HomeMy WebLinkAboutAIR SEALING AND INSULATION A.
BUILDING PERMIT IAORTH
TOWN OF NORTH ANDOVER
0
APPLICATION FOR PLAN EXAMINATION
Permit No#: Date Received
�SsaC LIS
Ec
Date Issued:
IMPORTANT: Applicant must complete all items on this page
A,
LOCATION V
Print
PROPERTY OWNER, I
100 yes no
Mstoric District ye no
I ��X
Print 100 Year Structure yes no
PARCEL: IS
D ING DISTRICT:MAP
Machine Shop)Village ye no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
El New Building El One family
El Addition El Two or more family 0 Industrial
El Alteration No. of units: Li Commercial
El Repair, replacement El Assessory Bldg El Others:
El Demolition 11 Other
'........
7 a er T E
W"t h""i'di,
..........
�gp Mof 4010�, k" NO
g�,X N
Water/Sewer
DESCRIPTION OF WORK TO BE PERFORMED:
/wf (a-�Uoa kcci +
(J
Identification- Please Type or Print Clearly Phone:
OWNER: Name:,
-
Address: 71() C
Contractor Name: 's �Q) Phone: L V 3 5--&D I
Email:
Address:2,1 O
Supervisor's Construction License: ae Exp. Date: q//
le 9
Home Improvement License: &2Exp. Date: ///4
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00PER S.F.
Total Project Cost: $ FEE: $
Check No.: L Receipt No.:
NOTE: Persons contracting wit d contractors do not have access to the r and
ent/Owne
Signature of contractor ,
fit,®RT
t F' town of
11, Andover
® :, _ :.
Vot
.- _ a
IL
T h ver Mass1/�, �(�
O LAKE ' '
CoCMIc"t—CK
U BOARD OF HEALTH
Food/Kitchen
. PER L D Septic System
THIS CERTIFIES THAT ................ . .. BUILDING INSPECTOR
ISO
Foundation
has permission to erect .......................... buildi on ............. ...................................... .............
® Rough
to be occupied as ............... ft.e.................
...............1 ! . . �!............................. Chimney
provided that the person accepting this permit shall in ery 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
LESS CONSTRUCTION ST RTS Rough
Service
...................... .... eLDIN6
,.o,,..,.. .................... Final
INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building 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.
�
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next step L
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~�~ M�pDe i'?Nero,v 0LX�H�
This agreement Is made by and among
Next Step Living,Inc.("N8[') �
David Logan 21 DrydnchAvonoa.2nd floor
Boston, MA 02210
7SGre8n� �t '
phone: (866)867-8729
North Andover, K8AD184S
SiteID: A55O632
21-Ju|-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 ofthisContract,
�
including the attached recommendations/work oWodeschbithe work indetail(the are incorporated byreference.Pricing reflected below may ha �
subject to adjustments in program pricing and offerings and is guaranteed for 30 days from the date the Contract|ophoted.. �
VVo/kLou@UoW Attic Flat
Attic Stair Cover Thermal Bh with Carpentry $237.65 $237.65
VVurkLoumflon: VVmU
Insulate Clapboard Sided Wall With 4" Dense Pack Cellulose 1,464 $1.85 sqft $2,708.40
VVorhL000Uow Doom
Door Weatherstripping w/Sweep 3 $75.00 Each $225.00
75 Y6VVeGtheriza1ion Incentive up to Program Max $2.000.00
Estimated Annual Energy Savings from the Above Improvements $348.00
2. PAYMENT. CUSTOMER agrees tvpay N8Lfor the work oafollows:
Paymmn1#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 ofscheduling. Deposit ionot toexceed 1Qof the total contract cost.
Additional Payments and Final Invoice: $817.18
-Additional pats for the Work shall bndue upon completion of the Work and will bocharged to the credit card onfile within 24hours ofdelivery ofthe Final Invoice.|f
this credit srd charge is declined for any reason,upon notice from INSL you will be responsible for providing valid alternative credit card information necessary to complete
payment
|
Next Step Living has agreed to pay$253.87 of the customer's conhibution, which will bereflected ivthe customers final invoice
Jul 24, 2015
Customer Signature Date
21 Jul 2015 Willi Aquino
N8�U|gntune Date Name ofNSLRepresentative A560632
The Terms vythis Agreement are contained onboth sides nfthis page
Next Step Living-21 Drydock Avenue 2nd floor-Boston,MA 02210-(866)867-8729-inquiry@nextsteplivinginc.com-
PERMS OF AGREEMENT
3.PROPOSED START DATE AND COMPLETION SCHEDULE
NSI_will contata rustonnertc schedule the iJork at a fnulwally agreeable unae,subject to the i3 ailabikiy of 3uixoriractors or materials of to delay IRnI:mo-ible to the
veafher or other evens byond NSL's contr 1.
