HomeMy WebLinkAboutBuilding Permit #936-14 - 258 BRIDGES LANE 6/24/2013.4D
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APPLICA-f Date Received_________
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permit t 0 --- lete all itei,
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Date Issued, opffOrf- ARD " 6�_
'0J &41/V
nt Jill! yes 110
ION 0 61 jo�—Year structure yes no
LOCAT 4ER print Ic-r.. oistoric District age Yes no
PROpER-Ty OW ZONING IDISTR Machine ShOP_\_1/�T�
MAP JiARCEL'
—P
an And
61dg PerMlt
Plan And
PeMlit
�ualce of 13ldg-
I I the 13oard of XPPeals
Sion fron, proof of recording
,one cOPY and
. .................................
t – �PE � �D V 'Q AF_- W
EN�e,jv Building
0 Addition
0 ter IOP -----
0 epair, replacement
0 [)emOli ion
0 Septic 0 \Nell
o \N
PROP Non-
Resid ritial U industrial
family 0 Commercial
0 0 or more family others'
N . Of units'.
A sessOrY 131dg
0 \,Vatershed District
1,0 plain \Netlands
DESCRIP f ON of WoRKTO BE P RFORMED.
filt( i,
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IdentifIcat'o" -1 JA 00 k IU
O\NNF-R'. Name-. 0
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Ad -dress:
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ContractOr Name ll4j�
- z- Ave-,
DIP
Address'.
0
L' ense, _q
qupervisOr's Construction Ic 1fl(07
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phone:
License,
Home
Date'.J`��
Reg.
ARCH 1) ON $125-00 PER S-F-
TAL r=STIMATED COST . S . ASE
$1000.0o OF THE TO
Address: FRMIT: $12-00 PER
SCHEDULE: SULDING Pr FEE:
FEE 1P "I'f
-Total Project Cost: Receipt No.*._c 7
ot have acce s to the guarantY
5
i tered contractors do n, _3
it unreg s
w h Ontractor
check NO-* actIng
ons contractIng OT G
A
§g��t�ie qf V
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: q� 6 -1
Date Issued: -Z,-q I
OIMPO-RTANT.: A
I rATI KJ
PROPERTY OWNER H*freo
I- Print 100 Year Structure
MAP IL�_PARCEL ZONING DISTRICT: Historic District
Machine Shop Vil
Date Received
must complete all items on this
z4vv
0"I,,IED 6
yes no
yes no
e ves.( no
TYPE OF I M PROVEM ff-N-T
USE
-PROPOSED
Residential
Non- Residential
New Building
_��ne family
[I Addition
wo or more family
0 w
[I Industrial
D Alteration
No. of units:
[I Commercial
El Repair, replacement
0 Assessory Bldg
11� Others:
El Demolition
A(Other
-Floodplain
0 Septic El Well
J [I Wetlands
0 Watershed District
[I Water/Sewer
UtbL;Klr I 1UN ur vv%jrxrx i w 1- L-1%1 wlxiw----
7t I A -y'UC,1W 011J A)
Identification -.,Please Ty orPrin-tClearly
OWNER: Name: I-K,4vrdell �� Iuc4w Phone:
Address: ZT-�? `?�i d1rej A-V
'_'e K'
n e'.
Contractor NameHA'3-9 6)&WhOg4e
Address: .5
7- Exp. Date:
Supervisor's Construction License:_z
Home Improvement License:_ //Y 417 Exp. Date:
ARCH ITECT/ENGI NEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDINGPERMIT.'$12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $
C h e c k N o.: D Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
R Agent/Owner SigRature.of co-ntra-cto,
I
r
Location �gs& � �a,,
No -C1.3 (.,v Date
I
Check # /43S-�-
n
v
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee ;3-F
Foundation Permit Fee
Other Permit Fee
TOTAL
Building Inspector
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i�Li g ri. 1. .1. 0 �-,
)ATE (MM/DD!YYYY)
OF LIABILITY INSURANCE - 1 19/24/2013 -
CERTIFICATE HOLDER. THIS
D AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE
TM6&GEHTIFICATE IS iSS,�-JF YAMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.
CERTIFICATE DOES No L�J�,M
, ATIVELY OR NEGATIVEL
'ANC,E DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING I NSURER(S), AUTHORIZED REPRESENTATIVE
THIS CERTIFICATE OF " IN,, � I E HOLDER.
OR CRODUCER, A i r__
RED, the policy(les) must be endorsed. if SUBROGATION IS WAIVED, subject to the
IMPORTANT: If the cerof �catt, nolder is an ADDITIONAL INSU. nt on this certificate does not confer rights to the
-:icy, certain policies may require and endorsement. A staterne
terms and conditions,-,! ihi:�
certificate h2_1der in
PRODUCER
155B OTIS STRI'.
