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HomeMy WebLinkAboutBuilding Permit #731-2016 - 90 COVENTRY LANE 12/14/2015< AJIJ � LP BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: 1,� Date Issued: Il/ ( � IMPORTANT: Date Received must complete all items on this LOCATION CIo CoVCt1�^'t LO r\k-- Print PROPERTY OWNER MAP PARC Print 100 Year Structure ZONING DISTRICT: Historic District Machine Shop Village yesno yes no yes no i TYPE OF IMPROVEMENT PROPOSED USE Resi ential Non- Residential ❑ New Building One family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑Commercial epair, replacement ❑ Assessory Bldg ❑ Others. Demolition ❑ Other _❑ ElSeptic ❑ Well ElFloodplain ElWetlands El Watershed District El Water/Sewer - -- - DESGRIF I IUN UI- VHUMr, 1 v 6c rr-nrvr,,nw. Identification - OWNER: Name:TXI 6 W'ttLrx% ir-1 Address: GJ 0 Co,/Cr., Contractor Name: Email: A mt, Addres O R; Type or Print Clearly t Supervisor's Construction License: Home Improvement License: ARCHITECT/ENGINEER Address: Phone: a -�Z SS -Lo • T -A B 3 . 5k3. k\03I Exp. Date: S I ZS ))+ Exp. Date: �0 Phone: r 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: $ (A I 11150 •-�H FEE: $ Check No.: ZCP ! I Receipt No.:y Z3%i72 NOTE: Persons contracting with unregistered contractors do not have access tp the guaranty fund Location lo aJa `� L� No. Date r Check 4t r S 1%23 TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $,�+ TOTAL $ Building Inspector Plans Submitted ❑ Plans Waived ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Well ❑ Private (septic tank, etc. ❑ Certified Plot Plan ❑ Stamped Plans ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ 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 ` L .Conservation Decision: Comments Wafter & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: , Located 384 Osgood Street 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 ®ANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A —F and G min.$10o-$1000 fine 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 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 )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 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 4, 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 4, Engineering Affidavits for Engineered products TOTE: 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 o v A0 1 2 N. O n0�n 3 z O 3; -a N' 'O % v vi a: cD o '17 C rt o,0 -1-0.rn tD W D• ID N p --1 — CD CD O Q. O n Q O CL 0 n -1 U) 0n U2 o lic O �•=rn CD S CD 0 -0 .Z Z O O O �r�• rm �N...., .=r �O 'b �� CD 00� — • _ Vi c0 -" N c� —: CQ n > m c �r ;�. O �' Q ><D CD 0 O t0 co)0 to 0 Q v, CLC<D _ - : s ;4•0.,� Z - X00 • — CD _CD CD O d7 3 r .a O Q CD U) � rt T N .O -r W e� Z O 0 Q0 CD = c3� Cl) o CO CD =r C CD CD y OCD Z C_ 3 CD n N v o ?� 0 --h O 70 czi: =: Z CDsu _• N O M C m O �. CD 0: a) o O -0 I' N W T po T N = T w T n T N T C O O O O O�• O O rD O °-' D-' v _� 77 rD :3D-' as M m 3 00 :3a rD S S S 7 7' Q n \ (D m (D lu LA0 m ° ` 0 O r O N S W 3 O 0 C C W mm W N v > v z A Z z v M n LA r +n O M m m O 70 -Ai O 0 s 0 O -0 I' Federal M # 05440Wn / RISE Engineering Ill contractor Registration No ansa MA r Ito on No 120879 A divitdon otThidseh Engineering RISE ENGINEERING 60 Showmat Unit #2, Canton, MA 02021 CONTRACT 339 6335 FAX&WSOZ4M Page 1 PROGRAM nuscoHmaerwcxreaeonroeama� Rna CMA-AES msoaaaanRaAwfTxaeuerorarwRwowrns scow cuffm Si PHONE oATE CAW VV�tltOman Nathaniel Smith (617)513-1639 10/29/2015 423903 00003 SERVICE arriW SUM STREET 90 Coventry Lane 90 Coventry Lane SERVICE CIrY,STAMW MUMQ WY.BTAMW .'