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HomeMy WebLinkAboutBuilding Permit #772-16 - 340 WOOD LANE 1/4/2016T BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received I Date lssuedti:lk IMPORTANT: Applicant must complete all items on this TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Ej New Building psOne family [I Addition 0 Two or more family I] Industrial ,k'Alteration No. of units: [I Commercial 0 Repair, replacement 0 Assessory Bldg t�Otherpi 0 Demolition 0 Other uj ea<h e -s qk,6a p g tk 3r, q b0i JL OWNER: Name: Ai Identification Please Type or Print Clearly) E9bE-WAWW-- A-- ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE: B ING PERMIT; $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F. Total Project Cost: FEE: $ Check No.: 4air4 4 4x Receipt No.: NOTE: Persons Arntractinj W* unregistered contractors do not have accesYio the guaranty fund 01 W� Plans Submitted ❑. Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL r Public Sewer ❑ Tanning/MassageMody Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales 0 Private (septic tank, etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF o U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature_ -CONSERVATION Reviewed on Signature _ COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes ft Planning Board Decision: Comments } Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Locaiea oo4 usgooa street 1. ;iJz�lt,tIgY'R4j Nr-5,fFiD'► EPA�� Rs"�r+T'HMf��E,� -N'Mk�mpst�-ea r o -F n'yre eda1aLocMr �FireDep�atea$`I.r.s�.te�rs",j«wt4-»fUFarmesignatuUe wt c��_• y'.'r+ i ti'"iw.i� ��T4Fy..� xr"Y+rt t ��.r�. 2" r �� Sa °nr f 6 .� 7+-tii..'iv. � '.•r�'e i t�'`°v'�t�� `n � t a�^��a.c•. y¢���.sr^'-r �i .�'�'kl;s xy+sr t`^;i, r, rN a r .,.,# '1 e�. �e}�,3�yfs-•...Y�V��'�T�.�+,�,��,T�'i.�'J�r 1�:.a�je,...t4�' COMMEIV'l i .s• ..1d1.. ..i .1.. r.�-��i{rfi..a '.t.�f.a.l '%,i. j '+' s , � Dimension Number of Stories: _ Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, roast 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 de ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 J 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 4. Building Permit Application 4. Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4s Floor Plan Or Proposed Interior Work 4. 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 4. Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) 4 Mass check Energy Compliance Report (If Applicable) 4. Engineering Affidavits for Engineered products TE: 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 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 Location Na ; Date Check v d` U073 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ 4 TOTAL $ Bui f fE ng Inspector 0 3 0 H M r • Q _ LL 0 o m L aV(U O O LL N ; > u Q N Ln W H z z m C O + -0 L 3 O LL 7 O 6' T ai C _ L U 0 LL W N H z z J d L 3 O w � c LL W z J V ~ U W L � O cc: V y {n C LL O U W z a � L bo� O s LL z W C' a W LU LU LL N 7 m O a+ N-14 Ln 0 N E 0 O W co • z w 5 E O O Z N AI W Q N •E m m (L O '�+ CD 0 oCL CL �- �a Oa O � Z cwj O V � Rf � i c U) i5 n 0 cc 0 0 V •a l L I E �} c000- 0 yY is c •r 1 Yi JO O 0 E L Y 0P40h c a 0 i CL J d N • OO > M i Gal > �. � O = � n a) �...�.� O Eoo QU,z - N 0 0 o CD cm ® 40W.a c > 1 Q. was $'y 0 0 0 r 0 �— c _ 0 = Q m d W = w . '0— 0 0 � m y C v-. O ml. P: •E v W V (D '� d N N U) .Q 04- 0 1 O H t w CL 0 U > O W co • z w 5 E O O Z N AI W Q N •E m m (L O '�+ CD 0 oCL CL �- �a Oa O � Z cwj O V � Rf � i c U) i5 06/99/2015 12:36 9786825399 PAGE 01 Flderel ID i RISE Eogiefaelriag NN VA Couba mr o A dlvbtoe of ThlOak "a ering CT Convector Revetton r/o pte 60 gbewlael Vail JI& Ce1n0a. JHA M21 CONTRACT RAIiMM.63ds It I S SPap PROGRAM e0a°0mMuict Is io 100CMA-HES oto � ran"waa� q 6NGlNBRRING oaoenaw aleTorsa p+oas sate cueRe IaoruioeceA Maureen Roche (978)979.2070 06/02201 S 41611S 00003 aettvtoe artgaT saute esaarr ..._ 340 Wood LaRt 340 Wood Lane etdlrte5 Cir, @TAM ib Balls OW. MiLaP North Andover, MA 01845 North Andover, MA 01645 JOB DESCRIPTION H E ONF -'06posal rorthis calendar year. $0.00 BARRIER: A B1owa Door Test will not be conduced at your home. due to the presesm of asbemrs. $0.00 13ARRICR: We have discovered whet appears to be a mold/ mildew -lite substance in your home. This is being brought to your Motion to W111 ly h as a pre-existing condition to the insulation and air sealing work planned fbr your ham. Your signature is your acimawltdgernard aft= conditions and agremnent to proemd. 