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HomeMy WebLinkAboutBuilding Permit # 11/5/2015 %AORTH q� t�ao �e^9N BUILDING PERMIT � �e�, '° �0 TOWN OF NORTH ANDOVER " � t �► APPLICATION FOR PLAN EXAMINATION * - Permit NO: Date Received .�- ��SSacHus�R�y Date Issued: " IMPORTANT: Applicant must complete all items on this page r y / / r i,, r 1 /;•;,f / /f / / r r ✓ / l ✓ f✓ /. r. ,f f „r, ,,✓,. r � r,o,. r� rr:r r.. ..,.rr,/ „, r /,e //' rs/, ✓ S / /, /r, r .,,, i. // ✓, < / , r r ✓rrr✓ s' 1� J, y, !.r J,,,,v n / �f,,x.%rr l �,L: /r ,''r rt,/!r r://; 4', r '(;.,,Dn f/»,a;. nr„ „ � i o.Ir.,rl1ir ! ekJ,v,;< ll,�d�¢,l�Gur,r„fits M171f:."e:rr,rr✓✓/ ,�rGl;.,o/, nR.L„YC//r/,�/,�rrriir,.,.y,i�s � r` /J J I; J"/ /f /�": s, Y l,li/�(. ,+J6,,"„ .,,r /,f �;Y.,3”.-yr ,Y /;. r,, 'e/7:%�,✓1 /l:, i . , r,,,, f ..✓ 3 r"r" s'. 1 J:..' r ,rel �. /. �,: it f a� / I-/f, 1 s, r/ ✓ ! r ✓ „r / 1, / r,, / /r / r lH / r t r, i ✓ / r .i, / i trr; r, / 1 ,✓,/ ,, l lr ,.<.,, rr„ r / ,r, /// , . 1 / , /'.: /r r ,.r,./r.. / /,, /,rir/ ,.+, ,,,,., f// 'Y r rr l! ,,. a .,/✓l i rrr, , /, r,;..,rr r,fr».,,,'.,,. a/%„/..,,r,.;,rrr. / p , y ,.;ri. l,v r /, r?/' .� / rn».r orr,.,' fi amu, f/ii,/r. ?i ✓/i,l!7` � r�:r /Jlri!! rd I':f✓' / / r f / ,r . a r.;,,:. i', ,.'✓, ,, ,... ,,, r.,J. 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( 1 r � / r r, /n, r f .r a / �r✓r� f n // / /, ✓ / r, 1 Y,it v r /7, r ,f r I � / ✓r ,, r, / 1 „9 , ,, ✓, / rl ren,J ./ r r ✓f. /, / / ✓ r 21a r / f i,r r, ,� /i rriir,r,.�irr,r,✓/(✓ ”r, /r rf�,"sr,✓Jr +,,,,1„//r'rr/{o'/✓..a� /rJc�,.�//,r,r,rc;,rr/e, „rr,.// ,rrr r✓j,�,ussl rirr/ ✓;:r 2rr s��s TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ;!r-One family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial epair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other r / ! u /r,✓' // I ,L %/;: !J r %/ r / Ir, ,' ✓/ / f{�y�f,�y/,y1yf // /// r t I / J ❑ I c� ✓s // /o /i /// i' //i L ✓/i r//; /r� / ;/ r r ,.� / / / -,✓. / /i r%ice/ l% F„.��rYt�'+/�� rs^"'iM..,,r/,„":,,,„r r /!i, ,, ,ze✓v, / :/!/� i !i //r//�/,r,ri:, /f„1„/ r;,//, rii,(» ,/,r 2r rrr/r A. 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H” ,r�s � . r /r/. r/ �r !/ rr✓i;. ir. ✓£„ /.r, ..l, �, ii+” !f.� r, rrrf l:: /� ,r � ,!/r, ,✓ r ,r „1/u / , �„ � , �(r%,,,,, 1, /,r„ l/r ✓ I/ ✓, f/ r ,� (r/i / //,r r/%,r, �//,�, r i „� i�, � r r ,, f hr, ✓ /,, .rrr v r r /r `/, ri „/nr m r�r,a , /t ,. v, r r /, ,n , +l✓ ✓ /� / f r / 1 / /s, ✓<,,, / / r, � I, J , �,,r rcr 1..0 � r„1 � rr ,,,Ar,,ii�� (r , � r / lrr r /,/,✓ e„rI r rrr �r, /(/ �/ 1 ✓., .JI / f� ,1 J ,✓ rl rr” n yr �/, / /, !l/// 115,".�� /r/r%/,..irf�lY.rf ri %i/�✓ n/arfi ,G�./.,y.,,r,;a/rrr✓,:/�L/,r.,ir,/!,r/r< lirt."::r O r r.,,:, // / ✓,.: I7/. l�" r 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. on Total Project Cost: $ - FEE: $ Check No.: Receipt No.: NOTE: Persons c ntracting with unregistered contractors do not have access to the guaranty fund,-.—,, Sl ulre gi riatof rlCwr� r ant�uar� rt °�' -" / � ofi v4®RT•H Town of M. No. "- 2z1;P �.o �.K. h ver, ass, ! �� cocc«twit. a. S U BOARD OF HEALTH Food/Kitchen P E r% MMM L D Septic System THIS CERTIFIES THAT .......... ... ..................................... .. ..�.��+�.�...................................... BUILDING INSPECTOR r,L a)VVL. Foundation has permission to erect .......................... buildings on ...... ....... .....................:�...................... Rough ..... -�j ............................................ to be occupied as ............ ..... � .. ........ .....,,�. . ��. b,✓1 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 and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final MONTHSPERMIT EXPIRES IN 6 ELECTRICAL INSPECTOR LES Rough a Service ........................ .................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — ®o Not Remove Fina° No Lathing or Dry Wall To Be ®one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. ' Federal ID#06-0405629 ISIS E ngincei-ing RI Contractor o 8106 lAA Contractor PRegistrationistration NNo 120979 A division of Thiclsch Engineering CT Contractor Registration Na 620120 60 Shawmuc,Cancan,NIA 02021 �g *� O I 339-502-5197 FAX 339-502-ti3d r Page 1 PROGRAM ENGINEERING 'titsCOWRACTMFlar RED TWO SEMEEriFOE % CIVIA-HIES E INEEERICROM UEtM ME CUSTaMEn FOR WORK AS OW CUSTOMER �,r .� Mw ,r„w,, o , t1aME OA'I'E WFUTS WORK ORD" Richard Denault 78)794-3773 07/09/2015 419086 00002 SERVICE STREET �, 1,�e� +""o '" a1LUNG STREET 80 Huckleberry Lane w " 80 Huckleberry Lane " ._ SERVICE CTfY,STATE,Z7P 'n � �^u � � ea.s_wc CIrY,STATE.ZIP North Andover, MA 01845 '' North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and matcrials to seal areas ol'your home agai ns(wasteful,excess air leakage. `I'his work will be performed in concert with the use of special tools and ding iostic tests to assure that your home will be lell with a healthful level of air exchange and'indoor air quality,Materials to be used to scat your home can include caulks,lbtans and other products, Primary areas I'or scaling include air leakage to attics,basements,attached garages and other unheated amas(windows are not generally addressed) 17tis will require(8)working hours, A reduction in cubic feet per minute(efin)of air'infiltration will oecur,but the actual number of cibu is not guaranteed. At the completion of the weatherixation work,and at no additional cost to the homeowner,a limit blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safely of tint indoor air quality, $680.00 AIR SEALING ADDER: (4)working hours. $310.00 A171C FLA f:Provide labor and matcrials;to install a ti"layer of R-21 Cuss 1 Cellulose added to(1670)square feet of open attic space, $2,104.20 ATTIC ACCESS:Provide labor and materials to insulate the back of(2)attic hatch with 2"rigid Tlicrmax board.Weatherstrip die perimeter. $120.00 VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom farts). $237.50 VENTILATION:Provide labor and materials it)install ventilation chutes in(84)railer bays to maintain air flow. $168,00 COMMON WALL:5:Provide labor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to(168)square feet of common will area. $588.00 RISE Engineering will apply all applicable,eligible incentives to this contract, You will only be billed the Net amount. Currently,for eligible measures,Columbia Gas offers 75%incentive,not to exceed 52,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to tate first 5680 and an additional$340 il'savings are justified by the auditor. For tine safety and health of your home's indoor air quality,we will be conducting a blower(loot diagnostic of the available air flow in your home both before the work is begun,and after the weathcrization work is complete.We will also conduct a lull assessment of the combustion safety ofyour beating system and water hunter.This has a value of$90 and is tit no cost to you. Total allowable wcatherizatiun incentive is$3,110. 