HomeMy WebLinkAboutMiscellaneous - 19 PHILLIPS COMMON 8/3/2015 tkORTH
BUILDING PERMIT o��iLeD Ib��o
TOWN OF NORTH ANDOVER 0 -
APPLICATION FOR PLAN EXAMINATION _
Permit No#: ' I `' Date Received ��ADRATED Pep�Zy
SsacHus�
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION `a � � f '�` Vsn
Print
PROPERTY OWNER I "
Kp-
Print 100 Year Structure ye
MAP PARCEL: ZC�WN6 DISTRICT: Historic District
Machine Shop Village y
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 ElAssessory Bldg ❑ Others:
❑ Demolition ❑ Other
F FlootlIain; "' ❑Wetlands F ;❑Watershed District
DSeptic ❑Well
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DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone:
Address: cl �hil I/ N i` J y. (' 1��if' ' ✓ 6 ,41.E
t, 'kit 14
Contractor Name: `'°` k'. Phone: S iD9 l l
Email:
Supervisor's Construction License: Exp. Date:
Home Improvement License: /bo aExp. Date: /
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ ,, �r �� FEE: $
Check No.: 6 62-k i � Receipt No.: 251�
NOTE: Persons contracting with un ' t contractors do not have access to the uar fund
gaORTH
Town of -E 1.' Andover
®
C,O ver, Mass,
COCKICKEWICK
X9.95°Rare o 011V? �5
U BOARD OF HEALTH
Food/Kitchen
P.. ERMIT T D Septic System
THIS CERTIFIES THAT ................. A BUILDING INSPECTOR
I.. ......... I
.. ..... . .......... ................
.................
has permission to erect ........ buildings on .� ��. Foundation
........ ...... . )... ..........�.............
Rough
to be occupied as ..... Chimney
.................................. ... . .... ...... ...... ......: ... �a .'�.�.
provided that the person accepting this permit shall in every respect conform to the terms of the application
on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, Alteration and Final
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
q ., PERMIT EXPIRES IN 6 MONI TIJS ELECTRICAL INSPECTOR
;l7�l UNLESS CONSTRUCT
Rough
Service
.... ........ ...................
BUILDING�INSPECTOR. Final
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz Rough
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.
next step living®
home energy solutions
This agreement is made by and among
Mike Sad Next Step'Living,lnc. ("NSL")
y -21.Drydock Avenue,-2nd floor
19 Phillips Common Boston,MA 02210
North Andover, MA 01845 phone: (866)867w!3729
Site ID: 41.8135
22-Jun-15
1. DESCRIPTION OF WORK TO BE PERFORMED
NSL will perform or cause to be performed the following work on the customers 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 Vork")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..
Qescriptionlr
Sealing Recommendations $850.00
Work Location: Attic:Flat
Perform Air-Sealing-at Estimated 62.5 CFM50-Per-Hour 10 -$85.00 Hr :$850.00
Weatherization Recommendations
Work Location: Attic Flat
Replace Bath Fan Hose 2 $50.00 Each $100:00
Attic Stair Cover ThermahBarrter:.with Carpentry 1 $237.:85 Each> $237.65'
Damming. 58 $2.05 Lnft. $118.90
prot 2''or 4'.`` 87 $2:00 Each >.. $174.00
Attic Floor Open Blow Cellulose 6" 1,012 $1.26 sgft $1,275.12
Work Location: Knee.Wall
Install 2"Thermal Barrier Polyiso on Kneewall 176 $3.50 sgft $616.00
Initial Investment: $3,371.67
1q0%Arsealirg lncettve up to Program Max $850.00
75%1Neatherization incentive up 6 Program Max $1,89126
Net Investment 0 .
Estlrrated Annual.energy Savings from the Above Improvements
2. AYP MENT: CUSTOMER agrees to pay NSL for the work as follows:
Payment#1: $100.00
-A non-refundable Deposit by credit card(Mastercard,Visa,or Discover card)is due at the time the Work is scheduled,Required payment information will be collected at
the time of scheduling. Deposit Is not to exceed V3 of the total contract cost..
Additional Payments and Fina Invoice: 530.41
-Additional payments for the Works II be due upon completion of the Work and will be charged to the credit card on file within 24 hours of delivery of the Final invoice.If
this credit card Charge Is declined for ny reaso ;upon noll ro SL you will be responsible for providing valid alternative credit card information necessary to complete
payment.
Cus re Date
22 Jun 2015 Joe Staropoli
NSL Sign re Date Name of NSL Representative Al 058614
The Terms of this Agreement are contained on both sides of this page
Next tep Living^21 Drydock Avenue 2nd Floor.Boston,MA 02210.(866)867-8729.lnquiry@nextsteplivinginc.com.www.nextstepliving.com
next step living®
home energy solutions
This agreement is made by and among
Next Step tiving,1nc.("NSL")
Mike Sady 21-Drydock.Avenue,2nd floor
19 Phillips Common Boston,MA 02210
North Andover, MA 01845 phone: •(866).867,9729
Site ID: 41$1.35
22-Jun-15
1. DESCRIPTION OF WORK TO BE PERFORMED
NSL will perform or cause to be performed the following work on the customers address above,In a professional manner and In accordance with the tons 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..
