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HomeMy WebLinkAboutBuilding Permit #680 - 49 OLD VILLAGE LANE 3/2/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: W6 v Date Issued: � I Z/ IMPORTANT: App LOCATION PROPERTY OWNER ' ` MA- t _ _ PARCEL ON Date Received must complete all items on this Print /Q'SgYBD /6'�NO 0 o y A �pQ�RArgo #,I' Print 100 Year Structure yes ING DISTRICT: Historic District yes no Machine Shop Village yes 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 0 Wetlands ❑ Watershed District ❑ Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification - Please Type or Print Clearly OWNER: Name: Address: ,01 Contractor N'ameoe1,�,2�?1t�£?$hone: 0 0/ Address: Uc-�.. Supervisor's Construction License: /O%% . Exp. Date: Home Improvement License: Exp. Dater )1-7 ARCHITECT/ENGINEER Phone: Address: 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: $ 1617 /C19) FEE: $ SO Check No.: (D -b Uv Receipt No.: NOTE: Persons contracting with e i ere ontractors do not have access to the a a LSig of Agent/Owner �gnature of contractor r ' rti 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 Signature COMMENTS CONSERVATION Reviewed o COMMENTS HEALTH COMMENTS Reviewed on nature nature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: t Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: LOcatea Jb4 Usg000 Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street = Fire ,Department signature/date 4 •_ . _. 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 NOTES and DATA — (For department use ❑ Notified for pickup Call Ema 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 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 ❑ 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 v U) n 10 O CD 0 Z N CDO Q _• O CLr- >(Q. O vCD C� � C 0 CD CD O CD C B. QvCD C' = QN v U) O 10 z CD 0 0 rmll O CD O CD z 0 rn X z cn cCn Z Cl) c z. z m 0 < o0=� --I O y-� m -0ti O > CD N O CD 0 p �Q--0 3 Z O S 3� O y rtCD m O O O •-F CL m 00 m N 0 y \ N CD m cD 2 O Q O @ @ a , O C n —1 N Q .tiMEMO - o O O 3 CD CD C (D,a Q' —f O O c� 0 CO OU O N U3 '-h N -0 p1 .00 0 a a `D N CL 0 Q < N in o N CD�CD CD cn W N cn .OI- . - i �� O7Nt co. o c c �> CD =rr 5'.p, '►� CD S C.) vCD0 CD- SU O • A� = = CL - Ln O !OrO Ln (OD i -r z W C O ((D �+ m m D 3 T j � O Q04 S H vZi n T N O (o m ,tl O 00q S r, n � n. cZi� .om m "iO T O' RL A O 00 0 S -p c W Z y m T O' n ? j 7 (D A O 000 S T O 0- w O c p z m In (D r) N (D 3 T O Q \ (3D ' ao D O D x -XI 1O m q �` 0 c neat step Living, home energy solutions This agreement is made by and among Jinming Chen 49 Old Village Ln North Andover, MA 01845 Site 1D: 411459 Next Step Living, Inc. ("NSL") 21 Drydock Avenue, 2nd floor Boston, MA 02210 phone: (866) 867-8729 15 -Jan -15 1. DESCRIPTION OF WORK TO BE PERFORMED 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: Work Location: Attic Flat Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 10 $75.00 Hr $750.00 Work Location: Doors Door Weatherstripping w/ Sweep 3 $75.00 Each $225.00 Work Location: Attic Flat Attic Stair Cover Thermal Barrier with Carpentry 1 $237.65 Each $237.65 Payment #1: $100.00 -Credit Card or Echeck 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: $53.16 -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. Customer Signature � ate 0� C �GiNs�vt,_ 15 Jan 2015 Leonard Earnshaw NSL Signature Date Name of NSL Representative A772856 The Terms of this Agreement are contained on both sides of this page Next Step Living 21 Drydock Avenue 2nd floor = Boston, MA 02210 0 (866) 867-8729 a Inquiry@nextsteplivinginc.com o www.nextstepliving.com TERMS OF AGREEMENT 3. PROPOSED START DATE AND COMPLETION SCHEDULE NSL will contact customer to schedule the Work at a mutually agreeable time, subject to the availability of subcontractors or materials, or to delays attributable to the weather or other events beyond NSL's control. 4. CONTRACTOR REGISTRATION Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston, MA 02116.617.973.8700. 5. PERMITS NSL will obtain any necessary permits as the Customer's agent. Customers who secure their own permits or deal with an unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law. 6. PERFORMANCE OF THE WORK AND CHANGES. 