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HomeMy WebLinkAboutBuilding Permit #729-2016 - 40 MEADOWVIEW ROAD 12/14/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#:I L Date Issued: IMPORTANT: LOCATION 0 C� Date Received t must complete all items on this Print PROPERTY OWNERS `6-Ljom Print 100 Year Structure MAP _PARCEL: 2,_ ZONING DISTRICT- Historic District Machine Shop Village NORTF1 OFtt�ec �6v9�C yes Onoyesyes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑ ddition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial Repair, replacement ElAssessory Bldg El Others: ❑ Demolition 11 Other __- ❑ Septic ElWell 11Floodplain q Wetlands ❑ 1NaterShed District El Water/Sewer DESCRIF I IUN Uf VVUMtX 1 v 6C rr-mrvn�ri ��►�., C�I���ev�. in. CAI Vh(J�ye.r l 4.,� ar Identification - Please Type or Print Clearly b b�0 OWNER: Name: S -C 14G�.S,%iy n �cl C�cXIo Phone:q ZL�� Address: q 0 M Contractor Name: a, -A'\, Phone: C1 H� 3 Email: I'h �n bul o►� • co Address: O Gvx �A '(,h Lot 30 Supervisor's Construction License: �' Exp. Date: Z �Exp. Home Improvement License: kg, z ARCH ITECT/ENGINEE 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: $ �l�,j�y •ycl FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the uargnty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ well ❑ Private (septic tank, etc. ❑ Tanning/Massage/Body Art ❑ Tobacco Sales ❑ Permanent Dmnpster on Site ❑ Swimming Pools ❑ Food Packaging/Sales ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF e U FORM PLANNING & DEVELOPMENT COMMENTS Reviewed On Signature, CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments a Conservation Decision: Comments Nater & Sewer Connection/Signature Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street `'FIRE DEPART M NTF' T �D _� 3. A c3 *"`�-Hemp umpstonjs'e,Y�e ItL co ated at 1�24Mam Street_ F ..y.....d. ...,�-s--�.., ..°`t e1Lu,.f' F e DepartKgnt4,signattur�e/dates - L -- 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 ®ANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine 2 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 46 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 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 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 I ECC Energy code Engineering Affidavits for Engineered products TOTE: 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 "[CJS No. 2 0 �1. Date Check #� 211011`. TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ capes Foundation Permit Fee $� Other Permit Fee $ TOTAL $�_ Building Inspector n O J w m L \ O LL aO+ T N U O. N Q a a z z m O ~ 'O 7 LL ..0 O' ? C c C U = LL 0 z Z CL t 7 C LL O W a Z Q U U W W fi L 7 O' V > N c LL O � d z t -7' O' � LL z ui 2 H W � Y. L N i CO O Z i1 !% v U O N C O O as Q c c U� E Q ol d N a.+ C �"u-som" A 0 O O O y+ E O O 7 c O (� L � O N J C1 ' m > _ M ON N d O = OO O C c U Q E� d O 0 z QI CL - oo c = o 0 L Q Q d cc yam. .y • y + CD 1- v O O •_ Q i L M Q 4 uiU) W_ _ ' O O LL � Ow C N QO m �.:E O 0 LU E 0-o 0 .__ M CD v o� �, U) d '> ;�= c N .Q O0 O W CL U) z Z 0 m C� vI r O O LLI Z ~ . a xLIJ 0 H V DC Cl) a ^z J Z- �: .N LIq lw fqc Federal 10 9 054405M RISE Engineering R1 Contractor Registration No sire MA Contractor Registration No 120975 division ofThlelsch Engineering CT Contractor Registration No =120 grcA 60 shawmut, Canton, MA 02021 M �' ��CONTRACT 339-502-5197 FAX 33�-502-831.1 I S E Page 1 PROGRAM ENGINEERING e WOOED CMA -ETES ENtrtrt nRc MOTrO FORWMAAS orscAVIED D LLM CUSTOM OHM DATE CL9WT8 t4aRKcam Sebastian Iacono (979)686-2294 0611012015 405553 00003 SERVICE. SiRM. os.Lwa STREET 