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HomeMy WebLinkAboutBuilding Permit # 8/6/2015 i BUILDINGPERMIT 0 %%Q°rFI b�+ T F THA V �� �� APPLICATION FOR PLAN EXAMINATION _ '0 Permit No#.• Date Received �q A�AAYEO PQp`�R� SSgCHUS Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION 31 Print PROPERTY OWNER f; 5 x C C.�V- Print 100 Year Structure yes no MAPO 7 2, PARCEL: ZONING DISTRICT:_ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ;K'One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other .. I , / // I W ter. h d,D / � / /� / / //, / laa lay, ❑ eflan ❑Well � / � � DESCRIPTION OF WORK TO BE PERFORMED: .4 /e- y4y 2® N 9" w r b low e7 1-, Cg--, -,'/, ia.3°�'. 11�e--A4o rrS17j011 CLo v r S ✓e✓ Ia 4-Ln, ®® .rvx4.r - `3 /.. r 4t da/d ..e " 07 c"e 41 Gem Identification- Please Type or Print Clearly OWNER: Name: dr-,* r s'.r c, Phone Address: 3 I Xo r 4-U. A-v%.cL vg, 1 0' qs— Contractor Name: Ac�yavrc�e� ae�-1ldLo ,G�tPhone '7o-/- ,4-n- r: Email: C Address: &8 U 4v 6. P-ea L 0 --4 1,17 64 Dar 9 6. en? Supervisor's Construction License: /��G �rr.�f�rL�r—f Date: 11z, tm Home Improvement License:44ve,,w Exp. Date: /// 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: $ FEE: $ Check No.: Receipt No.: �. ,) NOTE: Persons contracting with unregistered contractors do not have access to the ar ty u d NORTH \A" To-vwn of JULoover ®No. Z - 2415 ® �AK� h ver, Mass, 1�$ cocnac"IWiCK �1 AOji,ATE® BOARD OF HEALTH PER MIT T LU Food/Kitchen \ Septic System THIS CERTIFIES THAT ' �s 4 ��r BUILDING INSPECTOR ........................ .N............... ........... ................................ ............... S4wea+ has permission to erect .......................... buildings on .. ....... w�/. 1�.� .w!. ,,,,,,.,,, , Foundation Rough to be occupied as ..... .�.......... ♦h 4. ! �..;11�,,, p� ............. ...... ... ...®.............. .......... ....... Q.... .. 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 an 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 LESS CONSTRUCTIO ARTS Rough Service .......... .......... . ............ �.......... . . ... . Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t0 Occupy Bu ldin Rough Islay 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. mmw Elaine Brasseur(978)686-5453 address 31 Riverview St "/w/m°" North Andover, MA01G46 � contractor Advanced Energy Solutions 1.VVEATHERSTR|PP|NG/CAULK|NG QUANTITY TOTAL AUDITOR NOTES Door Kits O'LonvrEquiv. 1 51.00 Door Sweeps(Regu|mr) 1 17.84 Door Sweeps(Automa04 8.00 Reg|azaWindows/|n.inuh 0.00 VVindmwxVoa|hs|,Schlegel per side 0,00 Recessed light cover per SVVO. Not etenmm\cover 0.00 attic sealing 2part foam 0.00 attic sealing 1 part foam 0.5 35.00 Chimney basement and living space air sealing 1part 1 70.00 1 Chimney kitchen and bath sinks � ~~^~~ SUBTOTALS 17164 %A.|NHLTRATiON/INSULATION AUDITOR NOTES � Domestic pipe Hot Water Tank 1st 6' 1 17.70 Sill Two Part Foam vwFiberglass Batt 0.00 1"T-max only foam bnaTdPedmeterper|ECC&SVVSsq.ft, 0.00 2''T-max only foam bmordPer|meter per|ECC&SVVSsq,ft, 0.00 Drape DOOR R-SorT-max only 1 67.00 Tape Joints(A|umoGrip only)per hr. 0.00 Duct Ins w/Tape sq.ft.R-sconditioned space 0.00 Duct Ins wYTape sq.ft. R`8unconditioned urewkgaraQe/mU|m 0.00 Hydmniopipe insulation(o1''R'5 0.00 Mydmn|opipe|na.1.25"-2'g-5 0100 Steampipe Ins. 1.25"-2^iron pipe R-5 0,00 Shemmp|poIns.2.G'-3'iron pipe R-6 0.00 Air Conditioner Meeting Rail 0.00 Air Conditioner Cover 1 43.00 Air Conditioner Cover Special Order 0.00 SUBTOTALS 117.70 2B.INSULATION AUDITOR NOTES Open Unrestricted R49 O�VV � Open Unrestricted R 38 300 495�00 Depends on what is up there | Open Unrestricted R 30 0.00 � Open Unrestricted R 20 0.00 � Open Unrestricted R 10 8.00 | Restrict FUG|upmdR3O 0.00 Restrict FL/Sloped R3D 0.00 � � Restricted FUGbpedR2O 48 71.40 Restrict pUS|opedR1O 0.00 � m-19FGBopen m#emxwa|ls/knemwoUn 0.00 � R-11 pGBopen/aftemAwo||x/knoowm||u 0.00 Attic Stairm(utainvn|}ucommon wall) 0.00 Cover Pull Down Stairs Tharmmdnmeumho84Sper SVV8 0.00 Site built pull down stairs 2''foam box 0.00 � � Ba. HEALTH&SAFETY AUDITOR NOTES CO detector 0.00 Vont Bath/Kitchen Fan 1 100,00 Dryer vent w/exhaust duct Heartland 0.00 Dryer Transition Duct only 0.00 .._.....w..._..m.._.._....._.M.. __.