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HomeMy WebLinkAboutBuilding Permit #821-2016 - 25 COPLEY CIRCLE 1/20/2016BUILDING PERMITO NORTy -i> TOWN OF NORTH ANDOVER a APPLICATION FOR PLAN EXAMINATION O Permit No#: Date Received 10DRwTED �.4R`y.�5 qSS kcHus�� Date Issued: IMPORTANT: Applicant must complete all items on this Daae LOCATION PROPERTY OWNER�C � MAPy I PARCEL:ZONIN ri Print 100 Year Structure DISTRICT: Historic District Machine Shop Village yes (no yes yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building JKQne family ❑ Addition ❑ Two or more family ❑ Industrial AIZAlteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg CS:20the�rt,q-, ❑ Demolition ❑ Other 0 Septic ❑ Well El Floodplain 0 Wetlands ❑ Watershed District ❑ Watet'/Sewer , OWNER: Name: Address: Contractor N Address: DESCRIPTION OF WORK,TO BE PERFORMED: Identification - Please Type gr Print Clearly Phone: Supervisor's Construction License: 10 SC? 4� -D, Exp. Date: Home ImDrovement License: ARCHITECT/ENGINEER . Date: 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: $ �oZJ �' FEE: $ �10 Check No.: VReceipt No.: ?Al" NOTE: Persons c n ratting with unregistered contractors do not have access to the guaranty fund Le Location No. Date !� SZ, I -Z-0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ A Foundation Permit Fee $ Other Permit Fee TOTAL $ Check # ., _ .: Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Pennanent Dempster 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 Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes 4lanning Board Decision: Com 4 n V Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea M4 Usgooa Street FIREItDEPARTMENT, , I;.ernpiDumpsfer gn.site ,y s z•: �. �.V 'nog w t Located�aW24fMaincSt�eet - ' Ye _. 'FireDepartrnentisignature/date R Y 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 LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ Notified for pickup Call Emai Date Time Contact Name Doc.Building Permit Revised 2014 No 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 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 4. Copy Of Contract ;6 Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4. Mass check Energy Compliance Report (If Applicable) -, Engineering Affidavits for Engineered products IOTE: 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 C O O M O OM -, 0 cr U) MU 2 U) = < CD -a N CD CL 0 CD 0 CD 0 O n; Q. 0 3 � O 3 V� rt �D N 77 =� 0) rt CO)CD c°5� U) o -a N CD CD 2 O 0 c.WN @ D CDO =Drn O W ���D� Z CO) C (D cD 0-0 Z -0r- M CL -a o Oo < CQ --w y 0 0 � � a � • U) cp Vin v, < --1 70 Q: < � o cr y v 2: CL aw 07=4 CD O CD N r CD ca cnZ `�D0 U,• neo Q.0 N Cl)CD Er .' CD cn 0 -Z. CD e•f • N O c Z CID 0 O....si -Z _ D CD Z co cn O m c �. �D 0 � rt O ;0• N m T_ A T N 7 O ((D O O O O (D O O O N N N N _S � 'O OQ (D 00 �C aC rD - s ^ :3 Q C Z m rD d y CD -< n j 3 Pm" D7 '-' m C C 3 ' W � 7° ° v °° � a Z ° V z cci H r O MfA m 3 --4 O m m r -4 0 0 0 _ m Federal ID # 45.0405629 k RISE Engineering RI Contractor Registration No 8166 MA Contractor Registration No 120979 A division ofThitisch Engineering RIS ENGINEERING Gil Shawinnt unit N2, Canton, MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER r -� PHONE DATE CLIENT# WORKOROER Elaine Christman . ' (978)569-5500 12/01;2015 410505 r 00002 C SERVICE STREET `� ... `l BILtANG STREET ........... 