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HomeMy WebLinkAboutBuilding Permit # 5/11/2015 i! BUILDING PERMIT NORTf� O&�SI.E� TOWN OF NORTH ANDOVERto APPLICATION FOR PLAN EXAMINATION Permit No#: �ti � Date Received �SSACHusE�R Date Issued: IMPORTANT: Applicant must complete all items on this page r , PROPERTY OWNER f Pnnf 100 Year Structure yes no MAP r PARCEL ZONING DISTRICT Historic District yes no v x. Machlne;Shop Village ;yes 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 Septic` o Well ❑ Floodplain a Wetlands ❑ UVatershed;District �;UVate,r/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Ac Identification- Please Type or Print Clearly OWNER: Name: 4 Phone: Address: Contractor Name Address / I Supervisor's Construction xp a e Home Irnprouement„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: $ FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with u is contractors do not have access to the f nd Signature of Agent/Owner ignature of contractor _. 1 t%ORTH Town - � E ®ver ® "' _ " 0% Ver, Mass , 2A COC MICt't W'CK X9,9 Adj °RATED Pe�`,`�5 U BOARD OF HEALTH P �E Am& Food/Kitchen Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .....Rq..! T .. ...... .......................................... ............... Foundation has permission to erect .......................... buildings on .......R.1..........10..I............... ....... ...... Rough tobe occupied as .A.11111%tp..... .. ... !..... ........ .... .. . .... . ..... .......:.............................. 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 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 E XPIRES IN 6 MONTHSELECTRICAL INSPECTOR UNLESS T T RTS Rough R 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 ® Lathing or all To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. ,%" next step i This rnIs made by and among Amy Grose Next Step Living,Inc.("NSL") 281 Waverly Road 21 Drydock Avenue,2nd floor NORTH ANDOVER, MA 01845 Boston,MA 02210 phone: (866)867-8729 Site 1D.- A197253 I. CESCRIPTION OF WORK To RE pESEORI IED 21-Jan-14 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; W- B 0 n"MUM Work Locatic ri: Attic Flat a UMMOMM Propavent 2'or 4' Damming (Nat Rebate Eligible) 48 Each $180.00 Replace Bath Fan Hose (Not Rebate Eligible) 18 Lnft $33.30 Work Loc;&rti()rt; Knee Wall — --- 1--Each_ $22.00 Dense Pack Knee Wall Floor Dense Pack Knee Wall Floor 128 sgft $300.80 Install 2"Thermal Barrier P01yiso on Kneewall 288 sgft $676.80 Work l.ocrjti()r: Crawlspace — 256 sgft $960.00 _ InstallFiberglass6 Batting In OpenraC Wspace Ceiling Work L ocatiori: M oil 96 sgft $124.80 Sheathing Access House Wrap Overhead (Not Rebate Eligible) 3 Each $112.50 Work Location: Foundation 96 sgft $97.92 6mm Poly Vapor Barrier (Not Rebate Eligible) 140 sgft $114.80 tV MA Save Weatherization Incentive Honeywellm ($1,766.18) Estimated Annual Energy Savings from the Above Improvements 2. PA MEN : CUSTOMER agrees to pay NSL for the work as follows: $299.00 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: $756,74 -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. The of is Next Step Living o 21 Drydock Avenue-2nd floor s BolstongMA 02210reement x-(866)1867-87 on both-roguesdes of this page q y@nextste livin mc.com�ww�nr,nextste�Oivin .crarr7 The Commonwealth of Massachusetts Department of IndustrialAccidents W ®ice of Investigations d 1 Congress Street, Suite 100 Boston,MA 02114-2017 0 www mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leuibiv Name (Business/Organization/Individual): Next Step Living Address: 21 Drydock Ave City/State/Zip: Boston, MA 02210 Phone#:(366)1367-6729 Are you an employer?Check the appropriate box: Type of project(required): 1A I am a employer with 350 4. ® I am a general contractor and I employees (full and/or parttime).* have hired the sub-contractors 6. ®blew construction 2.® I am a sole proprietor or partner- listed on the attached sheet. 7. ®Remodeling ship and have no employees These sub-contractors have g. ®Demolition workingfor me in an capacity. employees and have workers' Y p �'° 9. ®Building addition [No workers' comp. insurance comp. insurance.t required.] 5. We are a corporation and its 10. Electrical repairs or additions 3.® 1 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.E]Roof repairs insurance required.] t c. 152, §1(4),and we have no Insulation employees. [No workers' 13.0 Other _ comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Ilomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new aflida,it indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or foot those entities;have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. lam an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. 