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HomeMy WebLinkAboutMiscellaneous - 245 CHESTNUT STREET 4/30/2018m o rn NORTFr �n ASV/) BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION `s ' �Z. b Permit No#: 5% U /Q�� C1 Date Received I _ - ?-0� qo 4 SSACHUS� Date Issued: 1 t (,,- IMPORTANT: Applicant must complete all items on this page LOCATION S Pri PROPERTY OWNER &-e-4-:s Print 100 Year Structure yes Dno MAP 0 PARCEL: 1 � ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ,50ne family ❑ Addition ❑ Two or more family ❑ Industrial ❑ Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others- ❑ Demolition ❑ Other ❑ Septic ❑ Well ❑ Floodplain ❑ Wetlands ❑ Watershed District ❑ Water/Sewer PTION OF. PERFORMED: OWNER: Name: 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. Total Project Cost: $ J?J� �. �� FEE: $ Z o Check No.: I y L Receipt No.: '3 i? V NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ^f Ar M+/n%Ainor 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 OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks 4, Building Permit Application .� Certified Surveyed Plot Plan Workers Comp Affidavit �. Photo Copy of H.I.C. And C.S.L. Licenses 4, Copy Of Contract � Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) .4 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) ,ra Copy of Contract 2012 I ECC 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 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 ❑ TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swunming 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 - U FORM PLANNING & DEVELOPMENT COMMENTS CONSERVATION COMMENTS HF4ALTH COMMENTS Reviewed On Signature_ Reviewed on Signature Reviewed on Signature Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comme Water & Sewer Connection/Signature & Date Drivewav Permit DPW Town Engineer: Signature: Located 384 Osgood Street FIRE DEPARTMENT - Temp-Dumpster on site yes no - -- — Located,at 124 Main Street - Fire Department signature/date COMMENTS 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 DANGER ZONE LITERATURE: Yes MGL Chapter 166 Section 21A —F and G min.$100-$1000 fine No Doc.Building Pennit Revised 2014 Location No. - � G� � l 1 Check # i u Date TOWN OF NORTH ANDOVER Certificate of Occupancy $ Building/Frame Permit Fee $ Foundation Permit Fee $ Other Permit Fee $ TOTAL $ 1-1/ Building Inspector — C � Cn n -0 O CD CD o0 Ai0 r. �• N -a O 0 CD CL cr VOL CD CSD O T W ou CDCD CD CL CD v cn �/ = y Cid CD ' � v 0 Z CD 0 .O'er o CD 0 CD O m x a TO cn Z O CA -11 o="o N --1 T 7 ai = CCD Cl) N O = O C CD c • C 0 CD T j 0 -n rt e -n Q. r O O S 'a B. cn T O 3 O rr Ln (D 'a N � Vl �, O. 1l o O .� n. ��N � v m Z M A -4 a o m '° n tZif V 0 � CD 13 @ CD _ 0 �O O Q CD n D z v O m 2 co O N. O O CCD D o0� < ro _� � .r O sU) hu) -0 - Z CD O h :� a n CD N O 0 O Q_ O Q— < N o tea, CDCD v W`�:rQ , . c CD s N :l r -c CD N .C -F i rt C :� co `AR, rt :� A f -' O ' C -+ c �D U(D CD CD 2 cn L :do* o API,0 a CD o v °�- CL v � N 3 T. 0 (D z co r_ O T 7 = O Dq 5 _-n 7 N O = O Z7 O m S T j A O aV S -n _S (D x O GQ S T O 3 O rr Ln (D 'a N T O a 7Z s v m D Z M A -4 m '° n tZif V 0 � °° z to 0 � 0 ° z m O A z v O m 2 * T-----rl � 0 u, Federal to 0 05440M RISE Engitteeting Rl Contractor Ragistmeon No area tW COatractnr Regtsuanae No 120079 Adivision of1hiciseh Engineering, RISE ENGINEERING 60 5hawmot Unit u92, Caston, MA 02021 CONTRACT CON 1 ISM 339.502.6333 PAX339-502-6315 M i PROGRAM pop 1 ; CMA-HLrS aa°°sagapi drmeataia"siReOsuwerataa t11n11E wet emote vtowtaRoan Ran yd Tibbet1l; (617y733.2103 0511612016 433351 am GERM a01Flil .. �.' ES ;J mum son. 245 Chestnut Soret 245 Chestnut Soret 2XIMA IXW. atanL rPt t 1 North Andovar, MA 0* S 7 sataea Mr. MIL err North Andover, MA 01945 ii;€; 1 JOB DESCRLP'x'tON AM SEALING Provide labor sod M21- tds to stud areae of your home against wrasefni. excess air leskagt. This work will be performed in concert with the use of ape W tools anddiagnostic teas to am= that your home 1011 be left with a heralthful level of air exchange and indoor air quality. Materials to be used to scat your home can iOCh* cardiac, foams and Other ptodaots. Primary areas far sealing inch* air leakage to allies, baeseeertts, attached gatagn and other wheated areas (windows ars not generally addressed.) This will require (d 0) working boors. A reduction in ctaidc feet per minute (efm) of air infiltration will occur, but the actual number ora rn is not gamrartteed At the Completion of the wwheriration work, and at no additional cost to the homeowner, a final blower door amdtor combustion safety analysis will be conducted by the subcontractor to ensure the safety of the indoor air quality. S8S0.00 DAMMINQ Provide labor and materials to inatafi a i P layer of R-38 unlaced fiberglass huts to (186) atpu re feet for damming Purposes. 