NORTIJBORO� �,;",2-2456
735H]H
INSURED INC
AN11-
SA1_1-,M,MA 01Q'(�
--TIFFICATE NUMBER:
PHONE
(A/C, No, Exl):
E-MAIL
ADDRESS:
FAX
(A/C, No)�
INSURER(S) AFFORDING COVERAGE NAIC'L
T -'A
FINSURER A: T7VELERS V46EMNITY COMPANY OF AMERK
INSURER B;
INSURER D:
F:
REVISION NUMBER:
COVERAGES BEEN ISSUEV 1`51RffFNSU_RFD PUE—D—MO—VE FOR THE POLICY F'Lmuu IFIILJIL-k I c�
TPIS IS Tn"Mrm"T_ 13ELOW RAVE RTI E MAY BE ISSUED OR MAY PERTAIN. THE INSUPANCE
)ND-noNc)FANyOONTRAcToRo-rHERDOCLIMEr,rTWTHRESPECrTOM04T"SCE FlCAT MAY HAVE BEEN REDUCED By
ANY RECU REMEFr ' TEFU CA �C BJECT TOALL THE TEMM, EXCLUSONS AND OONDITICNS OF 9" POLICIES L1IATSSHOVM
AFFORDED BY THE PiX0 1, [)ESCR BED HEREIN IS SU
PAID CLAJli r1ri ICY EXP nATE
ADD B'
I\ISR ICY NLUBER
L R POL
POLICY EFF u Ll"TS
(MDDYYYY) (MDD\YYYY)
2E �Y`R
LTR -fypf .)F
EACH OCCURRENCE
I!F,
GENERALL111
DAMAGE TO REN I ED
COMMERC:Ai_'1
WCLAIM"
REMISES (Ea occurrowc)
"I'\!-
OCCUR.
'mof
ED EXP (Atly one person)
$
ERSONAL & ADV INJURY
P L
Is
ENERAL AGGREGATE
'C'
J 1�
GEN'L AG 01-II-Gi,
PPLIES PER:
'C M
P RODUCI*S CO,MP/OP AGC;
UL"_�
POLICY
LOC
FROLB) _"v"_"'�
_T
IN ED SINGLE
COMBINED SINGLE
CC
AUTOMOBILE UAR:1
LIMIT (Ea accidW;)
NY Ljl(
ANY AU I C
A
BODILY INJURY
ALL OWNI�
A LL 0%'VN"
(per person)
SCHLDULI 1,::
(-[ LL)LIIJ'
iBODILY INJ URY____1
T,,
i
(Per accidet'0
I IIRCD Al J] � i,:
I IIR - DA
PROPERTY DAMAGE
N OWN,
ON
tA
(per accident)
EACH OCCURRENCE
Is
Ml3RELI_J%..1,L'6
u U 13RLLL,
)CCUR
AGGREGATE
s
EXCESS L-10-
A.AMS-MADE
TF-E—DUC, I 16L
$
OTHER
RETEN_110"� WC STATI - TORY
. .. . ..... X UVII,
WORKERS COMPE�1`,ATION TAND 13 091021/2014
EMPLOYER'S LIABIU Y/N UB-5B4493BA-13 09/03/20 E. L. EACH ACCIDENT 500,000
5
MN N/A
AM PROPERITORVA D I F , I-. ; :� I 't-GUTIVE C1. EDISLASC - F -A EMPLOY[C $ 500,000
OFFICEFVMB\4BER EXC_L� POLIC S _5C)o 000
_Y LIMIF
(Ma-datory In N-1) E,L. DISEASE POLICY LIMIT .500,000
It yes, describe LV6,
DESCRIPTICN 0-'
—R,,, LES/RESTRICTIONS/SPECIAL ITEM5
�ESCRIPTIONOFOPt�
ISSUED TO THE CERTIFICATE HOLDER AFFEC17ING WORKERS COMP COVERAGE
THIS [,EIILACESAN'�
EE _RTI F I C)�T_E � 0
...........
C S G,
T
4 0 Nk AS HL\1
wESTBOROC-
ORD 25 (2010,10S.'; �e?'�'�ORD name and
are registered
SHOULD ANY OFTHE ABOVE DESCRIBED POLICIES BE CANCELLED
BEFORETHE EXPIRATION DATE THEREOF, NOTICE WILL 13E DELIVERED
IM Ar.1.nRDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENT4:FVE .. I -'
... R ... D" ... 0 ... A'P"'O.-PATION. All rig reserved.