590.00 d Federal ID#09-0406629 RISE Enginecring Rt Contractor Registration No 8196 MA Contractor Registration No 120979 A division of TTliciscil Engineering CT Contractor Registration No 620120 / 00 Shawmat,Canton,NIA 02021 CONTRACT MIKE 339-502.5147 FAX 3,39-502-6345 S Page 2 I1tt7GRAM tit a11�1 1t1i ,,re'°" y "4"w, ry NUS CONTRACT IS ENTERED WO BETWEEN RISE CMA-HES EROINEERINO AtiDTRE CUSTOMER FOR WORK AS ,• w DESCRIBED 13-mow CUSTOMER "',••a ''vw""b �° PHOIIE _ DATE CUFIrT 9 WORK ORDER Richard nenauit (975)754-3773 07109/2015 418086 00002 SERVICE STREET 'UNO ST,IEET 80 Huckleberry La t 080 I•iuckleberry Lane SERVICE CITY,STATE,ZIP �^�h "^ ter^° BILUNO CITY,STATE,ZIP North Andover,MA 0IT d"x- „ �' North Andover,MA 01895 JOB DESCRIPTION Total: $4,327.70 Program Incentive: $3,109.99 Customer Total: $1,217.70 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUTA OF ***fine Thousand Two Hundred Seventeen&70/100 Dollars $1,217.70 UPON FINN.M CTION AND APPROVAL BY RISE ENGINE END.CUSTOMER AOREES TO REMIT AMOUNT DUE IN FULL,INTEREST OF 1%PALL BE CIUUIGEO MONTHLY ON AW UIWPNDSALAN AFTER UOAYS.SEEREVERSE FOR IMPORTANTBWFORMATIONON OUARANTEEB,R1OIiTB OP FTECI3iDCI,5CNEDUUNO.NWD CONTRACTOR REGISTRATION, DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK 5PACt S hUTIIORIXI'U 5iCNATit •RISE EAI,%IY,ftittlAtJ � 5TO R ACCMPTNWCE �� ',, NOTA TfRS CONTRACT MAY SE WMIDRAWN BY 09 IF NOT EXECUTED W1T}UN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT.THE ABOVE PRICFs.EPECWWATIONS AMC CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DD TNM WORK AS SPECIFIED,PAYMENT WILL BE MNIE AS OUTLINED ABOVE The Commonwealth of Massachusetts Print Form ..... ....... Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.goildia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): Builders Services Group d/b/a Quality Insulation Address: 110 Perimeter Rd City/State/Zip: Nashua NH 03063 Phone #:603-578-9275 Are you an employer? Check the appropriate box: Type of project(required): LZ I am a employer with 100 4. F—] I am a general contractor and 1 6. F-1 New construction employees (full and/or part-time).* have hired the sub-contractors 2.n I am a sole proprietor or partner- listed on the attached sheet. 7. n Remodeling ship and have no employees These sub-contractors have 8. [J Demolition working for me in any capacity. employees and have workers' + 9. [J Building addition [No workers' comp. insurance comp. insurance., required.] 5. We are a corporation and its I0.F_1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their II.F_1 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.F_1 Roof repairs insurance required.] c. 152, §1(4), and we have no employees. [No workers' 13.F,/] Other Insulation comp. insurance required.] I *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit 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 or the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ani an employer t/iat isproviding workers'compensation insurance for my emp/ovees. Below is the policy andjob site information. Insurance Company Name: Indemnity Insurance Co of North America Policy # or Self-ins. Lic. ii,W L T,C-6 k S-1i 5_-5_,_S Expiration Date:6/30/2016 Job Site Address: City/State/Zip; C�n( I 0�\ S�� 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. Ido hereby .17 certif under the pains and penalties qfperjury that the in for provided abo 'ye is true and correct. Signature: Date: r Phone fl:603-324-1974 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 6. Other Cont;act Person: Phone#: CERTIFICATE OF LIABILITY INSURANCERDED TE TE HOLDER. THIS DATE(MM/DD/YYYY) 06/24/2015 