HomeMy WebLinkAboutBuilding Permit #627-15 - 82 MEADOWOOD ROAD 1/30/2015BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Permit No#: �C 1/ `� 1� Date Received
Date Issued:
I IMPORTANT: AD-Dlicant must complete all items on this Dasie
LOCATION.
PROPERTY OWNER -IG
MAP 1 PARCEL:
/O. �tLED I 1,•4
�D I
\A -A 1
"4 QDRA7ED IPo-�.(5
Print T ,
Punt\7----1001Ye6r8tructure yes r,n
ZONING DISTRICT. _Historic District yes
Machine Shoo Villaae ves
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
Sepfic ❑ 1Nell
❑ Floo`dplain ❑ �Wetland_s;
�, Watershed, District
El Water/Sewer--
DESCRIPTION OF WORK TO BE PERFORMED:
Identification - Please Type or PVint Clearly
OWNER: Name: ( 161 Phone:
Address:
�tkv
Contractor Nam _ r one:—
Address: `
Supervisor's Construction.L-icense:—�� __ Exp. Date:._: ---
Home Improvement License. —'–.,.Expo Date:.
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE. BULDING PERMIT. $12.00 PER $1000.00 OF THE TOTAL ESTIMATED COSTBASEDON $125.00 PER S.F.
Total Project Cost: $� �0 FEE: $ 1 O.
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 Dumpster on Site ❑
THE FOLLOWING SECTIONS FOR OFFICE USE ONLY
INTERDEPARTMENTAL SIGN OFF - U FORM
PLANNING & DEVELOPMENT Reviewed On
COMMENTS
CONSERVATION
COMMENTS
HEALTH
COMMENTS
Signature
Reviewed on Signature
Reviewed on Signature
• Zoning Board of Appeals: Variance, Petition No:
U
Planning Board Decision:
Conservation Decision:
Comments
Comments
Zoning Decision/receipt submitted yes
Water & Sewer Connection/Signature & Date Driveway Permit
DPW Town Engineer: Signature:
Located 384 Osgood Street
FIRE 1 DEPARTMENT Temp ,Qumpster on site yes.. °no
Located at 124 Main Street ` r=
Fire Department signature/date
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
NU I t5 and UA I A — (For department use
❑ Notified for pickup Call Ema
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
o Workers Comp Affidavit
o Photo Copy Of H.I.C. And/Or C.S.L. Licenses
o 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
Li Photo Copy of H.I.C. And C.S.L. Licenses
o Copy Of Contract
o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Mass check Energy Compliance Report (If Applicable)
a 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)
o Building Permit Application
❑ Certified Proposed Plot Plan
o Photo of H.I.C. And C.S.L. Licenses
o Workers Comp Affidavit
o Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And
Hydraulic Calculations (If Applicable)
o Copy of Contract
o Mass check Energy Compliance Report
o Engineering Affidavits for Engineered products
NOTE: 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
r
Location 2—
No. (97g,105
Check I
23458
Date
ELI
TOWN OF NORTH ANDOVER
Certificate of Occupancy $— -
Building/Frame Permit Fee
Foundation Permit Fee
Other Permit Fee $
TOTAL $—
.Ouilding inspector
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Massachusetts - Department of Public Safety
Board of Building Regulations and Standards
Construcdon Supervisor Spccialt!
License-
55 ORE
AII
w Wk RH 02,899t
Expiration
Cor)rrUSSIQnef 091 2018
Rest oct8d TO: CSSWC o lnsWatlon CCntrr@CZOG
FaHure to Possess a current edition of the Massachusetts
,,te Building Code Is cause for revoc6COOn of this license.
For DPS Licensing lnfCrPU -3V0n `�e0'A" vm,,j.M@ss.Gn 1DPS
The Commonwealth of Massachusetts
Department of IndustrialAccidents
w ®ice of Invesfigadons
a a 1 Congress Street, Suite 100
� � a
Boston,
MA 0211YY4-201 i
VO•.mass.govIdia
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
ARIplicant Information Please Print Legibly
Name (Business/Organization/Individual):
Next Step Living
Address: 21 Drydock Ave
City/State/Zip: Boston, ISA 02210
Phone #: (866)867-8729
Are you an employer? Check the appropriate bozo
Type of project (required):
1. C] 1 am a employer with 850
4. ® l am a general contractor and 1
6 ® New construction
employees (full and/or part-time).*
have hired the sub -contractors
listed on the attached sheet.
