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HomeMy WebLinkAboutBuilding Permit #Exception - 86 WILLOW RIDGE ROAD 5/1/2018 L NORTH BUILDING PERMIT x 01�ttao TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION _ Permit No#: Date Received �,y°0A.TE, SSACHUS� 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 El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0 Septic ElWell ElFloodplain [IWetlands p Watershed District El Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: i 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: 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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund fi Plans Submitted tl Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ i 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 e 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 n Water& Sewer Connection/Signature& Date Driveway Permit DPW Town Engineer: Signature: FIRE _- Located 384 Osgood Street DEPARTMENT TernDurnpstertionsite y � .. � _ SW- ` I�Loca-d at'124 IVI es, e r .;- _.� ��( ain�Street Fre�Department�i 31 ,gr atuF0e/date„ COMMENTtS;._ n . I 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 E 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 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 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 Doe:Building Permit Revised 2014 Location No. Date �1 . • TOWN OF NORTH ANDOVER' Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ TOTAL $�— Check 45aa ` j J Building Inspector r 1 NORTH _ . w: 1 E : :. f . . ve, o No. t At o h ," ver, Mass, � N! 1 COC NIC Nl WICK � A04ATEO S V BOARD OF HEALTH Food/Kitchen PERMIT LD Septic System e&4 04 BUILDING INSPECTOR • THIS CERTIFIES THAT ............................................. f� ..................... ...................... ......... ........ . has permission to erect . buildings on .+� V .1�. 0.0. . .!!.1Z-1 a Foundation '� p r' • Rough to be occupied as ............� ll� ...�.....l� t. ....... .....ai .. ................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRESe1NM10N ELECTRICAL INSPECTOR UNLESS CONSTRUA S Rough Service ..... ........................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. CONTRACTOR WORK ORDER Conser ation Services Group 50 Washington St.Suite 3000 Printed: 4/14/2015 Westborough,MA 01581 Work Order Id: S31929P43504C332 Contractor Information Customer/Site Details ESE Brian Baker Email: bbaker86@comcast.net 52 Fitzgerald Dr 86 Willow Ridge Rd Phone(Eve): 508-265-3017 Phone(Day): 978-933-1110 Jaffrey,NH 03452 North Andover, MA 01845-6316 Site ID: S00002331929 Total Installed Measures Location Description Quantity Unit$ Total $ Damming 69 $2.19 $151.11 Living Space Attic Floor Open Blow Cellulose 8" 1,092 $1.60 $1,747.20 Attic Propavent 2'or 4' 8 $3.83 $30.64 Living Space Whole House Fan Box: Thermal Barrier Polyiso 1 $168.98 $168.98 Living Space Attic Stair Cover Thermal Barrier with carpentry 1 $260.23 $260.23 Living Space Perform Air Sealing at Estimated 62.5 CFM50 8 $84.32 $674.56 Door Sweep 1 $23.18 $23.18 Exterior Door Weather Stripping 1 $27.59 $27.59 Installed Measures Total $3,083.49 WorkOrder Notes Payments Incentive Payments Weatherization Incentive $1,446.71 Air Sealing Incentive $1,154.54 Total Incentive Payments $2,601.25 Customer Share Total Customer Share $482.24 Less Deposit Of $160.74 Customer Share Balance(Due Contractor) $321.50 Conservation Services Group-50 Washington Street Suite 3000-Westborough, MA 01581 -(508)836-9500 RCS PLANVIEW DIAGRAM Customer: Home Phone: ( )- Address Work Phone: ( )- Town: PikAaAokr- Cell Phone: 761-3 Any limitations for access by large truck? No Yes if yes,describe: Any specific directions or landmarks? No Yat If yes,describe: Site ID: 733117 Energy Specialist: C Reviewed by: Q Adwc f � hGvC'S '0ONi: j1c-,r(`cn t,/ S llcn�s 6 L.