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HomeMy WebLinkAboutBuilding Permit #308 2017 - 5 ROSEDALE AVENUE 9/22/2016 Z BUILDING PERMIT oNORrN q S"l-ED ,6 TOWN OF NORTH ANDOVEROM Y,:,h.=` o APPLICATION FOR PLAN EXAMINATION h np Permit No#: 9� ;a)a Date ReceivedArEo �gSSACH�s���� Date Issued: �71 IMPO TANT: Applicant must complete all items on this page LOCATION L<�g �e- //�J e- PROPERTY OWNER FGfle-C— 7 Print 100 Year Structure yes no MAP PARCEL: ��/ ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building �5Qne family ❑Addition ❑ Two or more family ❑ Industrial oH;Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands, ❑ Watershed District, O Water/Sewer D SCRIPTION OF WO K TO BE PERFORMED: , 4S ,t. -e Idetificat'on- ase ype or Print Clearly OWNER: Name: (�' �,1_ I, �f-' Phone: Address: Contractor N me: �-- Email: . r ,cm Address: Supervisor's Construction License: � ��(�� o� Exp. Date: a Home Improvement License: 1--7cl I L4 t Exp. Date: 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: $ C . '� FEE: $ Check No.: �i - Receipt No.:_ ©� C/ NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund J 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 m U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ I COMMENTS CONSERVATION Reviewed on Signature a CliMMENTS 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: ��. _�__ FIREDEP,�gRTME.N3T Temp ®um ster.on site R Located384 Osgood Street t �.., by _ o� i L=ocated'af x124 ih Sheet Fire�Departmen'tgnature%date; CQMMENT`S. T - 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 MGL Chapter 166 section 21A—F and G min.$1o0-$1000 fine N® NOTES and DATA— (For department use) ❑ Notified for pickup Call Email Date Time Contact Name Doc-Building Pen-nit Revised 2014 r 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 :rF 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 ;ra 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 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 2012 I ECC 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 Doc:Building Permit Revised 2014 Location kq 0 O A'✓.� No. 3 OF - e9G/7 Date 4-6, 6 • - TOWN OF NORTH ANDOVER N • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# n 0 -Zl Ail Building Inspector NORTH Town of t _ �� 6Andover No. * 't o h ver, Mass, 2Z A_ [Oc NIce4aw c 7d p�RAT I gD) ,",F y S U BOARD OF HEALTH Food/Kitchen P -ERMIT _T LD Septic System THIS CERTIFIES THAT ......,r......... Of /160. BUILDING INSPECTOR ...........". Foundation has permission to erect .......................... bu/dais on ... .,l..C, I.l�, ....... .......... Rough to be occupied as .......� � r. �r.. . ,.� ..,�. ,�. .. ,CI .......... cniy . ugmneprovided that the person accepting this permll 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 CONST IO Rough - Service . ... .. .. . .... . .... ......... ........ Final BUIL INSP TOR 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. x i`, FadaM 1110 9¢040= RISE E1>gi>;eeliag to Coaaa*w RMOWA oo Ito RIM ' A division ofihlelach&Watering NACeafrader l�ra8aa No 13M EEME Company Address,City,MA 08400ENGINN /� 4014231234 FAX401-123.1234 CONTRACT Q PROGRAM QUA-)t[hS �scwmtaeme19 iie unman eustasat uveae Guam sawaam M'ctchael Fuller r v lj' (78t}953.60g3 06/2 VM16 436460 00002 auorvrca neuter ua agar 5 Rosedale Avenue v `' 5 Rosedale Avenue asrrvtee enrsun►>�ar �,' num art Mw zP NoRfi Andover,MA Ol North Andover,MA 01845 Jr- JOB DESCRIPTION HAZARD BARRIER We have identified that there arc recessed lights present fn your home.wrless the faxwd lights am codified as IC-rated(Inm tion Contact Ratrd)wt wdl create a 3"clearance spece aromid the fluure by tag fiberglass hleasoet irselation as a dimming meterA no instilation will be installed Domes the top and closed cavities which contain recessed lights will not be h adawd $0.00 ATTIC FLAT:Provide labor and materials to install a 9'layer of R-30 ermined fiberglass baits to(80)spmra Em of attic apace. $133.60 ATTIC FLAT:Provide labor and materials to install a 6'layer of R-21 Gass 1 Cellulose added to(894)s m feet of open attic Spam $1,126.44 WHOLE HOUSE FAN:Provide labor and materials to fiabft and install a rigid foam insulating cover for the whole hoose fan $209.21 ATTIC ACCESS:Provide labor mrd malerials to