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HomeMy WebLinkAboutBuilding Permit #086-2015 - 75 WOODCREST DRIVE 7/21/2015 N - ORTH �� BUILDING PERMIT ,b 16 a"o TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION _ Permit No#: �' l Date Received I 'QA�gA7Eo�4P�R5 SS9CHUS Date Issued: � ?/I I IMPORTANT:Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 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 0 New Building ❑ One family I ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other - IFI©btl las `Wet ands" r,.Waterslied_ Di_ . v >31Se trc ❑tWel4P lW- � .�`Waterl DESCRIPTION OF WORK TO BE PERFORMED. i i Identification- Please Type or Print Clearly I n� Phone: OWNER: Name: Address:-7J� -` Contractor Name: Phone: j Email: Address: Supervisor's Construction License: Exp.. Date: Home Improvement License: l 017 1 Exp. Date: / g t 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: $_1 ''77 FEE: $ —' Check No.: LL* v5N Receipt No.: NOTE: Persons contracting wit e t red contractors do not have access to u a ty fund Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Taming/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 m U FORM PLANNING & DEVELOPMENT Reviewed On Si gnature_ COMMENT'S CONSERVATION Reviewed on Signature COMMENTS I i HEALTH Reviewed on Signature COMMENTS G Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Plo.nning Board Decision: Comments Conservation Decision: Comments 6.,Water& Sewer Connection/Signature& Date Driveway Permit ,DPW'Town Engineer: Signature: Located 384 Osgood Street AFIRE DEPARTIVIEINT - Temp Durvpsfer onsite, yesus « r=.. Located at 1P24 Main Sfr et �� ` .,� � � �� �,�� �;.. P� A, + aNt, r- ;' ,/dte° x ° 4 x .t *un#_CG?. 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 Pennit 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 4c 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 16 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) 4- Building Permit Application 4� 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 f 6-6XCfvi . No. ()VD 15 Date f • - TOWN OF NORTH ANDOVE Certificate of Occupancy $ Building/Frame Permit Fee $ — Foundation Permit Fee $ Other Permit Fee $ ` TOTAL $ Check# ' s 29086 �1p Building Inspector as F NORTH Town of . � ndover .. No. - �.oh ver, Mass,LAKI 4 COCKICKIWI(K y'►• p°RAreo 0kPa,�'�5 S U BOARD OF HEALTH PERMIT LD Food/Kitchen Septic System THIS CERTIFIES THAT ...Q ... . !�I BUILDING INSPECTOR .... ................... ................... ..........�............ has permission to erect ;, L41 f 4 Foundation .......................... buil ngs o ...... ` .... . ... .. ..... �.. �..... ♦ Rough • g to be occupied as .............. .. !. ............. ...... ....�..w.s . . ...!�.......................................... 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 CONSTRUCTION ST RT 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. zo next step living® home energy solutions This agreement is made by and among Nancy MacMillan Next Step Living,Inc.("NSL") 21 Drydock Avenue,2nd floor 75 Woodcrest Dr Boston,MA 02210 North Andover, MA 01845 phone: (866)867-8729 Site ID: 418816 01-Jun-15 1. DESCRIPjION 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.Pricing reflected below may be subject to adjustments in program pricing and offerings and is guaranteed for 30 days from the date the Contract is printed. cy escription nves men Air Sealing Recommendations $680,00. e Work Location: Attic Flat Perform Air Sealing at Estimated 62.5 CFM50 Per Hour. 8 $85.00 Hr $680.00 Weatherization Work Location: Attic Flat x Replace Bath Fan Hose 2 $50.00 Each $100.00 Attic'Starr Cover T77 hermal Barrier with Carpentry 1 $25765 Each $237:65 Work`:Locatlon ' .Miscp. Sheathing Access 1 $31.31 Each $31.31 Work Location: Foundation Insulate Rim Joist With 2"Thermal Barrier Polyiso 33 $3.52 sqft $116.16 Initial Investment: $1,165,12: 1QQ%Airsealtngancentive up fo:Program Max $680,00` 75%Weatherizatlon;lncentiye up to Prggram Max $363:84 Total Net Investment: 121.28 sbmated Annual Energy Savings from he Above'Improve ments $93:00 2. PAYMENT CUSTOMER agrees to pay NSL for the work as follows: Payment#1: $100.00 -Credit Card or check deposd Is due at the time the Work Is scheduled.Required payment information Mil be collected over the phone by a customer service representative at the time of scheduling. Deposit Is not to exceed 113 of the total retail costs.(Note:Mastercard,Visa,and Discover accepted). Additional Payments and Final Invoice: $21.28 -Additional payments for the Work shall be due upon completion of the Work If the final invoice Is being paid by check,credit card information will still be required at the time of scheduling. Notify the customer service representative that you are paying by check and your card will not be charged unless we fail to receive payment within 5 days of invoice. /0 S C40r Sii;nature Date 1 Jun 2015 Edward Yaracz NSL Signature V Date Name of NSL Representative A1091485 The Terms of this Agreement are contained on both sides of this page Next Step living.21 Drydock Avenue.2nd floor.Boston,MA 02210.(866)867-8729.Inquiry@nextsteplivinginc.com.www.nextsteolivins.com 4eT :: next step living® home energy solutions This agreement is made by and among Nancy MacMillan Next Step Living, Inc.