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HomeMy WebLinkAboutBuilding Permit # 7/27/2015 t%ORT11 ,,FD "6" BUILDING PERMIT . '16 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received AC14 Date Issued: F-- IMPORTANT:Applicant must complete all items on this page LOCATION # 0—1 /4, nt PROPERTY OWNER 7 Print 100 Year Structure yes no MAP 102-% PARCEL: A—ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential [I New Building [I One family F1 Addition [I Two or more family 11 Industrial No. of units: [i Commercial [I Alteration 11 Repair, replacement [I Assessory Bldg Others: 0 Demolition 0 Otherlr 11181 �k'1, fil In Nell DESCRIPTION OF WORK TO BE PERFORMED: A-1 Identificatio Please Type or Print Clearly OWNER: Name: Phone: "2 Address: , �o 3 Contractor Name: Phone: Email: 'T 4 L`� )60 45 Contractor Email rac to, Address:e Address: S up rviso Exp. Date: upervisor's Construction License: Home Improvement Lv�e 20 -Exp. Date: rLHome Improvement License: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERM $12.00 PER$1000-00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: 2-4 --Receipt No.: t h antyfund NOTE: Persons contracting with unregistered contractors do not have access o the g - ---7—_-77 77, n Siqnature6fcb 't1a6`tQ O)Ainer', k tjORTH Town of It T.", Andover ® .s.: ;2 C'o ver9 Mass, 15 cU .44 C OCHIMWIC ,- % �.eS AJAr 0 V BOARD OF HEALTH Food/Kitchen P E �R NL11 T Septic System } THIS CERTIFIES THAT ....1� .. BUILDING INSPECTOR ................... ........................ e..qj........................................................... Foundation has permission to erect .............. ........... buildings on .... ... .. C...4 I .... . . .... ............. IL.......................... Rough to be occupied as ....... ..:!� ... ....... ...... .. ...�. .....�. . . . 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 IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS ION TARTS Rough Service .... ... ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuRough 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 Approvedy the Building Inspector. - Burner Street No. Smoke Det. i Federal ID ff RISE ETigencerin StRestionAACon corRgiratNo A division of Thielsch Engineering CT Contractor Registration No `� 60 Shawmut Unit#2,Canton,MA 02021 iCONTRACT r� 339-502-6335 FAX 339-502-6345 I 7�q Page �$ PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE A r, A-„IIE�, ENGINEERING AND THE CUSTOMER FOR WORK AS pESCRISEO BELOW ENGINEERING .e. _...,_,.�_.__._....,..,w.. .._...,_._...�...�_.._..,_..._._. _...._..._. CUSTOMER PHONE OATS CLIENTfO WORK ORDER .. Elizabeth Trainor (978)766-7886 08/22/2014 403665 00002 SERVICE STREET ._.,._...._. _......,... �--,..,.....�.___....... BILLING STREET.... .".."""'"....._.._.___._....._._.__ 389 Marbleridge Rd 389 Marbleridge Rd SERVICE CITY,STATE,ZIP.,.,W.._..,........ BILLING CRY.STATE,ZIP North Andover,MA 01845-4716 North Andover,MA 01845-4716 JOB DESCRIPTION i AIR SEAI,ING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed it)concert with the use of special tools and diagnostic tests to assure that your home will be lett with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams,weatherstripping and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (10)working hours. At the completion of the wcatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the subcontractor to ensure the safety of the indoor air quality. $750,00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass balls to(62)square teat for damming purposes. $127.10 AT'T'IC FLAT:Provide labor and materials to install an 8"layer of R-28 Class 1 Cellulose added to(1092)square feet of open attic space. $1,419.60 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. "rhe cover has integral wealher-stripping to restrict air leakage. $200.00 VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with soffit mounted flapper vent to exhaust existing bathroom fan(s). $237.50 VENTiLATION:Provide labor and materials to install ventilation chutes in(36)rafter bays to maintain air flow. $72.00 VENTILATION:Provide labor and materials to install(12)4"X 16"rectangular aluminum soffit vents to increase ventilation in attic areas.Specify color:White or Gray. $300.00 CRAWLSPACE:Provide labor and materials to install (28)square feet of R-10 rigid Thermax insulation to the crawlspace perimeter wail up to the sill and against the band joist. $98.56 BASEMENT CEILING:Provide labor and materials to install(62)linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $99.20 JW NOV 17 2014 1fl�5. Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thicisch Engincering CT Contractor Registration No iii r! yl ff i � ,�rff� 6q Sha1YI11nt unit#2,Canton,MA g2U2t CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE tVCithT�lrltlAlG CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED DELOW CUSTOMER .__.._._.............._�..__—__._.....,.._.._....._ pH...�.__ __...,__....._...�. ,._._.._.�.._ _.,.-....._......._... -.-.,.....