HomeMy WebLinkAboutBuilding Permit # 3/2/2015 BUILDING PERMIT of "°oT"
TOWN OF NORTH ANDOVER 0�'
APPLICATION FOR PLAN EXAMINATION
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Permit No#: Date Received
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IMPORTANT:Applicant must complete all items on this page
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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 ❑ Other
0/1-1 V1101111,
/r❑ Septic; ❑Well' , , , , /, '/, ❑ Food Iain ❑;Wetlands / ❑ Watershed,D�stnc
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DESCRIPTION OF WORK TO BE PERFORMED:
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Identification- Please Type or Print Clearly'
OWNER: Name: Phone:
Address: ` J� �'f /'j't- o q
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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: $ / �-7 FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not knue,occess to the guaranty fund
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Signature of Agent/Own ' i,gnature of contr4
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NORT"
Town ofI� n aver
�.o��th ver, Mass,
coc«ic"t ICK "1
�11,Qs°4Areo J.p��,�5
L) BOARD OF HEALTH
Food/Kitchen
PER [ T D Septic System
THIS CERTIFIES THAT ............... ......................, BUILDING INSPECTOR
. .. ..... .... ........ ........
has permission to erect buildings on �. Foundation
......................... Rough
to be occupied as ... ...� .. �... ...�..„!!��1���Nw.................. Chimney
provided that the person accepfiing this per ' shall 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 CONSTRUC TS Rough
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.
un. next step livi n
home energy solutions
This agreement is made by and among
Next Step Living,Inc.("NSL")
Dan Fay 21 Drydock Avenue,2nd floor
215 Hickory Hill Rd pBoston,MA 02210
hone: (866)867-8729
North Andover, MA 01845
Site ID: A773147
20-Jan-15
1. DESCRIPTION OF WORK TO BE PERFORMED
N$L will perform or cause to be performed the following work on the customer's address above,in s 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:
Description,
Air Sealing Recommendations $450.00
Work Location: Attic Flat
Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 6 $75.00 Hr $450.00
Weatherization Recommendations •
Work Location: Attic Flat
Attic Stair Cover Thermal Barrier with Carpentry 1 $237.65 Each $237.65
Damming 60 $2.05 Lnft $123.00
Propavent 2'or 4' 45 $2.00 Each $90.00
Attic Floor Open Blow Cellulose 4" 696 $1,08 sgft $751.68
Work Location: Wall
Insulate Wall From Interior With 4"Dense Pack Cellulose 138 $1.85 sqft $255.30
Initial Investment: $1,907.63
100%Airsealing Incentive upto Program Max $450.00
75%Weatherization Incentive up to Program Max $1,093.23
Total . 1
Estimated Annual Energy Savings from the Above Improvements $215.00
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: $264.40
-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.
C
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Customer Signature Dat
20 Jan 2015 William Calder
NSL Signature Date Name of NSL Representative A773147
The Terms of this Agreement are contained on both sides of this page
Next Step Living-21 Drydock Avenue-2nd floor o Boston,MA 02210 0(866)867-8729 o inquiry@nextsteplivinginc.com o www.nextstepliving.com
TERMS OF AGREEMENT
3. PROPOSED START DATE AND COMPLETION SCHEDULE
NSL will contact customer to schedule the Work at a mutually agreeable time,subject to the availability of subcontractors or materials,or to delays
attributable to the weather or other events beyond NSL's control.
4. CONTRACTOR REGISTRATION
Massachusetts law requires home improvement contractors and subcontractors to be registered with the Director of Home Improvement Contractor
Registration. You may inquire about contractor registration by writing to Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite
5170,Boston,MA 02116.617.973-8700.
5. PERMITS
NSL will obtain any necessary permits as the Customers agent. Customers who secure their own permits or deal with an unregistered contractor will be
excluded from the Guaranty Fund provisions of the Home Improvement Contractor Law.
6. PERFORMANCE OF THE WORK AND CHANGES.
6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer
6.2 This Agreement may be supplemented,amended,or modified only by the mutual agreement of the parties.No supplement,amendment,or
modification of this Agreement shall be binding unless it is in writing and signed by all parties.
