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HomeMy WebLinkAboutBuilding Permit #726-2017 - 534 SOUTH BRADFORD STREET 1/19/2017BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#��-� " I Date Received 1 ( l Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 3 Y�� f 1(—oJJ%r4,y �" \ Print PROPERTY OWNER J ah&A k cry Pri t 100 Year Structure MAP PARCEL: ZONING DISTRICT: Historic District Machine Shop Village / V��t LBD F64'NC yes no yes no yes no TYPE OF IMPROVEMENT PROPOS D USE Resioefitial Non- Residential 0 New Building 1110ne family ❑ ition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Others: ❑ Repair, replacement ❑ Assessory Bldg - ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑Flood Iain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer utSc:KIPTION OF WORK TO BE PERFORKEQ: S -ca \ &OJ -AM i L-&-) r\ 0- OWNER: Name: 0,1 Address: S 39 Pleise Type or Print Clearly S )�- 0 1 &_Kkv1 I • ,;a oe .�o( --TH Contractor Name: ✓ CM &Aj► Phone_ SLO • Email: r► Address: d C' -,o) �LI I <<y�4 (,, t''t Supervisor's Construction License: Exp. Date: Home Improvement License: 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: $ 2-cl18�' • (o -7-1 FEE: $ 3 f Check No.: 3/o-7 Recei t No.: / NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanaing/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 a U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS A 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: uocatea ju4 FIRE DEP�RdTr2MENO� �,TernpDumps Y nslte&& iyes._ r%c ILo acac ted ati1r24 A9[5 Sfreef, men sigatur4e%date MOMMENTS_ street 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 No MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine NOTES and DATA — (For department use ❑ 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 4 Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses 4 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 aFloor/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 4. Photo of H.I.C. And C.S.L. Licenses 4, 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 Doc: Building Permit Revised 2014 E 0 Jp w LL Q0. D a O m a) Y \ O O LL E Y T N U a a1 N a Z Z oco m C N 'O 7 O LL L O O CC N Cr C .G U u O LL O a Z Z J d. L = O W O LL a Z u u W L O cr N U > N _ O LL OC LV Z (A C7 -C O _ co C LL Z cc W ° 95 LL i 61 O On O Z '�' v N a) N � Y O N n , C C O cQ �o r S� �• _�� CLi <� W L c VQO CL Cc E �• J d or: i m d LA > O w i N O O > s: N O Q C �• EC Q o �_�cn � > c c H Q. •o r m atm 2 O Q a) N N dV m d Ncc w G 'a- 4-: O ,F 0-m :E UJN C O W L 0 (D. O H 0 (D L 0 •p .. Q N U) M .O O cc H t w QOC) > O a z C!) 0 • m LS Z ~ C w0 �v �w LLI -j CL Z E � O O Z CD CM 0 � O .� N Q •E m ca .� O 4 0 mO Q a C. a� Q o� v J �CL O CD Z O L) tU m _ 30 am a Federal 10 0 0604WM RISE Engineering RI Contractor Realwation No 6168 6lACanunctorRaglaVatifon No 128879 RISE CT Contractpr ftoglatragon No820t10 EN61NEEffi NNCa 60 Sbewrnnt Road, Canton, iNi102021 CONTRACT CT 339 -M -633S FAX334-501-6345 �/'i V Page PROGRAM CMA -W s0° t ®et "tnapc+a CAR CiBxn daagitosman Joseph Uadiego ' - (978)806b674 101INM16 439858 23902 at7uaaa atdiear aacmo sumer 534 South Bradford Street S34 South Bradford Street scarier ae.amr up aatm eny.atxue.w North Andover, MA 01845 North Andover, MA 01845 i JOB DESMON HEALTH R SAFET Y: have your hepiegt rstear tuned up and retested to be sue that the u limed five VMdo not exceed 100 pacts per million (ppm) carbon nlonoXide.