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Home My WebLink AboutBuilding Permit #564 - 95 CAMPBELL ROAD 1/25/2012 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received Date Issued: - L IMPORTANT:Applicant must complete all items on this page LOCATION q5 Print PROPERTY OWNER t Unit# Print MAP NO:1PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village e Y e no I 100 year-old structure ye 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 _ ElOther ®t ptic .9]ells ®)Fl o pla ❑❑W lands ® "� �Watershed)Distnctz E ®Water/Sewers �' r � DESCRIPTIONS WORK TO BE PERFORMED - t1 eu T�Cr iZk(St 1 C kU0 [ 1k [ Identification Please Type or Print C arty) ( OWNER: Name: llr� STl c Pa 1 t(A— 1 cr.- Phone: Address: CONTRACTOR Name: - Phone: �QG �-� ti l �l -4-2_(—_S Address: PIC) 1PGJ� J&J Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: 2Q ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $_ l - FEE: $__ �D Check No.: Receipt No.:C9 ICI �1--- NOTE: Persons contracting with unregistered contractors do not have access to the guaranty nd Sgnatu�re�,ofAgent�Owners� y, ,: � ,.x`Signature�oficortractor� ' ` � - Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑' Tanning/MassageBody Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales I ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Sgnature 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: Located 384 Osgood Street FIRE DEPARTMENT -Temp Dempster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS Location "! ��11�10eclzC. a / r No. Date N°"Th TOWN OF NORTH ANDOVER 3?O�t«•o :•,1•� OL � R 9 t Certificate of Occupancy $ Building/Frame Permit Fee $ �� Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check F 24977, Building Inspector NORTH ® oAndover'' I No. b 4: o , dover, Mass., Y O - LAKE COCHICHEWICK 7�S RATED P'P9C, BOARD OF HEALTH Food/Kitchen Septic System PERM� IT T D BUILDING INSPECTOR THIS CERTIFIES THAT........ .' ..........................................................:............................................. ... ............... Foundation has permission to erect..*........ .................. .......... buildings on ....... ..��Vf-le ... .%.....:...'............... Rough to be occupied as.... 1!4 . ....... ... ............ .......................:..............................:................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final this office, and to theprovisions 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 S '. ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough Service ................ ....... ........ BUILDING INS OR Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE Smoke Det. NORTH 0 0Andover a No. 5 �q �►`( 0 , dover, Mass., Y O y- LAKE COCHICHEWICK V S RATED P -`C BOARD OF HEALTH Food/Kitchen Septic System PERMIT T D BUILDING INSPECTOR THISCERTIFIES THAT........9 .. . ............................................................................................................ ... ............... Foundation has permission to erect..,............................. ........ buildings on ...... .. � ..................... .%......:...'............... Rough to be occupied as.... ............:......................:.......: Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 c-0 PERMIT EXPIRES IN 6 S '. ... ELECTRICAL INSPECTOR UNLESS CONSTRUCTI Rough Service ................ ....... . .. BUILDING INS R Final Occupancy Permit Required to Occupy Building GAS INSPECTOR 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. SEE REVERSE SIDE smoke Det. The Commonwealth of Massachusetts Department of Industrial Accidents. t' Office of Investigations - 600 Washington Street �! Boston,MA 02111 www mass.govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual):_ 6al l K—M-Mi 41-C Address: C �i 5 City/State/Zip: Phone#: Are yqu an employer?Check the appropriate box: Type of project(required): 1. II am a employer with 4. ❑ I am a general contractor and I have hired the sub-contractors 6. E]New construction employees(full and/or part-time).* 2.❑ 1 am a sole proprietor or partner- These sub-contractors have listed on the attached sheet. 