40 Meadowview Road 40 Meadowview Road SERVICE CM.STATE.?m - BLUM CRY;STATE.ZIC North Andover, MA 01845 North Andover, MA 01845 e U, .roe DESCRIPTION PHASE ONE -Proposal for this calendaryear. AIR SEALING: Provide labor and materials to seal arty 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 Icft with a healthful level of air exchange and indoor air quality. Materials to be used to seal your home can include caulks, foams and olhcr products. Primary areas for sealing include air leakage to attics, limments, attached g=ges and other unheated arcus (windows are not generally addressed) This will require (8) working hours. A reduction in cubic feet per minute (clm) of air infiltration will occur, but the actual number of efm is not guaranteed. At the completion ofthe weatherization work, and at no additional cost to the homeowner, a final blower door andlor combustion satbty analysis will be conducted by the sub -contractor to ensure the safety of the indoor air quality, $&50.00 AIR SEALING ADDER: (4) working hours. $340.00 DAMMING: Provide labor and materials to install a 12" layer of R-38 unlaced fiberglass balls to (130) square text for damning purposes. $266.50 ATTIC FLAT: Provide tabor and materials to install a 9" layerof R-32 Glass I Cellulose added to (2113) square feet ofopen atticspace. 53,021.99. ATTIC ACCESS: Provide labor and materials to install (1) easily moved, insulating cover for the attic access foiding stair. The cover has integral wcather-stripping to restrict air leakage. $200.00 VENTILATION: Provide labor and materials to install ventilation chutes in (26) rafter bays to maintain air flow. $52.00 RISE Engineering will apply all applicable, eligible incentives to this contract. You will only be billed the Net amaunt. Currently, for etigiblo measures, Columbia Gus ofibrs 75% incentive, not to exceed S2,000 per calendar year, and an incentive of i00% for the Air Sealing measures up to the first $680 and an additional 5340 if savings are justitied by the auditor. For the safety and health ofyour homes indoor air quality, we wifl be conducting a blower door diagnostic of the available. air flow in your home both before the work is begun, and after the weatheizttion work is complete. We will also conduct a full messmc itt of the combustion safety of your heating system and water heater. This has a value of 890 and is at no cost to you. Total allowable weatherizaiion incentive is $3,110. 9'r70.00 JOB DESCRIPTION Total: $4,660.09 Program Incentive: $3,019.99 CustomerTotal: $1,63010 VVE AGREE HEREBY TO FURNISH SERVICES - COMPLETE W ACCORDANCE W111 ABOVE SPECIFICATIONS. FOR THE SUM OF *"One Thousand Six Hundred Thirty & 101100 Dollars SIGN M" E*AM-*V NOM THIS CONTRACT MAYSEVIMTHMAWN MY USIF NOT EXECUMWMM 30 OA", ERE ARE A,NY BLANK L— SPACM Z $1,630.10 OAXOFACCEPTANM ACCMTAftCEOF CONTRACT :THEA8OVZMZ6,SPEC=AT1093A= CONOTOOMARE SATIWACTORYTO US AND ARE NOMWACCMIM YOU NW AUTHORM TOOO THE WORK ASSPECUIMPAYWOW41WEV"ASOUTIMMAROVE Federal to S OS"5629 MSE Engineering R1 contractor Registratton No $186 MA Contractor Registration No 120979 tea„ P I A WI A divbion ofThidsch EngineMag CT contractor Reglab-&on No 62N20 60 SbawmuL Canton, MA 02021 CONTRACT , , 339-502-5197 FAX 339-.