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HomeMy WebLinkAboutBuilding Permit # 10/19/2015 OORTH BUILDING PERMIT °��RL�° 'g��'O �+ y�o;'s�C ��':�s 6 TOWN OF NORTH ANDOVER - APPLICATION FOR PLAN EXAMINATION �. / ^� �Qq CocNl[nG WI `V Permit Node Date Received � �RaTEo PQM �5 ����cwUS Date Issued: Q IMPORTANT:Applicant must complete all items on this page LOCATION �— Print PROPERTY OWNER 0 Print loo Year Structure yes 611,00 MAP ___PARCEL: m ZONING DISTRICT:__-_ Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Non- Residential Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial IterationNo. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 7 Y r rl it/i ,.. e rii,r,,. r�r��r"✓i9/f,+��4�'�F IA's"; qty , /fir �''�Muu6t' DIStrIGfiy /.r ;,, //.❑A-m��,.S•i�h;�e�_'''9�w,�'Y,�}L1,�.I��#,C���i��i/,.�,��.ffr®4W,�%yf�;%e')�r dirl.fl,i��1✓/-/•t,�r/r///�/%,lii�////J��i.!/�i/%ri//r�k�l�ti/,J�,JN��r�/r%/i�/�',r//,/%/j,,lfe;..Il`/%,//,.,,, �❑� �V/��etland/yJrS�///�%'i/�/r.��J;Ji/r//,r,,,�,.,r/�r1,�rJ,1/n�,f��J!rd;,��✓li�,,,,��I r�1 ///r,i,.R�,r.,,✓.,1�rll.r.i��r,�f,!,l<��^�"J,rrf� % DESCRIPTION OF WORK TO BE PERFORMED: GaSS �—InS�l��h� �- 'c� ;�- t. 4- fdentifiction- Please`Type or Print Clearly Phone' 1 401" �6®0 OWNER: Name:_ his( i'1 Address: M ` L3® Contractor Name: / t��t �I 0(1 - I Phone' Email: C,, 00b, rle e 11 Cloy'" Address: IDL 3Qh fi Supervisor's Construction License: %L® 1060S Exp. Date: Home Improvement License: �L,, �-. 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 Cast: $. a 6'7-D . q5 FEE: $ Check No.: Receipt No.: . NOT'lE: .Persons contracting with unregistered contractors, not have access to the guaranty fund -- wr -- -- - - — _T. Dimension Number of Stories:_— Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, masts or service drops requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes bio MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA-- (For department use) V�" El Notified for pickup Call Email Date Time Contact Name ......_............_............ _...__...___.__..__..._.__,.___-- Doc.Building Permit Revised 2014 --_---- _ NORTy To' wn 2 EAndover . ...'.�, 4 0 ...... No. o - C h ver, Mass, Q WW I O LAKS f cocN�cHew�cK S U BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR .........C . ...... .... .... Foundation has permission to erect .......................... buildings on .. ......... .d .. .................................................. Rough 4 . to be occupied as ........... .. 4.�. ..... ......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 I6 ® H ELECTRICAL INSPECTOR UNLESS C®NSTRU T T S Rough Service 3 � ............. .... . ........................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t0 ®ccupy,PLZRough 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. Burner Street No. Smoke Det. 10/71/2015 08:06 5083303403 WESTBOROUGH PAGE 04 DocuSign Envelope ID:26733082-E2D5-4E67-AD74-197F9F11FF26 CONTRA Cons+~r �tron p�t� Cr FOR . ServiCes Group DUCTS � .&wow. E WORK.- ... his service is broughtt4 you through n.' 9 su A. - dr' c7 t .,,,,,......:....,,. .•. .,,. IrtY) nP tram 7. tr local tiliq YID ' , :'] 7?' Nbftlx- Art � t rza M (. A.0 Ig 45,Y # Si fttl ; 9� g3tF tT. 'all7ri'%, �aod .17n' Si? 1 t.b ' ty �u ,1VJAi, tb rl ... 00�i��t btl tr DSCRIPTiQN OF WORK TO BE ,,.;. . .. .. >;.: .;•.