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Building Permit #206-13 - 28 AUTRAN AVENUE 9/17/2012
14ORTH BUILDING PERMIT o* qti TOWN OF NORTH ANDOVER - p APPLICATION FOR PLAN EXAMINATIONso Permit NO: Date ReceivedATED ACHU`���� Date Issued: t 12 IMPORTANT:Applicant must complete all items on this.page LOCATtUN -� - T-= LJto Pr�it PROPERW 01�1/aNER ; .. 40. Print ,,. MAP 2°1DPARGEL - ZONING DISTRIC3 1-i'is#oric Des#riot y n© :g IVlachiri;e Shop Viitag .ye no, . .TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building One family Addition Two or more family Industrial Alteration No of units: Commercial Repair, replacement Assessory Bldg Others: Demolition Other Septic alVe1) Floodptam; 1N.+eI)ands 1JUatershed District 1�/ate�lSewer.r � � ° DESCRIPTION OF WORK TO BE PREFORMED: !� v . Identification Pie se Type or Print Clearly) �— YP Y) OWNER: Name: o Phone: �C •�3 Address: (a / r-i ;. a►^ 3 COINTR,4CT0R Nene : . hA Phone-, Address, h.. " Sup�ervisor's Construe iQnr Licenses ..., Exp mate. -: • .P. /.s �Ho,rne T,,p,r- t eense� -�. r + p Date, ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERM/IT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ l.P J �_ : FEE: $ ��p •� l Check No.: �J � � Receipt No�� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature Io. A nt/Owner' Signature of contraeto Location s L N Date p TOWN OF NORTH ANDOVER Certificate of Occupancy $ �, gym? Building/Frame Permit Fee $ ,�6 r . " Foundation Permit Fee $ Other Permit Fee $ TOTAL 4 Check#- 25710 Building Inspector Plans Submitted Plans Waived Certified Plot Plan Stamped Plans .. TYPE OF SEWERAGE DISPOSAL Public Sewer Tanning/Massage/Body Art Swimming Pools= _ Well Tobacco Sales Food.Packaging/Sales Private(septic_t A;etc. Permanent-Dumpsterbn Site THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT I COMMENTS CONSERVATION Reviewed on Signature COMMENTS s HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street F�RE"'DEPARTSMENT , TelxipDumpster on si#e yes_: Located'a# 124=Alain Street= n0 ire:D"epartmentsigna#ureld ate . C-GM M.E`NTS i 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 - Date Doc.Building Permit Revised 2010 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 NOTE: Ali. 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/Crossection/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 NOTE: 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 a Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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 2008 c40RTI, Town of ndover 0 �., t No. Zo = - • • Y O LA14E h ver, Mass, A_ COC"1CMEWICM 11 7� RATED '%'*' y S U BOARD OF HEALTH PERMIT' T LD Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ........>...:. .......... ................. . ....... . ............................................... has permission to erect .........Zbui dings on Foundation ................ .... ... ..... .. ..................... .... ... Rough to be occupied as ....... �3�I. . . Vs................................:............................................. Chimney provided that the person accepting this permit shall in every r1511 -espect 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 MONT S ELECTRICAL INSPECTOR UNLESS CONSTRUC I ST Rough 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. SEE REVERSE SIDE i. y Job Number. . 