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HomeMy WebLinkAboutBuilding Permit #697-15 - 42 CHURCH STREET 3/4/2015�hI1ti BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 0116 Date Received Date Issued: LOCATION OQ�6�e4— x/O�tt�,ED 16 6N. a 7a A�R•�7Eo I.PP ,.(�7 'IMPORTANT: Applicant must complete all items on this page rint PROPERTY OWNER II/,a %✓IP. ��L)taAe-r7 � Print 100 Year Structure MAP PARCEL: tJ/��]/ ZONING DISTRICT: Historic District Machine Shop Vi n no no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer OWNER: Name: Address: Contractor Name Addres DESCRIPTION OF WORK TO BE PERFORMED: entification - Please Type or Print Clearly P Supervisor's Construction License: /ds1 % Exp. Date: 9L13 Home Improvement License: ARCHITECT/ENGINEER Address: 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: $Gj FEE: $ �— Check No.: d Receipt No.: NOTE: Persons contracting wit r red contractors do not have access to the a nd Signature of Agent/Owner Signature of contracto • 41 Locatio Ad � " " -- `r� No. 21(� ' S Date 13 L4 I 099 - i, TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check # v j . Building Inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public 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 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 Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: FIRE DEPARTMENT - Temp Dumpster on site yes Located at 124 Main Street Fire Department signature/date COMM Jt' -hYs " Locatea 3M Usgooa Street no 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 NOTES and DATA — (I -or department use ❑ Notified for pickup Call Emai 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 ❑ Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o 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 o Certified Surveyed Plot Plan ❑ Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses o Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) E3 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 ❑ Certified Proposed Plot Plan o 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) o Copy of Contract o Mass check Energy Compliance Report o 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 0 3 0 EEO Mt J Q S LL Q m C Nm -C 0 O ILL fz {n w vaf Z Z O J 7 LL =$ 7 C � U � LL O LLI a H Z Z m J CL. CO 7 0: � LL O CL H ? U W u J LV h0 7 O_ i N � LL � 0 U d N Q tip O� w LL Z LU2 °c a ui LU 25 LL C +- CO N � N Y O V1 n . O � O V .Q aD W �= y �Q w � E * o r S E Q L d � er =i G O 0 ",u O C = 01 C • is M J m a. cnj .> L. 0 > rn — �a a �' �•ts O Z Ego O QWz ai X00 c OL- H �a (�� as v •+ = C tm . V O r _ Q a�Li cc 0 o U) .2 z— W co -a r o o . LL y f/1 C O O F- U)O +, � � Z LUw Lu v v E L V ai 0-0 j .O O O H t y0. Q. O U > O w CL Z Lr) 0 m ``o Cl) r Z H 0 C co Z V W CL xZ W0 N � W LLI -j IL Z z Iml 00 O Q CL � Q J O Z V C. 10 Park Plaza e Suite 5170 B®st®n9 Massachusetts 02116 Home Improvement Contractor Registration NEXT STEP LIVING INC. ROGER OUELLETTE 21 ®RV®OCK AVE. 2TH FL BOSTON, MA 02210 CAS u 50M-04,04-Gio1216 ;'% f^nm-rrtcYncue�lir o j . l��zawclrusa!!a ., _. Office of Consumer Affairs & Business Regulation -HOME IMPROVEMENT CONTRACTOR Registration: 162111 Type: Expiration: 1114/2017 Supplement Card NEXT STEP LIVING iNC. ROGER OUELLETTE 21 DRYDOCK AVE. 2TH FL:— BOSTON: MA 02210 Undersecretary Registration: 162111 Type: Supplement Card Expiration: 1/14/2017 Update Address and return card. Dark reason for change. F] Address F] Renewal F1 Employment R LostCard (License or registration valid for individul use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Supte'5170 Boston, MA 02116,E f 'Kovalid without signature Ll Massachusetts department of Public Safety Board of Building Regulations and Standards Comtructioa Super%isor Specialh r. icense CSSL-102811 ROGER A ®VELLET wck RI 0280 iso %4-11 Expiration r fIm"Ilw0fle, 09MI 2016 Restricted To: CSSd C o Onsulation Contractor Failure to possess a current edition of the Mmachusetts State Building Code is cause for revocation of this Hcensea For (SPS Ucensing informa- tion C ift wtffP4,^s.M@ss.Gnv/®PS NEXTS-1 OP ID: EL �►��►�a,, CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDIYYYY) 10/0112014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ON4-Y AND CONFER$ NO RIGHTS UPON TH9 CERTIFIRATP HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EX END OR ASTER THE COVERAGE AFFORDED BY THE POLICIES SELOVV. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REP FSENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER, IMPORTANT: If the gertiftcate holder is an ADDITIONAL INSURED, the policy(ies) must be endorsed. If SUBROGATION IS YiIAIV Q, sepl8g g the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to top certificate holder in lieu of such endorsement(s). PRODUCER McLaughlin+ I Su�ance Agency 828 Lynn fells Parkwpy CONTACT Erin Lyons PHONE FAX Alc No x:781.665.2775 (A/C, No): 781-665=02 Melrose, MA 02176 John E. McLaughlin Jr. E-MAIL ADDRESS: X COMMERCIAL GENEFAL LIABILITY CLAIMS -MADE ® OCCUR INSURERS) AFFORDING COVERAGE NAIL 0 INSURER A: Nautilus Insurance 09130/2014 INSURED Mext Step Living, Inc. 21 Drydock Avenue, 2nd Floor Boston, MA 02210 INSURER B: Commerce Insurance Company 347 INsuRERC:A.1,M• Mutual Insurance Co. -- INSURERD:AXIS Insurance Company 15610 INSURER E: PERSONAL & ADV INJURY $ �, 1 INSURER F: GENERAL AGGREGATE $ �,QQO,QII COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY RgRI INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICF) THI� 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. INSRTYPE LTR OF INSURANCE L R POLICY NUMBER MMILDDI EFF t S DD EXP LIMITS A X COMMERCIAL GENEFAL LIABILITY CLAIMS -MADE ® OCCUR EcP2010198-12 09130/2014 09130/2015 EACH OCCURRENCE $ 1,000,000 PREM SES Ea occurAMAGE TO rence) $ 190,0001 MED EXP (Any one person) $ 0,000 PERSONAL & ADV INJURY $ �, 1 GEN'L AGGREGATE LIMIT APPLIES PER: POLICY ❑ JECT LOC OTHER GENERAL AGGREGATE $ �,QQO,QII PRODUCTS $ �, gIQ,Qp $ B AUTOMOBILE LIAB141TY ANY AUTO AALL UTOS OWNED X SCHEDULED UTOS NON -OWNED HIRED AUTOS AUTOS 14MMBGKKDM 09/30/2014 09/30/2015 COMBINED SINGLE LIMIT $ Ea accident ,. BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ D UMBRELLA LIAB EXCESS LIAB OCCUR CLAIMS -MADE E�11.1783547012014 09130/2014 09/30/2015 EACH OCCURRENCE $ 5,000 00 Q AGGREGATE $ 01909491 DED RETENTION $ $ �p. `io WORKERS COMPENSATIONPER AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE YIN OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below N / A O BE ISSUED BY CARRIER 09/3012014 08/30/2015 0TH. STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached If more space is required) FOR INFORMATION ONLY INFO -01 For Information Only SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE V, ©1988-2014 ACORD CORPORATION. All riahts reserved ACORD 25 (2014191) T-00 4RARP Igprq p 0 IoQQall) 4f AcoR The Common wealth of Massachasetis° Department of Industrial Accidents Office of Invesdgations I Congress Street, Suite 100 Boston, MA 02114-2. 017 � www.masc gevldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Next Step Living Address: 21 Drydock Ave . Boston, MA 02210 Phone #: (866)867-8729 Are you an employer? Check the appropriate box: LN I am a employer with 850 4. ❑ I am a general contractor and I employees (full and/or part-time).` have hired the sub -contractors 2. ❑ I 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 required.] comp. insurance.