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HomeMy WebLinkAboutBuilding Permit #454-14 - 49 BLUEBERRY HILL LANE 11/21/2013 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION PermitNO: "/ Date Received I Date Issued: IMPORTANT:Applicant must complete all items on this page , ', E PROPERTtYfOWNERIV'tr2 x. _ - ry - Pnnt R._ 100YeOIdStrucfure) y ye, nod: 3s l t� ' PARCEL ZONING DIS1TRICT: HistoncDlstnct y.s no) �. - Machine]ShopVillage y__ 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 _ ❑iSeptic) Well 'F gtFloodplainl ❑iV1%etlands ; Watersheds©istnct; • WIV ,titer/Sewers DESCRIPTION PF WOR=Alt- PERFO ED: Ap y2 OVAL � 1-a2 m sx�'* Identification Please Type or Print Clearly) OWNER: Name: �Ai(' Arz' LiAV G.,U<1 Phone: L924 Address: tL CQNTfRACTOR+ Name �7a�s"� .t..i1 Phone Address: SupervisorFs)Qo struction}LicefEkp Date - P _ . Homellm rovement te;; 1_. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ a Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranpAfjund Signature of ,gent/OWner Signature of contractor. Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans Location 4 '/�the a ? � . No. tJ'1"' a Date . - TOWN OF NORTH ANDOVER n,. Certificate of Occupancy $ � Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 12 'r /Building inspector Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Swimming Pools ❑ TanningfmassageBody Art ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ i 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 r Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connectionermit A DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT _Temp Dumpster onsite yes no Located at'l24 Maig Street - Fire Depaainerit.signature/date 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.$10041000 fine NOTES and DATA— (For department use B Notified for pickup - Date Doe.Building Permit Revised 2010 Building Department 1 The foli-owing 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 i ❑ Engineering Affidavits for Engineered products DOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks i ❑ Building Permit Application a Certified Surveyed Plot Plan ❑ Workers Comp Affidavit ❑ Photo Copy of H.I.C. And C.S.L. Licenses ❑ Copy Of Contract ❑ Floor/Crossection/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 VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) ❑ 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 gOTE: 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 subm:ated with the building application I Doc: Doc.Building permit Revised 2012 f M i f NORTH F � e Town of 2 : : �t . n over O - 0 No. 415q--- lit _ LAK, h , ver, Mass, �►e low t coc«�c«ewrc« y1' �d ADRATED J'P�,`'�5 S U BOARD OF HEALTH Food/Kitchen IT T D Septic System t�n �, �. , �irsv - THIS CERTIFIES THAT .�.........a..... ,,,,,,,, BUILDING INSPECTOR Foundation has permission to erect . buildings on '.... .... . ...................... ............. ......�.............. ...... Rough to be occupied as ..�... ��:' .. ..... ...... ....��:. ......................................................... 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service m...._ .............. .. . .. ........................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. SEE REVERSE SIDE APRIL Massachusetts_De Board of BuildingPa rati o;Puoi 5af�- Regulations and Scanctard: C nn,tructiun Sal,cn i,,,r License:CS.0.57754 1= 80 DHO�E = -- NVMA 01845 — Commissioner -.'(P.. 03/04/2014 O�ceofC�ofnsamWe��a�rmrcoeall/o�'C��a�ac/wael� �'--•-.._ .. _ -. _- - Affairs 8c Bosia�RegntaSoa .. -. ...-. ME 1MPROVEMEWT CON7usme R License or registration valid for indMdul use anty e9tstration: .id1730 before the expiration date. If found return to: ir4tion: 6!?g' Type: CtCeofcons ttmerAffairsand BusinessR Ptnmte Cotporatict, 10 Park P Regulation HRH CON STRUCTIQt±f.It�tC_ ' laza-Suite 5170 Boston,KA 02116 William Hope 1: 80 CAMPBELL RD NORTH ANDOVEp,MA 01845 IIndersegretar3, Not valid without si atnre A ©® CERTIFICATE OF LIABILITY INSURANCE I DATE(MM/DD,YYYY) 07/05/2013 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 NA MEAS Michael Emond Emond&Associates PNONE AX 857 Turnpike Street EMAIL pAM N" Suite 133 1 ADDRESS' ern dllibrmlamily Corn — North AndoverINSU S AFFORDING COVERAGE NAIL# MA 01845 INSURED INSURER A: Farm Family Casualty Insurance Company HRH Construction INSURER B: 80 Campbell Road INSURER C: INSURER D North Andover MA 01845 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 TERM EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. S, INSRAM LTR TYPE OF INSURANCE im UBR POLICY NUMBER MMILIDCDY EFF MMOD EXP YM LIMITS GENERAL LIABILITY X EACH OCCURRENCE $ 1 000 000 COMMERCIAL GENERAL LIABILITY0 PREMISES Ea occ��rrence $50,000 CLAIMS-MADE a OCCUR MED EXP(Any one erson) $5 000 A 2001XO726 11/20/2012 11/20/2013 PERSONAL&ADV INJURY S Included GENERAL AGGREGATE $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OPAGG $2.0 00.000 X POLICY PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT ANYAUTO Eaaccident S 1,000,000 ALL OW NED X SCHEDULED BODILY INJURY(Per person) $ A X AUTOHIRED x INOR-OrEO 200104287-4A 03/16/2013 03/16/2014 BODILY INJURY(Par accident) $ HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ S X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 '4 � � CLAIMS-MADE 2001EI169 12/14/2012 12/14/2013 AGGREGATE $ 1,000,000 DED I XI RETENTION S WORKERS COMPENSATION $ AND EMPLOYERS'1JA81LRY WC STATUS OTH- A ANYPROPRIETOR1PAttTNER/D(ECUTIVE YIN OFFICE/MEMBEREXCLUDED? � NIA 2OOSW6827 12/07/2012 12/07/2013 E.L.EACH ACCIDENT $500.000 (Mandatory f yes,de�srnbeIn Nundder E.L.DISEASE-EA EMPLOYEE $500,000 F _ (� E.L.DISEASE-POLICY LIMIT $500,000 i l DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space Is required) Operations by named insured CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE U'CY PatOVISIONS. AUTHORIZED REP %► O 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD Clear All The Comuronivealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 YWasllington Street Boston,MA 02111 ' www.-mass gov/dia Workers'Compensation Insurance Affidavit:BuilderslContractorslBlectricianslPlumbers Iicant Information Please Prin#Le 'bI 218($usiness/Or-ganization/Individual): 'Ii'veCly��ri '�:�` 't Il cress: �_y► N. L �� Ls— V� _ y/State/ZiP: ,Y06an employer. Check the appropriate box: I am a employer with 2— 4. I am a general contractor and I Type of project(required):, employees(full andlo=part time)*- have hired the stab-conttactois - 6 ❑Newconstruction I am a:'sole proprietor or pier_ listed on rhe'attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g. E]Demolition working for me in any capacity. employees and have workers' [No workers'comp,insurance comp,insurance.$" 9- ❑Budding addition required.] 5. 0 Weare a corporation and its 10-0 Electrical repairs or additions I am a homeowner doing an work officers have exercised their 11.❑Plumbing repairs or additions myself[Na workers'comp, right df exemption per MGL insurance required.)t c. 152,§1(4),and we have no 12_D oof repairs employees.[No workers' 13_ Other_ 1 •E,,� (,� comp.insurance required.] � licanc that P cheeks be x#1 t rtws also fill out the section below showing > o g their workers co tion - wners who mpansa ti informati _ subnnt this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. dors that check this boo must attached ori additional If thesub contractors have sheet showing the name of the sub-contractors and state whether or not those entities have employees,they trust provide their workers'co � -rr>p.po}icy number. . �n employer that is providing workers'compensation insurance for my employees. Below is the policy and job site talion. nee Company Name: • � �! ( ; t t L #or Self-ins.Lic.#: S r . Expiration ation Date: teAddress: 1 TY- A�i� a� h City/Statrazip- 1t a copy of the workers' compensation policy declaration page'(showing the policy number and expiration date).- e_to secure coverage as required under Section 25A of MGL c- 152 can lead to the imposition of criminal penalties of a P 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 to$250.00 a day against the violator. Be advised that a copy-of this statement may be forwarded to the Office of z atians of the DIA for insuran a coverer a verification. Hereby cert under th pains•a a&res ofperjury that the information provided above is true and correct Lure: Date: Tcial use only. Do not write in this area,to be completed by city or town o icloL . .ff '. I ty or Town: Permit/License# wing Authority(circle one): Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector Other intact Person: Phone#- 6 CONTRACT FOR nationalgrid Conner atlon PRODUCTS / SERVICE WORK HERE WITH YOU.HERE FOR YOU. Services Group This service is brought to you through support from your local utility ?'h' Agreement is matle by and among M* hae]�.eaver Slrclt a12d 49 Blue6eizy H111 jLn roup(C Conservation Services G :`North Aa'dover Iv1A. 01845 5301 : ' Atte RCS ;. 50 4Vashuigton Street,Supe 3000 .Site® 50000215824P Westborough,MA:01581 I'ro�ect lD P00000162919 Customer ID 000000168289 Reg leo 173484'. Contract II) 20131005 ASBAL Federal ID:No 222457170 (Mail completed Eonfract to address above), 1. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Premises"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: Description Quantity Location Attic Stair Cover Thermal Barrier 1 Living Space $206.70 -- ---- ..__ _. ._..- - _.__......._.._. .... Perform Air Seating at Estimated 62.5 CFM50 Per Hour 8 LivingS ace $616.00 _ - - P _. Exterior Door Weather Stripping ---------..__............... 3 NIA $75.60 _.. - .- ._ ... __..-..---- ----..__.._............. -. _.. Door Sweep -- -----........ _........_ 3_ N/A $63.51 _ _. ._ ................................