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HomeMy WebLinkAboutBuilding Permit #316-2017 - 99 WEYLAND CIRCLE 9/23/2016 FORTH Jr BUILDING PERMIT TOWN OF NORTH ANDOVER ; =T APPLICATION FOR PLAN EXAMINATION 4L Date Received Zj AORAreo PQa`�g Permit No#: cwus�c Date Issued: tN ORTANT:Applicant must complete all items on this page LOCATION r Print PROPERTY OWNER H eAARM Tom Ior Print 100 Year Structure yes no MAPPARCEL'�=ZONING DISTRICT: Ma Macorichine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building ❑ One family [I Addition [I Two or more family El Industrial El Alteration No. of units: ❑ Commercial �(Repair, replacement ❑Assessory Bldg ❑ Others: ❑ DemolitionElOther R=-- ��- at re sh'�ed Dstr�ict a;® Septa OWelli Y®odplai�n, 1Netlands �� �W DESCRIPTION OF WORK TO BE PERFORMED: air �ta.L�nq damn una inswt t a4h'c ° v :.,��� aut'ed loch ose �e P�CisFina baf?1 dun • irksi•+�1 ila4on Chukt :n CAR -v bGws Identification- Please Type or Print Clearly T OWNER: Name: Jla-1 a�lor Phone: (�I'1 $3c1 -2� Address: W . d vtXHA 00< LLHome r Name: Phone: 3$ f o n r's Construction License: 1\ 41 Exp. Date: 7 h 12o1q provement License:— ARCH icense: 182�g2 Exp. Date: 711-11 2ot'1 ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST ABED ON$925.00 PER S.F. Total Project Cost: $ 3-7181 . FEE. $ Check No.: 1 I Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ip �: � _ , - M _ — Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/BodyArt ❑ Swim1aingPools ❑ 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 PLANNING & DEVELOPMENT Reviewed On Signature— COMMENTS i9natureCOMMEN•I S I h CONSERVATION Reviewed on Signature . COMMENTS i HEALTH . Reviewed on Signature COMMENTS Zoning Board of Appeals:variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments I I Conservation Decision: Comments Water&Sewer Connection/Si nature ®ate Driveway Permit ]DPW Town.Engineer: Signature: FIRES®EP,4R�TfVEIli91T�. Located 384 Osgood Street Loceteci�at *rTernp DLrmpster on site flia" Pte i+r Fi�ejDepartrnerif�igriae , 1 ?i _ TS. COMMEN ' t r• Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, wast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE- lies No j MGL.Chapter 166 section 21A—F and G min.$1oo-si000 fine NOTES and DATA-- (For department ruse) I Notified for pickup Call Email Date Time Contact Name Doc.Building Pertuit Revised 2014 i Department ®e Building p 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 prior to issuance of Bldg Permit OTE: All dumpster permits require sign off from Fire Department p 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 x 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 B roof of of Ap that the appeal period is over. The applicant mustpeals then get this recorded at the Registry of Deeds. One copy p must be submitted with the building application Doc:Building)Permit Revised 2014 Location No. f�D ` t� Date I I< )hy � Y . - TOWN OF NORTH ANDOVER , v. Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee $ Other Permit Fee $ TOTAL $ Check# .. :fi Building Inspector `� NORTIy q Town of sAndover 1It 01,&I ohver, Mass, 2. ~%Y coc.uc...w.cw �1• A0R�TED S V BOARD OF HEALTH Food/Kitchen PERT LD Septic System g ... . ..........t. ►.... �. BUILDING INSPECTOR THIS CERTIFIES THAT ................... �"� .......... ... ....:.. ................... I�� ............. Foundation has permission to erect .......................... buildings on ..�...�.. ........ � Rough to be occupied as .......hy;w l. . Ill. ... R.. �.SS�!Q ... Chimney provided that the person accepting this erittshall in eve respect conform to the terms of the Iicatio�T� 1 p p p g p � p pp 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONST TION Rough Service i .. .... . .. ....... ...... . ' Fina BUILDING IN .. CTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. r r F"61 S E 60KShawmut Road,Unit Z Canton,MA 02021 (339-502-6335 ENGINEERING www.RISEengineering.com Ef rit;crty Cacrr�ix:d. OWNER AUTHORIZATION FORM Matthew Taylor (Owner's Name) owner of the property located at: 99 Weyland Circle (Property Address) N. Andover MA, 01845 (Property Address) hereby authorize �� gM (Subcontractor) U I an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. This form is only valid with a signed contract. Owner's q11 G Date Federal ID#06.0406629 RASE Engineering RI Contractor Registration No 8186 � , MA Contractor Registration No 120878 II RISE �, A division