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HomeMy WebLinkAboutBuilding Permit #1079 - 59 BERRINGTON PLACE 6/22/2015 `l•�,;�'�-t'�- �-c���,,•-�- t�� of�"�pT BUILDING PERMIT o TOWN OF NORTH ANDOVER [ 0 , APPLICATION FOR PLAN EXAMINATION Permit N0. ' Date Received '� °p ��--�• °' '` /� ^1 �9SSgc►+uSE��y Date Issued: ILI IMPORTANT: Applicant must complete all items on this page LOCATION PROPERTY OWNEk MAP NO PARCEI= ONINGATRICT, l�storc fl�stt ' •yes (0) TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne family C. Addition E Two or more family :1 Industrial I Iteration No. of units: I Commercial I Repair, replacement i Assessory Bldg I Others: E Demolition E Other I' t Septic [ Mil Flfladpiain Cl`Wetlands Wtersh>~d District `UVa#er/Sewer 'p d soroll swv) ` no - Q (Ja Identification Please Type or Print Clearly) p OWNER: Name: n Phone: �l Address: Jr U✓ Ail CONTRACTCOR �Nare ft ,c td Pon� � r Address Supervisor'sConstuf�a License s IrxpDate � 7.Q, ;€� Home:lmprvement LcerIsExp }at� s � 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. Total Project Cost: $ Cp , C FEE: $ � o� J Check No.: 92.791 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access o tlh guarantyf"d Signature ofiAgent/Owner reo,,con,ractor-, /0 tractor Location,,57 &ecr1S4 :A ✓'t t No./d Date G Z Z r- , • • TOWN OF NORTH ANDOVER w . w Certificate of Occupancy $ " 1 Building/Frame Permit Fee $ 2 Foundation Permit Fee $ r Other Permit Fee $ w' TOTAL . $ ik _ Check# &2111 269S1Building Inspector t4ORTH T nofT E 11. Andover ow O Z n ,- o h ver, Mass, C 2Z 1 1 C- COCKIC"IWICK yoi. ADRATED i S BOARD OF HEALTH Food/Kitchen, PERMIT T ILI LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ............... ..... .......(. c.:. Al.............................................. has permission to erect . buildings on�T.. ...... /. Foundation ..,. Rough to be occupied as ...... r�........ ..... .FR �!'r`....a.................................................................... .... Chimney provided that the person acceptin 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final 3� PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S T Rough Service ............................................ Final BUILDING 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. License_CSSL-1 39 g � JAMES MATERKOW ji 1BtRctfWOO00 204 D rrsiir 1012112016 • r-:/ qtr' �,' 1d" .� ?f'( 71 f? .. JtstfGt' u Office of CcnstEler Affa>rs and Business Regulation 10 Park Playa - Suite 5170 Boston, Massachusetts 0211 Home Improvement Contractor Registration Registration: 170936 Type: Corporation Expiration:— 1/20/2016 Trx 2477284 THE GREEN COCOON, INC. JAMES MATERKOWSI 141 BRIDGE RD. UNIT 200A ... SALISBURY, MA 01952 ._..... ......... ........ Update Address and return curd.Nlark reason for chagi_ t Address Renewal Employment Lost Card _ license or registration valid for individul use only. Office�f C ivfsiinfer�ffaia-s c4 33asineti�Re�nIaf�nn � - KOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 970936 Type: Office of Consumer Affairs and Business Regulation -v:Expiration: VM2016 Corporation 10 Park Plaza-Suite^170 Boston.NIA 02116 THE GREEN COCOON,INC. J/,MES MATERKOWSI ".41 BRIDGE RC}.UNIT 200A t inderstrrrtar? . SAUSSURY MA01952 Not valid without signature 3' �1 The Green Cocoon,Inc. Proposal PO Box 566 Proposal# - The reen Cocoon, Inc. Newburyport,MA 01950 � 1111 _Date. (978)462-0082 06/04/2015 2958 ................. info@thegreencocoon.com- Exp. Date Address Bryan Bendig 59 Berrington Place North Andover,MA Sales Rep Candace Lord Date Aetiv�ty Quant+ty Amount :.,::,..,.._ _ ..... 06/04/2015 Main Attic Roof Slopes: 2"Closed Cell R14 2880 6,45 f.20 06/04/2015 Main Attic Roof Slopes: 7"Open Cell R24 2880 8,064.00 06/04/2015 Gable Ends: 5.5"Open Cell R19 351 772.20 06/04/2015 BLAZELOK"TBX Thermal Barrier Paint 3231 4,620 33 Only in attics and crawl spaces that are unfinished and used for storage. 