Loading...
HomeMy WebLinkAboutBuilding Permit #Exception - 84 JOHNSON STREET 5/1/2018 BUILDING PERMIT T1o " R " tio TOWN OF NORTH ANDOVER F / ., APPLICATION FOR PLAN EXAMINATION y YY �O Otl Permit No#: Date Received 4 ACHUS5 Date Issued: 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 ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0_Septic 11 ell ❑ Flo.o�lai_n q WetlantlsY ; ❑ 1/Vat6shed Distract -$ -- -- < DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: Phone: Email: Address: Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: t Address: Reg. No. d FEE SCHEDULE.BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund a Si na a ,r {of Aaent/Owner: Sianaf ,rc- of reintrartor � 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 m 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 d Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: Located 384 Osgood Street � vt ..- -, -,. 1�� y.arr n. 'v FIRE DEPART,JMENT4��,erng;umpster onjsite: esu, 4��z s � z i' Lo a�tecl at`124[Main:Street• sty �� � �,,�+n -1Y r e .�. eTswr�,.,�y'.N'+�4 FirDepartment�ignature/date ��L X,' rof;r 7 ��,r.tea_ �ra`,rt'^yS is .�,_. y �.. R44 , ta, .i� ".�1�'�'iii'.t t�r h �• ��I.�� '�{4 {` n ;� .Y+',y COMMFNTS'" _ Syt y ;�' +,,ai } x r.. . .�t ti ,ils' � s•Pi�- x1`:'' 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 i 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 4. Workers Comp Affidavit j Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract 4. Floor Plan Or Proposed Interior Work 4. 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 pp 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 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 Doc:Building Permit Revised 2014 Location No. �? 4 1 Uj Date i . - TOWN OF NORTH ANDOVER . Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 4f Check# J / 2 ✓ U V 4 Building Inspector r 1 AORTh - ve' 'o O No. JK C. ; ih , ver, Mass, 1w o L . �K1 A- C OC KIC Nl W IC K 7�p0 ATE D, S U BOARD OF HEALTH - PERMIT L D Food/Kitchen xi4 Septic System THIS CERTIFIES THAT �; ••..,,•.•••.••.••••• BUILDING INSPECTOR ••...•••••••••. ..� ••••.. ... • M • ••••••.......... •.... . 1 . ••• has permission to erect ................ .... .. buildings ......... �.�.... . .........*Tet................ Foundation Rough tobe occupied as ......... ...... ................. .... ... . .. ................ ..................................... Chimney provided that the person accepting this permit shall in every respect conform to 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 RTS 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. r Dn C- oo Federal ID 00l►04011M RISE Engineering M contractor tteglatra ion do saes MA RISE A division ofThleisch Engineering Cordractor Registration No 121feT9 ENGINEERING' 60 Shawmut unit tn,Canton,MA 02021 FAX339-502-6345 CONTRACT PROGRAM Page CMA-PIES TX3CONTRACrMn►erusroraawwaca�As Ln MOFUSED BELOW 0 CUSTOM PPIN PX= DATE CUMTE wonaonoae Jeffrey Doggett t� a (617)686-2446 09/25/2015 420464 00002 SEW41ca 6TRaE? N SaLm STREET 84 Johnson Street 84 Johnson Street SEaYtCH GTY:BTATE,IIP Boma cn7 STATE.EP North Andover,MA 018 North Andover,MA 01845 i� JOB DESCRIPTION AIR SEALING:Provide labor and materials to scai areas of yeur home against wasteful,excess air leakage. This work will be perfomred in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level 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 sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(8)%vorking hours.A reduction in cubic feet per minute(efm)of air infiltration will occur,but the Below number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door arWor combustion' safety analysis will 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 120 layer of R-38 unlaced fiberglass balls to(60)square feet for damming Purposes. $123.00 ATTIC FLAT:Provide labor and materiels to install an r layer of R-29 Class 1 Cellulose added to(776)square feet of open attic sparx.KEEP 16XI8 FLOOR FOR STORAGE. $1,063.12 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(80)square feet of kneewall area. $280.