6.3 At times,our weatherization team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety concern
for residents.Such concerns can include but are not limited to ventilation,potentially hazardous materials such as mold or asbestos,or structural
concerns. In the case of health or safety concerns being identified,NSL reserves the right,per section 9.2 of this contract,to communicate concerns to
the Customer and halt work until such concerns have been addressed.
6.4 The rebates and incentives available from the Mass Save®Home Energy Services Program and amounts due from the Customer are based on the
best estimate of the situation in the structure by the NSL home energy advisor. However,at times our weatherization team discovers situations in the
home during the course of the Work that impact the availability of rebates and incentives from the Mass Save Program. In such situations,NSL will
communicate such changes to the Customer,including any impact on amount the Customer would be expected to pay for the Work. The Customer will
have the option to remove from the Contract the work elements that need adjustment,or set up a separate contract for performing the adjusted work.
6.5 NSL represents and warrants to the Customer that(a)the materials and equipment fumished under this Agreement will be of good quality and new,
(b)that the Work will be free from defects,and(c)that the Work will conform with the description of the Work described in Paragraph 1.
7. INSURANCE AND REGISTRATION
NSL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration(No:162111)and the necessary insurance
required by applicable law and normally maintained by prudent contractors in NSL's field,including,but not limited to,Workers Compensation Insurance
for all employees who will perform the Work.
8. QUALITY OF WORK.
NSL agrees that the Work will be performed in a good and workmanlike manner,and that NSL will repair and replace,at its own expense,and promptly
upon Customer's request,any defects in workmanship and materials provided by NSL which appear up to(1)year after completion of the Work or within
any longer period as permitted or required under applicable law,provided NSL has received final payment as provided herein.
9. PRE-EXISTING CONDITIONS&PROPERTY PROTECTION
9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions. These conditions
include but are not limited to poorly fastened or broken drywall,moisture damage,non-code construction,cracked or fragile siding or shingles,old pipes
and fittings,rotting wood,etc.
9.2 NSL reserves the right not to perform Work upon the discovery of asbestos,mold,or any other potential health risk to the Customer. In this event,the
Customer is responsible for remedying the at-risk situation,including any necessary removal of hazardous materials and all bills for services to date shall
be paid immediately. Work cannot resume until remediation is complete.
9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customers responsibility to remove or protect,including dust
protection,any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property
not properly protected prior to the commencement of the Work.
10. GENERAL PROVISIONS.
10.1 NSL reserves the right, the extent permitted by applicable law,to have,file or maintain a mechanic's or material men's lien,or to file a notice of
intention to lien,and to take any other steps to perfect and enforce such a lien,if Customer fails to pay NSL as provided herein.
10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts.
10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this
Agreement,they are not relying on any representations,warranties or terms other than as expressly contained herein. This Agreement supersedes all
prior agreements between the Customer and Contractor and may not be altered absent a subsequent written agreement signed by both parties.
You may cancel this Agreement if it has been signed at a place other than the NSL's normal place of business,provided you notify NSL in writing at its
main office or branch office 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. See the attached notice of cancellation form for an explanation of this right.
11. ENERGY BENEFITS.
The Sponsoring Utility Company(the Utility)is entitled to 100%of the energy benefits associated with all Energy Conservation Measures,excluding the
value of energy cost savings by the Customer,but including all rights to all associated ISO-NE Energy,Capacity and Reserves Products.NSL agrees to
provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products.
12. NOTICE CONCERNING SPONSORSHIP.
Customer understands and acknowledges that NSL is not an agent,vendor or sub-vendor of The Sponsoring Utility Company(the Utility)with respect to
the installation of an energy efficiency measures.In the event of the failure of an energy conservation device to perform as expected,Customers sole
recourse is to Contractor and not to Conservation Services Group(CSG)or to the Utility.The Utility and its operating companies shall not maintain,
remove or perform any work whatsoever on the energy conservation measures installed.
Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have
consented for Contractor to install the proposed energy conservation measures.
