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HomeMy WebLinkAboutBuilding Permit #529-15 - 73 BRENTWOOD CIRCLE 1/30/2015BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 02 �� Jif Jh a U� h TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family 0 Addition 0 Two or more family ❑ Industrial 0 Alteration No. of units: 0 Commercial 0 Repair, replacement 0 Assessory Bldg ❑ Others: 0 Demolition ❑ Other �O Se tic, � 1lVell 4 OtFloodplam Wetlands 4 ''AYi"tT�1 e�O kWatershed10 Tact a ,D Wa } FISewer4 DESCRIPTION OF WORK TO BE PERFORMED: - Please Type or Print Clearly OWNER: Name: 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: $ tr T 7J FEE: $ Check No.: b (J(�P Receipt No.: 2" NOTE: Persons contracting with u'st Fpntractors do not have access to the get atd co I O O oom W m � m � a CD -n 3. o m m N om -o 3 00 C w m CD -n co m -Ea -69 69 69 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming 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 COMMENTS Reviewed On Signature CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes P,lanning Board Decision: Comme Conservation Decision: Comments Water & Sewer Connection/Signature & Date Drivewav Permit DPW Town Engineer: Signature: 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 1 Date Time Contact Name F Doc.Building Pen -nit Revised 2014 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 NOTE: 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 NOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products NOTE: 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 r Doc: Building Permit Revised 2014 CD 0 Z Cr Q �. to O 00 CD CL cr CD O coCDo .L �• A� 10 O U) F 0 CD CD CDa C/�D VI ,O O CCD O CD in - Z m cn O Vr 0 0 cn W cnC z m 0 m TX V 55 m z z Cl) D Z h EF CDN O O cc O 1 Q X CD co _ N O E U) CD o O rt ar 2 =; C -6 F) ccD. m 0 CD n .0 rt O_- f! m O f/1 No, i D-' '77 oo.�M 0. m '0(A cn o CD_ S f y CD > O O : c� CL O .� N rt O O C7 =r C7 .r CO CD CD 0 O O y rt O to U) ID Z 00:APCr rt =r =" c CD D C. C cm Q. O 0 N 0 CLCD Am O C r, CD FL .iS CD .N r D U) 5.0 f o rt OCD O C = C CD O CD :d 5 n CD )6CD a� =F:0P: :� aF as o CL to W T w T En A T A -n (i .Z1 T In T C (D O p = < (D (M 07 OU tJ4 7 ❑. (D S 7 S O_ n \ Z � (D w to � (D p < O Y r (D S r w CD T m C C 3' w m N > v 03v Z n z � v N r Q -I' n N N L m m O m m n > O� N 4 6s - F N c J Z' `O ,qm AT i A- 206 Massachusetts - Department of Public Safety Beard of Building Regulations andStandards Construction Super0sor fir;-fr, License: C SSL -102811i 55 STANMORIK wandek RI 028 �/J 9 1161 Expiration corrinussioner 0911312018 ReiMdad To: CSSWC - 0nsu1a3uon Contractor rr Failure to possess a current edition of the Massachusetts Sate building Code is cause for revocation of this license. For ®PS Licensing information vidbt- tww—Mass-GOO/DPS The Commonwealth of Massachusetts Department of °Industrial Accidents ®ice o fInvestigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AvOcant Information Please Print Legibld Ne (business/Organization/Individual): Next Step Living Address: 21 Drydock Ave City/State/Zip: Boston, MA 02210 Phone #: (866)867-8729 Are you an employer? Check the appropriate bozo Type of project (required): 1. V i am a employer with 850 4. ® I am a general contractor and 1 6 ® New construction employees (full and/or part-time).* 2. ® 1 am a sole proprietor or partner- have hired the sub -contractors listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub -contractors have 8. ® Demolition working for me in any capacity. employees and have workers' comp: insurance.1 9. ® Building addition (No workers' comp. insurance 5. We are a corporation and its 10.n Electrical repairs or additions required.] 3. ® I am a homeowner doing all work officers have exercised their 11.® Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[�,] hoof repairs insurance required.] t c. 152, §1(4), and we have no 13.