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HomeMy WebLinkAboutBuilding Permit #0303-2017 - 9 ROCK ROAD 8/22/2017 V11 BUILDING PERMIT o�NO RT bq� 1. •� 3'� yE nY• ..gip.sb TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ~ � o permit No#: L13 103 Date Received 0Ri{TE RSSACHUS�� Date Issued: �✓�J C�.fA� LVRORTANT:Applicant must complete all items on this page —t3,4y, . y M1X ;"•�'- r " a""5 '. l�r • - 'f +,s 2 Ye p ,,;a`y' 3 r, +. 'M yRi+'�kX.."" ?'. , ,CATIONf v� � 'ROOK LOVX, Y P,trinty�F��,�-7 '{FPROPERT � �}d ^ F rc _ UR,:A §45_x1` t ` #�< f''Fk " s �i "�a 3A2t#y+ no MAP - FPARCEL ONIIVG DISTRICT:��� k � � � �- Histone®istrt�t :� ,� y ,►�.� es .t. no 1 = : .• op V ag . yes Machme.Sh : ill e 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: ❑p.Demo-lition ❑ Other Septic g 1Nell ❑ Floodplain E)Wetlands t " 0 Watershed Ristrict . ❑1Nat_er_/8ewer • ... tt�r -,• f RIPTION OF WORK TO BE PERFORMED: air S.c"'n O l a -ox host 4b rc b Identification- Please Type or Print Clearly' OWNER: Name: m Phone: IU 2K8'-aG Address: qgD_(X_ a 10064, Ahdoyllf- 01 PY Contractor' Name° PW.larc�l_ Phone Ni 382.- -, - _ _ . Ou - , Address: : 64 11, Ha.nc.kjhw- , NN DONS'. Supervisor's Construction License IIbU�-1.1. Exp: Date ,.,8 �r7 �2y1q. Exp. Date:.. 7 �.Z." Home.lmprovement License: _ 18.2.782- . ,-.._ -.- 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. I_ Y'otal Project Cost: $ y �ql . 'Il FEE: $ j Check No.: �`T Receipt No.: NOTE: Persons contracting Wath unregistered contractors do not have.access to the guaranty fund S`ignatu�e_of_Agerit(Owner ��. Signature of contractor; 1 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 (VOTE: 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 ❑ Mass check Energy Compliance Report ❑ Engineering Affidavits for Engineered products DOTE: 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 Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plans ❑ ` I YPE�F 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 i PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH, - Reviewed on . Signature. COMMENTS ° __ :`. . _ ��: . .• _ ;.•,: �' .:•, . •.. ,=} .;� Zoning Board of Appeals: Variance, Petition No: . i Zoning Decision/receipt submitted yes Planning Board-Decision: Comments' , t Conservation Decision: Comments Water & Sewer Connection/signature Date Driveway Permit DPW Town Engineer: Signature: ',Located ;'384 Osgood Street FIRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signatureldate g COMq&T;�� F -imension 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 lies No ®ANGER 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 ate Time Contact Name Doc.Building Permit Revised 2014 ;. ;. Location Date 1 � • - TOWN OF NORTH ANDOVER y Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL Check# . f -"r Building Inspector s MILLCITY-1 AGOULD CERTIFICATE OF LIABILITY INSURANCE DATE 1 7/119/21912016 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 License#AGR8150 CONTE CT Clark Insurance PHONE FAX One Sundial Ave Suite 302N A/c No EFA xt:(603)622-2855 C NO).(603)622-2854 Manchester,NH 03102n o'er;agould clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC A INSURER A:Arbella Mutual Insurance Co 17000 INSURED INSURER B:ArnGuard Ins co 43290 Mill City Energy INSURERC: 106 Joseph St INSURER D: PO Box 6411 Manchester,NH 03102 INSURERE: 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 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. INSR TYPE OF INSURANCEUOR POLICY EFF POLICY EXP LTR D WVD POLICY NUMBER MMIDD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE a OCCUR 8500065735 04/29/2016 04/29/2017 -DAMAGE TO RENT 0 PREMISES Ea occurrence $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,00 POLICY❑JECOT F-1 LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ .AUTOMOBILE LIABILITY Ea COMBINED SINGLE LIMIT $ 1,000,000 A X ANY AUTO 1020050919 04/29/2016 04/29/2017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY Per accident) $ AUTOS AUTOS ( ) NON-OWNED PROPER DAMAGE — X HIREDAUTOS X AUTOS Per accident $ X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600065736 04/29/2016 04/29/2017 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY X STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N MIWC791896 04/29/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N❑ N/A _ (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached B more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTA77VV,E. ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD The Commonwealth of Massachusetts Department of IndustrialAccidents ~, I Congress Street,Smite 100 <} Boston,MA 0.2114-2417 www..mass gov/dia Workers'Compensation Insurance Affidavit:General Businesses. TO BE TILED WITH THE PERMIT SING AVIN0RtTY. Applicant Information Please Print Legible Business/Organi.zation Marne;Mill City Energy Address:PO Box 6411 City/State/Zip:Manchester,NH 03108 Phone#:603-391-7923 Are you an employer?Check the appropriate box: Business.Type(required): L Q I am a employer with 12 employees(full and/ 5. 0 Retail or part-time).* 16. .E]RestaurantBar/Eating Establishment 2.C3 T ant a sole proprietor or partnership and have no T. M Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp:insurance required] $• [ Nein-profit. 3.0 We are a corporation and its officers have exercised 9. ❑Entertainment their right of exemption per c. 152,§1(4),and we have 10.0 Manufacturing no employees.(No workers'comp.insurance required]* I 1.[]Health Care 4.❑ We are a non-profit organization,staffed by volunteers. I with no employees.[No workers'comp.insurance req.] I2. Other 'Any applicant that checks box 91 must also fill out the section below showing their%wrkers'compensation policy information. "If the corporate officers have exempted themselves,but the corporation has other employees,a workers'compensation policy is required and such an organisation should check box#l. /ant an employer that.is providing workers'compensation insurance far my employees. Below is the policy information. Insurance Company Flame:dark Insurance :Insurer's Address:one Sundial Avenue Suite 302N City/State/Zip: Manchester,NH 03102 Policy or Self-ins.Lic.#MIWC791896 Expiration'Date:4/29/2017 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 hereby certify,u► ifts rand penalties of perjury diet the information provider(above is true and correct, Sienature: Bate: Phone#:603-396-7520 Olfficial 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.Boar @ of Health 2.Building Department 3.CityfTown Clerk 4.Licensing Board 5.Selectmen's Office 6.Other Contact Person: Phone#: wwwmass.gov/diia RISE Engineering Foa�raltauoao�oat)zo MA pRephhal9onMosin M Go r&char Roglatrrulcn do 1200 Rt atkm Na620120 60 Shawrnut Road,Canton,"A 02021 339-511 FAX 334-501.6345 CONTRACT Page 2 P>zorrtAM CMA-HU n *�axtxamrxrona t —CufrommRWORICAS Ashley Williams warp* �m aaxr. wwntoaooe (610)24&5656 01/31/2017 431695 23904 $TRW 9 Rock Road attxraa aurum 9 flock Road 9 aGSNCE aTAr$riP mate ago CITY,QrAtE- Norib Andover,MA 01845 Ndrth Andover,MAO]845 JOB UESCRUMN $237.50 VENfiLAITON.Provide Labor i;d materiels to install vernal=chutes in(87)rafter bays.to maintain air flow. $217.50 RISE Engineering will apply all gplictibl%eligible Incentives to this contract.You will only be billed the Net amount.Cummttly. for eligiblemeasurcs,Columbia Gas offers 75°x6 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 ane justifsod by the auditor. for the safety and health of your on s indoor air quality,we vall be eanducting a blower door diagnostic of the")able air flow in your home both before the work is begun,and after the tiveagm iration work is complete.We will also conduct a full assessment of the combustion safcfy of your heating system and water heater.This has a value of$90 and is at no cost.to you. Tire Permit wM.be secumd by the insulation contractor.This has a value of 575 and is atno cost to you.it is the homeowrm's responsibility to close out this permit bpconiaciing their municipality at the completion of"work.Total allow" weatheriza ion incentive is$3;185. { t i t } WVL, 3ql� fsdaral iD a105�0/Otiti29 RISE Engineering tai Contractor Reghrttaffon ti1o8188 ,Ty MA Contractor Ragletrallon No 120878 CT Contractor Registration No620120 FENSKIT 60 ShrtWrmat Road,Canton,HA 02021 ���.y�p p�s� EEti11�i"l C 339-'a02�fi33S PAX339-S02,G345 Page 1 PROGRAM "a CONTRACT ro aarsaea OM NVIREreMW CMA,-NES Ermrisewa AND 110CUSTO frcrOrrrooaacAS asaCRISCDDELOW CUSTOM !ROW DATE CLEWS WOnxoaas<x Ashley Williams (610)248-5656 01/31/2017 431695 23904 •zarnce L'TREHT - earaib aTRFfT :.. -' 9 Rock Read 1 Rock Road , 1 North Andover,MA 01845 North Andover,MA 01845 JOB DESGRIMOIY PRASE ONE-Proposal for this calender yeah:' _ $0.00 IRA ARD:BARIM:We have identified'ihat there an:recessed lights present in your home.unless the recessed lights am eeitified as IC-Mtcd(Insulation ContoLd Rated)we will create a 3"clearance space around the factum by using fiberglass:blanket insulation as n damming