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HomeMy WebLinkAboutBuilding Permit #128-2017 - 43 WOODBRIDGE ROAD 8/9/2016 V/ df tta.lC t6�'� BUILDING PERMIT TOWN OF NORTH ANDOVER o �Q n APPLICATION FOR PLAN EXAMINATION * - Permit NO: ILO !"�'l� Date Received M �.q QA4Tt0♦*t.�y psswc►�usE Date Issued: Z! 'IMPORTANT:ARplicant must complete all items on this page LOCATION y 3 hiocdb Road PROPERTY OWNER t��� - S as'Print MAPNO: PARCEL: ZC3NINC'DItptitTRlO Historic }istrict yes no 'Machine Slop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential U New Building u One family U Addition U Two or more family U Industrial U Alteration No. of units: U Commercial XRepair, replacement U Assessory Bldg U Others U Demolition tj Other U Septic U WellFloadp Floodplain., 'Vlfetlands �i WaterSlied District U water/Sewer �(QA�Nn,tXi�.o�k�or a.xr �c.al,�r►o'J�q�etA.lo�r. a:l�ic, dim 'na.7_jnS�a�l asw&W t&h hq%&fl? gAb na haft► Pan : insl-x4ycdhl"M c"& .cs i Identification Please Type or Print Clearly) OWNER: Name hlilliam Sah,�S Phone: 7t1) rZa-srr-7r Address: 43 Wood ov S CONTRACTOR Name; .- Phone lfg3p2 20�. lA 4 o� Address: _9P Box (0-Alk. , htavt k c r Nil_ p BAOIS - w Supervisor's Construction License... _ Exp. Date. GrO?'JS _ 0t$ \O Home Improvement License: EXp Date y 1,$2782 _7 2"i 201 t ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING.PERMIT.592.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ Gf FEE: $ �&, Check No. >5D Receipt No. ` 3b2d NOTE: Persoies contracting with xurregistered contractors do rent have access to the bray j,frayed Signature of AgentlOwner -:s a a nature f c ntracior, _. _ ''' - as ' `i OF NORT" q BUILDING PERMIT TOWN OF NORTH ANDOVER 0 = -'• APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received pDR 1TED gSSACHU5�4 Date Issued: IMPORTANT:Applicant must complete all items on this page ` LOCATION f Print PROPERTY OWNER Print 100 Year Structure yes no HistoricDistrict yes no MAP PARCEL: ZONING DISTRICT:-Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 11 Addition El Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement- [IAssessory Bldg El Others: 0 Demolition ❑ Other WeIIB ���`Floodpla'in� �'Wetlandsr O� ❑t Seppti& E1 - 1Water/Sewer� y DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: (NEER Phone: ARCHITECT/ENG � Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. I Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �--;�- ---— � arnfsrr•nntrart - – -� 4patur or C� Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑J Stamped Plans - p ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanming/Massage/BodyArt ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ ❑ Food Packaging/Sales ❑ Private(septic Tank, etc. Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY f INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments c Conservation Decision: Comments Wafter& Sewer Connection/signature &®ate . Driveway Permit DPW Town Engineer: Signature: FIRE DEP.AR+TMENT L � TempjDumpster on;site ,,yes Located 384 Osgood Street 124 ain Located at WE' eet 'Fire . 0p� atur `�' �ds .3 `i , artment sign a/date.- z ., ,p .� 'COMM ENTS'# ir . 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 N® MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) I I C.l 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 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 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 dum ster 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 Doe:Building Permit Revised 2014 Location 4--2 (Ab ; LA J, No. Date . - TOWN OF NORTH ANDOVER Certificate of Occupancy $ (e "FoBuilding/Frame Permit Fee $2(e-- Foundation undation Permit Fee $ Other Permit Fee $ TOTAL $ Check#j 1, � Building Inspector 3 r� NH ORT own of 6Andover No. 1A soh ver, Mass q coc.«c«ew �1' S fJ BOARD OF HEALTH Food/Kitchen PERM T, LD Septic System FA I .. .., .. BUILDING INSPECTOR THIS CERTIFIES THAT .................. .... ................To........ ..... ......... .. ......... ........... Foundation has permission to erect .......................... buildings on ..45... ... .�.. .............�. ` � � Rough � ;�rmit to be occupied as .. .... . . ..... ...:I.t+ 4 .. .. . �'r.r..c�. rr.1.. . .�..