6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer 6.2 This Agreement may be supplemented, amended, or modified only by the mutual agreement of the parties. No supplement, amendment, or modification of this Agreement shall be binding unless it is in writing and signed by all parties. 6.3 At times, our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern for residents. Such concerns can include but are not limited to ventilation, potentially hazardous materials such as mold or asbestos, or structural concerns. In the case of health or safety concerns being identified, NSL reserves the right, per section 9.2 of this contract, to communicate concerns to the Customer and halt work until such concerns have been addressed. 6.4 The rebates and incentives available from the Mass Save® Home Energy Services Program and amounts due from the Customer are based on the best estimate of the situation in the structure by the NSL home energy advisor. However, at times our weatherization team discovers situations in the home during the course of the Work that impact the availability of rebates and incentives from the Mass Save Program. In such situations, NSL will communicate such changes to the Customer, including any impact on amount the Customer would be expected to pay for the Work. The Customer will have the option to remove from the Contract the work elements that need adjustment, or set up a separate contract for performing the adjusted work. 6.5 NSL represents and warrants to the Customer that (a) the materials and equipment furnished under this Agreement will be of good quality and new, (b) that the Work will be free from defects, and (c) that the Work will conform with the description of the Work described in Paragraph 1. 7. INSURANCE AND REGISTRATION NSL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration (No: 162111) and the necessary insurance required by applicable law and normally maintained by prudent contractors in NSL's field, including, but not limited to, Workers Compensation Insurance for all employees who will perform the Work. 8. QUALITY OF WORK. NSL agrees that the Work will be performed in a good and workmanlike manner, and that NSL will repair and replace, at its own expense, and promptly upon Customer's request, any defects in workmanship and materials provided by NSL which appear up to (1) year after completion of the Work or within any longer period as permitted or required under applicable law, provided NSL has received final payment as provided herein. 9. PRE-EXISTING CONDITIONS & PROPERTY PROTECTION 9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions. These conditions include but are not limited to poorly fastened or broken drywall, moisture damage, non -code construction, cracked or fragile siding or shingles, old pipes and fittings, rotting wood, etc. 9.2 NSL reserves the right not to perform Work upon the discovery of asbestos, mold, or any other potential health risk to the Customer. In this event, the Customer is responsible for remedying the at -risk situation, including any necessary removal of hazardous materials and all bills for services to date shall be paid immediately. Work cannot resume until remediation is complete. 9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customer's responsibility to remove or protect, including dust protection, any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property not property protected prior to the commencement of the Work. 10. GENERAL PROVISIONS. 10.1 NSL reserves the right, the extent permitted by applicable law, to have, file or maintain a mechanic's or material men's lien, or to file a notice of intention to lien, and to take any other steps to perfect and enforce such a lien, if Customer fails to pay NSL as provided herein. 10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts. 10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this Agreement, they are not relying on any representations, warranties or terms other than as expressly contained herein. This Agreement supersedes aff prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties. You may cancel this Agreement if it has been signed at a place other than the NSL's normal place of business, provided you notify NSL in writing at its main office or branch office 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 See the attached notice of cancellation form for an explanation of this right. 