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HomeMy WebLinkAboutBuilding Permit #1080-2016 - 287 WAVERLY ROAD 4/16/2016 I BUILDING PERMIT TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINAT4 - Permit NO: - �� �/ Date Received �9SSAC HUSEt�h Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION PROPERTY OWNER bo nt..e `) J :Ls h Print MAP NO: 0 PARCEL:�S0t._:. ZONING DISTRICT: RLI Historic District yes no Machine Shop Villageyes no TYPE OF IMPROVEMENT PROPOSED USE Reside ial Non- Residential ❑ New Building ne family ❑ Addition ❑ Two or more family ❑ Industrial teration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic ❑Well ❑ Floodplain D Wetlands ❑ Watershed District ❑Water/Sewer Identification Please Type or Print Clearly) OWNER: Name: c'sY"��n /<P � G 5 Phone: 7E- 6 g2' 90 Sg Address: 1.�( yl� ri�DV� 0/97S� CONTRACTOR Name: 4 Phone: Address: Supervisor's Construction License: Exp. Date: gj'2o 1-7 Home Improvement License: Exp. Date: ARCHITECT/ENGINEER CJ - 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: $ D-1 �j FEE: $ 33 . 0 0 Check No.: Receipt No.: a Q NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/pwner Signature of contractor Location ! .'.i f t. !>'c` r It V . ! i No. J t_�ta' c {r' Date -I • - TOWN OF NORTH ANDOVER j Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee Other Permit Fee $ TOTAL $ f Check#57 2Z, 551 Building Inspector r 1 NORTH +. _ . w: .. . _ c . . ve. . 0 No. I Z oh , ver, Mass, 41 "Ila COCHIC"IWIC 1• U BOARD OF HEALTH Food/Kitchen PERMIT L D Septic System THIS CERTIFIES THATBUILDING INSPECTOR bore.ewn....... ...e.. ...h.c�.�.............. ............................. .. 8.�.... . .� .. ....Ro.� Foundation has permission to erect .......................... buildings on . v !! • Rough ... to be occupied as ............. . .f is.......1i !.'. .X1SI. .4[ ............................................. Chimney provided that the person accepting this permit shall in every respect 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 VIOLATION of the Zoning or Building Regulations Voids this Permit: Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough .. Service ........................... ../1�- -k./OLDING�.................... Final 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. t RISE60 Shawmut Road, Unit 2 Canton, MA 02021339-502-6335 ineerin S� 9• ENGINEERING www.RISEengineering.com I OWNER AUTHORIZATION FORM 1 (Owner's Name) owner of the property located at: az / (Property Ad e ) • f7N lam l� L tai Y'/ i Q� �'+�� Q' � , (Property Address) hereby authorize b !� Q U. (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. oar's Signa e Date U , 9 2016 Federal ID#05-0405629 N RISE Engineering RI Contractor Registration No 8186 RISEA division of Thielsch Engineering NA Contractor Registration No 120979 ENGINEERING' 60 Shawmut Unit#2,Canton,MA 02021 CONTRACT 339-502-6M FAX 339-502-6345 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO DEIYJEEN Rise CMA.-HES ENaW ERM AND THE CUSTOM FOR WORK AS DESCRIBED BELOW CUSTOM NE DATE CLIENT/ WORK ORDER Doreen Deshaiesrnr�� xulw U 8)633-5516 02/26/2016 432049 00002 SERVICE DTREHT - B O BTR 1 287 Waverley Road _ g 2016 Waverley Road SERVICE CITY,STATE.ZIP —SMUIG CRY.STAT$IIP North Andover,MA 01845 No Andover,MA 01845 JOB DESCRIPTION HEALTH&SAFETY:Weatherization work cannot proud until the gas leak issue is repa-ved. $0.00 HAZARD BARRIER:We have identified that there are recessed lights present in your home.unless the recessed lights are certified as IC-Hued(Insulation Contact Rated)we will create a 3"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 ofspecial tools and diagnostic 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,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(6)working hoots.A reduction in cubic feet per minute(cf n)of air infiltration will occur,but the actual number of cfin 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 of the indoor air quality. $510.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unf Iced fiberglass batts to(84)square feet for damming Pumoses- $172.20 ATTIC FLAT:Provide labor and materials to install an 8"layer of R-28 Class 1 Cellulose added to(504)square feet of open attic space.I COULD NOT ACCESS OVERHEAD ASSUMMED 6"EXISTS $690.48 ATTIC ACCESS:Provide labor and materials to insulate the back of the attic door with 2"rigid Thermax board and seal the door's edge with weatherstripping to restrict air leakage. $73.91 ATTIC ACCESS:Provide labor and materials to make(1) temporary access to an attic area. The opening will be closed with materials similar to those existing. Finish sanding and painting is not included. $85.00 VEN TUATION:Provide labor and materials to install ventilation chutes in(54)rafter bays to maintain air flow. $108.00 COMMON WALLS:Provide labor and materials to' " install blown in Class 1 Cellulose to(195)square feet of 4 common wall through an interior surface drill and plug method. Plugs will be s kled and left in a relative) smooth condition.Finish sanding and 1� Y 6 touch-up priming/painting will be the customer's responsibility.Homeowner has received a copy of the EPA's Renovate Right Lead- Safe information guide explaining the potential risk of the lead hazard exposure from the weattrerization work to be performed. Your signature is your acknowedgement of receipt and agreement to proceed t.BEi'WEEN GARAGE AND HOUSE. $360.75 COMMON WALLS:Provide labor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to(112)square feet of common wall area $392.00 Federal ID#054)405629 RISE Engineering RI Contractor Registration No 8186 RISEA diviaioo ofThie{ach EngineeringNIA Contractor Registration No 120979 ENGINEERING 60 Shawmut Unit#2,Canton,MA 02021 339-502-6335FAX 339-502-6345 CONTRACT Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-IES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT 0 WORK ORDER Doreen Deshaies (508)633-5516 02/26/2016 432049 00002 SERVICE STftwT BILLING STREET 287 Waverley Road 287 Waverley Road SERVICE CITY.STATE,IIP BILLING CRY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION BASEMENT CERANG:Provide labor and materials to install(126)linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $220.50 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 offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 1001/6 for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and after the weatherization work is complete.