4.CONTRACTOR REGISTRATION
(naso act asetts las+regaif:s harue irnprovemenf cun aa;kns and subi;ondfactcfs t be e"'jiste ed the DifrIctor of Horne Irnp�ovcnent Co nira Regia'Jml oin. You cony
inquire al-miit contfartor regisif�alion by tvri(ing to Office of Consumer Affairs and Business Regulation,Ten Park Plaza,Suite 5170,Boston,MA 02116.617-973-8700
5.PERMITS
NSL Vail(obtain airy int l essary I.omits as the Ct,f,tomer's agent. Customers who secure filo l own leen)arts or deal v,ith an finfegistered co ntra-'tof roll be excluded from the
Guaranty Fund provisions of the some Impfovenient Connector Law,
6.PERFORMANCE OF THE WORK AND CHANGES.
6.1 NSL will not coim;i:fire tile tNod<Prror to.signing this Atlf eennent and iranstngittai of a copy of Agro.rnank to the Customer
13.2 T f o Agier meat may be srpplemerded,amended,or(modified only by the rn auial agrr;a_meat of the panics.No srippiein;,nt,am r�dment,of modification of this
agreement shall oo binding unless it is in s,vi ilir,g and signed by all parties.
6.3 A[tunes:oaf weatherizcatfon learn dfscou.rs situations in the shirduie,doling the co!frse of the Work that indicates a risk fol a heal(h o safety concern foi residen1s,
Sikh ceneenns can indirde bill are not limited to ventilation? potentially n2cardous nhatu Mals such as rfoia oashe;los of stnictmal concerns. ha lie case of health of-
safety
rsafety concerns being id nUf ed,NS!,iesenves the fight tsei section 9.2 of this contract,to conhrnunicate concerns to file Cu.stome and halt Work until such Concerns brave
been addressed.
6.4 The iebates and inr,cntives available frond the Pias Save rJ Honne F rg igy Sufi,es Pru}f sm and airrounls due ff of ih the Custone f m,based oh the twit slnrate of
the situatf ra in the stiuchfre by the NSL horrhe en_igy.dusof IIo�,te�rar at i!nu>s oar weatbr,,fiatien te<of discovers si(uahons in the ncnre during the course of the Worl<
that impact Gu availol-ality of rebates and ireen(ives fina_n the Hass Savo"rograrn. In such slifialions,f lSL",rill cofnmunicaie solch changes to the C ustorner,including any
Impact on annount 1he Cusk)roer he expee'xed to pay for the Welk, The Coistofner vaill have t1 e,opiton to rcrnov._,fionn tine Conti act the wore dement,,Phar need
adjustment of set uta a sepr r rle centrad for peifomiing the adjusted work.
6,5 NSL repiesent>and wofioff[s to 010,Custonner That(a)!lie rolonals and equipment finish(d under this Agif.enieht tmih he of good quality affil n,ani,(b)feat the Varork
be f ee from derecfs.and(e)that the 'h1ork will conform,iilh the des.npt;on of the'.atlork d scribed Ili Pala(raph 1.
7.INSURANCE AND REGISTRATION
NS'L,represents and fwairants to the Custor.ier that It has a valid lion::hnpiove<r,ent Conti actor kegir«ation(No, 162 111 and the mer oss roy ms lance requifed by
appllcaHe raw an i norrna(ly m,7intainel by prudefnt couoactors in NSL�s held.intif.iding_.but f of I -iitea to d+lents@r Corrrperwaiion Insurance for all r.ianpluyccs stile ill
perforin'the Work.
8.QUALITY OF WORK.
HSL agrees that the UVork will be perffoltoed in a good and"fdohonanlike manner,and flint NSLwill repai!and relplace. a its own expense and promptly upon Customer's
request any defects in vvoikrnanship and inakerials,provided by hiSL which appear up to(1)y.r after completion of the i fo k car�,,vithin any longer pe;nod as per pitted or
required finder applicable late,provided NSI_has received final payment as piovfded herein.