!DescriptionQuantity
Other Recommendations
Work Location: Attic flat
Recessed Light Cover .(Not Rebate Eligible) 5 $31.25 Each -$156:25
initial Investment $156.25,
Not Rebate:Eiigible:
Total Net Investment: $156.25
Esttmatetl Annual Energy Savings from t1ie:`Above Improvements $21:00
2. PAYMENT CUSTOMER agrees to pay NSL for the work as follows:
Payment#1: $50.00
Additional Payments and Final Invoice: $106.25
Customer SignatureDate
/Z, _.'- -22 Jun 2015 Joe`Staropoli
NSL Signature f VDate Name of NSL Representative A1058614
VTwTerms of this Agreement are contained on both sides of this page
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,or to delays
attributable to the weather or other events 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 021116.617.973.8700,
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,NSL's 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 until 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 new,
(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.
6,6 NSL may determine in the course of pre-installation Technical Review that modifications are necessary to the scope of Work in order to ensure
professional quality of the installation. In the event of such modifications,NSL will request a written modification of the Agreement to be signed by all
parties.In the event that Customer and NSL cannot agree on the modification,the Agreement may be terminated by either party.
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 perfotrn 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 law,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
_ --an fittings;ro ngwood,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 properly 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,
Customers sole recourse is to Contractor and not to Conservation Services Group(CSG)or to the Utility.The Utility and its operating companies shall not
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 Contractors to perform its obligations under
this agreement,for failure of the energy conservation measures to function,for any damage to Customers Premises caused by Contractor or for any and
all damages to property 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 wrhing 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 agreement.
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T1 he Commonwealth of Massachusetts
Department of IndustrialArridemis
Office of Invesdgations
I Congress Street, Suite 100
Boston,MA 02114-2017
W -mo WW 5-010RUda-&.0-
Workers' Compensation Insurance Affldavitm Buflders/Con-t'ractors/'Electricians/Plumbers
Applicant Information ploaqo P)lain
Name Next Step Living
AI
dirty ss. 21 Drydock Ave.
City/State/ZLp. BOston, MA 02210 pfique#:(866)867-8729
Are you an employer? Check the appropriate box-, Type of project(required):
1.a I am a employer with 850 4. [] I am a general contractor and 1 6, New construction
employees (full and/or part-time).* have hired the,sub-contractors
1 F1 I am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have 8. El Demolition
working for mo in any capacib. employees and have workers'
[No workers' comp, insurance comp. insurance.1 9. F] Building addition
required.) 5. Vie are a corporation and its I O.El Electrical repairs or additions
3.0 1 ama,homeowner doing all work officers have exercised their 11.EJ Plumbing repairs or additions
myself, (No workers' comp. right of exemption per MGL 12.Ej Roof repairs
insurance required.] C. 152, §1(4),and we have no
employees. fNo workers' 13A Other Insulation
comp. insurance required.]
'"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy infornialion,
of Homeowners whe submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidal it indicating such.
k'oatmetorstWc heek this box mast attached an additional sheet showing the name of the sub-contractors and state whether or rot diomonlitie., 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 insurancefor my employees. Below is the policy andjoh 3fte
Information.
Insurance Company Name: A.I.M Mutual Insurance Company
Policy#or Self-ins. Lie.M 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 for insurance coverage'e' fi
Ption.
I d®hereby certify under thepains anoee �X%fp'ariury that the information provided above is true and correct
�ods
SigLiature: -Date:
Phone dglotq)&Q-9-708
Official use only. Do not write in this area,to be completed by city or town official.
City or Town: Permit/Ucense.#
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
I---- ___——----- I
NE TS-1 OP 10:EL
DATE(r1jM1DDffffYM
CERTIFICATE OF LIABILITY IP7NSURANCE -fojB2014
THIS CERTIFICATE 10 ISSUED AS A MATTER OF INFORMATION 0%y AND COfIFER4 t40 R10116q "IM 1ff QW-IFIGATP HOLDERTHIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND ON Ap TER THE COVERAGE AFFORDED r3y THE PaIr'JES
BELOW- THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A COMTRAC?T BETWEEN THE ISSUING INSkIREWS), AUTPORIZED
REPPFSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
1110P RTANT:- Tih;qerHfIrate holder is an ADDITIONAL INSURED,the pollcy(les)musk be endorswl,
the terms and conditions of the policy,certain 1001101es may require ail endarsenienL A statement on this cord0cate does ngt confer rights to Bhp
cartifi .ate holder Ill lieu of such endorsameW(8).