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 advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage v fi tion. I do hereby certify under the pains and pen les perjury that the information provided above is true and correct Signature: Date: Phone#461o(o)8077 9 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: Phone M NEXTS-1 OP ID:EL CERTIFICATEF LIABILITY INSURANCE DATE(MMIDD/Y" 10/01/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O%y AND CONFERS NO RIGHTS UPON THR 0911TIFIGATP HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AI-TER THE COVERAGE AFFORDED BY THE POLICIES BELOVV. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHOR12Ep RRP VSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMP RTANT: If the gertificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS 7pt IV�l r VOIts6 $g the terms and conditions of the policy,certain policies may require an endorsement, A statement on this certificate does not confer rights to 1hp certificate holder in lieu of such endorsement(s). PRODUCER CONTACTNAME: Erin Lyons McLaughlin Ippsurance Agency PHONE E,,,:751.665-2775 FAX No):761=66502 020 Lynn fells ParkWpiy Melrose,MA 02176 E-MAIL John E.McLaughlin Jr. ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC0 INSURER A:Nautilus Insurance INSUREDP�ext Step I Iving,Inc. INSURER B:Commerce Insurance Company 3475 21 Drydock Avenue,2nd Floor INS URERC:AJ.M.Mutual Insurance Co, Boston,MA 02210 INSURERD:AXIs 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 POLICY HER(Q INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T111� 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. TR TYPE OF INSURANCE DL BR POLICY NUMBER MM109EFF MMIDD EXP LIMITS A X COMMERCIAL GENEPAL LIABILITY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR ECP2010190=12 09/3012014 09/30/2015 PRAG TO EWT EM SES Ea oc u D nce$ 190,000 MED EXP(Any one person) $ 01900 PEI?SONAL&ADV INJURY S 11"919.0 GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ HrQOO,AQtl POLICY 1-1JELOC PRODUCTS•COMP/OP AGG $ ?19041000 OTHER: $ _ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1rt�®0,®p0 Ea accident �. B ANY AUTO 14MMBOKKOM 09/30/2014 09/30/2015 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS OS NON-OWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB X OCCUR EACH OCCURRENCE c 51000pQ0- 0 EXCESS LIAB CLAIMS-MADE EI U783547012014 09/30/2014 09/30/2015 AGGREGATE $ DED=RETENTION$ $ WORKERS COMPENSATION X AND EMPLOYERS'LIABILITY STATUTE ERH C ANY PROPRIETOR/PARTNER/EXECUTIVE Y I❑N TO BE ISSUED BY CARRIER 09/30/2014 00/30/2015 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? N/A (Mandatory in NH) E.L,DISEASE-EA EMPLOYE $ 500,000 III yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached If more space Is required) FOR INFORMATION 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 THE POLICY PROVISIONS. AUTH/O/R�IZED/D REPRESENTATIVE ©1900=2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/ 1) Tltfi A$QRR qIIR P Igyp are pq�o ��� 5tg 4f AC®R 0 iel ce o"r consumer Affai i and Au"'S' iness Regulation 10 Park Plaza, e Site 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 162111 Type: Supplement Card Expiration: 1/14/2017 NEdCT STEP LIVING INC. ROGER OUELLETTE 21 ®RY®GCK AVE. 2TE I FL BOSTON, MA 02210 Update Address and return card.Mark reason for change. Address n Renewal ❑ Employment Lost Card ®ffase of Consumer Affairs&AJ , Regulation business regullatianon (License or registration valid for individul use only Al. DOME IMPROVEMENT CONTRACTOR before the expiration date. 9f found return to: �. ` Office of Consumer Affairs and Business Regulation " Registration: 102911 Type= 10 Park Plaza-Suite X190 F Expiration: 1114/2017 Supplement Card Roston,MA 02116,, NEXT STEP LiV)NG INC. ROGER OUELLETTE 21 DRYDOCK AVE.2TH FL .��---- BOSTON.MA 02210 flndersecretsr' i lot valid without signature Departnwapt of fl,ubhc Safety Board of Fiukfing F'ZegWatk,w', an(i Standards Snare r,%ifor StwetwOO, C -102811 SSL ROGER A OVELLEiE 55 STANMORE�Ov, Wandek RH 0280 (0911312016 ReWvicbad To: CSSWC-lnsulation Contractor Failure to possess a current edition the Massachusetts State Building Code is cause for revocation out his license. For OPS Licensing infer matinflIASK: vmvn3.Mas&Gnv/DPS