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Home My WebLink AboutBuilding Permit #1338-2016 - 300 PLEASANT STREET 6/27/2016 �T%- 1 (/yU BUILDING PERMIT O �q LED 6 q�IO TOWN OF NORTH ANDOVER �2 h� '. APPLICATION FOR PLAN EXAMINATION Permit No#: � Date Received �yS0,r&D'S��cS ACHU Date Issued: Y 111 IM ORTANT: Applicant must complete all items on this page LOCATION J51 I PROPERTY OWNER ` Print 100 Year Structure yes MAP 0I�5 PARCEL: � � ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family El Addition Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial .repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other El Septic El Well El Floodplain -0-Wetlands El Watershed District ❑Water/Sewer - - DESCRIPTION OF W RK TO qq PERFOR D: Identicatio le a Type or Print Clearly �_� �� 13� I OWNER: Name: c �1 t KY 2C Phone: Address: Contractor Name: .w \ Phone: Email: , (— Address: Supervisor's Construction License: 1� �'0l Exp. Date: Home Improvement License: i�/� Exp. Date:��/,2 1. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �� ) FEE. $ ;l Check No.: _ �/" Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund — —— — - r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL f. Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ permanent Dinupster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF m 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 Planning Board Decision: Comments v ► Conservation Decision: Comments Wafter & Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: _ Located 384 Osgood Street FIRElD_EPARATMENiT TempDumpster,onsite �yes4_._. no�_R__ � � �.: } Locatedlaf"�12.4Main'cSt%eet Frre IDepartn`entp;signatureldate _. __y C®MMENTS- 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 Call Email Date Time Contact Name F Doc.Building Permit Revised 2014 -- — - -- - r 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 Section/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 OTE: 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 4. 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 1 Town of North Andover >ayment Date Monday,June 27,2016 )eposit Number 1606271 )perator Counter pc 1 ACR(BUILDING INSPECTION) $35.00 0 'otal Paid $35.00 :ash $35.00 :hangs $0.00 teceipt Number gov00004807 f 1127/2016 2:05:00 PM :ashier Id. treascoll-17 1 ! Location �7 i�1 ' L�,A No. —?. G�� Date eon, • - TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Z-16 Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# v Building Inspector r/ NORTH own of : _� Andover C, h , ver, Mass, %4e10(.., ( Tr cocN�cHew�c« 1• P � �,9 A°R�rE� ►' a�,�5 S U BOARD OF HEALTH Food/KitchenPERMIT 4 LD Septic System �.THIS CERTIFIES THAT BUILDING INSPECTOR V-41 Foundation has permission to erect ....... b 'Idings on Lk .... ..... ...... ... . .. .. . .......... Rough to be occu ied as '� �� ......... Chimney p .... .... .. ........ ...... ..��-. ........ ... ....... ' rovid � "'� '� ' p ed that the person accepting this perm) 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, Iteration 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 CONS Rough Service .. ... . .. ............. ..... ............. Final BUI G 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. v Federal ID 1105-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 A division at Thiciscb Engineering CT Contractor Registration No 620120 60 Sbawmut.Canton,MA 02021 CONTRACT 339.502-5197 FAX 339-502-6345 Page 1 PROGRAM naecasrwtcrtscaretteoartoscRwKsMae CMA-IIES ffliwamoCUSTOMFORWOMCAS o R Frank Fodera (617)877-1311 12/14."3015 427459 00003 110M DMI IRLUto SINEW 300 Pleasant Street 1 300 Pleasant Street I Forth Andover,MA 01845 North Andover.MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against uzctcfuL excess air h.