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HomeMy WebLinkAboutBuilding Permit # 7/27/2015 %AO R TH IJIL I PERMIT 0 �° �o TOWN OF NORTHA V R 0 - p APPLICATION FOR PLAN EXAMINATION _ n Permit No#: t ' 14 Date Received �R°°RATE°WPP� �5 �SSgcHus``R Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION �' Print PROPERTY OWNER ' �� `� is c w 100 Year Structure es(noPnnt Y5'KMAP PARCEL: ZONING DISTRICT: Historic District yeo Machine Shop Village yeo TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New BuildingOne family Addition ❑ o or more family 11 Industrial ❑Alteration No. of units: El Commercial El Repair, replacement ElAssessory Bldg El Others: ❑ Demolition ❑ Other w: r s «��., „� r r ar :r;';: r lion ,r ^-rfl�r'Hi��,rdb Yui!/tiJr�,r ,./,r„/,d/„J /r�/ilii///%';, r� �,r r r�r�,u r�,, �/P,rlx�. ?r /y ,d 11/ (/r wflulll,,�,,Vjaters r n M' , f I i/r ,i�� o:c -- r'� r-!e r..I rf J% ( // /G!:rN!„r//a/,,, ,,,% % rc .� r/!.f r,✓r/la lilen.rrrrf r / , 1 ,,,/i„ii nrm,rrs,ia,r arrr 6yxa J.'�f .. i��l%/.. / /�/JIj �1; > /t, / ed;Dtod'la: eWloo p �:"'� �! ,U 7 DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: i Phone: Address: InI ��� as Contractor Name: Phone: ' Email: Address: 24 c.T` " ”�0� � ' ��� �,� 1 , Supervisor's Construction License: ` Exp. Date: 4Co Home Improvement License: Exp. Date: - ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BOLDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 'a $ EE: � F $ Total Project Cost: �:� J µ 2.. .. l Receipt Check No.: t No.:p NOTE: Persons contracting wit >” red contractors do not have access to a fund F %aORTH Town of over 0 to I- I. . . M . i ® _Zb y a e� O LAKE h ver, Mass, COC KICNEWICN S U BOARD OF HEALTH Food/Kitchen E R D Septic System WTHIS CERTIFIES THAT ....... BUILDING INSPECTOR .......... .. ....I ......... ....................... ............................. . ..... ..... has permission to erect .......................... buildings on ................ .....>11ZAL............. Foundation ® Rough to be occupied as .............. ... .... ........ ......T.�C �/lR��► .................................... Chimney provided that the person accepting this perm' II 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 C S N RT Rough Service ....... ...... . ........................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Bulldin Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. - Burner Street No. Smoke Det. �snext step Living., home energy solutions This agreement Is made by and among Next Step Living,Inc.("NSL") Deb Visco 21 Drydock Avenue,2nd floor 62 Bannon Dr Boston,MA 02210 North Andover, MA 01845 phone: (866)867-8729 Site ID: 416162 09-Jun-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 recommendations/work 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. bqscrip,ion Sealing Recommendations $510,00 Work Location: Attic Flat Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 6 $85.00 Hr $510.00 Weathbrization Recommendations Work Location: Attic Flat Replace Bath Fan Hose 2 $50.00 Each $100.00 Attic:Stair Cover Thermal Barrier with Carpentry1 $237.65 Each- Damming acti Damming 96 $2.05 Lnft $196.80 Propavent 2'or 4' 80 $2'.00 >Each. $120.00 Attic Floor Open Blow Cellulose 9" 128 $1.43. sgft $183.04 Attic Floor Open Blow Cellulose 12" . 544 $1.60 sgft $820;40'. Initial Investinent: . . 100%Airsealing incentive up;to Program:Max $51sOQ.;; 75%VVeatheCizabon;;incentive up to Program Max $1,280;97.: total Estimated Annual Energy Savings#rom the Above Improvements $358 00 2. PAYMENT: CUSTOMER agrees to pay NSL for the work as follows: 4- Payment#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 1/3 of the total retail costs.(Note:Mastercard,Visa,and Discover accepted). Additional Payments and Final Invoice: $326.97 -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 fait to receive payment within 5 days of invoice. 