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HomeMy WebLinkAboutBuilding Permit # 4/30/2015 a —_-- NORTH q O`�4`a° ,�a �O UILDI PERMIT $+r b; d o� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: `J ' Date Received �9SSACHUSy Date Issued: ' IMPORTANT: Applicant must complete all items on this page "LOCATIQN:` R PROPERTY QINNER V`OL', �Pnrtt Y MAP N PARCEL ZONING DISTRICT: Historic,District " es Machin ShoVilla a es t C p° g Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building A One family Addition ❑ Two or more family Industrial Alteration No. of units: Commercial Repair, replacement L Assessory Bldg Others: Demolition L Other Septic,<< d UVell` L Floodplain= Weflarrds a Watershed District clNater�Sevirer Identification Please Type or Print Clearly) OWNER: Name: �t-t om � ����f I Phone: Address: � a21 1vz7—Y --- 4je ,-e; l'1�`i� CONTRACTOR Name:- Phone l ruc i License. Ex Date:; Supervisor's:Constior P Home tm'`rouement License: Exp: Date:': IL ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ S>� FEE: $ Check No.: 5.2,>?57 Receipt No.: ,9e 7/_-� � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/OwnerSignature of contractor , i i tkORT H Town oft _E ,, Andover . is — 0h ver, Mass, A / I J� o LAK �. COC HICKS wtCK V AERATED �' '`y S U BOARD OF HEALTH Food/Kitchen vER..MIT T L �D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT ............................................. ...................... .....................I....................... .... Foundation has permission to erect .......................... buildings on . .. ...... ;...�... .0... ..... -- ..•....•.... ,per. Rough to be occupied as ............i!k!10. ... . ...... ....... . ......At....... .. e. . a. ............... Chimney ' e provided that the person accepting this permit 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES e1N1 ON p �+ ELECTRICAL INSPECTOR UNLESS CONSTRU A SRoughService ....... ........................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildinga Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Latin or all ToBe Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. � cCONTRACTOR WORK ORDER t-�s�r -�'�� Services Groin 50 Washington St.Suite 3000 Printed: 4/14/2015 Westborough,MA 01581 Work Order Id: S31929P43504C332 Contractor Information Custom'dS te'Details ESE Brian Baker Email: bbaker86@comcast.net 52 Fitzgerald Dr 86 Willow Ridge Rd Phone(Eve): 508-265-3017 Phone(Day): 978-933-1110 Jaffrey,NH 03452 North Andover, MA 01845-6316 Site ID: S00002331929 Total installed Measures Location Description Quantity Unit$ Total $ Damming 69 $2.19 $151.11 Living Space Attic Floor Open Blow Cellulose 8" 1,092 $1.60 $1,747.20 Attic Propavent 2'or 4' 8 $3.83 $30.64 Living Space Whole House Fan Box: Thermal Barrier Polyiso 1 $168.98 $168.98 Living Space Attic Stair Cover Thermal Barrier with carpentry 1 $260.23 $260.23 Living Space Perform Air Sealing at Estimated 62.5 CFM50 8 $84.32 $674.56 Door Sweep 1 $23.18 $23.18 