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HomeMy WebLinkAboutBuilding Permit #Exception - 87 GLENNCREST DRIVE 3/24/2015BUILDINGPERMIT TOWN OF NORTH ANDOVER',:,'..:! APPLICATION FOR PLAN'E)(AMI.NAT,40N*`.`-._, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 0 One family 0 Addition El Two or more family O. -Industrial 0 Alteration No. of units: 0 Commercial 0 Repair, replacement 0 Assessory Bldg D Others: 0 Demolition 0 Other D s6ptic EI'We[I -lain 0 Floodp 0 Wetlands VvOtersh-ed),I)istrict 11 Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: ` Identification - Please Type or Print Clearly' OWNER: Name: , Phone: Address: I Contractor Name: Ph -one: Add res�s- Supervisor's Construction Licemse: at&. Home Improvement License: iP5 x mite ARCH ITECT/EN GI NEER —,Phone: Address: Reg-, FEE SCHEDULE: BULDING PERMIT. MOO PER $1000.00 OF THETOTAL ESTWATEO,60STBASED ON $125.00 PER S.F. Total Project Cost: $ FEE-.­$,.�.. Check No.: Receipj.N6i.-�`." NOTE: Persons contracting with unregistered':.conttactors-do,yiothave'�,acces,�-to the guarantyfund -0 -,q ,f -� 01VOWrle W Location B-1 No -T?:;, 3 - 1 65 Date TOWN OF NORTH ANDOVER Certificate of Occupancy Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee TOTAL $ Check # 28585 Building Inspector U 1E Plans Su�rnitted Plans Waived El Certified Plot Plan El Stamped Plans El FTW��PF--OF SEWERAGE DISPOSAL Public Sewer El Tanning/Massage/Body Art E] Swimming Pools Well El Tobacco Sales E] Food Packaging/Sales E) Private (septic tank, etc. El Permanent Dumpster on Site El THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On COMMENTS Signature. CONSERVATION Reviewed on Sianature 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: Dimension Number of Stories: Total square feet of floor area, based on -,Ext&i 6'r� 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 21 A —F and G min.$100-$l 000 fine NOTES and DATA — (For department use I 0 Notified for pickup Call Email Date Time Contact Name Building Department The foil -owing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits u Building Permit Application ci 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 NC:)TE: 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) u Building Permit Application u Certified Proposed Plot Plan a Photo of H. 1. C. And C. S. L. Licenses o Workers Comp Affidavit u Two Sets of. Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) o Copy of Contract u Mass check Energy Compliance Report E] Engineering Affidavits for Engineered products' 40TE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit ][n 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 4mo 0 LL 0 0 co _0 0 0 U- E 'CL w V) 0 u LLI z co C c M 0 tm =3 0 W E :E U U- 0 Z ca D to 0 cc U- 0 u LU to 0 > �5 (n s LL 0 LLI 0. z to 0 U- z LLI ui LU 25 L.L 6 V) (D 0 E Ln 4 'T cc -1: 4- U) CL m U) T C) r_ CD 0 CD 0 a 0 > U) -00 -00 M Cc r 0 0 U) An o 0 U) 0) > o r - CL CL 2 cc 0 U) 0) 0 c c T 4) CL L 'D 0 U) 4) in cn m UJ 0 0 2 U) CL LU uj E 0 -o =.0 C.) (1) .- 2 U a) 0 -0 4) U) CL 42) '5 = U) U) -0 0 4- = cc 0"= 0 CL 0 CD CL T) CO) :2 0 0 (D w 0 0 0 :z 0 0 r--!" ,z 0 z U) LLI w CL x LLI LLI CL 0 LLI a. cn CO M 0 L) Cl) Cl) ui -j z ,Z) 0 E 0 0 z 0 a 01- E 2 " 0 CD F- = cc o CL CL CL U) 0 CL 0 CD (j) z C 0 CL cc CL U) uE) CL 4 'T cc -1: 4- U) CL m U) T C) r_ CD 0 CD 0 a 0 > U) -00 -00 M Cc r 0 0 U) An o 0 U) 0) > o r - CL CL 2 cc 0 U) 0) 0 c c T 4) CL L 'D 0 U) 4) in cn m UJ 0 0 2 U) CL LU uj E 0 -o =.0 C.) (1) .