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HomeMy WebLinkAboutBuilding Permit # 7/27/2015 t%ORTH BU0,ILDING PERMIT 06 c TOWN OF NORTHA NDOVER 0 rw% APPLICATION FOR PLAN EXAMINATION Permit No#: µ Date Received rep Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION �4 ri nt PROPERTY OWNER &,l 67 eA,)--- Print 100 Year Structure '.yes no Machine Shop Village 0 yes no " r MAP PARCEL-07) 27ZONING DISTRICT: Historic District yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 0 One family El Addition El Two or more family El Industrial El Alteration No. of units: El Commercial Li Repair, replacement El Assessory Bldg 0 Demolition D Other 64 Of T101110k 11 rig 8( g/// wour 'gig I F111111111,11111 UN" DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: Contractor Name: f/,i A�16 "s ffqk-V6 Phone: '771 93 7,6 (P _ Email: Address: )41;J A I /h e-)' 6 Supervisor's Construction License: 6,,60 Exp. Date: )646 Home Improvement License: 10't ;52�e� Exp. Date: 7 " 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.: C1 C-55,- Receipt No.: 2- NOTE: Persons contracting with unregistered ontractors do not have access to the uarantvfund 1117 T ]A�7 F ttORTH fown of �. _ E 1, over 0% ® � pr, Ma �2vi 1� Y LAKE h verb SS' N t 0 1, COC KICKEwICK V A°RATe® AP���� S U BOARD OF HEALTH Food/Kitchen PtRMIT T L �D Septic System to c THIS CERTIFIES THAT ....... . BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on . .. ...... ... ...... . .®....... ��,.®® . A IL � Rough to be occupied as ....... �R.Vk ........ ......... ...�� ...... .. . ............................. Chimney 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXI IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONS1- ST RTS Rough — — Service ............ ... ........ ...... ............................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy BulldinRough Display in a Conspicuous Place on the Premises — Do Not 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. � I Federal to# RISE Engineering RI contractor Registration No SIA Contractor Registration No A division nf'1'htcisclh Engineering CT Contractor Registration No %A/ 60 Showwmut,Canton,NIA 02021 339-502-5197 FAX 339-502-6345 CONTRACT Page 1 ENGINEERING PROGRAM naa CONTRACT IS ErrrEREb INTO aEwJEEN n19E CMA HES ENOWEERrNOAUDTHE CUSTOMER FOR WORK AS --- DESCRIBED BELOW w ._.._.._._,. _..__..._,. ,...._..........,...,....._......,�, CUSTOMER PHO„E DATE CUENrS WORK ORDER Erica Nlegrew `� rM X101)680-0567 03/16/2015 406429 00002 _..__ __.___ .,e.. __- ____ _. ,. ._. _ _.... SERVICESTREET -„___,. ._._.__.._...... _..._....,....___..........,. ....._,..... ' � lr.MO STREET �f� 21 Cleveland Street f ::�( � -1 Cleveland Street _____e_c_._. _._._-.., ._. _.._._.._ _._. . BEawce nv.arArE.zIP � Biuraa clrr,STATE.ZIP Nortlt Andover,MA 018 North Andover,MA 01845 jo ON Alii SEALING:Provide labor and miucritds to seal arcus ofyour home against wvaslefui,excess air leakage. This work will he perforated in concert with the use ofspecial tools and diagnostic tests to assure that your home will he telt with a healthful levet ofnir exchange and indoor air quality.Materials to be used to seat your home can include caulks,founts and other products. Primary areas for scaling include air leakage to allies,basements,attached gamges,md other unheated areas(windows art,not generally addressed.) (8)working hours. At the completion or tile wveatherirntion work,and at no additional cost to tic homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-conimetor to ensure the saicty of the indoor air quality. $680.00 AIR SEALING ADDER; (2)working hours. $170.00 DAMMING:Provide labor and materials to install it 12”layer of R-38 unlaced fiberglass baits to(30)square feet for damming purposes. S61.50 ATTIC FLAT:Provide labor and materials to install a 10"layer of R-35 Class I Cellulose added to(390)square lect of open attic space. $573.30 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(180)square feet of kneewalt area. 5630.00 KNEEWALL FLOOR:Provide labor and materials to install a 6"layer ofdcnse packed R-22 Class l Cellulose added to(168)square feet of kneewail floor. 