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HomeMy WebLinkAboutBuilding Permit #847-16 - 328 SUMMER STREET 2/1/2016i s \, 4,4 1 Gi Permit NO: Date Issued: BUILDING PERMIT �t�a.^ 3? p6.1 •6 TOWN OF NORTH ANDOVER ° APPLICATION FOR PLAN EXAMINATION Date Received '� °4e ��-"A--.J IMPORTANT: Applicant must complete all items on this c St Print. 1 Print PARCE �" ZONING DISTRICT: Historic District yesrnoMachine Shop Village ves TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building - ne family ❑ 9dition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ " 6 dell E Floodplain 1 Wetlands Watershed District. ❑ ie or ° OWNER: Name: Address: -9D Q (T S Name: Identification Please Type or Print Clearly) F ry-\'P— - f— , Q dill: struction License: irrouff"t License: ° Phone: 6'/7, 3 ge, ref Exp. Date: I " Exp. Date: It ARCHITECT/ENGINEER 1u 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: $ Check No.: -5 0 Receipt No.: 2�1c11y NOTE: Persons contracting with unregistered contractors do not have access to the g�u�ranty fug A. �4� O-A-M� zA-k+i6'r' /Z . 22- I, I 1 V c fe-1 �>- i vy) 4--L Location &4 No. 7- / t Date TOWN OF NORTH ANDOVER Certificate of Occupancy $- Building/Frame Permit Fee s--34L- Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # Building Inspector M n rA H Q = LL o? C N N O LL E N T v1 u Q V) 0 W N Z Z m C O 'J 'D 7 LL L O 0 W > C :EC U LL O u W N Z m J d L O d' C LL Q V W N Z v W L u V) C LL OC Q U a Z a Q L 7' d' C LL Z W a W LU 0:m LL 61 c m O Z CU N (% N O Y O (n r L z p C) � _ :w O Q ` d Q.N :N R ' Z as i :z AW o }' V O :oma Z CL''EQ N 0 O co LW != O > �+ 0 ,>oa > a O y a�a a W 0 a O Q E 0 v � L) �Q Q c, _ co 0 CD N.N 3 Ll) 0 cc cc W J V Z m o O CL .S .y Aj V U) o = c 0 c = m C. ai N •� 0cc m N W 0 -0 +�-• O O w uml 1-- 0 u. 2 d y C 0 Q .���.2 Z , W — E V C O Q V Q O 'a N d 0 � y . �. . a.O .ov > R SE 60 S#raawinut Road, Unit 21 Canton, MA 020211339-602-6336 ENG4NEERING www.RISEenglneerfng.com Effkiarr CY Energised. OWNER AUTHORIZATION FORM "e. (Owner's Name) owner of the property located at: ... 4 M rn e (Property Ac hereby authorize M Q , G7 Address) 6 -1 ;—o an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform woric on my property. This form is only valid with a signed contract. t Date DEC A7 Federal 109064406629 RISE Engineering RI Contractor Registry on No 8196 MA Contractor Retildri tion No 920979 A division orlItietsch 8ngineerio ,RISE ENGINEERING 60 Shawmut unit N2. Conlon, l41A 02021 �»� n �a•p� CONRTi! C ! 339-a 2-6335 FAX 339-502--6343 Page 1 PROGRAM CMA -HES CHOWW A)MOTKVJ o aMRVMAS acataEo a>=covr C TOIdfiN - __....., ........ ... _..... _ ._..,. ._ VAT6._.._...,...... _. me .•• Cueff t . »„ .: Vr4nit ORPEft Elise Amendota (617)388-4179 12/17/2015 419976 00003 9EY2f M smer "Una srRk£T - 32-8 Stemmer Street 328 Summer Street MVIM C(M aTAMZW North Andover, MA 01845 North Andover. MA 01845 201 JOB DESCRIff [ON AIR SEALING: Provide labor and materials to seal areas of your home against wasteful, excess air leakage. This c perimmed in conceit 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 seat y€ntr home can include caulks, foams and other products. Primary arm for sealing include air hatkirgee to aides. basements, attached garages and other unheated areas (%vindows ark not generally addressed,) This will require; (8) working hours. A rcdttclimr in orbic feet per minute (cfm) or air infiltration will occur, but the actual nomberof clam is not guaranteed. Ax the completion of the wcaafterixation work, and at no additional .cast to the homeowner, a final blower door and/or comhustion safety analysis will be conducted by the sub -contractor to ensure the safety of the indoor air quality. $680.00 AIR SEWNG ADDER: (4) working boom, $340;00 AIR SEM-ING ADDER: (2) working hours. $170.00 KNEEWALLS: Provide labor and timicrints to install R !3 faced fiberglass to (237) square feel of kneewWl. 