butall(I) easily moved,iasudeting cover i so=a;ifa eoBolding stair. A small flat surface of plyvwad will be created amend the opening within the attic. This vulp elbwtbo cover's integral vavnher-stripping to restrict air $?37.65 VENTILATION:Pmvub labor andmaomWs to i=d(2)itnsdated uxthatnt hose verb roof mormicd iispper vent to uachauist et3stingbothro m fan(s). $237.50 VENTILATION:Provide labor and materials to install ventilationchutes in(63)rafter bays to maintain air flow. $126.00 INCFiNTIVfi:RISE Bngineeringva apply all applicable,digibta faceatives to this comrsat. You veil only be billed the Nat amoumt. Cumentty,for 0161h measures,Columbia On offers an mcantivoof 75%not to exceed$2,000 per eahadar year,and am incentive of 100%for the Air Sealing measures UP to the fast$680 and an additional$340 if savings aro JUAM by the auditor. FOR A LIM[TED TIME:Columbia On vrill also offer an additional 3100 incentive towels the vieatherization vmrk olitlined in this proposal.This R=W Summer Incentive is availelde to homeowners vAo have had their Col mbla(ins home energy audit before July 31.2016. A signed proposal for vuesthetiostion needs to be submitted by August 8,2016 and vwdc must be compleW by September 30,2016. For the aft and health of your home's Indoor air quality,we will be conducting a blow door diagnostic of the ovauleide air flow in your home both before the vwk is begm,and after the vadherkestim work is complete.We va also conduct a fun amassment of the oombusfon safety of your beating system and water heater.This has a value of$90 and is at no cost to you. The maximum allowable incentive for all meawe%including air seating,is 33,210 $90.00 t _. A. c FsdwW IDS 08%UW RISE Eoginceft RI comb aewr Ragickwon No e"es Adivision of1hieisch Fagineering MAContradm Registratlon No 1200x0 RI S E Company Addmn,City,MA OM ENGINEERING CONTRACT 401-133-1234 FAXQ01-123-1234 Page 2 PROGRAM T�00 oaawAatle®ro ern eetaI a+sa CMA.H4r4 �va<eustae�rat�aracRa am== F� RM Main _ Michail fllIler M1053.6063 06/2112016 436460 00002 sow=soma =L=air 5Rosedale Avenue S Rosedale Avenue smvm a w auiLw saran CINIMI M North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $2,16040 Program Incentive: $1,742.80 Customer Total: $417.60 wHAGMKEVt WTopum 8118"=.CUMLEMINACCpRDANce14RIIABOYESMMFMATmM&FORTNeaUMOF "*Four Hundred Sevenlleen&60N00 Dollars $417.60 YPCIIFNALINUCC MANnAVPRWN.1YItISN Wa14ERAORL WMWASKINVOWINFILLa1B8mTQ1%1Fi11 QYHORD®rWTlaiblY WQA�6 UWM 0k aHkW1MYF e -NrMIORYi=ON OWWAXIMMMOFIfECRa01,i0f�iR1N0. DO NOT SIGN WS CCNTR=IF IWEW A /V NOT8:7p0 BQWI,EIW.NarNB.N01E7�(�tIMBII ORLOFACC�DINCa ��� /�a, av�1O aln'4 AaatsE>?�i'Al'�IiRC,I®4108 ASenM Ae0Y8 RISE"': 60 Shawmut Road, Unit 2 Canton,AAA 02021 339.602- ENGINEERING www.MSEengineering.com ! 6335 OWNER AUTHORIZATION FORM qC/ (Owner's Name) ' owner of the property located at: /-'-Vo'c c0a l c VA - (Property Address) rCr • (� two v v,e / Vk-4 6" (Property Address) hereby authorize--n ( ubcontractor) 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. --- & O er's Signa ure 6uvi as 0 Date The Commonwealth of Massachusetts --�- _y Department of Industrial Accidents Office of Investigations _ - 1 Congress Street,Suite 100 Boston, MA 02114-2017 www.mass. ov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Builders Services Group d/b/a Quality Insulation Name (Business/Organization/Individual): 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): 1.7 1 am a employer with 100 4. [] I am a general contractor and 1 6 New construction employees(full and/or part-time).* have hired the subcontractors �.F-1l am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling These sub-contractors have 8. [] Demolition ship and have no employees employees and have workers' 9 E] Building addition working for me in any capacity. comp. insurance [No workers' comp. insurance 10.[] Electrical repairs or additions required.] 5. � We are a corporation and its 3.❑ I a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions right of exemption per MGL 12.❑ Roof repairs myself. [No workers comp. § c. 152, 1(4),and we have no insurance required.]t employees. [No workers' 13.Z Other Weatherization 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. 