25 Copley Circle ,1`� 25 Copley Circle SERWCE CITY, STATE, 7dP BILLING CITY, STATE, X1P North Andover, MA 01845 '' North Andover, MA 01845 r ,JOB DESCRIPTION I IAI.ARD BARRIER: We have identified that there are recessed lights present in your home. unless the recessed lights are certified as IC-rated (insulation Contact Rated) we will create -,13" clearance space around the fixture by using fiberglass blanket insulation as a damming material, no insulation will be installed across the top and closed cavities which contain recessed lights will not be insulated. $0.00 AIR SEALING: Provide labor and materials to seal areas of your home against wasteful, excess air leakage. This work will be performed in concert with the use of special toots and diagrostic tests to assure that your home 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. fbams and other products. Primary areas for scaling include air leakage to attics, basements, attached garages and other unheated areas (windows arc not generally addressed.) ]'his will require (8) working hours. A reduction in cubic feet per minute (cfrn) of air infiltration will occur, but the actual number of cfrn is not guaranteed. At the completion of the weatherization 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 otthe indoor air quality. $680.00 AIR SEALING ADDER: (4) working hours. $340.00 DAMMING: Provide labor and materials to install a 12" layer of R-38 unlaced fiberglass batty to (36) square tc-et for damming purposes, $73.80 ATI'IC FEAT: Provide labor and materials to install a 6" layer of R-21 Claus I Cellulose added to (612) square feet of open attic space. THIS INCLUDES SLOPES OVER MASTER BEDROOM VAULTY. $771.12 KNEEWALLS: Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to (86) square Iect of kneewall area. THIS ALSO iNCLUDES MASTER BEI.)R(X)M END OF VAULT. $31)1.00 ATnC ACCESS: Provide labor and materials to insulate the back of (1) attic hatch with 2" rigid Thermax board. Weatherstrip the pL7tmeter. $60.00 A171C ACCESS: Provide labor and materials to insulate the back of(1) attic hatch with 2" rigid "I'hermax board. Weatherstrip die perimeter. $60.00 VENTILATION: Provide labor and materials to install (3) insulated exhaust hose to existing bathroom fan(s). $150.00 RISE Engineering will apply all applicable, eligible incentives to this contract. You will only be billed the Net amount. Currently, tar eligible measures, Columbia Pias offers 75%, incentive, not to exceed $2,000 per calendar year, and an incentive of 100`6 fbr tine Air Seating measures op to the first $680 and an additional $340 ifsavings are justified by the auditor. For the safety and health otyour home's indoor air quality, we will be conducting a blower door diagnostic of the available air now in your home both before Ute work is begun, and after the wealhcri7ation work is complete. We will also conduct a full assessment of the combustion safety of your heating system and water heater. 'Phis has a value of S90 and is at no cost to you. Total allowable weatheriz%tion incentive is $'3,11#). 00 RISE Engineering RI Zj% E A division of Thielseh Engineering ENGINEERING' 60 ShaWmut Unit 92, Canton, MA 02021 339-502-6335 FAX 339-502-6345 - _....... .............. .. ... CUSTOMER Elaine Christman SERVICE STREET 25 Copley Circle ...... .... .. SERVICE CITY, STATE, YIP North Andover, MA 01845 Federal 10 11105-0405629 RI Contractor Registration No 8186 MA Contractor Registration No 120979 CONTRACT Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CASA -NES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW PHONE DATE CLIENT 9t WORK ORDER (978)569-5600 12/01/2015 410505 00002 BILLING STREET 25 Copley Circle ._BILLING CITY. STATE, ZIP North Andover, MA 01845 JOB DESCRIPTION $90.00 1 Total: $2,525.92 Program Incentive: $2,171.94 Customer Total: $353.98 WE AGREE HERESY TO FURNISH SERVICES • COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE SUM OF ***Three Hundred Fifty -Three & 98/100 Dollars $353.98 UPON FINAL. INSPECTION AND APPROVAL BY RISE ENGINEERING. CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL. INTEREST OF 1% WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE JO DAYS. SEE REVERS FOR IMPORTANT INFORMATION ON GUARANTEES, RIGHTS OF RECISION, SCHEDULING, AND CONTRACTOR REGISTRATION, OT SIGN THIS 1. CO1. NTRACT IF THERf ARE ANY BLANK SPACE 1. AM D ONATURE - RISE E instri CUS , ACCEPTANCE i a NOTE: THIS CONTRACT MAYBE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE _... ........ .. .........._ II, ACCEPTANCE OF CONTRACT THE ABOVE PRICES, SPECIFICATIONS AND CONDITIONS ARE 30DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED. YOU ARE AUTHORIZED TO DO THE WORK AS SPECMEO. PAYMENT WILL BE MADE AS OUTLINED ABOVE The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations kv, 1 Congress Street, Suite 100 Boston, MA 02114-2017 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: 1. ❑✓ I am a employer with 100 4. ❑ I 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. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 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 13.❑✓ Other Weatherization *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 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 may¢ Job Site Address: City/State/Zip: Attach a copy of the workers' compensa on 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 perjuryphat the information provided above is true and correct. 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 #: ACS ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06!24/2015 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 PHONEFAX (AIC.No.Ext): (866) 283-7122 AIC.No.): (800) 363-0105 E-MAIL ADDRESS: 3000 Town Center Suite 3000 Southfield MI 48075 USA MWZY3048 4 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A. Old Republic Insurance Company 24147 TODBUild Coro. INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER C: ACE Fire Underwriters Insurance Co. 20702 INSURER D: INSURER E: DA O N $2,000,000 PREMISES Ea occurrence INSURER F: COVERAGES CERTIFICATE NUMBER: 570058348882 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 INSD WVD POLICY NUMBER MM/DD/YYYY MMIDCD/YYYY LIMITS '4 I X COMMERCIAL GENERAL LIABILITY MWZY3048 4 b EACH OCCURRENCE S2,000,000 CLAIMS -MADE 7(❑ OCCUR DA O N $2,000,000 PREMISES Ea occurrence MED EXP (Any one person) $25,000 PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 X POLICY ❑ JPRO­ ED PRODUCTS - COMPIOP AGG $4 , OOO , OOO OTHER: A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT $5,000, 000 Ea accident BODILY INJURY ( Per person) X ANY AUTO BODILY INJURY (Per accident) ALL OWNED SCHEDULED AUTOS AUTOS PROPERTY DAMAGE X HIREDAUTOS X NON -OWNED Per accident AUTOS LIAROCCUR EACH OCCURRENCE AGGREGATE 4UMBRELLA EXCESS LIAB CLAIMS -MADE DEDT RETENTION B WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016X STATUTE ORH EMPLOYERS' LIABILITY YIN All Other States — E.L. EACH ACCIDENT $1,000,000 C ANY PROPRIETOR / PARTNER I EXECUTIVE 7 SCFC4815190 06/30/2015 06/30/2016 OFFICERIMEMBEREXCLUDED? (Mandatory in NH) NIA 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 I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of Coverage CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD M IN .61 rai O<= J ai Liu 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 (2014/01) The ACORD name and logo are registered marks of ACORD M IN .61 rai O<= J ai Liu rte\ ✓f / '`!_• _ f e o Co surr�er A� airs I usiness Regulation O 10 Park Plaza - Smite 5170 Boston, Massachusetts 0211 Horne Improvement Contractor Registration BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 Office rft.'onsutncr Affair, iT Business Rtguislain ;t`' e-3i'Jtd1E IMPROVEMENT CONTRACTOR �2gistration: ;7514 i Type Expiration: 625120116 Supplement --ard JILDEP. SERVICES GROUP; INC. CH.A.RD SCH',I%'A. RTZ G jjMrh 1Y ANN DRIVE .YTGNn cEACH. FL 32114 t'nder>ccrttan' Registratior:: 179141 Type: Supplement Card Expiration 6125!2016 t'.idate Address and return card. Mark reason for change. Address RenvAal F.n1111oNntent Last Card License or registration Valid for individul use unk before the expiration date. if found return to: ()t%ce of C:onsunter Affairs and Business Regulation t'ar, �12Za - Suite 5 It) Briton. MA 02116 s Not YailvK'1ti7011t 5ivn2ture . ., CV ! Cl Ul - in CGS _ f V% Z - xz �u r ^1: