHEDULE TO ACORD FORAP.,
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office of Consumcl-.— yrs end Bus ness Reguiati
10 Park laza - Suite 5170
Boston, Massachusetts 02116
Home Improvement C'ontraCtor Registration
Registration: 179141
Tyre: Supplement Card
BUILDER SERVICES GROUP, INC. Expiration 6/75/2016
RICHARD SCHWARTZ
110 PERIMETER RAJ
NASHUA, SIH 03063
Update Addres>and return card. Mark reason for change.
jddre t RciivFtial Efnplo^ fnent Lost Card
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negistrabor:: 17-9141 Type I0?2rk Plaza-Sufic 5170 h
t=xPirau0n,: 6.125/20 16 Supplement:.ard Boston.M.�021 ib
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