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HomeMy WebLinkAboutBuilding Permit #105-2017 - 58 MAY STREET 8/2/2016 NORTk Of tato 6'ggr BUILDING PERMIT ` TOWN OF NORTH ANDOVER ° APPLICATION FORPLAN EXAMINATIO 41Permit N0: Zo Date Received 7 c2bit, Date Issued: ��� �9SSACHUS IMPORTANT: Applicant must complete all items on this page LOCATION 57 Noy4bQ Print PROPERTY OWNER—M kw-., Fangsjrr- Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yesno Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition NTwo or more family ❑ Industrial T]Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑Water/Sewer ofic, Wall v r-1P�yfl��1�,1�j cx� Identification Please Type or Print Clearly) OWNER: Name: �.lJQ�r Phone:zT-J?• 2S$ Address: CONTRACTOR Name: , :SWN4rOS Phone: - - 125 Address: '�"I 1n1 M i N-tsr� �• 1-i�.� k t'UY1L 1M Pr Q213(o Supervisor's Construction License: Exp. Date: Lb)WT 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: $ -I . 9, FEE: $ Check No.: 103,6 j- Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to t e ua ty f d Signature of Agent/Owner Signature of contractor i Location No. /05 Date r3 OZ ter , • • TOWN OF NORTH ANDOVER � Ate' • • Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# f 1 7Z-- r+ Building Inspector / NORTF{ '9 Tow* n of t. 6 ndover No. hver, Mass, A- CO[NtG MlwK.t 0-9 D zw y1' 7a ORATED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System .�� .r,� ................ BUILDING INSPECTOR THIS CERTIFIES THAT .... .... . .6r.t..�!!�..... . 5.8. � Foundation has permission to erect .......................... buildings on ........ .... ...... ............... ............................ Rough to be occupied as ..� G ��.�k/��r.......... .1,1:1� �..I. .. chimney provided that the person ac pting this emit 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 CON T10 Rough Service ... .. ....... ..... ... .... ........ ' Final BUILDING I ECT 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. r r Work Order GREATER LAWRENCE COMMUNITY ACTION Job Number:20092154 COUNCIL,INC. Work Order Date:7/15/201.6 305 Essex Street Ownership:Owner Lawrence,MA 01840 Phone:978 681-4956 AMERICAN BUILDING TECHNOLOGIES Auditor:Keith Young 263 Western Ave Email:kyoung@glcac.org Lynn MA 01904 Cell:978 857-7841 Email:jobs@americanbuildingtechnologies.com Phone:978 681-4955 x4793 Phone:781598-7125 Cell:617 233-8704 Madeline Fontaine Columbia Gas $7,752.76 58 May St Apt 1 Total $7,752.76 North Andover Ma 01845-2328 978-258-1231 Safety Issue(s):Lead Paint Possible Autliorazed Aetual . Measure Descr�phon Qty Price Total Qty _ Total 1° Com ents . ' A,ttic Tnsulat,on � ' R49 unrestricted-settled cellulose 136 $1.80 $244.80 136 $244.80 for front porch flat Attic Yenhlahon Rectangular gable vent 1 $103.00 $103.00 1 $103.00 12 x 16 gable vent Basement Insulation Basement overhead insulation R19 136 $1.77 $240.72 136 $240.72 under front porch Fiberglass Doors i Fixed Sweep triple flange 6 $17.64 $105.84 6 1$105.84 Fr.ext./2 rear ext./2 base.int./door to attic Weatherstrip s/Q-Ion or equal 6 $51.00 $306.00 6 1$306.00 Fr.ext./2 rear ext./2 base.int./door to attic M sc. -suiahoa Rigid Foam Board 1 inch RFB PER 136 $2.63 $357.68 1136 1$357.68 136 sq.ft.foam board under front porch SHEET Date:7/15/2016 Page 1 Work Order: Job Number: 20092154 M�sc Measures ; s Attic/basement blower door guided 3 $70.00 $210.00 3 $210.00 Seal under sinks,chimney,plumbing,electrical sealing with one-part foam and all air penetrations to the living space. Replace Clothes Dryer Transition 2 $45.00 1$90.00 2 $90.00 Duct only Perms# Other 1 $0.00 $0.00 1 $0.00 Wall Insulation Drill rough plaster patch or finish 468 $2.04 $954.72 468 $954.72 wood plug(dense pack) Wood clapboard/shakes/shings or 2570 $2.00 $5,140.00 2570 $5,140.00 vinyl(dense pack) Total $7,752.76 $7,752.76 Contractor Instructions: Before Starting,the Job: During,the Job: 1.Please notify us 24 hours before starting or scheduling a job. 1.This residence was built before 1978.Lead safe practices are 2.Obtain required building permit. required. 