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Home My WebLink AboutBuilding Permit #813-2016 - 353 PLEASANT STREET 2/10/2016AaMBUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit Date Issued: 0 ( . I IMPORTANT: Applicant must complete all items on this naize I LOCATION 'Y f e S5 ti ar ; 5 -- Print PROPERTY OWNER Print 100 Year Structure yesno MAP PARCEL: 6W ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Date Received Residential Non- Residential 0 ( . I IMPORTANT: Applicant must complete all items on this naize I LOCATION 'Y f e S5 ti ar ; 5 -- Print PROPERTY OWNER Print 100 Year Structure yesno MAP PARCEL: 6W ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Co(nmercial ❑ Repair, replacement ❑ Assessory Bldg -t, Others: ❑ Demolition ❑ Other ;-!ael ❑;Septicµ I x ❑ ,Y. Flootlp lain D�str❑WetlandsWell ❑Waters ed❑ rct x D VVaterl Sewer DESCRIPTION OF WORK TO BE PERFORMED: 7-;;,-r L ; v.5 ✓l 4 ?:o ✓l 7V Q - Y S , rh %.*r4`f iD &I Identification - Please Type or Print Clearly OWNER: Name: Ttr= i- t4i'co a►- i Phone: fz-,>F 5a-2- 9a3� Address: rY�5,-.vt- s,— Contractor Name: P f 7 -e /av<C Phone: 9>'5;- Yo, -7c Address:. 2 Supervisor's Construction License:_ j oG o /7 Exp. Date: Home Improvement License: ARCHITECT/ENGINEER Address: r>.F/) JP - .Exp. Date: Phone: 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: $ 5-00, o a FEE: $�G Check No.: 1-1 Receipt No.: I NOTE: Persons contracting with Aregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL E Public Sewer ❑ Taming/Massage/Body Art ❑ Swimming 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 PLANNING & DEVELOPMENT Reviewed On COMMENT'S Signature_ CONSERVATION Reviewed on Signature COMMENTS HEALTH COMMENTS Reviewed on Sianature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Pyla-4ning Board Decision: Comments Con6ervation Decision: Comments Water & Sewer Connection/signature & Date Driveway Permit DPW Town Engineer: Signature: Locatea 364 Usgooa Street Au MOR AfRaTM NST --`Tem mDump� is er ontsites itLo ted at 1x24 MainfStreet 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 department use ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Permit Revised 2014 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 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 a, 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 . TOTE: 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 .-360 No. }/ Date d � r 7t7—/ - Check 4 TOWN OF NORTH ANDOVER Certificate of Occupancy $ r Building/Frame Permit Fee $-" Foundation Permit Fee $ Other Permit Fee $�_ TOTAL $ (- p Building Inspector H J W S LL m = O LL N N U Q N O U a Vf Z Z D J > m 2 m "a 7 LLL L C=$ C > cu C U _ N LL cr O U d Vf z Z m > J d L j C _ (O LL O d Ln Z U H W J LU L j C V i In _ (O LL cc O U a V) Q L .:3 C _ f0 11 W 2 Q LY w LL N L m z ++ v N D N Y a N Ix i Z m Z W IL w W CL U) J ES w w 5 L 0 CL CL � Q J � O O Z d N 111 / Federal to .105-0405629 IIT RlContractor RegistraOonNo81B6 RISE Engineering Contractor Registration No 120979 RISEMA «: A division orThiclsch Engineering ENGINEERING 60 Shnwmut Unit 02, Canton—NIA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 1 PROGRAM TM CONTRACT 6 ENTERED NITOBETWEEH WE CILIA -ll ES ENGn7EE1UNG AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER. PHONE -. OATE _. - GUENTN WORN ORDER__ Jeff Larcome (978)502-9038 01/19/2016 424038 00002 SERVICE STREET _ _- . _ - — _ BaUNG STREET - 353 Pleasant Street 353 Pleasant Street SERVICE cRY,STATE,ZIP - SRSDIG CRY.STATF-ZIP North Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION AIR SEALING: Provide labor and materials to seal areas of your home against wasteful, excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be Icfl with a healthful level of air exchanec and indoor air quality. Materials to he used to seal your home can include caulks, foams and other products. Primary areas for scaling include air leakage to attics. basements, attached garages and other unheated areas (windows are not generally addressed.) 