.. North Andover, MA 01845 North Andover, MA 01845JOB qm DESCRIPTION! AHt SEALING: Provide labor and materials to seal areas of your home against wasteful, excess air leakage. This work wit performed in concert with the use of special tools and diagnostic tests to assure that your home will be lett 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 (9) working hours. A reduction in cubic feet per minute (efin) of air infiltration will occur, but the actual number of of n is not guaranteed. At the completion of the weatherization work, and at no additional cost to the homeowner, a final blower door and/or combustion safely analysis will be conducted by the sub-contractor to ensure the safety oftere indoor air quality. $765.00 AIR SEALING ADDER: (4) working hours $340.00 ATTIC FLAT: Provide labor and materials to install an 8" layer of R-29 Class 1 Cellulose added to (120) square feet of floored attic space. $216.00 DAMMING: Provide labor and materials to install a 12" layer of R-39 unfaced fiberglass batts to (70) square feet for damming pufPWM $143.50 ATTIC FLAT. Provide labor and materials to install an 8" layer of R-28 Class I Cellulose added to (1452) square feet of open attic Spam I COULD NOT ACCESSS OVER FAMfl.Y ROOM ASSUMMED SAME AS MAIN ATTIC. $1,989.24 VENTILATION: Provide labor and materials to install ventilation chutes in (66) rafter bays to maintain air now. $132.00 COMMON WALLS: Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to (130) square feet of common wail area. I COULD NOT ACCESSS OVER FAMILY ROOM ASSUMMED SAME AS MAIN ATTIC. $455.00 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°x6 for the Air Sealing measures up to the first $680 and an additional $340 if savings are justified by the auditor. For the satiety and health ofyour home's indoor air quality, we will be conducting a blower door diagnostic of the available air flow in your hone both before the work is begun, and atter the weathcrUation work is complete. We will also conduct a full assessment of the combustion safety of your heating system and water heater. This has a value of $90 and is at no cost to you. Total allowable weatherization incentive is $3,110. $90.00 SW tD # 064405629 RISE Engineering RI Co rr R on NO SIN RegistrationNo 1=979 RISE A division of ntfth Engineering M ENGINEERING 60 Shama Unit gyp Caston, MA Om21 CONTRACT 3391-.%U335 FAX 339.OMMS Page 2 PROGRAM JWCoNIwIC:rM18NIEnE 0n*8ETVYWMRISE CMA -HE'S ENSMAERNSWOTNECUSTONBtMINOiRAM eausr alaTaml PRM DATE CIJTORS YJWIKORpER Nathaniel Smith (617)513-1639 10/29/2015 423903 00003 sWW= STR W Wk sTREET 90 Coventry Lane 90 Coventry bane BEIMCC CnY, STATE.IIP BELLOW CRY.STAMZIP North Andover, MA 01845 North Andover, MA 01845 JOB DESCRIPTION Total: $4,130.74 Program Incentive: $3,110.01 Customer Total: $1,020.74 WE AGREE HEREBY TO FUMM SERVICES -COMPLETE M A0001UMCE WITH ABOVE SPECIPM710M FOR TME SUM OF '""One Thousand Twenty & 741100 Dollars $1,020.74 BPCNrAMQ PEM1OMANDAPNWALWRMe O.QUiTOMERAGREES TORMT AMCUNTCIM W RAL WRESTOF I%VM.LMECM6®MOMMY CNAMT UMPAI0MWOCEAFTER UW S. SKMERSEMR WOWAMW CN_GUAPANIM MGM OF RECUM ==UK AM CONTRACTOR REGISTRAUX NOT MN THIS CONTRACT IF THERE ARE ANY BLANK SPACES