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HomeMy WebLinkAboutBuilding Permit #473 - 34 RICHARDSON AVENUE 12/12/2011Permit NO: q I'D* Date TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received t must complete all items on this IJ Print -- PROPERTY OWNER k1d,&,l I k Jl I, Lt�Unit # Print MAP NO: _PARCEL: ZONING DISTRICT: Historic District yesno Machine Shop Village yes no 100 year-old structure yes o TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building VOne family ❑ Addition ❑ Two or more family ❑ Industrial C] Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other glSeptic ''Well flFloodpla-m' Wetlands ❑D WatershedDistrief 91 Wator/Sewer DESCRIP'11ON OF WORK TO IW- PERFORMED: ��i �..r.,��.�.�a�a.■f���L=�iy�� 1�ri17�7[ti�lsi�'�L�i���`�11T'�����iZl.� ' 9. -Mc- SLOP& (Identification Please ' or Print Ih=4 t O Address: CONTRACTOR Name: IW I UC Phone: q=18 &4-922j�,-::! Address: 8-� C "hAeftL Supervisor's Construction License: Exp. Date: 3� Z Home Improvement License: ,Qj Exp. Date: 2-01.2.Q 12 ARCHITECT/ENGINEER_ %I -A Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT.• $92.00 PER $9000.00 OF THE TOTAL ESTIMATED COSTBASED ON $925.00 PER S.F. Total Project Cost: FEE: $ Check No.: `'Id-R�gReceipt No.: a� ff� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ie�ryn�+iirA rif 4iiant%(liAlnPra rP OF contract '� :. :_ Si . natu o� . Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ c 1—. I TYPE OF SEWERAGE DISPOSAL , Public Sewer ElTanning/Massage/Body Art ElSwimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private (septic tank, etc. ❑ Permanent Dumpster on Site ❑ _ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS r, HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Com Conservation Decision: Comme Water & Sewer Connection/Sicinature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street ; Fire Department 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 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.$10041000 fine NOTES and DATA -- (For department use Notified for pickup - Date Doc:.Building Permit Revised 2011 June/mi 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 NOTE: 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/Crossection/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 NOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products VOTE: 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 CIerks 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 rust be submitted with the building application Doc: Doc.Building Permit Revised 2008mi LocationT �''t ► C hal 7"� No. Date NORTH f �ti TOWN OF NORTH ANDOVE(I o� Certificate of Occupancy $ �ss�cHustt� Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ i1 �Cy Check # 24860 Building Inspector E 0 F=4 i M C 4 °a u°. CO O U o w° w°' ° U G w U a°' w cn w a c� a°' w w p 4 rA o z, cn v ° cn 0`�`�( :� :Ea c ;, ; .. Yd m w; Q fir. m '.►+ Ym = s It n � CL y ° CD CD C, :oo %N • : � . : Cis U 0 z 0 U �l 0 0 v CD O MMco o v Z C13 O. O CO) � C C7 C* Q hw CD CD mm CD CD � f+ a� L M 0 d a- mQ c c c c� C Z co CD V co � C C C CO) 0 0 LLI U) W W 19 W U) o m c C=* � : N O C V 40 C •d.. • CO, Wco 0`�`�( :� :Ea c ;, ; .. Yd m w; Q fir. m '.►+ Ym = s It n � CL y ° CD CD C, :oo %N • : � . : Cis U 0 z 0 U �l 0 0 v CD O MMco o v Z C13 O. O CO) � C C7 C* Q hw CD CD mm CD CD � f+ a� L M 0 d a- mQ c c c c� C Z co CD V co � C C C CO) 0 0 LLI U) W W 19 W U) Conner atlon Services Group `l+iorth Andover iv1A t)]845 3b10 "Customer TD: 000000013135 Cont c�em. mmimnni�an , , nationalgrid THE POWER OF ACTION This service is brought to you through support from your local utility servtion;Services:Group,(SG) •r' Washington Street,-Su1te 300D'. tbomugh{1VIA 01581 No.120837 eid.W No -222457170 I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on the "Pmnises" known as 2YoC4r"=_ f,/ . in a professional manner and in accordance with the terms of this Contract, including the attached reeommendations/work order describing the work in detail (the "Work") which are incorporated herein by reference: Description Quantity Location Attic Floor Open Blow Cellulose 8" 482 Living Space $645.88 Attic Slope Enclosed Cellulose Dense Pads U' 246 Living Space $536.28 Insulate Wall From Interior With 4" Dense Pack Cellulose 97 Living ce $194.00 Temporary Access (Other Part) 3 N/A $231.09 — Install 2" Polyisocyanurate On Kneewall 97 _ Livinq Space $288.09 Sub Total: $1,895.34 Energy Efficiency Incentive $1,421.50 Net Sales Tax After Incentive $0.00 Total $473.84 1. CUSTOMER affirms that they have received no incentives during the past 12 moriffm Initial here i 2. The incentive is dependent upon the package purchased and/or prior incentive ub'1¢ation. Changs wklual line items and/or previous incentives may increase or decrease the size of the incentive. 