7. ❑Remodeling ship and have no employees 8. ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers'comp.insurance comp. insurance required.] :- S. F1 We are a corporation and its 10.F1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Pldmbing repairs or additions myself. [No workers'comp. _ , right of exemption per MGL 12.❑ of repairs insurance required.]t c. 152,§1(4),and we have no 13. Other�K1ULk employees. [No workers' comp.insurance required.] *Any applicant that checks box#1 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'cofnpensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: EteEnl Policy#or Self-ins.Lic.#: _X��J W 6 8 2--+ Expiration Date: Job Site Address: ( ln Cbe.pAft.L)�qa City/State/Zip: J�kl%MMK'kik. 84!AS 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 a 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. . Ido Hereby certify eunthe ai s)an nalties of perjury that the information provided above is true and correct. Si de Signature: Date: o� Phone#: l tet– �� 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: ACORN® -— DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 12/1312011 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 CT NAME-- Michael Emond Emond 8r Associates PHONE FAX 857 Tumpike Street E-MAIL -208-4713 AIC No Suite 133 ADORESSt am ahmdamib)-mm — INSURER(S)AFFORDING COVERAGE NAIL 0 North Andover MA 01845 INSURER A: Farm Family Casualty Insurance Com an INSURED HRH Construction INSURER B: 80 Campbell Road INSURER C: INSURER D: North Andover MA 01845 INSURER E: 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. ILTRR TYPE OF INSURANCE DDL B pOLiDYNUMI3ER MMLIO EFF Pcm MOI-IIDU YYYI DIP LIMITS GENERAL LIABILITY EACH OCCURRENCDAMAGE TI E $ 1 OOO000 J% COMMERCIAL GENERAL LIABILITY PREMISES cam oenoa $ 0)000 CLAIMS MADE u OCCUR MED EXP(Any one person) 5 5,000 A 2001X0726 11/20/2011 11/20/2012 PERSONAL&ADV INJURY s Included GENERAL AGGREGATE. $2,000,000 GEML AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $2.000,000 PRO- X1 POLICY 24, LOC $ AUTOMOBILE LIABILITY i F COMBINEeD SINGLE LIMIT $1000000 ALL OWNED ANYAUTO SCHEDULED BODILY INJURY(Per person) $ X A. Ix AUTOS AUTOS-OWNED 200104287 4A 03116f2011 031`16120`12BODILY INJURY(Peraaident) S pROPEfm DAMAGE HIREDAUTOS x AUTOS $ Peracridern $ X UMBRELLA LIAR OCCUR _ EACH OCCURRENCE $12000,000 A EXCESS UAB CLyMS.MADE 2001 El 169 12/14/2011 12/14/2012 AGGREGATE $1,000,000 DED I I RETENTIONS $ WORKERSCOMPERSAnON WSTATU-COni- AND EMPLOYERS LIABILITY A ANY PROPRIETORIPARTNERIEXeCUnVE Y/N OFFICFMEMBER DCCLUDED?. NIA(r 2005W6827 12/07/2011 12/07/2012 E.L.EACH ACCIDENT .$500,000 (Mandatory in If yes,describe under aE.L.DISEASE-EA EMPLOYEE $500,000 :RATIONS below r r EL DISEASE-POLICY LIMIT $500,000 I I DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(Attach ACORD 101,Additional Remarks Schedule,if more space is required) Operations by named insured CERTIFICATE HOLDER CANCELLATION HRH Construction SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EMRA'RON DATE VEREOF. NOTICE WILL BE DELIVERED IN 80 Campbell Road ACCORDANCE WITH THECY P OVISIONS. 01 AUTHORS REPRESPIfRTP North Andover MA 01845 Q1988-204d ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACIDRD it > Massachusetts- Departnient ur Puhlic Sa1'ct} 4 Board or Building Regulations and Standard. Construction Supervisor License License: CS 57754 Restricted to: 00 WILLIAM D HOPE ' 57 CHASE ST ` METHUEN, MA 01844 Expiration: 3/4/2012 ('ommi.•incr Tr`: 18748 Office of/1o9u°mc>�{ .-F 1$ir�iness Finn— License or registration valid for individul use only w NO�VfE 1NIPROVET11T�13S CONTRACTOR before the expiration date. if found return to: k""==3f' Office of Consumer Affairs and Business Regulation j•�Registration: 101730 Type: ' ' ! Expiration: 6!29/2012 Private Corporation 10 Park Plaza-Suite 5170 p Boston,NIA 02116 HR-4-CONSTRUCTION INC. William Hope 57 CHASE STREET METHUEN,MA 01844 Undersecretary Not valid without signat' e " r Arff „ ;,t}�� ;; � nafiionalgrold Conser)attion - THE POWER OF ACTION Conser atlon Services Group This service is brought to you through support from your local utility This Agreement is made by and among and Christine I Michael Rice Conservation Services Group(CSG) 95 Campbell Rd 60 Washington Street,Suite 3000 North Andover,MA 01845-5709 Westborough,MA 01681 Customer ID:C00000036696 Contract ID:20120109 NVORK Reg.No.120837 Site 11):S00002626682 - - rederal'ID Nd.222467170 1. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Premises”in aprofessional manner and in accordance nvidn the terms of this Contract,including the attached recommendations/work order describing the work in detail(the'Work")which are incorporated herein by reference: Description Quantity Location • Attic Floor Open Blow Cellulose 6" 672 Living Space 8846,72 Insulate Rim Joist with 6.25'Fiberglass Batting 144 Living Space $279.36 Damming _� 16 N/A $28.32 Hatch;Polyisocyanurate 2 inch(Attic) — 1 Living Space $33.33 Sub Total: $1,187.73 Energy Efficiency Incentive $890.80 Net Sales Tax After Incentive $0.00 Total $296.93 • 1.CUSTOMER affirms that they have received no incentives during the past 12 months.Initial here • 2.The incentive is dependent upon the package purchased and/or prior incentive utilization.Changes to individual line items and/or previous incentives may increase or decrease the size of the incentive. 3.CUSTOMER affirms that their electric provider is National Grid Electric.Initial here • • Printed:1/10/2012 Page 1 of 1 . 11. PAYMENT Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows: Payment#1:$ as a Deposit payable to CSG upon signing the Contract(not to exceed 113 of the total retail costs or actual costs of special orders,whichever is greater). Final Payment:$ as the final payment for.the Work shall be due and payable to the Independent Installation Contractor("FIC")upon satisfactory completion of the Work. Customer understands that he/she twill not be required to pay the Utility Incentive Share of the Contract price in the amount of$ The Utility Incentive Share is dependent upon the package purchased and/or prior incentive utilization.Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. You may cancel this agreement if it has been signed by a party there to at a place other than an address of the seller,which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch by ordinary mail posted, by telegram sent or by delivery,not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. Customer Signature Date Indicate your selected 1IC here,if applicable (OR) Initial here if you want the Program to assign a CSG Signature Date Mame of CSG Representative(Printed) Participating Contractor 10/2011 Terms and Conditions appear on the reverse nationalgrid APW rX THE POWER OF ACTION Conser ation Services Group This service is brought to you through support from your local utility This Agreement is made by and among {F)EC' `1 G l�l� (r-ttcl Conservation Seivices Group(CSG). Christine/Michael Rice 50 Washington Street,Suite 3000 95 Campbell Rd4Iq Ilrestborough,IMA 01581 North Andover,MA 01845-5709 Reg.No. 120837 • Customer ED:C00000036696 Contract ID:20111209_wp h'ederal ID No.222457170 Site ID:S00002026682 1. DESCRIPTION OF WORK TO 8E PERFORMED ! �� Contractor w W perform or cause to bel) forested the following-work on these"Preunires"in a professional manner and in accordance w•itin the terms of this Contract;including the attached recomincndatiorstwork order describing tine M rk in detail(tine"Work")which are incorporated herein by reference: . f • Description Ou ntity Location Attic Floor Open Blow Cellulose 6" 672 Living Space $846.72 Damming XduninglThe NIA $28,32 Insulate Rim Joist with 6.25'Fiberglass Batting Living Space $310.40 Sub Total: $1,185.44 Energy Efficiency Incentive $889.08 Net Sales Tax Aker Incentive $0.00 Total 5296.36 1.CUSTOMER affirms that they have received no incenitmonths.Initial here 2.The incentive is dependent upon the package purch ed and/or prior in centi utilization.ChangesTo n rvrdual line items and/or • previous incentives may increase or decrease the size of the Incentive. 