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HomeMy WebLinkAboutMiscellaneous - 122 CHADWICK STREET 4/30/2018 / 122 CHADWICK STREET U-1 \ 210/07=001.0 \ 1f�� jt � PERMIT of "�oT" BUILDING TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: ^2% Date Received SSACHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page rL®CYATIQN R AQt + tPROP,ERTY OWNER._ 'I'M'9 ! PARCEL �rZONING4DIST�RICT ,Histo-rbc ®istrct ` � ye poi C �_�_ _ _ �_.� _---� _} -whine.ho •i I gn.. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ane family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Other ❑ Demolition ❑ Other Cr7ZGA tSeptic t❑Well ,�p,IFI'o dplairi L Wetl ds r� i❑ a et r'`�s+etl stn�t4 ; :> r € � q 3 � j F DESCRIPTION OF WORK TO BE PERFORMED: IV vjcl�.Al 0 Identification- Plea pe or Print Clearly OWNER: Name: Phone:"-37 - Y 5S� Address: o� C,9 i c �} t ©.ntractoN me:. �: ty P�honet `` • ` --_— � s x 4 ARCHITECT/ENGINEER Phone: ' Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ �] - _ FEE: $ 36__� Check No.: �/ / ! Receipt No.: 2� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner. _��Signtat�ure?ofontrac - _ Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ FTanniinig/Massage/Body Art ❑ Swimming Pools ❑ Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - 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 ee .Planning Board Decision: Comments Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: _Located 384 Osgood Street FIRE D =PA TME=N Temp D pster�on -Loc ed at 124 Mairi St eet3 � •`- � �� �`� " y''��` ` � �r��""'} F ` '� • ri :Fire Departrnen h sR nature'Idate L A 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 serviNeodrop requires approval of Electrical Inspector Yes DANGER ZONE LITERATURE: Yes No MGL Chapter 166 section 21A—F and G min.$100-$1000 fine i NOTES and DATA— (For department use) I I i ❑ Notified for pickup Call Email F Date Time Contact Name — Doe.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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses ❑ Copy of Contract o Floor Plan Or Proposed Interior Work o Engineering Affidavits for Engineered products VOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks ❑ Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o 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) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products COTE: 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 o 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 o Engineering Affidavits for Engineered products IOTE: 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 No. Date • - TOWN OF NORTH ANDOVER • 'CTLED 16 ' SF' 9c • - ,.-� Certificate of Occupancy $ � "- d���-._, Building/Frame Permit Fee $ { Building Inspector NORT�y Town of : _ Andover No. h ver; Mass, & coc»Ic»ew.cu y1. A°R�{rEo S U BOARD OF HEALTH Food/Kitchen PERM LD Septic System THIS CERTIFIES THAT ! BUILDING INSPECTOR . .... .... .... • has permission to erect ......................... buildings n ...� .�. M!t. ........................ Foundation • Rough tobe occupied as ......... ..j.. . .. ...... ..... ...!. . .....L.......... ...... ..................................... Chimney provided that the person accepting this per all in every respect 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 CONSTRUCTION TS Rough Service ........................ ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin,:; 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. Dec, 1. 2015 1:39AM No. 2262 P. 2 ' ���L� Federal toeds�4o�29 ,,,�• EYSE Engineering ?a ftn ftfilet radon No 120879 R I SE t A dwWou of Thwacb I1l11eedno ENGINEERING 69BhewtnutUaitA011310n,MA=I 339-s3s HMOs CONTRACT �7 Pa• 1 PROGRAM raaeoasaAcrrBtu+reaeu taroeeturewwse CMA•1i$S " men" aeuata�ttaawaaKaa v 411aTaYEq C) PROVE DATE C=ff weaneRM Karo Cal fiey (978)808-5652 it 1/06/2015 421374 00002 aMvae eiaaor Cum eraser 122(3ladwlek Street a 122 ChaWjk Stl`ed aeavaa am M72621+ amara env,amtt,ap North Andover,MA 01845 North Andover,MA 0180 JOB DESCE MON HMTH&SAFETY:Weethetiaadan work GNM preened until tic spillage of mobustion pm is fiaod. At AV S been f�ked,l Moo Alit SEAUNG:Provide tabor and Morlds to sol scrag of your home against waatc(bl,etrM air l"I mga, This wask will be pertamred to ooncxrt ositb the use of spaniel tools and diaBnnstte oases to esetare that your lame will beleft with a laoalttnlid harsh of air etocflango and indoor air quality.Mumials to be used toad your bonne can lncludo milts,foams and otherpreduee. 