50.60 $0.00 xrric FLXT: Provide labor ad materials to install a 9' lame of R-30 unfaced Aberalass bans to (16) square feet of attic space. $26.72 ATTIC FIAT: Provide labor and materials to install a 14' Jaya of R-49 Class I Cellulose added to (672) squat feet of o11on attic spaceAUDITOR: TYPE OVER THIS TEXT TO SHOW SPECIFIC PROBLEMS AND REMED93 FoR THIS HOMIL) THR00014 NORX IN WAIA- THERE MIOHT BE HOLD MUST BE CHECKEDIII BULKHEAD LCAK5 SEASONAL. WKrFRIII HOMSCOTF. CEILING IS BEING REPLACED DUE TO ICE DAMS! 51,135.60 So.00 ATTIC ACCESS: Provide labor and materials to insulate (1) beck of the kneawtll both with 2" rigid Themau board. end sod the edge ortht hatch win wo menitrlpping. 500.00 VENTILATION: Prcwtde IW)W and materials to Install ventilation chutes in (32) rafter bays to maintain air now. $104.00 v(?NTILATtON: Provide tabor and materials to install (O V X 16' rectangular aluminum sonit vents to irtaeaa0 vemitation is Blue ME. Specify cola: Whitt or Gm. 5200.00 RISE Engineering will apply all applicable, eligible Inoentivcs to this C041ML You will only be billed the Net emounl. Currently, W eligible measures, Columbia Gas Bffers 75 incentive, rain exceed 52,000 per calendaryter, and an incanivc of 1(1 % 01r rile Air Sading nMOW 8 ftp to dte firer 5690 and an additional 5340 if savings ars juWrted by tits ouditor. For the sarmy end twith oryour home's indoor air quality, we will be clmduating a blower door diagnostic orthe Wettable air Row in you► NM Eon 6010111 tat wok Is OWN and Alta INC waullalzateun work Is ci mptctc. We will also tmrtd%t a full a9se ""I ur the combustion softy of your heating system and water heater. This has a value 01`590 and is at no cost to you. Total allowdtle wastltaingion ingMiva is 53.110. Sap.no 06168/2015 12:34 9786825399 PAGE 01 Fed" 10 M RISE Engineering Al cownew res No MA Cw*w* RoeMbodon No 71 A &Won of ThldKh E48ftrlag cT C n No es 94aMal64 Unit a!, GRioA. MA Omll CONTRACT 339��24M FAX 139-JOUM R I S E"op ' PROGRAM ENGINEERING CMA -HES a c"As a11Yfo1eA p"M am GUM a noon oaOCA McWM Roche (978)979.2070 06/02/2015 416115 00003 340 Wood Lane 340 Wood Lane MRIIICL OMT. MTAR ai aUM criv, "Aw-w North Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION Total; $1,616.40 Program Incentive: $1,234.80 Customer Total: 1381.60 *9 A9M KMM TO FURARliM MMMa M • CMPLe1E tR AtCC tDME MAIM AS M6 BP CRO m COR TME sw oc "'Three Hundred Elghty-One & 801104 Dollars $381.60 aper � wweTar AND AveRarA� was gt4�Mo. euererp ACRCiA To Aprt AnOUN► OYaa Fvu. wTeaaT a T11 w4at TawloGo YDMTNL.OM AMt wmAio sMwrce AeTeR m ays.s� RcreAtE � maRTAMTMi�TaM oM , RIOMTA ao . sDMFaa.u�o, AMD COMTAACTOM AEBb:RATMIN. Dorm SIGN WO CONI = eF TMEIM ARE ANY SIAM SPACES iw+xon�oeio�iAiiwie:,�eka;,;,M+ao Ae�T,,,,eE . MOTs+�aaMt�Aarw.eewrnaRAw+ww�wTa�autsowmw wnor�vn►roe AoarrweaoP oorT*Arr•sxe A�OYE vwcw,aKwcAnoia Aialaoaor►p�a AR! CAM AA/MACi01nTOW MDMMAVMG gMTWO=WJIM =Ta00TM W=. Ase�neO. aATrertw�lee woeaOun�M®Aewe JUN - 8 2015 r The Commonwealth of Massachusetts L� ..� Department of Industrial Accidents Office of Investigations ' 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual) Address: 110 Perimeter Rd /State/Zip: Nashua NH 03063 Builders Services Group d/b/a Quality Insulation Phone #: 603-578-9275 Are you an employer? Check the appropriate box: I. ❑✓ 1 am a employer with 100 4. ❑ 1 am a general contractor and 1 employees (full and/or part-time).* have hired the sub -contractors 2. ❑ 1 am a sole proprietor or partner- listed on the attached sheet. ship and have no employees These sub -contractors have working for me in any capacity. employees and have workers' [No workers' comp. insurance comp. insurance.