487 11 DATE 10-Sep-12 r Client Josephine Longo. . address 28 Autran ave city/town. North Andover 508-560-3386 contractor 1.WEATHERSTRIPPING/CAULKING QUANTITYTOTAL AUDITOR NOTES Door Kits Q-Lon or Equiv. 5 227.50 Door Sweeps(Regular) 1 15.75 Door Sweeps(Automatic) . . 4. 92.00 Reglaze Windows/In:inch 0 0.00 I Window.Weathstr Schlegel per side 0 0.00 Tenmat Recessed Can Cover 6 . 180.00 Attic air sealing per manlhr 2 150.00 . basement and living space air,sealing _ 1 . 75.00 SUBTOTALS 740.25 2A.INFILTRATION/INSULATION AUDITOR NOTES . Domestic pipe Hot Water Tank 1 st 6' 0 0.00 Sill Insulation R-19 CF 0 0.00 Sill Two Part Foam w/Fiberglass.Batt 32 70.40 Drape Perimeter R-5 Anch.Sq.ft: 0 0.00 Perimeter 2"T-max or equivalent foam board sq'.ft. '. 0 0.00 Drape DOOR R-5 or T-max or equivalent,on door; 0 0.00,_ Tape Joints(Aluma Grip only)per hr. 0 0.00 Duct Insulation:&Tape sq.ft:R-5. 0 0.00 Rigid Foam Board Anch.'1"per board 0 0.00 - Hydronic pipe insulation to 1"R-5. . 0 0.00 Hydropic pipe ins.125+'-1.5"R=5 0 0.00 Steampipe Ins.tol.25"iron pipe R-5 0 0.00 Steampipe Ins.1.5"-2"iron pipe R-5 0 0.00 Steampipe Ins.3"iron pipe R-5 0 0.00 Air Conditioner Meeting Rail 0 0.00 .Air Conditioner Cover 0 0.00 Air Conditioner Cover Special Order 0 0.00. SUBTOTALS 70.40 26.INSULATION AUDITOR NATES.' .Open Unrestricted R 49 0 0.00 Open Unrestricted R 38. 1077: 1583.19 Open Unrestricted R 30: 0 0.00 Open Unrestricted R 20 0 0.00 Open Unrestricted.R 10 0 0.00 Restrict FUSloped R 30 540 799.20 Restricted_FUSloped R 20 0 p 0.00 Restrict FU$Ioped R 10 0 0.00 R-19 FGB open rafters/walls/kneewalls 0 0.00 R-11 FGB open rafters/walls/kneewalls 0 0.00: Attic,Stalrs(stairwell&common wall) 0 0.00 Cover Pull Down Stairs Thermadome. 1. 180.00 Site.built .puli down,stairs 2"foam box. 0. 0.00 - AUDITOR NOTES Attic/Kneewal Floor Transition,Dense pack cellulose. 0 0.00 W.S.Hatch Q-Lon or equal 0 0.00 W.S.&bat Hatch R-30/Q-Lon or= 0 0.00 Kneewail R-12 cell.behind Per:Memb 0 :. 0.00 Open Rafter R-20 Cell./w poly. : 0 0.00 Open Rafter R-30 Cell./w poly 0 .0.00 Basement'Overhead R-19 fiberglass 0 0.00 Basement Overhead R-30 fiberglass 0 0.00 Crawlpace Overhead<4'high*.R190 0.00 Crawlpace Overhead<4'high.R30 0 0.00 Garage Ceiling cavity filled w/.cellulose 0 0.0.0 Wood,Shake,Clapboaid,Shingles Vinyl 1268 2269.72 Asbestos(single nail)/Asphalt 0 0.00 Asbestos(doub.Nail)!Aluminum 0 0.00 Brick/Stucco : 0 0.00 Vinyl over Asbestos .0 .0.00 Multi-layered 3.or more layers 0. 0.00 Drill rough plaster or finish wood plug 0. 0.00 Drill finish plaster 120 228.00 garage wall/unless we can blow from top Test Drill Walls.(all.4) 0 0.00 SUBTOTALS 5060.11 2.INSULATION TOTAL 2A.+2B.. 5130.51 3.STORM WINDOWS/DEADLITES AUDITOR NOTES Plexiglass up to 88 u.i. 0 0.00 Additional per Ul over 88:' 0 0.00. Other(Negotiated Price) 0 0..00 SUBTOTALS 0.00 b.OTHER MATERIAL AUDITOR NOTES. Ridge vent In ft;. 0 0.00 Vents Gable rectangular 0 0.00:.. Varipitch Vent 0 0.00 Vent Roof 135(1 sq ft NFV)Large 0 0.00 Vent Roof 865.(A sq It NFV)Small 0. 0.00 Vent Soffit Rectangular. 0 0.00 Turbine Vents All 0 0.00 Stack Vent 0 0.00 Propa Vent. . . 40 160.00 . Permable House Wrap 0 0.00: Vapor barrier.. 0 0.00. Energy Star:R-.4 Rigid Vinyl Repl 94-101 U.I. 0 .0.00 SUBTOTALS 160.00 . 