1Mmety UM for scaltmg include air INUP to artier,baloatouth Mohed gatagas and other unhaded amee(windows ere net generally addressed) This wilt aquim(7)MOM hours.A redaction in etbte feet per minuoo(eft)of air itt ustion will occur,buttho actual number of ch Is not guaranteed At die completion of the weadiMriatation work,and at no additional out to tho homeowner;a Niel blower door Mwor eornbustion safety analysis will bo conducted by the sub-oontrecigr to ansae the satbty of the indoor air q»ah'hr. 5595.00 DAMM Ck Provide labor end materials to iuM a 12"layer ofR38 unlaced Bbereass baits to(25)squats hu for damming PUMOM ' S51zs ATTIC PLAT:Provide tabor and matcrl*to install on 8"lopes of it 28 am I Cellulase added to(580)s4a=feet of open attic sPece. $794.60 ATTIC ACCESS:Pmvldo labor and amirlols to lanulatc tiro back of(t)attic halch with 20 rlgid Thermax boanl.Weadierstrip the p 560.00 VEIVMAVON:Provide labor and materials to install ventilation chuew In(36)aft bays to maintain sir stow. 512.00 8ASMEN!'CEJl.1KG.-Provide tabor and mal Wa to install(72)linear fiat of 11.19 unked fiberglass is aeon m the padmater of thebasement ce ing at die ham still 51,26.00 MMAN&PmWdo labor and materials to install 10"R37 d=*packed Craw t Cellulose,insulation to(90 square fact of oft ler overhang touted below a heated Boor area,by&Mi g hotel in die overhang Rom below. Holes drilled will be plugged. Plugs wiU be seated with exmriar grade apeoMe and!eft in a relatively smooth cartdition.Igniah sanding and touch-up ppaiating will be rho castomur's tospanslbEtity. $384.00 RISE Engineering will apply sU spplloabl%ellipbte incentives to this conna. You will only bo bitted the Net amrou nt. Cunatuly, for eligible measures,Columbia ties ofi'as 75%incomtivo,not to o ned 52,000 per calendar year,and an lace dve of 100%ler the Air Sealing meosurem up to the Brat$680 and on addM000al$340 if savhrgs are Justified by the suditor. For the ser&ty and health ofyour homes indoor air quality,we will be conducting a blower door diagnostic,of the available alr flaw In yourheme balls befbm tho wctk is begun,and after*a weadwiastlon v a k is coraptata,we will also conduct a iWl assessment of the oorabustian sefbty of your heating system and water heater.This has a value*f590 and is at no cost is you. Total allowable urea buizetion iaccaft is$3,110. 990.00 Dec, 1. 1015 1:39AM No. 2262 P. 3 r Faderol roe69aao9926 �Ujjj:, RISE Engineering Rl Cotarador Reglah tea No 8996 MA ConUeCtOrReglatrattoa No 926676 RIS E AdMdoo d1MebchEngtaeertog ENGINEERING d ghawatyt unit#2,Caatoo.MA U021 FAX339.502r d CONTRACT Page 2 MOORAM TRIS cowraAafiild11E1tlOIN1O 1116111110111011 wee CtNA-M M� "MQMTOIfEatPOMTTORBAa MM vharro alE ct�alr� rroaicoaasa Kara Cdfty 978 808-5852 11/06/201 421374 ( ) S 00002 SWM OTOU GUIM arm lag Chadwick Street 122 Chadwick Stroat 9UAWS 011e OMP VP aiuwc Ca.MEAD North Andover,MA 01845 North Andover,MA 01845 JOB DESCRVnON Total: $2,172.65 Program Incentive: $1,800.89 Customer Total: $371.06 WGAaRBHHIMUDYTOFUM=BMMM-CQMMMWACC=MCEw=AmmspECIRCJ1T1 UFOR7ffr;=of '"Three Hundred Seventy-0118 S 961100 Dollars $371.96 uPOMP�NAIOIs ASiOAPWlOYAI.aNRgaHN0ua0'aiNaouaTcu9Rl�eaToeEplra�aaurauEauFu�nITOP�1lwa.�eaowtaeaoe�lN�robaav IIl1AA1D OAIS.aEa RO11q�ORTAMTGJFOAhtI1T10NOp Oi�AR�M16'Pb.WSMTSOARF�6lQfu.aQHS01>up0.AN000aTRAOTORRE0181i�Tf0A1. OT SIGN THIS 9:OMMM IF TH AM ANY GUMSPACES araaA s p --•— CL NOTGTtl{aOOAInMid►VUWF DRAY MByu91FNOTERFCttIEorYrtM1M McOFACCEMrcE AOQEPTA41OEOf WOIIRAC►•TItSfIBWSPwQEO,aPBpROATwAta ANDQCMOmaMe ARE 30 MY& :=10MAIMMMUMMAOC&P1pD MAUAUMRMTODDTHMM A9 a9EOaiE0.PArkEURWdLSITYA0EAa0111L1NE�1taoYE The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #:603-324-1974 Are you an employer? Check the appropriate box: Type of project(required): 1.