9.PRE-EXISTING CONDITIONS&PROPERTY PROTECTION
9.1 NSL shall not be responsible for any damages as a corny quence of the t(lork performed if)the home due to pn e existing conditions 1 nese conditions Include but are
not lirrdted to poorly fastened or woken drywall,moisture dauiriyc,non cote consinidion.(;racked or a ataile siding of snuggles old pipes and fittings,rolling v.00d,etc.
9.2 NSL eserve„the right not to perfonn V%rork upon the discovery of ash sits,mold,or any other potential health dsk to the Customer. In this even(,the DhIlorter is
responsible nor refneuying the at-risk sfPuation,including any necessary f emovel of hazardaf,ma(erlals and ail hints for ser u..,s is dale..Hall be paid urnmet lately irfJork
cannot resume until remediation is complete.
9.3 4rJrile NSL bAailr make btu>t eifo�s to p rotate any property of the Cucto�ner, itis tie Cus�rnnt is respo^sibrlty to iofnovc or protect,including dust piptec(iotf any
personal property melon+ir:g the home itself, NSL will not be responsible for damages to or los,.-es or any of the above nfentioned property nol properly protected odor to the
C01111 Hell of!lie Nlorh.
10.GENERAL PROVISIONS.
16.'1 NSL..reserves lhfe right the excerft penri-ftled by applicable law.to have 9ie or maintain a mechanics or matorial men's lien,of to fire n notice of intention to lien,and
to take any other steps to perfect and efifofce,such a lien,if Cus[orner fails to pay A!SL as provided herein.
10.2 Thi,Agreernentshali oe Co" fu,d ire accordance wilt silt h,J,>of the Comrnonwealtb of hlass.,cru,�.ts.
10.3 fhr. Agreement farms the cofhpietc integrated gf einent b.;brfeen ITS!,and Custom f The panles oprc,ugt and fvrfifant that rr executing Phis Agreement,they are
nol relying on any frau„reent tons h,nein. agneements be[weon the Customer
and Contractor and may not hr altered aosenk a sill»cqucnt written agreement signed'uy both paities.
You m {cancel this;gfeeme;nf if it ha s h..z:n sufu'd nit a place other than the L1SI's norgrnal place of hu i hiss_providedyou notify h1t,r_ir7,vrifh7g at its rrain prince or
branch office Lir ordi nay rna l poster( „y tolegiam sent(Ill by d,livery,not Wei than midnight of the th+f d ausin es,flay following the s9,Jng of this of mernerd� See`nae
attached notice of cancellation form for an expla nalion of this f igiht.
11.ENERGY BENEFITS.
he Sponsoring U[ility Company(ihe Utility)is entilled to 100%of the i nergy be,slit,as!1ociated with all Energy Conservalion ItAeacures,excluding Phe value of energy
cost savings by lhe Customer,but Including all n9f is to all associated ISO-NI-Energy.Ca}aaaty and Rowe,ees Products.N L agf nos fo provide the Utility wish such further
docunientatien as(lie,Utility may request'o confer,the Uiihiy a ov.,netship of slid)t.anefits and Products.
12.NOTICE CONCERNING SPONSORSHIP.
Ctistonner uridersfand",and ackno.m.ledges that INSIL is not all agent Vander or sub vendor of The Sporn.t,ring Utility Compal y(the utility)with respect to the irns'allotion of
all energy efficiency mca:,ures 1r the event of tins(nitons of au clgergy conservation device to perform as expected,Customers sola recourse r to Contractor and not to
Conseivaton Services Group(Cit)of to the Utilify.The Uiility and its operating vampanix small not firainitaim,remove or perform any stork vA-.1toever on 11 e energy
corfservation measures ihsfalled.
Custorner,ifndersL ads and acknc.,eiedges that th sif parircination in the,Mass Save Home E npjfjy Services,Piolpani is volt nl,ay and that they have,f,onscr(ed for
Contractor to install the proposed energy conseivalion measures.
Cers€omef agrees that it shall not hold t'SG,the Utility,their affiliates 01 opeiafifng companie..,liable(of Contractors to porfcu-n its obligations under this age umetnt,for
failure or,ihe oneigy conserti?iion nneasuf es to function,for by ba nage to Customer's Pref mseF trailed by Conir actor or for any and,all damages to prop ity or injoiry to
13.LIMITED TIME OFFER.
