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Home My WebLink AboutBuilding Permit #068-2017 - 313 SUMMER STREET 7/22/2016 AAA �� BUILDING PERMIT o`��oT E. ;6 TOWN OF NORTH ANDOVER 5 , APPLICATION FOR PLAN EXAMINATION _ N ' 1 Permit No#: 1 Date Received '�f,9�'oRnTeo I SSACHUS� Date Issued: ` I ORTANT:Applicant must complete all items on this page LOCATION S\?) SUMALW 20MU- Print PROPERTY OWNER gwNord, Kk�L< Print 100 Year Structure yes no MAP J6 PARCEL: ffa.!5_1 ZONING DISTRICT: Historic District yes no Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: 0 Commercial %Repair, replacement- 0 Assessory Bldg 0 Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Wea.4itiw�rc ioh' aur iinp,• Ins i&ta. �C+�evior Oferhana loCattcl Wow �cd' ar suj&Ix ctdmlL rt.i AA loc sd 100W {14a�hd P000- arerj. Identification- Please Type or Print Clearly OWNER: Name: Ricxard 1-kiWw Phone: Address: $ 5 k- No Contractor Name: M-UC % I Jf Phone: 38'2- 208-1 Email: in Address: Po bx _[ 111 . M.Anc h� , 08(0& Supervisor's Construction License: CS5L- 10(oo3.s Exp. Date: g/71LOi r x Home Improvement License: 182792 Exp. Date: 712-7 201 ARCHITECT/ENGINEER 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: $ 2- , tG( , RG FEE: $ Check No.: , 1� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of contract 1 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL PuL Sewer ❑ Tanning/Massage/Body Art ❑ Swinnning Pools ❑ ' Well ❑ Tobacco Sales ❑ Food Packaging/Sales, ;. ❑ Private(septic tank,etc. ❑ Pennanent Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN®FF - U-F®RIM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature - -• , '. . _.. sem- ._ , ' . . ., :. 'x_ �.. .. : '. . - ' . :, ' ,r COMMENTS HEALTH Reviewed ori Signature COMMENTS ` Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes A. Planning Board Decision: ' Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located •384.Osgood Street FIRE DEPARTMENT TenpDumpster on site. yes no Located at 124 Main Street Fire Departmen signature/date COMMENTS Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of(deter 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.$10o-$10oo fine NOTES and DATA— (For department apse) f i I 1 i ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 i 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 I` New Construction (Single and Two Family) � Building Permit Application pplication Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit �f 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 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 Doe:Building Permit Revised 2014 I Location V/-✓VA,%\ I tU�at+ No. Date 2 �/ • - TOWN OF NORTH ANDOVER 4 • E Certificate of Occupancy $ Building/Frame Permit Fee $ r Foundation Permit Fee $ Other Permit Fee $ r_ TOTAL $ Check#I .30644 30644 Building Inspector c r 1 NORTH •� - - ijinc . . ve. . O ..,•. L No. 0 2,611 ".. h verMass 360 COC MIC Nf W1C 1t q�'4ArEO s U BOARD OF HEALTH Food/Kitchen PER L D Septic System fCkA MAW BUILDING INSPECTOR THISCERTIFIES THAT ................ ............... ........................................................................................... has permission to erect ..... buildings on .. .�. .. Foundation � .� �� Rough to be occupied as .hV�lA� "t�e . ... Chimney provided that the person accepting this p�111'hit shall in every respect conform r s of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the InspectioAlteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR J VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR _ UNLESS CONST TION. Rough Service ... .. ................ . ....... Final BUILDING I ECT R 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. i 0 IV7 Federal t)#09.04 O9 -- 1 RISE Engiltoering Pi Contractor ltegistr acro No Oise RISE �A division of ThIelscb Bagin�tng 01A Contractor RegTsfiaaon No 126978 'ENGINEERING- 60 Shawraut Unitd4,Canton,NA 0=1 CONTRACT 339402.6335 FAX 339 Page 1 PROGRAM CMA-HES umnm wa c eeauaar custom wtomm - oate CEtFLirs vroncORM Richard iVliiter (978)689-8848 010=16 429709 00004 878wr _ aauW MMI 313 Stummer Street 313 Summer Sit e .smm,ar 04=0 enr srarKaa North Andover,MA 01845 North Andover,MA 0184$ S Aiv 2 2 X416 ' JOB DESCRI"10N _.. HEALTH&SAFEPY:Weatherization work cannot pr000ed until rho spillage of combust iou gases is faced. 