3.CUSTOMER affirms that their electric provider Is ational Grid Electric.Initial her • • Printed:112/9/2011 Page 2 of 2 II. PAYMENT Customer agrees to av Contractor for the Work,the Customer Share of tine Contract Price as follows: Payment N1:S 'Y X-• 7 je as a Deposit payable to CSG upon signing the Cout-ract(not to exceed 113 of tine total retail costs or actual costs of special orders,whichever is greater). F5na1 PayroenL'$ 9 y.�? as the final payment for the Rork shall be due and payable to the Independent Installation Contractor("ILC")upon satisfactory completion of the Work. Customer understands that he/she will not be required to pay the Utility incentive Share.of the Contact price hi the amount of S 9• ori' Tlne Utility Incentive Share is dependent upon tine package purchased and/or prior incentive utilization.Changes to individual line items and/or previous incentives may,increase or decrease the size of tine Utility Incentive Share. You may cancel this agreement if it has been signed by a party there to at a place other than an address of the seller,which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery,not later than midnight of the third business day yfollowing the signing of this agreement. DO NOT SIGN TTH" NTRACT IF THERE ARE ANY BLANK SPACES. ,n„r,..,c ._ h t�-15-11 1: �"� �� Co•�5�^^c.{'tc•t L w�j r•S�ahn? nationalgrid THE POWER OF ACTION Conser atlon Services Group This service is brought to you through support from your local utility This Agreement is made by and among and Conservation Services Group(CSG) Christine/Michael Rice 50 Washington Street.,Suite 3000 95 Campbell Rd Westborough,111A 01581 North Andover,MA 01845-5709 Reg. No. 120837 • Customer TD:C00000036696 Contract TD:20111209_ASEAL federal ID No.222457170 Site ID:S00002026682 I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Premises"in a professional roamer and in accovd.ulce with the terns of this Contract,including the attached recommendationshvork order describing the work in detail(the"Fork")which are incorporated herein by reference: Description Quantity Location Perform Air Sealing at Estimated 62.5 CFM50 Per Hour _ _6 Living Space .$451.50 Sub Total: $451.50 Energy Efficiency Incentive $451.50 Net Sales Tax After Incentive $0.00 Total $0.00 1.CUSTOMER affirms that they have received no incentives during the past 12 months.Initial here 2.The incentive is dependent upon the package purchased and/or prior incentive utilization.Changes to individual line items and/or previous incentives may increase or decrease the size of the incentive. 3.CUSTOMER affirms that their electric provider is National Grid Electric.Initial here f W V • • Printed:12/9/2011 Pago 1 of 2 11. PAYMENT Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows: Payment#I:$ 61 as a Deposit payable to CSG upon signing the Contract(not to exceed 1/3 of the total retail costs or actual costs of special orders,whichever is greater). Pynal Payment:$ 0 as the final payment for the Work shall he due and payable to the Independent Installation Contractor("II01)upon satisfactory completion of the{York. _ Customer understands that he/she trill not he required to pay the Utility incentive Share of the Contact price in the amount of$ yK /.fo The Utility Incentive Share is dependent upon the package purchased andfor prior incentive utilization.Changes to individual line items and/or previous huentives may increase or decrease the size of the Utility Incentive Shur. You may cancel this agreement if it has been signed by a party there to at a place other than an address of the seller,which may be his main office or a branch there of, provided you notify the seller in writing at his main office or branch by ordinary mail posted,by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS C TRACT IF THERE ARE ANY BLANK SPACES. K 12,-W-11 x 14914 �cnS'#✓�C `�Ita✓�' n�e� crSrgnahn a tr '� Date Indicate your selected IIC here,if applicable"'�-)I tial here if you want r the Program to assign a /ot VS—�/ /-� u +!. /f/�`�A .✓ Participating Contactor CSG Signature Date Name of CSG Representative(Printed) lOPdol l Terms and Conditions appear on the reverse Code End Pu3 apo Code Start :Pe4s , apo