%2-&U5 R I S E Pap 2 PROGRAM ENGINEERING CMA -RES CUSTOSAW MORE DATE CLRW# VWORKORW Sebastian Iacono (979)685-2294 06j 121115 405553 00005 SM"M STFUWT 40:Meadowview Road 53AM MET 40 Meadowvievv Road SOMM.CIMSTAMW North Andover, MA 01845 North Andover, MA €11845 JUN 1 2 2015 JOB DESCRIPTION Total: $4,660.09 Program Incentive: $3,019.99 CustomerTotal: $1,63010 VVE AGREE HEREBY TO FURNISH SERVICES - COMPLETE W ACCORDANCE W111 ABOVE SPECIFICATIONS. FOR THE SUM OF *"One Thousand Six Hundred Thirty & 101100 Dollars SIGN M" E*AM-*V NOM THIS CONTRACT MAYSEVIMTHMAWN MY USIF NOT EXECUMWMM 30 OA", ERE ARE A,NY BLANK L— SPACM Z $1,630.10 OAXOFACCEPTANM ACCMTAftCEOF CONTRACT :THEA8OVZMZ6,SPEC=AT1093A= CONOTOOMARE SATIWACTORYTO US AND ARE NOMWACCMIM YOU NW AUTHORM TOOO THE WORK ASSPECUIMPAYWOW41WEV"ASOUTIMMAROVE SP��rN I n owner of the property located at (Property Address) �s hereby authorize {Subcontractor} an authorhmd subcontractor for RISE Engineering, to ad on my behalf to obtain a building permit and to perform work on my property. Owner's Signature Date The Commonwealth of Massachusetts r T .......... . Department of Indust6afAccidents 0 .Twe of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 wwwinass4ovidia Workers' Compensation Insurance Affidavit: BuildersiContractors/Elettriciarcs; Piumbers Apoficant Informaififfl Please Print Lyzibly NaMe Adtimss: 00 flux 344 C�tstate/zip: t- MIt 01j.3 Phone M -LO yvr. Check the appropriate box- Are you an employ 'ryl* of project (required) - 1. M I am a cmployet with S 4 L] I am -a general contractor and 1 fa, New construction employees (full ftftdlorpart-time).* 211 1 am a soleptoptictor or partner- have hired, the sub -contractors listed on the attached sheet 7. Rcroodcling ship and have no crnplo)ves 11m, sub -,contractors have 8. Deniolitiori working for me in any capacity. employees and have workers" 9. Building addition (No workers' comp. iniumce TcquimLj zomp- msurance,' 5. We area Corporation and its 10.(3 Electrical repairs or additions 1 D I am a homeowner doing all work- o fficers have exetciW their 11, Plunibing repairs or additions myself [No workers' comp. right of exemption MMGL 12, Roof repairs insurance required.] c. 152, § I(*), and we have no 13.0 Other employees- t.No workers' comet- insurance rmuired.1 *Any 41 mastalso fill out thew donbelow f Harcownm*ho submit tette adavit indiotingthey are doingall s=v affuh-irit inEcatinssuch. *Coote etors that 4mck this tha t uttae f a a itio f caw trapthermitie of tftc strb 2te tots state MVIOYM. Iftlic sub-cmtera dum � Arc cmployvcs, chi' Mustpiruvidt the 'Workem, conTalicy oumba, I am an employer that is provident; workerV compensation iavarancefor my explaytes. Below is the policyR and job site in ,lormadon- Insurance Company Policy #or Self -ins. Lic. Expiration mate: A-011RI4 . ..... Job Site Ad; ress: --4..QON V 1 cityistateizip: r V ft&)Av-c( OLVI Attach a copy of the work -en' compensation policy declaration pop (showing the policy, number and expiration date). Follette to se= covcrage as requited under Section 25A of MGL c. 152 can I" to the imposition of criminal penalties of a fine up to 51,500.00 andior one-year imprisonmra, as wetl as civil peaalties in the form of a STOP WORK ORDER and a fine, otup to$25OMa day agautst the violator. Be advised that a copy of this statement may be forwarded too .the Office of Investigations of the DIA forinsuranec coverage verification. I do hereby certify under the paiins and penalties ofperjuty that the information provided above is true an4rorrod. Phone ry Official use ono. Do neat write in this area, to be completed by do or town official, City or Town: Permit/License #, J&suing Authority (circle on4e); I. Board of HeaM 2. Building Mpartment 3. Cityllfown Clerk 4. Electrical Inspector 5. Plumbing, Impeder 6. Other contact Person: none AC<>A'L> CERTIFICATE OF LIABILITY INSURANCE vl..