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Home My WebLink AboutBuilding Permit #691-15 - 41 BEAVER BROOK ROAD 3/2/2015Al, 1-1- 1 TYPE OF IMPROVEMENT PROPOSED USE' Residential Non- Residential 0 New Building 11 One family [I Addition 0 Two or more family 0 Industrial No. of units: D.Cbmmercial —NAlteration— E]'Npair, replacement 0 AssessorV Bldg El Others: El Demolition0 Other i U Septic - -- i r, - El - GFJO 'I Q_,-Wat%�J,& _wgr 6- 5 DESrIPTION OF WOKKA114, "-I= FtK1-L)KMtU:- ft1k ' Z7(J,5 J t A--/)() CAJ iaentincanon - riease type .UJ[-KKML,%-1V2111Y- OWNER: Name: - Phone: 17� we no toriff. a 0-1 o r, Name: �-,- I 6q E250 ARCHITECT/ENGINEER Phonef, Address: Rba:- No.;.v-, FEE SCHEDULE: BOLDING PERMIT. $12.00 PER $1000-00 Oj='THEiToTAL',-ESTJMA-TTED,COSTBASED ON $125.00 PER S -I=- l Total Project Cost: $ FEE ,,,,$' Check No.: Receipt—No':''. �Q NOTE: fie-r-s-o-nT —scodiracting with unregistered contractors- daxoihave- access to the g J -A -"d qqqlty J Location y NoC/// �� Date Check #o 2353`0 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee, Other Permit Fee $ TOTAL $ Building Inspector Plans Suhnitted ❑ ,Ck Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPF;OF SEWERAGE DISPOSAL. p��blic Sewer ❑ Tanning/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 COMMENTS Reviewed On Signature. CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS -__i;?oning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Conservation Decision: Comments Com Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: 384 Os 1FCR� E IDEPARTtMENT Ternp [®umpster�on�isite yes _ �- Located goo Street ocatedat 124 M I, p ain�Street� - - .—a Q1 _- 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.$100-$1000 fine NU I t5 and DATA — (For department use ❑ Notified for pickup Call Email I Date Time Contact Name., Doc.Building Permit Revised 2014 L r 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/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 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 7 ❑ 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. Permi 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 recordir, must be submitted with the building application Doc: Building Permit Revised 2014 _v N� C � Cl) 0 O D O 'a of � _• �CLo D cc a o vCD CQ = a CD CD O 013 W CDCD i CD 'v CD y� CC C ' � v O CD Z 0 �- rNIOL O CCD O CD 0 O V - d Z rnm �� 0 rn z X I 22 ;o ;om nN --j Z C G „03 -R E;''= —1 O y - < cr CDD y N O- 0 CCD n O 0 CL 0 Zp' _� tn' _-I 0 v' a` c m ,.r 0 0 r"' O- 0 m CD W 0 U) 0 cn N C CD '0 - m 2 CL O N @ n 5' n O to CD -0 -0 n ---i c 5 5' O < to CQ y: CCD 0to :O "' c O 0' as. .� < r0 0 00- CDs_' N a) CD 0� W`D CD . Cn Q) -a :Go+ ID 0 0 a . CD CD •_ U) cD C CD y C> O 0' D CD03 - CD s a) O CL , N Y W T O .Z1 O T 5' Ln O (D O S T O 7,7 O 5 T n rD rD ;U O S T O N (D �G T O rr t T m D m H Z EA O m m A a r- m V C W z m C Z Z m 3 ' W c O D z A A r 0 C mz some /'076 110116 a �- - C— > Z /'51 0 � Federal ID 0 k RISE Engineering RI Contractor Registration No MA Contractor Registration No _ A division oCfhielseb t ngineering CT Contractor Registration Na 60 Shawmut'Unit 92. Canton, MA 02021 CONTRACT 339-502-6335 FAX 339-5 �- 'i�ry. ,..,.----�-- - q�}j�j( Page i V Ear f� 1J PROGRAM TH*C0NMCTISEmEREJ)M?O9E1WEENFAf "aa.::•JJ CSMA 11 ES ENOWEERINO AND THE CUSTOMER FOR WORK AS ENGINEERING DEsca<aeos�ow _ _. _. _........................ ......_ __,..._. ....... ..._ .. _, _.._ . __ _ _ _. _..,.. .....- _........_.___... _.........._-.__..._._...,_w______...e..,_... CUSTOMER rjij` - PHONE. DATE CUENT11 Lvv .___ _. .... ._....__ WORK ORDER Bonnie Leblanc' (978)888-3629 1212912014 406293 06002 6ERVIC6 R.'UNO WREE, 41 Beaver Brook Road I Beaver Brook Road aERYICE CITr.sTATE.ZIP arwNa CITY.uTATE,X4P North Andover, MA 01.845 North Andover, MA 01845 JOB DESCRIPTION AIR SEALING: Provide tabor and materials to seal areas ofyourhome against.westerul, excess air leak -age. This -ovrk will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be Ica with a healthful level of air ex -change and indoor air quality. Materials to be used to seal your home can include caulks, roams, weatherstripping and other products. Primary areas for scaling include air leakage to attics, basements, attached garages and other unheated areas (windows are not generally addressed) (8) uvrrking hours. At the completion of the weadrerization work. and at no additional cost to the homeowner, a final blower door a ndlor combustion safety analysis will be conducted by the sub -contractor to ensure the safety of the indoor air quality..GHEC1 A/C E300"t511! HOUSE CLOSE TO BAS!!! $600.00 DAMMING: Provide labor and materials to install a 12" layer of R-38 unlaced fiberglass beats to (92) square rect for damming purposas, $188.60 ATTIC FLAT: Provide tabor and materials to install a 6" layer of R-21 Class I Cellulose added to (1264) square feet of open attic space. $1,516.80 RISE Engineering will apply all applicable, eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures, Columbin Cas offers 75% incentive, not to exceed $2,000 per calendar year, and an incentive of 1000/. for the Air Sealing measures up to $600. For 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 both bcrore the work is begun, and after the weatherization work is complete. We will also conduct a full assessment of the combustion safety oryour heating System rind water heater. This has a value of $90 and is at no cost to you. Total allowable wcWherization incentive is 52,690. $90.00 Federal ID A ngineering RISE r Rl Contractor Registration No V MA Contractor Registration No A division offhielsch Engineering CT Contractor Registration No f JOB DESCRIPTION Total., $2,396.40 Program Incentive: $1,969.05 Customer Total: $426.35 WE AGREE HEREBY TO FURNISH SERVICES - COMPLUE 1*4 ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE SUM OF ***Four Hundred Twenty -Six & 361100 Dollars $426.36 UPON MAL tuspecTiONAND APPROVAL. DY RISE ENGINEERM.CUSTOMER AGREES TO REMIT MOUNT DUE WAXk. MEREST OF I% WML BE CHARGED MOMMY ON ANY UNPAID OAVL-4q=x 30 DAYS. SEE REVERSE F IMPORTANT INFORIAATION ON GUARANTEES, RIGHTS Of RMSIM SCHEDULING, AND CONTRACTOR REGISTRATION. ....... . .. . ...... .. .... ........... . . . ..... . ..... . AFTER "All TER 00 NOT SIGN THIS CONTRACT IF THERE ARA, 81J�i�p '66 IS .y NATU DsF3"—' RE IS FRI40 MER ACCEPTANCE