-akage. This work will be perrforated it concert with the use of special tools and diagnostic tests to assure that your home sill he Iefl 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 snots for scaling include air leakage to anics.ltawments.attached garages and other unheated areas(wind(ws ate not generally addremal-) This will require(6)working lines. A reduction in cubic feet per minute term)of air infiltmrion will occur,bre the actual number of etre is not guaranteed. At the completion of the wcathcriration work,and at no addiliunal cost to the hunuvwoer.a final bluwcrdoor and.or combustion safety analysis will be conducted by the sub-eontmetur to ensure the safetyof the irsduur air quality. SS Hum ATTIC FLAT:Provide labor and materials to install u 9"layer of R-32 Class I Cellulose added In(X851 square feet of open attic space. S836.5S ATTIC ACCESS:Provide labor and materials to install t 1) easily moved.insulating cover for the attic access folding stair. The cower has integral weather-.stripping to restrict air Icakage. 5200.00 VENTILATION:Provide labor and materials to install ventilation chutes in(30)rallur bays to maintain air flow. S60.00 COMMON%VALLS:Provide labor and materials to install 2"FSK faced semi-rigid fiberglass hoard insulation to 1325)square feet of common wall area. 51.137.50 BASEMENT CEILING-Provide labor and materials to install 1431 linear rest of R-toy unfaecd fiberglass insulation to the perimeter of the basement ceiling at the house sill. S7S?S RISE.Engineering will apply all applicable,eligible incentives to this contract. You will only he bilhxl the Net amount.Cun%mth,for eligitdc measures.Columbia Gas offers 75%incentive.not to exceed S2.000 per cahaular year.and an instntivc of[Ma for the Air Scaling measures up to the first SUO and an additional 5340 if wrings are justified by the auditor. For the safety and health of your home's indoor air quality.sur will he conducting u blower door diugntmic of clic available air flow in your home both before the work is begin.and aflcr the awatherization work is complete.We will ulso conduct a full assessment of the combustion safely of your locating system and water heater.This has n value of S91)and is at no cost to you. Total allowable weatheriuttion incentive is 53.110. S90M I Federal to#05-0405629 RISE Engineering RI ContraetorRegistration No 8186 MA Contractor Registration No 120979 A division ofThtetsch Engineering CT Contractor Registration No 620120 60 ShawmD4 Canton,11fA 02021 ®7� B IMA B Ir 339-502-5197 FAX 339-502-6345 7� Page 2 PROGRAM TX:Bca>rTRAermoDTroeBsv+EENR+ae CMA-HES comm"Wo Com.FOR WORN AS CUSTawav— Pam tim amyl Frank Fodern (617)877-1311 12/14/2015 422459 00002 MMM AVEW WORG SIM 300 Pleasant Street 1 300 Pleasant Street I North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $2,909.30 Program Incentive: $2,331.97 Customer Total: $577.33 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF 'Five [ Hundred Seventy-Seven S 33/100 Do011a,rs 8 $577.33 ADALISNDAE OERtqTOMiW&WSoaQ� sCEEi0Y&GEEKYVARANN RC �TX6YIM ED DO 3 THIS CONTRACT IF THERE AREA PACES NOTE:TNIB CONTRACT NAY BEWRNORAWN BY DS 6 NOT EXECUTED YATIGN DATE OF ACCEPTANCE �-t" ACCEPTANCE OF CONTRACT-TNE Asove p ,er8,P8CD1CAy=AND comMONB ARE `30 DAY& A88PE PY%ANDt RERE VA OVTUN& AUn�DTODOYNEWORN L 60 Shawmut Road Unit 2 Canton,n,MA 02021 339-502-6335 EE EERING www.RISEengineering.com Energitp�. OWNER AUTHORIZATION FORM I Frank Fodera (Owner's Name) ' owner of the property located at: 300 Pleasant Street, North Andover, MA (Property Address) (Property Address) hereby authorize t -� (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 WeWesure ILI 14 Date The Commonwealth of Massachusetts Department of Industrial Accidents - Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 Z 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 4:603-324-1974 Are you an employer? Check the appropriate box: Type of project(required): 4. ❑ I am a general contractor and I 6 ❑ New construction 1.ED I am a employer with 100 employees(full and/or part-time).* have hired the sub-contractors 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 and have workers' working forme in any capacity. employees9. F-1 Building addition [No workers' comp. insurance comp. insurance.*,. required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.E] Roof repairs insurance required.] t c. 152, §1(4),and we have no V1leatherization employees. [No workers' 13. ✓❑ Other comp. insurance required.] *Any applicant that checks box 41 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:6/30/201621n I �[��— Job Site Address: OL en��n f S47 City/State/Zip: J fil ®(illi 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 S 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 enaltie's ofperjury that the in ormation provided above is true and correct. Sip—nature-1 Date Phone 4:603-324-1974 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#: �� ® DATE(MI.A/DDfYYYI') CERTIFICATE OF LIABILITY IK!SURANUCE o6/�sn0,6 THIS CERTIFICATE 15 ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFiC.^.TE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES EIELOVV. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETVYEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:ITrtan 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 T certificate holder in lieu of such endorsement(s). PRODUCER CONTACT a Aon kick Services Central, Inc. N'AnaL Southfield MI office (A/cnm.E.,) 166b/ 'b1-''11 I cNu.) (800) 363-0105 a, 3000 Town Center E-MAIL Suite 3000 ADDRESS: O Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC.: INSURED INSUREH,A old Republic Insurance Company ?414; TODBUi Id CO rD_ w 260 )immy Ann Drive SUPERB. ACE American insurance Company 22667 DayTona BeaCh FL 32114 USA INSURER ACE Fire underwriters Jnsurance Co. 20701 INSURER D INSURER E 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 HEREIF,'IS SUBJECT TO ALL. THE TERNS, EXCLUSIONS AND CONDITIOfjS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS Limits sho%vn are as requested S" TYPE OF INSURANCE S -TR INSD VWD POLICY NUMBER M�DOfYWYI�fMnO'./DDlYY1Y1 UMITS A I X I CON.r✓ERCIALGENER;LLLABILITY r4W'2Y'30-13-1 Ob/�0121f1 EACH OCCURFE NCE '000,000 CLAIMS-M.ADEX❑OCCUR. DAMAGE -0711 ED S?,DOD,ODO PRcIdISES Ea occu rtencrl MED EXP IAny one person) S25,ODO PERSONAL a ADV INJURY 52,OOD,ODO GENPOLICY PRO-AGGREGATE LIMIT APPLIES PER GENEP.AL AGGREGATE 14,000,000 m X Pn JECT E]LOC PRODUCTS-COMP/OP ACG S4,000,000 m OTHER R o 0 AUTOMOBILE LIABWTY NIa"B 304835 06/30/203 5jtj6/30/?026j COMBINED sINGLE LIMIT SS,ODD,OLIO ("ta ccid^nil ANY AUTO BODILY INJURY(Per prrsonl I O Z ALL O'✓'✓NEO SCHEDULED BODILY INJUP'Y(Pe'—d-1) AUTOS AUTOS X HIP-ED AUT OS X NON-OWNED PP.OFE PTY DAI,nr.GE O AUTOS Per a—denlj — G ""8F ELLA LIAB OCCUR, EACH OC CURREFICEESS LIAS CLAIMc_MADE AGGREGATE D 1 DETENTION WORheDS COMPENSATIONAND UJLRC48251553 061,30"2015 06,30/201 PER OTH- EMPLOYEP.c'LIABILI7Y YIN �` SiATUiE ER ANY PROPMETOP.I PARTNER.I EXECUTIY All Other States OFfICEPJMCrJ.5ERENCLUDED' � NIA SCFC4815190 06/301'015 06;30;.016 L EACH.ACCIDENT S),DDD,Upp (Mandasory in NI-0 W1 only EL DISEASE EA EMPLOi EE S1,ODO,000 H y-.de—nbc unde y 8E SCRIPTION GF OFERATIONS bele,• E L DISE ASE.P000Y L11!IT S1.000,ODD— I I I PIFTION OF OPERATION_<(LOCATIONS/VEHICLES(ACORD TOT,Addn:onal P-1 I,-,Sc he duly,yb,anachetl.t mnrr so:+ce.s'-,rod) ence OT coverage -^ - A r�J ttFy J FIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED SEFOPE THE EXPIP.ATION DATE THEREOF, NOTICE VILE BE DELIVERED IN ACCORDANCE WITH, THE POLICY PROVISIONS_ _jam Builder Ser Vices Group, Inc. AUTHOP.IZEDREPF,ESENTA7IVE A Top Build Company 260 )immy Ann Drive k=z— Daytona Beach FL 322214 USA Z� seri (D1988-2014 ACORD CORPORATION.All rights reserved. )RD 25(2014101) The ACORD name and logo are registered marks of ACORD I i I I fly+ - inF•iritn iji.11`tlih4'rt ll.;1'�l'L,'.'�!�� .��^'F. ,t RICHARD SCHWARTZ F95 111IN•I RE'SS S'['Ita.ET ftf:stttcfts cEer KEf (1-1102 fx��zsizfrl� Restricted J'c. B(A.-IC-insulation Contractor railure to posses,..)current edition of the Massachuse=tts State Building Code is Cause for revocation orf this license. . � -iF Off ce of Consumer Affairs rid"Business Regulation 3 10 Park Plaza - Supe 5170 'v Boston., .Massachusetts 02116 Home Improvement Contractor Registration Registration: 179141 Type: Supplement Card BUILDER SERVICES GROUP, INC. Expiration: 6125/2016 RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 1.spdate Address and return card.Mark reason for change. SCA 20,M-105ol Address Renewal Employment Lost Card zx Office of Consumer Affairs&Business Regulation License or registration valid for individul use only > SME IMPROVEMENT CONTRACTOR before the expiration bate. If found return to: Office of Consumer Affairs and Business Regulation 2egistratiari: 179141 Type 10 Park Plara-Suit{ >170 Expiration: 612512016 Supplement Card Boston,MA 02116 BUILDER SERVICES GROUP,INC. RICHARD S N DRI r'r r 260 JIMMY ANN DRIVE �:�:�.�•••--.�:�,.GJ---_.._.... DAYTONA BEACH,FL 32114 Undersecretary Not validCwithout signature