- 2 U a) 0 -0 4) U) CL 42) '5 = U) U) -0 0 4- = cc 0"= 0 CL 0 CD CL T) CO) :2 0 0 (D w 0 0 0 :z 0 0 r--!" ,z 0 z U) LLI w CL x LLI LLI CL 0 LLI a. cn CO M 0 L) Cl) Cl) ui -j z ,Z) 0 E 0 0 z 0 a 01- E 2 " 0 CD F- = cc o CL CL CL U) 0 CL 0 CD (j) z C 0 CL cc CL U) Cons(: a er Services Group 50 Washington St. Suite 3000 Westborough, MA 01581 CONTRACTOR WORK ORDER Printed: 3/13/2015 Work Order Id: S75774P80602C273 -Co0q7----1' io n Customer/Site Details Weatherization Incentive Location Building Efficiencies LLC Donna M King Email: donnamking@comcast.net 18 Tanguay Ave 87 Glencrest Dr Phone(Eve): Phone(Day): 978-794-1579 617-543-2278 Nashua, NH 03063 North Andover, MA 01845-1314 Site ID: S00002175774 Total Installed Measures $1,306.51 Weatherization Incentive Location Description Quantity Unit $ Total $ Exterior Door Weather Stripping 4 $27.59 $110.36 Door Sweep 4 $23.18 $92.72 Living Space Perform Air Sealing at Estimated 62.5 CFM50 10 $84.32 $843.20 Living Space Attic Stair Cover Thermal Barrier with carpentry 1 $260.23 $260.23 Living Space Insulate Vinyl Sided Wall With 4" Dense Pack 1,302 $2.41 $3,137.82 Attic Propavent 2' or 4' 4 $3.83 $15.32 Living Space Dense Pack 10" Cellulose In Overhang 50 $4.58 $229.00 Living Space Attic Floor Open Blow Cellulose 6" 1,232 $1.47 $1,811.04 Living Space Insulate Interior Buffered Wall With 4" Dense P 195 $2.31 $450.45 Living Space Insulate Rim Joist with 6.25" Fiberglass Batting 28 $2.40 $67.20 Damming 152 $2.19 $332.88 Living Space Insulate Buffer Wall From Interior With 4" Dens 224 $2.31 $517.44 Attic Vent bath fan to roof flapper 2 $129.21 $258.42 Installed Measures Total $8,126.08 Road Blocks Type Status Notes Asbestos UNKNOWN Payments Incentive Payments Customer Share Air Sealing Incentive $1,306.51 Weatherization Incentive $2,000.00 Total Incentive Payments $3,306.51 Total Customer Share $4,819.57 Less Deposit Of $1,606.52 Customer Share Balance (Due Contractor) $3,213.05 Conservation Services Group - 50 Washington Street Suite 3000 - Westborough, MA 01581 - (508) 836-9500 (SG CONTRACT FOR ConserVation PRODUCTS I SERVICE WORK Services Group This service is brought to you through support from your local utility This Agreement is made by and among and Donna M King Conservation Services Group (CSG) 87 Glencrest Dr Attn. RCS North Andover, MA 0 1845-1314 50 Washington'Streelt, Suite 3000 Site ID: S00002175774 Westborough, MA 01581 Project ID: POOOOO 180602 Reg. No. 173484 Customer rD: COOOOO 185832 Federal ID No. 222457170 Contract ID: 20150113WORK (Mail completed corib-act to address abovje) 1. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these *Premises' in a professional mariner and in accordance with the terms of this Contract, including the attached recommendations�work order describing the work in detail (the 'Work") which am incorporated herein by reference: Description Attic Floor Open Blow Cellulose 6" Quantity 1,232 Location Llving_�Pace $1,811.04 Propavent Z or 4� 4 Attic $15.32 Vent bath Mn to roof Hap r 2 Attic $258.42 Insulate Vinyl Sided Wall With 4' Dense Pack Cellulose Insulate Wall From Interior With 4- Dense Pack Cellulose 1,302 224 Living Space Living Space $3,137.82 $517.44 Insulate Interior Suffered wan With 4" Dense Pack Cellulose 195 Living Space $450.45 Dense Pack IOCellutose In Civerha so Living Space $229.00 Insulate Rim Joist with 6.2 28 Living S ce $67.20 Damming 152 N/A $332.88 Sub Total: Utility Incentive Share Customer Contribution $6.819.57 $2,000.00 $4,819.57 For office use only Printed: 2/1612015 Page I of 2 11. PAYMENT