of Thielsch Engineering CT Contractor Registration No ENGINEERING 60 Shawmut unit 42,Canton,NIA CONTRACT (401)784-3700 FAX(401)784-3710 Page 1 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE D CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK As DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT WORK ORDER Matthew Taylor (617)839-2424 02/29/2016 428635 00003 SERVICE STREET DILUNG STREET to 99 Weyland Circle 99 Weyland Circle SERVICE CITY,$TATE.IJP BIWNG CITY,STATE,ZIP T North Andover,MA 01845 app North Andover,MA 01845 ao DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left 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 scaling g include air leakage to allies,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(8)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number ofefm is not guaranteed. At the completion of the weatheri7ation work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 AiR SEALING ADDER: (2)working hours. $170.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass baits to(56)square feet for damming purposes. $114.80 ATTIC FLAT:Provide labor and materials to install a 4"layer of R-14 Class I Cellulose added to(1344)square feet of open attic space. $1,518.72 KNEEWALL.S:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to 181)square feet of kneewall area. $633.50 STORAGE BARRIER:Homeowner is responsible for the removal of the stored items blocking the installation of wcatheri7ation work in the kneewall areas. Removal must occur prior to the scheduled work start. $0.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thcrmax board.Weatherstrip the perimeter. $60.00 ATTIC ACCESS:Provide labor and materials to insulate(5) back of the knecwall hatch with 2"rigid TTtermax board,and seal the edge of the hatch with weatherstripping. $+300.00 VENTILA11ON:Provide labor and materials to install(2)insulated exhaust hose to existing bathroom fan(s). $100.00 VENTILATION:Provide labor and materials to install ventilation chutes in(57)ratter bays to maintain air flow. $114.00 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%for the Air Sealing measures up to the first$680 and an additional 5340 if savings are3ustified by the auditor. For the safety and health of your home's indoor air quality,we will he conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and after the 1,Alcatheri7ation work is complete.We will also conduct a full assessment of i Federal ID#054406629 RISE Engineering RI Contractor Registration No 8186 CT Contractor Registration No 120979 1 S E A division of 7'hielsch Engineering CT Contractor Registration No � ENGINEERING 60 Shawmut Unit d2,Canton,MA CON,r IC•r (401)784-3700 FAX(401)784-3710 Page 2 PROGRAM INIS CONTRACT 13 ENTERED INTO BETWEEN RISE CMA-NES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER �w NONE DATE CLIENTA WORK ORDER Matthew Taylor (617)839-2424 02/29/2016 428635 00003 SERVICE STREET BILLING STREET 99 Weyland Circle 99 Weyland Circle SERVICE CITY,STATE,ZIP BILLING CITY,STATE,LP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION 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 weathelimion incentive is$3,110. $90.00 Total: $3,7$1.02 Program Incentive: $2,940.01 Customer Total: $841.01 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Eight Hundred Forty-One 8r,011100 Dollars $841.01 UPON FINAL INSPECTIONANO APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORILEA SIGNATURE-RISE Enptnnring CL13TOMMOie NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE 2 ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE Y DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHOMD TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED AGOVC i I I The Commonwealth of Massachusetts Department of Industrid Accidents J, I Congress Street,Suite 100 Boston,MA 02114-2017 www,massgovldia Workers'Compensation Insurance Affidavit:General Businesses. TO BE PILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legiblj Business/Organi7ation Name.Mill City Energy Address:PO Bax 6411 City/State/Zip:Manchester, NH 03108 Phone#:603-391-7923 Are you an employer?Check the appropriate box: Business Type(required): 1.0 I am a employer with 12 employees(full and/ 5- E]Retail orpall-time).