Exterior Door Weather Stripping 1 $27.59 $27.59 Installed Measures Total $3,083.49 WorkOrder Notes Payments Incentive Payments Weatherization Incentive $1,446.71 Air Sealing Incentive $1,154.54 Total Incentive Payments $2,601.25 Customer Share Total Customer Share $482.24 Less Deposit Of $160.74 Customer Share Balance(Due Contractor) $321.50 Conservation Services Group-50 Washington Street Suite 3000-Westborough, MA 01581 -(508)836-9500 RCS PLANVIEW DIAGRAM Home Phone: ( )- Customer: Address: Work Phone: Town: a^ � CellPhone: Any limitations for access by targe truck? No—�19,,_ Yes if yes,describe: Any specific directions or landmarks? Noy Yes If yes,describe: Site ID: ^L Energy Specialist: Reviewed by: 33 G 0 Owc Al s b%k 04 cC- k� S 4 Noon -5 � Z %—0OMC ��C�tr�cV1 r 4 %o X 3 � � Door P.a c cp cam. } t� 3b Q For Office Use Only Bushes Ladder Neighbor Proximity Pocket Doors Insert Radiators Fences) Existing Conditions• X=Access ❑=Vents Note Inside Square R=Roof • S=Soffit G=Gable RV=Ridge Vent CS=Continuous Soffit CDE=Continuous Drip Edge T=Triangle W=Wali S=Sheathing Temp Unless Noted Otherwise Install O=New Access Note in Circle C=Ceiling M=12„Mushroom For Access =Vents Note in Triangle R=S"Roof S=Soffit G=Gable X290.19.1/15 I WO j 0" D�j/ ��r 'ir/,^ c✓/l%/r� illW a N ���0 ✓ � r �r �/ w"-rd PARTICIPATING mass save GONTRA4 FOR AUTHORIZATIONPERMIT I, BRIAN BAKER ,owner of the property located at: (Owner's dame,printed) 86 WILLOW RIDGE RD NORTH ANDOVER (Property street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X Owner's Signature („ �„��✓° Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date I eao Cff Ce Use Orf Rev.12132011 I"hrr t onlirrrcrrrtii,eulth rff, 1"assucNxusetty ,. Depttrttr ent a d�cler.qtr°anJ,� c�ci�lr arta �., l ("ar gi-e s 5tivet, Suile 100 i'txsion, AM 02115201i' \�rrr leers" ('011111nNatiora Irrararaarrce Affidavit: Boildel-A'ootraactors/1"Ica^tnciaa raw/1'"loIII trers. NO HEFTED"If II'I"Ilii:CERNII`tTING,%VTIIt'RII'1. _J_L ,_ I'Icarse N"rittt,_ILee«zi d'A _"1�a rlacaa_nt 1,r�fo��rrr�frtarC,........�...�...._�._._...�...._.W..._.w.�.._.,�.____ �... .__�__.__�._._ I� llT1C.tliutwtrra:" Orpxnot✓aturrrr/It7dt�..c!u.�ll FC, INC, Ac(&em52 F itzc emW Dr ltv/strlle/zlp._.Jaffrey, N1-I 03452 C'17tr17r g60153 11 2 fr346 1 ----- cc ruu it it errntdu�rr?('heck Ill aprrrwrpl-iale bav: I yI7Cot'project (I'll(lII ire d) f I am avinp)oivi laIlb `� np,lreecar�.rt`ull and/ur Irart.trnrcI" T i elc t olv9trucHon .�![,]I am a role ttr,Wt root or p Inivr:abrp and hoe no emMrn ces"tri a'rat fhr rite mi ,^y � ReITT Tit.IeI lit); ane e.y)IIA.1 • (Noeearrer ramp rrrnrrrance RNIalred I e) Elt)t.".PlloirUerla s Lj I;int a heirsiarnener'hnurt a(I eeorl�ev,,radii I Nl,mi ixl a,rnrtf', IM It,We o'er Iterred !tl D 13u)IcIIfI� ,rcl�ItVtrn d L...,tl itIn,t honivo ener mid"the huint"corinae4o";I to e;rertdrrct.ull trod,M n1r ittufntrut I e,+ill 6nr+trrc that nllrrntUarluf„etltrerltrrersert6.rr ewnp¢rtsaturrrat�'nruttce�rr ue .01C I ( L'IcG9Ci