11mis will require (8) working hours. A reduction in cubic feet per minute (efm) orair infiltration will occur, but dme actual number of cfm is not guaranteed. At the completion of the wcatheri7ntion work, mrd at no additional cost to the homeowner, a final blower door and/or combustion safety analysis will be conducted by the sub -contractor to ensure the safety of the indoor air quality. $680.00 DAMMING: Provide labor and materials to install a 12" layer of R-38 unfaccd fiberglass halts to (96) square feet for damming purposcs.KEEP DESIGNATED FLOOR. 5196.80 ATTIC FLAT: Provide labor and materials to install an 8" layer of R-28 Class i Cellulose added to (740) square feet oropen attic space. KELP DESIGNATED FLOOR. 51,013.80 ATI IC ACCESS: Provide labor and materials to install (1) easily moved, insulating cover for the attic access folding stair. The cover has integral %%rather -stripping to restrict air leakage. $200.00 VENTILATION: Provide labor and materials to install (2) insulated exhaust hose with soffit mounted flapper vent to exhaust existing bathroom fan(s). 5237.50 VEWILA11ON: Provide labor and materials to install vcniilauon chutes in (54) rifler bays to maintain air now. $108.00 BASEMENT DOOR: Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2" rigid board that meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and scams with FSK tape. 572.22 r l" n t.- ,JOB DESCRIPTION Total: $2,508.32 Program Incentive: $2,051.24 Customer Total: $457.08 WE AGREE HEREBY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE SUM OF ***Four Hundred Fifty -Seven & 08/100 Dollars $457.08 UPON FINAL INSPECTION AM APPROVAL BY RISE ENGINEERING. CUSTOMER ACREES TO REWT AMOUNT DUE IN FULL INTEREST OF 1% WILL DE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 10 DAYS. SEE REVERS! FOR YIPORTANT INFORMATION ON GUARANTEES, RIGHTS OF RECISION, SCHEDULING, AND CONTRACTOR REGISTRATION. DO NO GN THIS CONTRACT IF THERE ARE ANY BLANK SPACES ^ AUTH OSIDNATURE-RISE xeerinR CU )E -RA. CENOTE: TMS CONTRACT MAY DE WITHDRAWN DY US IF NOT EXECUTED BMTHW DATE OF ACCPTANCE ACCEPTANCE OF CONTRACT - TIIE ABOVE PRICES, SPECIFICATIOM AND CONDITIONS ANE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED. YOU ARE AUTHORMED TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED MOVE r r f , ,t` 1 Federal 10 N 0"405629 RISE Engineering RI Contractor Registration No 8186 � MA Contractor Registration No 120979 A dhisinn or'rhiclsch Engineering RISE ENGINEERING- 60 ShaTYmul Unit 02, Canton, DIA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAMTHIS CMA -TIE'S CONTRACT N RISE ENOWEERING.ANDTHE CUSTOMER INTO _TOMER FO WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENTS WORKORDIR Jeff Larcome (978)502-9038 01/19/2016 424038 00002 SERVICE STREET .. '. BILLING STREET 353 Pleasant Street 353 Pleasant Street SERVICE CITY.STATE.ZIP �- - -_ BILLING CnY,STATE-ZIP _ North Andover, MA 01845 North Andover, MA 01845 ,JOB DESCRIPTION Total: $2,508.32 Program Incentive: $2,051.24 Customer Total: $457.08 WE AGREE HEREBY TO FURNISH SERVICES - COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE SUM OF ***Four Hundred Fifty -Seven & 08/100 Dollars $457.08 UPON FINAL