3. CUSTOMER affirms that their electric provider is National Grid Electric. Initial here It. PAYMENT Customer agrees to pay Contractor for the Work, the Customer Share of the Contract Price as follows: Payment 111: $ � 4-i. 9 $ as a Deposit paid to CSG upon signing the Contract (no$id k�ltte total retail blrFa�t hal costs of special orders, whichever is greater). Final Payment: $ -74f-. `O Final payment for the Work shall be due and payable to the Installation Contractor within 30 days from the date shown on the Final Invoice. Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of $y iA.t " U The Utility Incentive Share is dependent upon the package purchased and/or prior incentive utilization. Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. Ill. ASSIGNMENT OF CONTRACT BY CSG Customer acknowledges that CSG will, and Customer hereby requests that CSG, assign this Contract to a specific independent installation contractor (TIC") to undertake the Work on the terms set forth in the Contract. Before such assignment, the tern "Contractor' refers to CSG. After such assignment, (a) the term "Contractor" refers to the IIC that assumes the Contract, (b) Customer shall provide CSG with such information regarding Contractor's performance as CSG may reasonably request and access to CSG at a reasonable time and permit CSG to inspect Contractor's work, (c) Customer shall have no recourse against CSG for any the performance, non-performance or deficient performance of the contract obligations on the part of Contractor, and (d) Customer and Contractor agree to notify CSG of any dispute between them concerning the Contract, to provide CSG with such information regarding the dispute as CSG may reasonably request and to consent to CSG's participation, at its sole election, in any arbitration or other dispute resolution proceeding. IU MISCELLANEOUS Contractor and Customer hereby mutually agree in advance that in the event that Contractor has a dispute concerning this Contract, Contractor may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L. c 142A. --�% Customer: /,LXJ l L „ ,(�,a Contractor; /4— u �— NOTICE: The aignaturSof the parties above apply only to the agreement of the parties to alternate dispute resolution initiated by the contractor. The customer may initiate alternative dispute resolution even _where this section Is not signed separately by the parties. You may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or a branch thereof, provided you notify the feller in writing at his main office or branch by ordinary mail posted, by.telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 10T- 3 glib `� B .. er Si a ate ` - }A -d f�� dC ��G i Iy.i .✓ :SG Signature Date Name of CSG Representative (Printed) 527.2011 Temw and Conditions appear on the reverse _ tilos-achusetts -Department ni f Public tiaetN 1 Boal -d of Buililing Regul:ttinns anti tir:tn(hii' is Construction Supervisor Licer:se License: CS 57754 Restricted to: 00 WILLIAM D HOPE 57 CHASE ST METHUEN, MA 01844 ('„nuni.cinner Expiration: 3/4/2012 Tom: 18748 Oftice o��on u°mcr"�� ilr5`Ji�$� inc�sZCegutS i`to HOME IMPROVEMENT CONTRACTOR Type: ( Registration: 101730 lit<; ;, 1 Expiration: 6129/2012 Private Corporation HRf CONSTRUCTION INC. William Hope 57 CHASE STREET METHUEN, MA 01844 Undersecretary 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 Plea - Suite '5170 Boston, \4A 02116 Not valid without signatuTe ACw � CERTIFICATE OF LIABILITY INSURANCE DATE (tAtl.IDDIYYYY) THIS CERTIFICATE IS ISSUED AS A MATTER 08/15/2011 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(les) 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 comfier rights to the certificate holder in lieu of such endorsement(s). PRODUCER CONTACT NAME: Michael Emond Emond & Associates PHONE— --- -- -- 857TumpiheStreet AtcAIL-No•EKL9?81Q8 Z13 — ____" AX No): Q7g_208-=�ifi __ EM-- Suite 133 ADDRESS: mik _ mon(artTlfamii Vrn __ North AndoverPAA 01845 INSURFJ2(S) AFFORDING COVERAGE j NAIL !: -- - -' - ---' --- — --- - INSURER A: Farm Family Casualty Insurance Company INSURED ..._ __ -' -------- -- E _.. -.