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic batch with 20 rigid Thmmax board.Weatherstrip the perimeter. $60.00 VENTILATION:Provide labor and materials to install(4)insulated exhaust hose to existing bathroom faa(s). $200.00 VENTILATION:Provide labor and materials to install ventilation chutes in(30)rafter bays to maintain air now. $60.00 VENTILAMON:Provide labor and materials to install(10) 60 X 16°rectangular aluminum soffit vents to increase ventilation in atticareas. Specify color.White or Gray. $250.00 OVERHANG:Provide labor and materials to install 10°R-37 densely pecked Class I Cellulose insulation to(76)square feet of exterior overhang located below a heated floor arm by drilling holes in the overhang fmm below. notes drilled will be plugged. Plugs will be sealed with exterior grade spackle and left in a relatively smooth condition.Finish sanding and touch-up priming/painting will be the customer's responsibility. $304.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. F f RISE En 'neerin Federal lD#05-N 51t88 g RI Contractor Registration No 8186 MA RISE A division ofThidsch Engineering Co nbacto,RBgtstiatian No 128879 ENGINEERING 60 Shawmut Unit A Canton,MA 02021 339-502433S FAX 339-502-6345 CONTRACT Page 2 PROGRAM TMCONT&ACTMCMA-HIES FOR AS CUSTOMER PHONE Jeffrey Doggett °A'a INTO waRlcoRoaR (61Tj686-2446 09/25/2015 420464 00002 SGRVICE STREET SWAT*STREET 84 Johnson Street 84 Johnson Street SFRVICa C".9TATLMP SSJM C"V.STAYAZP North Andover,MAO 1845 North Andover,MA 01845 JOB DESCRIPTION For the safety and health of your home's indoor air quality,the will be conducting a blower door diagnostic of the available air now in your home both before the work is begun,and after the weatherization work is complete.We win also conduct a full assessment of die combustion serety of your busting system and water heater.This has a value of$90 and is at no cost to you. Totai allowable weatherizadon incentive is 53.110. 590.00 Total: $3,450.12 Program incentive: $2,865.08 Customer Total: $586.03 WE AGREE HMMY TO FHRMSH SERVLO.COMPLETE aJ ACCORDANCE WRH ABOVE SPECgtM M&FOR THE SUM OF 'Five Hundred Eighty-Five&031100 Dollars $585.03 UPONAIDW.ALANCEMBaaiPECTiON AFTER iA°NDOJ1APY8.PROVALSEE FOaY aM"FOO 6OUZOM GBTOM AGREES TO RBUT AUouNT MM W R�fF]i RILL WOF 1%W LL Be MRSEDMMiLYON ANY tRtPR IMPORT MMMT MUON OUAR4MMA awn 0!Recmms--u aia.ANp CDNTRW RRMMMTON. OT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES BRSNA -- E NOTE:I=CONRWCrMAY 36WRIM"MBYUSWNOT EXECUTED VRnpN OATEOFACCEPTANCE , '� SAVE TARM TO��p 'SPWMUTIONSANOCOMUTIWIBARE QAY& ACCkp M YOU AIMAUOIOROSOTO OO TREWORK AS 8PEMFzM PAYNWWjLLaaNAOE AS OVTLW®ASOVE The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 y" 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): l. ✓❑ I am a employer with 100 4. ❑ l am a general contractor and 1 6 ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g. ❑ Demolition d have workers'an working for me in any capacity. employees9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ uired.] 5. ❑ We are a corporation and its 10.[] Electrical repairs or additions req❑ officers have exercised their 1 1.❑ Plumbing repairs or additions 3. 1 u a homeowner doing all work myself. [No workers' comp. right of exemption per MGL 12 ❑ Roof repairs insurance required.]fi c. 152, §1(4}, and we have no Insulation employees. [No workers' 13.RV Other 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. #.