Loading...
HomeMy WebLinkAboutBuilding Permit #069-2017 - 72 PEACH TREE LANE 7/22/2016 BUILDING PERMIT 0* NoszV&ORrN 6q4f, TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION �O 0y Permit No#: Date Received TED �SSACHUS�� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Lary. Print PROPERTY OWNER— KCmAA(y_ Wises 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 E ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial X Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic, ❑V\lell ❑ Floodpla n, _Wetlands: 's ❑ WatershedD.istn t D.Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: WAo�r4u2�nzc ioh' A< seaxnci • darnwin4 nsWalt- ahhc I 16nwWn llS insk- L insc AmkmA eacha>As� hose fe eaci5" 6&41,fah . insku( VrW4i(0.fidn Unwhes in 6a,.s� Identification- Please Type or Print Clearly ti OWNER: Name: Wc".\_ W\st_ Phone: (SZoI ?,7q-g293 Address: 7 .t c. tK� pr Ot j . -.Contractor Name: PQc)no.e-A Jov Phone: f) .392- ton Email.'.it& Q w-W 6kxj oAa,rcv�a.tcrh Address: 'Po 8T G41t� Munc,V�s4-c.r Mkj 0-410S Su .;, pervisor's.Construction License: CSSL to(go3S Exp. Date . $:�7 /2018 Home Improvement License 182741 2 Exp: Date:` 7 2'I 4 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED O $125.00 PER S.F. Total Project Cost: $ 3,qV7- FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ I TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/MassageMody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR'OFPICE,USE ONLY INTERDEPARTMENTAL SIGN-OFF - IJ 'FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Si qnature COMMENTS HEALTH Reviewed on Signature COMMENTS tZoning Board of Appeals:Variance, Petition No: Zoning.Decision/receipt submitted yes Pj�nning Board Decision: : ' Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located. 384 Osgood Street FIRE DEI?ARTMEN �T�ernp Durnpster on sit -` e-sk. no 't 124 M :_ s Located a ain Street ` Fire De artment - 4 n, psi,gnatur�e/dates . 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) ® Notified for pickup Call Email Date Time Contact Name Doc.Building Permit 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 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 a. 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) � 1 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 ' '. � i Date�� r' • - TOWN OF NORTH ANDOVER ��i,jam& +a.• Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ " Other Permit Fee $ E TOTAL $ Check# ?s�qicfi �' r Bng Inspector 30640 e Paul and Michele Wise 72 Peachtree Lane North Andover, MA 01845 (561) 319-6300 June 2, 2017 North Andover Building Department 120 Main Street North Andover, Ma 01845 Attn: Paul Hutchins and Maura Deems RE: Building permit#069-2017 I am writing in regards to the above referenced building permit. In July of 2016, we contracted a Mass Save company (Mill City Energy)to complete some attic weatherization and insulation at our home. We had subsequent) decided not to proceed with the work and did not Y complete the permit. I apologize for the delay in this permit being open so long. The permit was in the possession of the contractor until I received it in the mail on June 1, 2017. I would greatly appreciate it if you could close out the permit since the work was not complete Y p p and we are not planning to complete the work. Thank you very much! Paul Wise Michele Wise NORT1i Town of ? : _ : At' n ove r O �n No. 2 -K. - C,, _ � h , ver, Mass,D 7! ZZ Z®j COCHICN/wICM �1' x.95 R^reo 411 U BOARD OF HEALTH Food/Kitchen PERMIT T LD MIC0. Septic System THIS CERTIFIES THATOil........... ►� BUILDING INSPECTOR . . ... . ... . Foundation has permission to erect .......................... buildings on .....�..�... . . ............ ............ Rough : to be occupied as ... 4 ,t .. '.!�✓.. r.,�a�f .. f ....�. Chimney provided that the person accepting this permit shall in every respect conform to th"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 CONST R N Rough Service _6 10=-� .... . ..... . W., ... .. MPG P.91111r.,.......... """' Fina BUILDING IN CTO 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. t%ORTN Town of ? _ ' Andover f No. h A,R ver, Mass,® ZZ Z�l cocMUHIWICK 1' x�Do .95 RATED PP ,`�5 U BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ..... � i�r. ......... f ...... BUILDING INSPECTOR .. ......................................... 4.0. ... . ... ............ Foundation has permission to erect .......................... buildings on ....... .... ... . . . ............ Rough to be occupied as ...� .. . . .�'✓ �i+E ..� t. Chimney provided that the person accepting this permit shall in every respect conform to th 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 CONSTR N Rough Service .... .. ..... . . ...... . ........... . Fina BUILDING IN CTO 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. Federal 10#06-0405629 RISE En gineenng RI Contractor Registration No 8188 NW Contractor Reglstration No 120879 AdlTisionoT'fibclschE'nginccring RISE ENGINEERING" Contpray Address,City,NIA 00000 CONTRACT 401-123--1234 RAN,401-123-1234 Page 1 PROGRAM 11113 o� °� ` CMA-IES ENOLNEERnaa tE alRFORW RKK AS DESCRntEDGEUM cuslom --- Pilate DAM CUEM9 WORK ORDER Michelle Wise (561)379-9293 0611 DX---Q4 2 OM3 - -— - SERYM SweT' OIL—UNG WREEr 72 Peachtree Lane 72 Peachtree Lane 01 BERME Cr[Y.51hr--ZP SMUG carr.SINE,IJP ��� � � ���� North Andover,MA 01845- North Andover.MA 01845- JOB DESCRIMON '- HAZARD BARRIER:We have identified that there are recessed lights present in your home.unless the recessed lights are certult as IC-rated(Insulation Contact Rated)we will create u 3"clearance space around the fixture by using fiberglass blanket insulation as a damming ,material.no insulation trill be installed across the top and closed cavities tthich contain recessed lights will not be insulated. x0.00 AIR SEALING:Provide labor and materials to seal areas of your home against wasteftd,excess air leakage. This twrk iailb 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 seating include air leakage to attics,basements.attached garages and other tmhented areas(windows are not generally addressed.) Thisttill require('12)working how-&A rcduct inn in cubic'fcct per minunc(crm)ofair infittrmion sill occur,bud the actual number of cfm is not gutraniced. At the completion of the wcatherization twrk,and at no additional cost to the homeottncr,a final blotwr door andlor combustion safety analysis will be conducted by the stub-contractor to ensure the safety of the indoor air quality. $1,020.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 tmfaced fiberglass baits to(64)square feet for damming purposes. $131.20 ATTIC FLAT:Provide labor and materials to install a 4"layer of R-14 Class I Cellulose added to(692)square feet of open attic space.THESE AREAS HAVE FGB. 1W.-THIS INC LUEDS OVER MASTER BEDROOM+EXPOSED SLOPE. $781.96 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-ripid fiberglass board insulation to(262)square feet of kncewa0 area.OVER GARAGE ROOM AS WELL AS OVERMASTER BATH...THIS INCLUDES SKYLIGHT SHAFT. $917.00 ATTIC ACCESS:Provide labor and materials to insulate(3) back of the knccwall hatch with 2"rigid Thermaa board,and seal the edge of the hatch with weatherstripping. $180.00 VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with roof mounted flapper vl-nt to exhaust existing bathroom fan(s). $237.50 VENTILATION:Provide labor and materials to install ventilation chutes in(70)rafter bays to maintain air now. $140.00 COMMON WALLS:Provide labor and materials to install 2"FSK faced$mi-rigid fiberglass board insulation to(160)square feet of common wall arca.ABOVE MASTER BEDROOM VAULT. $560.00 Federal to#OW06629 ;RISE Engineering RI Contractor Registration No 6196 MAContractor Registration No 120979 A division of"icisch F,Ngincering I ENGINEERING CONTRACT Address, V CONTRAr�T 401-123-1234 hAX401-123-1234 Page 2 PROGRAM �wcamIQ�O �CVA-HES ENGINEERING Cus nWORKas DESCRIBED BEIM? CD41MRER - MORE OAT- CUENT6 WORRORDER Michelle Wise (361)371-9293 06110!2016 424832 X003 SERVICE STREET RULING BLREET 72 Peachtree Lane 72 Peachtree lane SERVICE CITY,SA'F-MP - B=No CnY,$AL.IIP North Andover,MA 01915- North Andover,MA 01845 jUI3 DESCRIPDON Total: $3,967.66 Program Incentive: $3,110.00 Customer Total: $857.66 YIEAGREE HE RE9Y TO FURNISH GMWES-COMM IN ACCOROANCEWUN ABOVE SPECIFICATIONS FOR THE5UM OF ***Eight Hundred Fifty-Seven&661100 Dotlars $857.66 RrOl F1NAL ECBDN ANA AP AL BY RISE ENOCIEERIHG CLISMIIVER AGREES IDR€NTAMDUNTDUEIN "r'.' OF 1%WILBE CHARGED hOMLY ON ANY l7NPAlD_ NC APER 99 DA. E@REVERSE FOR NrPORANTtrtF M710N ON GUARANTIES,RIgiPd WREC ,D ULM AND CONDRACWR REGIBIRA110N. ---- - BO fiSiCN THIS CQtpTRACT[F THERE ARE YS SPREES -O&EG1ip -RISE Engineer -.. [1(S. RACCE E Y BE WnHDRAWN BY US IF NOTEXECUIFDrAMN DAr OFACCEPANCE - - - AOCEPPME 0FCOHF-WT-1HE ABOVE PRICES.SPEDIFICAnONS