� Other Insulation employees. [No workers' comp. insurance required.l `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 affidwit indicating such. $Contractors 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 ant an employer that is providing workers' compensation insurance for my employees Below is the policy and job site information. Insurance Company Name: A.LM Mutual Insurance Company Policy # or Self -ins. Lic. #: AWC-400-7030025-2014A Expiration Date: 9/30/15 Job Site Address: City/State/Zip: 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 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 coverfyi tion. I do hereby certify under the pains and en es perfury that the information provided above is true and correct Si afore: Date: Phone # �� do) C�e�� FFOther only. Do not write in this area, to be completed by city or town official. n: Permit/License. # hority (circle one): Health 2. Building (Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing -Inspector rson: Phone #: �y NEXTS-1 OP ID: EL r A1C®R®' . CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDD,�Y) �� 10/0112014 THIS CER70FOCATE IS ISSUED AS A MATTER OF INFORMATOON 0"y y AND CONFERS NO RIGHT4 UPON THO CORTIMATP HOLDER. THEE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELPYf. THIS CERTIFICATE OF ONSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REP 9 ENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER. IMP RTANT: Of the gertificate holder is an ADDITIONAL INSURED, the policy(Res) merit be endorsed. Of SUBROGATION IS WAIYgpr SIBwn6; tg the terms and conditions of the policy, certain policies may require an endorsement. A statement on this certificate does not confer rights to 1hp certificate holder In lieu of such endorsement(s). PRODUCER I safarkw Aqency M;La8266 Lynn 52i Lynn $elUs ParKllyPgo Melrose, MA 02176 John E. McLaughlin Jr. CONTACT NAME: Erin Lyons A boEgl:781-665.2770 � No: 751=665=02 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL 0 INSURER A: Nautilus Insurance INSURED Mlext Steps �iving, Inc. 21 Dryd®ck Avenue, 2nd Fl®Or Boston, MA 02210 INSURERS:COMMerCG Insurance Company 34754 INSURERC:A.I.M. Mutual lnsurance Co. INSURER D:AXIS Insurance Company 15610 INSURER E: INSURER F: Baa®sle®®r.�c o �,CIERTOFOCATIE NUMBER: REVISION NUMBER: .e...__ - — THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY Ri RIQQP 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 kDOL R POLICV NUMBER POLICY MID EFF MMIDD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY CLAIMS -MADE ® OCCUR E(PP2010195=12 09/30/2014 06/30/2010 EACH OCCURRENCE $ 1,000,000 DAMAGE TO R PREMISES Eaoccurrence $ 100,000 MED EXP (Any one person) $ 0,00 PERSONAL & ADV INJURY $ Q s GEN'L AGGREGATE LIMIT APPLIES PER: RPOLICY E JEC LOC OTHER GENERAL AGGREGATE $ ;A01000 PRODUCTS-COMPIOPAGG $ q•r 04100 $ B AUTOMOBILE LIABII.ITY ANY AUTO ALL OWNEDX SCHEDULED AUTOS UTOS NON -OWNED HIRED AUTOS AUTOS 14MMBOKKOM 09/30/2014 09/30/2015 COMBINED SINGLE LIMIT rp Ea accident $ 1 so 61000 BODILY INJURY (Per person) $ BODILY INJURY (Per accident) $ PROPERTY DAMAGE $ Per accident $ D UMBRELLA LIAR EXCESS LIAR X OCCUR CLAIMS -MADE Ep U753647012014 09/30/2014 09/30/2013 EACH OCCURRENCE $ 5,000 00 AGGREGATE $ 0.909-90 DED RETENTION $ $ �a 6o WORKERS COMPENSATION AND EMPLOYERS' LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y OFFICERIMEMBER EXCLUDED? (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below NIA TO BE ISSUED BY CARRIER 09/30/2014 05/30/2015 X PER 0TH- STATUTE ER E.L. EACH ACCIDENT $ 500,00 E.L. DISEASE - EA EMPLOYEE $ 500,00 E.L. DISEASE - POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) FOR INFORMT10V ONLY ONFO=01 For Information Only 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 ollk *Vll�" ©19735=2014 ACORD CORPORATION. ARP ri ahet ra w%nrPd. ACORD 25 (2014191) apf ACORR 0 next step Living ti me energy sotutions This agreement Is made by and among Deanna Dunn 73 Brentwood Cir North Andover, MA 01845 Site ID: 400347 Next Step Living, Inc. ("NSL") 21 Drydock Avenue, 2nd floor Boston, MA 02210 phone: (866) 867-8729 09 -Dec -14 1. )ESCRIPTION OF WORK TO BE PERFORMED NSL will perform or cause to be performed the following work on the customer's address above, in a professional manner and in accordance with the terms of this Contract, including the attached recommendations/work order describing the work in detail (the "Work') which are incorporated herein by reference: Work Location: Attic Flat Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 8 $75.00 Hr $600.00 • • .�.,. m ' t� r+ ter Work Location: Attic Flat Hatch: Thermal Barrier Polyiso 2 inch (Attic) 1 $60.00 Each $60.00 Damming 18 $2.05 Lnft $36.90 Propavent 2' or 4' 60 $2.00 Each $120.00 Attic Floor Open Blow Cellulose 6'. 1,061 - $1.20 sgft $1,273.20 Work :Location: Foundation Insulate Rim Joist with 6.25" FiberglassBatting140 $1,75$y Lnft $245.00 {k,1 bf����+`v7.e° t. ,fin Work Location: Attic Flat Replace Bath Fan Hose 2 $50.00 Each $100.00 �.'�re. '`w1vfa t r r T7k`- _ ' e ,a ON s. k.: s? E 100% Airsealing Incentive up to Program Max $600.00 , 75 % Weatherization Incentive up to Program Max $1,301.32 Not'Rebafe Eligible $0.00 Estimated Annual Energy Savings from the Above.mprovements $119.00 JJ a LA Dec 13, 2014 t8ttti Rsii"ttirb3:2u n, Date .Scorr 9 Dec 2014 `gjtb Date Andrew Carpentier Name of NSL Representative A385461 The Terms of this Agreement are contained on both sides of this page Next: Step Living o 21 Drydock Avenue 2nd floor o Boston, MA 02210 (866) 867-8729 inquiry@nextsteplivinginc.com - www.nextstepliving.com TERMS OF AGREEMENT 3. PROPOSED START DATE AND COMPLETION SCHEDULE NSL will contact customer to schedule the Work at a mutually agreeable time, subject to the availability of subcontractors or materials, or to delays attributable to the weather or other events beyond NSL's control. 4. CONTRACTOR REGISTRATION Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor Registration. You may inquire about contractor registration by writing to Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite 5170, Boston, MA 02116.617.973.8700. 5. PERMITS NSL will be responsible for obtaining any necessary permits as the Customer's agent Customers who secure their own permits or deal with an unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law. 6. PERFORMANCE OF THE WORK AND CHANGES. 6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer 6.2 This Agreement may be supplemented, amended, or modified only by the mutual agreement of the parties. No supplement, amendment, or modification of this Agreement shall be binding unless it is in writing and signed by all parties. 6.3 At times, our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern for residents. Such concerns can include but are not limited to ventilation, potentially hazardous materials such as mold or asbestos, or structural concerns. In the case of health or safety concerns being identified, NSL reserves the right, per section 9.2 of this contract, to communicate concerns to the Customer and halt work until such concerns have been addressed. 6.4 The rebates and incentives available from the Mass Save® Home Energy Services Program and amounts due from the Customer are based on the best estimate of the situation in the structure by the NSL home energy advisor. However, at times our weatherization team discovers situations in the hone during the course of the Work that impact the availability of rebates and incentives from the Mass Save Program. In such situations, NSL will communicate such changes to the Customer, including any impact on amount the Customer would be expected to pay for the Work. The Customer will have the option to remove from the Contract the work elements that need adjustment, or set up a separate contract for performing the adjusted work. 6.5 NSL represents and warrants to the Customer that (a) the materials and equipment furnished under this Agreement will be of good quality and new, (b) that the Work will be free from defects, and (c) that the Work will conform with the description of the Work described in Paragraph 1. 7. INSURANCE AND REGISTRATION NSL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration (No: 162111) and the necessary insurance required by applicable law and normally maintained by prudent contractors in NSL's field, including, but not limited to, Workers Compensation Insurance for all employees who will perform the Work. 8. QUALITY OF WORK. NSL agrees that the Work will be performed in a good and workmanlike manner, and that NSL will repair and replace, at its own expense, and promptly upon Customer's request, any defects in workmanship and materials provided by NSL which appear up to one year after completion of the Work or within any longer period as permitted or required under applicable law, provided NSL has received final payment as provided herein. 