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HomeMy WebLinkAboutBuilding Permit # 10/29/2015 BUILDING PERMITao TOWN OF NORTH ANDOVER ''` APPLICATION FOR PLAN EXAMINATION " • .,• e r Permit No#: " �` Date Received SSS n.Hn5E442 Date Issued: 2-A 16- IMPORTANT:�g qq Applicant must complete all items on this page i Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non-Residential ❑New Building ❑One family ❑Addition ,KTwo or more famiIX ❑Industrial ❑Alteration No.of units: ❑Commercial ❑Repair,replacement ❑Assessory Bldg I I Others: ❑Demolition ❑Other ry- DESCRIPTION OF WORK TO BE PERFORMED: rh45«tw�N R•Fdr c. rya IR--�/r9 h- f"a["f-w rcr v-•.(s�a.l�5�i �`J� a��rfC,In�awa� r�, c.<-°<IuC�+yz' /'+r4cY 3��✓vz�{�sy U'�� �s _ Identification-please Type or Print Clearly OWNER: Name: E/Ie Phone: Address: � ' �N V'' !1 �f �N1i� 11 �IJ� V'fi�9AV'{Ytf ➢dUB4tk 9V �$� M /i a ARCHITECT/ENGINEER Phone: Address: Reg.No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. tlt� Total Project Cost:$ Y�579 .�L,` FEE:$ "J I �- r Check No.: )V Receipt No.: NOTE: Persons contracting with unregisteredcontractors do not have access tD a uarar Ind Sn'`t�ureofAgent(Owner gnature,pf,,'contfactor ;,, /! /' %i',,,,;% °RT" Andover Town of = �,E ,. . ° :.: No. �� h * ver,Mass, 10 Esq pOj+�reo SPP",�5 MIT TOS US BOARD OF HEALTHILD Food/Kitchen Septic System THIS CERTIFIES THAT...... .L14........n�.> .�,A,J.�........................ BUILDING INSPECTOR has permission to erect..........................buildings on j7.C,T..WA.a.dr°°plot!°n Rough to be occupied as............ n.... ..-.. �u.� h✓.1............................................. chimney provided that the person accepting this permit shall in every respect conform to the terms of the application Finel 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 PERMIT EXPIRES IN 6 MONTHS ELECMICALINSPECTOR UNLESS CONSTRUCTIO40SI TS °ugh ft -gh BUILDING INSPECTOR 1m.1 GASINSPECFOR Occupancy Permit Required to Occupv 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. 6°r r sheet N°. Smoke Det. oGUbb�� WAP STANDARD AGREEMENT ���� Tenant/Property Owner/Agency Weatherization Agreement I.The Parties to thiis�Agneement are the following: �C. ' )� (hereafter Tenant) ._(hereafter Property Owner),and Council.Inc.hereafter Agency) In consideration of the mutual promises hereafter stated,the Parties agree as follows: 2.The date of Agency's signature will be the effective date of this Agreement. 3.The Property Owner con5�t�and agees t, 'the A=no maydo the following with respect to the property located at - ry ith ��y n currently leased or rented to the Tenant: -and a.Enter the premises for the purpose of performing a weatheri anon inspection. b.Perform weatherization work which the Agency determines in its discretion is necessary and appropriate as a result of the Agency's inspection ofthe property and in accordance with the appropriate priority list fill the type of dwelling(See Attachment A).The Property Owner also agrees to permit the Agency and the Agency's contractors to enter both the Tenant's apartment and appropriate common areas of the building for the purposes of accomplishing the weatherization work.The weatherization work will be performed in accordance with the Property Owner's consent as further specified below:(Initial one) 1 consent to performance by the Agency and its contractors of any weatherization work determined necessary and appropriate by the Agency as a result of its inspection of the property.I understand that the Agency will Provide a detailed statement of the a the associated value at the completion of the work. ctual work performed and or I will provide a consent to performance by the Agency and its contractors of weatherization work following my receipt of the Agency's inspection report and the estimated work and associated value. a statement of This additional consent will be attached to this Agreement as Attachment B.I understand that the Agency will provide a detailedstatement of the actual work performed and the associated value at the completion of the work. APR 3 0 2015 9.