BKiRATURE- ARCE NOiE:Tw COMRACTMAY BEYATIUIWUMN BY IIS tF NOi F]WCUTIDfYIIIEN DATE OF ACCEPTANCE 30 DAYS, ACCEPTANCE OF CONTRACT -TME AWM PMM WM WIMW AND COMMN ARE GATNIFACTOW TO US AND ARM NUUM ACCEPIM YOU ARE AUTNORS=7ODOTFWWORK ASSPECOMPAYMMffWELL RE MM ASOUTLWWAMOYE t y 5! NOV 5 2015 .I OWNER AUTHORIZATION FORM 1, -Xilijtk- ovfiw of to PmPft bated at 170 Ca— - '14"ec7vev. /41c?, aig herby aftrbm an adhoftd mb=*aftrfm MSE ftMwft,to adonmy bd0lb obtain a bMng pwmk and to perform =* on my property. Data t\,OV 5 2015 The Common wea4th of Maysarhuwas Department of IndustrW Accidents Office of Invesfigafions I Congress Street, Suite 100 Ho n, MA 02114.2017 It$ wwwjnassgovIdia Workers' Compensation Insurance Affidavit: Builders/Contracters/Electricisns/Plumbers Applicant information Plemej%nt !AMft Name Phonem ctll Is -(P -34S3 Are you an employvil Check the appropriate box: 1.0 t am a employer with 5 4. 1 am a general contractor and I MPMYW-% (fall aft"t pad -time -" have hired the sub -contractors 2.0 1 am awk proprietor or partatr- listed on the attached sheet. ship and bavc no emplare-, working for M ill any capacity. [No workers' comp. insurance required] 10 1 a homeowner doing ail work myulf, [No workers'comp. imurance required] t These sub-wntractors have, employees and have workers' corals. insuranceJ 5. [] We an a corporation and its officers have exercised their right of exemption per X4GL c. 152, § 1(4), and we have no emitloyees- tNo i&vrk-ers* romp. insurance nuittired.1 Type of project (required) - 6, [3 New, construction 7. Remodeling S. Demolition 9. [3 Iktilding addition 10.13 Electrical repairs or additions 11.[3PIumbiAg rqxdrs or additions 12,j] Roof repairs 13.[3 Other "Any applimt the cf=ks box di viita aW FM ow dw sonion bdow- shmvin dwir work=* cornpensation Oky information. t Hmxvvmrs totio wbinii this affidavit indwatingt'hey art doing BUvk MW thcrhim ow -4k =nT,30M MuO submit a new Affianit indicatingstick # 'C ,ontmam Ow chc& ti*,is box muU,;IaPdWzn a4thtioral shm OMWVW the-mme orlh.- subcwuwom and stale %Irehet of not ftw CnAtks hMT eftrpfoym. if fbc sub-oontwm have MVIOYM, flic", MkA pftm& Mitis- *Vltes' COMT. pock -Y Mnlba- I Afton employer rhor is proviOng workers" compenumion imaramefor my exployem. Bel", is the pair 00job site Insutatice Convmy Name: Policy # or Self -ins. Lic, #J115"PI, 3 6913 lit Expiration. Datc,*A-0jIRIt4---, Job Site Addrass:q M4 016W Attach a copy of the workem' compensation policy declration pie (showing the policy number and expiration mate), of a -on 25A of MGL c. 152 can lead to the imposition ofcriminal penalties Fail= to swim coverage as required under -tion impti, ci fine up to $ 1,5M.00 and/or one-year sonvy-na, as wcIl as. , Ot penalties in the for of a STOP WORK ORDER and a fine of up to $250.00 a day against the violator. He advised that a copy of this statement may be forwarded tea the Mee of Investigations of the DIA for insurance coverage verification. I do hereby ceidfy under the pdm anrk nalftet ofperpay Mitt the wformadon pro Wded ague is true and rarrort. Oatc- lob offieWasconly. Do not write in this ores, to be compkie4lby city err town official. City or Town: Perndfticense # hwulng.kutbority (drek onc): ' 1. Boaril of Hedffi 2� Buflftg DeparE Ietment 3. City1rown Clerk 4. strical Inspector S. Plun*ing ter 6.t ther Contact Pont Phone Mim A<--"RjD' CERTIFICATE OF LIABILITY INSURANCE I 'WtIpmKWT�14 THIS UUMCATE 15 ISSO O AS A MATTER OF INFORMATION OKY AND Ct7POM NO RttgtYTS UM -m THE CERTIFICATE WXMR.. TMIS aimFICAT€ DMS NOT Al.