HomeMy WebLinkAboutBuilding Permit # 9/23/2015 IAORTH
BUILDING PERMIT
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION y® ' A
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Permit iV®#° Date Received 0S ATEO
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Date Issued: 'r
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IMPORTANT:Applicant must complete all items on this page
LOCATION
ROPERTY OWNER St'0— TO-N l- b U\'eC6)
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District ye no
Machine Shop Village ye no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition [I Two or more family 11 Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
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�� h� ,� ells /./�, , ,1/ f �, ❑ Flood n � „y,, ,,, �, „n / �/�
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DESCRIPTION OF WORK TO BE PERFORMED:
�TM
Idem% Location
OWNER: Name' ' °` No Date
TOWN OF NORTH ANDOVER
Contractor Name:
,i�, rail
Email:
Address:
Certificate of Occupancy $
Building/Frame Permit Fee $
Supervisor's Construction
Lice Foundation Permit Fee $
Other Permit Fee $
Home Improvement Licenser TOTAL $
ARCHITECT/ENGINEER
Address: check )C ` 6Z—",
r
FEE SCHEDULE:BULDING PERMIT:$I
Building Inspector
Total Project Cost: $
Check No.: � O a 30Receipt No.: .c
NOTE: Persons contracting with i contractors do not have access to the ca unci
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r'ff_1 A" t%cMTH -uver
74" vL
i own of
No.
ver, Mass,
COCMIC"t WICK 1_
Q�RATED
11 BOARD OF HEALTH
PE �Rmm� IT L) Food/Kitchen
Septic System
THIS CERTIFIES THAT ........ � / BUILDING INSPECTOR
. .. .�Jy SQL Foundation
has permission to erect .......................... buildings on .. `. —'.... .......................................................
p Rough
�. =i✓ScJ/,-�",0-"
tobe occupied as .............. r:.l.:.. .z................................................................................... Chimney
provided that the person accepting this permit sh�11 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
Rough
VIOLATION of the Zoning or Building Regulations voids this Permit.
Final
PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR
LES T T Rough
............. ...... .
Service
:.................................. Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permiteguired to Occupy Building Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
o Lathingor all To Be Done FIRE DEPARTMENT
Until Inspected and Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
f"1
next step Living,
home energy solutions
This agreement is made by and among
Next Step Living, Inc.("NSL")
Stefanie Johanson 21 Drydock Avenue,2nd floor
453 Johnson St Boston,MA 02210
phone: (866)867-8729
North Andover, MA 01845
Site ID: A886650
09-Mar-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:
!Description
SealingAir Recommendations $851 11
Work Location. Attic Flat
Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 10 $85.00 Hr $850.00
Weatherization Recommendationsi 1 •1
Work Location: Attic Flat
Hatch:Thermal Barrier Polyiso 2 inch(Attic) 1 $60.00 Each $60.00
Dammii� - 12 -
25 1 nit - $24 60
'Propavent 2'or 4' 74 $2.00 Each $148.00
Atttloar Qpenlow Celftalose{11":-
Wdrkl.oeatLdh Fountratton Im
� � s
Insulate Rim Joist with 6.25"Fiberglass Batting 115 $1.75 Lnft $201.25
Initial Investment: $2,680.6.0
- F 00%Alrseairng�ncentr�e up�o_program Max--� $$5�00
�-�� ' `Y5 d/o UVea�harizatioli lncer�tlu� up to4Prograrn Max $1372 95
Estlma�ed Annual Ent?rgy Sa�ingefrom�he Above-lmpro�ements �$552�00
2. PAYMENT: CUSTOMER agrees to pay NSL for the work as follows:
Payment#1: '$100.00
-Credit Card or E•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 113 of the total retail costs. (Note:Mastercard,Visa,and Discover accepted)
Additional Payments and Final Invoice:' $357.65
-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 u are paying by check and your card will not be charged unless we fail to receive payment within 5 days of invoice.
i
custornef Si nature date
_ 9 Mar 2015 Andrew Carpentier
NSL Signature Date Name of NSL Representative A886650
The Terms of this Agreement are contained on both sides of this page
Next Step Living.21 Drydock Avenue o 2nd floor.Boston,MA Q2210"(866)867-8729.inquiry@nextsteplivinginc.com o www.nextstepliving.com
TERMS OF AGREEMENT A886650
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,Sulte 5170,Boston,MA 02116.617.973.8700.
5.PERMITS
NSL will obtain any necessary permits as the Customer's agent. Customers who secure their own permits ordeal 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,our 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.
6A 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.