06/04/2015 Proper Vents 4': Continue venting cathedral sections to ridge 144 348.48 06/04/2015 Small Attic Slopes: 2 Closed Cell R14 804 1,80096 06/04/2015 Small Attic Slopes: 7" Open Cell R24 804 2,251.20 06/04/2015 Gables: 5.5"Open Cell R19 91 200.20 06/04/2015 NOTES: Vents may be needed in this area.9 TBD 06/04/2015 Wall Sections: 3" Closed Cell R21 NOTE: Includes bathroom,living room and other 51.0 1,718.70 small sections 06/04/201.5 Open Ceiling Sections in living room: 5.5" Closed Cell R38 113 697.21 167.8 -_` �d Tokalf $26,92448 Accepted By Accepted Date (978)462-0082 info@thegreencocoon.com The Commonwealth of Massachusetts �{ Department oflndustrialAccidents jm I Congress Street, Suite 100 r Boston, MA 02114-2017 :nye .A S,ev www mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers- TO BE FILED WITH THE PERMITTING AUTHORITY. AApOicant Information Please Print Legibly Name (Business/Organization/Individual):The Green Cocoon Address:107 Elm St. Rear City/State/Zip:Salisbury, MA 01952 Phone 4.978-462-0082 Are you an employer?Check the appropriate box: Type of project(required): 1 ✓❑I am a employer with 12 employees(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑ Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]' 10 Q Building addition 4.F�I am a homeowner and will be hiring contractors to conduct all work on my property 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5 1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. These sub-contractors have employees and have workers'comp.insurance.* 13.[:]Roof repairs 14.[DOther 6, We are a corporation and its officers have exercised their right of exemption per MGL c. 152.§1(4),and we have no employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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 in formation. Insurance Company Name:Selective Insurance Co. Policy#or Self-ins. Lic.4:V\ANC3100274 Expiration Date:7/28/2105 Job Site Address:59 Berrington PI. City/State/Zip:North Andover, MA 0182 Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby certif nder the p nd nalti of perjury that the information provided above is true and correct. Signature: Date: (04-0\1h Phone*978- 62-0082 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#: �.� GREEN11 OP ID: LK CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDIYYYY) 03/05/2015 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 CONTACT Marcos W.Shaner _ NAME: — Chase&Lunt LLC PHONE 978_462-4434 Fax 65 Parker Street (A—IN No Ezt: (ac,No): 978-465-6204 Newburyport,MA 01950 ADDRESS: —.— Marcos W.Shaner INSURERS)AFFORDING COVERAGE - NAIC tt INSURER A:Selective Insurance Company INSURED The Green Cocoon,Inc. INSURER B!Commerce Insurance Company Jim Materkowski 141 Bridge Road INSURER C: Salisbury,MA 01952 INSURER D: 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 I ADDL SUB POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCElusa POLICY NUMBER MMIDD/YYYY MM/DDIYYYY 1 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,800,000 DAMAGE TO RENTED CLAIMS-MADE X OCCUR X 52057643 03/01/2015 0310112016 PREMISESJEa occurrence $ t00,000 MED EXP(Anyone person) $ 5,000 -� PERSONAL&ADV INJURY. $ 1,000,000 _GEN'LAGGREGATELIMITAPPLIESPEP: GENERAL AGGREGATE $ 2,000,000 IrX� POLICY LJ PRO- u LOC PRODUCTS-COMPIOP AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 (Ea accident B ANY AUTO TBD 03/01/2015 03/01/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS --- --- NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS X AUTOS Per accident X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 52057643 03/01/2015 03/0112016 AGGREGATE $ 1,000,000 DED I X i RETENTION$ 0 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN X STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE WWC3100274 07128/2014 07/28/2015 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑ NIA - (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,00 If yes,describe under i500,000 ,DESCRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ I , i I FIT DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached it more space is required) 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. AUTHORIZED REPRESENTATIVE j..0'1, /ry�trfiW 06i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD