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HomeMy WebLinkAboutBuilding Permit # 11/5/2015 VAORT11 0) BUILDING PERMIT TOWN OF NORTH A0 NDOVER A, I APPLICATION FOR PLAN EXAMINATION it Permit NO: Date Received 0 04AYE SSAC US Date Issued: IMPORTANT: Applicant must complete all items on this page 71-1 ffil"'I""S' "�l 2'11'�' 1/8 '1'111�12"11�'1'111§ '�N"No' ""M W" „l,,/c..., „ai,/,z„/„ /c 7;;::,,, r,.,..�0%.. ,r„ /o,,%n ,� x,,,,7%//, ,r ,,,,.),,,r,,, „6,nr r,,,,,,,:,,,:✓,,/v,,,uU/✓,,,/f n rr,.✓ n, ,.J„,:, ., fi�,/t,., ,,,n,,: ,L, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ^One family [I Addition El Two or more family 11 Industrial et� Iteration No. of units: El Commercial C epair, replacement El Assessory Bldg 11 Others: [I Demolition 11 Other 'W Identification Please Type or Print Clearly) OWNER: Name: Phone: q7 Address: 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. LJ ' 6 L,J . C) ( Total Project Cost: $ FEE: Va/ Check No.: 04 '1 Receipt No.: -'-)5Z_ - NOTE: Persons conir&lti4 with, unregistered contractors do not have access to the guaranty fund Sid, ofAgeri 014 'bpOtt � F FORTH Town of A ndover ® ;` 0 No. 51vo 2z I jo �AKe ver, Mass, r coc NIc Ne WICK y�• �,9 A°R+p�D BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT d.�. P.."o Aq a L....; ................................................... BUILDING INSPECTOR .............. .. . ....... .......... has permission to erect buildings on ...8ROFoundation _ Rough to be occupied as ..... ....................................................` ..a .... ............................................ 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI^ ST TS Rough Service .................. . ......................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in aons icuous Place on the Premises — Do Not Remove Final Lathing No at I or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. yf d� Federal ID#0"405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120379 A division ofT hielsch Engineering CT Contractor Registration No 620120 60 Shawmut,Canton,MA 02021 CONTRACT 339-502-5197 FAX 339.iO2-6345 Page 1 PROGRAM N(1NEERINGTHIS CONTRACT is ENTERED INTO DEnNMA RME CIVIA-HES ENGINE£mNGAMUSCWTOkMERFOR WORK AS DESCRIBED SELOW CUSTOMER PHONE DATE CLENT'D WORK ORDER Patricia3aysane (978)857-8230 07/17f2015 414270 00002 SERVICE STREET naWNG STREET 55 Famum Street 55 FarnuYn Street .SERVICE CITY,STATE,ZIP .—� BIWNG CITY,STATE,ZIP pp" �k North Andover,MA 01845 North Andover,MA 018— ,JOB 8,JOB DESC PTIO I '1lASE 0 E-Proposal for this calendar year. $0100 Alli SEALING:Provide labor and materials to seat areas ofyour home against wasteful,excess air leakage. This work will be peribrmcd in concert with the use ofspeciai tools and diagnostic tests to assure that your home will he Jett with a healthful level ofair exchange and indoor air quality,Materials to be used to scat your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) 11his will require(8)working,hours. A reduction in cubic feet per minute(cfm)ofair inflliration will occur,but the actual number of cfin is not guaranteed. At the completion ofthe weatherization work,and at no additional cost to die hoincownr ,r,a final blower ofair mullor combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 Alit SEALING ADDER: (4)warkin,,hours. $340.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass baits to(122)square feet for damming,purposes. $250.1 t) AT riC FLAT:Provide labor and materials to install a 13"layer of 11-95 Class I Cellulose added to(252)square feet of open attic space. $410.76 NITIC FLAT:Provide labor and materials to install a 9"layer of R-32 Class 1 Cellulose added to(0120)square feet ofopcn attic space. $896.60 SLOPES:Provide labor and materials to install a 4"layer ofR-14 Class i Cellulose added to(102)square:feet ofstopc area.Wherever possible battles will be installed to the entire Length ofeach buy to maintain ventilation space, $181.56 ATTIC ACCESS:Provide labor rend mater ih;it)make(2) access opening from one attic arra to another by cutting a passage through sheathing This access will be left