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Home My WebLink AboutBuilding Permit #835-15 - 77 BRIDGES LANE 4/22/2015 ^'^ BUILDING PERMIT oFtNOR%ORT-iF/ TOWN OF NORTH ANDOVER �� h� .,t •.' •b ,APPLICATION FOR PLAN EXAMINATION A ' Permit No , Date Received �reo �SSACHU`'�� Date Issued: I PORTANT:Applic ant must complete all items on this page LOCATION in 4 jI .) ", e tis: it 1`S- *�1 _'' ¢ •i L '"fp„I$! 'i?F .'cy t ( ' PROPERTY OWNER �'l r 5eG` r 5, t x 4Y�, W aL#a w Pnnt1 " '� 100,Year Structure yes no a "s , yes no.. MAP b PARCE[� ZONING DISTRICT Historic District Maehme Sho Villa e `eS no . . p . g_ Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building , .One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other p`be sWia` =77 -; p,a n'= �tlan'd� sfirict AM L.o er/S=we - - - -- - - - -- DESCRIPTION OF WORK TO BE PERFORMED: F� "t-S•eg I;ha A-Y1t c ZnSd►4?Pov� Identifica 'on- Please Type or Print Clearly OWNER: Name: �4 vi ret Y 1`4 SeeL-r Phone: E%F GF6' I Address: 7� 8� " S Lh /I .___14 vi di v"Pr, Contra for Name: rb q t Phone:' Email: Vo%4 be , ►xS igt►e_' �wia>1. .�aei✓l 5 .�`r . . Address..` -o- ok gS' e(�vtt, ..Ii�.►/� Supervisor's Construction License C65L- !060/7: Exp Date: yla�lro/�'. Norrie Improvement License d �1- Exp:.;. Date: 7a� o/d 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: $ 3 FEE: $ Check No.: Receipt No.: � NOTE: Persons contracting with unregistered cont ctor do noJ have access to the guaranty fund Location--4 6a i d e c-a No. Date • - TOWN OF NORTH ANDOVER • S t l"ED'.y646 . Certificate of Occupancy $ ., Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Checkk ,1 .C; F Building Inspector C• Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ElSwimming Pools El 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 Signature_ COMMENT'S CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes %.J Planning Board Decision: Comments t. Conservation Decision: Comments Water& Sewer Connedion/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEP�1R�° EN Temp D rnpste n site^ yes �` �o. ;�, '3a '6� r . r 4 3d srt s+t a s.� •ti i ,+ ii. ,. Located at 1024 Main Street `�} ..�� ;��. Fire ®epartmen signature/date T - �' n ., s. s�a .s t !y� �F.kY i�D 5 ^� �'r t►{e f'�'t��s ` y �y rj° 4 - . I C'�. `�` � f�� a: s ! 'YF• s e,` f�. y*tom' t l ,;�'` �, � 1 C{ MMENTsS 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 DANCER 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 4. Building Permit Application Workers Comp Affidavit �& Photo Copy Of H.I.C. And/Or C.S.L. Licenses A Copy of Contract 4� 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 Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses 6 Copy Of Contract ,4. 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 ConstructionSin le and Two Family) � g Y) ,,6 Building Permit.Application 4, Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses 4. Workers Comp Affidavit ffldavit 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 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 OO R TH own of 2 s fAndover o . 0% No. t' T r�A"L ver, Mass, �� COCNICNEWICK y1. pDRATED I'Pp,`'�y s U BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System THIS CERTIFIES THAT ....... dP........ ............................................. BUILDING INSPECTOR has permission to erect ..... g ,,, ! n ......... �S. .fA, Le, Foundation..................... bulldin son ..... ..�+.... Rough to be occupied as ........At* ..��. ............ ��. . ��......................... Chimney provided that the person accepting this permit shevery 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 CONSTRUCTIONA3 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. `1 CONTRACT T FOR Conser atlon PRODUCTS � SERVICE WO ' Services Group This service is brought to you through support from your local utility This Agreement is made by and among and Conservation Services Group(CSG) Janice Piasecld 77 Bridges Ln Attn:RCS North Andover,MA 01845-2221 50 Washington Street,Suite 3000 _ Site ID:S00002328244 Westborough, MA 01581 Project ID:P00000339295 Reg.No. 173484 Customer ID:000000338390 Federal ID No. 222457170 Contract ID:20150123 ASEAL (Mail completed contract to address above) 1. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Premises"i n a professional manner and in accordance with the teams of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference: Description quantity Location j Perform Air Sealing at Estimated 62.5 CFM50 Per Hour _ 8 Living Space Door Sweep-- _ 2 N/A _ $46.36 _ Exterior Door Weather Stdpping� 2 N/A $55.18 Attic Stalr Cover Thermal Barrier with carpen 1` Living Space $260.23 Sub Total: $1,036.33 Utility Incentive Share $1,036.33 _i Customer Contribution $0.00 R f0. •i� .._�C!ti For office use only Printed:2/18/2015 Page 1 of 2 II. PAYMENT Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$ as a Deposit payable to CSG upon signing the Contract(not to exceed 1/3 ne total retail costs).Mail check&contract to CSG,Attn:RCS',50 Washington St.,Ste. 3000,Westborough,MA 01581.Final Payment-.$_ as the final payment for the Work shall be payable to the Independent Installation Contractor("IIC")upon satiqacto co )ion of the W rk.Customer miderstands that he/she will not be required to pay the Utility Incentive Share of the of Contract price in the amount $It hanges to individual Pune items and/or previous incentives may increase or decrease the size of the Utility Incentive Shane. III. DISPUTE RESOLUTION The HC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affahs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.c 142A You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided -you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third busi day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES: anise T Piasecki(Feb 18,2015) Feb 18, 2015 Customer Signature _ Date Indicate your selected IIC here,if applicable (OR) Initial here if you want �/► �,. �� /� �p r /�[� the Program to assign a r G n fl ` L` l�'"`�z Participating Contractor CSG Signature J D to Nam epresentat ve nted) 1.. i'•:_., - TEILbI6 AND CONDITIONS APPEAR ON THE REVERSE. 3/14 CONTRA CT FOR PRODUCTS SERVICE WORX Conser atlon Services Group This service is brought to you through support from your local utility This Agreement is made by and among and _ Janice Piasecki Conservation Services Group(CSG) 77 Bridges Ln Attn:RCS North Andover,MA 01845-2221 50 Washington Street,Suite 3000 Site ID:S00002328244 Westborough,MA 01581 Project ID:P00000339295 Reg. No. 173484 Customer ID:C00000338390 Federal ID No.222457170 Contract ID:20150123 WORK (Mall completed contract to address above) • 1. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perforni or cause to be perforated the following work on these"Premises"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: Description Quantity Location Propavent 2'or 4' _ 57 Attic _ $218.31 Damnlpq _ _ �88 N/A $192.72 Sheathing Access 1 N/A $36.14w Hatch:Thermal Barrier Polyiso 2 inch(At ic) 1 Living Space $41.71 Install 2"Thermal Barrler Polylso On tCneewall 78 Living 2 $343.20 Attic Floor Open Slow Cellulose 8" 818 Living Space $1,308.80 Sub Total: $2,140.88 Utility Incentive Share $1,605.66 Customer Contribution $535.22 QFC M For office use only Printed:2/18/2015 Page 2 of 2 t i 1 II. PAYMENT � ( �, -I Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$ 13S, '10 as a Deposit , payable to CSG upon signing the Contract(nota ed to€#pe total retail costs).Mail check&contract to CSG,Attar:RCS,50 Washington St.,Ste, 3000,Westborough,MA 01581.Final Payment:$_ a) as the final payment for the Work shall be payable to the Independent Installation A, Contractor("IIC")upon satiactory_co p .tion of the Work.Customer understands that he/she will not be required to pay the Utility Incentive Share`of fire Contract price in the amount of$ Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. III. DISPUTE RESOLUTION The IIC and Customer hereby mutually agree in advance that in the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided irr M.G.L c IVA. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided yoga notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third busi'nes day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. a.� Feb8nice T Piasedci(Feb 18.2015) b 18, 2015 Customer Signature DDD Indicate your selected IIC here,if applicable (OR) Initial here if you want Z, 5 ) the Program to assign a CSG Signature D to I Name of CSG epresentative(Prin d) Participating Contractor ,i TERMS AND CONDITIONS APPEAR ON TILE REVERSE. 3/14 The Commonwealth of Allassach itsetts Department of Inllitstrial Accidents - - Office of Investigations i_yt- it 600 Washingtoit Street Boston, MA 02111 w1ViV.11aSS.g0V/l1il1 Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p Please Print Legibly Niarlle (Business/Organization/Individual): 1 0 <<i� «r 7—r\ J�Q�T��y1) C.'n Address: P. D_ X9 0X fs-8 C'q,/State/Zip: ndo✓!C M# pjFlo Phone �5_l ? Are you an employer?Check the appropriate box: Type of project(required): 1.�•1 am a employer with —7 4• ❑ I am a general contractor and I employees(full and/or part-time). * have hired the sub-contractors 6. ❑New construction 2.