C,rl C"e:l)artR";oI ,rddllww, prerirnertrrr +vrtPr nu rzr'rtlrleeecc`` 12 El I�r�41111111Y1'I't10�,11i;t11 ath)YUtrf'I"� �f ( an a carer tl r ordraea+n oriel i hue e hind the wul nonit a Too MAWK lbw:anae lra:d afire°F iw, lite e ,nii-col ItracIor"h'n c enrplue cr<a ild has to rtoIkca e,rrrtp', ONII a"0, 1 �_..IMacri I r Ir I-d ETJtl)cl It ISL tleaattrarr 4a 41 e are u col .nratrrrn and its oil ie r t ha+c erne t.r acE Ilteu t`Z.. �II tl,turd Luer bavo no cmp6at a., l'der eerni.cr:;'eonrp rm,ui.rrrer�cgruue�at I sea II mitt fiber Wn Irelent"ho% nr wII mo,arIs�, orupav,anorr p,erlect mI(e naur rrr 'Ana"lre.tnl thrat e he Wt,.,taus!ri irrrrse rrLue Vr IlonruerwTias tvlrrr .uhtnrt Iles othdavil Ifaficahnu Iho are dome oil erark end then Fore ommdo e.arru,om%M”"OM a W" .,Itidw i ualu.rt W welt � al dic(r;II"No reuse luurAed stn adebtienral sheo shoesIIIV rbc amIw o I aoo�,;uzd '.t:nc evhctrre:r c+r rvrt tIIo;a�artitme,Nate u11'1r0o,,ees Iftile strb.-QoIITrttcirrrslrave:epill'rlravicer;.lh,n nruastivraesefctheir v.orr:er:; Col III loh", ilolrlwf ont an emplrlrer that is pro vitiling wort r:Y'conipensatrrrrr M6h'ldr"tare:"erf(I r'Xrl1'l'rrr)`It(J}'c'A'.'e'. Beloo'1.4the pol/a�r'1111rt joh.Site /rrJ"artrlatlarr. Itasurauur (."Grrt�l7s.u7v Ctiortc 1 Corirp�-alay Ntallorral Ll�alk�ilily & I uc, lrtiratice V9WC629429 016 I'itlicrw li or Sc:11°..u7:,°� LIC0� _ I rla)raUrtn 1>;rte° `,°''/fife' lot)Site elcicircr~7,. Attach .a copy°of the itrorkers, carrlpensatiorr polic cleclara loll page(shoming The Imilk y rrrrrrther°and cx pir'aatiorr date). ie r c I ,., r 2 ,e r anon �rr.nishahle In ,t [Ink, op let`h l all)(dL) �u7t/of one-ltc�ar rill]1-oorracnt,cac"yI ell a,s civil pea alties na tlat. briar til t'outerl viol 1 ourc�C t.tlaelctr 9`v9(.;l c I`y,.., 1 is ar crit I `'7 I()I 4`r't rRk t>Itl)FP and er lint"ol`rrlr tit C)t1.a elav al:witut die vtrriatin A coIn of ho,slaaWmeM "mv he titfwanferl ter IN:Wcv III Investrwtatre�ms Q The I MA Jur "sttro7cc coverage veritic:aattolr I tier herelq certr.j e1r rthe arrtrrs rrrrrl rrr t/tte,v rr ret°1tr-t'that thI,err orntatrrru rrot-itlol ubovtlI'll fro 41 till c/c orreel. I>,Gte. '�te.Irertt�Ic I'Itct)7c t� 6035306346 (IJjir/a111,ce orlhj% P)o not write itr this avert,to he t,onipleterl/rt rift'or filiv t gljkia/ (hy or l`oww I'cerraitll,irerrsc £t Issoing,Atrthorito (circle uric): 1. Board of Ile alth 2. Ilo WWg Dquirtrrrent .h ('ite°amn(Urk A 1;1eetricaal Impcctrrr ~i. 14mbingr Inspector 6. t:lftar:r Contact Ile r'soII: DATE(MMIDDIYYYY) ,q�® CERTIFICATELIABILITY I 4/27/2015 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 POLI LIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. (ies) must be endorsed. If SUBROGATION IS WAIVED, subject to IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy 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). CONT PRODUCER NAME; Karen Shaughnessy PHONE (603)669-3218 A1C FIAI/Cross Insurance E-MAIL No;(603)645-4331 1100 Elm Street ADDRESS:kshaughnessy@crossagency.com