I
S—\, Office of Consumer Affairs & Busi ess Regulation
IMPROVEMENT CONTRACTOR
ration: 111617 Type:
tion: 1/12/2015 Private Corporatic:
MASS WEATHERIZATION, INC
RICHARD LAMBY
3 OCEAN AVE
SALEM, MA 01970
Undersecretary
UMassachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supervisor Specialtv
License: CSSL-102293
RICHARD LAXB)�
3 OCEAN AVENUE
SALEM MA 01970
W, Expiration
Commissioner 05/03/2016
The Commonwealth ofMassachuseUs
Departmintofindusftiql.4ccid��ts
office of-Invesfigations
6#0 Washington Street
Boston., MA 02111
vww.mass.gov1dia
Workeis' Compensaflon Insurance AffidaAt: Buffders/Contractors/FIectricianslPliiinibers
*b
An-nlleant Wamation Pleme Print Led .1
h
Name, (Business/Organizationifn&idual):
Address: 3 441-e-�
City/Statefzip: /Y?9.-
Phone
Are you an employer? Ch kth appropriatebox:
Type of project (required):
14 1 am a employer with
4. El I am a general contractor and 1
6, []Now cOnstruction
employees (M and/or part-timq).*
2,E] I am a sole, proprietor or partner-
have Bired the sub -contractors
listed on the attached sheet. �
7. F] Remodeling
ship and1avano.employees
These sub -contractors have
8. E] Demolition
working forma in any capacity.
workers' comp. insurance.
9. rl Building addition
[No worl<-ors, comp. insurance
5. El We ate acorpora�onaudita
10.[] Electrical repairs or additions
required.]
3. El I am a homeovaer Aing all work
officers have exercised.their
right of exemption p or MOL
I I. Plumbing repairs or additions
Myself [E0W0rk0T8'G0Mp.
c. 152, §1(4), and we have no
12. Roofrapairs
insurancerequlied.)
employe6s. [No workers'
I other <17as 064,noad
comp. insurance reqdred.]
mAny applicant that checks box #I must also fillbut the scotionbel6w showing their workers' compensatf on polIGYMMIatioll.
T Homeowners who sabmit this affidavit fadicaffij they Ai� doing all worX and then hire outside contractors must submit a new affidavit indicatifig subfi.
tContractors th at check this b ox must attache d an 9d diflonal sheet showing the name of the sub -c ontractors and their workers' comp. policy information.
I am an employer that lsp�ovidlqg workers' compensation insurancefo? my enployeeg. Below is thapolley andjoh site
infolmallon.
Insurance Company
P011CY # Or S 01-f-iUS. UG. #:.
All
13 t5-0, q71. 5 ExpirationData:
7,�r dej /- /,/ r f -
lob Site Address, Piiy/State/Zip: AJ— t'��C
Attach a copy of the workers' compensation-pollcy declaration page (showing the policy number and expiration date).
Failure to secure coverage.as re 4 dunder Section 25A ofMGL o. 152 ran load to the imposition of criminal penalties of a
. ql=e .
flue, - up t o $ 1,5 0 0. 0 0 and/or one -ye ar mpns qment, a s w alla s c ivil p on affl a s in the form of a S TOP. WORK ORDER and a fin a
of up to $250.00 a day against the V-101ator. Be advised that a copy of this statement -may be forwarded to the Office -of.
Investigations of thoDIA for insurance, coverage -verification.
I do ierehy andpenalfies ofperjury Mat the informadonprovided above is frae and correct.