❑ I am a sole proprietor or partner- listed on the attached.sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. ❑ Demolition working for me in any capacity_ employees and have workers' 9. Building addition [No workers' comp.insurance comp. insurance.= required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 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 c. 152_ C 1(4).a 12•❑ Roof repairs insurance required.]' S nd��e have no employees. [No workers' 13.&Other '.LnS,J/4 1`pa V1 comp_ insurance required.] *Amy applicant that checks box=1 most also till out the section below shoe ine their workers compensation police information. Homeowners who submit this affidavit indicatins they are doing all work and then hire outside contractors must submit a new affidavit indicatins such. `Contractors that check this box must attached an additional sheet shoving the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have entplovees_the\•must provide their workers-comp.policy number. 1 tiny an employer that is providing►vorkeis'compensation insurance for my employees. Below is the policF and job site information. Insurance Company Name: /n a { Policy#or Self-ins. Lic.#: %Do we- 5- Expiration Date: Job Site Address: 7 ` 14r S L 11 City/State/Zip: , ;4 w!/, Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure covet-age as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 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 S250.00 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. 1 do hereby certif,under tth�e ppaai�ns andpenalties of perjttrl-that the information provided above is true and correct. Signature: ' `�� ^ Date Phone-,—,-: 4 a - 7 , Official use null•. Do irol write in tlii.s area,to be coiiipletcd br city or town offichtL 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#: -"1 OP ID:SS '`'�L' CERTIFICATE OF LIABILITY INSURANCE �OW1 THS 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 cwtiftete holo is an ADDITIONAL INSURED,the policy(fes)must be endorsed. It SUBROGATION IS WANED,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 endo s PRODUCER ANT Durso&Jankowski Ins Agcy LLC HAUL* PHONE FAX 198 Massachusetts Avencm North Andover,MA 01845 N Durso&Jankowski hm Agcy. POLAR-1 AFPDRDDIG COVERAN s NAIL INsueEo Polar Bear neU n Co, nc. �A:Penn America 82859 P O Box 958 mmom B insurance Co. 3W18 Andover,MA 01810 DIMERC: RAMER o DNSURER E UMMER 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. RMI sum rou" L'mTVPE OF DISYRIINCE POLICY ENEtt POmar E>m L MRB GWIERALLIAINUff EACH OCCURRENCE $ 11000,00 A X COMMERGALGENERALLL481LITY PAC7052023 03240015 034240016 PR�� occtarerW $ 50,0001 CLAIMS-MADECK OCCUR MED EXP Wq OM PMW A S S, PERSONAL&ADV INJURY $ 1,0009 GENERAL AGGREGATE S 2,000, GEN'.AGGREGATE LIMIT APPLIES PER: PRODUCTS-COLIPIOP AGG 5 1,000, POLICY P LOC $ AUTOMOBILE UAROJITY COMBINED SINGLE LIMIT B ANYAUM P201 00926 01/045 01/092016 (Eeeoaftd) $ 1,000,00 BODILY INJURY(Per Pet—) $ ALLOWNEDAUTOS X SCHEDULEDAUTOS BODILY INJURY(Per acdderd) $ PROPERTY DAMAGE $ X HDtmAUTOS (PER ACCIDENT) X NON.OVIMEDAUTOS $ s uINBRELLA Lu18 )( OCCUR EACH OCCURRENCE $ 1,000, A MUM uas CLAIM&MADE AC6906385 03124/2015 03242016 AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ iMDR1s�SCOYPENSATION VbCSTATU- TH- AND EMPLOYERS'LIABMY MY PROPRI Y!NUS O N/A E.L.EACH ACCIDENT s 090"Idwy In NM) ygg EL DISEASE-EA EMPLOYE $ DESCRIPTION OF OPERATIONS bak E.L.DISEASE-POLICY LIMIT $ OaN�YII 1�1Xm/VEHICLES NMhah ACORD 101.AdditIw l Rm"do SdrdeN,N Mwe spwe b n Ion Get1e<aloli� cerou NSTAR and National a addf�o I insured po cy. overage is Primary a No ontribw CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Conservelon Service Group THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Contractor Services Dept ACCORDANCE WrrH THE POLICY PROVISIONS. 50 Washington St Westborough,MA 01581 AUTHORIZED R�RESENrATME AA9� L B 19W2M ACORD CORPORATION. All rights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACORD 9.2- Office of Consumer Affairs and Zusiness Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Gontrctor Registration Registration: 102726 Type: DBA Expiration: 7/2/2016 Tr#.252249 POLAR BEAR INSULATION CO. Vincent LeBlanc- P.O_ BOX 958 ANDOVER, MA 01810 --- =- - Update Address and return card.Mark reason for change. - j Address Renewal F] Employment Lost Card DPS-CAI as BOM-04104.6101216 A,tassacriusaits 3fiC zta'�:'��f=tj Board C unstructil+n Supen"iaor SpecisltY C,9LA06017 pETER A LEBI-WC 2 EAST PINE STREET = Plaistow NH-0865 �', •..g 0412812018 r I `