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HomeMy WebLinkAboutBuilding Permit # 8/5/2015 %AORTH BUILDING PERMIT 0 te TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO: Date Received ATED Date Issued: A L7 C IMPORTANT: Applicant must complete all items on this page '8 X TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building El One family oAddition [I Two or more family 11 Industrial 11 Alteration No. of units: 11 Commercial 11 Repair, replacement 11 Assessory Bldg 11 Others: 11 Demolition 11 Other . ............... q KV 01 jg'gos, roc A dnrw- nA)=423 -v Identification Please Type or Print Clearly) OWNER: Name: Josn qa.nfas Phone: (,217- 2,33-3k)�J Address: Ittt im 7/7 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: $ �ILL33. 3� FEE: $ 4 ' Check No.: ,10 Q:J Receipt No.: I rVI) NOTE: Persons contracting with un egAster'ed contractors do not have access to the guaranty fund r gn-1,0T �Pf, n n 4 cp 11 , On ORTH , irown of Andover ® v- "i' 0% �1 ver, �.SS, �T6Z6145 COC® >_�K� �. A "I Ct4EWjCK Of�ATE® P'?���� amm T S L) L DP E 4%j_V001 ITlk1fOIIL BOARD OF HEALTH Food/Kitchen /� Septic System THIS CERTIFIES THAT ....... {,� .. . .. BUILDING INSPECTOR . ... . .. .. .... .................................... ........................ �® Foundation has permission to erect ................. ... buildings on ... .................. .. ....... ............. ............... ® Rough to be occupied as ..... ............ .. .. .ery-r. .t.. � ................... Chimney provided that the person accepting this permit hall 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, AI ration 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS STAT Rough Service ... .. .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 Approvedy the Building Inspector. - Burner Street No. Smoke Det. In , my if'ABT American Building Technologies Energy Savings Is Our Specialty 263 Western Avenue-Lynn-MA 01904 Phone-781-598-7125/Fax-781-479-0727 www.americanbtjildingtechnologies.com Authorization Letter 1,Jose Santos,HIC 163106 and CS-101376 holder hereby give my authorization to Andre Aguiar to act on my behalf regarding the Building Permit Application 84 Innis St, North Andover,MA01845 je ntos j /4/15 Job Number 5250 DATE 7/24/2015 Client John Casey address 84 Innis St. city Itown N.Andover,Ma. contractor A S _ 1.WEATHERSTRIPPING/CAULKING QUANTITY TOTAL AUDITOR NOTES Door Kits Q-Lon or Equiv. 3 153.00 Fr.ext/rear ext./base.ext. Door Sweeps(Regular) 2 35.28 Fr.ext./base.ext. Door Sweeps(Automatic) 1 26.00 rear ext. Reglaze Windows/In.inch 0.00 Window.Weathstr Schlegal per side 0.00 Recessed light cover per SWS.Not a tenmet cover 0.00 attic sealing 2 part foam 0.00 attic sealing 1 part foam 2 140.00 seal all top plates,plumbing,elect.and all chases basement and living space air sealing 1 part 1 70.00 seal under sinks,plumbing,elect,and any chases. SUBTOTALS 424.28 2A.INFILTRATION/INSULATION AUDITOR NOTES Domestic pipe Hot Water Tank 1st 6' 0.00 Sill Two Part Foam w/Fiberglass Batt 0.00 1"T-max only foam boardPerimeter per IECC&SWS sq.ft. 0.00 2"T-max only foam boardPerimeter per IECC&SWS sq.ft. 0.00 Drape DOOR R-5 or T-max only 0.00 Tape Joints(Aluma Grip only)per hr. 0.00 Duct Ins w/Tape sq.ft.R-5 conditioned space 0.00 Duct Ins w/Tape sq.ft.R-8 unconditioned crawl/garage/attic 0.00 Hydronic pipe insulation to 1"R-5 0.00 Hydronic pipe ins.1.25"-2"R-5 0.00 Steampipe Ins. 1.25"-2"iron pipe R-5 0.00 Steampipe Ins.2.5"-3"iron pipe R-5 0.00 Air Conditioner Meeting Rail 0.00 Air Conditioner Cover 0.00 Air Conditioner Cover Special Order 0.00 SUBTOTALS 0.00 2B.INSULATION AUDITOR NOTES _ Open Unrestricted R 49 0.00 Open Unrestricted R 38 0.00 Open Unrestricted R 30 0.00 Open Unrestricted R 20 0.00 Open Unrestricted R 10 0.00 Restrict FUSloped R 38 0.00 Restrict FUSloped R 30 0.00 Restricted FUSloped R 20 0.00 Restrict FUSloped R 10 0.00 R-19 FGB open rafters/walls/kneewalls 0.00 R-11 FGB open rafters/walls/kneewalls 0.00 Attic Stairs(stairwell&common wall) 0.00 Cover Pull Down Stairs Thermadome up to R49 per SWS 0.00 Site built pull down stairs 2"foam box 0.00 AUDITOR NOTES Attic/Kneewal Floor Transition. Dense pack cellulose 0.00 W.S. Hatch Q-Lon or equal 0.00 W.S.