HomeMy WebLinkAboutBuilding Permit #105-2017 - 58 MAY STREET 8/2/2016 NORTk
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BUILDING PERMIT
` TOWN OF NORTH ANDOVER °
APPLICATION FORPLAN EXAMINATIO 41Permit N0: Zo Date Received 7 c2bit,
Date Issued: ���
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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
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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.
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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
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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.
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(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