moteriat;no insulation will be installed across the top and closed cavities which comain recessed lights will not be insulated. $0.00 "SEAUNGi Piovide labor and mntcr till to`scal-arcw ofyour home against wasie8rh,excess sic icakage.This work viill.bo` _ perfomacd in concert with the use of special tools and diagnostic tests to assure that your home will be"with a healthful levrl Df air exchange and indoor airgurility.Materiels to be used to snot your home can include caulks,foams and other products. Primary, arras for sealing include air to attics,baseateat attached garages and othra unheated arses(windosys.are not generally addressed.)This Will require(12)workii;g hourstion in cubic feed Oc minu .A reduction (cf n)of air infiltration wiil,occur,but the actual number of elm is not guaranteed. At the oompletiomof the Wvflterbation work;and at no additional cost to the homeowner,a MW blower door and/or combustion safety analysis will W conducted by thesubacoatractor to ens tie the safety of the indoor air quality. :51,020.00 DAMMG:Provide labor and materials to install a 12"ittytx of'R38 tinfacxd`fiberglass harts to{116}square fent for daaming purposes, 5237.80 AT171C PIAT:Provide labor rind materials to install an 8" of R 30 Class 1.Ceilulaso sdalcxlw(928}square feet Ofopen stirs space. a $1,336.32 KNEEWALLS:Provide labor and materials itiittsttrU rigid board at R-10 or "' w�tlt'lhe regttimd foe rating to(200's41ioe id of kocewall area. S77Zl.00 , ATriC A1SCE5S:Provide labor and materials to is 1(1)easily aiovad:�g saver far:the attic accessibrWing sktii A scat O list 510fa ae ofplycvood will be created mottod the opeoingwithin the att . 'Iia wit!rrllovr the cvvet's intogrttf aYhet=: to restrict air heakagc. l # eporary erxext:toanaoii taut 1 aPB wt�l tan o1o#et!`wtifa _ 5237.bS ATTV ASS:hmvida-tabor dad tnittuxiola fo ttimloe(Z} tt simi�r 6o tlta»r 1 �agtd pnrariiig;s aotndridcd. ' VVEM Fiats [ I - �2} ata#1h ttrt#a tlrtt ___--- FSdWW 101106-040602@ Rt Conttsdor-Sts$fstratlon No 8186 MISE Engineering W 00�r R094WdW No+20979 ® CT Car{aacw Rpt MWan No820120 S LL, 0 Sbawmnt Road,Canton,:MA 0"21 CONTRACT ci1h1EERING 334-501rG�.35 FAX 339•:ti42-GU5 pap 3 PROGRAMmrnossm� 4 CMA-IM v suar woawarocKs cuaso��ir - wrs raorrr. WORK01MOe Ashley 9 lliams (610)248-5656 01/3112017 431695 23904 aEWM errs 9 Rock Road 9 Rock Road aMWEMY.arAW-DP M.WW crtr;araMMP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION $165:00 Tsx i» .77 Pw9fam I"centive, $3,10-00 { tsfx mer T*f —ppe T#oU#0d Trs'o Hued Sial&77/9# Doll=,- Do allas ..'�.��....�.....�.,"3:�`:�`�t�7r�7 �+�"� a�RyryfS�+y�y a�i'tr .wM♦� �j �y �a V I N•.I ,C.# STC:LC�t ,l OTxtt" 'SF f e • � r t t - 7 a, r Fn. • �a n r, I i es - .- MORtZATIONTORM NERAUT * a ow t ptt , bfa s r y t1 nix n i h b a r l am;' 'O " :my bs I tWobtain a buiwTv Ibis f06 I hor qtr ire m y . • t%0RTfj Town of t .F. 6 ndover 0 `" 0% �h ver, MassZd;74 COCNICNl WKN V �.9 q°RATED S U BOARD OF HEALTH Food/Kitchen PERMI LD Septic System a a *.. , ..� •THIS CERTIFIES THAT ......... •.............. ... BUILDING INSPECTOR has permission to erect .......................... buildings on 9Foundation Rough tobe occupied as .�� .....� � � every r s .......................................................... Chimney provided that the person accepting this permit sha pect 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST N Rough Service ..... .. . .. .... .... .. ' Final BUILDING INSP OR 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. ,Supervisor Massachusetts Department of Public Safety Constructionp Board of Building Regulations and Standards Restricted to: Unrestricted-Buildings of any use group which contain License:CS-110041 less than 35,000 cubic feet(991 cubic meters)of Construction Supervisor enclosed space. MICHAEL JOY �y 106 JOSEPH STREET MANCHESTER NH 03102 Failure to possess a current edition of the Massachusetts ' ,^_ CA---^K Expiration: Stale Buildirg Code is cause for revocation of this license. Commissioner 08107/2019 DPS Licensing information visit WWW.MASS.GOVdOPS f�ieense or re btratiau valid far iudividul use only "'� ofticeotC.onsvmerAtfairsete Binst e"Rtttvistion �' � NAME tMPROVEtYIEN'f COf#TRACTOR before the,expiration date. if found rtturn to, #��,rJastration; 102743 Type: flite of Consumer Affairs and Business ttcuimtthn taw 10 Park Pla'ia-Suite 5170 xpirsilon- 7=42tit7 LLC it Boston.NIA 02116 M!U_CITY ENERGY.Lt G, MIOMEL JOY 106 JOSEPH STREET., ' .. _ MANCHESTER,NH 03102 ilvdrr�rrrtAey N va �t lthorrt sl are