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HomeMy WebLinkAboutBuilding Permit # 6/25/2015 BUILDING PERMIT OORTHZ D TOWN OF NORTH ANDOVER 0 0 APPLICATION FOR PLAN EXAMINATION, PermitNo: Date Received. ArED Date Issued: ACHUS 14mORTANT:Applicant must complete all items on this page nn "4 t -ROPERTY:,:O) NNE Z1 9 XTRICT: Historic rid yes.;. no 0. - '' MAP NO P CE KIN _2 pricDist, '77777 Machine Village' -yep: no, M 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 Well Fl66dplain ,'-- Wetlands Watershed-,District Wa DESCRIPTION OF WORK TO BE PREFORMED: Identification Please Type or Print Clearly) OWNER: Name: I I Phone: Address:'�a� c)i 0 � CONTRACTR' bme: ?hbrib." Address (11 Supervisor'sP ,,C6bst irddt i o :Ek '., Date: a te' Home Improvement License., �EXp. QJ 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: $ cf) FEE: $ Check No.: (V/ d 2"Ow 1-1� Receipt No NOTE: Persons contracting W1thJZ0rT7Wi re kontractors do not have access to the n i d iqnatureof contractor. Signature of Agqnt/L0w_' ner . t%®RT'y nuuvv"'TU UfE No. iT I1 Vel' Mass,4�Y OR COCKIC IWICK y1. Q � Iii °RgTeo ►'Pa,�'�y `S U BOARD OF HEALTH Food/;Kitchen PERMIT D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT 'r e0`............................. Foundation Roughnd ation has permission to erect .................. buildings on •••••'Dt;)JL"""' p ..... ............... to be occupied as . ... .....4.!!�S .. -..............p............... Chimney ' provided that the person accepting this permitsJ!4,, every respect conform to the terms of thea plication al on file in this office, and to the provisions of the and By-Laws relating to the Inspection, Alteration and PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Finall'I PERMIT EXPIRES I ®NTS ELECTRICAL INSPECTOR LESS CONSTRU A TS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rou�h Final Islay in a Conspicuous Place on the Premises — DO Not Remove FIRE DEPARTMENT No Lathing or Dry Wall To Be Done Burlier Until Inspected and Approved y the Building Inspector. Str i No. Smoke Det. U3 Un next step Living., home energy solutions This agreement is made by and among Next Step Living,Inc.("NSL") Marie Bourgeois 21 Drydock Avenue,2nd floor Boston,MA 02210 92 Surrey Dr phone: (866)867-8729 North Andover, MA 01845 Site ID: 418993 28-May-15 1. DESCRIPTION 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 recommendationstwork order describing the work in detail(the"Work")which are incorporated herein by reference.Pricing reflected below may be subject to adjustments In program pricing and offerings and is guaranteed for 30 days from the date the Contract is printed. lWVM ®• e A . i Work Location: Wall Insulate Vinyl Sided Walt With 4"Dense Pack Cellulose 1,129 $1.85 sgft $2,088.65 Work Location: Overhang Dense Pack 10"Cellulose In Overhang 50 $4.00 sqft $200.00 Work Location: Doors Door Weatherstripping w/Sweep 2 $75.00 Each $150.00 75 %Wt3theriation`,Iltcen4lae up to Program Max $1,828;99 Estimated Annual Energy Savings from the Above[rhorovementa $252:00 2. PAYMEN : CUSTOMER agrees to pay NSL for the work as follows: Pdyment#1: $100.00 Credit card or 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 113 of the total retail costs.(Note:Mastercard,Visa,and Discover accepted). Additional Payments and Final Invoice: $509.66 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. Customer Signature Date 28 May 2015 Edward Yaracz NSL Signat---qf ure Date Name of NSL Representative A1094890 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"(866)867-8729.inquiry@nextsteplivinginc.com.www.nextstepliving corn 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,orto delays attributable to the weather or otherevents 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 writing to Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116.617.973.8700. 