2.Total for Heath&Safety and Repairs cannot exceed$2500.00. Additional Contractor Instructions: Attic Inspection form attached? Yes N/A (Circle One) Certificate of Insulation posted? Yes No (Circle Orae) AMERICAN BUILDING TECHNOLOGIES hereby certifies that this job was supervised and completed in compliance with all Department of Labor Standards and Lead RRP regulations. Conta afif5/Sia2U1rture: Date: RRP License#: Page 2 Work Order: Job Number: 20092154 1 hereby acknowlege that all work has been completed and inspected. Customer Signature: Date: Energy Director: Date: Fiscal Officer: Date: I FOR AGENCY USE ONLY Pre Post Language Other than English needed? Yes No (Circle One) Dryer CO 0.000 If Yes,indicate language: Stove CO 0.000 Occupany change in last 18 months? Yes No (Circle One) H2O Tank CO 0.000 Comments: Heating System CO 16.000 Number of windows Ambient CO 0.000 Number of rooms I Blower Door 0.00 I Date:7/15/2016 Page 3 -44 � � American Building Technoloes "--1 7) 752 1 570 ; Contract for Products/Service Work This Agreement is made by and among Madeline Fontaine 58 May St North Andover, MA 01845 American Building Technologies(ABT) 2 Neptune Rd, Suite 439 Boston, MA 02128 I. DESCRIPTION OF WORK TO BE PERFORMED 1-Attic,basement&wall insulation 2- Door sweeps&weatherstrips 3-Ventilation Total: $7,752.76 Customer Signature: Customer Name: ►'` ( dPa j � Date: Contractor Signature: Contractor Name: Date: �� r01) ABT American Building Technologies Energy Savings Is Our Specialty 263 Western Avenue- Lyhn-MA 01904 Phone-781-598-7125/Fax-781-479-0727 www.americanbuildingtechnologies.com Authorization Letter I,Jose Santos, HIC 163106 and CS-101378 holder hereby give my authorization to Stephanie DeTomasi to act on my behalf regarding the Building'Permit Application 58 May St. North Andover, MA 01845 i VJ e Santos /28/16 r s The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www mass.gov/dia Workers'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organi7.ation/Individuaq:American Building Technologies - Jose Santos Address: 2 Neptune RD #4 3 9 City/State/Zip:Boston MA 02128 Phone#: 617 233 8704 Are you an employer?Check the appropriate box: Type of project(required): 1.[3 I am a employer with 5 4. ❑ 1 am a general contractor and I 6. ❑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.t ❑Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. [:1 We are a corporation and its required.] officers have exercised their 10.[]Electrical repairs or additions 3.❑ I am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers'comp. c.152,§1(4),and we have no 12.❑Roof reDairs insurance required.]t employees.(No workers' 13.o they 1nSulatiOn 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-contraetors and their workers'comp.policy information. I am an employer that isproviding workers'compensation insurance for my employees. Below is thepolicy and job site information. Insurance Company Name: Ace American Insurance Policy#or Self-ins.Lic.