(*A licable only if Tenant's heat is included in rental a mens and blanks are filled in.)At the end of the one(1)year period set forth in Paragraph 8 above,the rent shall not be raised more than %Per year for an additional period of_years,and the provisions of 8b and 8c above shall continue in effect for such period.However,the rent provisions of this Paragraph 9 may be waived by the Agency in writing if,and only if,the premises are leased under a state or federal rent subsidy program,in which case the actual rent charged by the owner shall conform to the standards of the rent subsidy program. 10.The Parties agree that the terns of this Agreement are incorporated into any other lease or agreement between the Property Owner and the Tenant,and between the Property Owner and any successor tenant,and Where is any conflict between the provisions of this Agreement and the provisions of such other lease or agreement,the provisions of this Agreement shall govern. However,if such other lease or agreement,including without limitation a lease or agreement under a state or federal rent subsidy program,contains stronger protections for the Tenant,such stronger protections shall apply. I I.For breach of this Agreement by the Proper!;,Owner,the Properly Owner shall reimburse the Agency in an amount equal to the cost,as certified by the Agency;of the weatherization materials installed and labor performed on the premises,as well as attorney;fees and court costs.The Property Owner may also be liable for damages to the Tenant in accordance with applicable law; in such instance,the Property Owner shall reimburse the Tenant for attorney's fees and court costs. 12.The Parties acknowledge that this Agreement is under seal.It is intended by the Parties that the Tenant or any successor tenant is the intended beneficiary of this Agreement and shall have a right of enforcement. i 1Taat Date �F� net Date Agency — Evelyn Friedma ate Executive i or/C O .11- ELIE DEGLOUI-978-685-7016 aaares 24 JETWOOD ST. =Over=we N1.ANDOVE12,O1846 ontractor 1.WEATHERSTRIPPING/CAULKING QUANTITY TOTALj___jITOR NOTES Door Kits Q-Lon or Equiv. 4 20400 Door '-' Door Sweeps(Regular) 0.00 Door Sweeps(Autom.u.) 4 104.00 Reglaw Windows/InJech 000 Window.Weathstr Schlegel per side 0.00 Recessed light cover per SWS.Not a tonal cover 0.00 attic sealing 2 part foam 0.00 attic sealing 1 part foam 1 70.00 basement and living space air sealing 1 part 1 70.00 SUBTOTALS 448.00 2A.INFILTRATION/INSULATION RDITORNOTESDomestic pipe Hot Water Tank lst 6' 1 1770Sill Two Part Foam w/Fiberglass Batt 64 15744 1"T-max on:y roam boardPadan.ter per IECC&SWS sq.fl. g.002'T-max onlyfoam boardPerleter per IECC&SWS sq.ft. 0.00 Drape DOOR R-5 or T-max only 0.00 Tape Joints(Aluma Griponly)per In, 0.00 Duct Ins W Tap.sq.rt.R-5 conditioned space 0.00 Duct Ins w/Tape Sq.ftR-8unconditioned crawlltgarage/attic 0.00 Hydronic pipe insulation to1"R-5 110 420.203/4 COPPER Hydropic pipe ins.1.25"-2"R-5 0.00 Steampipe Ins.1.25"-2"Iron pipe R-6 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 595.34 2B,INSULATION WAUDITORNOTES Open Unrestricted R 49 0.00 Open UnresMcted R 38 0.00 Open Unresincted R30 0.00 Open Unrestricted R 20 680 979.20 Open Unrestricted R 10 0.00 Re:Oct FUSloped R 38 0.00 Restrict FUSloped R 30 0.00 Restricted FUSloped R 20 216 334.80 R.stnct FUSloped R 10 0.00 R-19FGB open rafters/walls/kneewalls 0.00 R-11'GS open rafters/walls/kneewalls 0.00 Adic Stairs(stairwell&common wall) 0.00 Cover Pull Down Stairs Thermadome up to R49 per 1 450.00 Site built pull down stairs 2"foam box 000 Attic/Kneewal Floor Transition.Dense pack