INSPECTION AM APPROVAL BY RISE ENGINEERING. CUSTOMER ACREES TO REWT AMOUNT DUE IN FULL INTEREST OF 1% WILL DE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 10 DAYS. SEE REVERS! FOR YIPORTANT INFORMATION ON GUARANTEES, RIGHTS OF RECISION, SCHEDULING, AND CONTRACTOR REGISTRATION. DO NO GN THIS CONTRACT IF THERE ARE ANY BLANK SPACES ^ AUTH OSIDNATURE-RISE xeerinR CU )E -RA. CENOTE: TMS CONTRACT MAY DE WITHDRAWN DY US IF NOT EXECUTED BMTHW DATE OF ACCPTANCE ACCEPTANCE OF CONTRACT - TIIE ABOVE PRICES, SPECIFICATIOM AND CONDITIONS ANE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED. YOU ARE AUTHORMED TO DO THE WORK AS SPECIFIED. PAYMENT WILL BE MADE AS OUTLINED MOVE r r f , ,t` 1 RISE60 Shawmut Road, Unit 21 Canton, MA 020211339-502-6335 ENGINEERING www.RISEengineering.com -e, OWNER AUTHORIZATION FORM Name) owner of the property located at: y' (Property Address) `, hereby authorize , (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. " ner's Si t e Date The Commonwealth ofmassaahuselis Depazrtmerat of 1ndustria1 fACCL enfs I Congress Ste-ee4 suite 100 Boseon, M4- 02114-2017 www.marss govldao Workers' Compensation Insurance Affidavit: $un'lders/C^ontree¢ors/lElectriciansfPlumbers. TO BE n JLEiD W]3b`dE PERI] n"I Z` NG AUT H'ORn-Y- , Name (Business/Or.-Autization/Individual):j� t� I A t 1 q !r'^ T ji. Address_ ' '_ r , �� /3 i- _-- City/State/Zip _ Art you nc, employed? Cbc :k Me appmprbte boy.: 1.�5:11 I .ploy r witb 2 _employees (full ancUir part-time).' 2E] I am a sole proprietor or parto--,sbip sous have no employers working fir roc in any tapaetty- (No workers- comp_ in=== requirctLJ 301 am a bamcowner doing nil worst my=IL (No warners' comp_ insauance req irc3_I t 4-01 am a bomcowna' and will be hiring Contractors to conduct sit worst on my property_ I will ensure that all contractors citbcr have workers' compeosnian invaarur or 8iz SOIc proprietors with no ®ployccs. 5.01 I nm a gmeai contractor and I bave bit -ed tl= sub-contrstots listed on the attached sheCL These sub-eoatrsctots stave employees and have wor kers' comp. instaanc-t 6.0 We arc a corporation and its officer, bave ecereised rb-irright ofoccappon per MGL 1(4), sod we have no employocs. (No workers' comp- insurance rrquirc&] Typeo$prrogect (required)- 7- F-1 New constmction 11- y0 Remodeling 6....i 9- DcIIOliti. 10 (moi'' Building addition I I.0 Electric,, repairs or additions 12. n Plumbing rcpails or additions 13.F]Roof repairs 14.0 Qther -Any applicant that cbct7¢ box 9 mast also fill out the section below sbowiog their workers' compeasatian policy information t Homcawncm who submit this afrudavit mdicsting they are doing all work and then hire outside Contractors must submit a acw-Mdavit indicating --h- tCootraaom that ebeck this box mast attschcd = additional sheer showing the name of tbesubcoanaetess_Rod sere whetbcr or ooh tb,,, Wtrti- bavc ccoployccs, ittbe sub-connacwts have employees, they roust provide their workcs' Wrap. policy number_ / air an e r -player that is providing Workers' compensation insurance for my employees. Below is the poluy and job site iraforma£ion. f � i insurance Company Name: �- Policy # or Self -ins- Lic_ #: j� (rJG 7%-•�=, J Expiration Date- e2 jrr//--a lob Site Address: it P �'S S vt T F, City/State/Zip: !n- ( -Agoy -e ✓' Attach a copy of the workers' compensation pal -icy declaration page (showing the policy number and eltpir-2601 date). Failure to secure coverage as required under MGL c_ 152, §25A is a criminal violation punishable by a fine up to SI,500_00 ind/or one-year imprisonment, as well as civil penalties in the form of a STOP