#: 2 E 918 4 4 5 Expiration Date: 10/�2 0�/"1"66 Job Site Address:�� City/State/Zip: /Mylly tyt�05 Attach a copy of the workers'co pensation 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 eragev rification. I do hereby certify under the sins a nald s o perjury that the information provided above is true and correct. I Si ature: A Z-11Date: Phone#: 617 233 8704 Official use only. Don rite in 's are 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#: -•^O-••'�"•'•� •++ i 11/ J, GV1J v . VO . JV tu,I Yt'.ur- G/VVG rax Derver CERTIFICATE OF LIABILITY INSURANCEDAT /Y E(MM/DDYYY) ` TMIS64MIFICATE 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 ACONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE ODUCER,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 he terms and conditions of the policy,certain policies may require and endorsement. A statement on this certificate does not confer rights to he certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: AMBROSE INS AGCY INC PHONE FAX 70 MIJNROE ST STE 5 (A/C,No,Ext): (A/C,No): E-MAIL LYNN,MA 02101 ADDRESS: 237LY INSURER(S)AFFORDING COVERAGE NA1C# INSURED INSURER A: ACE AMERICAN INSURANCE COMPANY AMERICAN BUILDING TECHNOLOGIES INC INSURER B: INSURER C: 263 WESTERN AVE INSURER D: LYNN,MA 01904 INSURER E: 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 TERMS,EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR ADD SUB POLICY EFF DATE POLICY EXP DATE LTR TYPE OF INSURANCE L R POLICY NUMBER (MM\DD\YYYY) (MMDD\YYYY) LIMITS GENERAL LIABILITY EACH OCCURRENCE $ rGEN1rL MMERCIAL GENERAL LIABILITY CLAIMS MADE Q OCCUR. DAMAGE TO RENTED $ PREMISES(Ea occurrence) ED EXP(Any one person) $ GREGATE LIMIT APPLIES PER: PERSONAL&ADV INJURY $ ENERALAGGREGATE $ ICY PROJECT[:]LOG PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY ANY AUTO COMBINED SINGLE $ LIMIT(Ea accident) ALL OWNED AUTOS BODILY INJURY $ SCHEDULE AUTOS (Per person) HIRED AUTOS BODILY INJURY $ NON-OWNED AUTOS (Per accident) PROPERTY DAMAGE $ (Per accident) UMBRELLA LIABOCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ A WORKER'S COMPENSATION AND WC STATUTORY OTHER EMPLOYER'S LIABILITY Y/N UB-2E918445-15 10/20/2015 10/20/2016X LIMITS ANY PROPERITORIPARTNERIEXECUTIVE OFFICER"EMBER EXCLUDED? M N/A E.L,EACH ACCIDENT $ 1,000,000 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 It yes,describe under DESCRIPTION OF OPERAI IONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONSNEHICLES/RESTRICTiONS/SPECIAL ITEMS THIS REPLACES ANY PRIOR CERTIFICATE ISSUED TO THE CERTIFICATE HOLDER AFFECTING WORKERS COMP COVERAGE. CERTIFICAI64400ER "" --•--.. - CANCELLATION GLCAC SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED WEATHERIZATION ASSISTANCE PROGRAM BEFORE THE EXPIRATION DATE THEREOF,NOTICE WILL B DELIV D 305 ESSEX ST IN ACCORDANCE WITH THE POLICY PRO LAWRENCE,MA 01840 AUTHORIZED REPRESENTATIVE ACORD 25'(2018/05.)The ACORD..a and logo are registered marks of ACORD 1988-2010 ACORD CORP R rag is reserved. i . I (J1e�cn»r�narrroetrlllr.a C?��asJac/%ccleht _ - Office of Consumer Affairs&Busidess Regulation - = OME IMPROVEMENT CONTRACTOR Registration: "163106 Type: Expiration: -.5!1'112017 Corporation -wa-• -~ '-w" - �"r`"""'""" """ AMERICAN BUILDING=TW NQLOOG'IES,INC. '. License or registration valid for individual use only - .. r before the expiration date. If found return to: JOSE SANTOS Office of Consumer Affairs and Business Regulation 2 NEPTUNE RD.SUITE 439 �� _ 10 Park Plaza-Suite 5170 BOSTON,MA 02128 Boston,MA'02116 Undersecretary Not v 'd wIou ignature Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CS-101378 `- Construction Supervisor • Construction Supervisor r � Restricted to: JOSE A SANTOS G ed-Buildings an use roup which contain Unrestricted Y 9 9 37 D MILTON STREET APT 1,, less than 35,000 cubic feet(991 cubic meters)of HYDE PARK MA 02136 ! - e. enclosed spat .�.� Expiration: Commissioner 11/27/2017 Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. DPS Licensing information visit: WWW.MASS.GOV/DPS