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICA CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFO BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING IN DED BTHE POLICIES S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED, the policy(ies)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 T certificate holder in lieu of such endorsement(s). — PRODUCER CONTACT N Aon Risk Services Central, Inc. NAME: 'O PHONE (866) 283-7122 Southfield MI Office (AIC.No.Ext): (Alc.No.): (800) 363-0105 d 3000 Town Center E-MAIL :2 Suite 3000 ADDRESS: O Southfield MI 48075 USA = INSURER(S) COVERAGE NAIC N INSURED INSURER A: Oldance Company 24147260BJimm Corn. INSURER B: ACEnce Company 22667260 Jimmy Ann DriveDaytona Beach FL 32114 USA INSURER C: ACErs Insurance Co. 20702 INSURER D: INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER:570058348882 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. Limits shown are as requested LTR TYPE OF INSURANCE IP-01 -7rr7 NSDSUBF 7c LICY FXP WVD POLICY NUMBER MMIDD/YYYY MMfDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304834 /30/2015 06/30/2016 EACH OCCURRENCE $2,000,000- CL 2,000,000 CLAIMS-MADE OCCUR DAMAGE TO RENTED $2,000,000 PREMISES Ea occurrence T, MED EXP(Any one person) $25,000 PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,000 X POLICY F-]PRO- F-]LOC ',.. JECT PRODUCTS-COMP/OP AGG $4,000,000 m OTHER: o A AUTOMOBILE LIABILITY MIVTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT accident 15,000,000 Ea _ X ANY AUTO BODILY INJURY(Per person) O ALL OWNED SCHEDULED Z '.. AUTOS AUTOS BODILY INJURY(Per acc(dent) N j X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE U AUTOS Per accident N UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND wl-RC48151553 06/30/2015 06/30/2016X PER H- EMPLOYERS'LIABILITY YIN OT All other States STATUTE ER C ANY PROPRIETOR/PARTNER/EXECUTIVE N OFFICER/MEMBER EXCLUDED? N/A SCFC48IS190 06/30/2015 06/30/2016 E.L.EACH ACCIDENT S1,000,000 (Mandatory in NH) wI only EL DISEASE-EA EMPLOYEE S1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I E .DISEASE-POLICY LIMIT $1,000,000—_ DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Evidence of Coverage KI AIL_j CERTIFICATE HOLDER CANCELLATION 271 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE .L I A TopBuild Company 11169�j 260 Jimmy Ann Drive Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD '- i 1�� fl; �i?S ITI�r Aita�tS � llSlrleSS R✓f�Ulatlon L :0 Part: Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Conti-actor Registration Registratiom 179141 Type: Supplement Card Expiration: 612512016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 Update Addres>and return card.;Bari:reason for change. !.ddreNt Renmal Emplu, meat Lost Card ()f,3cr of Consumer Affxit:,z� Business I2rt ulatsun License or registration Valid for individul use only = Ots,E Jt;�Pi?QSfEiUE?iT CONTRACTOR before the expiration Date. If found return to: c?iiice of Consumer. Affairs and Business Rerul2don negistratian: 17914 1 Type W Plaza-Sn:te 5! 0 !=xP1r2ti!0n. 6iG512G;6 Supplement and Boston.MA 02116 UILDER SERVICES GROUP,INC--. ICHk.RD SCHvYARTZ 50.;IMMY A.NIN DRIVE — AYTONA SEACH. FL 32-114 a Not 1 aii? i ithat3t si n2turc i rc t r+trrrizr}' CSSL-105992 t� A IMF h KEC;EEARD SC HE' AR Z � �s�ti 51 I"HUN TRESS STREET' Manchester NH 03102 09/26/2016 ` Restricted TO CSSL-i;; - Insc�iatwr�C_cxtFracrr j 1 {E Failure to Posses'. -rem edition A they Maymh,.setts Stare Braiding Wt -rause for rc:vor.a:irzn of°tris Imense