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HomeMy WebLinkAboutBuilding Permit #559-16 - 55 FARNUM STREET 11/5/2015 NORTh q �.� BUILDING PERMIT 2 - � �<<`� 6•6�°� TOWN OF NORTH ANDOVER ° t o APPLICATION FOR PLAN EXAMINATION - Permit NO: Date Received � SQA '•: �' � i � �9SSAs�t�� Date Issued: i CHl1 IMPORTANT: Applicant must complete all items on this 2age OP R SAP' P ZONl NG- tSTkICT H orto Distri'd Villa VW TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 2=9ne family ❑ Addition ❑ Two or more family ❑ Industrial &Alteration No. of units: ❑ Commercial -Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other / /may% C � 11 d, l �fbi h r ,c i Identification Please Type or Print Clearly) ` OWNER: Name: L� Phone: — 00300 Address+[ k �t1W ORQ P� / /r tillr r •.ry ...r 4 y. �eivr ©r' rt ion LiCe+ se gip. Dom, / /y /p 79/ HbM rttMor ae ase Exil e piz - o, r- 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: $ L4 �� . —? 0 FEE: $ 5a- Check No.: !123 Receipt No.: NOTE: Persons cent acting with unregistered contractors do not have access to the guaranty fund l 7 /V� en •.% r �g�a _ t1©�irter Sxg�a#u�`efi.con tract � s NORTH BUILDING PERMIT 32oh S,E� 'b;�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 70 Permit No#: Date Received �l A°R�reo�Pa`y(�J gSSAC HU`+�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 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 ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain El Wetlands ❑ Watershed District ❑Water/Sewer 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: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING 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 ,ignature of Agent/Owner Signature of contractor' Location No. f"/ ® Date � .�- 1S . - TOWN OF NORTH ANDOVER • - Certificate of Occupancy $ Building/Frame Permit Fee $� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check#C' v rjuilding Inspector J Plans Subm ted"D-- 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 on Siqnature COMMENTS HEALTH Reviewed on Siqnature 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: _� Located 384 Osgood Street FIRE 9-PARTMENT - Temp Dump -,r on site yes Locafed at 124.Main=Street - Kra Depadment signature/date _ LC QMMF_NTS , 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) i ❑ Notified for pickup Call Email Date Time Contact Name Doc.Building Penuit Revised 2014 I 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 VOTE: 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 Ir 1 t1ORTH - W" i -c ve . 0 No. ?,, , ver, Mass, 0 / l 1 A- coc»ic«ew$cr �1 7�A�R�tTED S U BOARD OF HEALTH { Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..........P. ................ K/ ....................................... BUILDING INSPECTOR has permission to erect Foundation .......................... buildings on .....,� ....... ..... ^.:!�:�''�'�:.....b'r' ..... . ......................... i Rough to be occupied as ............&Cx- . . Fl �. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. � Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONR Rough Service ........................ ............................... � BUILDING. . Final 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. 1 CC!y T Federal ID#05.0405529 RISE Engineering MA co�ctorRegf on No 120979 A division orrhietsch Engineering CF Contractor Registration No 620120 60 5hawmut,Canton,MA 02021 CONTRACT 339-.