•'. ':" .,;;:. ,,.,.;.,: , , . fiftp' ter't" tit9cf"t'Ps3'ri':. PE btii ` Contractor wil RFgRM!D t perform or cause Co he p tendo tate foAowinp.work on in it these"Pfrmiaes" profes9tonj1 manner and i11 aCeer(itxnce with the tennsfn this Contrsict,inClurlittg rho attached recomrneetdatinns/wont order dr.gct9bing 1,11p.worlc in de,, fChe"4Vorir" tivftich Ire ittcorpnrate-d hertin by t'el-erenr Description perfomt Air Seating at E$timatod$2,5 CFMSO Per Hour Quantity Location Doo^ $$Weep 8 l,tviny p,a ,- $6 4.58 Exterior Dilor Weather Stdp�►rf3 NIA 3 N/A $69-54_ — Sub Total: $82.6.87 Utility Incentive Share $826.87 Customer Contribution I O�rCI For office use only Frintett 91$0/20115 Page 2 of 2 PAYMENT �s q.Deposit tatot+trr ngraes to pay Contractor'fpr the Work,Lhr Oustome.r Share of 1,he Contrprl:Price as follows:Payment iPt.; tyabte to CSG upon signing the Contract(tr)t to excer:.rl 1{ f.the:IoM tet;til�Aos�sfitl�I PaYtnettC. r fhte�VorlrtshC l be p9YabiC o 50 `I dee nde tt7n t:Iliation )at),Wegthorougit,MA 01.581.pinfo Payment:4 -JC=) •— tnb'actnr("�iC")upon satisfn tet co ctio C9iftt SWork. to iviclual line trtmser 'ninct(Is that Uor ptr.�rirntalincnntives lnay intcecase r�t3 crt.�ReltheiSize.incentive T-ltilily Incentive sntract price i1t the rtntount.of -���l tare. I. DISPUTE RESOLUTION ;te TIC and cnstotr[or herchy[tllthuilly ugsw in ndvince that ill the event thst the IIC hill onsRnd Gnsiomer 9 tall tie rrrr�ired t4 g tltmiLva [nctht trbittittln[ma p tv lerl in MlC i s 142A. ,mt.,,which hho 1�nnn anprovrrl by the r)11TC.c?of C;utgumer A1Yaitw nnri flft5ine�t RC1 . ou may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided ou notify the seller in writing by ordinary agreement. Do NOT SIGN THIS CONTRACT 15 THERE ARE ANY BLANK SPACES, Ird �5;��,�ollowing the signing o ' 1 10/16/2015 _ _ (nR.l tGl'rkt�, � t ftt� TtatF inrliC£d.0 ynt1Y elccfed IiC itcro,14if applicaT.la the Prngt m joY011 a _t —� Par1:iriikingContrictor 'SG Signatu'. Date Name of CS(.:34(;P-we",tt-five(Pl'lnted) TE1RA)<8 ANDCON>niTI4Nps trrPF.AR ONrttr 1 O_O 1/2 015 8 : 4 9 A M (GMT-04:00) 10/01/2015 08:06 5083303403 WESTBOROUGH PAGE 03 DocuSign Envelo a ID:213733082-E2D5-4E67-AD74-197F9F1 1 FF2B CONTRA�FOR Conser Lation PRODUCTS / �'�R�/>>��' Services Group a WORK ,. . rri'o» Thissrice11` dis 61,11.1g ht to 0 u supPartfr Your Ivca I unlit`t :�Satttrough� it ar xl'` �r � 5e (� t}p g et'° .s 1; .:..:.. .... .:..:• _may MM. i,r .. ... \J 1'� QV1/ V y,} s/4.30-, r� �y IV• ,1}11 j►/y VV e ..-. ... ,. . tai . .:. .. . ..,._ ul�: Ou tI : 1. eo.y�.,, r, �F t:J yy yuy Y W r' DIF RtP X rf ma o N Q� w Yeti' o rt f1Ct'�' R To,BE Cont' PE tki"ttriri`' tartar will PERFORMED l)f.YTOYnt Or CftrLSe r this Cn .nt.ract,including t1le nj;l'lc, "o ho pet£nrtned the FogaK iniG work nn these bed trcommc:nclations/wol*o1YTer drsNr'ibing 1:he work in detilil(thr:."Work")which rtr.' PremiRN:r"in a.Professk)na1 mahncr and in accordance with the tetvn9 of e incorporated herein t)y reference; Description AfticMoor open Slow Cellulose 9^ Quantity Location Insula__tg Rl`m JQpStrvi(h� $zg^�lborgIMS sattino 898 Living Spam bam_ intoe 132 ^Llmg- _$1,487,36 -- -- — 18 N/A $318.84 Utility Incentive$hare $1.843.98 �i$160.68 Customer Contribution 460 .90 Forofflco use only Printed:0/30i201s Page 7 of 2 PAYMENT � ustnmm•afire(;,to pay Contra�tor for the Work,the C metamer Share of the Cpnl}nrl Fttice•<ls follows;Payment#1:" �� p tis u lleposit ayable to CSG upon Signing the ConirnCt(net tet .eel lig of t.nt,ll retnil Costs).Mail check&contract ix)CSG,Atte:RC"+,;t7 Washington 5t.,Sic. 000,Westborough,MA 01561,Final Payment$ � is the tier)!Payment for