---- HP,H Construction INSURER B: 80 Campbell Road INSURER C: INSURER O - North Andover MA 0184$ INSURER E: PER 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 T"kS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TFIE TER%iS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. rLTR� -- -" TYPE OF INSURANCE bbbLISUERf --- INSR WVDPOLICY EFF POULY EXP r- '------ . POLILY NUMBER I MMND A1tdfDD I LIMITSGENERAL LIABIlI7Y i I ' r-" 1 I ii ! EACH OCCURRENCE S i 000 j X i COMMERCIAL GENERAL LIABILITY I I CLAIMS-MADE .X I� OCCUR I I PREMISES (Ea v cu rencc SO.00 - AI i i ACED EXP (Any One person) _ I S 55.000 I i 2001 X0726 11120/2010 1112012011 PERSONAL E ADV INJURY + s Included i I — , — 1 GENERAL AGGREGATE c S 2,000_OrJO CEN'L AGGREGATE LIMIT APPLIES PER: I � -----�---- � - -- 1 - " `I PRO_ I _PRODUCTS - COUP/OP AGG_5 2,000 OLIO X !POLICY ? JECT ! l LOC 1 -`-' --'-- --- I AUTOMOBILE LIABILITY I —, IF ) I CtB:lBWED S NGL6 CIAfI — _[Ea aaodeat 1 S 1.000 000 _ ANY AUTO BODILY INJURY pers�nt ` A AUTOS ��IED X . SUTOSULED i I �- - -- (P�s t_ ---: ( 200IC4287-4A I BODILY INJURY(Pl accident)' S II X HIRED AUTOS X AUTO NON-OWNED I I 03/16/2011 03/16/2012 ' --s- - L.— AUTOS I I PI.Oi'ERTY DAMIiGE--"' i S I L(Pcr acJdent)- ---- 1 ' UMBRELLA LIAR' IITC OCCUR r 1 I S j -� ,IEACH OCCUP.RENCE 5 1,0000,000 A I EXCESS LIAR ! __._ _ ct vmsA+ODE ` 2001E1169 { 12114/2010 ; 12/14/2011 ; AGLREGATE — 1 5 1,000,000 �—_". -- lD -- - —. I WORKERS COMPENSATION j INCSTATU• S AND EMPLOYERS-LIABILITY ,LIN t i INC ST A 1A71YPROPRiBTOR:PARTHEPJEXECUTNE 2005WG827 — OFFICEPAEMBER EXCLUDED? ❑ N /AIF i 12%07/2010 12/07/2011 ^E.L_EACH ACCIDENT I S $�O,UQt) __ ! (IAandatory In NH) ..—.—. _ ! If yes. descnbe under E.L. DISEASE - EA cOPERATIONS 5 $00,000 • DSCRIP710OF bNn., ----- — I_i E.L. DISEASE - POLICY LIMIT I S 500.000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Atrach ACORD 101, Additional Remarks Schedule, Rmere space is required) Operations by named insured CERTIFICATE HOLDER HRH Construction 80 Campbell Road North Andover ACORD 25 (2010/05) CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE P&ICY PROVISInme: AUTHORIZED MA 01845 ©1988-2010 ACORD CORPORATION. All rights reserved. The ACORD name and logo are registered marks of ACORD Clear Ail Tile Commonwealth of Massachusetts Department of Industrial Accidents. !n ¢ Office of Investigations 600 Washington Street =f Boston, MA 02111 J` www.mass.gov1dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers -n' - - - - r- L T ,..,1-1, Name (Business/Organization/Individual): Address: ' 1 01L2 A —Phone City/State/Zip: , Are y an employer? Check the appropriate box: 4. ❑ I am a general contractor and I Type of project (required): 1. I am a employer with 6 ❑New construction employees (full and/or part-time).* have hired the sub -contractors listed on the attached sheet. 7. ❑ Remodeling 2. ❑ 1 am a sole proprietor or partner- ship and have no employees These sub -contractors have 8. F] Demolition working for me in any capacity. employees and have workers' comp. urance-t 9. ❑ Building addition [No workers' comp. insurance 5. a Corpora ❑ We area corporation and its 10.[] Electrical repairs or additions required.] 3. ❑ I am a homeowner doing all work � _ officers have exercised their 11. ❑ Pltimbing repairs or additions myself. [No workers' comp. = right of exemption per MGL c. 152, §i(4), and we have no of repairs 12.zc insurance required.] t employees. [No workers' 13her 1 Uz hJ'T7 Ci i 1 coma. insurance required.] *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. xContractors 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 lvorkers' compensation insurance for my employees. Below is the policy anti job site information. Insurance Company Name: T4am 1 x),o 1 Lim — Policy # or Self -ins. Lic. #: 2 Expiration Date: D 2 Job Site Address: City/State/Zip: ,% , 610w& 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 verification. I do hereby certify under the pai s an#pVnalties of perjury that the information provided above is true and correct. 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 Cleric 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone M