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HomeMy WebLinkAboutBuilding Permit #905-2016 - 41 BREWSTER STREET 2/22/2016 OF BORTH BUILDINGS PERMIT tits E "o TOWN OF NORTH ANDOVER 0 � p APPLICATION FOR PLAN EXAMINATION IJORTANT: Permit N®#: � Date Receiveds9S ACHU5Date Issued: Applicant must complete all items on this page LOCATION L-11 not PROPERTY OWNER CA C- to r rye 7 , , �—print 100 Year Structure yes no MAP �Z.�j PARCEL:I)Clp I ZONING DISTRICT: Historic District yes no 1 Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 2!PQne family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic [7 �® Floodtpl ®' e tlansI Waterers e ®stric�tz >` D Water Sewer ... m DESCRIPTION 9F WORKTO BE PER RD: C� OL Idenfific on Plea a Type or Print Clearly �� �/ �7"-7t OWNER: Name:`TO� �J Phone: Cly U Address: Ll I / Contractor N mePhone:' 3'J �-�— lGl �� : E Email: Address: I in Supervisor's Construction License: (t9� Exp. Date: o Home Improvement License: 1 ���u � Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$j12.00 PER$1000.000 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. FEE: $ 2J/}�� Total Project Cost: $ ---- Check No.: Receipt No.: NOTE: Persons con ratting with unregistered contractors do not have access to the guaran fu Cc -� Location Date No. ` i I . • TOWN OF NORTH ANDOVER jCertificate of Occupancy $ I. Building/Frame Permit Fee $ �� , Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# _? Building Inspector J a it -- —--------------------- ------- ----- Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE-OF.SEWERAGEDISPOSAL Public Sewer ❑ Tanning/MassageBodyArt ❑. . Swimming Pools ❑ Well ❑ Tobacco.Sales ❑ Food PackaginglSales ❑ 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 HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes . Planning Board Decision: Comments Conservation Decision: Comments Water &Sewer Connection/Signature&Date Driveway Permit DPW'Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT -Temp DurnOter on site yes-. . no Located at 124 Main Street Fire Department sigratureldate 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.$100-$1000 fine I NOTES and DATA—(For department use) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Pennit 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract o Floor Plan Or Proposed Interior Work o 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 o Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract o 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) o Building Permit Application o 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 NOTE: 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 ttORTfy Town 2Andover 4L h ver, Mass, e 22-uito coc Nlc N!wKK 1• x�pAo .95 44TED Ll BOARD OF HEALTH Food/Kitchen PERMIT T LD 000-10— Septic System THIS CERTIFIES THAT .............I.. e-ftjAo'^.&_ ''� BUILDING INSPECTOR ...................................... &.0it Foundation has permission to erect.......................... uildings on ...J41.... ..... .. .. .......... Rough tobe occupied as ....s c...... .. .. ...... !................................................................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO STARTS Rough .. ... Service ..... L/% ......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Einal YY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. • Foderal ID#054405524 RISE Engineering RI Contractor Registration No 8185 MA Contractor Registration No 120979 A division af!llfclsclt Engineering 11..141SE ENGINEERINGE,0 Shawntut Unit#2,Canton,AIA 02011 CONTRACT 339-502-6335 FAX 339-502-6345 Page 1 PROGRAM THIS CONTRACT 4 rNTERED INTO 13MYMN RISE CMA-IIES ENOINEEM6 AND THE CUSTOMER FOR{YORK AS MCRIREUeetow ....... .. .............. __._. ........_ _....._. ........._...... _,. _... _..., .................. ................................__ CUSTOMER RHONE DATE CUENT0 WORK ORDER Tara Richards-Heim (978)687-7182 01/14/3016 426557 00002 __.... _ _. ._. _..... __.. .. _ ........ SERVICE STREET ..... 0111IN0 STREET 41 Brewster Street 41 Brewster Street SERVICE CITY,STATE,ZIP BIWNO CITY,STATE,ZIP- North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIP'T'ION AIR SEALING:Provide labor and materials to stat areas of your home neninst wasteful,excess air leakage. This work will be performed in concert with the use of special tools and dia nostic tests to assure that your home will be IcR with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include cuulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated arras(windows are not generally addressed.) This will require(9)working hours.A reduction in cubic feet per minute(eft orHir infiltration will occur,but the actual number of efm is not guaranteed. At the completion of the weathcriration work,and at no additional frost to the homcomier,a Final blower door and/or combustion safety analysis will be conducted by the subcontractor to casuru the safety of the indoor air quality, $680.00 DAMMING:Provide labor and materials to install a 12"layer orR-38 unlaced fiberglass baits to(50)square feet for damming; Purposes. 5102.50 ATTIC FLAT:provide labor and materials to install a 6"layer of R-21 Class I Cellulose added to(300)square feel al'open attic space. 5378.00 STOItAUE BARRIER:Homeowner is Responsible for the removal of the stored items blocking the installation of wcadwrimtion work in the attic. Removal must occur prior to the scheduled work start, 50.00 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic occcgs folding stair. The cover has integral weather-stripping to restrict air leakage. $200.00 VEN111LATION.Provide lubur and maictials to install(I)insulatedexhaust hose with gable%vWl mounted flapper vent to exhaust existing bathrnont fart(s). $118.75 VENTILATION:Provide labor and matcrialq to install vcnii lotion chutes in(18)railer hays to maintain air flow. S36,00 STORAGE BARRIER:Homeowner iq responsible for the removal of the stored items blocking the installation orweatheriYation work in the basement. Removal must occur prior to the scheduled work start. $0.00 CRAWBPACE:Provide labor and materials to install (224)square feet of ft-10 rigid Thermal insulation to the cmwlspace perimeter wall up to the sill and against the band joist.THIS 1S ACTUALLY A CRAWL SPACE CEILING IN CONVE11TED GARAGE.30"HEADROOM CONrRACTOR DISCRECTION. 5828.80 RISE Engineering will apply alt applicable,eligible incentives to this contract. You will only be billed dtc Nct amount. Currently, lbr eligible measures,Columbia Lias offers 75%incentive,not to exceed 52,000 per calendar year.and an incentive of 100'l I'or the Air Scaling measures up to the first$680and on additional 5340 irsavings arejustified by the auditor. For the safely and health of your home's indoor air quality,we will he conducting,a blower door diagnostic orthc available air f ovv in your home bath before the work is begun,and after die weatherization work is complete.We will also conduct a fool as essrnetll of the comhustion safety of your heating system and water heater.This has a value of$90 and is at on cost to you. 'rain)allowable Federal ID#06.0405629 RISE Engineerinn No 8186 g MA CCoRntracto RegistrsRegistraation No 120970 RISE A division of bielsch Engineering ENGINEERING 60 ShRTvmut Unit#1,Canton.MA 02021 CONTRACT! 339-301-6335 FAX 339-501.63€5 Page 2 PROGRAM MIS CONTRACT IS ENTERED NITO BETWEEN RISE CMA-HES ENMEERINO AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW _._..,. . ...... CUSTOMER PHONE DATE ...... WENT WORK ORDER T ara lticliards-Heim (97$)687-7182 0/14/20 16 426557 00002 SERVICE STREET SIUDND STREET 41 Brewster Street 41 Brewster Street _.__... ....._... ..........._.. _.... �_..._ ............ . . ._ _....__.. . __._..._._ . SERVICE C[TY,STATE,IIP BIWNO CtTY,BTATTE,aP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION weadwrization incentive is$3,114. 5930.00 Total: $2,434.05 Program Incentive: $2,018,04 Customer Total: $416.01 WE AGREE HEREBY TO FURNISH SERVICES•COMPLEME IN ACCORDANCE WItH ABOVE SPEiCIFTCA'nCNS.FOR THE SUM OF '"'Four Hundred Sixteen&01/100 Collars $416.01 UPON FOUA.I ECTK1 CA PPROVAL BY EIHHNEERMC.CUSTOMER AGREES To REABTAMOUNT DDE IN FULL INTEREST OF S A.WILL DE CHARDED MONTHLY ON ANY UNPAID CE QAYS,3EE E FDR IMPORTANT POORIAA110H ON OUARANTEES.RNSHTG OF RECISION,SCHEODUHO,AND CONTRACTOR REGMTRATION. _. :_.._ _ a O-rS-1G-N THIS CONTRACT IF THEREARE�E ANY titANK SPACES y TI, SIGNATU4 EE"i .0 CUSTOMERACCE"A.It:E NOTE:THIS COTlTRACT MAY BE YNTMORAWN BY US IF NOT EXECUTED YBTHdt! DATE OF ACCEPTANCE .. ..._ .. ,,._ ....... .._..._........... ACCEPTANCE OF CONTRACT•THE.ABOVE PRICES.SPECIFICATK)tF AND COMITOND ARE 3O DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHOR=TO 00 THE WORK AB SPECIFIED,PAYMENT WRA 90 MADE AS OUTUftED ABOVE The Commonwealth of Massachusetts Print Form 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): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone#:603-324-1974 Are you an employer?Check the appropriate box: Type of project(required): 1.21 I am a employer with 100 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6. E]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' Y ,. 