7.NSURANCE 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 perform 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(1),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 COND1fIONS&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 and fittings,rotting wood,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
remedlation 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 eROV1866.
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 falls 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.
You may cancel this Agreement If it has been signed at a place other than the NSL's normal place of business,provided you notify NSL In writing at its main office or branch office 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. Seethe attached notice of cancellation
form for an explanation of this right.
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:
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,Customer's sole recourse is to Contractor and not to RISE Engineering(RISE)
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.
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.
Customer agrees that it shall not hold RISE,the Utility,their affiliates or operating companies liable for Contractor's 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 polViiersto 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 4 ate, aAdvisor Name: Cdr e.,, ke—
Address �1 T3 �o tin s0-1 fd, Advisor Phone #: Q�7 2 — �8gs—s�os'
Town AM Anel o ver- Any limitations to access by truck?
Site ID fA-9 9 126 `S O NO
NOTES Any work scoped outside of Best Practices?
Approved by: ®.� RAJ `� �` 3 t 5I
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The Commonwealth ofMassachaseffs
Departmew of IndustriW',4cridengs
Oft-ice of In vesdgadons
Congress Streei, Sufte 100
Boston, HA 02114-2017
wmw.ma&g�.gols�,fi*a
Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers
Apacant Information plpaep print
Name (Busiricr./Organi�ationUdividual): Next Step Living
Address: 21 DrydockAve
C
ity/Statel p:_Boston, MA 02210 phone#:(866)867-8729_Zi _
Are you an employer? Check the appropriate box-, Type of project(required):
I am a employer with 860 4. [] I am a general contractor and 1 6. n New construction
employees (full and/or part-time).* have hired the sub-contractors
10 1 am a sole proprietor or partner- listed on the attached sheet. 7. Remodeling
ship and have no employees These sub-contractors have 8. Demolition
working for me in any capacity. employees and have workers' 9. E] Buil&ag addition
[No workers' comp. insurance comp. insurance't
required.] 5. EJ We are a corporation and its 10.El Electrical repairs or additions
3.0 1 am a homeowner doing all work officers have exercised their 111,E]Plumbirtg repairs or additions
myself [No workers' comp. right of exemption per MGL 12.n Roof repairs
insurance required.] t c. 152, §1(4) and we have no Insulation
employees. [.No workers' 13.X Other
comp. insurance required.]
*Any applicant that checks box 01 must also fill out the section below showing their workers'compensation policy information.
I lomeowners whe submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidal-it indicating such.
xCoatractors tthai clieck this box miist attached an additional sheet showing the name of the sub-contractors and state whether or rot th030 Ontitim, have
employees. If the sub-contractors have employees,they must provide their workers'comp.policy mjtnber.
I am an e;;P,=I—oyer that is providing workers'comp ensadoninsuranceformyemployee& Below is the policy and job 3fte
A.I.M Mutual Insurance Company
Insurance Company Name:
Policy A 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$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations of the DIA fbi insurance coverafie y0flotion.
1
I do hereby certify under the pains andpenllles 1,111periu,y that the information provided above is true and correct.
Phone U P_idQ)
1.[Oficial,ricial use only. Do not write in this area,to be completed by co or town qfflciaL
City or Town- Permit/License#
f
a'use'
City or Tow
Issuing Authority((circle one):
Board of Health 2.Building Department 3.City/Tower Clerk 4.Electrical inspector 5.Plumbing Inspector
6.Other
Contact
Per
ontact Person: Phone S.—
WEXTa_li OP 10:EL
CERTIFICATE OF LIABILITY INSURANCE
10101/200
14
THIS CERTIFICATE IS ISSUED AS A mATTEP, OF INFORMA71 RON 0%y AND CONFERS NQRIQHTq VVION THV RRTIFIGATP HOLDER.THIS
CERTIFICATE DOES HOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR, AR C-R THE COVERAGE AFFORDED BY THE POLICIES
BELQW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTPUACT BETWEEN THE ISSUING INSURER($), AUTMORIMP
RSP I �SEHTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER,
111017 RTANT: if the qeMficata holder is an ADDITIONAL INSURED,the pollcy(les)m",q-k he endorsed. If SUBROGATION Iq WANED,qg0jagg tq
the terms @nd conditions of the policy,certain pollMeo may vegulve ml(""dorsenient, A statement oil tills cefifflGate-does not cofiie�wights t®
—certificate holder in lieu of such end-oreemeriffs). _..CONTACT
PRODUCER NAME: F-An Lyons
All
M�LaLlghil PHONE..,,,,,70-665-2775 AIC.No):
to_
n Fel Es ParkWpy (A IN I F
1328 Lyn
Melrose MA Q-1176 E-MAIL
John E. I McLaughlin Jr. E-MAIL INSURERS)AFFORDING COVERAGE NAIL if
wsuRrr A;P1,gigAillus Insurance
INSURED �J@A Step�Wlna,1111C. IMSUPEP 0:Gammpwce Insurance compaily
21 Drydock Avenue,2nd Floov IMSupEp c:A.I.M.Mutual Instirance Co.
Bostan,MA 02210
INSURER D:hVIS Insurance Company 15610
INSURER E*.