_...._....... Sub Total: $961.81 Utility Incentive Share $961.81 Customer Contribution $0.00 For office use only Printed:10/512013 Page 1 of 2 Il. PAYMENT Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$ as a Deposit payable to CSG upon signing the Contract(not to exceed 1/3 of the total retail costs or actual costs oftial orders,whichever is greater).Mail check R contract to CSG, Attn:RCS,50 Washington St.,Ste.3000,Westborough,MA 01581.Final Payment:$ as the finala p yment for the Work shall be due and payable to the Independent installation Contractor("IIC")upon tisfactory completion of the Work Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount cf S The Utility Incentive Share is dependent upon the package purchased and/or prior incentive utilization.Changes to individual line items and/or previous incentives y increase or decrease the size of the Utility Incentive Share. III. DISPUTE RESOLUTION The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the 11C may submit such dispute to a private arbitration service whichhas prov y the of C nsumer Affairs and Business Regulation and Customers be required to submit to such arbitration as provided in XG.L c 142A. CustomerA . Contractor: You,Away cancel this agreement if it has been signed by a party there to at a place other than an ddress of the seller, which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch by ordinary mail osted, by telegram sent or by delivery,not later than midnight of the third business day following the signi of this greem . D9 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. `1 2� mer Si fur ate `Indicate vour selected here,if applicable (0 'al here' -want /9—!5-r5 ri, i L the Program to assign a CSG Sighature Date Name of CSG Representative( rinted) Participating Contractor TERMS AND CONDITIONS APPEAR ON THE REVERSE. 1/13 CONTRACT FOR nationalgrid Conner atlon PRODUCTS SERVICE WORK HERE WITH YOU.HERE FOR YOU. Services Group This service is brought to you through support from your local utili This Agreement is made by and among nd Michael Leaversuch ` .00 Lnd 49 Blueberry Hill Ln G ation Services Group(CSG) North Andover,MA 01845-5301 r�d S ington Street,Suite 3000 Site ID:500002158241 rough,MA 01581 Project ID:P00000162919 . 173484 Customer ID:C00000168289 Contract ID:20131005 WORK ID No.222457170 OCT 1 7 2013 pleted contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Premises"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: Description Quantity Location Attic Floor Open Blow Cellulose 5" 352 Living Space -- $450_56 Hatch:Thermal Barrer Poso 2 inch(Attic) 1 Living Space $38_09 Attic Floor Open Blow Cellulose 6" _ 540 Living Space__ __ _ _ $7_23.60_ -Install 2"Thermal Barrier Pol)nso On Kneewall 25 Living Space _ $100.50 Install 2"Thermal Barrier Polyiso On Kneewall _ 34 living Space �� S136_68 Install 3.5"Fiberglass Batting in Open Kneewall _ 25— Living Space __ $36.50 _ - — — --- 12"Mushroom Vent 1 Attic 2 _—.._--- ----- --- $126.00 12"Mushroom Vent _— 1 _Attic 2 _$126.00 Damming _ _ 120 _N/A vW_$222.00 Sub Total: $1,959.93 Utility Incentive Share $1,469.95 Customer Contribution $489.98 6❑$J!J For office use only Printed:1 01512 01 3 Page 2 of 2 II. PAYMENT aa [ f Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$A f d as a Deposit payable to CSG upon signing the Contract(not to exceed 1/3 of the total retail costs or actual cost;of ec'alor els,whichever is greater).Mail check&contract to CSG, Attn:RCS,50 Washington St.,Ste.3000,Westborough,MA 01581.Final Payment:$ I'S the final payment for the Work shall be due and payable to the Independent Installation Contractor("HC")upon satb a ry completion of the or k Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of$ .The Utility Incentive Share is dependent upon the package purchased and/or prior incentive in utilization.Changes to individual line items and/or previous incentives may crease or decrease the size of the Utility Incentive Share. III. DISPUTE RESOLUTION The IIC and Customer hereby mutually agree in advance at in the event that the IIC has a dispute concerning this Contract,the 11C may submit such dispute to a private arbitration service th ce which has been approved by theAtSce of Con, er -and Business Regulation and Customerla be required to submit to such arbitration as provided in M.G.L c 142A- Contractor- You 4LA. Contractor.You ma cancel this agreement if it has been signed by a party there to at a place other than an lddress of the seller, which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch by ordinary mall pos d,by tele ram sent or by delivery,not later than midnight of the third business day following the signing a emen . OT SIGN THI/S�CONTRACT IF THERE ARE ANY BLANK SPACES. C e i e atedicate your sele�d IIC here,if applicable (OR�Ini'' here if you want � the rogram to assign a CS Signature Date Name�f CSG Represen 've(Printed) Participating Contractor TERMS AND CONDITIONS APPEAR ON THE REVERSE. 1/13