80.00 AIR SEALUft- Provide labor and materials to seep areas cfyout home against waswK pmts air leakage. This work win be perf coned in concert with the use of special tools and diagnostic taste to mum that your home win be left with a healthful levet of air cKehaage and indoor air quality.Materials to be used to seat your tome can include caulks,rbens and other products.Wanary A reas tir Scaling include air lea2Bge to attics,basements,attached gaffs and other unheated am(windows an:not generally ad&tse&) This will mannite(8)worWng hatim A reduction in cubic feet per minute(cfin)ofair infitlraiion will occur,bur the actual net of cfin is not number guaranteed. At tho completion of the weatherization work,and at no additional cost to the homeownp,a final blower door and/or combustion s;ac►y analyshs will be opWw*d by the sub-contractor to ensum the safely of the Indoor air qualiq. $680.00 OVERHANG.Provide labor and materials to install 10"R-37 densely paelmd Class I Cellulose Imulat en to(76)square feet of o dcrior overhang hicated below a heated floor area,by drilling hales in the Overhang from below. Holes dulled will be plugged. Plugs will be seated will Carter grade spael*and lett to a alsllvely smooth condttloti.Finish sanding and touscb�up primin$ll ating will be the custarne"s responsibility. $304.00 GARAGEC located Provid labor and materials to Install 10"R-35 densely packed Class I Cdtulose insulation to 528 square feet of BUW ootl hcaW Roorarm by drilling holes In Oto ceiling fr_mtt bdW Holes drilled will be plugged. Plugs will be spadded and bA in a relatively smooth condition.Finish sanding and touch-up primhtg/paiming win be the customer's responsibility. $1,09296 RISE Eagjne A%wt11 apply all applicable,eligible incentives to this contract. Yott wiU only be billed the Net am= Windy, for eligible treasures,Columbia On offers 75%incentive,not to ameed AGOG per calendar year,and an incentive of 100%for the Air Scaling measures up to the first$680 and an aNkiona18340 if saving on 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 airflow in your lumto both before:the work is begun,and alter the weatherization work Is oomplft We will also conduct a ibn assemnm of the combustion saWy of your heating system and water heater.This has a value of 890 and Is at no cost to you.Total allowable wentheriration incentive is S3,1 t0. $90.00 I . .o wFed=10#c$-0ao8 9 4,. RISE 18ttgineeriutg su Conba w Reolwatton No 8186 RISE HA ► ,No VANS A division ar7'htetsch ILLeeTiR,� ENGINEERING 60 Show=Uait#2.Canton,INA 02021 339602.6334 PAX 33PL502-Wi CONTRACT tie 2 PROGRAM Dnapowmeemmme CKA-®IS Atm Tl@ F0FtVXYR S oascRaiw tRao+�i CUSTOM - -�- --- - PKOW Cm CUMTO til=CfAw Richard Miller (978)689-8848 O1f21/2016 429709 00004 BMW=STVAST --. WLUXO STEM 313 Smnmer Street 313 Sumner Street S6Rf=CpY.STATQZP •��• - �_••__• a. wwo CIIY.mv-z. __- North Andover,MA 01845 North Andover,MA 01845 JOB BBSCRWnON Total: $2,196.98 Program Incentive: $1,817.72 Customer Total: $349.24 WBAORFLNBRWTOFUNNMSEM4=-COMPLETEINAL MNCEWTTBASMSPWRCAMotaFORTAESUMOF ***Three Hundred Forty-Mine$2411Q0 Dollars $349.24 OPLtiFpIALRZSPECTANOAO�ABPRQYALBdf RISFEOISWEHGNtt CUSTO[d&71 ALR®i0 BEEOri DUa W F111LaTOF1SiH�1.8E OIC MOHnO.YONAtflf UNPA108AlADICaAF1ERtD0AY8,8F�RFOR�90RTAH1'06ilAJAA1�LCY OYA�16rtES8.(UQNIO�R1ECBtObLBC1lg1UtRL0.AR0 RE�1RATtOfL. DO,MWSM IM CONTRACIr IF WMA.RE ANY SPACE 0, Alli101 -R6a� - t ACCEPTAjLGR WM TM COUMW UAYaHMMMAM LY LS tF OOT MCUnM== OATEOFACCEPTARM 30 ACCI�P'fARCE OFCONiRACP'Tt�AHCAIEPA�S.SALtlRCAT�AiB AaD COtRSIf6P�ARR 8AT16¢AC70RYT0 tib AI10 AIR RE@itAfTL�YOSAtAYOl6ROgD1000TItHNPOIaf .,. DAYS. A93PBCWMPAVL=V1UBBK4WASOUTLWWA6= ,J ASd 2 ? 