HomeMy WebLinkAboutBuilding Permit #951-15 - 28 MORNINGSIDE LANE 5/21/2014I- r -
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: �v /�
Date Received
Date Issued:
IMPORTANT: Applicant must complete all -items on this page
LOCATION -2 rylt o5 5i'de �A
Frint
.PROPERTYOWNER eL14 ?\I V.
Print 100 Year Structure yes no
MAP PARCEL: ZONI NG. DISTRICT: Historic District yes, no
Machine, Shop Vill'ag-p. yes no
TYPE OF IMPROVEMENT
PROPOSED USE
0
ArED
Residential
LOCATION -2 rylt o5 5i'de �A
Frint
.PROPERTYOWNER eL14 ?\I V.
Print 100 Year Structure yes no
MAP PARCEL: ZONI NG. DISTRICT: Historic District yes, no
Machine, Shop Vill'ag-p. yes no
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
El One family
El Addition
0 Two or more family
0 Industrial
0 Alteration
No. of units:
El Commercial
El Repair, replacement
0 Assessory Bldg
N Others:
0 Demolition
AdOther 7Y,5,i k -t- � o K
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DESCRIPTION OF WORK TO BE PER1-L)KMLU:
Identification - Please Type or Print Clearly
OWNER: Name: 5��dol pig -e 7-4 Phone: f >F-%)4 - 1,00
Address: M8 PIA r. a )—,, Jf L -
'Contractor Name: Prrc ltbl4kc., Pho.ne;
Address: f7, A hk 'f
Supervisor's Construction License: !�*t �Ve, 0 I'> Exp. Date;
Home Improvement License: /o)-- >d-6,
ARCH ITECT/ENGINE
Date:
Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $1Z 00 PER $1000. 00 OF THE TOTAL ES TIMA TED COST BASED ON $125. 00 PER S.F.
Total Project Cost: $ 2 foo FEE: $
Check No.: -176 / ? Receipt No.: a qj7 0 z
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
Plans Submitted 11 Plans Waived 11 Certified Plot Plan [I Stamped Plans 11
TYPE OF SEWERAGE DISPOSAL
Public Sewer
Tanning/Massage/Body Art
Switaming Pools 11
well
Tobacco Sales El
Food Packaging/Sales El
Private (septic tank etc. El
Pennanent Dumpster on Site
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On
COMMENTS
CONSERVATION Reviewed o
COMMENTS
HEALTH
COMMENTS
Signature.
Sianature
Reviewed on Signature
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
6
DPW Town Engineer: Signat-are:
Located 384 Osgood Street
E7 1 i Ei 71KPk�!
a
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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
We
I Ll Notified for pickup Call Email I
Date Time Contact Na
Doc.Building Pennit Revised 2014
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
Copy Of Contract
Floor/Cross SectionlElevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
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
4L Engineering Affidavits for Engineered products
TE: 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
Location
9��—/ al
No. Date
Check# 261 `7
TOWN OF NORTH ANDOVER
Certificate of Occupancy
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $
TOTAL $
Building Inspector
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Federal ID #
RISE Engineering RI Contractor Registration No
MA Contractor Registration No
A division ofnicisch Engineering CT Contractor Registration No
60 Showinut Unit #2, Canton. MA 02021 CONTRACT
339-502-6335 FAX 339-502-6345
R I S E PROGRAM Page I
lafts CONTRACT IS ENTERED INTO BETWEEN FUSE
CNIA-HES ENGINEERING AND T14E CUSTOMER FOR WORK AS
ENGINEERING
DESCRIBED SELOW
CUSTOMER PHONE DATE CUENT 0 WORKO
A I issa Evangelista (978)726-1210 02/227/2015 413649
SlinVICE �ET SIUJNG STREET
28 Morningside Lane 28 Morningside Lane
SERVICE CITY. STATE. 7JP BILUNG CFTY.STAMZIP
North Andover, MA 0 1845
North Andover, MA 0 1845
JOB DESCRIPTION
13ARRIEIZ: We have discovered whnt appears to be a mold mildcw-likc substance in your home. This is being brought NVI40%010—
)tI7
attention to identify it as a pre-existing condition to the insulation and air scaling work planned for your home. Your signa; rc i's
your acknowledgement of these conditions and agreement to proceed.) SERVPRO.
HAS BEEN AT THE HOUSE To r- VALUATE13 I -OR MOLD MILDEW DUE -1-0 ICE_ DAMSH! NEED ALI. CLEAR F!�
THE!!! THE ROOFING CONTRACTORIMAY ADD WHEN RE -ROOF!!!
S0.00
Alit SEALING: Provide labor and materiats to seal areas oryour home against wasteful. excess air leakage. This work will be
performed in concert with the use orspccial tools and diagnostic tests to assure that your home will be left with -.I healthful level of
air exchange and indoor air quality. Materials to he used to seal your home can include caulks. foams and other products. Primary
areas for sealing include air leakage to attics. basements. attached garages and other unheated arm (windows arc not gencrally
addressed.) (10),,vorkinghours.
