HomeMy WebLinkAboutBuilding Permit # 3/17/2015 p+ ® II
BUILDING PERNORTH
O��TLED 16
46 Om i
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION * '� _
Permit No#: Date Received
'sacause
Date Issued:
IMPORTANT: Applicant must complete all items on this page
i
not
PROPERTY OWNER��t�� .�f� �Lt
`' , Pnnt 100 Year Structure` yes no
MAP PARCEL ZONING DISTRICT HistoncDIOtnct ye no
Shop Village
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
CI Septic ;Well: .:❑ Floodplain 'b"Wetlands" ❑ 1Natershed District
D" IVate►/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
I (�
Identification- lease Type or Print Clearly
OWNER: Name: )ca, 1�I9 Phone:
Address ac L
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Contractor Name ZPhone
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A77
ddress c
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Supervisor's Construction License �(���� Exp Date
MAW
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Home lrn rouement License
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: $ �1 FEE: $
Check No.: 66/ 7/ _Receipt No.: d.
NOTE: Persons contracting with i er ontractors Flo not have access to the r and
Signature of Agent/OwnerSignature of contractor`
FORTH
T-own of ndover
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u h y ver, Mass, 1
T ° LUNE
COCHIC.9-C. 1-V
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BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT L."va. ®se-6 BUILDING INSPECTOR
................................................................................... . ..........................
has permission to erect buildings on 4'a Foundation�
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to be occupied as ....... . � ...�.� Pa
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it
'"tats agreement is made by and among
Next Step Living,Inc.("NSL")
Laura Loiselle 21 Drydock Avenue.2nd floor
212 Middlesex St Boston,MA 02210
phone: (866)867-8729
North Andover, MA 01845
Situ ID: A177003
22-Dec-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 atlached recommendations/v✓ork order describing the work in detail(the"\/vrork")which are
incorporated herein by reference:
�^" �,�' 'if-i�""; ,,�� 1 ��.,�vz�r'�, ✓wda'3'�` ""�;�r".'a'�^�v-�"k�Gr,.`".'f'.1 s:N�v� h�N �j3� ,�Ct�'�-''�j,,t� ° �T��,"�': �,.Nr7 r�.?i by ..�.,$'"�d �%3 r ':
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Work Location: Wall
Insulate Vinyl Sided Wall With 4" Dense Pack Cellulose 2,710 $1.65 sgft $4,471.50
75%Weatherization Incentive up to Program Max $2,000.00
Estimated Annual Energy Savings from the Above Improvements $575.00
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 1f3 of the total retail costs. (Dote:fvtastercam,Visa,and Discover accepted)
Additional Payments and Final Invoice: $2,371.50
-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.
Jan 22, 2015
Customer Signature Date
2)e41o.fah Fv_LLexroti_ _-- -. r � 5 Debor
23TtIN@mulder
NSL Signature Date Name of NSL Representative
The Terms of this Agreement are contained on both sides of this page
Next Step Living�21 Drydock Avenue 2nd floor-Boston,MA 02210 (466)g67-8729 inquiry@nextstepllvinginccom 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 wrifing 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 preexisting 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 Customer's 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 property 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 Customers 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 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.
Plainview Diagram Team 1 2 3
Customer Advisor Name:
Address dl-.z_ dl-.z Advisor Phone #: (2,m) S' r- -7xg-;�
Town AlwveA Any limitations to access by truck?
Site ID
NOTES Any work scoped outside of Best Practice?
Approved by:
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Office ®t d6"T�s"�umei Affai and Business Regulation
.r` ® 1�ar�� Plaza
Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 162111
Type: Supplement Card
Expiration: 1/14/2017
VSE®LT STEP LIVING INC.
ROGER OUELLETTE
21 ®R°Y®®CK AVE. 2TH FL
BOSTON, NAA. 0221
Update Address and return card.Mark reason for change.
F] Address [:] Renewal ❑ Employment Lost Card
14,
efface of Consumer Affairs&Business Regulation 7
License or registration valid for ieadividul use only
HOME IMPROVEMENT CONT CT®fit before the expiration date. If found return to:
office of Consumer Affairs and Business Regulation
Registration. 162191 Type 10 Park plaza-Suite 517D
Expiration: U1412017 Suppiemenf Card Boston,Mm 02116
NEXT STEP LlViNGINC.
ROGER OUELLETTE
21 DRYDOCK AVE.2TH EL —
BOSTON,MA 02210 Undersecretary "dart valid without signature
massa�'J-�usett,s Departrnent ot Pubhcl S�ift"Ay
f`loard (�)f Bud(j�rug RegWatm,, s ,inn Stanclards
conit rucrton I�tjper%mor Spccsah'�
ROGER A(OVELLETT #
55 STAKMORE RO
WmMek R-71 0230
i ratarRri
Resiricted To: CSS OC-insulation Contractor
Failure to possess a current edition 0�the M,assachusetts
Stake Building Code is cause f®r revocation Cf this Ocense.