7. ® Remodeling
2. ®i am a sole proprietor or partner-
and have no employees
se sub -contractors have
These
S. ® Demolition
working for me in any capacity.
employees and have workers'
comp. insurance.
9 ® Building addition
o workers' co insurance
[l�1 �•
5. E] We are a corporation and its
10.[] Electrical repairs or additions
required.]
3.0 1 am a homeowner doing all work
officers have exercised their
I LE] Plumbing repairs or additions
myself. [No workers comp•
insurance required.] t
right of exemption per MGL
c. 152, § fl(4), and we have no
12.®Roof repairs
13.N Other. Insulation
employees. [No workers'
corn. 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 affidavit indicating such.
xContractors that check this box must attached an additional sheet showing the name of the sub -contractors and state whether or rot those Entities have
employees. If the sub -contractors have employees, they must provide their workers' comp. policy number.
I arra an eMployer Haat is providing workers' com pensada®n insurance for nay employees. Below is the policy and job site
ani®►matu®ra>
A•I.iVI Mutual Insurance Company
insurance Company Name:
Policy # or Self -ins. Lic. #: 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 S'L'OP 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 )pAfiotion.
I do hereby cerdlfy sander the pains
Haat the information pFovlded above is trace and correct
nate. G n l o 1 /L1
Official use only. Do not aerate in this area, to be completed by city or town officiaal.
City or Town:
Permlt/I.icense. #
Issuing Authority (circle one):
1. Board of Health 2. Banding Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector
6. Other
Contact Person- Phone #:
NEXTS-1 OP 10o EL
CERTIFICATE OF LIABILITY INSURANCE
DATE(MMIDD)YYVV)
10/01/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATIONS OW AND CONFE114 NO PIGHT4 RIPON THS CERTIFICATIE HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR Aq TER THE COVERAGE AFFORDED BY THE POLICIES
BELOVIf. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), 40THOftlZgD
RPP FSENTATIVE OR PRODUCER, AND THE CERTIFICATE HOLDER.
WP RTAN T: If the gertificate holder is an A009TIONAL INSURED, the Policy(les) must he endorsed. Of SUBROGATION I§ W'A r �P9611w16� �
the terms and conditions of the Policy, certain policies may require an endorsement. A stateme=nt on this certificate does not conger rights to hp
certiRcite holder In lief of such endorsement(!).
PRODUCER
MgLaughUrp Igqppsurance Agency
826 Lynn 1°e90s Part wpy
Melrose, MA 02376
John E. MCLalughtin Jr.
CONTACT
NAME: Erin Lyons
HO wESI :X51=6�5=2TT5 �c No :X131=605=02
e
E-MAIL
ADDRESS:
E(P(P2010198-12
INSURER(S) AFFORDING COVERAGE NAIL €S
INSURER A: Nautilus Insurance
EACH OCCURRENCE $ 1,000,000
INSURED Next Step �IVing, Inc.
21 Dryd®ckAvenue, 2nd Floor
Boston, MA 02210
INSURER 8: COMMerCG Insurance Company 3475
INSURER C: A.I.M. Mutual Insurance Co.
INS uRERD:AXIS Insurance C®rnp;kny 35610
INSURER E:
GENERAL AGGREGATE $ M01010
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 POLICYRE�QQ
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH it
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,
I TR
TYPE OF INSNRANCE
I OL
R
POLICY NUMBER
POLICY
YIYEVW
fNMIDD EXP
LIMITS
A
X COMMERCIAL GENERAL LIABILITY
CLAIMS -MADE ® OCCUR
E(P(P2010198-12
09/30/2034
09130/2015
EACH OCCURRENCE $ 1,000,000
DAMAGE TO RENTED
PREMISES Ea occurrence) $ 100,000
MED EXP (Any one person) $ 0,000
PERSONAL & ADV INJURY $ �, 1010
GEN'L AGGREGATE LIMIT APPLIES PER:
POLICY O JECT F .1 LOC
OTHER:
GENERAL AGGREGATE $ M01010
PRODUCTS -COMP/OPAGG $ ?, QQ,QQO
$
AUTOMOBILE LIABIbITY
ANY AUTO
ALL OWNEDii SCHEDULED
AUTOS NON OWNED OS
HIRED AUTOS r AUTOS
1�MMHG&�03®M
09/3012034
®9130/201 S
COMBINED SINGLE LIMIT $ —1@®00 000
Ea accident v v
BODILY INJURY (Per person) $
BODILY INJURY (Per accident) $
PROPERTYDANAGE $
Per accident
$
D
UMBRELLA LIAB
EXCESS LIAB
X
OCCUR
CLAIMS -MADE
E(�U763647032014
09/30/2014
09/30/2015
EACH OCCURRENCE $ 5,000 00
AGGREGATE $ 0.909-09
DED I I RETENTION$
$
WORKERS COMPENSATION
AND EMPLOYERS' LIABILITY
YINC ANY PROPRIEfORIPARTNER/EXECUTIVE
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH)
If yes, describe under
DESCRIPTION OF OPERATIONS below
N /A
TO BE ISSUED BY CARRIER
09/30/2014
0/30/2015
X STATUTE ER
E.L. EACH ACCIDENT $ 000,000
E.L. DISEASE - EA EMPLOYEE $ 500,00
E.L. DISEASE - POLICY LIMIT $ 000,000
r -
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 909, Additional Remarhs Schedule, may be attached If more space is required)
MR )INFORMAE TZON ONLY
INFO -01
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
For Information Only ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
Q,J IwUG=&U'I4 44[x4 Ku w9ZvUJKA I Ot4Jm d9UI rlgnm reserveca.
