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HomeMy WebLinkAboutBuilding Permit # 6/22/2015 BUILDING1 E1�19,IT �4Ky18O r6 6 0 BUILDING TOWN OF NORTH ANDOVER ° o 1 APPLICATION FOR PLAN EXAMINATION Permit NO. Date ReceivedIle— Q�h'Ai&oriPP`4„t? Date Issued: h71111 it �SSACHUS IMPORTANT: Applicant must complete all items on this pae LOCATION ev bAn Print PROPERTY4VVNER t Pry t MAP NO: ��" PARCEL. ZON1N CRICT H�stc►r�c Dastr�cf yes o Mapftif`op:�Village yes o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building ne family Addition E Two or more family Industrial Iteration No. of units: Commercial Repair, replacement i Assessory Bldg I Others: Demolition C Other I Septic' Q VV61l . FJ1 Flgodplain [I Wetla' ds '[, UVatershbd District ❑Water/Sewer 11e JI� Identification Please Type or Print Clearly) OWNER: Name: 1 j i ,F.G Phone: w L cd l9 Address: All ,-, CONTRACTOR Name t `P,lhone,,- r Address:•, i � i` C;CtI Supervisor°s,Corasttuct[ n= rlwl Ara tkORTH A"Wft 0%'W Tif% W n 0 lidu V cr fie% ® .o - h ver, Mass, 2� I� coc.uc..ew.cx `® ®aATEO Pp¢��� BOARD OF HEALTH Food/Kitchen Pt: RMIT 1�� LD Septic System THIS CERTIFIES THAT4 BUILDING INSPECTOR has permission to erect buildings on ..... . , „ Foundation .......................... ...... ..�,.. .... . ... ......................... Rough to be occupied as ............................................. Chimney ...... ...... ... ......... ............................................. provided that the person acceptin 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 IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION g5T Rough Service ................................................................................ Final BUILDING INSPECTOR +' GAS INSPECTOR (�ccu�a�c-V Permit Required t® Occupy Buil�liaa� Rough is la in a Dons its S Isco o ®�t�hePremises — Do of 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. JAMES MATERKOW 7 BIRCHWWOPOIN f 26 cF 1012 1201 i Office of Consumer Affairs and BLIsmess e(t,llati011 1�) Pat Pl-za -- Suite 5170 Roston., Massachusetts 021 16 Hoine Improvement Contractor Registration Registration: 170936 Type: Corporation Expiration: 1/20/2016 Trr SHE GREEN COCOON, INC. ,JAMES MATERKOW 6 141 BRIDGE RCS. UNIT 200A SALISBURY, MA 0195 Update Address.and return card.Nlaik reason for .Imwt Address Renewal FrnploN ntem Lim t:rir d f)t41i, rr�`C;,,�ti�trart^r �f( rzs& License or registration%olid for indisidul use ontN 'HOME €MPROVEMENT CONTRACTOR hrfrrre the expiration date. If fecund return to: 'Registration: 170936 Ty}ae. Office of Consumer Affairs and Business Regulation Expiration: 1/20/2016 Crrrporatiort B ostnatCit n Playa-Suite65170rt . I t}"i rPa Ger-C-E*,i COCOON,�NC �1 �^;P�1E:fi2k4C�WtISE i r4 BR D; E R1) UNIT 200A `' PwJA Oip L I nderwretar) Not valid without signature The Green Cocoon,Inc. Proposal PO Box 566 Newburyport,MA 01950 Date. Proposal# (978)462-0082 06/04/2015 2958 info@thegrecncocoon.coin Exp. Date Address Bryan Bendig 59 Berrington Place North Andover,MA Sales Rep Candace Lord Date j Activity Quantity Amount -- - - 06/04/2015 Main Attic Roof Slopes: 2 Closed Cell R14 2880 6,451.20 06/04/2015 Main Attic Rool'Slopes: 7" Open Cell R24 2880 8,064.00 06/04/2015 Gable Ends: 5.5" Open Cell R19 351 772.20 06/04/2015 Bl_AZELOK" TBX Thermal Barrier Paint 3231 4,620.33 Only in attics and crawl spaces that are unfinished and used for storage. 06/04/2015 Proper Vents 4': Continue venting cathedral sections to ridge 144 348.48 06/04/2015 Small Attic Slopes: 2" Closed Cell R14 804 1,800.96 06/04/2015 Small Attic Slopes: 7" Open Cell R24 804 2,251.20 06/04/2015 Gables: 5.5" Open Cell R19 91 200.20 06/04/2015 NOTES: Vents may be needed in this area.4 TBD 06/04/2015 Wall Sections: 3" Closed Cell R21 NOTE: Includes bathroom,living room and other 510 1,718.70 small sections 06/04/2015 Open Ceiling Sections in living room: 5.5" Closed Cell R38 113 697.21 167.8 Total!, $26,924.48 Accepted B\ Accepted Date (978)-162-0082 info y;thegreencocoon.eom The Commonwealth of Massachusetts 6 Department ofIndustrialAccUents I Congress Street, Suite 100 Boston, MA 021142017 wwwmass.govl(lia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Legibly Name (Business/Ot-ganization/Individual):The Green Cocoon Address:107 Elm St. Rear City/State/Zip:Salisbury, MA 01952 Phone #:978-462-0082 Are you an employer?Check the appropriate box: Type of project(required)-, 1,0 1 am a employer with 12 employees(full and/or part-time)-* 7. F1 New construction 2.n I am a sole proprietor or partnership and have no employees working for me in 9. E] Remodeling any capacity.