5. PERMITS NSL will be responsible for obtaining any necessary permits as the Customer's 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 unfit 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 furnished under this Agreement will be of good quality and neva, (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 one year after completion of the Work or within any longer period as permitted or required under applicable taw,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 pre-existing 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. 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. 12.1 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, - - - - - - -Customee sole-recourse-into-Contractorand-notto-Conservation-Services-Group-(CSG)_orto the-Utility The-UfiliVand-its_operaling-companies shattnoL maintain,remove or perform any work whatsoever on the energy conservation measures installed. 12.2 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. 12.3 Customer agrees that it shall not hold CSG,the Utility,their affiliates or operating companies liable for Contractor's to perform its obligations under this agreement,for failure of the energy conservation measures to function,for any damage to Customer's Premises caused by Contractor or for any and all damages to properly 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 fax,or by e-mail sent or by delivery,not later than midnight of the third business day following the signing of this agveement. Mass Save PlanvilewDiagram Customer Mwv'%t Advisor Name: Address R*2 Sot« Dc, Advisor Number: Town N, ^�,�•��� Any limitations to access by truck? Site I® ,Ijq3 ��oy NOTES / ©q" Q PCL 41 �/',�,y ��,�5 117 q 3 �S W Oooc,, 2 ✓ VAlk r �� Flr t • �S ---Q --- ---- ---- -- �,- ------------------- -------------- -- -------- ------ 2.4 --------- -- ------------------------------------- -- -- --- - t �,5' 1�• rr 4 J� The Commonwealth of Massachusetts Department of Industrial Accidents W Office of Investigations a d 1 Congress Street, Suite 100 a< f Boston,NIA 02114-.2017 www,masse,govldia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Next step Living Address: 21 ®rydock Ave City/State/Zip: Boston, MA 02210 Phone#:(866)867-8729 Are you an employer?Check the appropriate bog: 'type of project(required): 1.9 I am a employer with $50 4. ® I am a general contractor and I 6 [)New construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ®Remodeling 2.[1 I am a sole proprietor or partner- sub-contractors have su ship and have no employees These 8. ®Demolition working for me in any capacity. employees and have workers' 9 ®Building addition o workers' com insurance comp.insurance.l [N p• 10.�Electrical repairs or additions required.] 5. 0 We are a corporation and its 3.® 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.] t c. 152, §1(4),and we have no 13.®Other Insulation _ employees. [No workers' comp. insurance required.] *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t I Iomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new aftida,it indicating such. tC'oatractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or rot t1103e ontities 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 for buy employees. Below is the policy and job site information. A•!•M Mutual Insurance Company Insurance Company Name: Policy#or Self-ins. Lie.#: AWC-400-7030025-2014A Expiration bate: 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DTA for insurance coverage v fi - 1 do hereby certify ander the pains and pen es -perjury that the information provided above is true and correct Si ature: Date: I / 1 a Phone# z a) 2!M9 Official use only. Ido not write in this area,to be completed by city or town official. City or Town: Permit/License.# Issuing Authority(circle one)'- 1. nes1.Board of health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: NEXTS-1 OP ID:EL DATE(MMIDDIWYY) CERTIFICATE I ILIT`t INSURANCE 10/01/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION 0"� y AND CONFERS NO RIGHTS PONTHE C9RTIFIC Tr HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR A(TER THE COVERAGE AFFORDED BY THE POLICIES BELOVy. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORlzgp RSP RPSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 14 IMP RTANT: If the gertilicate holder is an ADDITIONAL INSURED,the policy(ies)must 6e endorsed. s SUBROGATION YV- IVr.Q,Quo 6@1 tg the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to 1hR certificate holder in lieu of such endorsement(s), CONTACT PRODUCER NAME: Erin Ly®n� McLaughl!"I}�sulweg Agency PHONE 701=665=2775 FAX No),781-665-0290 (AJO820 Lynn fells ParkW?iy -M No Etd Melrose,MA 02176 EMAIL ADDRESS: John E.McLaughlin Jr. INSURER(S)AFFORDING COVERAGE NAIL 0 INSURER A:Nautilus Insurance 3475 INSURED f�eX$$tell I.iVing,Inc. INSURER B:Commerce Insurance Company 21 Drydock Avenue,2nd Floor INSURERC:A•I.M.Mutual Insurance Co. Boston,MA 02210 IS Insurance Company 15610 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 RI Rwp INDICATED. NOTWITHSTANDING ANY REQUIREMENT, TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH T}{18 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. DO BR POL CY EFF POLICY EXP LIMITS INN—SRTYPE OF INSURANCE POLICY NU41SER MMIDDM(VY MMIDD AO0000,0900 A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 09/30/2014 09/30/2015 DA AG TORE TED (J(IMa MAUr ®Uf GUTt E�yP2090198=12 PREMISES Ea occurrenceL— MED EXP(Any one person) $PERSONAL&ADV INJURY GENERAL AGGREGATE $ �,aQNA(of,Ql� GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS•COMP/OP AGG $ +QAQ+AP POLICY❑JEPRO•CT El LOC $ OTHER: COMBINED SINGLE IT s lit) AUYOMOBILE LIABIbITY Ea accide B ANY AUTO 14MMBGKKOM 09130/2014 09/3012015 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ALL INJURY(Per accident) $ AUTOS NALITON-OWNED PROPer PERTY DAMAGE $ accident HIRED AUTOS X AUTOS $ EACH OCCURRENCE $ 5,000 Q0 UMBRELLA LIAB X OCCUR 0,909.9011 D EXCESS LIAB CLAIMS-MADE El,U783547012014 0913012014 09130/x095 AGGREGATE $ DED RETENTION$ X STATUTE ERH WORKERS COMPENSATION 500900 AND EMPLOYERS'LIABILITY TO BE ISSUED BY CARRIER 09/3012014 00/3012015 E.L.EACH ACCIDENT $ C ANY PROPRIETORIPARTNERIEXECUTIVE Y�NIA E.L.DISEASE-EA EMPLOYE $ 500,00 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) 500,000 If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES(ACORD 101,Additional Remart(s Schedule,may be attached if more space Is required) FOR INFONWIXON ONLY CERTIFICATE HOLDERINF®=01 CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN For Information Only ACCORDANCE L:9TH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE ---- ©1980.2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014191) Tho ApgRR q@MR knj I°igp'are P@ q1'%er��I, �F�.f ACORN e.(W14', , . Mice ®f Consumer Regulation siness 10 Park Plaza - Suite 5170 ` Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 162111 "type: Supplement Card Expiration: 1/14/2017 NEXT STEP LIVING INC. ROGER OUELLETTE 21 ®RY®®CK AVE. 2TH FL BOSTON, MA 02210 Update Address and return card.Mark reason ffoY cl"®ange° ❑ Address ❑ Renewal ❑ Employment ❑ )Lost Card Office of Consumer Affairs der Business Reguiafior, )License or registration valid for individul use only before the expiration date. bff found return to: k } HOME IMPROVLMENT CONTRACTOR office of Consumer Affairs and Business Regulation Registration. 982919 Type: 10 Park Plaza-Suite 5190 i Expiration: 111412017 Supplement Card Boston,MA 02116,,, NEXT STEP LIVING INC. , ROGER OUELLETTE 21 DRYDOCK AVE.2TH FL r� G%�'� — --� BOSTON:MA 02210 Lindersecretar9 '1�1oTvalid without signature Massibc,husefls DeparinierO ot Pubhc Safety R!�)ard of BuMmg RegWafions an(J Standards o its I r'"C do n SU rmr,�ir k iu)r 'S"foc",4"i a It CSSL-102811 ROGER A OVE OLLT V 55 STAMOn Wandek RK 02M (0911312016 Rastdcted TO: CSSL-OC e Insulation Contra(Mor Failure to possess a current edition OF the M1 assachusetts Stere Building Code is cause for revo-C9,!on 0111fthis license. For DPS Licensing informajon VIA: WINVAMSSAMPPS