* required.] 5_ ❑ We are a corporation and its 3. ❑ I am a homeowner doing all work officers have exercised their myself. [No workers' comp. right of exemption per MGL insurance required.] t 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 1 l .❑ Plumbing repairs or additions 12.❑ Roof repairs 13.❑✓ Other Insulation *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: Indemnity Insurance Co of North America Policy # or Self -ins. Lic. #. tk) Lfc:-6 \SkSJ� Job Site Address: L,t�%� Expiration Date: 6/30/2014, City/State/Zip: N - AjweZ & Q/I U 1 - 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 IterebV certify under the pains and penalties of perjury that the in formation provided above is true and correct 603-324-1974 Official use only. Do not write in this area, to be completed by city or town offieiat 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 #: A RL)® CERTIFICATE OF LIABILITY INSURANCE DATE(MM06l2412015 YY) 2015 r 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 Aon Risk Services Central, Inc. Southfield MI office 3000 Town Center Suite 3000 CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (AIC. No. 111): (AIC. No.): E-MAIL ADDRESS: Southfield MI 48075 USA MWZY304834 INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A Old Republic Insurance Company 24147 TODBUild Corp. 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER B: ACE American Insurance Company 22667 INSURER C: ACE Fire Underwriters Insurance Co. 20702 INSURER D: INSURER E MED EXP (Any one person) $25,000 INSURER F: uuvc "CJ tmFw IIFII:C IF NI IMKtW- �/l II 1"XAAXXXf UL'UMIMM IJIIa11000- 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. Limits shown are as requested S LTR TYPE OF INSURANCE ADDI INSD S VVVD POLICY NUMBER O C MMIDDO'YYY O C MMIDDlYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304834 EACH OCCURRENCE $2,000,000 ❑XOCCUR $2,000,000CLAIMS-MADE PREMISES Ea occurrence MED EXP (Any one person) $25,000 PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: X POLICY 0PR0. JECT ❑LOC GENERAL AGGREGATE S4,0001066 PRODUCTS - COMPIOPAGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT Ea accident S5,000,000 BODILY INJURY ( Per person) ANY AUTO ALL DINNEDHSCHEDULED AUTOS AUTOS JX BODILY INJURY (Per accident) PROPERTY DAMAGE (Per acddenl HIRED AUTOS NON -OWNED AUTOS UMBRELLA LIABOCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS -MADE AGGREGATE DED I RETENTION B C WORKERS' COMPENSATION AND EMPLOYERS'UABILITY YIN OFFICER/MEMBEREXCCLLUEDvexEcuTIVE F9 (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA WLRC48151553 All other states SCFC4815190 WI only 06/30/2015 06/30/2015 06/30/2016X 06/30/2016 PER OTH- STATUTE ER E. L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE 31,000,000 E.L. DISEASE -POLICY LIMIT $1,000,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) Evidence of coverage `m �i 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. Builder Services Group, Inc. A TopBuild Company 260 Jimmy Ann Drive Daytona Beach FL 32114 USA AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014!01) The ACORD name and logo are registered marks of ACORD air O�ie of Consumer Afta*rsn business Reguaatior3 <- 10 Park Plaza - Suite 51170 Boston; Miassachusetts 02116 Home Improvement Contractor Registration BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RU NASHUA, NH 03063 -. t)fsee o; t:'0nsurrer Affairs & Business Rtgulation ,.jj0id1E lid1PROVEidENT CONTRACTOR ri2gs5ttatia ;73141 Type Expiration: &25/201E Supplement —ard _DER SERVICES GROUP, NC. iA.RD SCr-WARTZ J11NATAY ANN DRIVE TONIA BEACH. FL 32114 I ndtrsrrrrtzn' Regis?ration: 179141 Type: Supplement Card Expiration.: 6.'25!2G16 1. tgd3t: Address and rtiurn card. 'liars: reason for Change. Adrt>> Renewal Employment i..ast Card IJeense or registration 1,21id for inchvidol use unl� before the expiration daft% if found return to: ni3:ce of t:onsunjer Affairs and Business Rtgularion 10 F6r'. P12u- - Suite 5 to Boston, h'IA 612116 Not raii&t ithout signvure \§ 30 //g zz— . �®® $§j � �>