cellulose 0.00 W.S.Hatch Q-Lon or equal 0.00 W.S.8 bat Hatch,dam around atc.complete to attic R value 0.00 Kneewal)R-12 cell behind Per.Memb 0.00 Open Rafter R-20 Cell,by poly 0.00 Open Rafter 11-30 Cell.Av poly 0.00 Basement Overhead R-19 fiberglass 0.00 Basement Overhead R-30 fiberglass 0.00 C-iPace Overhead<4'high RIB 0.00 Crawlpaoe Overhead 14'high R30 0.00 Garage Ceiling cavity filled w/cellulose 0.00 Wood,Bhake,Clapboard,Shingme Vinyl 924 1848.00 WALLS MAY BE FULL Asbestos(single nail)/Asphalt 0.00 Asbestos(daub.Neil)/Aluminum 0.00 Brick/Stucco 2 hole 0.00 Vinyl over Asbestos 0.00 Melfi-layered 3 or more layers 0.00 Drill rough plaster or finish wood plug 0.00 Drill finish plaster 0.00 Test Drill Walls(sll4) 1 67.00 CAREFULL W/GARAGE WALLSMAS BSBOARD SUBTOTALS 3679.00 2.INSULATION TOTAL 2A.t2B. 427434 3.STORM WINDOWS/DEADLITES AUDITOR NOTES Plexiglass up to 88 u.1. 0.00 Additional per UI over 88" 0.00 Dead light 0.00 SUBTOTALS 0.00 S.OTHER MATERIAL AUDITOR NOTES Ridge vent In ft 0.00 Gable Vent rectangular 0.00 Varipitch Venl 0.00 Roof Vent 135(1 eq ft NFV)Large 0.00 Roof Vent 865(A sq It NFV)Small 0.00 Soffit Vent Rectangular 0.00 Turbine Vents All 0.00 Slack Vent 000 Acuvent Proper(Must be this product)available @F 30 138.00 HAS SHORT PROPA VENTS Perri House Wrap 0.00 '- Bmlipolyonground 0.00 -- Energy Star R-4 Rigid Vinyl Repl 94-101 U.I. 0.00 SUBTOTALS 138.00 6.17.E.C.MATERIALILABOR 4860.34 Us. HEALTH&SAFETY AUDITOR NOTES CO detector 0.00 Vent Bath/Kitchen Fan 0.00 Dryer vent w/exhaust duct Heartland 0.00 Dryer Transition Duct only 1 4500 Beth 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 - 90A0 - - 8b.REPAIR MATERIAULABOR AUDITOR NOTES Basement outside door s tIlld 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 Rep[pre hung 3236"Steel-W;Lite 0.00 Door Reel interior solid core 28-32" 0.00 Door Repl pre hung 32-36"wood"w I Lite 0.00 Window Replacement w/SIR less than 1 0.00 Basement Window Repl.Awning/Hopper 000 Basement Window Repl.With a frame 0.00 Lockeet(door)Schlage or equal 0.00 Repair/Refit Door 0.00 Replace Side Slop 0.00 Replace Casing 0.00 Glass Replacement to 64 U.I. 0.00 Glass Replacement per u1 over 64 0.00 Thermo pane Glass replacement 0.00 Sash Sidelock crop Replacement 0.00 Threshold(Wood) 0.00 Threshold(Aluminum) 0.00 Slide Bolts/pull handle 0M Cut/finish a8iokneewall access 0.00 Cut/close attic-knsawall 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 OM Permits/Fees(Wap only) 0.00 SUBTOTALS 0.00 TOTAL REPAIR•HEALTH&SAFETY 90.00 GRAND TOTAL WORK ORDER# (A) 5316 4950.34 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: --.--------T---_._.__ CONTRACTOWCOMPANY: 0 ACCEPTANCECompany/Contractor AUTHORIZED SIGNATURE: Data AGENCY APPROVALS: CTI Authorized Signature: Data GLCAC Authorized Signature: Date . The Commonwealth ofMassachusetts - Department of fndustrialAccidents t -, 1 Congress Street,Suite 100 Boston, 0017 wrvw.mamass.gorldigov/din Wothers Compensation Insurance Affidavit-.Builders/Contraetm's/E lactrieians/Plumbers. TO BE FILED WITH THE PERMITTING ADTRORITY. Appli—thaf-andical Please Print Legibly Name(B ivess/Organizatinv/t dividusl): �i✓r�'he c" - •_ / �.o>"a c C Address: '?8 t��,�ri//' City/State/zip: !c<-4 6160/9Go Phone#:2,?LIt7S-dv._4f Arcyou an wployerY Cheek tfie apyiop date box: Type of project(required): 1.�IomaemPlnYarwith_ employccs(flill evd/orparbtlme).+—. 7,❑New eonsttoeper, 2.❑Iran asola pmpdetor or parhrcrship audhavemornpleyees working kr mo iv $,❑Remodeling ouy capacity.[Noworlmrs'—P.inve—",ar,d] 3.❑I—st—eowncrdoinaoll,wrk my.1f.[NowoAI comp.insmancerequired.]t 1 Demolition 4.❑tam a homeowner and will ba ld' tractors to condvet ell work onm Iwill 10 Building additiosio nu&con aprooperty. re that al—1a ehher have k.,—V anon mamaweer ale 11.❑Elechical repair xadditions propuem with vo wployees. 12.