INSURER(S)AFFORDING COVERAGE NAIC# Manchester NH 03101 INSURERA;West American Insurance CO. INSURED INSURERB;Ohio Security Ins Co 4082 ESE, Inc. INSURERC:Ohlo Casualty Insurance Com an 4074 Energy Saver Enablers INSURER DAmerican Alternative Insurance 52 Fitzgerald Drive INSURER E: Jaffrey NH 03452 INSURER F: COVERAGES CERTIFICATE NUMBER:14-15 All w/ 15-16 WC 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. INSR ADDL BR POLICY NUMBER MMIDDIYEYYY MMIDDIYYYY LIMITS LTR TYPE OF INSURANCE NS D 1,000,000 EACH OCCURRENCE $ GENERAL LIABILITY D 300,000 PREMISES Ea occurrence $ X COMMERCIAL GENERAL LIABILITY /31/2014 7/31/2015 MED EXP(Any one person) $ 15,000 A CLAIMS-MADE ❑X KW55684997 OCCUR 1,000,000 PERSONALE ADV INJURY $ GENERAL AGGREGATE $ 2,000,000 PRODUCTS-COMPIOP AGG $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: $ X POLICY PRO LOC COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident $ 1 000 000 BODILY INJURY(Per person) $ B X ANY AUTO 7/31/2014 7/31/2015 gODILYINJURY(Peraccident) $ ALL OWNED SCHEDULED AS55684497 AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED Per accident HIRED AUTOS AUTOS Uninsured motorist combined 1,000,000 EACH OCCURRENCE $ 1,000,000 X UMBRELLA LIAB X OCCUR 1,000,000 AGGREGATE $ C EXCESS LIAB CLAIMS-MADE 7/31/2014 7/31/2015 ,00 5055684497 $ 10 DED X RETENTION$ WC STATU- OTH- D WORKERS COMPENSATION 2A2WC0000371-03 X TORYLMI ER AND EMPLOYERS'LIABILITY (3a.) NH & MA E.L.EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNER/EXECUTIVE FN/A /8/2016 500 000 OFFICER/MEMBER EXCLUDED? 11 officers included /8/2015 E.L.DISEASE-EA EMPLOYE $ (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Refer to policy for exclusionary endorsements and special provisions. 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, MA 1600 Osgood Street AUTHORIZED REPRESENTATIVE North Andover, MA 01845 Laura Perrin/JSC ) ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) Tho ACr1Ril namc anri Inns arc rcnlr ictcrcrl marc of Af r1Rr1 INS025 rgnlnn5�m Mass a(,,,h usetts Deparfinent of Pu bbc Satety Bay,d of Bu0ding lguiations and Standards Supe mwi- Lucerise: CS-072316 jj CALEBAHO 482 JARMANY 14LL", SHARON Nil 03458 Exparaficm 12/1912015 Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 51.70 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration: 161406 Type: Individual Expiration: 10/2012016 Tr# 258803 CALEB AHO CALEB AHO 482 JARMANY HILL RD. SHARON, NH 03458 Update Address and return card.Mark reason for change. Address Renewal Employment Lost Card S'CAI AN-0501 /k' �Y lAcense or registration valid for individul use only Office of Consumer Affairs&Business flegulation N (NOME IMPROVEMENT CONTRACTOR before the expiration(late. If found return to: office of Consumer Affairs and Business Regulation egistration: 161406 Type: 10 Park Plaza-Suite 5170 Expiration: 10/20/2016 Individual Boston,MA 02116 CALEB AHO CALEB AHO 482 JARMANY HILL RD. SHARON,NH 03458 Undersecretary Not valid without signature