9. E] Building addition [No workers' comp. insurance comp. insurance.'+ required.] 5. ❑ We are a corporation and its l0.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.] !- c. 152, §1(4),and we have no Weatherization employees. [No workers' 13. ✓❑ Other comp. 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. *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: ACE American Insurance Company Policy#or Self-ins.Lic.#:WLRC 48151553 Q Expiration Date:6/30/2016 ' Job Site Address: _mac 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 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. e e.Ido hereby certi under the pains andpenalties ofperjury that the in ormation provided above is true and correct. 3 Si nature: Date: Phone#:603-324-1974 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: i �1 ® DATE(MM/DDYYYY) A�Ra CERTIFICATE OF LIABILITY INSURANCE 1 06/24/2015 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(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 confer rights to the w certificate holder in lieu of such endorsement(s). PRODUCER CONTACT a NAME. AoSouthfield MI office (Arc.No.Ext):n Risk Services Central, Inc. PHONE (866) 283-7122 Faxac.No.l: (800) 363-0105 d a 3000 ToWn Center E-MAIL o suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER AI Old Republic Insurance Company 24147 TODBuild Corn. INSURER B: ACE American insurance Company 22667 Daytona Beach FL 32114 USA Jimmy Ann Dr1Ve DayINSURER C: ACE Fire Underwriters Insurance Co. 20702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570058348882 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. Limits shown are as requested INSR ADDI SUER POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER (MWDDIYYYYI IMMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 4 4 ' Ub/SU/2U15 Ub/3U/201b EACH OCCURRENCE $2,00D,000 CLAIMS-MADE X❑OCCUR A SAG O $2,000,000 PREMISES Ea occurrence MED EXP(Any one person) $2S,000 PERSONAL B ADV INJURY $2,000,000 m GENT AGGREGATE LIMIT APPLIES PER! GENERAL AGGREGATE $4,000,006 m X POLICY ❑PERO- ❑LOC PRODUCTS-COMPIOP AGO $4,000,000 OTHER: o n A AUTOMOBILE LIABILnY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT Ea accident $5,ODD,000 X ANVAUTO BODILY INJURY(Per person) O Z ALL OWNEDSCHEDULED BODILY INJURY(Per accident)AUTOS AUTOS AUTOS AUTOOWNED PROPERTY DAMAGE M X HIRED AUTOS X Peracadem — AUTOS t: m UMBRELLA UAB OCCUR EACH OCCURRENCE U EXCESS LIAR CLAIMS-MAGE AGGREGATE DED RETENTION e WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE ORH EMPLOYERS'UABILITY YIN All other States ANY PROPRIETOR I PARTNER/EXECUTIVE E.L,EACH ACCIDENT $1,000,000 C OFF ICER/MEMSEREXCLUDED? NIA SCFC481519D 06/30/2015 06/30/2016 (Mandatory in NH) WI Drily E.L.DISEASE-EA EMPLOYEE S1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000— DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of coverage C=J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE HALL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE SJU A TopBUild Company 260 Ann Drive Daytonaona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Office of Coy surer Al a rs sand Bsiness Regulation 10 Part: Plaza - Suite 51170 Boston; Mlassaehusetts 02116 Home Improvement Contractor Registration Registration: 179141 Type: Supplement Card Expiration: 622512016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 i adate adores,and return card.Bari:reason for change. jddres Rene"al Fna1)InYmL'nt Last Card piicenfConsumerAffairsS Business Rcgulation License orregisiritiant'alidfor indisidulusrc3ni� t�'- }OME iMPROVEMENT CONTRACTOR before the expiration date. If found return to: _.;,f._ Ofi.ce of Consumer Affairs and Business Regul2tion - Ri egistration: ;79141 Type i0?ar P12z2-tiuir 5'_iU Expiration: 62512616 Supplement and Boston,1N9A 02116 11LDER SERVICES GROUP,INC. SHA.RD SCi iI ARTZ G JIM1Y1 Y ANN DP.!VE ~��-- NTONA SE CH. =L-12114 t nderstcrttarn Not sign21ure CSSL-105992 RWHARU WRWAR Z 193 HUNTRESS STREIET Manchester NF1 113102 c✓.� — ..f 09/26/2016 Restricted To CSSLIC insulation Contractor Failure to pCISSes,. -rent Pdaiun of the Massachusetts State ftuilding Cot Buse for revocation of t.h,K Incense