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HomeMy WebLinkAboutBuilding Permit #560-16 - 80 HUCKLEBERRY LANE 11/5/2015 `&ORTH BUILDING PERMIT °�s"a' "ti 16 O TOWN OF NORTH ANDOVER ° wo --- `� APPLICATION FOR PLAN EXAMINATION t4wt - Permit NO: mss' Date Received '4 » » » Date Issued: i r SS US IMPORTANT: Applicant must complete all items on this a e LOCATIONI PRO--Ppo'Y C?WNER P"�rrt MA NQ PAR " ZONING D1STRl t" �stori�District yes no -" � attie Shop Village yes n TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial cr!FAlteration No. of units: ❑ Commercial (gtepair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic 1t�ll &F t rtds L1„W torsi ed District - , ❑Water�Suet , Z Identification Please Type or Print Clearly) OWNER: Name: VYn" ODeP A.,t,(A_ Phone: fftl 7.3 ^_37'7� Address: p,� x CC3NTRACTOR Navle. O - 2'4 "�'? I Supervjsp s Construction LEkp Date: IL '"' I Home Irr rou0,_p t L�cerlse , 'Date: i ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDI rrNG ��PERMIT.$ff122�.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. "1 Total Project Cost: $ (0 (D1 ® � FEE: $ Y f Check No.: il 12, Receipt No.: NOTE: Persons contra'Ank with unregistered contractors do not have access to the guaranty fund _. -..w, _.. ._r SignatureofAgentltwner Sigriature of contract ,�'' 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 NOTE: 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 NOTE: 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 o Workers Comp Affidavit ❑ Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) ❑ Copy of Contract ❑ Mass check Energy Compliance Report Li Engineering Affidavits for Engineered products VOTE: 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 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 Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ St mped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dmnpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on 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 DEPARTMENT - Temp Dumpster on site yesno Located of 124,Main Street Fire Department signature/date COMMENTS °°P Location 4/ c.-'C. No. ���U Date ltl�l, I/ I i OU TOWN OF NORTH ANDOVER . Certificate of Occupancy $�_ Building/Frame Permit Fee $ / Foundation Permit Fee $ Other Permit Fee $ TOTAL $ ' Check# J 3 Building Inspector NORTH Town of t E ndover O - 0 No. - ,� o�h ver, Mass, I S COC NICNl WICK ��� p°RATED S U BOARD OF HEALTH Food/Kitchen PERMIT T LD� JJ Septic System THIS CERTIFIES THAT I..(�.V-- -- `' P.tivqaL....f BUILDING INSPECTOR has permission to erect buildings onOFoundation Rough /II to be occupied as .....,I�.....:��. .....�i'..... '" ..a............................................ Chimney j 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS. CONSTRUCTIO ST Rough Service ............:..... . )..r..................................................... 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. Federal 11)#05-=S629 RISE Engineering RI Contractor Registration No 8186 PISA Contractor Registration No 120979 A division of Thieisch Engineering CT Contractor Registration No 620120 60 Shawmut,Canton,MA 02021 CONTRACT 339-502-5197 FAX 339-502-6345 i S E Page 1 PROGRAtvI E N C l N E E 81 N G TrrlS CONTRACT IS ENTERED rNrO EiL•TwEF?i ruse CMA-HES excureERMANO TIM CUSTOMERMWOMAS OESCnrM SEL"i CUSTOMER - PRONE DATE CLIENT A WORK ORDER Patricia Jaysane (978)$57-8230 Ulf 17/2015 414270 00002 SERVICE STREET 6a.WNG STREET � �� 55 Farntnn Street 55 Farnurn Street \VJJnn S$RV=CITY,STATE,ZIP MLL910 CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 018 : JUL ? 2 2.015 JOB DESCRIPTION j 1�fASE O '-Proposal for this calendar year. $0.00 AIR SEALING:provide labor and materials to seat ares of your home against wasteful,excess air leakage. This work will be performed in concert with die use of special tools and diagnostic tests to assure that your home will be Icft with a healthful level of air exchange and indoor air quality.Materials to be used to seat your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached tl,arages and other unheated areas(windows are not generally addressed.) This will require(8)working hours. A reduction in cubic feet per minute(cfm)of air infiltration tivill occur,but the actual number of cfm is riot guaranteed, At the completion ofthe weathetrration work,and at no additional cost to the homeowner,a final blower dour andlor combustion safety analysis wilt be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 AIR SEALING ADDER: (4)working hours. $340.