At the completion of the weatherization work, and at no raiditional cost to the homeowner, a final blower door and/or combustion
safety analysis will be conducted by the sub -contractor to ensure the safety ofthc indoor air quality.
S750.00
DAMMING: Provide labor and ninterials; to install a 12" InycrofR-38 unfaccd fiberglass hatis lo(60)squarcl�cl rordamming
purposes.
S112100
ATTIC FLAT: Provide labor and materials to install a 6" layer or R-21 Class I Cellulose added to (988) square rect ofopen attic
space.
$1.185.60
SO.00
ATTIC ACCESS: Provide labor and materials to insulute the back of(l) attic batch with 2" rigid Thcrmax board. Weatherstrip the
perimeter.
$60.00
VENTILATION: Provide labor and materials to install ventilation chutes in (28) railer bays to maintain air flow.
$56.00
VENTILATION: Provide labor and materials to install (10) 6" X 16" rectangular aluminum soffit vents to increase ventilation in
attic areas. Specify color: White or Gray.) SERVPRO.
HAS BEEN AT THE HOUSE TO EVALUATED FOR MOLD MILDEW DULTO ICE DAMS!!! NEED ALL CLEAR FROM
TFIE!!! THE ROOFING CONTRACTOR MAY ADD WHEN RE -ROOF!!!
$250.00
BASEMENT CE [LING: Provide labor and materials to install (95) linear feet orR-19 unlaced FilicrPlass; insulation to the perimeter
ofthe basement ceiling at the house sill.
$166.25
BASEMENT DOOR: Provide labor and materials to insulate the back ofthe basement door leading to the bulkhead with 2" riaid
board that meets the sections R -316.5A and 316.6 requirements ofbuilding code. Sealall edges; and scams with FSK tape.
$72.22
i
WNW �� Federal iD #
FF)
RISE Engineering RI Contractor Registration No
MA Contractor Registration No
A division ofThiclsch Engineering CT Contractor Registration No
�Ij 60 Shawmut Unit #2. Canton. AIIA 02021
1 CONTRACT
339-502-6335 FAX 339-502-0415
R I S E PROGRAM Page 2
TH 3 CONTRACT 93 ENTERED INTO BETWEEN RISE
CMA -HES ENGINEERING AND THE CUSTOMER FOR WONX AS
ENCANEERING DESCRJOED DFLOW
CUSTOMER PHONE DATE CLIENT a WORK ORDER
Alissa Evang
gelista (978)726-1210 02/27/2015 413649 0
SERVICE STREET BILLING STREET
28 Morninoside Lane 28 Morningside Lane
SERVICE CITY. STATIE� ZIP SURIG CiTYSTAtE,?JP
North Andover, MA 0 1845 North Andover, MA 0 1845
JOB DESCRIPTION
OVERHANG: Provide labor and materials to install 10" R-37 densely Packed Class I Cellulose insulation to (38) square
exterior overhang located below a heated floor area. by drilling holes in the overhang from below. Holes drilled will be plugg
u
Plugs will be scaled with exterior grade spackle and Icft in a relatively smooth condition. Finish sanding and touch-up
priming/paintin.- %vill be the custornexs responsibility.
$152.00
RISE Engineering will apply all applicable, eligible incentives to this contract. You will only be billed the Net amount. Currently,
for eligible measures, Columbia Gas offiers 75% incentive, not to exceed $2,000 per calendar year, and an incentive of 100% for the
Air Scaling- measures up to the firsi. S600 and an additional $300 ifsavings irejustified by the auditor.
For the safety and health of your homes indoor air quality, we will be conducting a blower door diagnostic of the available air flo%v in
your home both before the work is begun., and after the weatheri7ation %vork is complete. Iffle %vill also conduct a full assessment of
the combustion safety of�vur heating system and water heater. This has a value of$90 and is at no cost to you. Total allowable
weatherization incentive is S2,990.
$90.00
Total: $2,905.07
Program Incentive: $2,388.80
Customer Total: $516.27
WE AGREE HEREBY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE VVITH ABOVE SPECIFICATIONS. FOR THE SUM OF
'Five Hundred Sixteen & 271100 Dollars $616.27
UPON FINAL INSPECTION AND APPROVAL ENGINEERING. CUSTOMER AGREES TO REMrT AMOUNT DUE IN FUU- INTEREST OF 1% WILL 13E CHARGED MONTHLY ON ANY
30 PAYS. - R EFORINIPORTANTINFORMATIONON GUARANTEES. RIGHTS OF RECISION. SCHFDUUNG. AND CONTRACTOR REGISTRATION.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
2, �
A I= SIGNATU RISE Eng ring CE
NOTF-'THIS CONTRACT WITHDRAWN BY U3 OF 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 00 THE WORK
— AS SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED ABOVE
a
a
OWNER AUTHORIZATION FORM
1, 41
owner of the property Iocatdd at
C,^ a- M a 1A Ina" R rag L."N
(Prop6ify Address)
4.&IPO 0114a �
hereby authorize
an authorized subcontractor for RISE Engineering, to act on my behaff to o*\�
permit and to perform work on my property.