9 ^ /5. Customer g ature Date - 9 Jun 2015 Elizabeth Venuti NSL Signature Date Name of NSL Representative Al 109266 The Terms of this Agreement are contained on both sides of this page Next Step Living-21 Drydock Avenue"2nd floor"Boston,MA 02210"(866)867-8729"inquiry@nextstepllvinginc.com.www.nextstepliving.com next step Living. home energy solutions This agreement is made by and among Next Step Living,Inc.("NSL") Deb ViSco 21 Drydock Avenue,2nd floor 62 Bannon Dr Boston,MA 02210 North Andover, MA 01845 phone: (866)867-8729 Site ID: 416162 09-Jun-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. as 6 criptionQuantityInvestment Other • Work Location: Attic Flat Floor: Remove and relocate flooring onsite (Not Rebate 32 $1.41 sqft $45.20 Eligible) Initial Investment: $45.20 Nod Rebat6. ligible Total Not Investment: 5 Estimated Annual Energy Savings.from th e Above lmprovemerit 2. PAYMENT: CUSTOMER agrees to pay NSL for the work as follows: Payment#1: $45.20 Additional Payments and Final Invoice: $0.00 -Additional Payments for the Work shall be due upon completion of the Work. CusIgrplure Date 9 Jun 2015 Elizabeth Venuti NSL Signature Date Name of NSL Representative All 109266 The Terms of this Agreement are contained on both sides of this page Maas Save Planviewr Diagram Customer Pcn VvcCn Advisor Name: eU�� VON()n Address 62 2�t1UA®QV_ Advisor Number: Town JA Lr4 &A0(1V, Any limitations to access by truck? Site ID ND NOTES / V Mov— �� +�2Ewu� O,y s�(92- v VMS: � 1� � �112bcS Q V-!s 14-mc-rL N42�) (-� WX:@ 1 LOO ibf Nom, Z� ®I Ns. enc r(, (914y6) ©T—Vomf,r qN t ® oRMMIN&, ct(" C�►°���vG�rS, 1,�r1 te0 I� Look QoeteDS (IZ'K!��'� V � � �d� The Commonwealth of Massachusetts Department ofIndustrialAccidents Office of Investigations 1 Congress Street, Suite 100 Boston,MA 02114-2017 Workers'Compensation Insurance Affidavit-. Builders/Contractors/Electricians/Plumbers AppUcant Informal on Please Print Legibly Name (Business/Organization/Individual): Next Step Living Address: 21 Drydock Ave City/State/Zip: Boston, MA 022110 Phone#:(866)867-8729 Are you an employer?Check the appropriate box: Type of project(required): I.* I am a employer with 860 4. 1 am a general contractor and I tj 11 employees(full and/or part-time).* have hired the sub-contractors 6. ®New construction 211 1 am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling ship and have no employees These sub-contractors have 8. []Demolition working for me in any capacity. employees and have workers' 9. E]Building addition [No workers' comp. insurance comp. insurance.t required.] 5. We are a corporation and its io.nElectrical repairs or additions 3.El I am a homeowner doing all work officers have exercised their 11.®Plumbing repairs or additions right of exemption per MGL myself. [No workers' comp. 12.El Roof repairs insurance required.] t c. 152,§1(4),and we have no 13.9 Other Insulation employees. [No workers' comp. insurance required.] J *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t I lomeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lCont-nactors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those onlitie.,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 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$250.00 a day against the violator. Be advise-d that a copy of this statement may be forwarded to the Office of Investigations of the DIA verY flytion. for insurance coverage n I- -- - ==L� I do hereby certifyI under the pains and peh es 1-lperjury that the information provided above is true and correct Sipgture: Date: I o/ 1-1 /r Phone Moida) n Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License.# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Persom Phone NEXTS-1 OP ID:EL CERTIFICATE T F LIABILITY INSUMNCEFDATE(MMI)DIYYYY) 10/01/2014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION O%y AND CONFER$ N® RIONTq UPON TH9 URTIFIGATP HOLDER,THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AI TER THE COVERAGE AFFORDED BY THE POLIVIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIap RRR RSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMP RTANT: If the pertiflcate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION Iq W�IV��r OOItL6$ 4 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 ill lieu of such endorsement(s). PRODUCER NAME CT Erin Lyons 828 Lynn f 1psurance Agency A/OONN Ext:761=605.2775 AIc No:761=665.02 820 Lynn fells ParkrAt�y EMAIL Melrose,MA 02176 John E.McLaughlin Jr. ADDRESS: INSURER(S)AFFORDING COVERAGE NAIL C INSURER A:Nautilus Insurance INSURED Next Step Iaiving,Inc. INSURERS:Commerce Insurance Company 34754 21 Dryd®okAvenue,2nd Flour INSURERC:A.I.M.Mutual Insurance Co. Boston,MA 02210 INsuaERD: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 I R INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH TR 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, INSRADDLSUBR POLICY EFF POLICY EXP TYPE OF INSURANCE LTR S POLICY NUMBER JMMIDDffnffl (MMIODNYYYILIMITS A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 ® E(PP2010198-12 09/30/2014 09/30/2016 D AG To 100,000 CLAIMS-MADE OCCUR PREMISES Ea occurrence $ 9Q0,000 MED EXP(Any one person) $ 0,900 PERSONAL&ADV INJURY S 1 r i1flfl GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ ?,Q}7®,Mp PPOLICY❑JECT LOC PRODUCTS-COMPIOPAGG $ �, AYrQpO OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1®0p,0p0 Ea accident ,. B ANY AUTO 14MMBGKKOM 09/30/2014 09/30/2015 BODILYINJURY(Per person) S ALL OWNED FV_1 SCHEDULED BODILY INJURY(Per accident) $ = AUTOS NUTOS ON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident $ UMBRELLA LIAB OCCUR. EACH OCCURRENCE $ 0,000,00 D EXCESS LIAB CLAIMS-MADE E�1.1783547012014 09/3012014 09/3012015 AGGREGATE $ drQO , 0p DED RETENTION$ $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ERH C ANY PROPRIETORIPARTNERIEXECUTIVE Y/N TO BE ISSUED BY CARRIER 09/30/2014 08/30/2015 E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBER EXCLUDED? ❑N I A (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,desedbeunder DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 161,Additional Remarks Schedule,maybe attached If more space Is required) FOR INFORMATXON ONLY CERTIFICATE HOLDEN 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. AUTHORIZREPRESENTATIVE ©1988-2014 AaCORD CORPORATION. All rights reserved. AC®R®25(2014/91) Th@ ApipRR qRPS R q I9p are r �P�e � pa&gof AO®R 4 0 ci sum an Business Regulation i�i" ' fton' erAffai�) ', d 10 Park Plaza e Suite 5170 Boston, Massachusetts 02116 Home Improvement rovement 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 02230 Update Address and return card.Mark reason for change. E] Address F] Renewal ❑ Employment Lost Card F Offiee of Consumer Affairs&Business Regulation License or registration valid for individul use only t HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: r Office of Consumer Affairs and Business Regulation RegWretlon: 162111 Type: 10 Park Plaza-Suite'5190 Expiration: 1114!2017 Supple�mem Card {i Boston,51A 0.21 NEXT STEP LIVING 1NC. ROGER OUELLETTE 21 DRYDOCK AVE.2TH Ft -- BOSTON.MA 02210 Undersecretary '�o�slid without signature M ass ac h usetts Departfnenl of Pwbk- Safet�y 8,�)wd ot Buddmg Regukatwis aw-I �,-,Aaridwds Cwxi I ructitim ko r' Si'fhnk,6A,I USK-102811 ROGER A ONVELLET T 55 STAMORE, RO- wandek IUI 029w) (9911312(018 Regricted To: CSSWC-lnsulation Conatract©r Failure to possess a current edition of the Massachusetts State Building Code is cause for reum,Cation of this license. For DPS Licensing inWormation volsit' MWAM-GOV/0PS