-)4 %o Poor 5%-jec�3 16 s 2� 1� a 36 0 For Office Use Only Bushes Ladder Neighbor Proximity Pocket Doors Insert Radiators Fence(s) Existing Conditions• X=Access ❑=Vents Note Inside Square R=Roof S=Soffit G=Gable RV=Ridge Vent CS=Continuous Soffit CDE=Continuous Drip Edge T=Triangle Install O=New Access Note in Circle C=Ceiling W=Wail S=Sheathing Temp Unless Noted Otherwise Q=Vents Note in Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access . 3290.1Si'-1/15 ��e tcoro►tp�i :Iryl s IM mass save CONTRACTOR 6� C8�3TRACTOR PERMIT AUTHORIZATION FORM I, BRIAN BAKER ,owner of the property located at: (Owner's Name,printed) 86 WILLOW RIDGE RD NORTH ANDOVER (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X:—K- C," - �5 , Owner's Signature (OA ~ Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date i 10 [NilFor Office Use Orly Rev.12132011 The Continonwealth of Massachusetts Department of Itrthistrial Accidents 7 I Congress Street. Smite 100 Boston, MA 02114-2017 w y` www.ntass.gov/Jia Wovkers'Compensation Insurance.affidavit: Builders/('ontractors/Electricians/Plumbers. TO BE FILED WITII THE PE1t1I1'1"I'l�G Al"1'##{)ILI'1'1. Applicant Information Please Print Lelaihly Name(liusincss/Orkanizatton/Indrttduaf). ESE INC Address 52 Fitzgerald Dr Cite/state/zip: Jaffrey, NN 03452 pijonc #- 603-532-6346 .ire You art employer'Check the appropriate hom Type of project(required) I ❑✓ I:unacmplover+,Ith 5 cntplotces4full arid for part-unicl7 E] \e%% constrUCttOn aI am a sole proprietor or pannership and have no employees working for me in 8 Remodeling int any capacttt [Nn+torkers'comp insurance required I q El Demolition i�I am a homcowncr doing all+,ora msscli iNn workers coma, insurance required I' a I am a homent~ncr;:nd+sill he hiring contractors to conduct all wur6 an ms prupem I%N ill JOE] Buildiny addition ensure that all contractors either hate twi Urs 11 E]Electrical repairs or adi itiOnJ proprietors%%-till no cmplotces 12 0 Plumping repairs lir additions ❑I am a general contractor and I havr hired the sub-cunliactors hsicd un the anachcd sheet 1; ❑Rttafrcpatts f`he,e soh-comracu,rs hate employees ar,d hate wor6crs cooly insurance' 14 E]Othcr Insulation G❑ 1 care a corporation and its orliccrs hair cacrciscd their right of escmption per MGI-c 152.,,1141.and we have no etnplovees I`o+,oikers comp insurance rcyutred I *Any applicant that checks bo\k l must also fill out the section belo++sh(mine their%%o 6crs eompensauon polio information tlon,euwncrs tchu submit this affidavt indicating Chet arc doing all work and then hoc outside contractors nnrst suborn a net,al)idm n in,hi::un loch Contractors that check this box must at achcd an additional sheet sho.+ing the name of the sub-contractors and late t+ktethet or not those cntmc,Iw e empiotees II the sut}contractors have emplmees.ihec must provide their %torkers'comp pohet number I ant an elinp/n)•er that is providing workers'c'onrpensation insurtutc•e for ora•ernp/r�t'ee . Kelow is the policy and%oh sire iia!formation. Insurance Company Name National Liability&Fire Insurance Company Poltc\ :/or self-Ins Lic i/ V9WC629429 Lxplrauon Date 3//8/20J16 Joh Site Address_ a .� _ Cm'State/!_Ip /l✓{�+ �� � Attach a copy of the workers' compensation polic, declaration page(showing the police number and expiration(late). Failure to secure coverage as required under MGL c 1-5-2.