Customer agrees to pay Contractor for the Work, the Customer Share of the Contract Price -is follows- Payment #1: s-1606.52 as a Deposit payable to CSG upon signing the Contract (not to exceed 1/3 of the total retail costs). Mail check & contract to CSG, Attn: RCS, 60 Washington SL, Ste. 3000, Westborough, MA01581. Rnal Payment- S as the final payment for the Work shall be payable to the Independent Installation Contractor ("IIC") upon satisfactory completion of the Work. Customer understands that helshe will not be required to pay the Utility Incentive Sham ofthe Contract price in the amount of$ 2000.00 Changes to individual line iternsartizi/or previous incentives may increase or decrease the size of the Utility Incentive Share. Ill. DISPUTE RESOLUTION I'he IIC and Customer hereby mutually ag" in adva= that in the everit that the HC has a dispute concerning this ConlrSiCt, the HC may siibrrdt such dispute to a private arbitration service which has been approved by the Office of Comimer Affairs and l3usiness Regulation and Custoiner "I be irwluired 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 2> businpseay following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE Y BLANK SPACES. '04" &-- ";w Donna M KkV (Feb 16. j7015) Feb 16, 2015 Want program to assign contractor DMK Customer Signature Date Indicate your selected 11C here, ir applicabfc- (OR) Initial here if you want the Program to assign a AfaqA eaufuu 2/16/1S Mark Couture 212 Participating Contractor CSG Signature Date Name of CSG Representative (Printed) TERMS AND CONDMONS AFPEAR ON a REVERSE. 3/14 (NG ConserVation Services Group CONTRACT FOR PRODUCTS I SERVICE WORK FThis Agreement is made by and among Donna M King 87 Glencrest Dr North Andover, MA 0 1845-1314 Site ID: S00002175774 Project U): POOOOO 180602 Customer I D: COOOOO 185832 Contract ID: 20150113ASEAL This service is brought to you through support from your local utility and Conservation Services Group (CSG' Attru RCS 60 Washington Street, Suite 3000 Westborough, MA 01581 Reg. No. 173484 Federal ID No. 222457170 (Mail completed contract to address above) 1. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be perfonined the following work on these"Premises" in a professional manner and in accordance with the terms of this Contract, including the attached recommendationstwork order describing the work in d" (the 'Work") which are incorporated herein by relerence: Description Quantity Location Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 10 Livin- Space $843.20 Attic Stair Cover Thermal Barrier with ca!pen I Living_�pace S260.23 Door Sweep 4 N/A $92.72 Exterior Door Weather Stri 21�tng 4 NIA $110.36 Sub Total: $1,306.51 Utility Incentive Share $1,306.51 Customer Contribution $0.00 A[oil $'on IN For office use only Printed- 211612015 Page 2 of 2 II. PAYMENT Customeragmes to pay Contractor for the Work, the Customer Sham of the Contract Price as follows: Payment4l: $ 0*00 as a Deposit payable to CSO upon signing the Contract (net to exceed W of the total retudl costs). Mail check & contract to CSG, Attn: RCS. 50 Washington St., Ste. 3000, Westborough, KA01581. Rnal Payment- $ ()-(M as the final payment for the Work shall be payable to the Independent Installation Contractor ("[IV') upon satisfactory completion of the WorlL Customer understands tliat hrJshe will not be required to pay the Utility Incentive Share of the Contract price in Lheamountof 5 1306.51 Changes to individual line Items and/or previous incentives may increase or decrease the size of the Utility Incentive Sham Ill. DISPUTE RESOLUTION The OC and Customer hereby mutually -vee in advance that in the emit that the 11C has a dispute concerning this Contract, the 9C nrky submit such dispute to a private arbitrudw service which has been apliroved by ihe Office of Consumer Affhas and Business Regulation anrl CustomershaIll be required to submit to such arbitration as provided in NLG.