open as it is between two common unheated non firewalled attic areas. S62.62 A771C ACCESS:Provide labor and inaterials to install(1) easily moved,insulating;cover for the attic access folding stair. A small flat surface of plywood will be created around the opening within tine attic. "Chis will allow the cover's integral weather-stripping to restrict air leakage. $237.65 VFNTII..A"1"ION:Providc labor and materials to install ventilation chutes in(29)rafter bays to maintain air now, $58.00 COMMON WALLS:Provide labor and materials to install 2"FSK faced semi-rigid fiberglass board insulation to(174)square feet of common wall area $509,00 13A.SE#viL;NT CEfL1N(i:Provide Tabor and materials to install(I Of))linear feet of R-19 naf°aced fiberghiss insulation to the perimeter of the basement ceiling at the horse sin. $185.50 �, Federal ID#05-0405529 IUS E Engineering RI Contractor Registration No 8185 MA Contractor Registration No 120979 A division ofThiclsch Engineering CT Contractor Registration No 520120 ON60 60ShaAvmut,Cantnrr, 49:10202! T CT 339-502-5197 FAX 330-502-6345 S Page 2 PROGRAM E N G I N E E R I N G THIS CONT WALT IS ENTERED INTO BETVIEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORTS AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIEN $ WORK ORDER Patricia Jaysane (979)857-9230 07/1712015 414270 00002 AERVICE STREET BILLING STREET k` v 55 Farninn Street 55 Farntirn Street SERVICE CITY,STATE,ZIP BILLING CITY.STATE,ZIP °� North Andover,MA 018#5 North Andover,MA 01845 J,I�. .JCB RESCRI TION BASEMENT DOOR:Provide labor and materials to insulate the back of die basement door Icadini to the bulk It meets the sections R-316,5.4 and 316.6 requirements ofbuilding code. Seal all edges and scares with FSK tape. $72.22 RISE Engineering will apply all applicable,eligible incentives to this contract, You will only be billed lire Net amount, Currently,fbr eligible measures,Columbia Gas offers 7S%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional$34011'savings arc justified by the auditor. For the safety and health ofyour home's indoor air quality,Ave will be conducting a blower door diagnostic of tlrc available air flow in your home both before the work is begun,and after the weatherization work is complete.We will also conduct a full assessment of the combustion safety ofyour heating;system and water heater,1161 has a value of S90 and is at no cost to you. 'total allowable weathcri,ition incentive is$3,110. .vr90.00 Total: $4,064,01 Program Incentive: $3,110,00 Customer Total; $054.01 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE SUM OF '... ***Nine Hundred Fifty-Four&011100 Dollars $954.01 UPOAN FINAL INSPECTION AND APPROVAL BY RISE ENGMEEROX.CUSTOMER AGREES TO REMIT AMOUNT DUE III FULL.IINTEREST OF TX WILT..BE CIMACED MONmLY ON ANY UNPAID BALANCE AFTER JO DAYS,SEE REVERSE FDR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECtSION,SCHEDULINO,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BANK SPACES AUTHOR BIG ATURE-R15E EASIAaarinS CU18F0 CCEPTANCE tNOTE7 THIS COUTRACT MAY BE WITHORAWN BY US IF NOT EXECUTED VIITHIN DATE OF ACCF,PTANCE ACCEPTANCE OF CONTRACT•TIIE ABOVE PRICES,SPECIFICATIONS AND CONOTNONS ARE 30 DAYS. AATISFACTOnY TO US AND ARE HERESY ACCEPTED,YOU ARE AUTHORIZED TO DO THE VNORK AS SPECIFIEO.PAYMENT War.BE MADE AS OUTLINED ABOVE The Commonwealth of Massachusetts Print For Department ofIndustrial Accidents Office of Investigations I Congress Street, Suite 100 Boston, MA 02114-2017 wwminass.govIdia 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. [_1 I am a general contractor and 1 6. F1 New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am sole proprietor or partner- listed on the attached sheet. 7. r❑-1 Rei-nodeling ship and have no employees These sub-contractors have 8. E] Demolition working for me in any capacity. employees and have workers' + 9. E] Building addition [No workers' comp. insurance comp. insurance., required.] 