signature:. . OeV! Data:
Thone4:
Ofil-cialuseoply. Do not Vf ite in mis area, to be completed by cii� or lown official
City or Town: Permit/License 9
issuing Authority (circle one):
1.)3oard of Health 2.BuildingDepartmeRtI Cliyffown Clerk 4. Electrical Inspector S. Plumbing Inspector
6. Other
Coatact Person; Phone
C(DI-ls CONTRACTOR WORK ORDER
ser -\/Ices
50 Washington St Suite 3000 Printed: 6/6/2014
Westborough, MA 01581 Work Order Id: S52668P57285C199
Contractor Information
Customer/Site Details
Mass Weatherization Inc
Maureen Magauran
Email:
mfmagauran@gmaii.com
Quantity
Unit $
Phone(Eve):
978-683-0132
3 Ocean Ave
258 Bridges Ln
Phone(Day):
617-759-1445
Salem, MA 01970
North Andover, MA 01845-2223
Site ID:
S00002152668
WorkOrder Notes
I
IPayments
Incentive Payments
Customer Share
Air Sealing Incentive $1,223.76
Weatherization Incentive $1,486.09
Total Incentive Payments $2,709.85
Total Customer Share $495.36
Less Deposit Of $165.12
Customer Share Balance (Due Contractor) $330.24
Conservation Services Group - 50 Washington Street Suite 3000 - Westborough, MA 01581 - (508) 836-9500
Total Installed Measures
Location
Description
Quantity
Unit $
Total $
Hallway
Whole House Fan Box: Thermal Barrier Polyiso
1
$154.32
$154.32
Hallway
Attic Stair Cover Thermal Barrier
1
$206.70
$206.70
Exterior Door Weather Stripping
2
$25.20
$50.40
Door Sweep
2
$21.17
$42.34
Living Space
Perform Air Sealing at Estimated 62.5 CFM50
10
$77.00
$770.00
Attic
Propavent Zor 4'
ill
$3.50
$388.50
Damming
107
$1.85
$197.95
Living Space
Attic Floor Open Blow Cellulose 5
1,000
$1.28
$1,280.00
Attic
Vent bath fan to soffit exhaust
1
$1-15.00
$115.00
Installed Measures Total
$3,205.21
WorkOrder Notes
I
IPayments
Incentive Payments
Customer Share
Air Sealing Incentive $1,223.76
Weatherization Incentive $1,486.09
Total Incentive Payments $2,709.85
Total Customer Share $495.36
Less Deposit Of $165.12
Customer Share Balance (Due Contractor) $330.24
Conservation Services Group - 50 Washington Street Suite 3000 - Westborough, MA 01581 - (508) 836-9500
1. DESCRIPTION OF WORK TO BE PERFORMED
Contractor will perform or cause. to be perform . ed the fol[lowing work on these "Premises" in aprofessional manner and in accordance with the terrns of
this Gontract, including the attached recon-miendatiorWwork order desedbing the work in detail (the 'Worle') which axe incorporated herein by reference:
Descriptlon
Quantity
Location
Perform Air Sealing at Estimated 62.5 CFM50 Per Hour
10
Living _§pa
$770�00
Door Sw'
2 N/A
$42.34
Exterior Door Weather Stri
2
NIA ----- --- -----
$50.40
Attic Stair Cover Thermal Barrier
1
Hallwa;
Whole House Fan Box; Thermal Barrier Polviso 2" (Attic)
- - ---- ----
Hallway
$154.32
Sub Total:
$1,223.76
Utility Incentive Share
$1,223.76
Customer Contribution
$0.00
(IOW"FIN]
NY
M4
use only
Printed4 512212014 page 1 of I
Il. PAYMENT 6-5)m
Ciistomer agrees to pay Gont-actor for the Work, the Customer Share of the Contract Price as follows: Payment #1: as a Deposit payable
to CSG upon signing the Contract (not to exceed 1/3 of the tntal retail costs or actual costs ofsp heve'r is greater), Mail check & contract to CSG,
Attm- RCS, 50 Washington St., Ste. 3000, Westborough, MA 01581. Final Payment: esvlorders, whic
as the final payment for the Work shall be due and
payable to the Independent Installiition Contractor ("IIC") upon s mpletion of the Work. Customer understands that he/she wW not be required
to pay the Utility Incentive Share of the Contractprice in the amount of$ The Utility Incentive Share is dependent upon the package purchased and/or
prior incentive uWizabon. Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share.
Ill. DISPUTE RESOLUTION
'Ihe IIC and Customer hereby mutually agree in advance that in the event that the 1IC has a dispute concerning this Coniz-act the IIC may submit such dispute to aprivate arl�itration
service which has been approved by the Office of Consumer Affairs and Business Rquiation and Customer shaR be iWiin� to submit ti) such arbitration as provided in M.G1. e 142A.
Customer: Cnntrnr�n�
You may cancel this agreement if it has been signed by a party there to at a place other than an address of the seller,
which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch
by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the
signing o isagre ent. DO NOT SIGN THIS, CONTRACT IF THERE ARE ANY BLANK SPACES.
0 Signature V Date Indicate your selected IIC here, if applicable (OR)
initial here if you want
the Program to assign a
Paxteipating Contractor
-b-ate Nahie of CSG Repre-sentattl(Printed)
TERMS AND CONDITIONS APPEAR ON THE REVERSE. 1/13
lot
mass save
PERMIT AUTHORIZATION FORM -
Maureen Magauran owner of the property located at:
(Ownees NBrne, printed)
258 Bridges Ln North Andover
(property Street Address) . (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building p rnit to perform insulation and/or weatherization
work on my property.
-x "M 11 A-1
Owner's Sign*i
Date
FOR CSG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
participating Contractor Date
For office Use Only
Rev. 12132011