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass batty to(122)square feet for damming purposes. 5250.10 ATTIC FLAT:Provide labor and materials to install a 13"layer of R-45 Class f Cellulose added to(252)square feet of open attic space. 5410.76 ATTIC FLAT:Provide labor and materials to install a 9"layer of R-32 Class 1 Cellulose added to(620)square lta:t of open attic space. $886.60 SLOPES:provide labor and materials to install a 4"layer ofR-14 Class I Cellulose added to(102)square feet olstope area.Wherever possible baffles will be installed to the entire length of each bay to maintain ventilation space. 5181.56 ATTIC ACCESS:Provide labor and materials to make(2) access opening from one attic men to another by cutting a passage through sheathing. This access will be left open as it is between two common unheated non firewalied attic arias. $62.62 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small flat surface ofptywood will be created around the opening within the attic. This will allow,the cover's integral weathcrr-stripping to restrict air leakage. 5237.65 VENTILATION:Provide labor and materials to install ventilation chutes in(29)rafter bays to maintain air flow, $58,00 COMMON WALLS:Provide labor and malcriais to install 2"FSK faced semi-rigid fiberglass board insulation to(J 74)square feel of common wall area. 5609.00 BASEMENT CEILING:Provide labor and materials to install(106)linear feet of R-19 unlaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $185.50 ...................................... FtadtNal Ip A 65-0466629 RISE Engineering Rt Contractor Registration No 8186 MA Contractor Registration No 126979 A division ofTbielsch Engineering CT Contractor Registration NO 636126 60 Shawmut,Canton,MA 02021 CONTRACT�� 334-502-5197 FAX 339-502-6333 i„/ (r A R I S E PRPage PROGRAM £NCIN E ERItYC THIS CONTRACT is ENTERED INTO BErvEEa RISE CMA-HES ENGINEERING AND THE CUSTOM FOR WORK AS DESCRra£D BELOW CUSTOMER PHOris DATE MARTO VIORKORDER Patrieia3aysane (978)857-8230 47117_12013 414270 00002 SERVICE STREET OTLUNG STREET r- fifi „� r--• � 55 Famutn Street 55 Farnutn Street I D)�— i.� 1 . n7n SERVICE CITY,STATE,ZIP BILLING Cnr STATE,LP North Andover,MA 01845 Notch Andover,MA 01845 1 J U L f L 2015 .IUB DESCRIPTION BASENIEW DOOR:Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2"rsgl meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and scams with FSK tape. $72.22 RUSE Engineering will apply all applicable,eligible incentives uT this contract. You will only be billed the Net amount. Currently,for eligible measures,Columbia Gas oilers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Scaling measures up to the first$680 and an additional$340 ifsavines are justified by the auditor. For the safety and health of your home's indoor air quality,wC will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and aver the weatherization work is complete,We will also conduct a full assessment oftltc combustion safety of your heating system and water heater,This bas a value of S90 and is at no cost to you. Total allowable weatheriration incentive is$3,110. $90.00 Total: $4,064.01 Program Incentive: $3,110,00 Customer Total: $984,01 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Nine Hundred Fifty-Pour&01/100 Dollars $954.01 UPON flHAL WSPECTION AND APPROVAL SY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN fUU-INTEREST OF tY WaL SE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES.RIGHTS OF RECISION.SCHEDULING.AND CONTRACTOR REGISTRATION. 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES _ 1 S TUBE-RISE EAWAeari OUST EPTANCE NOTE:THIS CONTRACT MAY BE VATUDRAm BY Us IF NOT cxECUTED WITHIN DATE OF ACCEPTANCE ( • -4& ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTGORSIED TO DO THE MORN AS SPEMMO,PAYMENT WU.L BE MADE AS OIIfLGN£D ABOVE The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/individual): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #:603-578-9275 Are you an employer? Check the appropriate box: Type of project(required): 1.FV1 I am a employer with 100 4. ❑ I am a general contractor and 1 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 g. ❑ Demolition workingfor me in an capacity. employees and have workers' y P y• 9. F-1 Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 l.