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HomeMy WebLinkAboutBuilding Permit #588-2017 - 75 MEADOW LANE 12/2/2016 BUILDING PERMIT - / of NoRTy q TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION 6 /-7 Date Received (� — � — 3L o I � �q Permit No#: � �R17Eo•'PPy'(5 �SSACHUS�( Date Issued: c� _�' 16 IMPORTANT:Applicant must complete all items on this page LOCATION -75 M.t.adow Lays. Print PROPERTY OWNER NAij Print 100 Year Structure yes Ono MAP QL(s PARCEL:60 ?a ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 1i Repair, replacement - ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic ❑W--0ll ❑Flpodplain Wetlands D Watershed Distract DESCRIPTION OF WORK TO BE PERFORMED: gz i da i ��1�w1����hla„liort c�ru�s in �a�-� ba�,rs Identification- Please Type or Print Clearly OWNER: Name: N lin V-Colcxury Phone: 5b 'Y23-6-1&q Address: 76 ow LAvv- Nl041• Abed v Contractor Name: N_I�.c ha A v Phone: (-QA 3g-1-2031 Email: i 1 co Address: 93109' Supervisor's Construction License: ItOO'A\ Exp. Date. �(-.l 2-0l°► _ Home Improvement License: 1%'Ll 12- Exp. Date: -71=z=1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 2- , V 35 52 FEE: $ Check No.: 1 -7 Receipt No.: (o q NOTE: Persons contracting with unregistered contractors do not have access to theu ra fund _ 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 Dempster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING a DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed ori Signature COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: ' Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: - - �- Located - 384 Osgood Street FIRE,DEPAR=TMENT TempDumpster onsite ,yes_._ _ . Locatedjaf _ _a Street. Fire:�Department�s gnaturO/date- i COMMENTS 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 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 4 Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit aPhoto 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 Doe:Building Permit Revised 2014 Location 7 5S Aj G _ z No. dO Date • - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# 7 9 Building Inspector � NORTH own of ndover o - �+ Z oh ver, Mass, I� • I� �► 0/ �oC.«c«awic« 1. �f SAO P%.4s R^reo �P 5 V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System t �......0� � CO BUILDING INSPECTOR THIS CERTIFIES THAT ......... .... ......... .... ..................... 9.. ........® has permission to erect .......................... buildings on ..... . ............. W..... Foundation % M Rough to be occupied as .... ..0......MIA.,..:`...�.......... ...�.. ' .S.0.................. Chimney provided that the person accepting this permit shall in every respect conform to the 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 CONSTRUCT9N UART Rough Service ......... .. ......... ......................................................... Final BUILDING INSPECTOR 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. RISEt ` 60 Shawmut Road,Unit 2 1 Canton, MA 02021 339-502-6335 ENGINEERING www.RISEengineering.com Ef'ici—cy Enc-r cil;•d. OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: (Property Address) (Property Address) ; ,` i hereby authorize (Subcontract ) _----- 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. 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 m cia ity a e completion of this work. Owner's gnatre ,7 (/f(l 1/[n Date�� 6.2016 Federal ID 7 05-0405629 RISE Engineering Rl Contractor Roglstration No 8186 MAContractorRogistratlon No 120979 RI ` � CT Contractor Registration No620120 (dY'` 6n Sha„•mut Road,Canton,MA 02021 CONTRACT ENGINEERING' 339-502-6335 FAX 339-502-6345 Page 1 FROG TUN\4 RISE Ch1IA-5105 EN�CIMEERMCANDWECUSNTRACTIS ENTEREDiIONEREFORW'ORKAS DESCRIBED BELOW CUSTJG£R PHONE DAM CLIENTS WORK ORDER Philip Decologero (508)123-6709 11/11/2016 441545 23902 SERVICE STREET BILLING STREET _ „�.._ 75 Meadow Lane 75 Meadow Lane __..L=11i SERVICE CITY,SW7-,DP BILLING CRY,S'QTc,DP North Andover,MA 01845 Notch Andover,MA 019,15 JOIE DEMRWTION i