5. F] We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.R Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' .21 Other Insulation 13 comp. insurance required.] *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 of 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. lam an emplQwrthat isproviding workers'compensation insurance forn�V employees. Below is the policy and job site information. Insurance Company Name: Indemnity Insurance Co of North America Policy # or Self-ins. Lie. #NQCKC:--6Vj5�57) Expiration Date:6/30/2016 Job Site Address: aQ 14 -e_.,6ec-r Uza n e-, City/State/Zip: 17 Attach a copy of the workers' compensation poJcy 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 under the pains and penalties qfperjui- y that the information provided above is true and correct. Si nature Date: - _q25? ZZ 5' Phone#: 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 ft 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#: A� CERTIFICATE OF LIABILITY INSURANCE DATE( 2/DD/YYYY) 06/24/2015 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(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 certificate holder in lieu of such endorsement(s). — PRODUCER CONTACT N Aon Risk Services Central, Inc. NAME: '6 PHONE Southfield MI Office (A/C.No.Ext): (866) 283-7122 (A/C.No.): (800) 363-0105 `y 3000 Town Center E-MAIL a suite 3000 ADDRESS: O Southfield MI 48075 USA = INSURER(S)AFFORDING COVERAGE NAIC iY INSURED INSURER A: Old Republic Insurance Company 24147 TODBUild Corp. INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann Drive Daytona Beach FL 32114 USA INSURER C: ACE Fire Underwriters Insurance Co. 20702 j SURER D:SURER 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. INSRLimits shown are as requested LTR TYPE OF INSURANCE LICYEXPJ INSD WVD POLICY NUMBER MM/DD/Yl'YY MM/DD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304634 1 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X❑OCCUR DAMAGE TO RENTED $2,000,000 PREMISES Ea occurrence MED EXP(Any one person) $25,000 '.. PERSONAL&ADV INJURY $2,000,000 - GEN'L AGGREGATE LIMIT APPLIES PER: 00 GENERAL AGGREGATE $4,000,000 m X POLICY [—]PRO- ❑ JECT LOC PRODUCTS-COMPIOP AGG $4,000,000 ro OTHER: m 0 A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT t` N Ea accident $5,000,000 X ANY AUTO - BODILY INJURY(Per person) O ALL OWNED SCHEDULED Z AUTOS AUTOS BODILY INJURY(Per accident) y X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE U AUTOS Per accident t= 0) UMBRELLA LIAR OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WLRc48151553 06/30/2015 06/30/2016 PER OTH- EMPLOYERS'LIABILITY YIN All other States X STATUTE ER C ANY PROPRIETOR I PARTNER I EXECUTIVE N E.L.EACH ACCIDENT $:L,000,000 OFFICE EMBER EXCLUDED? ❑ NIA SCFC4815190 06/30/2015 06/30/2016 If NH) WI Only E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under '. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT _$I,000,000-- DESCRIPTION OF OPERATIONS 1 LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Coverage cl�.J CERTIFICATE HOLDER CANCELLATION 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 A TopBUild Company o-° 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 ill., r; �'. tr -e of Consume: A a' nd Business Regulation 0 Part: Plaza - Suite 5 170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 179141 Type: Supplement Card BUILDER SERVICES GROUP, INC. Expiration: 6125'2016 RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 ['.)date Addres,and return card. 'hark reason for change. Address Renewal Efliolovrnent Lost Care --_(3; ice of t:unsumer A;fxias e- Business dRegulation License or re�istr:itian valid for individul use ranl_t HAPROVE MENT CONTRACT OR before the expiration date. 1f found return to: Office of Consumer Affairs and Business}2egularion Registration: 170141 Type EY.P3r2tJ0n. 6 225;2016 Supplement -a'-d Ro.<,tor,.,N1A 021 16 UiLDER SERVICES GROUP,IiVC, ICHA.RD SCH.A.'ARTZ 50 dlMMY ANIN DRIVE �� :G,..._... ✓, — AY T ONA SE elCi-1. F–L 32114t' t r,derstcrttas} Not vali'dv+Jthout signature CSSL-'0,5932 Y" F'TL;NTR[i4S STREET' Manchester!cif 03102 y y 09 252016 { Restricted To CSSL IC. Insuiativr,Conirtacta Frliillrf?to pc sses,. edgion of the Macsachusetts State Building Cot ause Eor revocauun of my we>nse