AC®RD 25 (2034113) Thp A( Qftp 9@Mo pIggpale ffgagostplqQfAC®R
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1.
iW e step living,,
home energy solutions'
This agreement is made by and among
Rajeev Krishnapillai
82 Meadowood Rd
North Andover, MA 01845
Site ID: A180379
Next Step Living, Inc. ("NSL")
21 Drydock Avenue, 2nd floor
Boston, MA 02210
phone: (866) 867-8729
10 -Dec -14
1. )ESCRIPTION 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:
)escription 1111 , It 1 111 111
M.
Quantity Investment
air Sealing Recommendations $600,00
Work Location: Attic Flat
Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 8 $75.00 Hr $600.00
Work Location: Attic Flat
Hatch: Thermal Barrier Polyiso 2 inch (Attic)
1
$60.00
Each
$60.00
Damming
18
$2.05
Lnft
$36.90
Propavent 2' or 4'
45
$2.00
Each
$90.00
Attic Floor Open Blow Cellulose 8"
912
$1.30
sgft
$1,185.60
Work Location: knee Wall
Install 2" Thermal Barrier Polyiso on Kneewall
127
$3.31
sqft
$420.37
Work Location: Doors
Door: Thermal Barrier Polyiso 2" (Attic) 1 $73.91 Each $73.91
Work Location: Attic Flat
Estimated Annual Energy Savings from the Above Improvements $187.00
1b.j. a I �/ ` I Dec 19, 2014
Ple_ .�� 1x.201-4; Date
n/1
J1,kn6a� 10 Dec 2014 Matthew Read
[x.rera.
A, '<5f,9rl-201a; Dec 19a a Name of NSL Representative A180379
Anna Hilditch
The Terms of this Agreement are contained on both sides of this page
Next Step Living o 21 Drydock Avenue 2nd floor - Boston, MA 02210 (866) 867-8729 i, inquiry@nextsteplivinginc.com - www.nextstepliving.com
TERMS OF AGREEMENT
3. PROPOSED START DATE AND COMPLETION SCHEDULE
NSL will contact customer to schedule the Work at a mutually agreeable time, subject to the availability of subcontractors or materials, or to delays
attributable to the weather or other events beyond NSL's control.
Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor
Registration. You may inquire about contractor registration by writing to Office of Consumer Affairs and Business Regulation, Ten Park Plaza, Suite
5170, Boston, MA 02116.617.973.8700.
5. PERMITS
NSL will be responsible for obtaining any necessary permits as the Customer's agent Customers who secure their own permits or deal with an
unregistered contractor will be excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law.
6. PERFORMANCE OF THE WORK AND CHANGES.
6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer
6.2 This Agreement may be supplemented, amended, or modified only by the mutual agreement of the parties. No supplement amendment, or
modification of this Agreement shall be binding unless it is in writing and signed by all parties.
6.3 At times, our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern
for residents. Such concerns can include but are not limited to ventilation, potentially hazardous materials such as mold or asbestos, or structural
concerns. In the case of health or safety concerns being identified, NSL reserves the right, per section 9.2 of this contract, to communicate concerns to
the Customer and halt work until such concerns have been addressed.