Customer agrees that it shall not hold CSG,the Utility,their affiliates or operating companies liable for Contractors to perform its obligations under this
agreement,for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by Contractor or for any and all
damages to property or injury to persons caused by the energy conservation measures.
13. LIMITED TIME OFFER.
The prices and incentive offered in this Contract are subject to change in accordance with The Sponsoring Utility Company Mass Save Home Energy
Services Program offers.
14. CONTRACT CANCELLATION Under Massachusetts law,you may cancel this agreement if it has been signed by a party thereto at a
place other than an address of the seller,which maybe his main office or a branch thereof,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.
i
Mass Save Planview Diagram
Customer. NIV, Baju Advisor Name: 1,/ CG(
Address - r` !�*(� Advisor Number:
Town d o V�� Any limitations to access by truck?
Site ID ���?�j AOVLf-
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0I'I��� Consumer l� �a* ani tusiness I�.eg�lati®n
10 Park Plaza o Site 5 170
Bosttong Massachusetts 02116
Home Improvement Contractor Registration
Registration: 162111
Type: Supplement.Card
Expiration: 1/14/2017
NEXT STEP LIVING INC.
ROGER OUELLETTE
21 ®RYD®CK AVE. 2TH FL
BOSTON, MA 0221
Update Address and return card.Mark reason for change.
Address [] Renewal E] Fmployment Lost Lard
office of Consumer Affairs Gia Business Regulation License or registration valid for individul use only
before the,expiration date. If found return toe
HOME IMPROVEMENT CONTRACTOR
office of(Consumer Affairs and Business Regulation
Registration.iatsatiaro: 962919 Type: 10 Park Plaza-Suite 5170
Expiration: 1114/2017 Supplement Card Boston,MA 02116
NEXT STEP LIVING INC.
ROGER OUELLETTE
21 DRYDOCK AVE.2TH Fl
Not'valid without signature
BOSTON:MA 02210 Uadersee,retnry
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.1jure to pwsess a current edition of the Mi assachusems
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For ops uicensing information vidt:
The Commonwealth ofl assaehusetts
Department of IndustrialAccidents
W ®fee of InvesUgations
a I Congress Street, Suite 100
�< Boston,MA 02114-2017
www massogov/dia
Workers, Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers
A��Iflcant Information
Please Print Ee�ibl�
Next Step Living
Mame (Business/Organization/Individual)o
Address: 21 ®rydock Ave
City/State/Zip
Boston, MA 02210 Photle#:(066)067-0729
Are you an enmployer?Check the appropriate box*, 'hype of project(required):
050 4, ® I am a general contractor and 1 0 New construction
1° ] I am a employer with have hired the subcontractors
employees (full and/or part-time)." listed on the attached sheet. 7, E]Remodeling
2.® 1 am a sole proprietor or partner- These subcontractors have 8, ®Demolition
ship and have no employees employees and have workers'
working for me in any capacity. comp.insurance. 9, ®Building addition
[No workers' comp.insurance We are a corporation and its 10.[]Electrical repairs or additions
required.] officers have exercised their 11.®Plumbing repairs or additions
3.0 1 am a homeowner doing all work right of exemption per MGL
myself. [No workers' comp. � p 12,C]Roof repairs
c. 152, §1(4),and we have no 13.®Other Insulation
insurance required.] t employees. [No workers'
L
comp.insurance required-]
*Any applicant tha,,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 aflida,-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 Entities have
employees. if the sub-contractors have employees,they must provide their workers'comp.policy number.
,am m an employer that is providing workers,compensation insurance for►►ay omplayees° Below is the policy anal fob site
1►►f®r►►iati®►►°
Insurance Company Name: A.I.M NiutU81 Insurance Company _.._..
AWC-400-7030025-2014A Expiration Date: 9/30/16
Policy#or Self-ins. Lic.M
Job Site Address: City/State/dip:
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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for Insurance coverageV/P tion.