6.17.E.C.MATERIALILABOR: . . 6030.76 Page 3 _ 8a. HEALTH&.SAFETY AUDITOR NOTES. Vent Bath/Kitchen Fan 1 89.00 could not find where bath is.vented • Dryer vent w/exhaust duct Heartland 0 0.00 Dryer Transition Duct only 0 0.00 Blower Door Test Pre Post 0 0.00 1ALWAYS INCLUDE PRE AND POST Lip to contractor pogsible.asb tiles SUBTOTALS- 89:00 Sb.REPAIR MATERIALILABOR AUDITOR:NOTES Basement outside door only 0 0.00" Basement outside door w/jambs ..0 0.00 Door Repl pre hung 32-36"Steel•"w/Lite 0 0.00 Door Repl interior-solid core 28-32" 0 0.00 Door Repi pre hung 32-36"wood""w/Lite 0 0.00 Window Replacement w/SIR less than 1 .0 0.00 Basement Window Repl.Awningf Hopper 0 0.00 Basement Window Repl.With:a frame. 0 0.00 Lockset(door)Schlage or equal 0 0.00... Repair/Refit-boor . . 0 0.00 Replace Side.Stop . 0 0.00 Replace Casing ; 0. 0.00. Glass Replacement to 64 uA. .0 0.00 I Glass Replacement per u.i,over.64 0 0.00 Sash Sidelock/Top Replacement 0 0.00 Threshold(Woodj. 0. 0.00 Threshold(Aluminum). 0 0.00 Slide Bolts 0 0.00 Plug Plate Cover 0 . 0.00 Cut/finish attic-kheewall access 0 0.00: Cut/close attic-kneewall access: . . 0 0.00 Labor Rate Hours .3.25 195.00 remove f/g,door,tdome Permits./Fees.(Wap only) 0. 0.00:. .' SUBTOTALS 196.00 TOTAL REPAIR+HEALTH&SAFETY 284.00 GRAND TOTAL WORK ORDER# (A) 4371 8314.76 Josephine Longo 28 Autran ave North Andover 508-660-3386 j Any alterations or deviations from the above specifications involving extra,costs must be cleared in writing before installation. . The Work Order must be complete within 15 workingdays from acceptance date below: --------------------------------------------------------------------------- CONTRACTOR/COMPANY: --------CONTRACTOR/COMPANY: 0: . . ACCEPTANCE:Company/Contractor - - AUTHORIZED SIGNATURE. Date/ AGENCY APPROVALS: CTI Authorized Signature: Date :. . GLC AC Authorized Signature: Date i ACC>R& CERTIFICATE OF LIABILITY °^�(^�/°dm^) INSURANCE 6/8 THIS12 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: ff the certificate holder is an ADDITIONAL INSURED,the policyCeS) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions ofthe policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsemengs). PRODUCER CONTACT NAME: Appletree Insurance PNONE 603 881-9900 216 Central St. E•M/UL At No: (603) 594-9840 Hudson, NH 03051 ADDRESS: PRODUCER 1648 _ INSURE S AFFORDING COVERAGE tt INSURED NAIC----- INSURER A:HANOVER INSURANCE _ CARBONNEAU INSULATION LLL. INSURER B:TECHNOLOGY INSURANCE COMPANY _ 21 LENNY LANE INSURER C: -- HUDSON, NH 03051 INSURER D, A INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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. LTR TYPE OF INSURANCE ADDL SUER POLICY EFF POLICY EXP GENERAL LIABILITY -- POLICY NUMBER MIDDN MN/DDVYYYY I LIMITS � • EACH OCCURRENCE S 1 1000,000 A X COMMERCIAL GENERAL LIABILITY ORV6410533 6/9/12 6/9/13' PDAMIAGETORENTED n� S 300,000 CU41MS•MADE a OCCUR MED EXP(Anyone person) S 5,000 ' PERSONAL&ADVINJURY S 1 000 000 I j GENERAL AGGREGATE s 2 000 000 GEN'LAGGREGATE LIMIT APPLIES PER � � PRODUCTS-ODMP/OPAGG S POLICY PRO I 21000,000 LOC S AUTOMOBILE LIABILITY COMB INED SINGLE L IM IT A ANY AUTO OHV6430533 6/9/121 6/9/13 (Eaaccldern) $ 1,000,000 ALLOWNEDAUTOS I (Per person) I S X SCHEDULEDAUTOS I BODILY INJURY(Per accident)! s — HIREDAUTOS i PROPERTY DAMAGE $ (Peracddent) NON•O WNE D AUTOS i S A X UhBRELLALm,— PX LIAS oCCuR OHV6430533 6/9/121 6/9/13' s EACH OCCURRENCE S 1,OOO,OOO DEDUCEXCESSIBLE CLAIMS-MADE i i AGGREGATE S 11000,000 RETENTION $ I S B WORKERS COMPENSATION S AND EMPLOYERS'LIASIUTY TWC3321964 6/2/12 6/2/1311wcsrAru- X OTH- ANY PROPRIE70PJPARTNERIEXECUTIVE Y!N OFFICE RUE MBER EXCLUDED? NIA E.L.EACH ACO DENT S 500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-EA EMPLOYEE $ . 