11. ENERGY BENEFITS. The Sponsoring Utility Company (the Utility) is entitled to 100% of the energy benefits associated with all Energy Conservation Measures, excluding the value of energy cost savings by the Customer, but including all rights to all associated ISO -NE Energy, Capacity and Reserves Products. NSL agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products. 12. NOTICE CONCERNING SPONSORSHIP. Customer understands and acknowledges that NSL is not an agent, vendor or sub -vendor of The Sponsoring Utility Company (the Utility) with respect to the installation of an energy efficiency measures. In the event of the failure of an energy conservation device to perform as expected, Customer's sole recourse is to Contractor and not to Conservation Services Group (CSG) or to the Utility. The Utility and its operating companies shall not maintain, remove or perform any work whatsoever on the energy conservation measures installed. Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have consented for Contractor to install the proposed energy conservation measures. Customer agrees that it shall not hold CSG, the Utility, their affiliates or operating companies liable for Contractor's to perform its obligations under this agreement, for failure of the energy conservation measures to function, for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 13. LIMITED TIME OFFER. The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy Services Program offers. 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. Ate 0 eConsumer Aff ld Bus' ess Reg� ation =_ =; 110 Park k Plaza e Suite 51170 '`M >= Foston, Massachusetts 0211116 Home improvement Contractor Registration Registration: 162111 Type: Supplement Card Expiration: 1/14/2017 NE,®T STEP LIVING INC. ROGER OUELLETTE 21 ®RY®®CK AVE. 2TH FL r BOSTON, MA 02210 Update Address and return card. Mark reason for change. Address [] Renewal R IEnmioytiient E] Lost Card SPS-CA� ca SDt1-0':OGG'Q12?E office of Consumer Affairs df. Business Regulation _'HOME IMPROVEMENT CONTRACTOR t Registration: 162111 Tyke: Expiration: 111412017 Suppiement Card NEXT STEP UV)NG INC. ROGER OUELLETTE 21 DRYDOCK AVE. 2TH FL BOSTON, MA 02210 Undersecretarg License or registration valid for individul use only before the expiration date. If found return too office of Consumer Affairs and Business Regulation 10 Park plaza - Suite 5190 Boston, MA 02116,E !N.ot°valid without signature fJ Massachusetts Department of Public Safety Board of Building Regulations and Standards Construction Sapenisor tialh uicense ROM �+v�v��7A�(�®�i7�eil L /`��T 55 [�910.Ad'd SV!1®J1eI JS�r�/211aJ 'h wamck RI 02M� 1 Expiration r, nnmiSSIOne Rcpeitoctgd To: CSSWC - Onsu0FO 6®n COnt FaCtOF FaHure ¢o possess a current edition GTOG W118358chusE'Ms State Building Code is muse for revoca uon iii this licensee For ops uice sins informZVOOrI vlge0t: kiamtv.DA@s�.GnvjDPS The Commonwealth of Massachusetts Department of Industrial Aceldents Oce of Investigations d I Congress Street, Suite 100 y Boston, MA 02114-2017 www,massogov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers ARpincant Information Please Print Le�ibiy Name (Business/Organization/individual): Next step Living Address: 21 ®rydock Ave iBoston, MA 02210 phone #: (866)867-8729 Are you an eanpl®yer'd Cheep the appropriate box: 1. 1 am a employer with 850 4. ® 1 am a general contractor and I employees (full and/or part-time).' have hired the sub -contractors listed on the attached sheet. 2. ® 1 am a sole proprietor or partner- These sub -contractors have ship and have no employees employees and have workers' working for me in any capacity. comp. insurance.t [No workers' comp, insurance 5. ®�hle are a corporation and its required.) 3. ® I am a homeowner doing all work officers have exercised their myself [No workers' comp. right of exemption per MGL c. 152, §1(4), and we have no insurance required.] t employees. [No workers' come. insurance required.] Type of project (required): 6. ® New construction 7. ® Remodeling S. ® Demolition 9. ® Building addition 10.[] Electrical repairs or additions 11.® Plumbing repairs or additions 12.