§25A is a criminal violation punishable h\ a fine up to$1";00 hU and/or one-year imprisonment.as\%ell as civil penalties in the Conn of a ST()P WORK ()RDFR and a fine til'up to S-150 un a da} against the violator A cope ofthis statement mac he torx\arded to the 00,ice of lnvesusatrons of the DIA li,r insurance coverage verification I do hereh}r certdfu r the pains and pe hies of perjure'that the information provided abot• istru can rt correct. Signature � — — — Date �� �� -— I'hone h. 603-532-6346 —--- — _ -- — _-- _.— Official use onll•. Do not write in this area.to he completed hl•cin'or town official. City or Town: Permit/License h Issuing Authority (circle one): L Board of health 2. Building Department 3.City/Toyvn Clerk 4. Electrical Inspector 5. Plumbing, Inspector 6.Other Contact Person: Phone h: A�® CERTIFICATE OF LIABILITY INSURANCE 427/2015' 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(les) 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 Karen Shaughnessy NAME: g Y FIAI/Cross Insurance PHOAIC.NE (603)669-3218 (AIC. IC No:(603)645-4331 1100 Elm Street E-MAIL kshau hness @crossa enc com ADDRESS: g Y 4 Y INSURER(S)AFFORDING COVERAGE NAIC# Manchester NH 03101 INSURERAWest American Insurance Co. INSURED INSURERB Ohio Security Ins CO 24082 ESE, Inc. INSURERC:Ohio Casualty Insurance Company 4074 Energy Saver Enablers INSURER D'American Alternative Insurance 52 Fitzgerald Drive INSURER E: Jaffrey NH 03452 INSURER F: COVERAGES CERTIFICATE NUMBER:14-15 All w/ 15-16 WC 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. ILTR TYPE OF INSURANCE POLICY NUMBER POLICY EFF POLICY EXP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED X COMMERCIAL GENERAL LIABILITY PREMISES Ea occurrence $ 300,000 A CLAIMS-MADE F_x1 OCCUR BKW55684497 /31/2014 /31/2015 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 X1 POLICY PRO LOC $ AUTOMOBILE LIABILITY EOM�BIINdEeDtSINGLE LIMIT $ 1,000,000 B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED 55684497 /31/2014 /31/2015 BODILY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,00 SO55684497 /31/2014 /31/2015 $ D WORKERS COMPENSATION 2A2WC0000371-03 X WC STATU- OTH- AND EMPLOYERS'LIABILITYTORY ER ANY PROPRIETOR/PARTNER/EXECUTIVE YIN (38.) NH 6 MA E.L.EACH ACCIDENT $ 500,000 (Mandatory OFFICER/MEMBER EXCLUDED7 NIA 11 officers included /8/2015 /8/2016 (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/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Refer to policy for exclusionary endorsements and special provisions. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover, MA ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood Street North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Laura Perrin/JSC ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 oninnal ni Tho Arf)Pn name nnrt Innn aro ronictororf mnrirc of Arnpn Massachusetts -Department of Public Safety Board of Building Regulations and Standards i i Construction Supervisor License: CS-072316 CALEB AHO 482 JARMANY H[L SHARON NH 03458 j}1 Expiration Commissioner 12119/2015 L Office of Consumer Affairs and Business Regulation - 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 161406 Type: Individual Expiration: 10/20/2016 Tr# 258803 CALEB AHO CALEB AHO 482 JARMANY HILL RD. - - - SHARON, NH 03458 ' ; Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card SCA 1 Co 20M-05111 / nirrnrn....... Office of Consumer Affairs&Business Regulation License or registration valid for individul use only before the expiration date. If found return to: OME IMPROVEMENT CONTRACTOR egistration: 161406 Type: Office of Consumer Affairs and Business Regulation Expiration: 10/20[2016 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 CALEB AHO CALEB AHO 482 JARMANY HILL RD. SHARON,NH 03458 Undersecretary Not valid without signature i I