V AIR SEALING:Provide labor and materials to seal areas of your home aninst wasteful,excess air leakage. This Murk%%ill he performed in concert%tit h the use of special tools and diagnostic tests to assure that your home%%ill be lett%%ith a healthful devgl 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 staling include air leakage to attics,basements,attached carates and other unheated areas(nindous are not generally addresse(i) This trill require(9)%torkine hours.A reduction in cubic feet per minute(cfm)ofair infiltration%till occur,but the acral number ofcfm is not guaranteed. At the completion of the ucmheriztt ion%%ork.and at no addit Tonal cost to the homeowner.a final blo%%cr door and/or combustion safety analysis%%ill be conducted by the sub-contractor to ensure the safety of the indoor air quahiv. $765.00 DAMMING:Provide labor and materials to install a 12"layer of 12-38 unfaced fibergla_cs hies to(30)square feet for damming purposes. 561.50 ATTIC FLAT:Provide labor and materials to install an 8"layer of R-30 Class I Cellulose added to(1008)square feet ofopcn attic space. $1,380.96 ATTIC ACCES&Provide labor and materials to insudate the hack of(1)attic hatch%lith 2"rigid insulation hoard.Weatherstrip the perinicfer. $60.00 ATTIC ACCESS:Pnn•ide later and materials to make(1) access opening from one attic arca to another by cut tine a passage throuell sheathing This access Hill Ix:left open as it is tvi%wen t%%o common unheated non firettalled attic areas. $31.31 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose%%ith roof niounted flapper vent to exhatnt existing bathroom fan(s).Broan model g 636 or equivalent. $118.75 VEN'T'ILATION:Provide labor and materials to install ventilation chutes in(63)rafter hays to maintain air flow. 5126.00 RISE Engineering%%ill apply all applicable,eligible incentives to this contract. You mill only be billed the Net amount. Currently, for eligible measures,Cohanbia Gas offers 75%incentive,not to exceed S2,000 per calendar year,and an incentive of 100%for the Air Scaling measures up to the first 5680 and an additional S3,10 if savings are justified by the auditor. For the safely and health of your home's indoor air quality.%tu%%ill be conducting a blo%ter door diagnostic of the available air Now in your home both before the%%urk is begun,and tiller the weatherir tion cork is complete.We%%ill also conduct a full assessment of the combustion safety of your heating system and stater heater.This has a value of 590 and is at no cost to you Total M 6 Federal 1D d 05-0405629 RISE Engineering RI Contractor Registration No 8186 rRAContractor Registration No 120979 RISE CT Contractor Registration No620120 Gil Sh0lymnt Road,Canton,1i:\(12021 CT ENGINEERING' 339-502-4335 FVX339-542-6345 Page 2 PROGRAM 'HIS CON•StACTIS EH'BRED IN'D BE'WEEN RISE CMA-11 F'S ENGINEERING ELOW ANDIHE CUSTONER FOR WORK AS DESCIZIRECUS'ONER PHONE DAE CUENTa WORK ORDER Philip Decologena (508)423.6709 11/11/2016 441545 23902 SERVICE STREET BILUNC STREET 75 Meadow Lane 75 Meadow Lane SERVICE CnY.STATE.ZIP WWNG CRY.SME.ZIP North Andover,MA 01845 North Andover;MA 01845 JOB DESCRIP TION allowable%%catherirat ion incentive is S3.1 10. The Permit%,till b:secured by the insulation contractor,at no additional cost.It is the homco%Nner's responsibility to close out this permit by contacting their mw'icipality at the completion ol'lhis L1ork. ,9tJ.0f? `1 I lit t Iu L Total: $2,633.52 Program Incentive: $2,188.89 Customer Total: $444.63 W EAGREEHERESY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Forty-Four&63/100 Dollars $444.63 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGiNEERIN0.CUS'OiER AGUES W REMTAtADUNTDUE IN FULL INERESTOF t:L WILLBE CHARGED MNII/LY ON ANY UNPAID BALANCE A5ZT1t20 DAYS.SEE REVERSE FOR 17MORLINTINFOMIAT10H ON CUARANEES.FUGHM OF RECISION.SCR':DUUHG,AND COtal&ZIUR RECISWtuON. NOT SIGN THIS CONTRACT IF THERE AR" ITL KS we ,P S AU'H GHA E-RISE Erb eMp CUS R 'ePr_IiCE NOTE:7415 C n�, ERAWN BY US IF NOTEXECUEO WMIN DALE OF ACCEPTANCE -r ACCEP'RNCE OFCOH'RACT•'HE ABOVE PRICES,SPECIFICATOR5 AND CONDITIONS ARE 30DAYS. 43 SPECIFIED.PAENTWRIDE 7.10E ASC OU'Ut EO ABOVE AUBiORIZEO TO 00'H=_WORK The Commonwealth of Massachusetts Department of IndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass govfdia Workers'Compensation Insurance Affidavit:General Businesses. TO BE FILED WITH THE PERNW TWIG AUTHORITY. Applicant Information Please Print Legibly 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): I.Q I am a employer with 12 employees(full and/ 5. ❑Retail or part-time)." 