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HomeMy WebLinkAboutBuilding Permit #454-2017 - 62 MEADOWOOD ROAD 10/28/2016 V BUILDING PERMIT NORTH �a TOWN OF NORTH ANDOVER ``- APPLICATION FOR PLAN EXAMINATION y 7D Permit No#: q57 Lf - )017 Date Received [0 •ol 8' �SSACHt15�t•( Date Issued: l.0 r :t ;-o I b IMPORTANT: Applicant must complete all items on this page LOCATION 41 Mt adowoo d )&ad Print PROPERTY OWNER Alison Qwi1a—J(,e.h16ecK 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 0 Alteration No. of units: ❑ Commercial )(Repair, replacement - ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _ 0^Septic ❑Well ❑'Floodplain n Wetlands ❑ Watershed District 0 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: air sc.aAf;n j damrnina inSuAok- akbc. . L O'cum Kn&jArd.11s ; itls4AA kisu4hd xhau5f- host fly uish� batt. Ilanin-54all V m'lwh'on d,64as 4% r44.r bars Identification- Please Type or Print Clearly OWNER: Name: Aff5byl U_,vik— ICxJ%16,Lc,l< Phone: (1748s�. Address: 62 awood f2d ovltl over I'ti 01 S Contractor Name: Riaae ToPhone: Email: .t u. Address: ?bboy (o 4, Ma c-�esa-xe, "N0'610% Supervisor's Construction License`. 110041 Exp. Date: 1��?�,olg Home Improvement License: 112182 Exp. Date:- -71 n I U0 , ARCHITECT/ENGINEER Phone: . No. Address: Reg. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2.59 Z. q'1 FEE: $ 3 Check No.: a 3 Receipt No.: 3/ 0 5 NOTE: Persons contracting with unregistered contractors do not have access to the u ra fund r Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped flans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Switumiug 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 Signature COMMENTS IALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Fanning Board Decision:.t Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: NT Te iFIRE DEP N t rnp ®umpste�o y Loca e .384 Osgood Street iLo ated at'12MainStreetr Fire De r p_�artmentignature/date 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 Pen-nit Revised 2014 r 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 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 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 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 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 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 Location ro f A Do w o o 1) - No. o Date 10 - dc • - TOWN OF NORTH ANDOVER • Certificate of Occupancy $ Building/Frame Permit Fee $ "— Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 'Q f 3 In, 9 U/3 c%Building Inspector NORTF/ q - v�: :. . . . s ic ve" _ G 0 L h ver, Mass, • �► 0 COCNICN%WICK �as RATED IkP��,�� U BOARD OF HEALTH ■ Food/Kitchen . RM- IT T D Septic System .... . ES THAT ........Yn .&A � S6.................`TO.......F•........................................................... BUILDING INSPECTOR .. .... )n to erect ...... buildings on ....V..}..... �.01,b0.W..�.b. Pat Foundation .................... ....... Rough f.d as .....N.��........O.A�!.� .�...... .........1 A..�. !/ ................................ Chimney 14 the person accepting this permit shall in every respect conform to the terms of the application Final office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and of Buildings in the Town of North Andover. PLUMBING INSPECTOR `the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO S RTS Rough ."'............. Service ......... ... ...�..�. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough ay 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. L Smoke Det. ' fI r RISE = 60 Shawmut Road,Unit 21 Canton,MA 020211339-502-6335 ENGINEERING www.RI$Eenginsering.com OWNER AUTHORIZATION FORM I, _ l;'5 o/,/ ge I-Q We, Hb-e Gk (Owner's Name) owner of the property located at: (Property Address) N V a tf 0- q. 0 / Y) - (Property Address) J U L 2 U 610 hereby authorize , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. k ko' k 0 10 Owner's lgn ture Date 0 " " Federal 10 0 064405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 A diwlsion ot'11tie1sch Engineering RIS ENGINEERING' Company Address,City,MA 00000 COWRACT 401-123-1234 FAX 401-123-1234 Page 1 PROGRAM 1HISCONTIACCMA-NES EE"W rat IM CUSM�R��MX as DESCRIBEDBEtf1Y1 cuss m£R iNthlbelK RE PRCOAS cuairs WOMM gtDLR Alison Devitai�Zlr�ecl: (978)835-3271 07 1 SERVICE STREET OWNa a1REET 62 Meadowood Road 62 MeadowroodRoad f SERVICE CnY,S1AIE,DP MWNa cm,81AXaP .UL ✓ U rU-ib North Andover,MA 01845 North Andover,MA 01845 c- N ) 1 LU JOB DESCRIPTION HEALTH&SAFETY:Wea lterization wxlrk cannot proceed until mechanical ventilation that will provide(0)cfm(cubic feet per minute)of continuous air flowhas been installed in your home. $0.00 AIR SEALING:Provide labor and materials to seal antes of your home against MUSICK 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 