$ 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. El Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.❑ Roof repairs 13.© Other Insulation *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 affida-it indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or not tho3e 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: A.I.M Mutual Insurance Company Policy # or Self -ins. Lic. #: AWC-400-7030025-2014A Job Site Address: Expiration Date: 9/30/15 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 vp6Otion. Ido hereby certify under the pains and pen es perjury that the information provided above is true and correct. Signature: Date: I C) / t / Phone #45tdq) 8Y7 -n&9 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 #: /.t 00 ^ur-e energy satut,ars This agreement is made by and among Nadine Juliano 44 Church St North Andover, MA 01845 Site ID: A497601 1. )ESCRIPTION OF WORK TO BE PERFORMED Next Step Living, Inc. ("NSL") 21 Drydock Avenue, 2nd floor Boston, MA 02210 phone: (866) 867-8729 28 -Nov -14 NSL will perform or cause to be performed the following work on the customer's address above, in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail (the 'Work") which are incorporated herein by reference: rr _ .. '�ttC•aa i3x�•7a�v��L�E�•]�i-3 �� • - • � , Work Location: Wall s�q-ftt Insulate Vinyl Sided Wall With 4" Dense Pack Cellulose 1,610 $�11.6665y7 � (� L UL117�-r1 �111�17�a l -f 14. �$72r,y656{..5y0� ��'i'1"�'Li1� 75 % Weatherization Incentive up to Program Max $1,992.38 li�•,'`�(� % p "519�iii X 1 1 Estimated Annual Energy Savings from the Above Improvements $341.00 2. 'AYMENT: CUSTOMER agrees to pay NSL for the work as follows: Payment #1: $100.00 -Credit Card or E -check deposit is due at the time the Work is scheduled. Required payment information will be collected over the phone by a customer service representative at the time of scheduling. Deposit is not to exceed 1/3 of the total retail costs. (Note: Mastercard, Visa, and Discover accepted) Additional Payments and Final Invoice: $564.12 -Additional payments for the Work shall be due upon completion of the Work. If the final invoice is being paid by check, credit card information will still be required at the time of scheduling. Notify the customer service representative that you are paying by check and your card will not be charged unless we fail to receive payment within 5 days of invoice. AL. U.11111 Dec 8, 2014 ustwiue nature Date Az'. 28 Nov 2014 NSL-Signature Date William Calder Name of NSL Representative A497601 The Terms of this Agreement are contained on both sides of this page Next Step Living e 21 Drydock Avenue o 2nd floor o Boston, MA 02210 - (866) 867-8729 a inquiry@nextsteplivinginc.com a www.nextstepliving.com TERMS OF AGREEMENT 3. PROPOSED STAR' DATE ANL) COMPLETION SCHEDULE -vON RAVi_R REG13 i RAT;3V j Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston, MA 02116.617.973.8700 5. PERMITS 6. PERFORMANCE OF THE WORK AND CHANGES. 'a JC_, f')Ter AT, ITC 'L 5 1,. 7. INSURANCE AND REGISTRATION 8. QUALITY OF WORK. 9. PRE-EXISTING CONDITIONS & PROPERTY PROTECTION 10. GENERAL PROVISIONS. 11. ENERGY BENEFITS. :m, , _� •, % 12. NOTICE CONCERNING SPONSORSHIP. 13. LIMITED TIME OFFER 14. CONTRACT CANCELLATION Under Massachusetts law, you may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or a branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Plainview Diagram Team 1 2 3 Customer �t c� vt Advisor Name: IAJ Address "l C (A Advisor Phone #: Town < mo Any limitations to access by truck? Site ID 4q-,� M s -A NOTES Any work scoped outside of Best Practice? Approved by; rr II'' k -- t ,(�J Tm�W� v i F to s