6. E RestaurantlBar/Eating Establishment 2.0 1 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. Non-profit 3.0 We are a corporation and its officers have exercised 9. Q Entertainment their right of exemption per c. 152,§1(4),and we have 10.[]Manufacturing no employees.[No workers!comp.insurance required]" 4.❑ We are a non-profit organization,staffed by volunteers, 11.❑Health Care with no employees.[No workers'comp.insurance req.} 12. Other YJ Lp,�t I,y►7 A.�i(�y� *Any applicant that checks box#i must also fill 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 organization should check box 91. /am an employer that is providing workers'c©inpensation insurance for my employees. Below is the polity information. Insurance Company Name:Clark Insurance Insurer's Address:One Sundial Avenue Suite 302N City/Stare/Zip: Manchester,NH 03102 Policy or Self-ins.L.ic.#MIWC791896 Expiration Date:4/2912017 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 andlorone-year imprisonment,as well as civil penalties in the forth 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,ains and penalties of perjury that the information provided above is true and correct j, Simature; Date: I ` Ol(y 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): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: www.mass.gov1dia MILLCITY-1 AGOULD ACORO� CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DOIYYYY) 1 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 PHONE FAX One Sundial Ave Suite 302N AIC No Ell:(603)622-2855 ac No),(603)622-2854 Manchester,NH 03102 E-MAIL g ADDRESS:a ould clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Arbella Mutual Insurance Co 17000 INSURED INSURERS:AmGuard Ins c0 43290 Mill City Energy INSURER C 106 Joseph St PO BOX 6411 INSURER 0: 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. ?LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER POLICY EFF MM UD EXP LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE T OCCUR 8500065735 04/29/2016 04/29/2017 DAMAGE O RENTED 300 00 PREMISES Ea occurrence $ MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 1 POLICY PRO- ❑ JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea a.dent $ 1,000,00 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 Pe,..dent X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 $ WORKERS COMPENSATIONX PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE YIN MFWC791896 04/29/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? Al N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ 500,000 Iles,describe under DCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 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 A ACCORDANCE WITH THE POLICY PROVISIONS. t. 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 use group which 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 of the Massachusetts Expiration: State auiidirg Code is cause for revocation of this license. Commissioner 08/07/2019 DPS Licensing information visit:WWW.MASS.00VMPS ...erra .vx Ia t CEtlYt OF r! y {trice of consomer Affsirs&ossifies*Regolatioo reg r#lid for ind'n idol use only r --we FfONIE IMPROVEMENT CONTRACTOR before the expiration date. If found return to: _ gFstration. IR112 Type; Office of CansumtF Affairs and)3usiness Regulation?hY 10 Part:Plaza..Suite 51'70 xpiratfat: 7W=17 LLC 4 _`I Boston—MA 02116 MILD&ENERGY,LLC MICHAEL JOY 108 JOSEPH STREET MANCHESTER,NM 03102 t nsfrrsrerttrtrp ti Fa � itttaut.s' _ ore