* 6. E]Restaurant/Bar/Eating Establishment 1C3 1 am a sole proprietor or partnership and have no 7. ®Office and/or Sales(incl.real estate,auto,etc.) employees working for me in any capacity. [No workers'comp.insurance required] �• Non-profit 3.Q We are a corporation and its officers have exercised 9. Entertainment their right of exemption per c. 152,X1(4),and we have 10.[]Manufacturing no employees.[No workers'comp.insurance required]* I t.�Health Care 4.0 We are a non-profit organization,staffed by volunteers, with no employees.[No workers'comp.insurance req.] 12.[X Other *Any applicant that checks box 91 must also fill out the section below showing their workers'compensation policy information. "if the corporate officers have exempted themselves,but the corporation has other employces;a workers'compensation policy is required and such an organization should check box 0. I am an employer that is providing workers'compensation insurance far my employees. Below is the policy information. Insurance Company Name:Clark Insurance Insurer's Address:One Sundial Avenue Suite 302N City/State/Zip: Manchester, NH 03102 Policy#or Self-ins.Lic.#MIWC791896 Expiration Date:4/2912017 .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 MGI,c.152 can lead to the imposition of criminal penalties of a fine up to 51,500.00 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. I do hereby certify,a ins and penalties of perjury that the information provided above is true and correct Si ature Date: Phone#:603-396-7520 Official use only. Do not write in this area,to be completed by city or town official City or Town: Permit/License# Issuing Authority(eircle one):. I.Board of health 2.Building Department 3.City/Town Clerk 4.Licensing Board 5.Selectmen's Office 6.Other. Contact Person: Phone#: vmrw.mass.govldia MILLCITY-1 AGOULD .4`oRO• CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDryrYY) 7/1912016 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 License#AGR8150 CONTACT Clark Insurance NAME: PHONE (603)622.2855 FA1c No:(603)622-2854 One Sundial Ave Suite 302N Arc No Ext Manchester,NH 03102 AIL ADDRESS:agouid@clarkinsurance.com INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Arbella Mutual Insurance Co 17000 INSURED INSURER B:AmGuard Ins co 43290 Mill City Energy 106 Joseph St INSURERC: PO BOX 6411 INSURER D: Manchester,NH 03102 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. INSR A D S R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM/DD MM/DD LIMITS A X COMMERCIAL GENERAL LIABILITY EACH -MADE $ 1,000,000 CLAIMS-MADE OCCUR 8500065735 04/29/2016 04/2912017 PREMISES EIKENIFU a occurrence $ 300,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑ PRO- ❑ JECT LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Eaaccident $ 1,000,000 A X ANY AUTO 1020050919 ALL OWNED SCHEDULED 04/29/2016 0412912017 BODILY INJURY(Per person) E AUTOS AUTOS BODILY INJURY(Per accident) $ X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE AUTOS Per accident $ $ X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS-MADE 4600065736 04/29/2016 04129/2017 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY X STATUTE ETH B ANY PROPRIETOR/PARTNER/EXECUTIVE Y� N/A MIWC791896 04/29/2016 04129/2017 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? (Mandatory in NH) If E.L.DISEASE-EA EMPLOYE $ 500,000 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 5001000 DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space is required) i 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 REPRESENTATIVE ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department of public Safety Construction Supervisor Board of Building Regulations and Standards Restricted to: Unrestricted,Buildings of any use group which contain License:CS410041 less than 35,004 cubic feet(991 cubic meters)of Construction Supervisor enclosed space. MICHAEL JOY 906 JOSEPH STREET 4.4 MANCHESTER NH 03102 Failure to possess a current edition of the Massachusetts Z^^_ CA-- Expiration: State BuiidirgCode is cause for revocation of this license. Commissioner 08/07/2018 OPS'Licensing Information visit-,WWW.MASSGOVIOPS F ' 7Ar Y11/r ^1&4s. u c(I + ivi rtor registration valid for r»dtiidui use oatydirc of "otmaaerAffairs&Oaau est xegtmriao ME IMPROVEMENT CONTRACTOR before the eipiration date. If found return to: ttgistraYron: i827g2 Typo; Office of Consumer 1Affsir�s and Business Regulation 1xplratlon: 712712097 LLC 10 Park Plaza-Suite 51 70 Boston,VIA 02116 fr4tLL t1Y t:IvERGY,LLC. MICHAEL JOY 106 JOSEPH STREET MANCRESTER,NH 03102 t as3rrrxserrr�ry� - IN r ithatit s.' are I