WORD ORDER and a fine of up to $254.411 a Jay against the violator_ A copy of this statement may be forwarded to the Office of investigations ofthem DLk for ;,somn e ;overage verification. t do "'—eby ceTdfy ndndel nice pains and penalties- of perlaarY that tke informer ion proyided abode is true erred correct a. , >iznature: L c - �-, ,�: - Date 2( 'hone #: Oflkial use only. Do not write in this area, to be completed by City or towm O flk aL City or 'lT'owza_ peFmit/it,icense # Issuing Authority (circle one): ~ I- Board of ]Healon 2. Building Department 3. Cnty/Town Clerk 4. EIeadcal inspector S: Piuvabing gnspector 6- Other Contact Persona: Phone #: IW2016 Preview: Certificates of Insurance A�®W®° CERTIFICATE OF LIABILITY INSURANCE �TERAMiDDYYYY) 0110412016 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 CONTACT AME- NAME- Automatic Data Processing Insurance Agency, Inc. PHONE IA c Ni . E=n: I (,Auc. No): E-MAIL ADDRESS: 1 Adp Boulevard WSURER(S)AFFORDING COVERAGE NAIC 9 Roseland, NJ 07068 LIEDE•J'r _-w INSURER A: NorGUARD insurance Company 31470 INSURED INSURER 8: POLAR BEAR INSULATION CO INC PO BOX 958 INSURER C: INSURER D: Andover, MA 01810 INSURER E: INSURER F _ COVERAGES CERTIFICATE NUMBEK: 4PJIU3 KEVISIUN NUM13EK: THIS IS TO CERTIFY THAT THE POL!c:ES OF INSURANCE LISTED BELO'11 HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOT10,11THSTANDING ANY REOUIRELIENT. TERL1 OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT VF(TH RESPECT TO INHICH THIS CERTiRCATE MAY BE ISSUED OR MAY PERTAIN. THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HERE;N tS SUBJECT TO ALL THE TERRA'S. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHO%,%. N !.;AY HAVE BEEN REDUCED BY PAID CLAIL'S IF LTR TYPE OF INSURANCE INSD MO POLICY NUMBER FF (G1htiDD,YYYY) POLICY EXP ( %VDD YYYYj I LIMITS AUTHORIZED REPRESENTATIVE COMMERCIAL GENERAL LIABILITY CLAIMS MAUL ❑r:CCLK EACH CL WIF. 10E — Ff;EF.IISE SIta o,_e:•r_r,�e; 5 LIEDE•J'r _-w FERSMAL v AU'v II.JIK: GEt,L ivGGREUAI E LIL111;d°FLIES FEF: FRO- L::C PCU,; IEC " ;;f1-:Eli: GENER=1L AGGIiEGt IE "s I'RULi!t:IS - C4L1F-;;I' %•GG i 5 AUTOMOBILE LIABILITY M, AL'IU ALL r;;1.ED S:FIEL:LLED ALI10::; AUT CS I,UN C':`it.,Et) HIREU AI GS HA-.- 171 7J'1NEU SiNt-Lfz LIIAI I IEa:- cnl' BCUIL'! INJ L`I:Y rf-a p r -,on; S 6GUIL'i I(UUI%lPr. s.a_enli S I .1,u. -t h I I''A7, i,lit 1W, UMBRELLA LUIS EXCESS LIAB .^_.LLUti CLAIIJS-LIADE EACH C CCUFJiENCE AGGHECATE LIEU IiEfEN IlOt:S A WORKERS COMPENSATION ANOEMPLOYERS'LIABILITY Y ; N ANY l''IiCI'IilEl Cf:l'AF:I r:EItiEtiECU17'•tE �� CFFiCE LlE1 8H--. EA;LLCED? I _1 (Mandatory in NH) it— t .: es. UE L'•ESCHIFNCN CE CPERt, lICKS JiuJ:: NIA N POWC772258 01101:2016 01101/2017 't t V Y. X STA(UIE EV': E.L EACF ACGIIiEF.I 5 1,000,000 EL. DIS'v,SE - Ei. EIJPU.YE - 5 1,000,000 E.L-DISEASE- FOLICt Utdil' S 1,000,000 DESCRIPTION OF OPERATIONSI LOCATIONS I VEHICLES (ACORD 161. Additional Remarks SchW.W. may be attached it.—pace is required) CERTIFICATE HOLDER CANCELLATION AG 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) 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 Thedsch Engineering, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 195 Frances Ave AUTHORIZED REPRESENTATIVE Cranston, RI 02910 AG 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD �� RegaIaxion of Coen Ams an Office 10 parkPiaza - S�dv 5170 u- {4211 - B`(`,tOZ �t�OII OlfleImpro 4�e%OII Reg°n. 1fi�726 '[t# 2.522AS _ - Co- VOLAR BEAR INSlULA V'mceni LeBlanc 8tor Im pA. BOX 958 01lER� ASA �'I8�0 = - _ U dauAddreMs�rebuca went D LostCerd = Adder '-I Renewal � �P _ ` + OVSZp,t jM a e �Q NE 03945 _