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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 El Piz rN �2 rA dl� rA LLJ LL 0 0 ca -C u 0 0 1, E 0- a) Ln 0 1-- u . . z z co c .2 0 LL -C tto o cr >. a) c E !E U r- LL- 0 u (L z z D i CL -C M 0 cr LL 0 z u -i uj -C 0 cr ai U > V) m L.L 0: 0 CL (A z LA -C bD :3 o CC LL- z LU ui 13 ui CC w ca z (V 0) Ln 0 E Ln 0 '40 tcc rL m 4.2 6� . j. - A 0 U) CL Cc cn CF) oar: V)CL ma .2 U) so; 0 its CL 4) CL 4 a) ) 0 0 0 — cc U) cc 0 OL CL (D 0.2 m cn w = *: %- i66 Lju!g -0-06, .(—D r- 0 .0 cL:5 :E .2 z = 0 E 0 — LU 0 a).- 0-0 4) 4) _j Ckm y (n -0 O'P- o m o " c 0 1�- M .CLOL) > 0 uj Z z co z 0 2 co z V) w w CL x LLI w a. F- U) z 0 0 U) Cf) LU -i z 0-7� ZE 0 E 0 z 0 CD IM r_ c 0 E Cc CL 0 CA z r_ 0 CL U CL U) 6( ',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,