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Home My WebLink AboutBuilding Permit # 3/4/2015 i i BUILDING PERMIT t�Eu NORTH 16�tio f 4 TOWN OF NORTH ANDOVER 0 - APPLICATION FOR PLAN EXAMINATION A 1 n � Permit No#: � � Date Received �,9 °RArso ,� SSACHUS� Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION � 1 I . r xr r r x r � r�r r ;r Prinf ' 100 Year Structure MAP PARCEL ZONING DISTRICT Historic District es no ;Machine Shop Village ;„ , es ' no 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 t- 0 , 1Nell ❑ Floodplain 0 UVetlands ❑.Watershed Distract- CI ewe' DESCRIPTION DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: k./I' . i 1� )j I0- c) Phone: Address: I k r �i CorltracfQr Namei ne. ; MEW'', Fp- Zak Superuisor'sC,onstruction License � � �t''f Exp Date �� /�� r. Home Improvement License � �� Exp Date ,. c ,.• 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: FEE: $ 'U-- Check -- Check No.: a f Receipt No.: `� NOTE: Persons contracting wit r red contractors do not have access to the a nd ' I Signature of Agent/Owner Signature of contractor AID NORTH town ot nduveit ® y.: 0% ® h ®ver, Mass, OII o�i 6� �' O � �w�c[ 1• COCKIGIEWICK V A°RATeD r4a,�g9 S UMonk BOARD OF HEALTH Food/Kitchen P. ER IT T Lu Septic System THIS CERTIFIES THAT ......... .. �..AkkN ..... �A %��..................................................... BUILDING INSPECTOR .. ............. Foundation has permission to erect.......................... buildings on ..... .................................. .............. e Rough to be occupied as .......rV ..... 1n .... ..... v . ........................................ Chimney provided that the person accepting this permitII 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 COSTRUCTI ST 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. jAl je , 0i4c'e o er Affai and Business Regulation 10 Pari Plaza o Suite 70 Foston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 162111 Type: Supplement Card Expiration: 1/14/2017 NEXT STEP LIVING INC. ROGER OUELLETTE 21 ®RYDOCK AVE. 2TH FL BOSTON, MA 02210 Update Address and return card.[dark reason for change. F] Address 0 Renewal [] Employment F] Lost Card :. Offlee of Consumer Affairs&Business Regulation License or registration valid for individul use only tbefore the expiration date. WT found return to 9 .M®6if1E 9(1f1P63aDllEiUlE6t9T CONTRACTOR Office of Consumer Affairs and Business Regulation Registration: 162911 Type: 14 Park Plaza-Suite`517D ' Expiration: 111412017 Supplement Card Boston,MA 02116„ ;,)E>Fl STEP UMNG)NG. ROGER OUELLETTE 21 DRYDOCK AVE.2TH FL BOSTON.MA 02210Underseexetary �ovvalid without signature Massachusetts Deparin,)eM o� P�,,ibhc- Satety Board of BWW�ng ��?egWa�mns and Staridards CSS[ =102811 ROGER A OVEL14EY 55 STANMORE WaFmck ICI 029w) (OW1.312016 Restvicted To: CSSWC-Insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For OPS Licensing information Ask- WWWAMS&GOVOPS WEXTS-1i UP W:EL DATE(MMIDDAYM CERTIFICATE OF LIABILITY INSURANCE 101/20114 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 0%y AND CQNrER$ t40 r.IGIJT4 VPUN THV 0MIFIGATP "OLDER.THIS CERTIFICATE DUES NOT AFFIRMATIVELY UP, NEGATIVELY AMEND, HK END OR All ER THE 60VERAGE AFFORDED 13Y THE POL101158 BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURERM, AUTHORIZED 119PIPSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 11014C)IRTANT: If the Vertificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION 14 WAIIF95-559—weii iq the terms and conditions of the policy,certain policies may require an endorsement, A statement an this certificate does not confer rights to(hp certificate holder In lieu of such endorsement(s). PRODUCER CONTACT NAME: Erin Lyons MQLamghIIvj Igsuranco Agency PHONE. AX_ I , 828 Lynn fells Parkwpy (A/C.No E,,1:781-665-2775 (An No):781 Melrose,MA 02176 EMAIL John E.McLaughlin Jr. ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL 3 INSURER A:WEIIIIHIUS Insurance INSURED Next Stop RIvinq,Inc. iNsumR E;:Commerce Insurance Company 34754 21 DrydIck Avenue,2nd Floor INSURER Boston,MA 02210 c-A.I.M.Mutual Insurance Co. INSURE DAMS Insurance Company 15610 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 POLICY7%QP INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIG T is CERTIFICAT E 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 DO UBO POLICY EFF POLICY EXP LTR TYPEOFINSURANCE INSO WVO POLICY NUMBER 19mmar—rMM-L IMN21Y/nm LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 100,000 DAMAGE TO RENTED CLAIMS-MADE OCCUR ECP2010198.12 09/3012014 09/3012015 PREMISES(Ea occurrence) $ 190,006 MED EXP(Any one person) $ %900 PERSONAL&ADV INJURY $ I'Dog,opq GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ P"Q001000 POLICY 7 PRO- JECT F-1 LOG