%'—)5197 FAX 339-502-6345 !! E \ �e Page 1 % PROGRAMINTO TS CONTRACT EITTERED iETYEiRISE Af1NEE21*G CMA-HES E7GHERMANOTIM CUSTOMER FOYORK AS DE3CRISED ne= r 4 CUSTOMER4.l DATE CLIENTS VWMORM Richard Denault ,�`v CC X378)794-3773 0710912015 419085 GM2 SERVICE STREET _ WU.010 STREET 80 Huckleberry Lane *��!N\\\ 80 Huckleberry Lane SERVICE COY.STATE.YTP Sa WO CTT,STAT'£,ZIP North Andover,MA 0 1845 North Andover,MA 01 845 JOB DESCRIPTION AIRSEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to he used to seal your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages;and other unheated at=(windows am not generally addressed.)This will require(8)working hours. A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number oram is not guaranteed. At the completion of the wcatherization work,and at no additional cost to the homeowner,a rnal blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 AIR SEALING ADDER: (4)working hour.. $340.00 AI TiC FLAT:Provide labor and materials to install a V layer of R-21 Class 1 Cellulose added to(1670)square feet of open attic space. $2,104.20 ATTIC ACCESS:Provide labor and materials to insulate rite back of(2)tactic hatch with 2"rigid Thermax board.Weatherstrip the perimeter. $120.00 VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). $237.30 VENTtLADON:Provide labor and materials to instal(ventilation chutes in(84)rafter bays to maintain air flow. $168.00 COMMON WALLS:Provide labor and materials to install 2"FSK faced semi-rigid fibe°re_,lass board insulation to(168)square feet of common wall area. $588.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only he billed the Net amount. Currently,for eligible measures,Columbia Cas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive or 1000/.for the Air Sealing measures up to the first$680 and an additional$340 il'stwings arc justified by the auditor. For the safety and Wealth of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air now in your home both before the work is begun,and after the weathcri7zion work is complete.We will also conduct a Cull assessment of the combustion safety of your heating system and water huucr.This has a value orS90 and is at no cost to you. Total allowable weatherization incentive is$3,110. 590.00 r Federal ID#05-MBS29 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 Adivision ofThiththEn inrering CT contractor Regista nNo520120 � GO Shawmnt.Canton.MA 02021 CONTRACT FAX 339-SOU345 E Page 2 Pf2t)fiIZAM ari EIBIS1NEERINIG 4 ,0 TCONTPACTISEN EREOTaroeETWEENRME {/J CMA-HES ENOINE MO AM THE CUSTOM FOR WORK As V OESClIMS0 0[Ww CUSTOMERi 1\ 79- DATE CUENT$ ;i—ft ORDERRichard Denault 4 `� 8)794-3773 07109P2015 418686 00002 SERVICE STREET 034=STREET 80 Huckleberry La N V 80 Huckleberry Lane SERVICE CrrY,STATE.2TP +7` BIU,NG CITY,STATE.T2P North Andover,MA 01 North Andover,MA 01845 \� JOB DESCRIPTION Total: $4,327.701 Program Incentive: $3,109.99 Customer Total: $1,297.70 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE SUM OF ""fine Thousand Two hundred Seventeen&701100 Dollars $9,217.70 UPON F3TdAL CnON AND APPROVALOY RISE ENGi"N£ERIDIG.CUSTOMER AGREES TO RUM AMOUNT OUE M FULL INTEREST Or T%WTLL BE CHARGED MONTHLY ON ANY UNPAId3 AFTER 30"M SES REYERS£FOR NI MAK WORMATION ON GUAWnM,MMOFFMCOMI.SCMUUNG.VMCOUnt4aoRPX-GISMAMk L no NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZED SiGNA .RISE e*k* * COST ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WM4N OATS OF ACCEPTANCE ACCEPTANCE OF CONTRACT,THE ABOVE PRICES.SPECIFICATIONS AILD CONOI nom ARE 30 DAA y SAYMFACT40RY TO US ANO ARE HEREBY ACCEPTED.YOU ARE AUTHORRED TO OO THE WORK AS SPECIFIED,PAYMENT WILL BE MADE AS OUTLINED ABOVE . The Commonwealth of Massachusetts ,.Print Form, Department of Industrial Accidents "i Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #:603-578-9275 Are you an employer? Check the appropriate box: Type of project(required): 1.21 t am a employer with 100 4. ❑ I am a general contractor and 1 6. F] New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- 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' 9. E] Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their l 1.❑ Plumbing repairs or additions myself. No workers' com right of exemption per MGL y [ P• 12.❑ Roof repairs insurance required.] c. 152, §](4), and we have no employees. [No workers' 13.❑✓ Other Insulation comp. insurance required.] *Any applicant that checks box 41 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 job site information. Insurance Company Name: Indemnity Insurance Co of North America Policy #or Self-ins. Lic. #.��7i772A, LKC-i$V. i_ j?j Expiration Date:6/30/201 Job Site Address: �� ('AtM City/State/Zip: Mt AnIttec R9 g-1 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. Ido hereby certify under the pains and penalties of perjury that the information provided abot;t is true and correct. Si nature: Date: 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 S. Plumbing Inspector 6. Other Contact Person: Phone#• A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06/24/2015 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 C CONTACT d Aon Risk Services Central, Inc. NAME: •p Southfield MI office PHONE (866) 283-7122 FAX (AIC.No.Ext): 3000 Town Center (AIC.No.): (800) 363-0105 Suite 3000 E-MAIL ADDRESS: O Southfield MI 48075 USA = INSURER(S)AFFORDING COVERAGE NAIC p INSUREDTOI) INSURER A: Old Republic Insurance Company 24147 260 Jimmy y Annn Drive iCon. INSURER B: ACE American Insurance Company 22667 260 Daytona Beach FL 32114 USA INSURER C: ACE Fire Underwriters Insurance Co. 20702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570058348882 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. LTR TYPE OF INSURANCE S O C O c EXP Limits shown are as requested INSD WVD POLICY NUMBER MMIDDlYYYY M M /DDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304834 EACH OCCURRENCE $2,000,000 CLAIMS-MADE a OCCUR AMAG 0 RENTED $2,000,000 PREMISES Ea occurrence MED EXP(Any one person) $25,000 PERSONAL B ADV INJURY $2,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 v X POLICY ❑PRO- ❑ JEC7 LOC PRODUCTS•COMP/OP AGG $4,000,000 00 OTHER: 0 A o AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT Ea accident $5,000,000 X ANY AUTO BODILY INJURY(Per person) O EXHIRED L OWNED SCHEDULED Z TOS AUTOS BODILY INJURY(Per accident) d AUTOS X NON-OWNED JP PERTY DAMAGE i6 AUTOS accident O w UMBRELLA LIAR OCCUR H OCCURRENCE U EXCESS LIAB CLAIMS-MADE REGATE DED RETENTION B WORKERS COMPENSATION AND WLRC481S1SS3 06/30/2015 06/30/2016 PER EMPLOYERS'LIABILITY X STATUTE OTH- ANYPROPRIETORIPARTNER/EXECUTIVE YIN All Other StdteS ER C OFFICER/MEMBER EXCLUDED? NIA SCFC4815190 06/30/2015 06/30/2016 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) WI Only If yes,describe underE.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Coverage N4 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES.BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. aTj, Builder Services Group, Inc. A TopBuild Company AUTHORIZED REPRESENTATIVE 260 Jimmy Ann Drive Daytona Beach FL 32114 USA ACORD 25 2014/01 ©1988-2014 ACORD CORPORATION.All rights reserved. ) The ACORD name and logo are registered marks of ACORD /'` V/ � "J tr'f`✓ { ftr`` Of Ce of Consumer Ai ai 'rs nd Business Regulation sN-y 10 Part; 'Plaza - :Suite 5170 Boston. .NAlassachusetts 02116 Home Improvement Contractor Registration Registration: 179141 Type. Supplement Card BUILDER SERVICES GROUP, INC. expiration: 6/25!2616 RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03003 Updaie Address and return card.!hart:reason for change. A.ddrest Renmtial Eniployment L u s i ( :rti -=_0.f ce of Consumer Affxi:,& Business Reguiaiion license or registration valid for individul use unh ;,.... oME 1tt9PRQi'EiUiETiT CONTRACTORbefore the extiiraiion daie. If found return to: :. 01,ice of Consurncr A lairs and Business Regulai'on tiet3istraiiOr: 179141, Tp Expirabom 6i25120116 Supplement :arG Be, un.NIA t>11'i UILDER SERVICES GROUP, INC. ICHA.RD SCH'I ARTZ 50 jIMMY ANIN DRIVE AYTQNA BEACH. F-1 32114 �r �� 1'r,Ler;tcrriar� Not vaii'_vi"it3eot3t signature i i i I I CSSL-105992 RiCRARU SCH$vVARTZ y 19 k#U1eTRE SS s,rItEET Manchester NH (13102 �✓ 09/26/2016 1 Restricted To CSSL IC Insu`atiu.' L:orttre�c'.:,. i i Failure to posses- -rem edition of the Massachusetts State Building Coe ause for revocation of thl,,hcense I