❑ 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 employees. [No workers' 13.❑✓ Other Insulation comp. insurance required.] *Any applicant that checks box 41 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 affidavit indicating such. Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees.they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Indemnity Insurance Co of North America Policy #or Self-ins. Lic. 4.WLKC:-6\St S--5� Expiration Date:6/30/201 Job Site Address: Q City/State/Zip: N.",MzE M40 C>q� Attach a copy of the workers' compensation poi cy 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 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. Ido hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Signature r Date: / S Phone#:603-324-1974 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#: CERTIFICATE OF LIABILITY INSURANCE DATE(MM/06/24/22015015 Y) 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). _ c PRODUCER CONTACT y Aon Risk Services Central, Inc. NAME: O Southfield MI office (HONE ) (866) 283-7122 A C.No.Ext (A C.No.): (800) 363-0105 a 3000 Town Center E-MAIL suite 3000 ADDRESS: O Southfield MI 48075 USA I Z INSURER(S)AFFORDING COVERAGE NAIC# INSURED EINSURERB: Republic Insurance Company 24147 TopBuild Corp. American Insurance Company 22667 260 Jimmy Ann DriveDaytona Beach FL 32114 USA Fire Underwriters Insurance Co. 20702 INSURER F: COVERAGES CERTIFICATE NUMBER:570058348882 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. lrysR AUDI LTR TYPE OF INSURANCE s o c o c Limits shown are as requested INS[ WVD POLICY NUMBER MM/DDIYYYY MM/DD/YYYY LIMITS '4 X COMMERCIAL GENERAL LIABILITY MWZY304834 7GENERALAGGREGATTE 7one $2,000,000 CLAIMS-MADE ❑X OCCUR $2,000,000 nce son) $25,000URY $2,000,000GEN'L AGGREGATE LIMIT APPLIES PER: E $4,000,OOOX POLICY ❑PRO- ❑JECT LOCP AGG $4,000,000 m OTHER: u _ o 0 ALROMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT n Ea accident $5,000,000 X ANY AUTO BODILY INJURY(Per person) O ALL OWNED SCHEDULED Z AUTOS AUTOS BODILY INJURY(Per accident) d X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE t0 AUTOS Per accident _V UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERSCOMPENSATIONAND _ WLRC48151553 06/30/2015 06/30/2016 PER EMPLOYERS'LIABILITY STATUTE OTH- ANY PROPRIETOR/PARTNER/EXECUTIVE YIN All Other States X ER C OFFICER/MEMBER EXCLUDED? N/A SCFC4815190 06/30/2015 06/30/2016 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) WI Only If yes,describe under y E.L.DISEASE-EA EMPLOYEE $1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of coverage KI �J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Builder SerclmpS Group, Inc. AUTHORIZED REPRESENTATIVE A TopBuild Company � 260 Jimmy Ann Drive Daytona Beach FL 32114 USA ACORD 25 2014/01 ©1988-2014 ACORD CORPORATION.All rights reserved. ) The ACORD name and logo are registered marks of ACORD 1 / r.6 (('410"N = fie of Cosurr;e �rs Business Regulation 0 Part; 'Plaza - Suite 517 Boston, Massachusetts 02116 Home Improvement Conti-actor Registration Regis?ration: 179141 Type: Supplement Card BUILDER SERVICES GROUP, INC. PXplfatlGn: 6125!2016 ;RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 i r)d2te Address and return csrd. 'Bari:reason for change. —.ddrr. t Rene"al l:n)1)loyment Lost ('arca .0Jfijcr of Consurner Affiirs& Business Regulation License or registration valid for individul use onh ffOME iidf PRQVEEt3T CONTRACTOR before the ext)irtation date. If found return to: i r Office of Consumer Affairs and Business Re-ulation 'Registration: 179141 Type PIL ExPirav0n: 625;2016 Supplement Boston.NIA fiat?., UILD R SERVICES GROUP,!NC. ICHARD SCH%AIARTZ f 50 j1hAMY ANIN DRIVE AYTGI•A BEACH, =L 3211= tioi vaiid`w it3 t rider>Ct rti2 rt bout sl nature . � » . . . . . . . . . znaemaynwr%+c±. < 2» . CSSL-105992 ?�^ � RICRARDS t%! V:Iz f� \ ! IIUN,rRESS¥rkrET 6 Manchester NH U!Q �5 ?6/2016 Restricted To S«mu«m+mtmtaem Failure to pose, —m dmm of the Massachusetts State Building CO( aue for revocation e A2,env