500,000 i DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500 000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Aftach ACORD 101,Additional Remarks Schedule,if more space is requi reel) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE FOR THE BENEFIT OF THE INSURED THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE PATRICK J. CONWAY ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations 600 Washington Street Boston,MA 02111 i www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly I Name (Business/Organization/Individual): � � n P.2" 7 5',11 kkaA.2 z Address:_' LA / YL City/State/Zip: 62,p&—_ Phone #: 3 Are you an employer? Check the appropriate box: Type of project(required): 1.$Lam a employer with 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E] New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.$ required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 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 employees. [No workers' 13.❑ Other comp. insurance required.] *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. tContractors 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: octaa OOV ,► c C� Policy #or Self-ins. Lic. #: W C_ l (,r Expiration Date: 06 aP •1--J Job Site Address: � 44k-4,�At- /�Z City/State/Zip: _� 744M 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 cer1tW unde the pa' s d lties o perjury that the information provided above is true and correct Si nature: Date: Phone#: 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#: Restricted To: CSSL-IC-Insulation Contractor 115 Massachusetts -Department of Public Safety Board of Building Regulations and Standards ! f onstruction Superiiwr Spj•ciult% License: CSSL-102166 ALBERT S CAI2BONNE�ALtr, 21 B LENNy DANE HUDSON NH 0301-s1 r Failure to possess a current edition of the Massachusetts rI State Building Code is cause for revor_ation of this license- For For DPS Licensing information visit: www.tv'ass.GovJDPS Expiration Commissioner 06f l$12014 Delhi tnient of Public `afct% ' Boar0 of i1(:ildim2 Re�„ulatintls and Stan(laf•ds _r -.:tion License 00-35,000 cf enclosed space License: CS 97614 to-;Masonry only , i0-1 2 Family Homes a NORMAN CARBONNEAU , Failure to possess a current edition of the 4 CARRIER ST rqassachusetts State Building Code LONDONDERRY, N.H 03053 i is cause for revocation of this license. — `^•�" Expiration: 1/19/2013 ( ommi..i+wirr Tr#: 10243 ✓fie "V�anv�nancuea��, o�✓�/faac��uaelta _ � � ___ Office of Consumer Affairs&Business Regulation License or registration valid for individul use only MOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation Registration: 162729 Type: 10 Park Plaza-Suite 5170 Expiration:1416/2013 Supplement Card Boston,MA 0211.6 CARBONNEAUINSULATION;LLC. ALBERT CARBONNEAU 2 LENNY LANE HUDSON,NH 03051 Undersecretary Not valid without signature