the Work Ahad he Payabtc to the Independent lnstallntitrn ontrnctor( TiC")upon gatid to cotta lehon of the Work, Custoiner undevibinla that,li&she will not;he repel++,rl to pay the tltility 111.0011tive Share Of the nntraCt price in the atttoutlt of$ .Chringes to individual line:items anrVor prp.Anas incentives may incr'ea8e Oy deorNase the size(if ire Utiliity Ttrcentive 1AYfl. I. DISPUTE RESOLUTION he 110 and Customer lierel)y muhlal(y agree in arivance.that;in the event that the.TTG hats a rlispnte concominp+this Contract,the TTO may submit surh xlislnitn txt a Private arhitraHon :fviee which his beell approved by lite Offlee Of Consumer AT111it,and 13nshim5 Ro ilition anti r istomt:r shall Tin regmirerl to srthmitto mach arhitrntlon ag pmvirleri in M.G.L.c 142A. ou may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided ou notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third lil g tggybjollowing the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 10/16/2015 ltatorne• ' ire Tate Thdicate yl ur seteftod I1(;here,if 1pplieilble (OR) lltfttal Ilere tf yoU want; -599D - � the.Program tri nA9ign a SG Si Hato'. aaafff lit i �d 1— [1 Panicipating Contractort;' \ 1?ate 1Vame of(;5c.i itePrese..nlntive(Prints ti) T33ItittrtlAND CotvntT1tOM4;AVrr'.ARONTHT. 10/01/2015 8 : 49AM (GMT-04: 00)"" DocuSign Envelope ID:2B733082-E2D5-4E67-AD74-197F9F11 FF2B z �i �,,'P�➢ gM)IiG �JVMv PARTICIPmAVING mass save, counuoll � ra d,,�i°wr�ra biro�.a i,ry d fii,e 4wzr�r 111" Q ly!OW, PERMIT AUTHORIZATION FORM I, Beth Driscoll ,owner of the property located at: (Owner's Name,printed) 89 Moody St North Andover (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. CDocuSigned by: �fl virisce t Owners ignature,437 10/16/2015 Date FOR CSG OFFICE USE ONLY Services Participating atin Conservation Services Group has assigned the following Mass Save Home Energy Ser p g Contractor to the above referenced project: Participating Contractor Date OfjO For Office Use Only Rev.12132011 DATE(MMIDWYYYY) ACCOREP CERTIFICATE LIABILITY INSURANCE 8/6/2015 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 11 CERTIFICATE HOLDER, IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. !f 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 F3Mourid rtificate holder in lieu of such endorsement(s). cortracr UCER NAME: Sarah' Lauersen _ PHONE E,,_(800)258-1776 �(A/C No}: i603)429-1813 wsby insurance Agency E-MAIL slauersen@minutemangroup.com Ct, Suite B ADDRESS: - BOA 1807 _ INSURERiS)AFFORDING COVERAGE__ MAIC Merrimack NH 03054-1807 INSURER :Liberty Mutual -_ INSURED - --_-� _- INSURER B: -- Mi11 City Energy LLC INSURER C: -- PO BOX 6411 INSURER D: -- INSURER E Manchester NB 03108-6411 INSURER F: COVERAGES CERTIFICATE PdUMBER:2015-2016 REVISION NUMDER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEQ 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. -- ADDL U '- POLICY EFF POLICY EXP LIMITS INSR TYPE OF INSURANCE POLICY NUMBER MMIDD/Y MMIDD LTR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 DAMAGETOR NTED $ CLAIMS-MADE El OCCUR PREMISES(Ea occurrence) MED EXP(Aoy one l2rson) $ PERSONAL&ADV INJURY $ - GENERAL AGGREGATE 5 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGO $ POLICY❑JECOT LOC S - OTHER: COMB NED SIN LE LIMIT $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE S NON-0WNED Per accident} HIRED AUTOS AUTOS _ $ EACH OCCURRENCE S UMBRELLA LIAR OCCUR AGGREGATE $ _ EXCESS�UTAB CLAIMS-MADE - DED RETENTION$ PER I OTH• $ WORKERS