OAees Signature -
Date
I
The Connnonivealti, of massachusetts
Department of Industrial Accidents
Office of Investigations
Z!
600 WasIlington Street
7
Boslon, MA 02111
tvjviv.nzassgov1dia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
'Name (Business/Ot�_panizationlindividual): ro Iqf- 'k 'ea (- rr\5V1gr7 A 0 '1 C 0- 2hc—,
Address: K
Phone #: Q 7
Are you an employer? Check the appropriate box:
A6
1. U!� I am a employer with -7
4- C] I am R general contractor and I
employees (Ml and(or part-time).*
have hired the sub -contractors
2- El I am a sole proprietor or partner-
I Isted an the attached. sheet.
ship and have no employees
These sub -contractors have
working for me in any capacity.
employees and have workers'
(NO WOrkers' comp. insurance
comp. insurance.' .
required.]
5. We are a corporation and its
3-0 1 am a homeowner doing all work
officers have e.xercised their
mYself V\0 WorkeW comp.
right of exemption per MGL
insurance required.]
c- 152- § 1(4). and we have no
employees. [No work-eW
comp. insurance required.1
e S --
Type of project (required):
6- New construction
7. Remodeling
S. Demolition
9. Building addition
10.0 Electrical repairs or additions
I LEI Plumbing repairs or additions
1211 Roof repairs
:A.y.pplic.ntd-tCh1dz, boxzE I must also Mlout the section below sho-inathcirwork-ers- compensation policy infbnnalion.
I tomeouners 'WhOsubmit this affidavit indicatinathey am doine all ivurk- a, - -submit a ne v affidavit dicatingsuch.
id then hire outside contractors must in
�Contractors that check- this box must attached an additional sheet showing the name ofthe sub -contractors and state whethcr or not those entities have
employces. Ifthe sub -contractors have emplikyees. they must provide thtir workers- comp. policy number.
I lima" employgr that isproviding ivorkersCOMPe"SiTtion insurancefornig- eniplayees. ftelotp is tile polkly andjob site
information.
Insurance Compa%, Name..
Policv 9 or Self -ins. Lic.
tr &V & Expiration Date:
Job Site Address: City/State/Zip: -
Attach a copy of the workers' compensation policy declaration page (showing the policy.number and expiration date).
Failure rosecure coverap
ge as required under Section 25A of MGL c- 152 can lead to the imposition of criminal penalties of a
fine UP to SI 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 S250-00 a day against the violator- Be advised that a copy of this statement may, be fonvarded to the Office of
Investigations of the DIA for insurance coverage verification.
I do llerekr cerdfi- ' tinder the pains andpe"offies OfPCY110T that tIM ififormation provided abo ve is triteand correct.
r�,% :.J 'A
Offl6al 'Ise on�r Do not itrifeinthis area, to be coftlPletedby city or totun 01TIciat
City or Town:
Permit/License #
Issuing Authority (circle one):
1. Board of lle2lth 2. Buildin- Department 3. Ciril/T011-0 Clcr1%
6. Other
Contact Person -
4. Electrical Inspector i. Plumbing Inspector
Phone Irr.
ACCM0 CERTIFICATE OF UABILITY INSURANCE
441 �-
I 01MM815
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGA71VELY 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, A14D THE CERTIFICATE HOLDER.
IMPORTANT- If the-cerfmcate holder Is an A0017IONAL INSURED, the pollcy(les) must be endorsed. N SUBROGATION IS WAIVED, Subject: to
the term and conditions of the policy, certain policies may require an endorsemeaL A statement on this covifficate does not confer rights to the
certilleaft holder In lieu of such endorsament(s).
PrdxKfm
Automatic Data Pcocessing Insumnce Agency, Inc.
I Adp BouW4ard
CONTACT
UWE:
SUM oft,
EXP
Roseland, NJ 07068
114SURERM AFFORDING COVERAGE MAIC#
INSUMA: NorGUARDInsuninceCamimy 31470
INSURED POLAR BEAR INSULA710H CO INC
WSUREIIB:
01SURERC:
518 CANAL ST
PO Box 958
LawrOM, MA 01843
INSURER D:
0"UME:
NSURMF:
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THIS ISTO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING A14Y 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 13Y THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS.
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS.
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCMA.ED BEFORE
TYPE OF INSIJRANCE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CPLUMBIAGAS
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ACORD 26 (2014101) The ACORD name and logo are registered marks of ACORD
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCMA.ED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CPLUMBIAGAS
ACCORDANCE WITH THE POUCY PROVISIONS.
195 FRANCIS STREET
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REPRESENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
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Boston, Massachusetts Registration
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14ome ImPrOv Registration: 102726
Type: DBA Tr* 252249
Expiration: 7WO1 6
EAR INSULATION 10.
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License: CrISL-1106017
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plaistow NK 03865
Expiration
0412W2018
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