5299.04 A171C ACCESS:Provide labor and materials to institute(4) buck of Ute kneewali hatch wish 2"rigid Thennax board,and seal the edge of the hatch with weatherstripping. 5240.00 VENTILATION:Provide tabor and materials to install ventilation chutes in(43)rafter bays to maintain air flow. $86.00 BASEMEN"1'DOOR:Provide labor and materials to insulate fire back of fbc basement door leading to the bulkhead with 2"rigid board that meets the sections R-316.5.4 and 316.6 requirements ol'building code. Seal all edges and scams with FSK tape. $72.22 j Foderar to# It RISE Engineering RIContractor Registration No A division ar7"Itictsah F,ntinooring MA Contractor Registration No CT Contractor Registration No 60 SBbavInnt,Canton,NIA 02021 339.502-5197 TAX 339-502-6345 CONTRACT Page 2 ENGINEERING PROGRAi1l TiS$CONTRACT IS ENTERED INTO BETWEEN RI$E - CMA-HCS ENGINEER"ANDTHE CUSTOMER FOR WORK AS ., . .. - DE9CRIbEa BELOW & �q° CUSTOMER VV ....._._... PHONE DATE CLIENT I$ WORK ORDER (401)680-0567 03/16/2015 406429 00002 ._SERVIC Erica Megrew _ ,e K L. ILII.._ E STREET ��" ��" ��p�R BILLING STREET 21 Cleveland Street 21 Cleveland Street SERVICE CRY,STATE.ZIP North Andover,MA 0I845m�mm� u u BILLING CITY,STATE,ZIP North Andover,MA 01845 JOB DESCRIPTION Total: $2,812.06 Program Incentive: $2,329.55 Customer Total: $490.61 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE SUM OF 'Four Hundred Ninety&511900 Dollars $490.61 UPON FINAL PaIPECnon AND APPROVAL BY RISE EnSwEERpla,CUSTOMER AGREE$To REMR AMOUNT DUE 91 FULL INTEREST OF 1%WILL DE CNARCED MONTHLY ON ANY ILII. NPAIO BALANCEREVERSE FOR UAPORTANT IPIFOAGIATIDN ON GUARANTEES,RIGHTS OF RECUiIDN,SCHEDUUNa,AND CONTRACTOR REOYSTRAnON ,AFTER 1p GAYS.$EE EV., �\\._.._.,... _. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES _. _ AviR iZEDSIONA •RI9EEn$Inaminp CUSTOMER ACCEPTANCE v\ NOTE.THIS CONTRACT MAY BE varnom N BY US IF NOT EXECUTED WRHIN DATE OFACCEPTANCE 30 ACCEPTANCE OF CONTRACT 711E ABOVE PRICES,SPECIRCATIDUS AND CONDITIONS ARE DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORg"TO 00 THE WORK AS SPECIFIED.PAYMENT VALL DE MADE AS OUTLINED ABOVE The Commonwealth of Massachusetts Department of IndustrialAccidents w. a I Congress Street, Suite 100 ' Boston,MA 02114-2017 www massgov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Lellibly Name (Business/Organization/Individual): N Address: IL, City/State/Zip: l t Phone Are you an employer?Check the appropriate box: Type of project(required): -1-` Tmi'm a employer with employees(full and/or part-time).* 7. ❑Now construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3_Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10 ❑Building addition 4.❑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 11.❑Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.F1 Roof repairs These sub-contractors have employees and have workers'comp.insruance.$ 6.Q We area corporation and its officers have exercised their right of exemption per MGL c, 14 Other r 152,§1(4),and we have no.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. i 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 sheet 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'comp.policy number. I am an employes'that is providing workers'compensation insurance for my employees.'