��... �..._...._....�.._.�_w_. .�� ..........�. Bath fan 50 CFM(replace exsisitng)fan only 0.00 Bath fan 50 CFM(new install)with timer 1 750.00 Bath fan Smart timer 0.00 Blower Door lest Pre Post 1 46,00 SUBTOTALS 895.00 Bb, 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 32.38"Steel"w/Lite 0,00 Door Repl interior solid core 2832" 0,00 Door Repl pre hung 32-38"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 Class Replacement to 84 u,i. 0.00 Class Replacement per u.l,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-kneewali access 0.00 Labor Rate Hours 0.00 Labor Rate Hours 0.00 Labor Rate Hours 0.00 Labor Rate Hours 0.00 Labor Rate Hours 0.00 Permits/Fees(Wap only) SUBTOTALS 0.00 TOTAL REPAIR+HEALTH&SAFETY 895,00 GRAND TOTAL WORK OaRDER# (A) 4528.14 Any alterations ur 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: Advanced Energy Solutions ACCEPTANCE:Company/Contractor �` AUTHORIZED SIGNATURE: `� Date AGENCY APPROVALS: CTI Authorized Signature: Date —w GLCAC Authorized Signature: � Date � 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 Kneawall R-12 call behind Per.Memb 0.00 Open Rafter R-20 Coll,/w 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 Crawlpace Overhead<4'high R19 0,00 CrawlPace Overhead<4'high R30 0,00 Garage Ceiling cavity filled w/cellulose 0.00 Wood,Shake,Clapboard,Shingles Vinyl 1352 2704.00 Asbestos(single nail)I Asphalt 0.00 Asbestos(daub.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 0,00 Drill finish plaster 0,00 Test Drill Walls(all 4) 0,00 SUBTOTAj,S 3340.40 2.INSULATION TOTAL 2A.+2B, 3468,10 3.STORM WINDOWS/DEADLITES AUDITOR Plexiglass up to 88 U.1, 0.00 Additional per UI over 88,, 0100 Dead light 0,00 SUBTOTALS 0100 5,OTHER MATERIAL AUDITOR NOTES Ridge vent In ft, 0,00 Gable Vent rectangular 0,00 Varipitch Vent 0.00 Roof Vent 136(1 sq It NFV)Large 0.00 Roof Vent 865(A sq ft NFV)Small OM Soffit Vent Rectangular 0.00 Turbine Vents All 0.00 Stack Vent 0.00 Activent proper(Must be this product)available HomeDepot 0.00 Permable House Wrap 0.00 6 mil poly on ground 0.00 Energy Star R-4 Rigid Vinyl Rapl 94-101 U,1, 0100 SUBTOTALS 0.00 6,17.E.C.MATERIAL/LABOR 3631,74 The Commonwealth OflMassc!chusetts ZDepartment of IndustrialAccidents X Congress Street,Suite 100 P C Boston,MA.02114-2017 °tet www mass.gov1dna SJ, Workers'Compensation hisuran'ce Affidavit:Builders/Contractors/EZeetricians/Plumbers. TO BE FILED W[TH THE PERI HTTING AUTHORITY. Applicant Information. / Please Print Legibly Name (Business/Organizadon/Tndividual): � iury<rof ��`y7�loQ� L� G .Address: 28 City/State/Zip: vv, 4 019 G ej Phone##: 7/) - 4(P,5-- 2oc7' Are you an employer?Check&e appropriate box: Type of project )required): 1.FeP am a employer with nloyees(full and/or part-time).* 'l, E]New construction 2.Q I am a sole proprietor or partnership and have no employees working for me in 8. El Remo delilig any capacity.[No workers'comp.insurance required.] 3,F]I am a homeowner doing all work myself[No workers'comp.insurance required.]t 9. ❑Demolition 10 F1 Building addition 4.E]I am a homeowner and will be hiring contractors to conduct all work on my property. 1 wiIl ensure that all contractors either have workers'compensation insurance or are sole 11.[❑Electrical repairs or additions proprietors with no employees. 12,Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance. 6.Q We are a corporation and its officers have exercised their right of exemption per MGI,c, 14.Q Other 152,§1(4),and we have na employees.[No workers'comp.insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. I Homeowners who submif 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-c6n6cfors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workerscompensation insurance for my employees'Below is the policy alldjob site information. Insurance Company Name: yq- V__ — Policy#or Self-ins,Lic.#: i9 0 W r 9 / 11 Z Lf ExpirationDate: f ,I/Z, Job Site Address: S dt City/State/Zip: _A�• 4,,L,,/, "'-r P9 6 Attach a copy of the workers'compepsation-policy declaration.page(showing the policy number and expiration.elate). 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 DTA.for insurance coverage verification. I do hereby certify underrep ' s andpenalties ofperjury that the information provided alcove is true and•correct. Sign e: �;,/ Yx Date: Phone#: te l• Le 7 S-L d 9 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 - b.Other Contact Person: Phone#: hP CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DD/YYYY) 6!9/2015 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 15 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 NAME: Select Dept Eastern Insurance Group LLC PHONE (800)333-7234 x66807 FAx 233 West Central St .781-586-8244 —MAIL ADDRESS:selectwork@easterninsurance.com Natick INSURERS AFFORDING COVERAGE NAIL# MA 01760 INSURED INSURERA:Guard Insurance Group Advanced Energy Solutions Llc INSURER B: C/o Richard Borges INSURER C: 28 Hamilton Rd INSURER D: Peabod INSURER E: MA 01960 INSURER F: COVERAGES CERTIFICATE NUMBER.-15-16 Master 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 1 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 CLAI INSR MS.ADDL SUER LTR TYPE OF INSURANCE POLICY NUMBER MOL1pY YYY POL1p�EYP LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED CLAIMS-MADE OCCUR- PREMISES(Ea occurrence) MEG EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY MPRO LOC PRODUCTS-COMP/OP AGG $ AUTOMOBILE LIABILITY $ COMBINED SINGLE LIMIT ANY AUTO I (Ea accident) S 1 ALL OWNED SCHEDULED BODILY INJURY(Per parson) $ AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED HIRED AUTOS AUTOS PROPERTY DAMAGE Per accident $ UMBRELLA LIABCLAIMS-MADE OCCUR EXCESS LIAR EACH OCCURRENCE $ AGGREGATE $ DED RETENTION A WORKERS COMPENSATION $ AND EMPLOYERS'LIABILITYWC STATU- OTH- ANY Y/NX I ER OFFICER/MEMBER EXCLUDED?ECUTIVE LJ N/A E.L.EACH ACCIDENT (Mandatory In NH) DWC691424 /14/2015 /14/2016 $ 1,000,000 If yes,describe under E.L DISEASE-EA EMPLOYEEI$ 1,000,000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ 1,000 000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 10+ Al"ItIonal Remarks Schedule,If more space Is required) I 1 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION UATh E THEREOF, NUT ICE WILL BE UELIVEREU IN Town of Reading ACCORDANCE WITH THE POLICY PROVISIONS. 16 Lowell Street Reading, MA 01867 AUTHORIZED REPRESENTATIVE I � John Koeael/FKG ACORD 25(2010/05) ©1988-2010 ACORD CORPORATION. All rights reserved. 1 AO(ll(IMS 11 wOPP19 9P1PI tMI�gP®PpPi�CTaP®Ii PiP19Pt[@ f9T AI 1��MI II e no�rr�izanrreallr a,C�/luJJrcc�a ell .I _ Office of ConsumerAffairs&BosinessRegulation ' ) ME IMPROVEMENT CONTRACTOR eg�stration: 164893 i xpiration: 11/30/2015 TYpe: Corporation ADVANCED ENERGY SOLUTIONS LLC, RICHARD BORGES t 28 HAMILTON RD. PEABODY,MA 01960 Undersecretary y 1 m, tts Massachusetts _ -__ - - -- -- -- - Board of use is Department of Public Safety allilg Regulations and Stand Construct,,On Super`isoi ards License: CS-090902 .t. 9 RICHARD B BO :�. RHES 28 HAMI ,TON ROAD a PeabodyAY i r i L; Commissioner Expiratior, 1,1/01/2016