PRODUCER CONTACT
NAME: _-EVIIII LYOH�_.
McLaughlin Wsuranca,Aqan�y PME.,
e a N
1828 Lynn FBI s Pirkwpy (Af EIII-781-665-2775 IRI`C.No):701-665.02go
Melrose,IMA 0:5,176 E-NIAIL
John E.McLaughlin Av. ADDRESS:
IMSURER(S)AFFORDING COVERAGE MAIC!7
INSURER A:Nautilus insurance
INSURRI) �jwd stop�Ivinpj'Inc. INSURER S.C 0-MMeFC0 InSffanCg CORIPEfflY 3476,4
21 Drydock Avenue,2nd Flow INSURERCA.H.M.Mutual Inswance Co.
BostcR,MA 02210 INsuREp D:AXIS Insurance Company .15610
[
INSURER E
"URERr
INSURER
:
r
GES CERTIFICAT E NUMBEIR- REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY ffIRM(P
INDICAT ED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH IS
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,
INSR ADOL SUER POLICY EFF POLICY EXP
POLICY NUMBER xMMR8Mn(M LIMITS
LTR i VPE Or INSURANCE IMPM
A X COMMERCIAL GENEFALLIABILITY EACH OCCURRENCE s 1,0®0,000
CLAIMS- DE ®OCCUREI3�®'1®'18��� DAMAGE 10 RENT11
1,(E.
PREMISE occurrence) $ 840,000
MED EXP(Any one person)
PENSONAL&ADV INJURY
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
POLICY F—]PROT- F—]LOC PRODUCTS-COMP/OP AGG $
JEC
OTHER: $
COMBINED SINGLE LIMIT AUVOMOBILE LIABII.ITY Ea
accident)
ANY AUTO 14MM13OKKOM 09/30/20114 09/30f209r? BODILY INJURY(Per person)
ALL OWNED x SCHEDULED
AUTOS AUTOS BODILY INJURY(Per nccidenil
_X_ NON-OWNED PROPERTY DAMAGE
HIREDAUTIOS AUTOS Per accident
71�1egtRl I.I lArl OCCUR EACI I OCCURRENCE 1$
M(CESS LIAB CLAIMS-MADE AGGREGATE $
_=k)FD I _]RETENTIONS PER ST U 1=_=__
.9 --bWR�_
WORKERS COMPENSATION STATUTE
F1
AND EMPLOYERS'LIABILIT Y Vim
C ANY PROPRIETORIPARTNER/EXECUTIVE TO BE ISSUED BY CARRIER 09/30/20113 09/30120'ir) E.L.EACH ACCIDENT $ s00,000
OFFICEP/MEMBER EXCLUDED? DMIA
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE9
If yes,describe under
_DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I S 500,000
DESCRIPTION or OPERATIONS/LOCATIONS I VEHICLES(ACORID 101,Additional PeraarZme Schedule,nay be attached N more space Is n2quirad)
FOR INFORM-4ATION ONLY
CERTIFICATE HOLDER CANCELLATION
81-IOULD ANY OF THE ABOVE DESCRIBED POLICIES BE GANCELLrD BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELiVERED IN
Fur InformAlon omly ACCORDANCE WITH 714k FULICY PROVISIONS.
AUTHORIZED REPREGENTAIgIVE
AG-ORD 25(20145101) 'VGjp,A(RIQVin%q�V4 pbj�%q pqN,�g'V- ACORD
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CCIISSL-102811
ROGER A OVELLET
95 SWAIWORE,
wamck Wil WSW F
Restricted To: cs%-0c-insulation Contractor
Failure to possess a current edition OT the klassachusGtts
State Building Code is cause for revotaidon of this licensee
Ror BPS Licensing informatoof,crises tAjv3tj.DAoss.6nv/DPS
Office of Consumer AffaiA and Business Regulation
10 Park Plaza e Suite 5170
Bostton9 Massachusetts 02116
Home lI prroveme t Contractor Registration
Registration: 162111
TVpe: Supplement Card
Expiration: 1/14/2017
NEXT STEP LIVING INC,
ROGER OUELLETTE
21 DRYDOCK AVE. 2TH FL
BOSTON, MA 0221
Update Address and return card.PWark reason ffoy change.
Ej Address [-] Renewal F-] Employment F] Lost Card
0friee or Consumer Affairs&Business Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found rreturn to:
Office of Consumer Affairs and Business Reguln6on
Registration: 169111 Type: 10 Park Plaza-Suite 517D
Expiratioaa: -WIV2017 Srr s lu rrr ss4 C a 1 Boston,IIA 02 16
NEXT STEP LIVING INC.
ROGER OUELLETTE
21 DRYDOCK AVE,2TH FL —
BOSTON,MA 02210 �tndeasec etaa^? jNot valid without signature