❑✓ I am a employer with 100 4. ❑ I am a general contractor and I 6. ❑ New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. E] We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] c. 152, §1(4), and we have no employees. [No workers' 13. ✓❑ Other Weatherization comp. insurance required.] *Any applicant that checks box#I 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'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: ACE American Insurance Company Policy# or Self-ins. Lic. #:WLRC 48151553 '5+L Expiration Date:6/30/2016 Job Site Address: '2,)s �a (.J Jrl City/State/Zip: 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 certift under the gains and penalties of er'ur that the in ormation provided above is true and correct. Signature: ___ Date: Phone#:603-324-1974 Official use only. Do not write in this area,to be completed by city or town offfciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: DATE(MM/DDNYYY) A�RL� CERTIFICATE OF LIABILITY INSURANCE 1 06/24/2015 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 °t certificate holder in lieu of such endorsement(s). PRODUCER CONTACT a NAME: Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 d Southfield MI office (A/c.No.Ext): A/C.No.): a 3000 Town Center E-MAIL Suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC tt INSURED INSURER A Old Republic Insurance Company 24147 TODBuild Cori). INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER C: ACE Fire underwriters Insurance Co. 20702 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER:570058348882 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. Limits shown are as requested Y EXP LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MM/DD/YYYY /Y MMIDDYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY30 $ 4 _ EACH OCCURRENCE S2,000,000 CLAIMS-MADEOCCUR DAMAGE TO-RENTED 52,000,000 PREMISES Ea occurrence MED EXP(Any one person) $25,000 PERSONAL B ADV INJURY 52,000,000 o, GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE 54,000,000 Ei X POLICY ❑PEET ❑LOC PRODUCTS-COMP/OPAGG 54,000,000 OTHER: p r- A MwT6 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $5,000,000 JX ANY AUTO BODILY INJURY(Per person) ZALL OWNED SCHEDULED BODILY INJURY(Per accident) 4) AUTOS AUTOSHIREDAUTOS X NON-OWNED PROPERTY DAMAGE v AUTOS Peraccident — . d7 UMBRELLA LIAB OCCUR EACH OCCURRENCE 0 EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS SERCOMPENSAS'LIABILITY ION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE ORTH YIN All Other States ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S1,000,000 C OFFICEWMEMBEREXCLUDED7 rg N/A SCFC4815190 06/30/2015 06/30/2016 (Mandatory in NH) WI Only E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,desaibe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000— DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) �y,I Evidence of Coverage YJ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Builder services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBuild Company 260 Jimmy Ann Drive Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD F!.' ':d t!C 'R'.'C 1'? !£ ' / •' t`Js��•?'{'.':F'.! a tion ON Off, of Co'su*er Aff-a— nd Business Regu t r� Y 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Replistration: 179141 Type: Supplement Card Expiration: 6!2512016 BUILDER SERVICES GROUP, INC. !RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 t'.-)date AddresN.and return card. !Bari:reason for change. -.ddrrsti Rene"al l.mt C.;rd = 0 lice o'Consumer Affairs b Business Regulation License or reg stratian Valid for individul use anh ,>-- before the expiration date. if found return to: IMPROVEMENT CflNTCTOROlz;ce of C:onsunter.•affairs and Business Rerul2tit�n %'-Registration: 179141 TYPE l(}?4r' Plaza Suite 70 Expiration: 6!2-5/2016 Supplement and Boston.MA 02116 JILDER SERVICES GROUP;1NC. SHARD SCH,AIARTZ o jIMTvlY F.NN DRIVE ,—�y�-- .YTONA SEACH.=L 321141'ndi netrttzn' =Not'vvaafiifu',r✓ithout sign2ture b ( , t,.Itti�rn,n �utrr;:�„r`Ytt•::.t!u CSSL-105992 RICHARD SCI'fWART2 1`.5 HUNTRESS STEEP Manchester NH 03102 `✓ � 09/26/2016 Restricted To CSSLIC tmu?attvn Contractor Failure to posses, -rent edition of the Massat.husetts State Building Cot ..ause for revocation of tris Incense