2016 r p RISE 60$hawmut Road,knit 21 Germ,MA 02021 l 3394024WO ENGINEERING Wrw AISEengineering.cam OWNER AUTHORIZATION FORM h c� ! . (Owner's Name) owner of the property located at (Property Address) Very W q (Property Address) hereby authorize (Subcontractor) an authorized subcontractor farr RISE Engineering,to act on my behalf to obtain a building pemrft and to perlbon work on my property.This fbrm is only valid with a signed contract. ec Owner's Signakwe 2 �p�6 Date The Commonwealth:of Massachusetts Department of Industrial Accidents 1 Congress Street,Suite 100 Boston, HA 02114-2017 www.massgov/dia Workers'Compensation insurance Affidavit:General Businesses. TO BE FILED WITII'rIIE PERN111"IfhG AUTHORITY. Applicant Information Please Print Legibly Business/Organization Nalne:Mill City Energy Address:PO Box 6411 City/State/Zip:Manchester, NH 03108 Phone#:603-391-7923 Are you an employee?Check the appropriate box: Business Type(required): 1.0 I am a employer with 12 employees(frill and/ 5. [l Retail or part-time).* b. n Restaurant/Bar/Eating Establishment 2.[] 1 am a sole proprietor or partnership and have no 7. ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] 8, Non-profit 3.0 We are a corporation and its officers have exercised 9. Entertainment their right of exemption per c_152,§1(4),and we have 10.0 Manufacturing no employees.[No workers'comp.insurance required]* IL n Health Care 4.0 We are a non-profit organization,staffed by volunteers, r� with no employees.[No workers'comp.insurance req.] 12.R Other __ 6 *Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy int'ormation. **If the corporate offi=cers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an orgaoi4ation should check box n 1. I am an employer that is providing workers'compensation insurance for any employees. Below is the policy information. Insurance Company Name:Clark Insurance Insurer's Address:One Sundial Avenue Suite 302N T City/State/Zip: Manchester, NH 03102 Policy#or Self-ins.Lic.#MIWC791896 Expiration Date:4/2912017 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 MGG 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 STOP WORK ORDFR 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 cert,ut ins and penalties of perjury that the iaaformation provided above is true and correct Si nature: Date: Phone#:603-396-7520 Official use only. Do not write in this area,to he completed by city or town offacia! City or Town: Permit/License# Issuing Authority(circle one): I. Board of Stealth 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office G.Other Contact Person: Phone#: wvw Ncntass.gov/dia { MILLCITY-1 AGOULD CERTIFICATE OF LIABILITY INSURANCE DATE/19/2016 //191219/201166 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 License#AGR8150 CONTACT Clark Insurance PHONE 603 622-2855 FAX 603 622-2854 One Sundial Ave Suite 302N (AIC, A/c No Ext):( ) A/c,No): ( ) Manchester,NH 03102 ADDRESS:agould@clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Arbella Mutual Insurance Co 17000 INSURED INSURERB:AmGuard Ins co 43290 Mill City Energy INSURER C: 106 Joseph St INSURER D PO Box 6411 Manchester,NH 03102 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. INSR I TYPE OF INSURANCE ADDL SUBR POLICY EFF POLICY EXP LTR INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE FXI OCCUR 8500065735 04/29/2016 04/29/2017 PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY F1 JE E LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT 2Eaaccident $ 1,000,000 A X ANY AUTO 1020050919 04/29/2016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY Per accident) $ p X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE E AUTOS Per accident $ i X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N X STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVEN/A MIWC791896 04/29/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-106035 Construction Supervisor Specialty R�1 S MICHAEL JOY 106 JOSEPH STREETIU2_MANCHESTER NH 63r t C/l_� Expiration; Commissioner 08107/2018 Fra„e„eo,iauecr/l/+,oGllirccc/zcuel�- ,icense or registration valid for individul use only Office of Consumer Affairs&6usi ess Regulation g rbOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: __Registration 182792 Type: Office of Consumer Affairs and Business Regulation `expiration 7!27/2017 LLC 10 Park Plaza-:Suite 5170 Boston,MA 02116 MILL CITY ENERGY LLC_, MICHAEL JOY ' 106 JOSEPH STREET MANCHESTER,NH 03102 _ Undersecretary 4Zofvai 4Su re i