[No workers'comp_insurance required.] 9. El Demolition 3.[j 1 am a homeowner doing all work myself [No workers'comp.insurance required.] 10 n Building add ition 4,Fj I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole I I.E]Electrical repairs or additions proprietors with no employees. 12.Q Plumbing repairs or additions .5f]1 am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.' 14.f-v-1 Other Insulation 6.n We are a corporation and its officers have exercised their right of exemption per MGL c. 152,§1(4),and we have no employees. [No workers'cornp,insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and then hire Outside contractors must submit a new affidavit indicating such 'Contractors that check this box must attached an additional street 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'cornp.policy number. I ant an entlVoyer that isprovidingworkers'compensation insurance for my employees. Below is thepolicj,andjoh site hilorination. Insurance Company Name:Selective Insurance Co. Policy#or Self-ins. Li,c. #:WVVC3100274 Expiration Date:7/28/2105 Job Site Address:59 Berrington Pl. City/State/Zip:North Andover, MA 018 Attach a copy of the workers' compensation policy declaration page (showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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 LIP to$250.00a clay against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebj,certifjAunder the��nd unit' ofpejltty that the information provided above is true and correct. ,signature: Date: -C), Phone 9:978-462-0082 Official use only. Do not write in this area, to be completed ky city or tolvil 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#: GREEN11 OP ID: LK DATE(MM/DDfYYYY) CERTIFICATE OF LIABILITY INSURANCE 03/05/2015 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 POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les) must be endorsed. If SUBROGATION IS WAIVED, subject to 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). PRODUCER CONTACT NAME: Marcos W. Shaner 0 FAX Chase&Lunt LLC PHONE 65 Parker Street C No Ex*978-462-4434 I_Wc,No): 978-465-6204 Newburyport, MA 01950 E-MAIL -ADDRESS: --- Marcos W.Shatter F INSURER(S)AFFORDING COVERAGE NAIC 4 INSURER A:Selective Insurance Company INSURED The Green Cocoon,Inc. INSURER B:Commerce Insurance Company Jim Materkowski 141 Bridge Road INSURER C: Salisbury,MA 01952 -INSURER D: 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 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. R -------- POLICY EFF- INSR AID—DE SUBLIMITS 130—LICY EXP LTR TYPE OF INSURANCE INSD VA1D POLICY NUMBER (MM/DDIYYYYI (MMIDONYYYI A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 11000,000 DAMAGE TiD RENTED CLAIMS-MADE Lx] OCCUR X S2057643 03/01/2015 03/01/2016 PREMISES Ed oc urre ace $ 100,000 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY I PRO- 2,000,000 D JECT LOC PRODUCTS-CO AGG LS OTHER: C $ COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Ea accident) $ 1,000,000 B 1 ANY AUTO TBD 03/01=15 03/01/2016 BODILY INJURY(Per person) $ ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ AUTOS UTOS NON-OWNED PROPERTY DAMAGE $ X HIRED AUTOS AUTOS _APer accident).-- -- X UMBRELLA LIAB X OCCUR EACH OCCURRENCE S 1,000,000 A EXCESS LIAB CLAIMS-MADE S2057643 03/01/2015 03/01/2016 AGGREGATE $ 1,000,000 DED I X 1 RETENTION$ 0 $ WORKERS COMPENSATIONPER TH AND EMPLOYERS'LIABILITY ---X-LDAT—uT-E--1.—L&- C ANY PROPRIETOR/PARTNER/EXECUTIVE YIN WWC3100274 07/28/2014 07/28/2015 E.L.EACH ACCIDENT_ $ 500,000 OFFICER/MEMBER EXCLUDE[ NIA� ...... (Mandatory in NH) 500,00o (Mail E-L.DISEASE-EA EMPLOYE$ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 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. AUTHORIZED REPRESENTATIVE 6A'.Jt'y ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD