HomeMy WebLinkAboutBuilding Permit #929-15 - 742 WINTER STREET 5/15/2015Permit NO: q2_9 -
-11-5
Date Issued: 10
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
IMPORTANT: ADOicant must comt)lete all items on this
LOCATION kilmLv- _5--t
Print
PROPERTY OWNER 6�rie_e, 1'1'169UIlil!�
mo ZO Print J
MAP NO: PARCEL: NING DISTRICT: Historic District yes
Machine Shop Village yes <fnp—
TYPE OF IMPROVEMENT
PROPOSED USE
Residential
Non- Residential
New Building
0< One family
11 Addition
11 Two or more family
Industrial
[I Alteration
No. of units:
Commercial
K-Rbpair, replacement
11 Assessory Bldg
Others:
[TOemolition
11 Other
[I Septic i i Well
1, Floodplain -_1 Wetlands
U1 Watershed District
—1-i Water/Sewer
I
I I
4-D a, -4-t, ,mj
I
Identification Please Type or Print Clearly)
OWNER: Name:
- 1J
Address: -7qz glln��Sk ltivg gnivo#-, enn
CONTRACTOR Name: I —Phone:
64t"L 6 P [10
Address: ss glz,��V,-4j b�- ,
/ 7- -445-q- -766 Z
Supervisor's Construction ticense: Exp. Date: 2-11 T/,
e� 7 7-316 1
Home Improvement License: Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE: BULDING PERMIT. MOO PER $1000.00 OF THE TOTAL ESTIMATED COSZAASED ON $125.00 PER S.F.
Total Project Cost: $ 3, ?k V, — FEE: $ 46 -u -
Check No.: �5 L:W Receipt No.: 24-1 t I
NOTE: Persons contracting with unregistered ontractors do not have access tro the uarantyfund
Signature of Agent/Owner ignature of contracto
Permit No#:
Date Issued:
t%ORTH
F �4
0 0 16 ,0
BUILDING PERMIT -'.1h "6 C
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION -1K
IMPORTANT:
Date Received
must comi)lete all items on this
LOCATION Print
PROPERTY OWNER
Print 100 Year Structure
MAP PARCEL:- ZONING DISTR'ICT:-Historic District
Machine Shop Village
yes no
yes no
yes. no
TYPE OF IMPROVEMENT
PROPOSEDUSE
Residential
Non- Residential
0 New Building
El Addition
El Alteration
0 One family
11 Two or more family
No. of units:
El Industrial
0 Commercial
0 Repair, replacement
El Assessory Bldg
0 Others:
[I Demolition
0 Other
I ��, I L �m z
-V TO': ffietl g
i�-
-M-l�, ers
�V 11� I thlt-
222�
M -S ,tid
JZ e
()P WORK TO RE PERFORMED:
-e
r'%C(2('D1DT1r)K]
Identification - Please Type or Print Clearly
OWNER: Name: Phone:
IAUU I t:bb.
Contractor Name: Phone:
Email:
Address:
I Supervisor's Construction License:
� Home improvement License:
ARCH ITECT/ENGI NEER
Exp.. Date:
. Date:
Phone: -
Address: Reg. No.
FEE SCHEDULE. BULDINGPERMIT.-MOO PER $1000.00 OF THE TOTAL ESTIMATED COST BASED ON $125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guarantyfund
xI �
Plans Submitted 11
Plans Waived Certified Plot Plan Stamped Plans F1
TYPE OF SEWERAGE Dff-0-SA-L
Public Sewer 11
Tanning/Massage/Body Art El
Swimming Pools El
Well El
Tobacco Sales El
Food Packaging/Sales El
Private (septic tank, etc. El
Permanent Dumpster on Site El
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT
COMMENTS
Reviewed On Signature.
CONSERVATION Reviewed on Signature
COMMENTS
HEALTH
COMMENTS
Reviewed on Signature
�-Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes
Planning Board Decision:
Com
Conservation Decision: Comments
Water & Sewer ConnectionlSignature & Date - Driveway Permit
]DPW Town Engineer: Signat-ure:
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)
LJ Notified for pickup Call Email
Date Time Contact Name
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
4� Floor Plan Or Proposed Interior Work
,4. 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
All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit
New Construction (Single and Two Family)
�6 Building Permit Application
I Certified Proposed Plot Plan
4. Photo of H.I.C. And C.S.L. Licenses
�6 Workers Comp Affidavit
4� 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
IOTE: 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
Doe: Building Permit Revised 2014
-�JZ
Location
No. C129-( Date
Check #
2676 7
TOWN OF NORTH ANDOVER
Certificate of Occupancy $
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee
TOTAL 1 $-U
Building Inspector
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',yj ",I �, CONTRACTOR WORK ORDER
Printed: 5/8/2015
Work Order Id: S85914P89062C332
Contractor Information
Customer/Site Details
Air Sealing Incentive
$1,105.87
ESE
Erica Mcewing
Email:
ericamcewing@comcast.net
52 Fitzgerald Dr
742 Winter St
Phone(Eve):
978-687-8793
$260.23
$260.23
Phone(Day):
617-359-7662
Jaffrey, NH 03452
North Andover, MA 01845-1417
Site ID:
S00002085914
Installed Measures Total $3,863.40
WorkOrder Notes
IPayments
Incentive Payments
Customer Share
Weatherization Incentive
-------- --- — - -----
Total Installed Measures
Air Sealing Incentive
$1,105.87
Location
Description
Quantity
Unit $
Total $
Living Space
Attic Stair Cover Thermal Barrier with carpentry
1
$260.23
$260.23
Door Sweep
5
$23.18
$115.90
Living Space
Perform Air Sealing at Estimated 62.5 CFM50
8
$84.32
$674.56
Exterior Door Weather Stripping
2
$27.59
$55.18
Attic
Propavent 2' or 4'
90
$3.83
$344.70
Living Space
Hatch: Thermal Barrier Polyiso 2 inch (Attic)
1
$41.71
$41.71
Damming
64
$2.19
$140.16
Living Space
Kneewall Floor Enclosed Cellulose Dense Pack
356
$2.60
$925.60
Living Space
Attic Floor Open Blow Cellulose 6"
888
$1.47
$1,305.36
Installed Measures Total $3,863.40
WorkOrder Notes
IPayments
Incentive Payments
Customer Share
Weatherization Incentive
$2,000.00
Air Sealing Incentive
$1,105.87
Total Incentive Payments
$3,105.87
Total Customer Share $757.53
Less Deposit Of $252.51
Customer Share Balance (Due Contractor) $505.02
Conservation Services Group - 50 Washington Street Suite 3000 - Westborough, MA 01581 - (508) 836-9500
6C1>yLjyzg(--'4 N Z� 3
RCS PLANVIEW DIAGRAM
Customer: ErLCV�- OAC, C -W 1 C4
Home Phone: A 79 6 S7 -137"137
Address: .742- WinteE
Work Phone: (
Town: 144 do L) ef —
Cell Phone: (
Any limitations for access by large truck? No Yes If yes, describe:
Any specific directions or landmarks? No Yes If yes. describe:
Site ID: 2.0851141
Energy Specialist:
Reviewed by:
Air Sealing: 8 hrs (888 sq. ft.)-, Attic Stair Cover Thermal Barrier with carpentry
5 Door Sweeps and 2 Weatherstrips
1. Propaventt'.,
90
2. Damming:
64 ft.
3. Attic Floor Open Blow Cellulose X":
888 sq. ft.
4. Kneewall Floor Enclosed Cellulose Dense Pack 8":
356 sq. ft.
5. Hatch: Thermal Barrier Polyiso 2":
1
'e --\P1' 1>
(D
E B1F5-(g2r EBF
AIR
RMIN 40
LEI
ON
For Office Use Only
Bushes Ladder Neighbor Proximity Pocket Doors Insert Radiators Fence(s)
Existing Conditions X Access = Vents Note Inside SQuare
R= Roof S = Soffit G = Gable
RV = Ridge Vent CS = Continuous Soffit
CDE = Continuous Drip Edge T = Triangle
Install 0 = New Access Note in Circle C = Ceiling W = wall
S Sheathing Temp Unless Noted Otherwise
A = Vents Note in Triangle R = 8" Roof S = Soffit
G Gable M = 12" Mushroom For Access
Rev 1/14
mass save
PERMIT AUTHORIZATION FORM
liell tlll:rqk sf*1`11�-
PARMIPATING
CONTRACTOR
ERICA MCEWING owner of the property located at:
(Ownees Name, printed)
742 Winter St NORTH ANDOVER
(Property street Address) (city)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
below to act on my behalf and obtain a building permit to perform insulation and/or weatherization
work on my property.
x Y
Owner's Slg�nature V
cl 2)
Date
FOR CSG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
I--- 1--- 511
/� 5,e - /,VCI -
Participating Contractor
Rev. 12132011
Date
e
NI $;a EN I
I MR.
The Cominoweallis of Massachusetts
Departlitient of 1whistrialAccidetits
I Congress Sfreet, Suite 100
Boston, MA 02114-2017
wim n1ass. go 1,11fia
Workers' Compensation Insurance Affidavit: Biiilder.s/('ontractors/Electricians/[)Itimbei-,,.
TO BE FILEI) NATFI I 'I'll E' PERMITTING AUT1101011 -
Applicant Information Please Print Le2iblN
Name idl.1311: ESE INC
Address 52 Fitzgerald Dr
City/State//Zip: Jaffrey. NH 03452
'ire .%,oil an cruploN er? Ch cc k flit a p prop riatt hoi.:
p1jolle g- 603-532-6346
1.[D I am jempimet wth 5 emplot ccs I Ild I an&m patt-irmci
I ani a sole proprietor or parinership and have no ciliplax cc, twrk I ne for nie I it
jn� capacax [No %torker, comp insurance required I
3 1 am a homeo%�llcr joulgall %Nork ni%se I I I.No k%orl,vts comp insurance required I'
4 1 am a honico%%ner and w I I lie hiring contractors to conduct a I I %%ork on m% propen% I%% ill
ensure that all comractors either ha% e %wri.ers compensation insurance or ate Nole
proprietors wilh no cmilitnces
5 1 am a genewl contirruloi and I ha%c hired the 'Uh-i:0o1lacu)r,% hstcd on tire attached street
These sub -contractors haxe cniplo%ces and have %%orkcrs comp in�urdncc*
6 n"e area corptirationand its ol'ficers ha,ecxcrcj.scd their light ot exemption pet N161, c
wmp in.sura lice req ul tell I
Type of project (required)
rl Ne�% consirtiction
1:1 Reniodehrilz
9. El Demolition
10E] Building addition
I I E] E-lectrical repairs or additions
12 F] Plumbing repairs or additions
I i FjRoofrcpa.irs
14-PI)tlicir Insulation
:A m applicant that cliecks box;$ I or u St a I 5o fill or it I lie sect loll lie lo%% MwN%i tie i lie ir %%orkers compensation polrv% in tormition
I I onicowners %%,hit subm it this affidav it indicaling i he% art: do in&: al I %%ork arid then hire outs r& contracloiN mu.si subm it a nc\k it 111dat 11 1 lldK:J1 I ll.L' IM h
' 'ontracuir,; that ClICCL this bit% III List at tached an add it lonal shect shovolig 1 lie natue w I lie miucontracior., and irate %\hethei ot not i how ciltil I C�, lij� e
enirilmees 11*1 lie sub-coluraclors have cjuplir� cc.,, dw N, must pro% ide their %korkers conip polic% rioniber
I alln an ernph�verlhalisproviditiig workerw' compensation insurancefor nil, employees. Bei"-i.ithept�lit--t-titidjob.viti,
information.
Insurance Cornpan� Name National Liability & Fire Insurance Company
Pollc\ "i or Self -ills Lie ig V9WC629429 FxPiration I)ate 3/8/2016
Jot) Site Addresb. -7 1/ Z CIO\ Statel'Zip MP 615Lls-
Artach a copy of the workers' compensation policy declaration page (sholiving the policy number And expiration date).
Failure to secure coverage as required under MGL c 152. §25A is a cruninal violation punishall1c h\ a finc if!-) to S 1500 (it)
and/or one-year irnprisonmeni. as �\ell as civil penalties in the tbrin ofa ST01) WORK ()RDFR and a finc ofull it) S-22io 00 it
day against [he V101,11017 A cop\ ofthvs statement may he tbr�,.arded to lhe Offlice ol'Invcsti-gations ofthe DIA lor insurance
co%erap-e verification
ldoherebvcert�fyund thepai . nsaytipena 'es fperjun-thalitheirn rinorion pro wiett (wo ve is tru e wr a correci.
Vo
Sienature: 7""'� Date
Phone 9 603-532 6346
Ojficial use on1r. Do tiot wrile in this oreet; to be completed ki, ci�y or town official
City or Toili, n:
Perl"R/License 9
lssuingAuthorit.% (circle tine):
1. Board of Ilealth 2. Building Department 3. City[l'own Clerk 4. Electrical Inspector i. Plurnhina Inspector
6. Other
Contact Person:
Plicitte 4:
7 0
ACOORO CERTIFICATE OF LIABILITY INSURANCE
DATE (MM/DD1YYYY)
4/27/2015
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
FIAI/Cross Insurance
1100 Elm Street
Manchester NH 03101
CONTACT
NAME: Karen Shaughnessy
H AX
,�NEO.Extl, (603)669-3218 1C, (603)645-4331
IPA C N (A No):
E-MAIL
ADDRESS:kshaughnessy@crossagency.com
INSURER(S) AFFORDING COVERAGE NAIC #
—
INSURERA.-West American Insurance Co.
