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HomeMy WebLinkAboutBuilding Permit #823-2016 - 249 CARLTON LANE 1/20/2016NORT►I BUILDING PERMIT 0�,•{-E� TOWN OF NORTH ANDOVER = h,id. _'4• 6 APPLICATION FOR PLAN EXAMINATION -isw ,/ Permit No#: � Date Received �SsacHUS Date Issued:% IMPORTANT: Applicant must complete all items on this page Z LOCATION �l cnc 1 t `t C) Pri- n PROPERTY OWNER_ Print 100 Year Structure yes no MAP PARCEL: _Z4 ZONING DISTRICT: Historic District ye no Machine Shop Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building A-Qne family ❑ Addition ❑ Two or more family ❑ Industrial alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg �9, Others- ❑ Demolition ❑ Other I��► V���iz� � ®IWell� _ ❑�pl ins ® Wet ands � ❑ -Water �e tD tt gqESC IPTION OF W RK TO PERFORMED:<; Z:2:x 2 MC r 4 & I �--- Identification - Please T e or Print Clearly 1571 O OWNER: Name: Phone: o� Address: L r Contractor Name: Phone: — 1 - Email: c Address: e Supervisor's Construction License: (�S j� C;1 Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: d Address: Reg. No. FEE SCHEDULE: BULDING PERMIT: $12.00 PER $9000.00 OF THE TOTAL ESTIMATED COST B%%SS�ED ON $125.00 PER S.F. Total Project Cost: 6 FEE: lIJ� Check No.: I Receipt No.:�.Q17 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund -- -�_ - tsunaingir-rame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL Building Inspector, Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL 6 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 - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENT'S Signature_ -- CONSERVATION--- ----Reviewed on_ --_---_—_ . _.__Signature COMMENTS HEALTH COMMENTS Reviewed on nature Zoning Board of Appeals: Variance, Petition No: Zoning Decisionlreceipt submitted yes ti Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature � Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FISDEPAR+TIIiIENT `}Temp,;,Dumpster on sites es n ' rAr r r r s 3y S 5�s ISS`�nDO �L�ocated at 124 Main S rt ee�t- t� tf�+u} 3z s r, �aAM1a 3Fire Depa ament syignature/dates r � 'i� '� � ���{ •'4} N+1 3'. NUT t 1 '+yam 1 i 7 �lki sus J ii ��n�y c ii <1 s l � �. ♦ �. i 1 r �" f.�4ji �4 .tr sk. 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, rust or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes 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 IM 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 Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of.H.I.C. And C.S.L. Licenses Copy Of Contract 4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) 4; Engineering Affidavits for Engineered products . TE: 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 IOTE: 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 4no 0 E J 2 LL p O O c N v o LL E � v In p rZ �+ N Z Z > c O o LL o CC t U c LL O W N Z Z > O. to o K c LL i O W Nf Z U V W °�° o w v N c LL O U W of Z a C7 o CC c LL W a W LUm ca Z (% a-+ N Y N 1 tn 5141 0a O . O • �•Q L Q. as Q: Q O O Q � y d O 0 O F+ E O O c N J 4)m a y > = N N N dvow O . C N > CF) cc 0-0 > O c CL U) _ 0)0 N O O O O = CL (DCL ,w c :� m ea 0 .� O . o c = c Q L L cc .O CL u U)Co O uml LL tip N = O N .Q =O Z •+ Fr i+ .E V 'a c V O W L 0 CD ._ p � Q. 0-0 4)Q V1 -Q O = O CL cc H t aO. QOV > 0 LU CL Z Z m Cl) 0 ~ CO � Z U W li y CL x Z w U H N W az ZF 0 20 w L W m m H � ca �' 0 O CL CL � Q i = a � J -a a) z v Q. Federal 10 # 06-UO5629 RISE :Engineering R1 Contractor Registration No 8186 FAA Contractor Registration No 120979 = R EA division ur'rhietseh Engineering IS ENGINEERING' 60 Shawmut Unit 42, Canton. AIA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 1 PROGRAM EN�CmEOFRKASCMA-HES ENGINEERINGAO ENTERED CUSTMEROR WOKA DESCRIBED BELOW ......_.. ..., _. ..._ ,.._...._.,_...... _. _.._ ...... .._. ...... .. .. .._.... .............. ............................... _ .. ......_ ..,.,. .... ._ _. CUSTOMER PHONE DATE CLIENT L WORK ORDER Tammy Griffin (978)208-1422 10/15/2015 416647 00002 _._____.._.. ........................ SERVICE STREET. all: dNG STREET 249 Carleton Lane 249 Carleton Lane ............. .., ......_...........