.Below is the policy and job site information. Insurance Company Name: a ' Policy#or Self-ins.Lic. Date: t,° Expiration#: p ..m 41sme\ Job Site Address: , "4-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 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 up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. Ido hereby certify under lie pails a dpenalties ofpef jury that the information provided above is true and correct, Si nature ", - ~� Date O Phone# 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#: TDINS-1 OP ID:MR CERTIFICATE OF LIABILITY INSURANCE Efe,61110120116 (MMDDWY 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 CERTIFICATH. 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 TYG Insurance Agency,Inc. NAME: 68 Freeman street AIC.o •781-641-3002 ac ND:781-641-3009 Arlington,MA 02474-6614 E-MAIL ADDRESS: INSURER(S)AFFORDING COVERAGE NAIC# INSURERA:Scottsdale insurance Company INSURED TD Insuiation,Inc. INSURERa:AmGuard Insurance Compan dba Hugh's Energy INSURERc:Arbelia Protection Ins Co. 41360 259 Milton Street Dedham,MA 020:16 INSURER D: INSURERE: 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. ILTR TYPEOFINSURANCE gp POLICY NUMBER POLICY EFF MMlDD EXP LIMITS A X COMMERCIAL GENERAL LIABIIJTY EACH OCCURRENCE $ 1,000,000 CLAIMS•MADE ®OCCUR CPS2020992 08114/2014 08/14/2015 PREMISES Ea occurrence $ 50,00 MED EXP(Anyone person) S 5,000 PERSONAL&ADV INJURY S 1,000,00 GENt AGGREGATE LIMITAPPLIES FER: GENERAL AGGREGATE S 2,000,00 POLICY❑PROECT FILOC PRODUCTS-COMPIOPAGG S 2,000,00 J OTHER: S AUTOMOBILE LIABILITY COMBINEOSINGLE LIMIT $ a acciden 1,000,00 C ANY AUTO 1020032764 08114/2014 08/14/2015 BODILY INJURY(Perperson) S ALL OWNED X SCHEDULED PROPERTY YINJURY Peracdtlent S AUTOS AUTOS ( ) HIRED AUTOS AUTOSV/NED PdDAMAGE S S UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 1,000,00 A EXCESSLIAB CLAIMS-MADE XBS0044410 10/07/2014 0811412015 AGGREGATE $ 1,000,00 DED I X I RETENTIONS 10000 S WORKERS COMPENSATION PER OTH AND EMPLOYERS'LIABILITY STATUTE ER B ANY PROPRIETOR/PARTNER/EXECUTIIfE Y/N R2WC641650 05/30/2015 05130/2016 EJ-EACH ACCIDENT S 5500,000 OFFICER/MEMBER EXCLUDED? ®N I A (Mandatory In NH) EL DISEASE-EA EMPLOYE $ 5500,000 If yes,describe under DESCRIPTION OF OPERATIONS betvv E.L DISEASE-POUCY LIMIT S J(tQ>OQD Commercial Appiica DESCRIPTIONOFOPERA71ON#/LOCATION9:/VEHICLES(ACORD101,Additl...I Remarks Schodata,maybe attaah¢d Hrmn=*pamehs-quired) Conservation Services Group,ilnc,National Grid NSTAR and WMEC are added as additional insured as their interest may appear for work contracted with the nomad insured. CERTIFICATE HOLDER CANCELLATION CONSWES SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORED REPRESENTATIVE f I (/ ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts -Deparim�r.t of Public Safety Board cf m-uildi ng Rcgulatic;ls an a anc'a;u� License: CS$30784� ' Thomas P Dromgople i 259 Milton Street Dedham MA 02016 Pxpiration " 1012212016 commissioner �• ��d'�� �Qt'��'��di�/1�L�P�IiCil'�'� �' �_�i'//��/�!1��6'Fi���i1��: _ Office of Consumer Affairs and Business Regulation 4 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 104800 Type: Supplement Card HUGH'S ENERGY CORPORATION Expiration: 7/15/2016 THOMAS DROMGOOLE 259 MILTON STREET DEDHAM, MA 02026 Update Address and return card.Mark reason for change. SCA 1 i3 20M-05/11 L I Address 'I Renewal i�j Employment 17 Lost Card � �e�(cr:�uurn.rrorrN/�a/C�!(rr:;Jac/rn.;nfi.; oMee of Consumer Affairs&Business Regulation License or registration valid for individul use only I' IF E IMPROVEMENT CONTRACTOR before the expiration date. If found return to: M Office of Consumer Affairs and Business Regulation G _,Registration: 104800 Type: 10 Park Plaza-Suite 5170 Expiration 7/15/201-6 Supplement Card Boston,MA 02116 HUGH'S ENERGY 0ORPORATI01V, THOMAS DROMGOOLE . 259 MILTON STREET DEDHAM,MA 02026 Undersecretary Not valid without signature