COMPENSATION STATUTE_ ER AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT $ 500,000 ANY PROPRIETOR/PARTNERIEXECUTIVE �� NIA ---` A OFFICER/MEMBER EXCLUDED? _• WC531S391202-025 7/25/2015 7/25/2016 E.L.DISEASE-EA EMPLOYE S 500,000 (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT S 500 000 DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) 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. AUTHORIZED REPRESENTATIVE ---------- David David Herod/SARAH ' 4 ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2094/01) The ACORD name and logo are registered marks of ACORD INS 025(201401) The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 wminassgovIdin Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Aimlicant Information Please PrinLLe X,ibly Name(Business/Organization/Individual): Mill City Energy,LLC Address: P.O.Box 6411 City/State/Zip: Manchester,NH 03108 Phone#: 603-391-7923 on wa Are n employer?Check the appropriate box: Type of project(required): 1. I I am a employer with 6 4. n I am a general contractor and 1 6. n New construction employees(full and/or part-time).* have hired the sub-contractors 2.El I am a sole proprietor or partner- listed on the attached sheet. 7. El Remodeling ship and have no employees 'These sub-contractors have 8. n Demolition working for me in any capacity. employees and have workers' 9. EJ Building addition [No workers'comp,insurance comp.insurance.) required.] 5. F1 We are a corporation and its IO.E]Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their I ITI Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL 12TI Roof repairs c. 152,§1(4),and we have no 13.F1 Other insurance required.] employees.[No workers' comp.insurance required.] *Any applicant that checks box*1 must also rill out the section below showing their workers'compensation policy information. I Homeowners-who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. lContractors 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. I art an employer that is providing workers'compensation insurancefor iny employees. Below is flee policy and job site information. Insurance Company Name: Liberty Mutual Insurance Policy 4 or Self-ins.Lic.9: WC5-31S-391202025 Expiration Date: 712512016 - Job Site Address: odl S4 city/State/Zipfi-ot, Avdovej 0 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. I do hereby certify un e its andpettalfies of perjury that the inforinafion provided aboile is trite and correct. Siggature: Date: Phone-9: 603-391-79213 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): I.Board of Health 2.Building Department 3.City[Fown Clerk 4.Electrical Inspector 5.Plumbing Inspector 11 6.Other Cont ct -son: Contact Person:._ Phone#: Massachusetts Department of Public Safety Board of Building Regulations and Standards License: CSSL-106035 Construction Supervisor Spec:alt y I MICHAEL JOY 106 JOSEPH STREET `S T MANCHESTER NH 0 ^^' l Expiration: Commissioner 08/07/2018 , »Y° (J"v,p�l17PG 1f f�rl✓r/✓!!///�� �/(Y.:,SNC"d'1ILi(?�✓J Office o1 C onsunacr Affau-s&Iiusiiicss Itegul.ition License or registration valid for individul use only s ;� rbjOME IMPROVEMENT CONTRACTOR before the expiration elate. If found return to: registration: 182792 Type: Office of Consumer Affairs and Business Regulationp 1° j , (rExpiration: 712712017. LLC 10 furl Plaza-Suite 5170 Boston,MA 02116 MILL CITY ENERGY, LLC, MICHAEL JOY 106 JOSEPH STREET }� v"^,NCHESTER, NH 03102 y tV Vav t ita T t1ndcrsecreiar tout si ure I