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HomeMy WebLinkAboutBuilding Permit # 3/2/2015 BUILDING PERMIT of"°RT b�ti TOWN OF NORTH ANDOVER0� APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received �,ys RgrEo P4a��5 4; sA Date Issued:- ✓'I cHus� IMPORTANT Applicant must complete all items on this page , / icy,,., ,yi/ /, ��l ✓ /�/�/��/�� ,, ✓ /, ,..,.. .,/// / ,/ �� ,./, / ,/�/ ...,,cc ,i rr� ,.rirr �i e rr ri a,�r, r r ,. J TYPE OF IMPROVEMENT PROPOSED USE Residential Nan- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑Septic,!/❑Well /r/ C7rFfoad Iain ,❑,Wetlandsr //// ❑;;Water shed District ,,; ` r✓i�, ,,,,rrr / // r. /r„r / /r,. / r. , ,/ ,r, r / ,,., / „ii rrrr ./r///�,,, ���,%�r,ic/lam//,/rr//,,,,/,� „i i,,,,,ri//„rr,�%rr//lc,,,,, ,,,,✓c�/,i/%�/e, /�/////�i/ao/�.r�%�r/„�i//r��/ri�J,;,�%%i////,�,,,,/%,�,,r r,�/i�,, DESCRIPTION OF WORK TO BE PERFORMED: o, -i- lno torto Identification- Please Type or Print Clearly OWNER: Name: ►I1 M I Phone: Address: �r I ,;r//lir-,O,-, / / ”./sir r,, ! �✓ � ,/// /1 Qne / G.J/„ ,,/r/„o-,::/ �,,,,,i:. li„ ,,,,/%,;,/i,,,r,�/,al,,, 1„/ %%fi„/„ U / r; / i„ ,,,r/, /,r.r / / / %r//i, a,,, / /,,,,rrr , it/,// ✓/i ,, / r,, ai r r, r r r,--„ r / //i r /rrr ri � / ✓ / / r r /� , „, ,r,• ./ „c, �/, ir, %/,/rrrr /!./r,,,, r / .., r /� � /r ri// .r „� o o r /r i/ � r / 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: $_'e chi I FEE: $ � J Check No.: Receipt No.: r NOTE: Persons contracting with e i ere ontractors do not have access to the a a Signature of Agent/Owner ignature of contractor NO R Tl-� Town � y : �. ¢6 � Bdover o _ 0 - - 1 0 s y � ae � o�h ver, Mass, COC MICI{EWICK IV y1. X11,9 p°RAreo S � r BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT .....PERMIT .... ....... ............... ............... BUILDING INSPECTOR has permission to erect .. ..... ....... buil in s on Foundation ... . *41 � Rough to be occupied as .........h ....�. . �.. ..... .......1.1� . . . . ....M!............................... Chimney provided that the person accepting this permit shal in every respect conform to the terms of the application Final on file in this office, and to the provisions of the Co es 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 TH ELECTRICAL INSPECTOR UNLESS CONSTRUCTI S Rough 1 Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. Lion) next step Living, home energy solutions This agreement is made by and among Next Step Living,Inc.("NSL") Jinming Chen 21 Drydock Avenue,2nd floor 49 Old Village Ln Boston,MA 02210 North Andover,MA 01845 phone: (866)867-8729 Site ID: 411459 15-Jan-15 1. DESCRIPTION OF WORK TO BE PERFORMED NSL will perform or cause to be performed the following work on the customer's address above,in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference: 0• • ion SealingQuantity Investment Air Recommendations $975.00 Work Location: Attic Flat Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 10 $75.00 Hr $750.00 Work Location: Doors Door Weatherstripping w/Sweep 3 $75.00 Each $225.00 Weatherization Work Location: Attic Flat Attic Stair Cover Thermal Barrier with Carpentry 1 $237.65 Each $237.65 Initial Investment: $1,2 12.6 E! 100%Airsealing Incentive up to Program Max $600.00 75'%Weatherization Incentive up to Program Max $178.24 Air Sealing Remainder as 75%Weatherization Incentive up to Program Max $281.25 Total Net Investment: $153.16 Estimated Annual Energy Savings from the Above Improvements $100:00 2. PAYMENT: CUSTOMER agrees to pay NSL for the work as follows: Payment#1: $100.00 -Credit Card or E-check deposit is due at the time the Work is scheduled. Required payment information will be collected over the phone by a customer service representative at the time of scheduling. Deposit