® Roof repairs 13.0 Other Insulation *Any applicant that checks box # 1 must also fill out the section below showing their workers' compensation policy information. t flomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new aflida, -it indicating such. tCont�actors 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 I compensation insurance for nay employees. BeIow is the policy and job site information. Insurance Company Name: AJ.M Mutual Insurance Company Policy # or Self -ins. Lic. #: AWC-4004030025-2014A 3 b St•te AMress Expiration Date: 9130/15 City/State/Zip: o 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 SWOP WORK ORDER and a fine of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of investigations of the DIA for insurance coverage ±tion. I do hereby certdfy sander the pains and pees es perjury that the dnformatdon provided above is true and correct Si afore: Date: FFAuthority only. Do not write in this area, leo be completed by city or town official, Town: Permit/I.icense. # hority (circle one)cHealth 2. Building Department 3. City/T'own Clerk 4. Electrical Inspector 5. Plumbing Inspector rson° Phone #° NEXTS=1 OIC ID: EL � �� CERTIFICATE ®F LIABILITY INSURANCE DATE(M1120 A 4 10/01!2014 . F THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O%y AND CCNfERS N® RIGHT4 UPON THO CORTIFICATF !HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR A} TER THE COVERAGE AFFORDED BY THE POLICIES BELOVV. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRArT BETWEEN THE ISSUING ONSURER(S), 40THOItIM RgP FSENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMP RTANT N the gertificate holder is are ADDITIONAL INSURED, the pooicy(ies) must be endorsed. If SUBROGATION Iq WAIV01 % Q9*09$ t.9 the terms and conditions of the policy, certain policies may require ars endorsement. A statement on this certificate does not confer rights t6 top certificate holder In lieu of such endorsement(s). GUN PRODUCER NAME CT Erin Lyons lft.LaughOlrl OglsaaPaaaca; AgencyPHONE 761.663=2773 A/C, Nor. 7'51=665.02Q§ lAI/� Pln C,A1• I ilii E. -McLaughlin Jr. INSURED "0uU$n lt-owouu%j, uuu-. 21 Dryd®ck Avenue, 2nd Floor Boston, MA 02210 INSURER(S) AFFORDING COVERAGE A: Nautilus Insurance B: Commerce Insurance Compar C:A.I,M. Mutual Insurance Co. D:AXIS Insurance Company 0=11aIP9R1 MRIIIIM120. 15610 COVERAGES u'=nInu-Ia.rrerLV. „.w„n+ —. OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY R�RIeD THIS IS TO CERTIFY THAT THE POLICIES ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TFH{Ig INDICATED. NOTWITHSTANDING OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, CERTIFICATE MAY BE ISSUED CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. EXCLUSIONS AND POL CY EFF POLICY EXP LIMITSTYPE OF INSURANCE POLICY NUMBER MMIDDRNW MMIDDCIAL GEIyEI�AL LIABILITY EACH OCCURRENCE $1,®®®,®®® MS -MADE LK OCCUR E P2010195=12 09/30/2094 ©9/3012015 r'TRqERI PAMAGE REMISES Eaoccurrrence $ 190,000 MED EXP (Any one person) $ PERSONAL & ADV INJURY $ q0+900 p 3091496 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ M00100 POLICY F-1JEC LOC PRODUCTS-COMPIOPAGG $ �cQOQ+AOO OTHER: COMBINED SINGLE LIMIT$ Ea accident 1,001f AUTOMOBILE LIABILITY BODILY INJURY (Per person) $ 1�¢MMI3G6t0Z®M 09130/2014 0913012015 B ANY AUTO ALL OWNED X SCHEDULED BODILY INJURY (Per accident) $ PROPERTY DAMAGE Per accident $ AUTOS AUTOS NON -OWNED X HIRED AUTOS AUTOS UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 AGGREGATE $ Ep U733547012014 09/30/2014 09/30/2015 D EXCESS LIAB CLAIMS -MADE $ DED RETENTION $ WOR RS COMPENSATION AND EMPLOYERS' LIABILITY YIN TO BE ISSUED BY CARRIER 09130/2014 011/30/2015 STATUTE ERH E.L. EACH ACCIDENT $ 500,000 C ANY PROPRIETOR/PARTNERIEXECUTIVE a N I A 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory In NH) If yes, descnbe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - EA EMPLOYE $ E.L. DISEASE - POLICY LIMIT $ 500+®® DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 909, Additional Remarks Schedule, may be attached it more space is required) FOR INTO TIOM OXY E C'tt(yILIJItrG ---- -- INFO -01 ISHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION [SATE THEREOF, NOTICE WILL BE DELIVERED IN For Information Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©1995=2014 ACORD CORPORATION. ADI rights reserved. �fACORN ACORD 25 (2014191) Location No. 1 Jf Check A90 i `G u 236`1: l� Date } TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ r Building Inspector