AND COIDIDONS ARE 30 DAYS. AS SSPECUMO.PPAYNEIMMLOSSAISFAVIORY IDLIS AND ARE MADYE�D.Y�EAU710R6ED 74 DOWIE NPOF2lI (EC60 0VDE JUS! 4 2016 RISE60 Shawmut Road,Unit 21 Canton,MA 020211 339-502-MS ENGINEERING www-RISEengineering,com OWNER AUTHORIZATION FORM • 4 Is L (Owner's Name) owner of the property located at: Pea a (Property Address) (Property Address) 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 prop hi form is only valid with a signed contract. Owner's Signa re RE (D [F Date J U N 1 4 2016 The Commonwealth of Massachusetts Department of IndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITIi"INE PERMITTiNG AUTHORITY. Am icant Information Please Print Legible Business/Organization Name:Mill City Energy Address:PO Box 6411 City/State/Zip:Manchester,NH 03108 phone#:603-391-7923 Are you an employer?Check the appropriate box: Business Type(required): 1..Q I am a employer with 12 employecs(full and/ 5. []Retail or part-time).* 6. Restaurant/Bar/Eating:Establishment _>. I am a sole proprietor or partnership and have no 7. Office and/or Sales(incl.real estate;auto;etc_) employees working for me in any capacity. [No workers'comp.insurance required] 8- F1 Non-profit 3.❑ We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,$1(4);and we have I0.[]Manufacturing no employees.[No workers'comp.insurance required]* I l.❑.Health Care v 4.❑ We are a non-profit organization,staffed by volunteers, with no employees.[No workers'comp.insurance req.j 12.W Other ILAMAA.AXA*lby, *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy inforniation. *ifthe corporate officers have exempted themselves,but the corporation has oiher employecs a workers compensation policy is required and such an organization should check box;1. Iain an employer tftat is providing workers'cotnpenstidon insurancefo,r my enipinyees. Below is the policy information. Insurance Company Name:Clark Insurance Insurer's Address:One Sundial Avenue Suite 302N City/StateiZip: Manchester, NH 03102 Policy 9 or Self-ins.Lic.#MIWC791896 Expiration Date:4/29/2017 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 tine 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. I do hereby certify,tr ins and penalties ofperjury that the information pro vidett above is true and correct Sianature: Date: Phone#-603-396-7520 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): L Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: %,mw.mass.govidia MILLCITY-1 AGOULD ACORO" DATE(MM/DD/YYYY) �„r r CERTIFICATE OF LIABILITY INSURANCE 7/19/2016 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#AGR8150 CONTACT NAME: Clark insurance PHONEFAX One Sundial Ave Suite 302N A/c No Ext):(603)622-2855 ac No):(603)622-2854 Manchester,NH 03102 n DRESS:agould@clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURER A:Arbella Mutual Insurance Co 17000 INSURED INSURER 13:AmGuard Ins Co 43290 Mill City Energy INSURER C: 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. INSR LTR TYPE OF INSURANCE ISPOLICYDDLSUBR EFF EXP NSD WVD POLICY NUMBER MM/DDMMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -DAMAGE TO CLAIMS-MADE T OCCUR 8500065735 04/29/2016 04/29/2017 PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY ]PECOT- F�LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY EO a8.1 tleDISINGLE LIMIT $ 1,000,000 A X ANY AUTO 1020050919 04/29/2016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,000 DED I X RETENTION$ 10,000 $ WORKERS COMPENSATION X I PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE / N/A MIWC791896 04/29/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,000 OFFICERIMEMBER EXCLUDED? (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 I LOCATIONS I 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 s I (Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-106035 Construction Supervisor Specialty MICHAEL JOY 106 JOSEPH STREETI® A ` MANCHESTER NH (l3142� = x Expiration: . missioner 0810712018: Q-3/lG 4JftJ320ftLlm.Ql/•f7 11 C,.'! fr4itCl3C�"4; I� Offic4 of Consumer Affairs&Bus4_1 Regulation License or registration valid for individul use only QME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: a egistration fig27g2 Type: Office of Consumer Affairs and Business Regula ri 10 Park Plaza-Suite 5170 xpiration 712W2017_ LLC Boston,MA 0211.6 MILL CITY ENERGY LLC • t ,+r MICHAEL JOY 106 JOSEPH STREET MANCHESTER,NH 03103: :z' [Indersecretary N va vithout si tore