INSURER r:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER-
TH'IS IS TO'CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED 10 THE INSURED NAMED ABOVE FOR THE POLICY gRO
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT-10 WHICH T Is
CERTIFICA,T E MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
E)(CLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS,
INSR 4DOL SUER POLICY EFF POLICY EXP
LTR TYPE OF INSjJRAMCE anWVPOLICVNUMBEP MMIODP OTA-102= LIMITS
A X COMMERCIAL GENEIZALLIABILITY EACH OCCURRENCE
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CLAIMS-MADE FRI OCCUR PREMMjGsEES`(0E!E TuEfD
a occ rence)
MED EXP(Any one person)
PEPSONAL.ADV INJURY 8
GEM'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $
PRO-
POLICY F�JECTT FILOC PRODUCTS-COMPIOP AGG $
POLICY
$
OTHER::
CdFABINE I GLELIMIT S
AUTOMOBILE LQAGIIATV (Ea accident)
ANY AUTO 09130f20-1 5 130DILY INJURY(Per person)
ALL OWNEDSCHEDULED BODILY INJURY(Pei accident)
AUTO., x NON-OWNED (PROPcE.R DAMAGE
AUTOS Per. Q
HIRED AUTOS id )
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—L'o-L, —CCCL., F-ACH OCCURRENCE
EXCESS RETENTIONS
LIAB CLAINIS-MADE AGGREGATE $
DIED RET ENTION 5; —k— STATUTE
PUFOTHWORKERS COMPENSATION SEAR
T T TE
AND EMPLOYERS'LIABILITY YIN STATUTE ER
ANY PROPRIETORtPARTNERIE),ECUTIVE MIA TO BE ISSUED BY CARRIER 09/301,2014 OP/30/2015 E.L.EACH ACCIDENT $
OFFICERIMEMBER EXCLUDED? El
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $
if es,desonbeunder 30I�0®11
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DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Rernar'4s Schedule,may be allechod 11 more space is required)
rOR INEFORMATION ONLY
CERTIFICATE(HOLDER CANCELLATION
IMFO-01
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Foir lilforrPhatlop oply ACCORDANCE WITH THE POLWY PRUAASIOMG.
AUTHORIZED REPRESENTATIVE
Alp— CORPOPIATlCK ILII 1°flats 1°eSeU err,
VW wo onq lRoaz w')m4fth7i VNI"' 'v4p'V ACORR,'
i
office' of Consumer Affai��� and B������� Regulation
10 Farre Plaza o Suite 5170
Boston, Massachusetts 02116
Home Improvement Contractor Registration
Registration: 162111
T Vpo: Supplement Card
Expiration: 1/14/2017
NEXT STEP LIVING INC.
ROGER OUELLETTE
21 ®RY®®CK AVE. 2 E H FL
BOSTON, MA 02210
Update Address and return card.Hark reason ffDr change-
M Address E] Renewal [] Employment E] Lost Card
10" r(.,
office of Consumer Affairs&Business Regulation License or registration valid for individul use only
before the expiration date. If sound return to-
HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Regulation
Registration: 162111 Type: 10 Park Plaza-Suite 517D
Expiration: 1114122017 �;uppfernenl Card Boston,1AA D21 k6
NEXT STEP LIVING INC.
POGER OUELLETTI"
21 DRYDOCK AVE.2TN FL � � -
BOGTONf MA 02210 (U¢a¢derseere a�°g INot valid arliti ouCcc signature
L 0 C140,rW,�,'Ujo iujpc'#"', vor crft,, t v,flo,
11 — : CSSL402811
dna OGE,R A OVELLIET
55 STARMORE,
WnMck IN NOW
09§132018
Reaivicted TO: CSSL-OC-WuNlion Contractor
t
Failure to possess a current edition cO the UWassachusetts
State Building Code is c�use for revocat,bn coOthis license.