9. PRE-EXISTING CONDITIONS & PROPERTY PROTECTION 9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions. These conditions include but are not limited to poorly fastened or broken drywall, moisture damage, non -code construction, cracked or fragile siding or shingles, old pipes and fittings, rotting wood, etc. 9.2 NSL reserves the right not to perform Work upon the discovery of asbestos, mold, or any other potential health risk to the Customer. In this event, the Customer is responsible for remedying the at -risk situation, including any necessary removal of hazardous materials and all bills for services to date shall be paid immediately. Work cannot resume until remediation is complete. 9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customer's responsibility to remove or protect, including dust protection, any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property not properly protected prior to the commencement of the Work. 10. GENERAL PROVISIONS. 10.1 NSL reserves the right, the extent permitted by applicable law, to have, file or maintain a mechanic's or material men's lien, or to file a notice of intention to lien, and to take any other steps to perfect and enforce such a lien, if Customer fails to pay NSL as provided herein. 10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts. 10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this Agreement, they are not relying on any representations, warranties or terms other than as expressly contained herein. This Agreement supersedes all prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties. 11. ENERGY BENEFITS. The Sponsoring Utility Company (the Utility) is entitled to 100% of the energy benefits associated with all Energy Conservation Measures, excluding the value of energy cost savings by the Customer, but including all rights to all associated ISO -NE Energy, Capacity and Reserves Products. NSL agrees to provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products. 12. NOTICE CONCERNING SPONSORSHIP. 12.1 Customer understands and acknowledges that NSL is not an agent, vendor or sub -vendor of The Sponsoring Utility Company (the Utility) with respect to the installation of an energy efficiency measures. In the event of the failure of an energy conservation device to perform as expected, Customer's sole recourse is to Contractor and not to Conservation Services Group (CSG) or to the Utility. The Utility and its operating companies shall not maintain, remove or perform any work whatsoever on the energy conservation measures installed. 12.2 Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have consented for Contractor to install the proposed energy conservation measures. 12.3 Customer agrees that it shall not hold CSG, the Utility, their affiliates or operating companies liable for Contractor's to perform its obligations under this agreement, for failure of the energy conservation measures to function, for any damage to Customer's Premises caused by Contractor or for any and all damages to property or injury to persons caused by the energy conservation measures. 13. LIMITED TIME OFFER. The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy Services Program offers. 14. CONTRACT CANCELLATION Under Massachusetts law, you may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller, which may be his main office or a branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by fax, or by e-mail sent or by delivery, not later than midnight of the third business day following the signing of this agreement. Planview Diagram Customer Advisor Name: � Sit - :J`v Address 7 3 Br"wood /' Ie_ Advisor Phone *: Q7t—O fs--ssyIr Town y, Any limitations to access by truck? Site ID -A 3 ergl V NOTES Any work scoped outside of Best Practices? Approved by: �"oac.— (oar i9rvip�,,ewf— (ao'� 2ept��e � is l.,osc — i Aorc,4 2 FtlI- 11 8 13 7 -� f5} C� u�rt co 7 6arzrj e �J