The prices and incentive;offetod in this Cofnuaul are subject to change in accof dance wish T!10 Spoon sonny Utility Cornpany Idass Save Home Energy Senate es Piograrn
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 telegram sent or by
delivery,not later than midnight of the third business day following the signing of this agreement.
Plainview Diagram
Customer MV,+b �� Advisor Name:
AddressA1,�_.G&4, _ Advisor Phone #: 1%
Town u- A-hdn\cc V . _ Any limitations to access by truck?
Site ID A SC5 Q(,Q31=
NOTES Any Any work scoped outside of Best Practices?
Approved by:
it V�Vqbpovvd W SVS
u ops
xe
'2
2L'
�,�•�-•- , 24
i�
The Common walth,of Massuchiesefis?
Department of-IndustrialAeddents
Office of Invesfigadons
b I Coag ress&reet, Suite- 100
oc�aBoston, MA 02114490!7
WMM Moss--goRwya
Workers' Compensation Insurance Affidavite. Builders/Con-tractors/E lectriclans/Plumbers
Applicant Information plewup. P1
Name (Btisiness/Organizaiion/Indijidual.': Next Step Living
Address- 21 Drydock Ave
Citj/State/Zip: Boston, MA 02210 phone#:(866)867-8729
Are you an employer? Check the appropriate box-, Type of project(required):
1.a I am 0,employer with 850 4. F1 I am a general contractor and 1 6. ]
-i New constraction
employees (fidl and/or part-time.).!,' have hired the sub-contracto-
-es
2,n I am a sole proprietor or partner- listed on the attached sheet. 7. E]Remodeling
ship and have no employees These sub-contractors have 8. [1 Demolition
working for me in an capacity. employees and have workers' 9. E]Buildiug addition
[No workers' comp. insurance comp, insurance.$
required.] 5. D We are a corporation and its 10.n Electrical repairs or additions
3 1 am e,homeovm_er doing all work officers have exercised their i LEJ Plumbing repairs or additions
myself. [No workers' comp. right of exemption per MGL 12.0 Roof repairs
insurance required.] c. 152, §1(4),and we have no Insulation
employees. [No workers' 13.M Other
comp. insurance required.] —1 L
"Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
T I lomeowners whe submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affida,it indicating such.
'Coatractors than cl leek this box naist attached an additional sheet showing the name of the sub-contractors and state whether or not ih030 onlitie,.i have
employees. If the sub-contractors have employees,they must provide their -%vorkers'comp,policy mirnber.
I am 4in employer that is providing workers'compensation ifisurancefor my(employees. Below is the policy andjoh site
informadon.
Insurance Company Name: A.I.M Mutual Insurance Company
Polioy 4 or Self-ins. Lic.M AWC-4001-7030025-20'1 4A 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA for insurance covera
,ge fi ion.
—
I do hereby cerdfy under the pains anpen * s erjury that the information provided above is true and correct.
Signature: Date:
Phone#46(oto) -9-708
Official use only. Do not write In this area,to be completed by city or town official.
City or Town., Permit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Towo Clerk 4.Electrical Inspector 5.Plumbing Inspector
6.Other
Contact Persom.
NEXT 19.1 OP ID:EL
CERTHGATE OF LIABILITY INSURANCE DATE(MMIDDIYYM
THIS CERTIFICATE 10 ISSUED AS A mAwpm OF INFORMATION ON�y AND comfms tit) waviq upoN r wKywicAfrn E-10WER,THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR AVI-ER THE COVERAGE AFFORDED By THE vair'JES
REL01q. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A GOMTRSAPT BETWEEN TF-IE ISSUING INSUREF1,109, �UTVIORIZPP
RFPPFSENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMP RTANT: If the Certificate holder is an ADDITIONAL INSURED,the pollcy(les)must be endorsed. Of SUBROGATION 1%,
the terms and Conditions of the policy,certain policies iblay&A� ulva an endorsement, A statemeM on this coOfflcaie does not confer rights to jhp
certificate holder in Bern®f such
PRODUCER CONTA Evia Lyow�
A
hilvi 9 suirance.Aj,-'ency
Ift" I F01C(,No):701-665-02Q§
820L nnfelpE pqrkwfqy (PAH10021o,
.1 . y
MA 0 A, 76 (-100
-.'
John E.McLaughlin Jr. ADDRESS: -
IMSURER($)AFFFOP DiNGCOVrRAGI: IqAlf;0
INSURED P48xt stag�Ivlriqi'Inc. INSURER 13:1,ommp-rce,Ins rinse Company 3476,j
21 DIrydock Avenue,2nd Flow INSURER c:A.M.Mutual Insuranc(9 Co.
Boston,MA 02210 INSURER DAMS Inswrance Qumpany M10
INSURER E:
INSURER r:
COVET aBEG CERTIFICATE NUMBER: REVISION 6UM—SER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PSRWQP
INDICAT ED. NOTWITHST ANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH JID
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 INDDL SUBR POLICY EFF POLICY ERI' LIMITS
LTR i YPE Or INSI[JRAMCE Iffm OLD— POLIGYMUNIBEP 9MMR8Tffj_I --
A COMMERCIAL SENkRALLIABILITY EACH OCCURRENCE 1,666'm
M_
A AGE TO RtN I IzU
CLAIMS-MADE FX1 OCCUR GIDISW2613 PREM Ea occurrence) $ '190900D
MED EXP(Any one person) $ 0,000
PERSONAL&ADV INJURY $ 1, 90
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ P119901000
PRO- LOC PRODUCTS-COMP/OPAGG $
POLICY FIJECT F
OTHER:
A YOMOBILC LlAftITY COMBINED SINGLE LIMIT $ 607,6-0
(Ea accident
ANY AUTO �4MMDOISIgOfJi 09/30/2013 BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident)
AUTOS AUTOS PROPERTY DAMAGE
NOM,OWNEO (par.,:
HIREDAUTOS 1A AUTOS oid I)
11M.PIRELLA OCCUR EACI 1 OCCURRENCE $
EXCESS UAB CLAIMS-MADE 091,9012014 09MM/2015 AGGREGATE $
DED I_--[RETENTION S— — --F----- - IH.
WORKERS COMPENSATION
ST
AND EMPLOYERS'LIABILITY YIN PEARTUTE ER
lei ANY PROPRIETOR/PARTNER/EXECUTIVE TO BE ISSUED 8V CARRIER 09/30/22 Z1 09130120'M E.L.EACH ACCIDENT $ 500,000
OFFICEPIMEMBER EXCLUDED? MIA
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE1$ 590,008
If yes,describe under
_DESCRIPTION OF OPERATIONS below E.L. 000
DESCRIPTION OF OPEPATIONS I LOCATIONS I VEHICLES (AGORD 101,Additional Pernarks Schedule,nay be awachod if more space Is r%3quh%ad)
TFOR INFORN—WElON ONLY
CERTIFICATE HOLDER CANCELLATION
IMFO-01
SHOULD ANY OF TME ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE ENPIRAVON DATE THEREOF, NOTICE WILL BE DELIVERED IN
For Inforl-o'non 0-5'iy ACCORDANCE liliffl-I TIDE POLICY PROVISIONS.
AUTHORIZED REPRESENTATIVE
@
ACORD 25 p
ph pj
:eACORP
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p� „j
F
VffiVe of
ConsumerBusiness
'
Affairs and Bu siness Regulation
10 Park Plaza = Suite 5170
Bostton9 Massachusetts 021116
Home Improvement Contractor Registration
Registration: 162111
Tijpa: Siapplernent Card
Expiration: 1/14/2017
NEXT STEP LIVING INC.
ROGER OUELLETTE
21 DRV®®CK AVE. 2TH FL
BOSTON, MA 02210
Update Address and return card.Mark Treason for change.
Address [:] Renewal E] Employment r] Lost Card
Office of Consumer Affairs vac Business Regulation License or registration valid for iandnvidnnl nese only
HOME IMPROVEMENT��N� G�® before the expiration date. R found return tea
Off4'iee of Consumer Affairs and Business Regulations
Registration: 162111 Type: 10 Park Plaza-Smite 517D
Expiration: 1/1412017 Bo5ten,,Fr1A 02116;
NEXT STEP L)V)NG NO.
ROGER OUELLETTE
21 DRYDOCK AVE.2TN EL
BOSTON.MA 02210 flJnderse�re�avy _ idiot valid without signature
ass,al" u, eft's bmf a r rf e I 1 �f4 9a
I f( 4'7'.,;rI I'�d4
'i j a
ROGERAOVELLE'A'
55STIAMMORE'
02899
09§132018
Res'Weted To: CSSWC-lnsulation Contractor
Failure,to possess a current edition d the Wilassachusetts
Stake Building Cade is oause for revocoadon Cf this lic anse.
UUMU-MOSSAMIDPS