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 business d following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE A BLANK SPACES. ". /V �,f DMX Feb 16, 2015Want program to assign contractor M%..% - (OR) Initial hem if you want 'nerSignatum' Date Indicate your selected TIC here, if applicable the Prograrn to assign a AtaxA ea"fuze 2/16/15 Mark Couture 212 Participating Contnctor tSG Signature Date Name or CSG Representative (Printed) TERMS AND CONDIrrZONS APPEAR ON THE REVERSE- 3114 4 k mass save* &WV,P dmmb -M eff6—o PERMIT AUTHORIZATION FORM o twat t" 0 PARTICIPATING COWRACrOR IMINEENNF- Donna M King owner of the property located at: lOwner's Name, printed) 87 Glencrest Dr (Property Street Address) N. Andover (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. 1. Donna rA KIM (Feb 16. 9DI Owner's Signature Feb 16, 2015 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: I— Contractor n ( e- ac 9 -� Date For Office U.Se only 32011 'WeW 21-E 7----- The Commonwealth of Massachusew Department ofIndustrkdAccidents Offlce of Investigations I Congress Street, Suite 100 Boston., MA 02114-2017 IF wwwmassgov1dia Workers' Compensation Insurance Affidavit: Buflders/Contractors/Electricians/Plumbers V%_§- V _21A Name (BusinessIOrganizadon4ndividual): 101-5 Addms: L/ / 1-?tYC-,- L),& -� /4� via, 0A IYP 0,404Y Phone #: 9"C[6�5 AN Y03AM employer? Check the appropriate box: 1. 201 -am a employer with 10 __ 4. [3 1 am a general contnictor and I a loym (M and/or pan -time). have hired the sub-contnictors listed on the attached sheet. 2.[3mp 1 am a sole proprietor or partner- ship and have no employees These sub -contractors have employees no have workers' working for me in any capacity. (No workers' comp. insurance comp. insurance.; S. We an a corporation and its required.] 3. [11 am a homeowner doing all work officers have exercised their myself. [No workas' comp. right of exemption per MOL insurance required.] t c. 152, § 1 (4), and we have no employees. [No workers' comp. insivance required-] Type of project (required): 6. [:]New construction 7. C] Remodeling 8, 0 Demolition 9. Building addition 10. Electrical repairs or addition I I.[] Plumbing repairs or addition 12.[:] Roof repairs 13. [a Other- 0 �'Py that chegla bm #1 must also fill out the section below shinving their wOrkffs' MmPemtiOn policy infwmation such. who submit this affidsvit t Ym"WPw1inewon, indicow dwy am domg a work and thm him outside contractors must subnut a new affidavit indicath* sCmusam that chwk this box nsust attached an additional shed shomnS the name of the sub-cOnusdm and state whether Or not those enddes have employm If the Mocounc= have employcM they mug provide their woltets' camp. policy number. Jam ot employer dia &providing workers'Compensadon insurancefor my employee& Below is thepolicyandjob ske 1Xf*rX"*6X- Insun=c Company N=9:__ 8 C_ A T-rl-5 C Policy # or Self -ins. Lic. #: &-.,) , Q 4V Yl ExpirationDate: 7 - Job Site AddMs: 1517 ",PYCAU 7-10 1� city/state/zip Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Faihire