&bat Hatch,dam around etc.complete to attic 1 67.00 Kneewall R-12 cell behind Per.Memb 0.00 Open Rafter R-20 Cell.1w poly 0.00 Open Rafter R-30 Cell.1w poly 0.00 Basement Overhead R-19 fiberglass 0.00 Basement Overhead R-30 fiberglass 0.00 Crawipace Overhead<4'high R19 0.00 Crawipace Overhead<4'high R30 0.00 Garage Ceiling cavity filled w/cellulose 0.00 Wood,Shake,Clapboard,Shingles Vinyl 1216 2432.00 Asbestos(single nail)/Asphalt 0.00 Asbestos(doub.Nail)/Aluminum 0.00 Brick/Stucco 2 hole 0.00 Vinyl over Asbestos 0.00 Multi-layered 3 or more layers 0.00 Drill rough plaster or finish wood plug 176 359.04 Drill finish plaster 0.00 Test Drill Walls(all 4) 0.00 SUBTOTALS 2858.04 2.INSULATION TOTAL 2A.+213. 2858.04 3.STORM WINDOWS I DEADLITES AUDITOR NOTES Plexiglass up to 88 0. 0.00 Additional per UI over 88" 0.00 Dead light 0.00 SUBTOTALS 0.00 5.OTHER MATERIAL AUDITOR NOTES Ridge vent In ft. 0.00 Gable Vent rectangular 0.00 Varipitch Vent 0.00 Roof Vent 135(1 sq ft NFV)Large 2 212.00 on backside Roof Vent 865(A sq ft NFV)Small 0.00 Soffit Vent Rectangular 6 180.00 6x16 vents 2 in fr.Left side&4 out back Turbine Vents All 0.00 Stack Vent 0.00 Acuvent proper(Must be this product)available @ F 10 46.00 Permabie House Wrap 0.00 6 mil poly on ground 0.00 Energy Star R4 Rigid Vinyl Repl 94-101 U.1. 0.00 SUBTOTALS 438.00 6.17.E.C.MATERIALILABOR 3720.32 Page 3 8a. HEALTH&SAFETY AUDITOR NOTES _ CO detector 0.00 _ Vent Bath/Kitchen Fan 2 200.00 bath fan and exhaust fan vent out roof Dryer vent w/exhaust duct Heartland 0.00 Dryer Transition Duct only 0.00 Bath fan 50 CFM(replace exsisitng)fan only 0.00 Bath fan 50 CFM(new install)with timer 0.00 Bath fan Smart timer 0.00 Blower Door Test Pre Post 1 45.00 SUBTOTALS r 246.00 8b.REPAIR MATERIAL/LABOR AUDITOR NOTES Basement outside door solild core inc all hardware 0.00 _ Basement outside door w/jambs inc all hardware 0.00 Basement outside door site built per SWS inc all hardware 0.00 Door Repl pre hung 32-36"Steel**w/Lite 0.00 Door Repl interior solid core 28-32" 0.00 Door Repl pre hung 32-36"wood**w/Lite 0.00 Window Replacement w/SIR less than 1 0.00 Basement Window Repl.Awning/Hopper 0.00 Basement Window Repl.With a frame 0.00 Lockset(door)Schlage or equal 0.00 Repair/Refit Door 0.00 Replace Side Stop 0.00 Replace Casing 0.00 Glass Replacement to 64 u.i. 0.00 Glass Replacement per u.i.over 64 0.00 Thermo pane Glass replacement 0.00 Sash Sidelock/Top Replacement 0.00 Threshold(Wood) 0.00 Threshold(Aluminum) 0.00 Slide Bolts/pull handle 0.00 Cut/finish attic-kneewall access 0.00 Cut/close attic-kneewall access 0.00 Labor Rate Hours 1 67.00 repair around hatch Labor Rate Hours 0.00 Labor Rate Hours 0.00 K&T inspection 0.00 K&T repairs 0.00 Permits/Fees(Wap only) 0.00 SUBTOTALS 67.00 TOTAL REPAIR+HEALTH&SAFETY 312.00 -------------2'- _3 =L-`z ---- ------ - - GRAND TOTAL WORK ORDER# (A) 5250 4032.32 Any alterations or deviations from the above specifications involving extra costs must be cleared in writing before installation. The Work Order must be complete within 15 working days from acceptance date below: CONTRACTOR/COMPANY: 0 ACC E PTANC E:Company/Contractor AUTHORIZED SIGNATURE: Date AGENCY APPROVALS: CTI Authorized Signature: Date GLCAC Authorized Signature: Date The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/organizationfindividuaq:American Building Technologies - Jose Santos Address: 2 Neptune RD #439 City/State/Zip:Boston MA 02128 Phone#: 617 233 8704 Are you an employer?Check the appropriate box: Type of project(required): 1.(3 I am a employer with 5 4. ❑I am a general contractor and 1 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.El am a sole proprietor or partner- listed on the attached sheet.t �• E]Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. workers'comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑We are a corporation and its required.] officers have exercised their 10.0 Electrical repairs or additions 3. 