1 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 WLRC 48151553 Expiration Date:6/30/201'7 Policy#or Self-ins. Lic. #: Q Job Site Address: e (, '� City/State/Zip: &C 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 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. I do herebv certi_v under the pains and enalties o eriury that the in ormation provided above is true and correct. Date Si nature: 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 DATE(MM/DD/YYYY) A CERTIFICATE OF LIABILITY INSURANC 06/14/2016 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(ies)must have ADDITIONAL INSURED provisions or 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). d CONTACT PRODUCER NAME: Aon Risk Services Central, Inc. P oN (866) 283-7122 aC Ne : (800) 363-0105 Southfield Mi Office (ac.No.Ext): _ 3000 Town CenterC EA DRESS: _ Suite 3000 Southfield MI 48075 USA INSURER(S)AFFORDING CIOVERAGE NAIC a INSURED INSURER A Old Republic Insuran a Company 24147 TrUTeam Builder Services Group, Inc. INSURER B: ACE American Insurance Company 22667 d/b/a Quality Insulation INSURER C: Lloyd's Syndicate No 1969 AA1120106 A Topeuild Company 110 Perimeter Rd INSURER D: Nashua NH 03063 USA INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570062471987 REVISI N NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NA ED ABOVE FOR THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUN ENT WITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HER EDN 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 -POLICY EFF POLICYEX TYPE OF INSURANCE INSD WVD POLICY NUMSUBIRBER MMID MMIDDIWVY LIMITS LTR MWZY 1 EACHOCCURRENCE $2,000,000 X COMMERCIAL GENERAL LIABILITY CLAIMS-MADE X❑OCCUR PREMI ES Ea occurrence) $2,000,000 MED E P(Any one person) j $25,0 PERS( 8 ADV INJURY $2,000,000 rn GEN'L AGGREGATE LIMIT APPLIES PER: GENEAl_AGGREGATE $4,000,000— n X POLICY ❑ PRI LOC PROD CTS-COMP/OP AGG $4,OOO,000 ID 0 0 OTHER: MWTB 307519 06/30/2016 06/30/2017 COMB ED SINGLE LIMIT i $5,000,000 A AUTOMOBILE LIABILITY Ea ae.ident BODIL INJURY(Per person) C Ix ANY AUTO _ OWNED SCHEDULED BODIL INJURY(Par accident) w AUTOS ONLY AUTOS PROP RTY DAMAGE V HIRED AUTOS X NON-OWNED Pera 'dent r- ONLY AUTOS ONLY t: d X OCCUR TH1600027 06/30/2016 06/30/2017 EACH CCURRENCE $2,000, C X UMBRELLA LIAR000 V SIR applies per policy ter 5 & condi- 1Of15 AGGREGATE $2,000,000 EXCESS LIAR CLAIMS-MADE DED I X RETENTION B WORKERS COMPENSATIONAND WLRC47860180 06/30/2016 06/30/2017 X gTUTE 0fH- EMPLOYERS'LUU3ILITY YIN All Other States E.L.E CH ACCIDENT $1,000,000 ANY PROPRIETOR I PARTNER I EXECUTIVE SCFC47860209 06/30/2016 06/30/2017 B OFFICERIMEMBER EXCLUDED? NIA (Mandatory in NH) WI onlyE.L.DISEASE-EA EMPLOYEE S1,000,000 If yyes,describe under E.L.D EASE-POLICY LIMIT $1,000,000— DESCRIPTION OF OPERATIONS below —_ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached H more space is required) Evidence of Insurance. ,( r=1 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 POLICY PROVISIONS. Builder Services Group, In AUTHORIZED REPRESENTATIVE dba Quality Insulation A TopBuild Company Nashua NH 03063 USA ©1988-2015 ACOR CORPORATION.All rights reserved. ACORD 25(2016103) The ACORD name and logo are registered marks of ACORD I f&M~wwsumer rsid(;/&usmess eg anon 10 Park Plaza - Suite 5170 Boston, M sachusetts 02116 Horne ImprovernQ9,ontractor Registration Registration: 179141 Type: Supplement Card Expiration: 6/25/2018 BUILDER SERVICES GROUP, INC RICHARD SCHWA TZ 2fi0 JIMMY ANN DRIVE DAYTONA BEACH, FL 32114 4* Update Address and return card.Mark reason for change. SCA 1 0 Address (] Renewal [] Employment Lost Card C,r/ie� o9a; ,o� ssad+uaella tee of Cansumer Afrsira&Bnsieess Regulation License or registration valid for individual on only E IMPROV'[ENT�CONTRACM11 before the expiration date. If found return to: :'�'`ti Office of Consumer Affairs and Busixess Regulation Type' 14 Park Plaza-Suite 5170 Supplemem Cana Boston,MA 02116 BUILDERSERVICE RICHARD SCFiWAR ` _ !r• 110 PERkMETER RD NkSHUA,NH 03063 Undersecretary Not valid without signature J low "S R It' CSSL-105992 RICHARD SCHWARTZ 19i HUNTRESS STREET manchester N11 0102 09/26/2016 Restricted To, CSSL-IC-insulation Contractor Failure to posseV —\.rren't edition of the MassachusettS State Bultdirig d lause for revocation of this license.