to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a no 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 fin of up to $250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA fbr insurance coventge verification. " 1 6 I do hereby Md& Oe-dury that the informadon provided above is owe and correct T 74� Date:_3—,� PhonaM um ox4K Do not write in this area, to be completed by city or town Offidal City or Town: Permit/License #, Issuing Authority (circle one): 1. Board of Heath 2. Building Department 3. City/Town Clerk 4. Electrical Inspector S. Plumbing inspector 6. Other Contad Person: Phone#: BUILD1 Clientill: 58837 F LIABILITY INSURANCE CERTIFICATE 0 ... DER 'iEl'. WOL .......... TE E POUCITEHSt' ACORM ;il tS110 is is 181506—DA-8-A—MV71111-1 OF �INFORMA VONLY 4- WIFE11 ;6 OR ALTER THE COVERAGE AFFORDED By TH ELY OR NEGATIVEILijMEND. EXTEI 6 INSURER($), AUTHORIZED CERTIFICATIE DOES NOT AFFIRMATIVI , A CONTRACT SIETWEEN THE ISSUIN A.M OF NSURANcF- DOES NOT CONSTITUTE THE CERTIFICATE HOLDER. . . . . ....... NAIVED, subject 4 Davis & Towle Group Prww Square P.O. Sol 23100 - - " ILA n**A9 INSURED Building Ef"OnCles LLC Ig TsngWW Avenue Nashua. NIH 03063 L------- INSURER %I AFFORDING COVERAGE INSURER A � Aca 18 insurance Co. INSURER S' INSURER C -�!NS �RF I URER D: INSURIEft 11: =w___:._5VE FOR THE POLICYPI ............. wSPECT TO WHICH f-ATIF utABER, . 0 E IN�SUREO NAMEDABC *v6R"98 tTgg-)-S-E-Lo—%� �yE BEEN iSSUEI )R OTHER DOCUMENT WITH RE TO ALL THE TI INSURANCE LI! OR CONDITION OF ANY CONTRACT I THIS IS TO GtKllv'g UIREMENT. TERM ; DESCRIBED HEREIN is SUBJECT STANDING ANY REG kANCE AFFORDED By THE POLICIES Y PAID CLAIMS. INDICATED- NOTW'TH (PERTAIN, THE INSUI ,Ave SEEN REDUCED LIMITS CERTIpICATE MAy BE ISSUED OR W I POLICIES. LIMITS SHOWN MAY I P EXCLUSMS AND CONDITIONS OF SUC� $11 0 ADD 89 pOLIcy mUMUR E ENTED 15250001 rIPS OF INSURUM 5/12/2014,05/12/20 5 EACH Occuft"NC I CpASM82912 0 A GENERAL tAED EX An OnG foor IS5000 �=TX RCtAL GENERAL LIABILITY pf.RSoNAL & ADV wiURY 6 1,0_0 0 1( CLANISAADF 5: OCCUR nowpRAL AGIGRE E . s2000( AGGRAGAT LIMIT APPLIES PER� P�Ro* 51i2/20i4io5ii2/2015 LOC CAA5076178112 A AuTON05" LIANLITY X AWAVM OCKEOUL90 bcmg" Aural X HWM AUTOS AUTOS 5112/ 014 05112/2019 CUA50SJ859112 A U"A"6A I" OCCUR aya"s UA& ....... ... ... .... 5/12/2001 OS/11 2/201 - wc�11 ""3412 A 110111011111 li;�l v "I"I XECUTFVEr7V NIA- ----------- ...... . ....... (AWwh ACORD LOCATIONS I Val-ROL" Warilen; Comp Information pmpristompartniers/Execlutive officers/Mgmbefs Excluded: Jonathan 7OD7LY wiuRy (Pw Per—) BODILY INJURY (per 80"' pitopERTY OAMAGE 13 E.L. DISEASE - EA EIA LOYFE $500 OC — , AAA At Inoluded gums - NIH & MA named as additional Insured as it pertains to the work being done during coo, Nominal Grid, and NSTAR and do policy period. N 9L ON f 99 CANCE" SCPJBBD POUCIES SHOuL.9) ANY oF THE A004E 0 CE WILL, Be DELI% T14E EXPIRATION DATE THEREOF. NOTI ConserVations BOrvic" Group ACCORDANCE WITH THE POLICY PROVISIONS' So WashingWn SftvM ItEpRESEwATIVE wesoorough, MA 01581 AUTKOVaEO &.2010 ACORD CORpOpATION, All right ,stered marks of ACORD ELS ACORD I of, The ACORD name and 1090 We rag' 061502010M511 60249 c4U m ui 0 CL r m ta tm !E E 0 L) to M 0 cn T4, 's U :,,� C.I. IT. C) C) 0 �—w E V a 'o U) Q. 0 x Lij 4; cl tA �.) 40. U) LU C) Z 0 LLI (-) uj Lo 5 Lu > CIO) I—L R < C:) LL (D >- :r LLI < Z (r) >- Z) - �5; z (D < 0 Z::) < z co < co < , z R JL* CE Ae '2 E CL C/) to 0 z 0 uj F, MW > 0 j% z CL Lu x U - U. ul Lu ca � I 0 v 0 ul LCO, LU � m ly 0 C.D 7: < z z (9 < 0 z T- < F - Z