("NSL') 21 Drydock Avenue,2nd floor 75 Woodcrest Dr Boston,MA 02210 North Andover, MA 01845 phone: (866)867-8729 Site ID: 418816 01-Jun-15 1. DESCRIPTION OF WORK TQ 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.Pricing reflected below may be subject to adjustments in program pricing and offerings and is guaranteed for 30 days from the date the Contract is printed. ';Descrip i6hQuan it Investment; Other • - • • $62.50 Work Location: Attic Flat Recessed light boxing (Not Rebate Eligible) 2 $31.25 Each $62.50 Initial Investrrient: $62.50 -777777777:��7�_ 77777 Not Re bate`Ellgible Total Estimated Annual Energy Savings from the AboveImprovements 2. PAYMENT CUSTOMER agrees to pay NSL for the work as follows: oeSf Payment#1: —rtf 4 (250 i n I r-ex( Additional Paymen n ` oito 1 me forth s be u n completion etlon of e W r Custo Signature Date 1 Jun 2015 Edward Yaracz NSL Signature Date Name of NSL Representative A1091485 The Terns of this Agreement are contained on both sides of this page ` Mass Save Planview Diagram Customer rin I N`c�.�. G�, Advisor Name:F�.;,suc�_ U"0*&Q Address e.&.4 ams Advisor Number: X51 Town Any limitations to access by truck? Site ID NOTES a Bogy M L3 C I a7 1 id` s \a The Commonwealth of1Mlassachiesetts Department of Industrial Accidents l?yfice of Investigations ' d 1 Congress Street, Suite 100 ' W Boston,MA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit: Budders/Contractors/Electricions/Plumbers Applicant InforilYlation Please Print LegLbly Name (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.N I am a employer with 850 4. ® I am a general contractor and I 6 ®New construction employees(full and/or part-time).* have hired the sub-contractors 2.® I am a sole proprietor or partner- 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. 9. ®Building addition [No workers comp.insurance p' 10.El Electrical.repairs or additions required.] 5. ® We are a corporation and its 3.® officers have exercised their I am a homeowner doing all work 11.®Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.®Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation Other employees. [No workers' 13. _ comp. insurance required.] *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 affida"it indicating such. tConrxcters that eneck this box must attached an additional sheet showing the name of the sub-contractors and state whether or not t1103e entities have employees._Yf the subcontractors have employees,they must provide their-workets;comp.policy number.. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. insurance Company Name: A.I.M Mutual insurance Company Policy#or Self-ins. Lie.#: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 WORD 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 v fi tion. Ido hereby certify under the pains and pen es perjury that the information provided aboveistwos and correct Signature: ] Date: Phone#:� � �� /C" 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): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: - ' NEX78.1 OP ID:EL CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDNYYY) 10/01/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONS%AND CONFERS NO FIGHT§ UPON TH9 WRTOFICATF HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED 13Y THE POLIOIES BELOVY. THIS CERTIFICATE OF ONSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZ9D RgP PSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. (IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. Of SUBROGATION Iq WARP,sdkla6>l j9 the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to ghp certificate holder in lieu of such endorsements.___,_ PRODUCER CONTACT M6Laughlirl I��ppsuranceAgency PHOMNEE Erin Lyons FAX 828 Lynn fells Parkwpy (AIC.No EI:761.605-2775 (AIC'No):751=665=02 Melrose,MA 02176 E-MAIL John E.McLaughlin Jr. ADDRESS: INSURERS AFFORDING COVERAGE NAIL 0 INSURER A;Nautilus Insurance INSURED Next Step diving,Inc. INSURERS:Commerce Insurance Company 341 21 Drydock Avenue,2nd Floor Boston,MA 02210 INSURERC:A.I.M.Mutual Insurance Co. INSURERD:AXIS Insurance Company 15610 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 fadR�®P INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICFI 1 IA 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 TYPE OF INSURANCE DDL POLICY NUMBER MMIDPOLICD/EFF MEONLDD EXP LIMITS A X COMMERCIAL GEWEjM LIABILITY EACH OCCURRENCE $ 000,000 CLAIMS-MADE ®OCCUR ECP2010198-12 09/30/2014 09/30/2015 PREM SES Ea occur ante $ 900s000 MED EXP(Any one person) $ 0,000 PERSONAL&ADV INJURY $ IM9,004 ppppb� p GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JEC LOC PRODUCTS-COMP/OPAGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea act dent �. B ANY AUTO 14MMSOKKOM 09130/2014 09/30/2015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILYI.--T PeraccdeM) $ ;AUTOS Ww- AUTOS�...�. ..�. � HIRED AUTOS NON-OWNED Par. de DAMAGE $ $ UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 5,000,00 D EXCESS UAB CLAIMS-MADE EI,U783547012014 0913012014 09/3012015 AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ERH _ C ANFICER/MEMBER EXCLUDED?ECUTIVE Y�N 1 A O BE ISSUED BY CARRIER 09/3012014 08/30/2015 E.L.EACH ACCIDENT $ 500,000 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) FOR INFORMATION ONLY CERTIFICATE HOLDER CANCELLATION INFO-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE For Information®n0 THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Y ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATM VAk ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) Tip 4909P wwo W9 IggRaw Pf�c:nte�� 9fACORR --y�-- Massachusetts - Department of Public Safety Board of Building Regulations and Standards Construction Supervisor Specialt} License- 0SK-1028111 ROGER A OVILLE T a 55 STA1 ®RUIZZ im - —� wa rl�ek REI QD�I V1.1 E✓xpr ration commissioner Rest octed To: CSSWC e lnsulation Contrador Failure to possess a currents edition OT the Massachusetts State Building Cale is cause for revocation of this license. For DPS Licensing 0n0ormalt0on v0sit: F?,wt,,,f.M@sco.G v/DPS