-Wcd1h0ttdiun %otk cannot proceed tmtfl this is fixed 50.00 HAZARD BARRIER We hese ide atifaed that than ere teixxsed lusts present in your bane. lentos the teceusd lights are certified as IOGrated (Insulation Contact Rated) We mall create a 3' clearance space around the fixture by tsiag fihaiftss blanks hnsdetion as a damming material, no insdation Wail be installed across the top and closed cavities Whicln contain raoessed lights vA not be insulated 50.00 AIR SEALINtk Provide labor and materials to sail areas of yaw home against Wm dul„ excess air WebeL This work PA be performed in ooaoet whit the Use of spatial tools and diagaostie tests to assure that your home vA be left Wstb a heaftw level of air exebmige and indoor ah• quality. Materials to be need to seal your home can include caulks, foams and other products, Primary area for strafing include air leakage to attics„ basements, attached gtaragesand other msih um ares (wimdm we not @newly Addressed) This will nepdre (10) working hours. A reduction in caublc feet per minute (efm) of air Infiltration will ottani, but the actual amber of efm is not gw anteed At the completion of the weathaidzatiaa work, and at no additional cost to the homeowner, a final blower door andfar combustion safaty analysis may be conducted by the sub -contractor to ensure the safety of the indoor air quality. $850.00 DAtM4INCx Provide labor and materials to install a f2' layer of R-38 unWWfibertas Batts to (106) sgmroe feet for damming ptaposs.KEEP Di NGNATED FLOOR S2 t 730 ATTIC FLAT: Provide labor and materials to hwo a 6' layer of I1r22 (lass 1 Cellulose added to (1008) span tat of open attic spM• KEEP DESIGNATED FLOOR S1.270.08 VENTILATIOR. Provide labor and materials to insan (3) insulated a dwA base With roof mounted flapper vent to extuuat exilingbathmm fir(s). 8356.25 VENTILATION: Provide labor and materials to install ventilation chutes in (102) rafter bays to maintain air float 5204.00 RISE Engineerfng will apply all applicable, eligible incentives to this contract. You will only be billed the Net amount. Currently. for e[iglble meaaaes, Columbia Gu offers TS% incentive. not to exceed $2.000 parc eleadar year. and an incentive of 10094 for the Air Seating measures up to the fust $680 and an additional 5340 if savings me justified by the auditor. RISE ENGINEERING' 60 ShawnM Road, Unit 21 Corm, ARA 02021 , 3U4U4 335 ww wAlsEer4heering aom OWNER AUTHORIZATION FORM ii ya Ch (Owner's Name) z owner of the property located at �3 �! S. oreaco ward -fl, (Property Address) d • Row, . D1 'r iii' hereby authorize '4 Gw 0% J C r I U, Sy W- an , ' .-- (Subcontractor) • " an authorize! sutrcontractm for RISE Engineering, to act on my behalf to obtain a building per nit and to perfomn watt an my property. This form is only valid with a signed contract. Ther Permit will be secured by the insubtian corrtrac tor" at no additional cost. It Is the homeowneft responsibility to close out this permit by conbcdM their municipality at the comptedon of this work. S Signature Date M The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02H4-2017 ,,%� www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AaalicAnt Information Please Print Legibly Name (Business/Organization/Individual): SQl 1.t.1-iQl'1-, \V`t-, Address: Tom- 6 130 "344 Ci /State/Zi : IOALJ (U\ r i A 0 °13 6 Phone #: fit_ • 34 6 3 Are you an employerl Check the appropriate box: Type of project (required): 1. am a employer with �� 4. ® I am a general contractor and I 6 [3New construction employees (full and/or part-time).` 2.[] 1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. ® Remodeling ship and have no employees These sub -contractors have g, ® Demolition working for me in any capacity. employees and have workers' comp. insurance.t 9 Q Building addition [No workers' comp. insurance 5. ® We are a corporation and its 10.