NOTE; THIS CONTRACT MAY SE "THOMM BY US IF NOT EXCCUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT. -c—tVID-n-m—us ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED. YOU AM AUTHORVED T*�Pd\ WORK DAYS. ASSPECIFIED. PAYMEMWUGEPdADEASOMUNWASDVC -0 Shmmut uqgt n4, Canion, MA. 02021 CONTRACT 339-502-6335 FAX 339-502,6345 Page 2 RI S E PROGMM CMA -RES THIS CONTRACT IS CUMED INTO 8 M-VEEN RISS ENGINEERING AND THE CMTOM FOR WORK AS ENGINEERING mcnaca naaw CUSTOMER .......... . . None DATE CLIENT I WORK ORDER Bonnie Leblanc (979)888-3629 12/29/2014 406293 00002 SERVICE STRSET DIU= STREET 41 Beaver BrookRoad 41 Beaver Brook Road SERVICE TY, STATE, ZIP 13WUG CITY, STATE, ZIP Worth Andover, MA 01843 North Andover, MA 01845 JOB DESCRIPTION Total., $2,396.40 Program Incentive: $1,969.05 Customer Total: $426.35 WE AGREE HEREBY TO FURNISH SERVICES - COMPLUE 1*4 ACCORDANCE WITH ABOVE SPECIFICATIONS. FOR THE SUM OF ***Four Hundred Twenty -Six & 361100 Dollars $426.36 UPON MAL tuspecTiONAND APPROVAL. DY RISE ENGINEERM.CUSTOMER AGREES TO REMIT MOUNT DUE WAXk. MEREST OF I% WML BE CHARGED MOMMY ON ANY UNPAID OAVL-4q=x 30 DAYS. SEE REVERSE F IMPORTANT INFORIAATION ON GUARANTEES, RIGHTS Of RMSIM SCHEDULING, AND CONTRACTOR REGISTRATION. ....... . .. . ...... .. .... ........... . . . ..... . ..... . AFTER "All TER 00 NOT SIGN THIS CONTRACT IF THERE ARA, 81J�i�p '66 IS .y NATU DsF3"—' RE IS FRI40 MER ACCEPTANCE NOTE; THIS CONTRACT MAY SE "THOMM BY US IF NOT EXCCUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT. -c—tVID-n-m—us ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED. YOU AM AUTHORVED T*�Pd\ WORK DAYS. ASSPECIFIED. PAYMEMWUGEPdADEASOMUNWASDVC M owner of he prgmM located at LlI 13 -0—R v e, V^ t7roo l < hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to acton my behalf to obtain a building permit and to perform work on my property. &2e WQe9—woauaealllt ol(pl sel Office of Consumer Affairs &Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ' gistraiFon: ,194800 Type: Office of Consumer Affairs and Business Regulation ® irafion: 752016 Private Corporation 10 Park Plaza .Suite 5.170 HUGH'S ENERGY CORP.O... iON `: ' Boston, KA 02I16 DANIEL DRISCOLL 259 MILTON STREET �r;, DEDHAM, MA 02026 Undersecretary Not valid without signatu Massachusetts�-ePa�rtrnerntt soars of Euii i;�aof p ubiIC vlanSarfueti07S#rCy f7firtn� iSpr Lice nse: L`"5 rhonlaspzoro 259Mitt0�os+te �dl1a��t /► a ks 46 Cornrnissioner fzxpiration 1O122✓2016 CERTIFICATE OF LIA13IL11Y INSURANCE CAiE(kN WIIIII YyI THIS CERiIPlCA7E 1S ISSUED ASA MATTE111111 R OF INFORMATION ONLY AND C 10/06I2094 CERTIFICATE DOES NOT AFl7RMATill OR NEGATIVQY ONfERS NO RIGHTS IrPON THE CERTIFICATE HOLDER. THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT COCA EXTEND OR ALTER THE COVERAGE REPRESENTATIVE OR PRODUCER, AND THE CEDOES NO MOLDER. A CONTRACT 13ETN MNN THE' ISSUTAMM 8Y THE POLICIES IMPORTANTi ff the �� holder is an ADDlTlpl►AL INSURED, the olt (bi. AUTHORIZED the terms and conditions of the policy, certain pol(c(� P cy(les) must be endorsed, I€ StIBROOAiION IS WAIVED. subject to Cerdflcate holder in ileo .6—L endo s � rMp an endorsement A statement on this cer6Rcate does not