___.............................. __.................. . SERVICE CITY, STATE, IJP BI W NO CITY, STATE, LP North Andover, MA 01 845 North Andover, MA 01845 j Y I� "`l 4,r ......._...................... . .. . JOB DESCRIPTION AIR SEALING: Provide labor and materials to seal areas ofyour home against wasteful. excess air leakage. This work will :be— performed in concert with the use of special fools and diagnostic "tests to assure that your home will be fefl 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 f'or sealing include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed) This will require (9) working hours. A reduction in cubic rect per mince (c(m) or air infiltration will occur. but the actual number of cam is not auaranteed. At the completion or the wettheri-ration work, and at no additional cost to the homeowner, a final blower door and/or combustion safety analysis will be conducted by the sub -contractor to ensure the safety of the indoor air quality. $6811.00 AIR SEALING ADDER: (4) working hours. $340.00 DAMMING: Provide labor and materials to install it 12" layer of R-38 unlaced fiberglass balls to (128) square feet for damming purposes. $202A0 ATTIC FI.A•1': Provide labor and materials to install a 7" layer or R-25 Class t Cellulose added to (15 12) square feet oropen attic space, $1,965.60 KNEEWALLS: Provide labor and materials to install 2" FSK faced semi-rigid f ibetkfass board insulation to (256) square feet of kneetivull area. $896.00 KNEEWALL FLOOR! Provide labor and materials to install a 7" layer of R-14 Class I Cellulose added to (288) square feet of open kntewall floor $357.12 A"ITIC ACCESS: Provide labor and materials to insulate the back of (1) attic hatch with 2" rigid Thermax board. Weatherstrip die perimeter. 560.00 ATTIC ACCESS: Provide labor and materials to install (1) new, linishcd plywood. knccwall space access hatch: tic hatch will be insulated with code compliant 2" rigid Thermax board. weather-stripped, and held closed by eye hooks. (Good surfaces will be unfinished, Prime coat and/or paint is nol included.) $120.00 VENTILATION: Provide labor and materials to install (2) insulated exhaust hose with roormounted flapper vent to exhaust existing/ bathroom ran(s). $237,50 VEN11LATION: Provide labor and materials to install ventilation choles in ((A) railer bays to maintain airflow, S128.00 RISE Engineering will apply all applicable, eligible incentives to this contract. You will only be billed the Net amount. Currently. for eligible measures, Columbia Gars of)ers 75% incentive, not to exceed $2,000 per calendar year, and an incentive of 1000/0 for the Air Sealing measures up to the first $680 and an additional $340 if savings are justified by the auditor. %. f,#f RISE Engineering FOOZ I S A divis&an of `1'hieisch Enpinrerillg ENGINEERING7 60 Shawmut knit 92, Canton, MA 02021 339.502-033i FAX 339-502-6345 CUSTOMER Tammy Griffin SERVICE STREET 249 Carleton Lane SERVICE CRY, STATE, LP North Andover, MA 01845 Federal IDS 05-0405629 RI Contractor Registration No 8186 MA Contractor Registration No 120979 CONTRACT Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA -1'I ES ENGINEERING AND THE CUSTOMER FOR WORK AS OESCAtaED BELDW PHONE DATE CUENTa ... WORK ORDER (978)208-1422 1011512015 416647 00002 BILLING STREET 249 Carleton Lane BILLING CITY, STATE, ZIP North Andover, MA 01845 JOB DESCRIPTION For the safety and health of your home's indoor air quality, we will be conducting a blower door diagnostic ol'the available air flow your home both before the work is begun, and tiller the wcatheri>,ation wort: is complete. We will also conduct a ruts assessment or the combustion sarety of your beating system and water heater. This has a value or$90 and is at no cost to you. Total allowable weatheriuration incentive is $3,110. 590.00 OCi tip Total: $5,136.62 Program Incentive: $3,109.99 Customer Total: $2,026.63 WE AGREE HEREBY TO FURNISH SERVICES • COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS, FOR THE SUM OF ***Two Thousand Twenty -Six 8163/100 Dollars $2,026.63 UPON FINAL OSSPECTt ANO OVAL BY RISE ENGINEER NG. CUSTOMER AOREEE TO REMtr AMOUNT DUE IN FULL INTEREST OF 1% YAIt. DE CHARGED MONTHLY ON ANY UNPAID BALAMJCE SD S. SEE REVERSE FOR IMPORTANT INFORMATION Ott GUARANTEES, RIGHTS OF RECISION, SCHEDULING, AND CONTRACTOR REGISTRATION. ..._....... .. .......... .. ....._.. .... ........_....... ._..._.. ... ......... ......... .....,,..................__... _.__..,..._. __ __ ... .... ...,. _. ._... ._ .. _. 