1 am a homeowner doing all work right of exemption per MGL I l.❑Plumbing repairs or additions myself.[No workers'comp. c.152,§1(4),and we have no 12.❑Roof repairs insurance required.]t employees.(No workers' 13.[3COther I insulation comp.insurance required.] °Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. iContractors that check this box must attached an additional sheet showing the name of the sub-contractors and their workers'comp.policy information. I am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Hartford Policy#or Self-ins.L6BO2483-5-13fic.#: Expiration Date: 5/2 9/17 Job Site Address: b 1 Ian City/State/Zip:WARM Nyl utcr,"k O 1i45 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 coverage verification. I do hereby certify ui er t pains and penalties ofperjury that the information provided above is true and correct nat Si ure: Date: 13 1 Phone#: 617 3 8 7 Official use only. Do not write in this area,to he 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#: AC R ® CERTIFICATE LIABILITY INSURANCE DATE(MM/DDIYYYY) 5/29/2015 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 CERTIFICATE 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 y NAME: Mar O Demala Ambrose Insurance Agency, Inc. PHONE FAX AIC.No, c e: 70 Munroe Street, Suite D aDMRIe33,mdemala@prescottandson.com INSURER(S)AFFORDING COVERAGE NAIC# Lynn MA 01901 INSURER AAtlantic Casualty Insurance CO. INSURED INSURERB:TOrus Specialty Insurance Co. American Building Technologies, Inc. INSURERC:Hartford Insurance Co. 263 Western Ave. INSURER D: INSURER E: Lynn MA 01904 INSURER F: COVERAGES CERTIFICATE NUMBER:CL14103019581 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. INSR TYPE OF INSURANCE A DL SUBR POLICY EFF POLICY EXP LTR S POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LIMITS '.. GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DPREAMAGE MISES TO Ea occurRENTErence $ rD 100 000 A CLAIMS-MADE aOCCUR 035-011680 0/17/201410/17/2015 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 '.... GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY PRO-GT LOC $ AUTOMOBILE LIABILITYCOMBINED SINGLE LIMIT '.... Ea accident ANY AUTO BODILY INJURY(Per person) $ X ALL OWNED SCHEDULED BODILY INJURY(Per $ AUTOS AUTOS er accident) HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS Per accident $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION 83310H141AL 10/17/2019 0/17/2015 $ C WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY YIN X O S ANY PROPRIETOR/PARTNER/EXECUTIVEE.L.EACH ACCIDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED? ® N/A (Mandatory In NH) 6BO2483-5-1 6/29/2015 6/29/2016 E.L.DISEASE-EA EMPLOYE $ 11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) Insulation Contractor Community Teamwork, Inc, NGrid Corporate Services, LLC, dba Boston Gas Co. , dba Colonial Gas Co. , dba Essex Gas Co. , Action Inc. , NStar, and ABCD, Inc. as additional insured general liability, excess liability, auto liability CERTIFICATE HOLDER CANCELLATION (978)681-4980 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN GLCAC ACCORDANCE WITH THE POLICY PROVISIONS. Weatherization Assistance Program 305 Essex St. AUTHORIZED REPRESENTATIVE Lawrence, MA 01840 J S Scholnick/SJG ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. INS025 rgmmn.ri m Th.ACr11711 name..A I———iefer.4 of Af.rlPn Of xf of't€f Njj aer Off ri'm& Itk—_UlafiGn I,ic"AC or rgiArafion valid for 61dividul use on[- �� E IMPROVEMENT CONTRACTOR �tfcirc the ealSiralrron d�tc. If found re9urn to- Lgist�tinat; Ys3tgT Typo: Office a l"C onsa meff A(17243 and ft®�inc.�c R.�itl rtivae ^7aspcn�&14t�: SdPY7�,ii LLC 14)Park-Play..2-.13t1ittST31) [cw4um,MA 0211,6 AA9h.3CIC.AND11ILDING 1ti:H'h I-OGIF.S JOSE AWES-CAN I OS 2 NrPTI1NF PD SUITE 41ft t:n($tl3srrra�ry taut valid without signature Mass lruset r1eRartm-nl W public S.aftsy 8044rd of ETwIding Regutafatan:o alai Starr'darEIs .cense: 101379 e.11o, 3-7 ti3,Aiillon S;t &i'ark KA 0213fi,