17 ®hcreby cc►�i�y under the pains a�pe i�s pc►,�u►'y that the in ormadon provided above is true areal correct
Date: 1 /
Si ature:
�P• � e
Phone#:
E
®rely° Do►rot write in this area,to be completed by city or town®ficial°
ne Permit/i,icense.#
hority(circle one):
Health 2°building Department 3°City/Town Clerk 4°Electrical inspector 5°Plumbing Inspector
Phone#°rsom
NEATS-1 OP ID:EL
'44C<30I CERTIFICATE OF LIABILITY INSURANCE F DATE(MMiDDffYVV)
kaI 1 10101/2014
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONI-Y AND CONrER5 No RirmTq UPON THV oVIRTWIGATIE HOLDER.THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ASTER THE COVERAGE AFFORDED By THE POLICIES
BELOW THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRA(U BETWEEN THE ISSUING INSURER(S), AMTHORIgEp
ROP. pSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
'P Jorsed. it SUIBROGATION 11,J,WA �Log$tq
NT. V qenificate holder is an ADDITIONAL INSURED,the policy(jes)must be enr QU
. if the
I�M4+PRTAZT: If the
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the terms and conditions of the policy,certain pollclw may require kin A statement oil this certificate(1008'1 confer rights to jk�
certificate holder in lieu of such endorsement(s).CONTACT
PRODUCER NAME: Erin Lyons
McLatighl!"I surance Agency PHONE, 781-6'65-2775
820 Lynn felp, ParkWlly (A/C,No ,,):
Melrose,MA 02176 AUMD"RLESS:
John E.McLaughlin Jr. INSURER(S)AFFORDING COVERAGE NAIL fi
ImsuRER A:Nautilus Insurance
IMSUR(Ti iving,Inc. jNsuRER 0:Commerce Insurance Company 34754
2'ji lry-d-o"Ick Avenue,2nd Floor INSURER c:A.I.M.Mutual Insurance Co.
Boston,MA 02210 INSURER U:AXIS Insurance Company 15610
INSURER r:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: —
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW W HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY ngRwp
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT T I's
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.
h-K I NDDL 0BR POLICY EFF POLICY EXP
IINS1. TYPE OF INSURANCE = WVD POLICY NUMBER MMI (MMIDDIPOM LIMITS
LT — — _
A X COMMERCIALGENEPLUABILITV EACH OCCURRENCE $
F—W-1DAMAGE To RTErO $
CLAIMS-MADE OCCUR -PREMISES(Ea ocENcUence) 100,000
MED EXP(Any one person)
PENSONAL&ADV INJURY $
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
POLICY jECT LOC PRODUCTS-COMPIOP AGG $
COMBINED SINGLE LIMIT —7 A'9'a 0 a
AUjOMOBILE LI (Ea accident)
— ANY AUTO 09/3012016 09/30/2015 BODILY INJURY(Per pe I rson)
— ALL OWNED x SCHEDULED BODILY INJURY(Per accident)
AUTO AUTOS NON-OWNED PROPERTYI
_R_
HIRED AUTOS — AUTOS Per accident
UMBRELLA 1311 OCCUR EACH OCCURRENCE
GXCEGG LIAB CLAIMS-MADE AGGREGATE
DED RETENTION$
wo KERS COMPENSATION SPER TATUTE ER
AND EMPLOYERS!LIABILITY YIN TO BE ISSUED BY CARRIER 09/3012014 Q/3012015 E.L.EACH ACCIDENT
C ANY PROPRIETOR/PARTNER/EXECUTIVE
OFFICERIMEMBER EYCLUDED? El NIA E.L.DISEASE-EA EMPLOYEE $ 500,000
(Mandatory in NH)
If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS below
FDESCRIPTION OF OPERATIONS I LOCATIONS I 110-11CLES(ACORD 101,Additional PerI Schedule,may he aftachad if more space is required)
XhqFOI"I ON ONLY
CERTIFICATE HOLDER CANCELLATION
INFO-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPUZATI10N DATE THEREOF, NOTICE WILL BE DELIVERED IN
For Infor=tl0n Only ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
YZI>T
1988-2014 ACORD CORPORATION. All rights reserved.
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ACORD 25(201 41(11) qre 9f ACOR%