�._._ ONE DATE CLIENT WORKORDER Elizabeth Trainor (978)766-7886 08/22/201.4 403665 00002 SERVICE STREET BILLING STREET 389 Marbleridge Rd 389 Marbleridge Rd SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845-4716 North Andover,MA 018454716 JOB DESCRIPTION Total: $3,303.96 Program Incentive: $2,515,47 Customer Total: $788,49 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Seven Hundred Eighty-Eight&49/100 Dollars $788.49 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED 14ONTHLY ON ANY '.. UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INF ATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTH bSIONATURE-RISEENGI EERING C �TMER PIAN NOTE:THIS CONTRACT MAYBE WffHDRAWN BY US IF NOT EXECUTED WRHIN DATE OF ACCEPTANCE t -y –� _......._._. _._...._. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK -.– —.. DAYS. AS SPECIFIED,PAYMENT WILL BE MADE AS OUTLINED ABOVE The Commonwealth of Masso chusefis Department of IndustrialAccidents ,l� •¢d 1 Congress Street, Suite 100 Boston,MA 02114-2017 , www mass.gov/dia .yt ,y. Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY- Ap,plicaut Information Please Print Legib Name (Business/Organization/In�divdual): Address: City/State/Zip: j17Z& 6 24a6 Phone#i: � + Are you an employer?Check tlye appropriate box: Type of project(required): 1 I am a employer with .—employees(full and/or part-tone).* 7. New construction 2. 1 am a sole proprietor or partnership and have no employees working for me in $, [1 Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 10E]Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 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.Q Roof repairs These sub-contractors have employees and have workers'comp.instuance.t 6.FJ We are a corporation and its officers have exercised their right of exemption per MGL G. 14Other�r l d 152,§1(4),and we have m 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. 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-con rac6s have employees,tiiey must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is the policy and jab site information. Insurance Company Name: Policy#or Self-ins.Lic.#: t`t 6q 166 Expiratiopate: 67 fob Site Address: City/State/Zip: Attach a copy of the workers' compepsation policy de ai ation 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 Hepar s a dpenalties ofperjury that the information provided �+above is true and correct. Date: "` _m �O/10 Si nature: Phone# �� x Official use only. Do notwritein 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#: TDINS4 OP ID:MR DATE(MM/DDlYYYY) E TIFI `TE LI iLl IN lJ CE 06/10/2016 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 su0h endorsement(s). PRODUCER CONTACT TYG Insurance Agency,Inc. NAME: 68 Freeman Street ac°NNo Ed):781-041-3002 ac No):781-641-3009 Arlington,MA 02474.6614 EMAIL ADDRESS: INSURERS AFFORDING COVERAGE NAIL# INSURERA:Scottsdale Insurance Company INSURED TD insulation,Inc. INSURSRO AmGUard insurance company dba Hugh's EneriW 269 Milton StreetINsuRERC:Arbella Protection Ins Co. 41360 Dedham,MA 02026 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. NOTWITHSTANDINO 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. ADDL SUER YFXP IL SSR TYPE OF INSURANCE ` MSD POLICY NUMBER POLICY E FF MMODUDD LIMITS A X COMMERCIAL GENERALLIABIIJTY EACH OCCURRENCE _ S 1,000,000 DAMAGE TO RENTEff- CLAIMS-MADE ®OCCUR CPS2020992 08/1412014 08/14/2015 PREMISES Ea occurrence S 50,00 MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY S 1,000,00 GEN'LAGGREGATE LIMIT APPUESFER: GENERALAGGREGATE S 2,000,00 POLICY❑PROJECT ❑LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acciden S 1,000,00 C ANY AUTO 1020032764 08/14/2014 08/14/2015 BODILY INJURY(Per person) S AALL UTOS X AUTOStILED BODILY INJURY(Per accident) S NON-OVINED PROPERTY DAMAGE S HIREDAUTOS AUTOS Peraccident S UMBRELLALIAB X OCCUR EACH OCCURRENCE S 1,000,00 A EXCESSLIAB CLAIMS-MADE XBS0044410 10/07/2014 08114/2015 AGGREGATE $ 1,000,00 DED I X I RETENTIONS 10000 S WORKERS COMPENSATIONPER 0TH AND EMPLOYERS'LIABILITY STATUTE ER _ B ANY PROPRIETORIPARTNERIEXECUTIIIE YIN R2WC641650 05/30/2015 05/3012016 E.L.EACH ACCIDENT S 500,000 OFFICERIMEMBER EXCLUDED? ®N I A (Mandatory In NH) EL DISEASE-EA EMPLOYEE $ 500,000 ff yes,describe under DESCRIPTION OF OPERATIONS batow E.L.DISEASE-POLICY LIMIT S 504,000 Commercial Applica DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLt9S(ACORD 101,AddlHanal Ra exo Sehodula,may bo attaohad It more apace Is mquimu) Conservation Services Group,linc,National Grid NSTAR and WMEC are added as additional insured as their interest may appear?or work contracted with the named 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. AUTHORIZED REPRESENTATIVE i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD s Massachusetts -Departm nt of Public SatetV Board o;vuiiui ng 4sculado. , a',—,d .ds tl/llStl Ll 1.Illi 11 Jll it C'1 4 SSill _ License: C&O507$4 Thomas P Dram,opt, 259 Nulton Street Dedham MA 02026 l L J Expiration 10/22/2016 commissioner al Law Office of Consumer Affairs and Business Regulation Law = ! 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 831TREET DEDHAM, MA 02026 Update Address and return card.Mark reason for change. SCA 1 C; 20M-05111 L Address 'I Renewal Employment 1--] Lost Card !l/re�c�iuucurorn(I�a�G(lrr;lrrc/in.;eC1 _ � ice of Consumer Affairs&Business Regulation License or registration valid for individul use only ,ate —I' §ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Office of Consumer Affairs and Business Regulation �,�Registration: 104800 Type: 10 Park Plaza-Suite 5170 Expiration 7/15/201E;- Supplement CE!;d Boston,MA 02116 HUGH'S ENERGY CORPORATIw THOMAS DROMGOOLE 259 MILTON STREET — DEDHAM,MA 02026 Undersecretary Not valid without signature