� -F ' "IS C€RTiF CAM 15 ISSUED ASA KATTER OF MfOWATIONikii f ANO CS N= P .ISM R N THE CERTIMATE SOLDER. ii;lS CERTIFICATE DOES NOT Afi i?YaTiVE'Ly CA�St+f"ME Y OeN , tMM> OR ALTER. Tiff COVE GE A CRD Ea By THE POUC ft -low. TMS CERTIFICATE OF WSURANCE WES XOT CO€nSfYi'ii`?f. A CONTRACT EC WEIN THE ISSUING INSURERtS), AUTHORIZED ROMESEN ATWE OR PROOKER, AND Ttf£ C 13FICATC HOLMA MA IPORTNT: If tt* 19 ;;A _ L IX5U F t M, t t k Ys } M atS;T t RTI N IS k#AIM,' to t t" -Ag Atid 0(ft VOW, ca~fWft arta; rq er4o sAftWn , A i8r w%T on tteTSr *At d4ts Rat a rjw mtft to toe 4'1EltffsL�t$ hdaw in t%; tat swh ertitXtrsemA41f(5l. ChytM MaftM J Ins Aqwmy bw 8rrxt A frxst Risk Services 160 ftorOwnptanSt ice'! Box SO €rte t �f SSA +�.+m.4 iii i� Zl� isit� "a"ke MA 01041 OMRAsf a�€xc+a 1 ;Ii r Gou"ofImultdot°t W max€ Po Box ttt Ipmoc'k MA Q9$ sv5w§xs€ a SMECT T TO ALL TifE TERMS, #ds 113Y 160"-" fes" p 'vA€tA7d: d eS�' f& M A m m ,, sI m SHM40AW Of ;^ ..Abq-Q OL$ i— z, tae --Es sE CWMtEO W Claaraau[t TW-EPR4TK)M0ATETHMOfaT L Coati dor SVCS ACCD14rANa4M IHT{�' 54 Vidxshwot ttt s'ifaot 04h,MA 01541 ACM 25 (20110105) 8RAC 3139 , uA*%ft t 01 UEA-110"DW ?Sffata WFASE . INX14 SHM40AW Of ;^ ..Abq-Q OL$ i— z, tae --Es sE CWMtEO W Claaraau[t TW-EPR4TK)M0ATETHMOfaT L Coati dor SVCS ACCD14rANa4M IHT{�' 54 Vidxshwot ttt s'ifaot 04h,MA 01541 ACM 25 (20110105) 8RAC 3139 ACORO0 CERTIFICATE OF LIABILITY INSURANCE DATE (MM/DD/YYY1) 7/7/2015 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 Martin J Clayton Insurance Agency, Inc. 1649 Northampton Street P. 0. BOX 989 Holyoke MA 01041-0989 CONTACT Nancy Usher NAME: y PHONE a/c No Cl: (413)536-0804 Nol: (413)534-7874 E-MAADDRIESS: INSURERS AFFORDING COVERAGE NAIC# INSURERA:Nationwide Mutual -Harleysville NATIO INSURED Gauthier Insulation 44 ESSEX ROAD IPSWICH MA 01938 INSURERB:Allied World Natl Assurance Co INSURERC: INSURER D: INSURER E : INSURER F: COVERAGES CERTIFICATE NUMBER:CL157701379 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 nign SUBR wvn POLICY NUMBER POLICY EFF MMIDONYYY) POLICY EXP I 1MM/DDIYYYY1 LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE FxI OCCUR X GL43487F 7/6/2015 7/6/2016 EACH OCCURRENCE $ 1, 000 , 0(10 DAMAGE TO RENTED PREM SES Ea occurrrence $ 50,000 MED EXP (Any one person) $ 5,000 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY PRO- JECT LOC OTHER: GENERAL AGGREGATE $ 2,000,000 PRODUCTS - COMP/OP AGG $ 2,000,000 $ AUTOMOBILE LIABILITY ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS NON -OWNED HIRED AUTOS AUTOS COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ {Per accident) B X UMBRELLA LIAB EXCESS LIAB HCLAIMS-MADE OCCUR BE020792125-194985 10/18/2014 10/18/2015 EACH OCCURRENCE Is 1,000,000 AGGREGATE $ 1 , 000 , 000 DED I I RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE ❑ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA PER OTH- STATUTE I I ER E.L. EACH ACCIDENT $ — E.L. DISEASE - EA EMPLOYEE $ E.L. DISEASE - POLICY LIMIT I $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) CSG, NSTAR AND NATIONAL GRID ARE LISTED AS ADDITIONAL INSURED CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD MF?r §tbd with pdfFactory trial version www.l)dffactory.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MASS SAVE PROGRAM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET AUTHORIZED REPRESENTATIVE WESTBOROUGH, MA 01581 Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD MF?r §tbd with pdfFactory trial version www.l)dffactory.com rn C a {� A RI 0�.� f c GHQ L Q � v n o' `fl C r1« G D"i=r t _ m � ;o , f f •*}il L Q � /1 14.E r1« § , CL M t M 4 C L.' G D"i=r t _ m � ;o L Q V /1 14.E r1« § , CL 06 0 r A 2 ! K E... O S7 O �... s i m 01m 2 ty O M = n � i i i