5381.30 ATTIC FLAT: Provide labor and materials to install an 8' layer of R-28 Clw t Ceihdose added to (t 000) sptaoe feet of open attic space. $1.3700.00 ATTIC ACCM Provide labor and materials to inoalt (t) easily moved, insalatiagcover for the attic across foldingslik A smell Qat surface of ptyoaod vtill be stated around the opening within the attic. This wall allow the coves integral weather-stripping to restrict air leakage. $237.63 VENTILATION: Provide labor and materials to install (2) insulated exhaoat hose v*b roof mounted flapper vent to exhnw existingbrthroom fan(s). 5237.50 VENTILATION: Provide labor and materials to instait ventilation chutes in (101) rafter boys to maintain air flow $200.00 RISE EngineerkugwiU apply all appkenhha, cligft iacwtives to tbis contract. You will only be billed the Net amount. Currently, for ciigihle mcaxorm Columbia Cas offetu 75% incentive, not to exceed $2.000 per calendar year, and an incentive of 100% for the Air Seating measures up to the fust $680 and an additional $340 if savings are justified by the sudit or. For the safety and health of your home's indoor air quality, we will be conducting a biovw door e%aostic of the available air flow in your home both before the vxA is begun, and after the weatberi2atiam wok is complete. We will also conduct a fail assament of the combustion safety of your heating systema and water heater. This has a value of S90 and is at no cost to you Total allowable wwtbcrixation incentive is $3.110. S90.00 RISE Esgineerilrg FWwd ID9OW6osero RI cartracew Pbeho gm Ro elm wcoeetraeta Rem No 1900TY ' SE � RISE A eHvtateo or761etsatr FAgloexrtog EHWNEER 60 shawmat Nott 02, Caotoo, MA 02031 CV CONTRACT 3392-GM FAX339402.6345 Page 2 PROGRAM CMA4 S � ea �aar�cas curum vaam WAR aa9in 11womBA RandyTbbetts (617J33.2103 05/16/2016 435351 00002 asps eater 245 Chestnut Street Nunn .sant 245 Chestnut Street sexes aw.aeaw.s Munn cn.aamw North Andover, MA 01845 North Andover. MA 01845 JOB DESCRIMON Tocol: $3„374.45 Program hummd": $21765.84 C udomer Total: $608.6l weaaaetrmesrrowRxm� etariom-eoraaEteM wmtMreyesaradRtr�toerarar nmsar of *"Six Hundred CSgM A 6U100 Dollars $608.61 ALVJRafmato war i a e. °oime°aOWAUPAL NUMMUL Do Nor aw! 6 ZMt'F8 M 11 MiYBLMtK r^- aaroaaAM aam.tiw ea+wamw►wrnw�r�emaaneawna SIM saoai OM 30 DAM r� ��marlaroaeroto00+ae�ioor The Commonwealth of Massachusetts - Department of Industrial Accidents OfIce of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia /Cntractors/El Workers' Compensation Insurance Affidavit: BuildersoPlease Print Le Lb -11 A licant 1nlormauu�t Builders Services Group d/b/a Quality Insulation Name (Business/Organization/Individual): Address: 110 Perimeter Rd City/Sta in• Nashua NH 03063 Phone #: 603-324-1974 Are you an employer? Check the appropriate box: aa general contractor and 1 l . ✓❑ I am a employer with 100 employees (full and/or part-time).* 2. ❑ 1 am a sole proprietor or partner- ship and have no employees working for me in any capacity. [No workers' comp. insurance required.] ;. ❑ I am a homeowner doing all work myself. [No workers' comp - insurance required.] s have hired the sub -contractors listed on the attached sheet. These sub -contractors have employees and have workers' comp. insurance.' 5. ❑ We are a corporation and its officers have exercised their right of exemption per MGL c. 152. § 1(4), and we have no employees. [No workers' comp. insurance required.] Type of project (required): 6. ❑ New construction 7. ❑ Remodeling 8. ❑ Demolition 9. ❑ Building addition 10.❑ Electrical repairs or additions 11.