be used to seal your home can include caulks foams and other products. Primary areas for sealing include air leakage to attics.basements,attached garages and other unheated areas(windows are not generally . addressed.)This will require(8) mrking hours.A reduction in cubic feet per minide(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed At the completion of the weatherizat ion work,and at no additional test to the homeowner,a final 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 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberelass 6atts to(152)square feel for damming purposes. $311.60 ATTIC FLAT:Provide tabor and materials to install a 6"layer of R-21 Class 1 Ccllulost:added to(36)square feet ofopen attic Spam $45.36 ATTIC FLAT:Provide labor and materials to install a 7"layer of R-25 Class l Cellulose added to(363)square feet of open attic space. $471.90 KNEEWALLS:Provide labor and materials to install 3.5"R-13 faced fiberglass batt insulation to(20)square feet of knecwall area $26.40 KNEEWALLS Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(122)square feet of kneewall area. S427.00 ATTIC ACCESS:Provide tabor and materials to insudate the back of(1)attic hatch with 2"rigid Thennax board. $35.00 ATTIC ACCESS:Provide labor and materials to make(1) access opening from one attic area to another by cutting a passage through sheathing. This access will be left open as it is between two common unheated non frc%Wled attic areas. S31.31 ATTIC ACCESS Provide labor and materials to install(t) easily moved insulating cover for the attic access folding stair. A small flat surface of ply%wodwill be created around the opening within the attic. This will allow the cover's integral weather-stripping to- restrict orestrict air leakage. $237.65 Federal ID#05-0406628 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RISEA division oflLiNsch Engineering ENGINEERING' Company Address,City,NIA 00000 V�y.�p��p w RAC^� 401-123-1234 FAX401-123-1234 CONTRACT Page 2 PROGRAM W CONWAen4 OMAEO PMBEKYEEN RIS£ CA1A-HES ENOWERM AND*M CUMER FOR WORK AS DESCRIBED BELOW CUSIMER PHONE DAIS- CLIENT! WORK ORDER Alison Devita (978)835.3271 07/19/2016 437164 00002 SERVICE STREET mum STREET ;l z'.. 62Meado%vood Road 62 Meadowood Road SERvBC£CW,0IATE,LP BKt7N6CnY,BSiTE,tP t North Andover,MA 01845 North Andover,MA 01845 j ' ! }. 7 0 2016 I JOB DESCRIPTION VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with roof mounted flapper dent-to-errhe existing bathroom fan(s). S118.75 VENTILATION:Provide labor and materials to install ventilation chutes in(59)rafter bays to maintain air flow. 5118:00 INCENTIVE:RISE Engineering will apply all applicable,eligible incentives to this contract. You ti%ill only be billed the Net amount. Currently,for eligible measures,Colo nbia finis offers an incentiveof 75%q not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing meas res tet to the First 5680 and an additional$340 if savings are justified by the auditor. FOR A LIMITED TIME:Columbia Gas%illalso offer an additional$100 incentive towards the weatherimtion v ork outlined in this proposal.This special Summer Incentive is available to homeowners wfio have had their Colombia Gas home energy audit before July 31,201& A signed proposal for%watherization needs to be submitted by August 8,2016 and work must be completed by September 30,2016. For the safety and health of your home's indoor air quality,we will be conducting a blowcr door diagnostic of the available air flow in your home both before the vmrk isbeM and after the weatherization vmrk is complete.We will also conduct a full amwncnt of the combustion safety of your heating system and water heater.This has a value of 590 and is at no cost to you The maximum allowable incentive for all measures,including air sealing,is$3,210 The Permit will be secured by the insulation contractor,at no additional cost.It is the homeowner's responsibility to close out this permit by contacting their municipality at the completion ofthis-tmrk. $90.00 Total: $2,592.97 . Program Incentive: $2,237.23 Customer Total: $355.74 WEAGREEHER®Y TO FURNISH SERMES-COMMEM W ACCORDANCE W ITN ABOVE SPECIFICAnoNS.FOR THE SUM OF ***Three Hundred fifty-Five&741100 Dollars $355.74 UPON FIRALINSPECUN AND APPROVALBY RISE ENOIiEERM CUSIDr1ER AGREES 1D RENlTAMUNTOUE IN FULL INIERESTOF 1St WILL BE CHARGED MWNLY ON ANY UNPAID BALANCEACIERm DAYS.SEE REVERSE FOR D'PORTANTWFOIi1.110N ON GUARJU EES,RK*M OF RECEION,S AND CCIIRACIOR REGMIRAIZON. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY 81 SPACES AU1H Da EECII3TONE NOTE:HIM CWMCTM%y BE WH710RAWNaY us r NorrXECUED WININ DAIS OFACCEPtINCE ACCEPTANCE OF CONIRACT.AIE JVE PRICES.SPECIFICAVOM Alai CONMONS ARE 30 DAYS, SAISFACIORY TO US AND ARE HEREBY ACCEPED.You ARE AtMORCED W DO THE WORK AS SPECIAED.PAYNENTWILLBE MADE AS OUXtXEO ABOVE The Commonwealth of Massachusetts Department of Industrial Accidents .l Congress Street,Suite 100 Boston,MA 02114-2017 www. ssgov/dia Workers'Compensation insurance Affidavit;General Businesses. TO BE i'II:ED WITH T14E PERMI l T[NG AUTHORITY. Applicant Information Please Print_Legibly Business/Organization Name:Milt City Energy Address:PO Box 6411 City/Mate/Zip;Manchester,NH 03148 Phone#:603-391-7923 Are you an employer?Check the appropriate.box: Business Type(requ red.): 1.[Z] i am a employer with 12 employees(full and/ 5. [:]Retail or part-time).* b. E]Restaurant/Bar/Eating:Establishment 2.❑ 1 am a sole proprietor or partnership and have no 7. 0 Office and/or Sales(incl real estate,auto,etc) employees working for the in any capacity. [No workers'comp.insurance required] 8• Q Hon-profit 3.0 We are a.corporation and its officers have exercised 9. 0 Entertainment their right of exemption per'c. l 52,§1(4),and we have 10.0 Manufacturing no employees.[No workers'comp.insurance required)* r—t 4.Q We are a non-profit organization,staffed by volunteers, I I:l�..i Health Care with no employed.[No workers'comp.insurance req.) 12.1%rOther W I.A LlRX1 ZOI , 'Any applicant that checks box#1 must also:nlI out the section below showing their workers'compensation policy information. **If the corporate officers have exempted themselves,but the corporation has other employees a workers'compensation policy is required and such an organisation should check box 91. I atm an employer that is pruvitfing workers`toiWensadon insurance for my employees. Below is the policy uaformadon. Insurance Company Name:dark lnsuranee insurer's Address:One Sundial Avenue Suite 302N City/Stato2ip: Manchester,NH 03102 Policy#or Self-ins.Lie.#MIWC791896 Expiration Date:4/29/2017 Attach a copy of the workers'compensation policydeclaration 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 ofcriminal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the fonn.of.a.STOP WORD ORDER and a fine of up to$254:00 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 cert,u ins rind penalfies of perjury that the ti formation provide4 above is true and correct Si attire: Date: ,Phone 4:603-396-7524. Official use only. Dv not write in this area,to he 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.Licensing Board S.Selectmen's Office 5.Other Contact Person: Phone#: wmvxmass.govldia MILLCITY-1 AGOULD '4�i EP° CERTIFICATE OF LIABILITY INSURANCE DAT119/2DIY 7/19/2016 6 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 License#AOR8150 CONTACT Clark Insurance PHONE -2855 FAX -2854One Sundial Ave Suite 302N A/C No, Ex :(603)622 o: Manchester,NH 03102 ADDRESS:agould@clarkinsurance.com INSURER(S)AFFORDING COVERAGE MAIC# INSURER A:Arbella Mutual Insurance Co 17000 INSURED INSURER 8:AmGuard Ins Co 43290 Mill City Energy INSURERC: 106 Joseph St INSURER D PO Box 6411 Manchester,NH 03102 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. ILTR TYPE OF INSURANCE INSD WvO POLICY NUMBER MBRI PNM/DDY EFF MMIUDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE X OCCUR 8500065735 04/29/2016 04/29/2017 PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PO- POLICY❑JET 1:1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident $ 1,000,000 A X ANY AUTO 1020050919 04/29/2016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident $ AUTOS AUTOS ( ) X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LIAR CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,00 DED X t RETENTION$ 10,000 $ WORKERS COMPENSATION I OTH- AND EMPLOYERS'LIABILITY X STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N MIWC791896 04/29/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,00 OFFICERIMEMBER EXCLUDED? ® N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of Public Safety Construction Supervisor Board of Building Regulations and Standards Restricted to:: Unrestricted Buildings of any usegroupwthich contain License:CS-110041 less than 35,000 cubic feet(991 cubic meters)of Construction Supervisor enclosed space. MICHAEL JOY 106 JOSEPH STREET MANCHESTER NH 03102 _ Failure to possess a current edition otthe Massachusetts Expiration: State Buildirg Code is cause for revocation of this license. Commissioner 08107/2019 DRS Lirensirn3 imam otion visit:WWW.MASS.GOWtDPS M 7Rf` .rrrrt e xtrr r�/1#+ t' l u rlsc li fi License or re titration x�atid for Individut use on ,+*�''�k (}fTcarstt"x��asurr�tfairs�stssittla�: vn HOME IMPROVEMENT T CONTRACTOR before the expiration date+ If found return to: 8gistration, 182792 TY Offirtof!Gonsumer�Affairsand stintsRegulationn Yxpirptfori. 7)Vr017` LLC 10 Pnric Pia7a-Suitt Si70 Bostont MA 021,16 Mltt -ITY ENERGY,LLC,. MICHAEL JOY 106 JOSEPH STREET; , n�cesrrrrtry Inr outurr MANCHESTER,NM03t02 . th ....