� . Chimney provided that the person accepting thi shall in every respect conform to the terms�e application Final on file in this office, and to the provisions of the Codes and By-Laws relating to Te Inspec ' , Alteration and Construction of Buildings in the Town of North Andover. WC q Rough PLUMBING INSPECTOR , VIOLATION of the Zoning or Building Regulations Voids this Permit. l� Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSaXWBU61iE6DIN1GZiuNw Rough Service ..... .... " Final CT GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. r Federal 10 9 05-0405629 RISC Engineering Ill Contractor Registration No 0106 120979 CT ContractorRegistration Registration o 20120 RA diitision ofThielseh Fogineeriog CTConbae for Registration Mo 020120 ENGINEERING 60Shattmut,Canton,NIA 02021 RACT CONT 339-502-5147 FAX 339-502-6345 E�/"1 � Page 1 PROGRAM 110 OMMCn9 E AINI aNARETY M TUBE CMA-HIFS ERQYEE;=XMMCU=rRRR1YQD¢A9 DISCRIRED aEerrx CUSIONER PhIm DATE Q,EMI TVQtIa CRDEa Wllxttn Sahlas (781)820-5871 07/11/2016 436881 00002 SERVICE 31MIT aIWNa srxET _ 43 Woodbridge Road 43 Woodbridge Road 0 V CEhNICE em,ME,aP --- - elwaa CM.51067.ZIP North Andover,MA 01845 North Andover,MA 01845 C 10 U JOB DESCRE''IO1S ASE ONE- oral for this calendar year. 50.00 AIR SEALING:Provide labor and materials to seal arses of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diamostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.M utetxits to be used to seal your home can include caulks,foams ami other products. Primary in for sealing include air leakage to attics,basements,attached ga>aggs and other unheated areas(windows are not generally addressed.)This will require(12) working hours.A roduct ion in cubic feet per minute(cfn)of air infiltration will occur,but the actual number of crm is not grvameed. At the completion of the wettheriaation work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the subeontrtctor to ensure the safety of the indoor air quality. 51,020.00 AIR SEALING ADDER: (6)workinghours. $510.00 ATTIC FLAT:Provide labor and materials to install a 6"layer of R-21 Class I Cellulose added to(628)square feet of floc red attic space. 51,117.84 ATTIC FLAT:Provide labor and materials to install a 9"Paye of R-30 unf iced fiberglass batts to(120)square feet of attic space. 5200.40 DAM M ING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass butts to(314)square feet for damming purposes. 5643.70 ATTIC FLAT:Provide labor and materials to install a 9"layer of R-32 Class 1 Cellulose added to(1592)square feet ofopen attic spare. $2,276.56 VENTILATION:Provide labor and materials to install(3)insulated exhaust hose with roof mounted flapper vett to exhaust tasting bathroom foals). 5356.25 VENTILATION:Provide labor and materials to install ventilation chutes in(124)ratter bays to maintain air now. 5248.00 INCENTIVE.RISE Engineering vvalt apply all applicable,eligibic incentives to this contract. You will only be billed the Ne amount. Currently,for eligible measures,Columbia Gas offers an ineentivcof 75%.not to iced$2,000 per calendar year,and an incentive of 100% for the Air Scaling measures up to the fast 5680 and an additional 5340 ifsavints are justified by the auditor. FOR A LIMITED TIME:Columbia Gas will also offer an additional 5100 incentive towards the weatherrzation work outlined in this proposal.This special Summer Incentive is available to homeowners who have had their Columbia Gas home energy audit before July 31, Federal ID 8 05-0406629 RISE Engine ring RI Contractor Registrallon No 6166 MA Contractor Registration No 120979 Aditiislon ofThielsch Engineering CTContmctur Registration No 620120 I ENGINEERING 60 Shamnut,Canton,RIA 02021 GflNTRAT 339.502-5197 FAX 339-502-6345 Page 2 PROGRAM IRS,COMM ERRERO DI10eMUN FWE CR'LA-us ENGIMMUNDARDWECUSICS RXWOUAS OCR=SEWS WSRMR PMONE DAZE 6UENTi VMMGRM Wv'ram Sahlas (781)820-5871 07/11/2016 436881 00002 SERVICE SWEET sum DSiEET _- 43 Woodbridge Road 43 Woodbridge Road BERM M.S`V.W SUM Cm.Mr.aP - - North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION 2016. A sided proposal for wmthtrizotion needs to be submitted by August 8,2016 and work must be completed by September 30, 2016. For the safety and health ofyour home's indoor air quality,we will be coaductingo blower door diagiostic of tilt available air Row in your home bath before the work is bgwn,and after the wcathcrization work is complete We will also coirduct a full assessment of the combustion safety of your heating sy stem.and water heater.This has a value of$40 and is at no cost to you.The maximum allowahle incentive for all measures,includingair scaling is$3,210 The Permit will be seared by the insulation contractor,at no additional cost.It is the homeo+met's responsibility to close out this permit by contaetingthcir municipality at the completion ofthis work. $90.00 E LEE* 0VIE JUL 1 3 2016 Total: $6,462.75 Program Incentive: $3,210.00 Customer Total: $3,252-75 WE AGREE HEREBYTO FURNISH SERVICES-COYFLETE IN ACCORDANCE WITH ABOVE SPECIFICAMONS.FOR THE SUMOF ***Three Thousand Two Hundred Fifty-Two&751100 Dollars $3,252.75 UPON DiSPE0ECRI AROAPPMAL@Yloe E=nERWMCW=ERA4�ESWIMUtAtIDDW"MFULI-KVMSTCFI%WILL SE CHAMZD KNOAYON OY IRIPAD AF 30 DAYS.SEE REVERSE FOR MFOROMWOMMON ON GLIARANIEES.RMM OFRECl+MSCIEDU M ANO=MAC=REGSItAWK tm NOT SIGN THIS CONTRACT IF 1HE ARE ANY BLANK SPACES —1-1 DNA rasEEn�- -0 RarsrDRER NOM:M CONOiACMGY at tgfb AAWN BY IE 6 MUECUED WTM DArn O-ACCEPIM" ACCEPLVICE tF CAII61ACt•OIE EPRtSt7f,SP - t NO ACO�MM=ARE 30 SARSFACnff. NMAREN YACCEMD.Y AREAUMOREDIODOWWOM DAYS. AS SPECOWM PAY ENTWRL DE WADE AS DU%NED ADOVE r t RISL 60 Shawmut Road,Unit 2 1 Canton,MA 020211339-6024336 ENGINEERING www.PJ$Eenglneering.com Efficiency Ene.gird. OWNER AUTHORIZATION FORM William Sahlas (Owner's Name) owner of the property located at. 43 Woodbridge Road, North Andover, MA (Property Address) (Properly Address) hereby authorize kik` lei (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 ees r rtfih(hr Date EGF�0VF. - JUt 1 3 2016 The Commonwealth of Massachusetts Departntent of Industrid Aeddents. I Congress Street,Suite 100 Boston,MA 02114-2017 www.massgov/tfda workers'Compensation Insurance Affidavit:GeneralBusinesses, TO BE TILED WITH THE PERmnrTING AUTHORf'I"Y. Applicant Information Please Print Lkgibl), Business/Organization Name:Mill City Energy .Address:PO Box 64.11 City/State/Zip:Manchester,NH 03108Picone#:603-391-7925 Are you an•employer?Check the appropriate box: Business Type(required): I.M I am a employer with 12 employees(full and/ 5. 0 Retail orpart-time).* 6. Restaurant/Bar/Eating Establishment 2,C3 I am-a sole proprietor or partnership and have no 7. Office and/or Sales(incl.real.estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] S. 0 Non-profit 3.0 We are a corporation and its officers have exercised9. 0 Entertainment their right ofexemption,per c.152,§1(4),acid we have 10.[]Manufacturing no employees.[No workers'comp.insurance required]* 4.Q We are anon-profit organization,staffed by volunteers, I I. Health Care 12. Other �11f Zm -i o w':th no emp] ees. o workers corn .insurance d ►'� p y [N p req.) 4'Any applicant that checks box 41 must also tilt out the section'oct0u s`towir utieir workm wrnpensation policy snfomM;ion. *•If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organirmtion should check box M. I ant on employer tliat is provirting workers"compensator(insttrattce for my employees. Betmu is the policy information. Insurance Company Name:dark Insurance Insurer's Address One Sundial Avenue Suite 302N City/State/Zip: Manchester, NH 03102 Policy*or Self-ins.Lic.#Ml1 0791896Expiration Date:4/29/20.17 Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). g required can lead to the imposition of criminal penalties of a Failure to secure coverage as u�red under Section 250 of MGL c. 152 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$2510.00 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. I do hereby certify,a ins and penalties of perjury that the infornurtian provi4e4 above is true and correct q Signature: Date: Phone#:603-3964520 Official use only. Do not write in this area;to becompleted by cityor town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department.3.City/Town Clerk 4.Licensing Board &Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov/dia MILLCITY-1 AGOULD CERTIFICATE OF LIABILITY INSURANCE DATE 1 71/19/219/2016 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 certificate holder in lieu of such endorsement(s). PRODUCER License#AGR8150 CONTACT Clark Insurance PHONE FAX One Sundial Ave Suite 302N ac No EI:(603)622-2855 AIC No):(603)622-2854 Manchester,NH 03102 E-MAIL ADDRESS:agould@clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Mutual Insurance Co 17000 INSURED INSURER a:AmGuard Ins co 43290 Mill City Energy INSURERC: 106 Joseph St INSURER D PO Box 6411 Manchester,NH 03102 INSURERE: INSURER F: 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 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 I ADDLSUBRPOLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS MADE XOCCUR 8500065735 04129/2016 04/2912017 TED PREMISES AMAGE ToEa occurrence $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JET LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea accident $ _1,000,000 A X ANY AUTO 1020050919 04/29/2016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,00 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATION X PER OTH- AND EMPLOYERS'LIABILITY Y/N STATUTE ER B ANY PROPRIET ER EXCLUDED?ECUTIVE N/A MIWC791896 04/2912016 04/29/2017 E.L.EACH ACCIDENT $ 500,000 OFF(Mandatary In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL406035 Construction Supervisor Specialty MICHAEL_JOY 106 JOSEPH STREETT E µ MANCHESTER NH 030 �..M Expiration: Commissioner 0810712018 eerrrnro,irrzrr// n�.G/>'tir �rc/uaellJ License or re istration valid for individul use only Office of Consumer Affairs&Busibess Regulation g Y OME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: egistration: •f82792 Type: Office of Consumer Affairs and Business Regulation xpiration 7/27/2017 LLC 10 Park Plaza-Suite 5170 Boston,MA 02116 MILL CITY ENERGY LLC MICHAEL JOY 106 JOSEPH STREET MANCHESTER,NH 03102 Undersecretary N va i ithout si y lure ��