is not to exceed 1/3 of the total retail costs. (Note:Mastercard,Visa,and Discover accepted) Additional Payments and Final Invoice: $53.16 -Additional payments for the Work shall be due upon completion of the Work If the final invoice is being paid by check,credit card information will still be required at the time of scheduling. Notify the customer service representative that you are paying by check and your card will not be charged unless we fail to receive payment within 5 days of invoice. t L4- �(s Customer Signature date (' C 15 Jan 2015 Leonard Earnshaw NSL Signature Date Name of NSL Representative A772856 The Terms of this Agreement are contained on both sides of this page Next Step Living-21 Drydock Avenue.2nd floor.Boston,MA 02210.(866)867-8729.inquiry@nextsteplivinginc.com o www.nextstepliving.com Mass Save Planview Diagram Customer ` Advisor Name: ,� �..g�r,w Address (�l (� Vj o , L- / Advisor Number: oC-7�S- Town A y/k„&„ Any limitations to access by truck? Site ID NOTES 4 See cen Zko r 14'J dTfice of Consumer Affair and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 0211116 Home Improvement Contractor Registration Registration: 162111 Type: Supplement Card Expiration: 1/14/2017 NE®CT STEP LIVING INC. ROGEROUELLETTE 21 ®RYD®CK AVE. 2TH FL BOSTON, btliA 02210 [Update Address and return card.Mark reason for change- Address [:] Renewal [:] !Employment Lost Card office of Consumer!affairs&Business Regulation License or registration valid for individnl use only ®itliE IMPROVEMENT CONTRACTOR before the expiration date. If found return to: office of Consumer Affairs and Business Regulation Registration: 162111 Type: 10 Park Plaza-Suite 5170 Expiration: 1114/2017 Supplement Card Boston,MA 02116: NERT STEP L)V)NG WC. ROGER OUELLETTE 21 DRYDOCK AVE.2TN FL — BOSTON:MA 02210 Not valid without signature q pf, i t r mo, ROGRR A OVE, SS SjrORE, AKM wameRK RJ-1 NOW wil Reeteocted TO: CSSWC InsulOtiOn CGntr@C`oF Failure TO KOM a current edition OTthG NIOS59chuseEls state Building Code is Cause for rev"8�10"of this"C'P-nse. For DPS Liconsing ifftrm,00-fl @99@9 e tqvjw ,q@SS.Gov/DPS The Commonwealth of Maassaachusetts Department of Industr°laal Accidents W Office of Investigations a b D Congress Street, Suite 100 Boston,CdA 02114-2017 fci v��y Vu'9wwomass.gov1dia Workers' Compensation insurance Affidavit: builders/Contractors/Electrician/Plumbers Applicant Information Please Print E gwy Name (Business/organization/Individual) Next Step Loving Address. 21 Drydock Ave City/Stale/Zip: Boston, MA102210 Phone#o(066)067-6729 Are you an employer?Check the appropriate box; Type of project(required): 1. I am a employer with 360 4. ® I am a general contractor and I New contraction hve hired the subcontractors employees(full and/or part�time)."� aRemodelin 2.® I am a sole proprietor or partner listed on the attached sheet. �� ® g These subcontractors have 8. ®Demolition ship and have no employees employees and have workers' working for me in any capacity. comp.insurance.l 9. Building addition [No workers' comp.insurance 10. Electrical repairs or additions required.] �. ® fie are a corporation and its l atm a homeowner doing all work officers have exercised their 11.®Plumbing repairs or additions myself, [No workers' comp. right of exemption per MGL12,®Roof repairs insurance required.]t c. 152, §1(4),and we have noL13.®Other Instllatlon _ 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 aflidal'it 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 ontities have employees. if the sub-contractors have employees,they must provide their workers'comp.policy number. D urn an employer that is providing worker's'compensation insurancefor my employees. Below is the policy nand job site information. Insurance Company Flame: A.LM N1utUal Insurance Company Policy#or Self-ins. 1✓ic.