confer rights to the �onuceR G Insurance Agency, Ina _-- BOURED 258 Milton Street • Dedham. MA 02028 THIS • •vrsac n1VRl6GK: i5 TO CERTIFY THAT THE POLICIES OFUI INSURANCE USTEp BELOW HAVE BEIN ISSUED TO THE IN3UREp NAMED ABOVE FOR TtIE POIJCY PERIOD INDICATED. NDTWiiHSTgNDING ANY REQUIREMENT REVISION NUIiIIBER. CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POUCIES DESCRIBED HEREIN 13 SUBJECT TO ALL THE TERMS, OR COIVOITiON OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS EXCLUSIONS AND CONDIT(ON3 OF SUCH POLICIES LIMITS SHAWN MAY HAVE BEEN REDUC®BY PAID CLAIMS. 1E�B ` wrw CL004 � oe OCCUR X unlzs EACH X PS2020892 OH412014 08/14/2015 E 29AAOG1EQAT UWrAPPMPM MEDE7O+ mlepal POLICY a ❑ LOCGMEMAt aA[31/HUM S AGr¢REQATE s AUTOMOME UABMM PRODUCTS-C011�A7PAGO S C Al AtLOVMW X �ULEa 70200327'64 s 08/74/2014 0817 ° 5 S 4/Z015 BDDILYMAIRYOWPIMM) MMMAUMS AUTOO W S RODn-YINJ wapIllll) s UAWROLLAUAS X OCCUR C s A DCCENUAB CLAMS•MADE DEQsscoYPENSAX nETENnoNs 90000 044410 8 10107=14 011114/2075 FACHO �� 5 willu roN $ ANDEeIPLOYERSLy l3 S MYPRWWW Y OFM DED? IA (rt ndtmryInfpi) R2WC513M STATUTE ER 08108/12/2015 cI cenu w....n...w QESCR1Pr10NOFOPARgT(pN51U7CAitQNsIVEHICIES (ACORDIOt.p !�Y boaoaehad ffnareype�e is ADRRCHE THE SHOULDANYOFTHBASOVHDEBMBEDTION DATE POLICIESBECANCFr BEFORE ACCORDANCEWM TTMHEPTHEREOF, NOTIOE vaL BE DELIVERED IN OLICYPROVWOM ACORD 28 (2094109) 19 Memed. The ACORD ail Olaw"l094 ORDAUUMCORPORATION. AN 119hts name and Logo ar+a registered marks of ACORD The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street, Suite 100 Boston,'MA 02114-2017 www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LetsibiV Name (Business/Organization/Individual): Address: City/State/Zip: Are you an employer? Check the appropriate box: Phone #: 7T/ 6 0 6 / 3 6y 1,Q4—,n i a employer with employees (full and/or part-time).* 2. ❑ I am a sole proprietor or partnership and have no employees working for me in any capacity. [No workers' comp. insurance required.] 3. ❑ I am a homeowner doing all work myself. [No workers' comp. insurance required.] t 4.F1 I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers' compensation insurance or are sole proprietors with no employees. 5. ❑ I am a general contractor and I have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.$ 6. ❑ 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): 7. ❑ New construction 8. ❑ Remodeling 9. ❑ Demolition 10 ❑ Building addition 11.❑ Electrical repairs or additions 12. ❑ Plumbing repairs or additions 13. ❑ Roof repairs 14. *Any applicant that checks box #1 must also fill out the section below showing their workers' compensation policy information. f 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 employee's, 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: v Policy # or Self -ins. Lic.. #: ��, �?j d�j Expiration Date: L 15 Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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. A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. /I /,-) I do hereby certify under Phone #: 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 - ,Z - )-J l 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