❑ Plumbing repairs or additions 12.0 Roof repairs 13.0 Other Weatherization *Any applicant that checks box 91 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. tractors Contractors thatcheck sub-contractors this box must u svetemployees.eheyomust provide their the name workers' compf the spolicynnumber.and state whether or not those entities have employees. If th I am an employer that is providing workers' compensation insurance for my employees Below is the policy and�ob site information_ Insurance Company Name: ACE American Insurance Company WLRC 48151553 Expiration Date: 6/30/201' Policy # or Self -ins. Lic. #: � QV Job Site Address: 1, r 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, l of this'es in the form of a state Hent ay be forwOardedOto the Office of RK ORDER d a fine of up to $250.00 a day against the violator. Be advised that acopy Investigations of the DIA for insurance coverage verification. I do hereby certify under the ains and enalties of erjury that the information provided above is/true and correct rintp• 11 17 v 603-324-1974 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): . City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 1. Board of Health 2. Building Department 3 6. Other Contact Person: Phone #: ffice oW�onsumer �s end usuiess e o g atlon 10 Park Plaza - Suite 5170 Foston, Massachusetts 02116 Home Improvemazontractor Registration BUILDER SERVICES GROUP, IN RICHARD SCHWARTZ 260 JIMMY ANN DRIVE DAYTONA BEACH, FL 32114 SCA 1 8 20M-OU/1 �� C.rir�»urruue� o�Cii2'ax:rrc�iiuelG of Consumer Affairs & Business Regulation BUILDER RICHARD SCHWAR• u'' 110 PERIMETER RD`. NASHUA, NH 03063 COIgTRACTOR Type: Supplement Card Undersecretary Registration: 179141 Type: Supplement Card Expiration: 6!26!2018 to Address and return card. Mark reason for change. U—ddress ❑Renewal ❑ Employment J Lost Card License or registration valid for individual use only before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, MA 02116 Not valid without signature 144 ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 10/25/2016 1 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 have ADDITIONAL INSURED provisions or 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 Aon Risk Services Central, Inc. Southfield MI office CONTACT NAME: PHONE (866) 283-7122 FAX (800) 363-0105 (A/C. No. Ent): (A/C. No.): E-MAIL ADDRESS: 3000 Town Center Suite 3000 Southfield MI 48075 USA MWZY INSURER(S) AFFORDING COVERAGE NAIC # INSURED INSURER A: Old Republic Insurance Company 24147 TrUTeam Builder Services Group, Inc. d/b/a Quality Insulation A Topeuild Company INSURER B: ACE American Insurance Company 22667 INSURER C: 110 Perimeter Rd Nashua NH 03063 USA INSURER D: INSURER E: INSURER F: MED EXP (Any one person) $25,000 COVERAGES CERTIFICATE NUMBER: 570064230317 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDD MMIDD LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY 1 EACH OCCURRENCE $2,000,000' CLAIMS -MADE❑ OCCUR DAM GE TO RENTED $2,000,000 PREMISES Ea occurrence MED EXP (Any one person) $25,000 PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 X POLICY ❑ PRO —] LOC JECT PRODUCTS - COMP/OP AGG $4,000,000 OTHER: A AUTOMOBILE LIABILITY MwTB 307519 06/30/201606/30/2017 COMBINED SINGLE LIMIT $5,000,000 Ea accident BODILY INJURY ( Per person) X ANY AUTO OWNED SCHEDULED BODILY INJURY (Per accident) AUTOS ONLY AUTOS X HIRED AUTOS X NON -OWNED ONLY AUTOS ONLY PROPERTY DAMAGE Per accident UMBRELLA LIAB EACH OCCURRENCE HOCCUR EXCESS LIAB CLAIMS -MADE AGGREGATE DED RETENTION B B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR / PARTNER / EXECUTIVE OFFICER/MEMBER EXCLUDED, NIA WLRC47860180 All Other States SCFC47860209 06/30/2016 06/30/2016 06/30/2017 06/30/2017 X PER OTH- STATUTE I ER E.L. EACH ACCIDENT $1,000,000 E.L. DISEASE -EA EMPLOYEE $1,000,000 (Mandatory in NH) WI Only If yes, describe under DESCRIPTION OF OPERATIONS below E.L. DISEASE -POLICY LIMIT $1,000,000 DESCRIPTION OF OPERATIONS / LOCATIONS I VEHICLES (ACORD 101, Additional Remarks Schedule, maybe attached if more space is required) 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. Town Of North Andover AUTHORIZED REPRESENTATIVE Building Department Attn: Donald Belanger 1600 Osgood Street, Suite 2035 North Andover MA 01845 USA ©1988-2015 ACORD CORPORATION. All rights reserved. ACORD 25 (2016/03) The ACORD name and logo are registered marks of ACORD u> m w c d 9 d 0 2 n O 2 d V w d V Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-105992 Construction Supervisor Specialty R1CINARD SCHWARTZ '�•�' M 260 JIMMY ANN DRIVE - DAYTONABEACH FL 32114 t Expiration: CoMmissioner 0W612018 Construction Supervisor Specialty Restricted to: CSSL-IC - Insulation Contractor Failure to.possess a.currentedition.of the. Massachusetts State Building Code Is cause for revocation of this license. DPS Licensing Information visit: WWW.MASS.GOV/DPS