INSURED
ESE, Inc.
Energy Saver Enablers
52 Fitzgerald Drive
,Jaffrey NH 03452
INSURERB-Ohio Security Ins Co 24082
INSURERC:Ohio Casualty Insurance Company 24074
INSURER D.American Alternative Insurance
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER:14-15 All w/ 15-16 WC 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
ADDLSUBR
INSR
WVD
POLICY NUMBER
POLICY EFF
(MMIDDIYYYY)
POLICY EXP
(MMIDDIYYYY)
LIMITS
GENERAL LIABILITY
EACH OCCURRENCE $ 1,000,000
DAMkGr7UTTIq=
PREMISES (Ea occurrence) $ 300,000
X COMMERCIAL GENERAL LIABILITY
A
CLAIMS-MADEFx_]OCCUR
BKW55684497
7/31/2014
7/31/2015
MED EXP (Any one person) $ 15,000
PERSONAL & ADV INJURY $ 1,000,000
_7
GENERAL AGGREGATE $ 2,000,000
GEN'L AGGREGATE LIMIT APPLIES PER:
PRODUCTS - COMP/OP AGG $ 2,000,000
$
rx-1 POLICYF—] PRO- F
JECT LOC
AUTOMOBILE LIABILITY
COMBINED SINGLE LIMIT
(Ea accident) $ 1,000,000
BODILY INJURY (Per person) $
B
X ANY AUTO
ALL OWNED SCHEDULED
AUTOS AUTOS
BAS55684497
7/31/2014
7/31/2015
BODILY INJURY (Per accident) $
PROPERTY DAMAGE
(per .dent) $
NON -OWNED
HIRED AUTOS AUTOS
Uninsured motorist combined $ 1,000,000
X
UMBRELLA LIAB
OCCUR
EACH OCCURRENCE $ 1,000,000
AGGREGATE $ 1,000,000
C
EXCESS LIAB
CLAIMS -MADE
I
I DED I X I RETENTION$ 10,00C
$
US055684497
7/31/2014
7/31/2015
D
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY Y/N
ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICER/MEMBER EXCLUDED'
(Mandatory In NH)
NIA
W2A2WC0000371-03
(3a.) NH & MA
11 officers included
3/8/2015
3/8/2016
WC STATU
X TORY LIMIT� I I 9TH
E.L. EACH ACCIDENT $ 500,000
E.L. DISEASE - EA EMPLOYE9 $ 500,000
E.L. DISEASE - POLICY LIMIT 1 $ 500,000
If yes, describe under
DESCRIPTION OF OPERATIONS below
DESCRIPTION OF OPERATIONS i LOCATIONS I VEHICLES (Attach ACORD 101, Additional Remarks Schedule, if more space Is required)
Refer to policy for exclusionary endorsements and special provisions.
CERTIFIrATF wni nFR CANCELLATION
ACORD 25 (2010105)
INS025 (gnlnn.r,) ni
(0 19BB-2010 AGURU E;L)RPURATIUN. All rignts reservea.
Thg% Arr)pn n2ma 2nd Innn nra ranieforarl mArlea nf Arnpn
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Town of North Andover, MA
ACCORDANCE WITH THE POLICY PROVISIONS.
1600 Osgood Street
North Andover, MA 01845
AUTHORIZED REPRESENTATIVE
Laura Perrin/JSC
ACORD 25 (2010105)
INS025 (gnlnn.r,) ni
(0 19BB-2010 AGURU E;L)RPURATIUN. All rignts reservea.
Thg% Arr)pn n2ma 2nd Innn nra ranieforarl mArlea nf Arnpn
Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construction Supenisor
License: CS -072316
V I . I ,
CALEB AHO
411 JARMANY Ht
I
SHARON NH ( U5jLq
Expiration
Commissioner 12/1912015
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5 170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 161406
Type: Individual
Expiration: 10/2012016
CALEB AHO
CALEB AHO
482 JARMANY HILL RD.
SHARON, NH 03458
SCA 1 G 20M-05/11
Office of Consumer Affairs & Business Regulation
OME IMPROVEMENT CONTRACTOR
egistration: 161406 Type:
'Expiration: 10/20/2016 Individual
CALEB AHO
CALEB AHO
482 JARMANY HILL RD.
SHARON, NH 03458 Undersecretary
Tr# 258803
Update Address and return card. Mark reason for change.
Address Renewal Employment , LostCard
License or registration valid for individul use only
before the expiration date. If found return to:
Office of Consumer Affairs and Business Regulation
10 Park Plaza - Suite 5170
Boston. MA 02116
Not valid without sig,