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$3,110. $90.00 AR _ o. c016 Total: $2,702.84 Program Incentive: $2,177.13 Customer Total: $525.71 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF 'Five Hundred Twenty-Five 8L 711100 Dollars $525.71 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED NO UNPAID BALANCE AFTER 00 GAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISKK SCHEDULING,AND ISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPA 41SIGRE . Engbmftg ACCEPT NOTE THIS CONTRACT MAY BE WITHDRAWN BY US.IFNOT EXECUTED WITHIN DATE OF ACCEPT CE ACCEPTANCE OF ONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 pAyg, SATISFACTORY 0US AND ARE REREBY ACCEPTED.YOU ARE AUTHORMDTO DO�VM5M AS SPECIFIED.P YM EHT WILL BE MADE AS OUTLINED ABOVE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Co-op Power Address: 15A West Street City/State/Zip: West Hatfield, MA 01088 Phone#: (413)772-8898 Are you an employer?Check the appropriate box: Type of project(required): 1.® 1 am a employer with 20 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet. + E] Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. workers' comp.insurance. 9. ❑ Building addition [No workers' comp. insurance 5. ❑ We are a corporation and its required.] officers have exercised their ]0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.0 Plumbing repairs or additions myself. [No workers' comp. c. 152, §1(4),and we have no 12.[] Roof repairs insurance required.]t employees. [No workers' �+ ' comp. insurance required.] 13.® Other /t'15U��C//O/1 *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 their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site -information. Insurance Company Name: HDI Gerling America Insurance Company Policy#or Self-ins. Lic.#: EWGCC000187715 Expiration Date: 11/08/2016 Job Site Address: "V� ' City/State/Zip:&. iw 110A l J Attach a copy of the workers' compensation p licy 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 certffy goer the pains andpenalties ofperju at the information provided above is true and correct. Signature`"�;',_;J�..�-'�� f `��--, Date: Phone#: 7 7 P — '3 3 4 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(MMIDDIYYYY) `.,�..� 11/12/2015 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 NAME:CONTACT MacNeal James J. Dowd & Sons Ins PHONE 14 Bobala Road (A/C,No Ext):4 13-53 8-74 44 No): Holyoke MA 01040 ADDRESS: dmacneal@dowd.com PRODUCER CUSTOMER ID#:COOP INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURERA:HDI-Gerliri America Insurance Compa Co-op Power, Inc. INSURERB:Torus National Insurance Company 25496 15A West Street West Hatfield MA 01088 INSURER C: INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:1503274623 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. INSR TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSR WVD POLICY NUMBER MMIDD/YYYY MM/DDIYYYY LIMITS A GENERAL LIABILITY EGGCC000187715 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE T REN100,000 PREMISES Ea occurrence) $ CLAIMS-MADEa OCCUR MED EXP(Any one person) $5,000 PERSONAL&ADV INJURY $1,000,000 GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2,000,000 X POLICY PRO--JECT F7 LOC $ A AUTOMOBILE LIABILITY EAGCC000187715 11/8/2015 11/8/2016 COMBINED SINGLE LIMIT $1,000,000 (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS X PROPERTY DAMAGE $ HIRED AUTOS (Per accident) X NON-OWNED AUTOS $ Comprehensiv $ B X UMBRELLA LIAB OCCUR 70354Q150ALI 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $1,000,000 DEDUCTIBLE $ X RETENTION $10,000 $ A WORKERS COMPENSATION EWGCC000187715 11/8/2015 11/8/2016 TNRY IMT OT AND EMPLOYERS'LIABILITY Y/N ER ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $1,000,000 OFFICER/MEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describeunder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Certificate Holder is named as Additional Insured per written contract in regard to general liability only. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Thielsch Engineering, Inc. 195 Frances Ave. Cranston RI 02910 AUTHORIZED REPRESENTATIVE `)(\( ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ' 1 e t C I1I y{Z 01/MW-Y'71 4M, C1 - ' - office of Consurner Affairs and Business Reculatlon i, 10 Part: Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Y Registration: 165217 Type: Supplement Card CO-OP POWER, INC. `` Expiration: 1/21/2018 - - LEAH DANIELS - 15A WEST ST WEST HATFIELD, MA 01088 -' Update Address and return card. Mark reason for change. scA s tr 2eM-05iif / Address Renewal Employment Lost Card Ve 7`r rrurrr rra r rf/�r�r` d lrr,r.rrrt'�rr.,r// _—)Rice of Consumer Affairs n Business Regulation License or registration valid for individul use only ry -HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: V w"Registration: 165217 TYpe: Office of Consumer Affairs and Business Regulationulation 10 Park Plaza, Suite 5170 Expiration: 1/21/2018 Supplement Card Boston,MA 02116 CO-OP POWER. INC. LEAH DANIELS 15A WEST ST _ ... WEST HATFIELD, MA 01088 tndersecretai-A Not valid without signature i Massachusetts Department of Public~ Safety Board of Building Regulations and Standards License: CS-097409 Construction Supervisor LEAN M DANIELS 12 MARCELLA ST ROXBURY MA 02119 ( -' '7',, .—,__ Expiration. Coinrnissioner 05/1812017