-FIRA SR'JVtLY Ok Nt"nVMY AMEND, WUD OR AITER Tl* COVMAGE AFFOROW BY THE 4'OUCHS anow. "HIS CtRTSFtwE Cf IWAU U.NCE Dots NOT COXSTnWE m CONTRACT RETWEEN M4 LSSUI NO INSURER S;)„At1T4RiZE s RE S ATTVr P OR obv-C#, AN T"f L lm-rricATE work. IMPORTANT. it the "+r *ift paw, n R;cd. $ lUgoC REM tS WAt§P T satb t tfi� ttMS tnd ag*&ft s of” polKy, cwtWn p&3du may mquVe an etxlo 5trr , A siafesr:etsi on true tr e ter €i tiE� is Etre mt fCM her in tip, of eWvm" nti '4`M 0 CERTIFICATE OF LIABILITY INSURANCE F DA7iMWDDfY5 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 Nancy Usher Martin J Clayton Insurance Agency, Inc. BONN .Ext: (413)536-0804 ac No: (413)534-7874 1649 Northampton Street E-MAIL ADDRESS: INSURER(SS AFFORDING COVERAGE NAIC# P. 0. BOX 989 INSURERA:Na_tionwide Mutual -Harleysville NATIO Holyoke MA 01041-0989 INSURED INSURERB:Allied World Natl Assurance Co INSURER_C: ` Gauthier Insulation INSURER D: MED EXP (Any one person) $ 5,000 44 ESSEX ROAD INSURER E: X INSURER F: 7/6/2015 IPSWICH MA 01938 COVERAGES CERTIFICATE NUMBER:CL157701379 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 LTR TYPE OF INSURANCE ADDL SUBR POLICY NUMBER POLICY EFF T POLICY EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS -MADE ❑X OCCUR DAMAGE TO RENTED 50,000 -PREMISES $ a occurrence MED EXP (Any one person) $ 5,000 X GL43487F 7/6/2015 7/6/2016 PERSONAL & ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY 1:1JECOT- F LOC PRODUCTS - COMP/OP AGG $ 2,000,000 $ rOTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident BODILY INJURY (Per person) $ ANY AUTO ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY (Per accident) $ NON -OWNED HIRED AUTOS AUTOS PR PER accidenlDAMAGE $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 11000,000 B EXCESS LIAB CLAIMS -MADE AGGREGATE $ 1,000,000 DED RETENTION $ BE020792125-194985 10/18/2014,10/18/2015 WORKERS COMPENSATION AND EMPLOYERS' LIABILITY Y / N ANY PROPRIETOR/PARTNER/EXECUTIVE PER OTH- STATUTE ER E.L. EACH ACCIDENT $ OFFICEWMEMBER EXCLUDED? N / A E.L. DISEASE - EA EMPLOYE $ (Mandatory in NH) If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE - POLICY LIMIT $ DESCRIPTION OF OPERATIONS / LOCATIONS / VEHICLES (ACORD 101, Additional Remarks Schedule, may be attached if more space is required) TEI, AND ANYONE ELSE REQUIRED ARE NAMED AS ADDITIONAL INSUREDS) ON A PRIMARY AND NON-CONTRIBUTORY BASIS TO ANY OTHER INSURANCE CARRIED BY TEI, UNDER THE SUBCONTRACTORS GENERAL LIABILITY AND UMBRELLA COVERAGE. 30 DAYS NOTICE OF CANCELLATION CERTIFICATE HOLDER CANCELLATION ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD i F?rdr6§tbd with pdfFactory trial version www.pdffactorV.com SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THIELSCH ENGINEERING, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 FRANCIS AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. CRANSTON, RI 02910 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG--'- ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25 (2014101) The ACORD name and logo are registered marks of ACORD i F?rdr6§tbd with pdfFactory trial version www.pdffactorV.com l ri$ ti 5 w'�n' a £ cnQCG r 9 Q $ O V G)G IIID-IIIaaa =X>> KOCC it. k" Fn m � 1i�i T .j}. y. co m : Sty