❑Plumbing repairs or additions - 5.❑I am agacral contractorand Ih—llci dthe auboontractore listedonthe attached sheet. 13.QReofrepairs These sub-contractors have wployees avd have workers'comp.insurance.I 6.❑Wen corporation end itseffl shay enlised diel,rirdrt ofexemptov per MGL c. 14.❑0ther 152,§1(4),and we have employwo em[M. rkers wrap.insurance mquircd.] 'Any applxarathat checks box#lomnot aloe fill out tiro sectionbelow shewingthcirworkers'comPensatien policy irSormation. t fIomwwners who submit this atidnit indiwtingthl are dnivg all work.laln enhire outside contractors musesubmtt anew affidavit indkating such. - tContractom that checkthis box mustetteched an additional sheetshowing lire vame ofthe sub-coviractors avdsfate whetherornot those entities have employees,rfthosubcb t tons havewployees,they must provide their workne wrap.policy number. Iran an enployer Haat is providing tvorke,s'rnn pensation insurancefnr my ernplayeu.'Belon is-thepolicy and job site inforrnalion. Insurance Company Name: ....... Policy#or Self-ins.Lie.#.__A o WC(o% I h Expiration Date: Co rob site Addreaa: o�c�)�{w Mn 1Q s f City/State/Zip:Attach a copy of the workers'e'ompepsation Polley declaration page(showing the policy number and oxpiratiou date). Failure to seeure 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 WORT{ORDER and a fine of up to$250.00 a day agahhst the vfo)ator.A copy nfthia statement may be forwarded to the Off-aflnvestigations ofthe DIA for imurence overage verification. I do hereby certify under t1 dd penaIn,,ofperjury don lee Information provided abov tram and correct Sig t G /J f`�-- D t' /o�Z '•W,57 Phone it: 79/- S S Official use only.Do nod write in this area,to 5e completed by Bc or roam official City or Town: Permit/Licause A- Issuing Authority(circle ono): I.Board of Health 2.BuildingDepm'tment 3.City/Town Cleric 4.Electrical Inspector 5.PlwubingDrspeetor 6.Other Contact Person: Phone#: �cosz® CERTIFICATE OF LIABILITY INSURANCE 10/23°...."'°°""""' /_2015 THIS CERITFICATE IS ISSUED AS A MATTER OF INFORMATTON ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATWELY 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 INSUREII AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the cedificate holder Is an ADDITIONAL INSURED,the polky(ies)must IN,eIRIDOM 1.If SUBROGATION IS WAIVED,subject to the terms and Conditions of the policy,certain policies may require an end—am ort.A statement on this cenificom dues not confer rights to the certill holder in lieu of such..do,sement(s). cE Select Dept Eastern Insurance Group LLC .(800)333-7234 X66807 233 West Central St aelectwrork@eaeterninaurance.icom T sU Natick MA 01760 RAGuardInsurance sGroup INSURED Advanced Energy Solutions Llc c/0 Richard Borges 28 Ramilt0n Rd INSURER E Peabod HA 01960 COVERAGES CERTIFICATENUMBER:15-16-at..Ve� 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.—WITHSTANDING 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. TYPE OF INSURANCEN POLICY NUMBER I'M E.AL LIAwLnYEACH OURRENCELIMITS COMMERCIAL GENRAL E YASfMl1E❑Ao^s.AS ExPMM ana Pv +1 5 R E AUTOMOBILEPC PRO H. LIABILITY RY ryarparsonl E ° Rr ryer TossaTae,x1 E OAUT ED INCRERTY-MADE E E E =LA LIA 8 A and X I gy1TATUoTH- LITY AANY PROPRETRCI un N wc69T424 /i§/zois 11412 016 E 1 000 000 B�n:Ia:m Bm Nx)ExctuoeO. O x E S 1,000,000 wSEASE-POLICY LIMIT 1 11000,00 DESCRIPTION OH OPERAnorvs 1 LOCATIONS i vEHICLEs IAM ACORD 101,Addin—I Rama,ea sanedale,If mor Pac Ia regmradl CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Lawrence Building Department ACCORDANCE WITH THE POLICY PROVISIONS. 200 Common Street Suite 209 AUTHORIZED REPRESENTATIVE Lawrence, NA 01840 Sohn Koegal/PKI ACORD 25(2010(05) ©1988-2010 ACORD CORPORATION,All rights reserved. INRnfF r�mmr n, T_ArDnD..n,.,ee..nl_n.e.w,ete.a.l—U.,'ACIDIC. 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