For DPS UcensInG-InfOrMOOnMeft' VM?IPJ-MQS9-GOV/DPS
The Common
Department qfIndusirialAceldems
Office of Investigations
I Congress Streei., Safte 100
Boston, _444 0.1144)017
n"W.MaSS.gov1d&
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Applicant InformLationPleaseX[1RjLgg&!X
Name (Busiiiess/orga-aizatiordbdiijidual): Next Step Living
Address: 21 Drydock Ave
City/State/Zip: Boston, MA 02210 Phone#:(866)367-8729
Are you an employer? Check the appropriate box-. Type of project(required):
1.a I am a employer with 850 4. E] I am a general contractor and 1 6. E]New construction
employees (full and/or part-time).* have hired the sub-contractors
2.El I am a sole proprietor or partner- listed on the attached sheet, 7. E]Remodeling
ship and have no employees These sub-contractors have 8. [1 Demolition
working for me in any capacity. employees and have workers' 9. E]Buil&ag addition
[No workers' comp.insurance comp. insurance.,
required.] 5. We are a corporation and its I O.El Electrical repairs or additions
3.El I am a homeowner doing all work officers have exercised their 11.®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' 13.9 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 affidal it indicating such.
tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or vot 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, my employees. Below is the policy andiob Me
Informadon.
Insurance Company Name: A.I.M Mutual Insurance Company
Policy#or Self-ins. Lic.#.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 advise'd that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance coverage rdflytion.
I do hereby certify under the pains and pita es perjury that the information provided above is true and correet,
Signature: Z Date: 1Q/ 81 /9
Phone#: 14)
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):
1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Person.,
NEXTS-11 OP ID.EL
CERTIFICATE OF LIABILITY INSURANCE F DATE I NIIDDIYYM
THIS CERTIFICATE 18 ISSUED AS A MATTER OF INFORMATION 0%y AND CQNf ERj 40 RIQ11TJ UPON TK, 09Kj'IFjGATP HOLDER. THIS
CERTIFICATE DOES NOT AFFIRMA:-iiVELY UP, NEGATIVELY AMEND, EKfENU OR AiJERTHE COVERAGE AFFORDED BY THE POLIPIES
RELOV1. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), 44THOR1,79P
ROPFFSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
JPAP _RTANT: If the qwdficate holder is an ADDITIONAL INSURED,the inust he endorsed. If SURROGATION Iq YVA,IVIW-1�1111)l ZlTq
the terins and conditions of the policy,certain policies may require an endorsement. A statement on this carilficate does not confer rights to Bhp
certificate holder irl lieu of such endorsement(s).
PRODUCER CONTACT
MqLRmghlivj 111suraiow Agency -NAME: Erin Lyons
PHONE FAX
828 Lynn fel s ParkWpy (A/C,No Ext):781-665-2775 LA/C,No):781-665-0290
Melrose,MA 02176 E-MAIL
John E.McLaughlin Jr. ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIP 0
INSURER A:NOUltilUIS Insurance
INSURED Next Stop�Iving,Inc. INSURER s:Commerce Insurance Company 34754
21 Drydock Avenue,2nd Floor
Boston,MA 02210 INSURER C:A.I.M.Mutual Insurance Co.
INSURERO AXIS Insurance Company 15610
INSURER r:
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 10 THE INSURED NAMED ABOVE FOR THE POLICY ngRwp
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT-10 WHICI Is
CERTIFICA71 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,
INSIR ADD L SUEIR POLICY EFF POLICY EXP
LTR TYPE OF INSURANCE INSO WVD POLiCV NUMBER Po9MIODO= (MMIDRI= LIMITS
A X COMMERCIAL SE6ERAL LIABILITY EACH OCCURRENCE 1,666,000
F_V_1 PREM
TO_R_EffTEO
CLAIMS-MADE OCCUR 09130/2014 09/30/2015 PREMES(Ea occurrence) 190,000
MED EXP(Any one person) S 0,000
PEkSONAL&ADVINJURY 8 1,109,10
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE
RO-
POLICY❑JPECT LOC PRODUCTS-COMPIOPAGG
HER: $
COMINED SINGLE LrM—[T—'-
A970MOSILE LIABI[,ITY (Ea acc13ident)
$ 19000,000
B ANY AUTO 14MMB8KK0M 09130/20'14 09130/2015 BODILY INJURY(Per person)
ALL OWNEDSCHEDULED BODILY INJURY(Peraccident)
AUTOS EX NOAUTOS
N-OWNED PROPERTY DAMAGE
HIREDAUTOS � AUTOS Per accident
UMBRELLA IJAB X OCCUR EACH OCCURRENCE
D EXCESS LIAB EI U783547012014 0913012014 09130/2016 AGGREGATE $
DED I I RETENTION$ — $
WORKERS COMPENSATION ER"m —
EMPLOYERS'LIABILITY Vim _xT_ IER
C ANY PROPRIETOR]PART NERIEXECUTiVE N TO BE ISSUED BY CARRIER 09/3012014 99/30/2015 E.L.EACH ACCIDENT $ 590,000
OFFICER/MEMBER EXCLUDED? r /A
(Mandatory
Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 590,000
if
if s ri
POLICY LIMIT $ 500,000
DESCRIPTION
be under
RIPTION OF OPERATIONS below E.L.DISEASE
DESCRIPTION OF OPEPATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached 1-1 more space is required)
FOR INFORMAPITION ONLY
CERTIFICATE HOLDER CANCELLATION
INFO-01
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
For Information Only ACCORDANCE WITH THC POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
@'1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 26(20141pl) TII APQRP q@MR p
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