'Chen install 2" rigid board insulation. Sea} all seams with FSK tape. $965.05 STORAGE BARRIER: tloincowner is responsible for the removal orthe stored items blocking the installation of ivcathed7attion work in the knocwall areas. Removal must occur prior to the scheduled wark start. $0.00 KNEBWALL R.0011: Provide labor and materials to install an k" layerofdense packed R-30 Glass I Cellulose added to (3 10) square feet of kneewall floor. $539;00 ATTIC ACCM: Providelabor and materials to insulate (3) back ofthe kneewall batch with 2" rigid Thernarx board. and scat the edge ofthe'hatch with weatherstripping $1800) RISEEngincicring mill apply all applicable, eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures. Columbia teas offers 75% incentive, not to exceed 52,000 per calendar year, and an incentive orI00"Jn for the Air Sealing measures tip to the first $680 and an additional 5340 ifsovings aro juslifted by the auditor. ror 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 botfi 6etme, the work is begun, and aider the weatherima tion work is complete. tele will also conduct a (all assessment of the combustion nfety of your heating system and water heater. Tis has a value of $90 and is at no cost to you. Total allowable weadicrization incentive is $3,11 O $90.00 WSEEngineerng A division of rhidseh Engineering 60 Shawatut Unit 2, Canton. MA 02021 339-502-035 FAX 339-502-6345 Federal iD# OB.Od05629 RI Contractor Registration No 6186 MSA Contractor Registration No 920573 Page 2 PROGRAM rtes cotsrsu � r to �ast�ReP Pine s�nvaeta Yt CMA -HES ENGIIIEEYtINGAiJaTNECP8T0rA€RFOPt pltAL OESOMED CELOW CU3TOt1ER PHt1tsE PATE CWE?3T3 t°dORKORPER Elise Amendola (617)3884179 12117/2415 419976 44443 � . _ DTtzT e1uIND M€sr 328 Summer Street 328 Summer Street CITY.it'rATE.iB+..w.._�..,....... ..».�____...._......_...,....,u....,_e.....,....„.....,,..... nitL!i6 CtrY,STATE.ZIP _....,..»»......_ m,....._....�..,._......«.,.�..._ <... North Andover, MA 01845 North Andover, MA 41845 JOB DESCRIPTION Total: $2i883.06 Program incentive: $2,439:79 Customer Total: $"3.26 Wt- AGREE HE.REBY TO FURNI H SERVICES . COMPL£'M M ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR TK SUM OF ***Four Hundred Forty -Three & 261100 Dollars $443.26 NOT SIGN THIS CONMCT IF ROM TW COUTRACT MAY 6E WITHDRAWN DY US IP NOT EX£CUM YMHQ! 30 DAYS, DATE OP ACCEPTANCE ... ,., ... .% f ........ ...,,..».�...4,».®. ACGCPTAOM OF COMACT • THE ABOVE PRICES, SPECtFIC'ATIONS AW COIiPMONS AIM SATISFACTORY TO US APO ARE HERERY ACCEPTED. YOU ARE:AUTNORM4 TO 00 THE WORK AS SPEMMED. PAYWIT WU OC MADE AS OUTWIM ABOVE I DEC 1015 The Commonwealth of Massachusetts 1U 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: ® I am a employer with 20 4. ❑ I am a general contractor and I employees (full and/or part-time).* have hired the sub -contractors !. ❑ I am a sole proprietor or partner- listed on the attached sheet. I ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t These sub -contractors have workers' comp. insurance. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152, § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10. ❑ Electrical repairs or additions 11. ❑ Plumbing repairs or additions 12. ❑ Roof repairs W,&^ 13.® Other ! S � *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. $Contractors 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.c`#: EWGCC000187715 Expiration Date: 11/08/2016 / Job Site Address:_- C71 1City/State/Zip: O I/JU ���� 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 verificatic .\ I do hereby penalties of perjury provided above is true and correct. Date: 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 #: D ' L �wrllli• o CERTIFICATE '�`rc ►r O CERTIFICATE OF LIABILITY INSURANCE �,�,.•�`'` DATE 11 / 12 / 12/2 2' 015 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 James J. Dowd & Sons Ins 14 Bobal.a Road Holyoke MA 01040 CONTACT NAME: Debbie MacNeal PHONE FAX AIC No Ext): 4 13-538-7AIC No): AIL ADDRESS: dmacneal@dowd.com GENERAL LIABILITY. PRODUCER CUSTOMER ID#: COOP INSURER(S) AFFORDING COVERAGE NAIC # EGGCC000187715 INSURED INSURER A: HDI—Gerling America Insurance Compa Co-op Power, Inc. 15A West Street INSURERB:Torus National Insurance Company 25496 INSURERC: West Hatfield MA 01088 INSURER D: INSURER E: DAMMISESS Ea occurrence AGE(RENTED $ PRE$100,000 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 LTR TYPE OF INSURANCE ADDL NS S POLICY NUMBER POLICY EFF MM/DD/YYYY POLICY EXP MWDDIYYYY LIMITS A GENERAL LIABILITY. EGGCC000187715 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE IX7 OCCUR DAMMISESS Ea occurrence AGE(RENTED $ PRE$100,000 MED EXP (Any one person) $5, 000 PERSONAL BADV 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 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) $ - X X ALL OWNED AUTOS SCHEDULED AUTOS HIRED AUTOS BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ (Per accident) $ X NON -OWNED AUTOS $ Comprehensiv B X UMBRELLA LIAB HOCCUR 70354Q150ALI 11/8/2015 11/8/2016 EACH OCCURRENCE $1,000, 000 AGGREGATE $1,000,000 EXCESS LIAB CLAIMS -MADE DEDUCTIBLE $ $ X RETENTION $10,000 A WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y/ N ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICER/MEMBER EXCLUDED' ❑ N / A EWGCC000187715 11/8/2015 11/8/2016 WR - T T YYLIMITSRR E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE - EA EMPLOYEE $1,000, 000 (Mandatory in NH) If yes, describe under 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 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD 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 ACORD 25 (2009/09) © 1988-2009 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD MI(IiJ i(1(CX ", j e /-7// C Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration CO-OP POWER, INC. LEAH DANIELS 15A WEST ST WEST HATFIELD, MA 01088 SCA 1 0 )ffice ofConsumer ;Affairs & Business Regulation I,ME IMPROVEMENT CONTRACTOR I �Reqistration: 165217 Type: Expiration: 1/2112018 Supplement Card CO-OP POWER, INC, LEAH DANIELS 15A WEST ST WEST HATFIELD, MA 01088 Under,ecretar, Registration 165217 Type: Supplement Card Expiration. 1 /21 /2018 Update Address and return card. Mark reason for change. Address Renewal Employment Lost Card License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston,NIA 02116 Not valid without signature MassacnL,setll; Department of Public Safety Board of BuOd€riq Regulations and Standards cease CS -097409 'S C - LEAH M DANIELS 12 MARCELLA ST ROXBURY MA 02119 '7--, — ' — Expirat;on ':­�rr�ss 1-1r,— 0611810117