#: AU11C-40047030026-2014A Expiration Date: 9/30/16 Job Site Address: 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 MO1 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of lnvestigations of the DIA for insurance coverage fi tion. IT do hereby certify under thepains aandpen °es perjury that the in ormaadonprovided above is true aaa�d correct Si afore: Date: I / Phone#: ®f�ciaal use only. D o not write in this area,to be completed by city or'town 0 Iciul° City or Town: Permit/l.�icernse.# Issuing Authority(circle one)* 1°Board of Health 2°Building Department 3°City/Town Clerk 4°Electrical Inspector 5°Plumbing Inspector 6°®finer Contact Person> Phone#o OP 10:EL CERTIFICATE F LIABILITY INSURANCE 10101/2014®1091CE DATE01/DffVM �014�� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 0%Y AND CONFER$ NO RIGHT)UPON THU 09ftTIVjrATr HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ASTER THE COVERAGE AFFORDED BY THE P®LIr'ES B§L13 '. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AL-!Ty®W= RSP �SENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER, 9�P DANT If the certificate holier is an ADDITIOML INSURED,ties p®lit y(ies)must ht eslEl�rSed. If SUBR®DATION I 19. -P, the�erm9S ani c�nditierss of'the Policy,certain ®Iiciev rn rega 0 an endorser'"I, A statement On this Certificate ERoes uaot confer rights to 9f�� cerlifio�te holder III Ilea of selch end, emrentds). coNTACT PRODUCER NAME: Erin Lyon McLaLlghli"I sufance Agency PHONE 761=665=277 mac,we:���=66�=h� 820 Lynn fells ParkwpyE-MAIL E:a Melrose,MA 02176 ADDRESS: John E.McLaughl'rrr elr. INSURERS)AFFORDING COVERAGE NAIL tY INSURERA:NBUMUS lrn"ranee INSURED Nexj Step�iVing,W. INsuRER 0:GornmerCe Insurance Company 3475 23 Drydo kAVenue,2nd FI®®r INJURE,,c.A.I.M.Mutual Insu ance Co. B®st®n,MA 02210 INSURERD: 1S Insurance Company 16616 INSURER r: 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 ThIE POLICY P�RI9P INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T}N{IS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSUP.ANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, TR RJ WD—DL BR POL CY EFF POLICY rXP LIMITS iYPEOFINSURANCE !Sb POLICYNUMSE[ MMDIYYYY MMIDD A Y, COMMERCIAL GEP)EFALLIABILITY DAMAGETORRENTED $ �,�®®,®®0 E'I�'P203��'I9S=`�� ��'I 0/207 ©9I3BI203� DA AGES(Ea CLAIMS-MADE '% OCCUR PREMISES(Ea occurrence $ �QO,®01I MED EXP(Anyone person) S 01900 PERSONAL&ADV INJURY S 1109140 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ S�eOff®,A�II POLICY❑jECT LOC PRODUCTS-COMP/OPAGG $ OTHER: COMBINED SINGLE LIMIT AUTOMOBILE LIASIbITY Ea accident $ I,Q®p,llpll ANY AUTO 941�M[SGG�IZDM 09/310/2014 69/3012015 BODILY INJURY(Per person) S ALL OWNED x SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAS X OCCUR EACH OCCURRENCE $ 5,006 00 ® EXCESS LIAB CLAIMS-MADE EI�UeBHeG'.50`I2®� 09/3012033 09/3012095 AGGREGATE $ DEDRETENTION S WORKERS COMPENSATION PER ERH AND EMPLOYERS'LIABILITY Y/N600,000 ANY PROPRIETOR/PARTNER/EXECUTIVET BE ISSUED BY CARRIER 09/3r�12093 QI(f/3®/209 E.L.EACH ACCIDEN I $ N/A OFFICERWEMSER EXCLUDED? E.L.DISEASE-EA EMPLOYEE $ 500,000 (Mandatory In NN) Ifyes,describe under E.L.DISEASE-POLICY LIMIT S 6110,000 DESCRIPTION OF OPEP.ATIONS below DESCRIPTION OF OPEPATIONS I LOCATIONS I VCI-11CLES(ACORD 901,Additional Ioemarl:S Schedule,cony be attachod If morn space is required) 707 3MORR'LA'IOLN OLMT- CERTIFICATE HOLDER CANCELLATION INFO=0� SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL. BE DELIVERED IN For Information Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ©9960=2093 ACORD CORPORATION. All rights reserved. ACORD 25(2014191) Thp APPRO 9w r" OPop&fe rgg14t,r��k 4��9f AC®R