00 NOT SIG S CONTRACT IF THERE ARE LANK SP AUTHO ONATURE • RtMi EngiAeed USTOMER ACCEPTANCE NOTE' THIS CONTRACT MAY BE VHTNORAVOI BY US If NOT EXECUTED WITHIN DATE OF ACCEPTANCE ._.... . _................ _ _... . ACCEPTANCE OF CONTRACT. THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO 001HE WORK AS SPECIFIED. PAYMENT WIU. BE MADE AS OUTLINED ABOVE N The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 Print ForF71 �' www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly 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: I.0 I am a employer with 100 4. ❑ 1 am a general contractor and I employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ 1 am a homeowner doing all work myself. [No workers' comp. insurance required.] ' 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 10.0 Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 131,_(� Other Weatherization *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. 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: ACE American Insurance Company Policy # or Self -ins. Lic. #: WLRC 48151553 Expiration Date: 6/30/2016 Job Site Address: a �� rn=e Hnn Lone City/State/Zip: ) © VV - 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 the pains and penalties of perjury_Ijiat the in formation provided above is true and correct. 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 #: 11 A�RL7® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/06!24/22001YYYY) 15 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 NAME: PHONE(866) 283-7122 (800) 363-0105 (A1C. No. Ext): FAX (ac. No.): 3000 Town Center suite 3000 E.MaIL ADDRESS: Southfield MI 48075 USA INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A Old Republic Insurance company 24147 TODBuild Corr). 260 Jimmy Ann FLDrive2 Daytona Beach FL 32114 USA INSURER B: ACE American Insurance Company 22667 INSURER C; ACE Fire Underwriters Insurance Co. 20702 INSURER D: DAMAGE o 52,000,000 PREMISES Ea occurrence INSURER E: INSURER F: UUVtKAI'it5 CERTIFICATE NUMBER: 570058348882 RFVISIr1N NIIMRFR- 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 INSR LTR TYPE OF INSURANCE ADDL INSD SUBR WVD POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY Daytona Beach FL 32114 USA MWZY304$ 4 EACH OCCURRENCE 52,000,000 CLAIMS -MADE X❑ OCCUR DAMAGE o 52,000,000 PREMISES Ea occurrence MED EXP (Any one person) $25,000 PERSONAL B ADV INJURY 52,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 54, 000, 000 PRO - JECT � LOC PRODUCTS - COMP/OPAGG 54,000,000 OTHER: OTHER: A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT Ea accident S5,000,000 BODILY INJURY ( Per person) X ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) PROPERTY DAMAGE Per accident X HIREDAUTOS X NON -OWNED AUTOS UMBRELLA LIABOCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE DED RETENTION B C WORKERS EMPLOYERS' COMPENLIABILITYSATION AND ANY PROPRIETOR/ PARTNER I EXECUTIVE YIN OFFICER/MEMBER EXCLUDED? N I A WLRC48151553 All Other States SCFC4815190 06/30/2015 06/30/2015 06/30/2016 06/30/2016 X STATUTE ORH E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) If yes, describe under WI Only 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 H more space is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) 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 IN ACCORDANCE WITH THE POLICY PROVISIONS. Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBUild Company 260 Jimmy Ann Drive Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD t �I' ee o Consumer Affairs �idBusiness Regulation 10 Park Plaza - Suite 5170 Boston; .Massachusetts 02116 Home Improvement Contractor Registration BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 Office rf Consumcr Affairs A Businw, Rcgulation 4OME WPRGVEMENT Cfl;J?RAC 3 0R ~r"22gistratior.: 179141 Type Expiration_ 61-2512016 Supplement -ard JILD=P. SERVICES GROUP, INC. CHARD SCi iWARTZ 0 -ilidMY ANN DRIVE .YTGNA 6EACH. FL 32114 t ndersecrctary Registration:: 179141 Type: Supplement Card Expiration: 6,'25!2016 t'tjdatc Address and return card. Mark reason for change. 3tidrr. t Renewal l;:mliloymcnI Lost Card License or registration valid for individul use onh before the expiration daft. if found return to: (gince of Consumer Affairs and Business Regulation to par', P!2z2 - Suite 5170 Boston. RIA 02 3 H) Notvaiiu w it tout signature N L� U r > s r W