���-- -"t ������ Expiration Date:6/30/20{&, 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 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 Iterebv certify under the sins and penalties of perjury that the information provided above is true and correct. Signature Date 7 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#: A CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 06124/2D15 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 CONTACT 4J NAME: a Aon Risk services Central, Inc. PHONE (866) 283-7122 IFAX (800) 363-0105 m Southfield MI Office (AIC.No.EXI): No.): a 3000 Town Center E-MAIL Suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A: Old Republic Insurance Company 24147 TOpBUild Corp. INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER C: ACE Fire Underwriters Insurance Co. 20702 INSURER D: INSURER E: 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. Limits shown are as requested INR ADDIBIR POLICY EFF POLIY EXP LTR TYPE OF INSURANCE INSO SU POLICY NUMBER MWDDIYYYY MMIDDIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY3 48 4 06/30/2015 Ub/JU/ZU7 EACH OCCURRENCE S2,000,000 CLAIMS-MADE X❑OCCUR DAMAGE To RFN7E5 PREMISES Ea occurrence) S2,000,000 MED EXP(Any one person) S25,000 PERSONAL B ADV INJURY $2,000,000 No GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,000 v PR0. X POLICY ❑JECT LOC PRODUCTS-COMPIOP AGG $4,000,000 oo OTHER: 0 r` A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT $5,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) O ALL OWNED SCHEDULED Z AUTOS AUTOS BODILY INJURY(Per accident) y X HIREDAUTOS X NON-OWNED PROPERTYDAMAGE V AUTOS Per accident m UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIA13 CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS EMPLOYERS'LIABILITY COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE ERH ANVPROPRIETOR/PARTNER I EXECUTIVE YIN All Other States C OFFICERIMEMBER EXCLUDED? NIA SCFC4815190 06/30/2015 06/30/2016 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) F9 WI only E.L.DISEASE-EA EMPLOYEE S1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000— DESCRIPTION OF OPERATIONS 1-1 OCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Coverage _ .4J � 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, r ts�a Builder servicesGroup, Inc. A TopBuildAUTHORIZED REPRESENTATIVE ld company ny 260 Jimmy Ann Drive Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD ✓� f > P. >�t'<' ' n' ' , j ` ':A/•,:*,r,�(�„�.�� Ofee of Cosurner Aiairsan Business Regulation 10 park Plaza - Sulte 51170 Boston; .Massachusetts 02 116 Home Improvement Contractor Registration Registration:: 179141 Type: Supplement Card Expiration,: 6.'2512016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 i'adate Addresh and re?urn card. N1ark reason for change. Addrrs� Rem,"al Emlilavment Lost Pard -= p.rner of t:onsumcr Affairs e: Business Rrgulalann License or registration Valid for individul use unl� IMPROVEINENT CONTRACTOR before the expiration date. If found return to: Oii:ce of(:onsurner Affairs and Business Regulation Registration: 9141 T4P� ?(}�Gr' PIBZa-�u:Lt 5170 Expiration: 61,25/2016 Supplement a;d Roston. t'1A 021 R) JILDER SERVICES GROUP, !NC. CHARD SCnWP::tTZ `` -- 0 JlMhl!F,NN DR!VE ;.;.�.:•-_�_.;,�n.G;......... /, .YTONA SE-.CH.FL 32114 1'ndrr>ctrttan' Not vaiiuvr'it;tout sign2iure r I CSSL A05992 RICHARD S(,[-IWAR'CZ 14 E;EJN,CRESS s,rREET' Manchester NH 03102 ✓.� lt. f't .. 09/26/2016 Restricted To (-.SSL.I(- - intulahcm Contractor t Failure to posses- -rent ed,tion of the Matisachusetts State Building Cot .ause for revocation of t.h",license