6.4 The rebates and incentives available from the Mass Save® Home Energy Services Program and amounts due from the Customer are based on the
best estimate of the situation in the structure by the NSL home energy advisor. However, at times our weatherization team discovers situations in the
home during the course of the Work that impact the availability of rebates and incentives from the Mass Save Program. In such situations, NSL will
communicate such changes to the Customer, including any impact on amount the Customer would be expected to pay for the Work. The Customer will
have the option to remove from the Contract the work elements that need adjustment, or set up a separate contract for performing the adjusted work.
6.5 NSL represents and warrants to the Customer that (a) the materials and equipment furnished under this Agreement will be of good quality and new,
(b) that the Work will be free from defects, and (c) that the Work will conform with the description of the Work described in Paragraph 1.
7. INSURANCE AND REGISTRATION
NSL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration (No: 162111) and the necessary insurance
required by applicable law and normally maintained by prudent contractors in NSL's field, including, but not limited to, Workers Compensation Insurance
for all employees who will perform the Work.
8. QUALITY OF WORK.
NSL agrees that the Work will be performed in a good and workmanlike manner, and that NSL will repair and replace, at its own expense, and promptly
upon Customer's request, any defects'in workmanship and materials provided by NSL which appear up to one year atter completion of the Work or within
any longer period as permitted or required under applicable law, provided NSL has received final payment as provided herein.
9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to preexisting conditions. These conditions
include but are not limited to poorly fastened or broken drywall, moisture damage, non -code construction, cracked or fragile siding or shingles, rid pipes
and fittings, rotting wood, etc.
9.2 NSL reserves the right not to perform Work upon the discovery of asbestos, mold, or any other potential health risk to the Customer. In this event, the
Customer is responsible for remedying the at -risk situation, induding any necessary removal of hazardous materials and all bills for services to date shall
be paid immediately. Work cannot resume until remediation is complete.
9.3 While NSL will make best efforts to protect any property of the Customer, ti is the Customer's responsibility to remove or protect, induding dust
protection, any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property
not property protected prior to the commencement of the Work.
10. GENERAL PROVISIONS.
10.1 NSL reserves the right, the extent permitted by applicable law, to have, file or maintain a mechanic's or material men's lien, or to file a notice of
intention to lien, and to take any other steps to perfect and enforce such a lien, if Customer fails to pay NSL as provided herein.
10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts.
10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this
Agreement, they are not relying on any representations, warranties or terms other than as expressly contained herein. This Agreement supersedes aff
prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties.
11. ENERGY BENEFITS.
The Sponsoring Utility Company (the Utility) is entitled to 100% of the energy benefits associated with all Energy Conservation Measures, exduding the
value of energy cost savings by the Customer, but including all rights to all associated ISO -NE Energy, Capacity and Reserves Products. NSL agrees to
provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products.
12. NOTICE CONCERNING SPONSORSHIP.
12.1 Customer understands and acknowledges that NSL is not an agent, vendor or sub -vendor of The Sponsoring Utility Company (the Utility) with
respect to the installation of an energy efficiency measures. In the event of the failure of an energy conservation device to perform as expected,
Customer's sole recourse is to Contractor and not to Conservation Services Group (CSG) or to the Utility. The Utility and its operating companies shall not
maintain, remove or perform any work whatsoever on the energy conservation measures installed.
12.2 Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have
consented for Contractor to install the proposed energy conservation measures.
12.3 Customer agrees that it shall not hold CSG, the Utility, their affiliates or operating companies liable for Contractor's to perform its obligations under
this agreement, for failure of the energy conservation measures to function, for any damage to Customer's Premises caused by Contractor or for any and
all damages to property or injury to persons caused by the energy conservation measures.
13. LIMITED TIME OFFER.
The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy
Services Program offers.
14. CONTRACT CANCELLATION
Under Massachusetts law, you may cancel this agreement if it has been signed by a party thereto at a place other than an address of the seller,
which may be his main office or a branch thereof, provided you notify the seller in writing at his main office or branch by ordinary mail posted,
by fax, or by e-mail sent or by delivery, not later than midnight of the third business day following the signing of this agreement.
{ Planiview Diagram Tea 1 2 3
customer 44'ctu kri 5 ,t q k2'j Advisor Name: im X a 4
Address o o I fZ Advisor Phone #:
Town Any limitations to access by truck?
Site ID V
NOTES Any work scoped outside of Best Practice? �� rApproved by: (J)Uz
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