PRODUCTS-COMPIOP AGG M0111100 OTHER: $ AUVOMOBILE LIA816 (CEOM, 'n)IBINESINGLE LIMIT B ANY AUTO 14MMBGKK13M 09130/2014 09/30/2015 BODILY INJURY(Per person) $ ALL OWNED ) SCHEDULEDSCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident) UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 69000 Q0 EXCESS LIAB CLAIMS-MADE E1,11.1783547012014 09/30/2014 09/30/2015 AGGREGATE $ DED RETENTION H- OT WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YIN X STATUTE ER" C ANY PROPRIETOR/PARTNERIEXECUTIVE TO BE ISSUED BY CARRIER 09/3012014 00/30/2015 E.L.EACH ACCIDENT $ 500,000 I. OFFICERIMEMBER EXCLUDED? FINIA (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 If yes,describe under — DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached Ir mor.space Is required) rOR INFOPMATION 014LY CERTIFICATE HOLDER CANCELLATION INFO-01 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION 13ATE THEREOF, NOTICE WILL BE DELIVERED IN For Informati®n Only ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ou— 512ROAv_&a @'1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014191) X610 A6QRP qqMR ffirjq jqqPiq1,q rqqj,�jffqj W q.f ACORR, The C01111110"Wealth ofmassuchasefi& Department ofludustrialAccidents Office of In Pestigations ire I Congress Street, Sa" 100 Boston, 41.4 02114-21017 WWK MaK11C go VIdNa Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Inforingtion Please Pri> t Name (Btisiness/OrganizatioiAndi3iidual): Next Stop Living Address: 21 Drydock Ave City/State/Z�p: Boston, MA 02210 Phone#:(866)867-8729 Are you an employer? Check the appropriate box- 1.a I am a employer with 850 4. 0 1 am a general contractor and I Type of project(required): employees (full and/or part-time).* have hired the sub-contractors 6. 0 New construction 2.D I am a sole proprietor or partner- listed on the attached sheet. 7, El Remodeling ship and have no employees These sub-contractors have 8. El Demolition working for me in any capacity. employees and have workers' 9. ®Building addition [No workers' comp. insurance comp. insuranceJ required.] 5. E] We are a corporation and its 10.0 Electrical repairs or additions 3.El I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13.9 Other Insulation comp. insurance required.] "Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidarit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not tho3e entitim have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurancefor any employees. Below is the policy and yob Me information. Insurance Company Name: A.I.M Mutual Insurance Company Policy#or Self-ins. Lie.#:AWC-400-7030025-2014A Expiration Date: 9/30/15 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 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 Ofiqdtion. I do hereby certify under the pains:,� that the information provided above is true and correct Sioature: Date: Phone#:63 toto)&_7-9-7 2" Official use only. Do not write in this area,to be completed by c4 or town official, 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#. I — This agreement is made by and among Next Step Living, Inc.("NSL") Nadine Juliano 21 Dryclock Avenue,2nd floor 44 Church St Boston, MA 02210 phone: (866)867-8729 North Andover, MA 01845 Site ID: A497601 28-Nov-14 1. )ESCRIPTION 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: Work LocationWall Insulate Vinyl Sided Wall With 4"Dense Pack Cellulose 1,610 $1.65 sqft $2,656.50 75% Weatherization Incentive up to Program Max $1,992.38 Estimated Annual Energy Savings from the Above Improvements $341.00 2. 'AYMENT 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: $564.12 -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�m, LL aDec 8, 2014 n Vb6af6re Date L. 28 Nov 2014 William Calder NSLfSignature Date Name of NSL Representative A497601 The Terms of this Agreement are contained on both sides of this page Next Step Living o 21 Drydock Avenue-2nd floor-Boston,MA 02210 a(866)867-8729-inquiry@nextsteplivinginc.com www.nextstepliving.com TERMS or AGREEMENT imIV EN 3.PROPOSLU S ARI DALE AND PLE i IC>r1 SCHEDULE yVIV f\rl� vl\ \LVIJ I\!11IV I'1 Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116.617.973.8700 5.PERMITS n.PERFORMANCE OF THE WORK ANL)CHANGED. 7.INSURANCE AND REGISTRATION 3.QUALITY OF WORK 9.PRE-EXIS TING CONDITIONS,",PROPERTY PROTECTION 10.GENERAL PROVISIONS, 11.ENERGY BENEFITS. i 12.NOTICE CONCERNING SPONSORSHIP, 13,LIMITED TIME OFFER. 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 may be 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. Planview Diagram Team 1 2 Customer Wit , Advisor Name: IAJ ICa 2�ef Address L� L l Advisor Phone #: Town &Govtf-.-r Any limitations to access by truck? Site ID c7 NOTES Any work scoped outside of Best Practice? Approved by: (D Tm Z� I� to