[3Electrical repairs or additions required.] 3.0 I am a homeowner doing all work officers have exercised their 11.® Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL c. 152, §1(4), and we have no 12.[3Roof repairs insurance required.] t employees. [No workers' 13.[] Other coma, 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. I am an employer that is providing workers' compensation insurance for my employees Below is the policy and fob site information. Insurance Company Name:ClA 1 i(\�V \Ck, Lo Policy # or Self -ins. Lic. #: �'C �._i� Z Expiration Date: 2 CS Job Site Address. ) %.4 5 D �j 0� � u'J City/State/Zip � 1-7 dl 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 verification. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. o fjicial use only. Do not write in this area, to be completed by city or town q&ial. 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 #: DATE (MMA)O/YYYY) AC40 V CERTIFICATE OF LIABILITY INSURANCE 10/18/2016 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). corlracr Me Munroe PRODUCER NAME: g PHONE 413 536-0804 FAX No: MARTIN J. CLAYTON INSURANCE AGENCY INC A/c N Ext: ( ) mmunroe -miclayton.com 1649 NORTHAMPTON ST., RTE 5 INSURER(S) AFFORDING COVERAGE NAIL# HOLYOKE MA 01041 INSURER A: ACADIA INS CO 31325 INSURED INSURE18: GAUTHIER INSULATION INC INSURE IC: INSURER D: PO BOX 344 INSURER E: IPSWICH MA 01938 INSURER F: COVERAGES CERTIFICATE NUMBER: 94521 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, F:xr.I I ISInNS AND CONDITIONS OF SUCH POLICIES, LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OF INSURANCE ADDL Si COMMERCIAL GENERAL LIABILITY CLAIMS -MADE 1:1 OCCUR GEN'L AGGREGATE LIMIT APPLIES PER: ❑ PRO ❑ LOC JECT LIABILITYONED SCHEDULED AUTOS NONOWNED I UTOS AUTOS LLA LIAR OCCUR LIAB RETENTION $ WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANYPROPRIETOR/PARTNER/EXECUTIVE A OFFICER/MEMBER EXCLUDED? I WA WA (Mandatory In NH) If yes, describe under DESCRIPTION OF OPERATIONS below N/A NIA N/A N/A I MAARP300327 N/A 10/30/2016 110/30/2017 LIMITS EACH MED EXP (Any one person) 4 - PERSONAL PERSONAL & ADV INJURY $ GENERAL AGGREGATE $ PRODUCTS - COMP/OP AGG $ Is COMBINED SINGLE LIMIT 1 $ (Ea accident BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident EACH OCCURRENCE AGGREGATE $ E.L. EACH ACCIDENT E.L. DISEASE - EA E.L. DISEASE - PO $ 500,000 .OYEE $ 500,000 LIMIT $ 500,000 DESCRIPTION OF OPERATIONS / LOCATIONS /VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached It more space Is required) Workers' Compensation ebe s sttsltrEndorsement WC 20 03 s lon is ttto pay aims fobenfits to employees in stateother thanMassahuse f he insured hires, or has hired hose employeeoutside of Massachusetts. This certificate of insurance shows the policy in force on the date that this certificate was issued (unless the expiration date on the above policy precedes the issue date of this certificate of insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage - Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. ,ERTIFICATE 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. TOWN OF NORTH ANDOVER 1200 OSGOOD STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01845 Daniel M. Crow y, CPCU, Vice President — Residual Market — WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014/01) The ACORD name and logo are registered marks of ACORD (� co �n�� SCCA D 0 7a m m COD�� Ov N O 4 N f G QAC A to e� Q e (� co �n�� SCCA D 0 7a m m COD�� Ov N O 4 »�■c �\/$ § »\ �: \ƒ Location S 3 << 13 r 4 �a F i A- n No. -77G' 2-00 Date ! C7 a of 7 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ t TOTAL $ Check #,3(0-7 y32 f L S 1 1 5 4 LBeilding inspector