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HomeMy WebLinkAboutBuilding Permit # 11/5/2015 p10RTh , , BUILDING PERMIT ,-( a ", - TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO:�a Date Received C US Date Issued: IMPORTANT: Applicant must complete all items on this page �g 11 W4rrru TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building [] One family .❑ [I Addition [I Two or more family [I Industrial 2KAlteration No. of units: El Commercial ,repair, replacement El Assessory Bldg El Others: [I Demolition 11 Other WNW 11,11, "A I's 0,11k ,"Y"ErPr,�'. OP.Yiir ng,— "All" '7E,Z Identification Please Type or Print Clearly) OWNER: Name: 4 61 Phone: 76 F Address: vown M K 10 "M "'M V 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. "-2 Total Project Cost: $ C"A i FEE: $ Check No.: Receipt No.: Z) 77,e NOTE: Persons'coffin' dacting with unregistered contractors do not have access tot&e'guaranty fund ................... FORTH Town of E Andover ® 0 ® ® 261 �. _ h ver, Mass, f COC4 04,q NICMEWICK V BOARD OF HEALTH Food/Kitchen PEKMIT T LD Septic System THIS CERTIFIES THAT .................................................. BUILDING INSPECTOR . . has permission to erect .......................... buildings on ....U.......... .:....... .. Foundation..... Rough tobe occupied as .......... . .. .�.�..... ...........................-C............�_21 �.... . ......................................... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRESIN 6 MONTHS ELECTRICAL INSPECTOR UNLESS Tl Rough Service ............:.......... ... ... ............................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done, FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal to# RISC El ttgineering RI Contractor Registration No MA Contractor Registration No A division of"Thicisch Engineering CT Contractor Registration No 605hawirlul Unit tl2,Canton,lllA 02021 CONTRACT E±± 337-502-6335 Ft%,X339-502-634.x'+ PROGRAM Page 7 THIS CONTRACT IS ENTERED INTO RIETWEEI RISE ENGINEERING CiVIA-kll? DESSCRISE BELowT'+EcusTaNaERroawaatcaa CUSTOMER ....... ..... PHONE .. DATE CLIENT# WORRORDER Deidre}tack (978)852-1170 07/2312015 411175 00003 _. _ .. ._ ... _ .. . _.._....... SERVICE STREET 811.1.1116 STREET I 1 Francis Street i 1 Francis Street SERVICE CITY,STATE,ZIP 84.LW6 CITY,STATE.ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION 1' ASG ONE-Proposal for this calendar year. $0.00 Alli SEALING:Provide labor and materials to scat arc is ofyour home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be felt with a healthful level or air exchange and indoor air quality.Materials to be used to seal your home can include caulks,(bro s and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unhealed areas(windows are not generally addressed.) This will require(8)working hours.A reduction in cubic feet per minute(cfni)of air infiltration will occur,but Ure actual number of efrn is not guaranteed. At the completion of the weatheriration work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety ofthC indoor air quality. $680.0£) AIR SEALING ADDER: (2)working hours. $170.00 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with soffit mounted flapper vent to exhaust existing bathroom fan(s). $118.75 WALLS:Provide labor and materials to install blown in Class£Cellulose to(192)squarc feet of exterior walls through an interior surface drill and plug method. Plugs will be spack£ed and tell with a tough finish.Finish sanding and louch-up priming/painting will be the customer's responsibility, invoicing will occur upon completion of installation. Subsequent to your payment,as am added service,RISE Engineering will return when weather permits to check far any voids with an infrared scanner. Any major voids that may be found will be filled at no additional Cost. $384.00 WAILS:Famish and install blown in Class 1 Cellulose to(864)square feet ofshingle and/or clapboard exterior walls,The butt orthe upper course oryour wood siding is cut to drill hales into the wail sheathing behind.The holes are then plugged and the wood siding is reinstalled using stainless steel finish nails.Touch-up painting,if eluded,will be the custamces responsibility. Invoicing will occur upon completion of installation. Subsequent to your payment,as at added service,RISE Engineering will return when weather permits to Check for any voids with an infrared scanner. Any major voids that may be found will be filled at no additional cost.l"EXISTSI $ls9s.aa 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 oll"ers 73%incentive,not to exceed$2,000 per calendar year,and an incentive of 100°J6 for the Air Scaling measures up to the first$680 and an additional 5340 irsavings arc justified by tic auditor. For the safety-,aid health ol'your home's indoor air quality,we will be conducting a blower door diagnostic ai'the available air flow in your homc 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.This has it value or$90 and is at no cost to you. Total allowable wcather£ratinn incentive is$3,110, f rfir)j EOV IF.nr) $90.00 k.ft 2 �C��P Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division or`rideisciT EA incering CT Contractor Registration No 71 - 60 Shaivinut Unit tit,Canton,MA 02021 CONTRACT O NThtif`11V�T 339-502-6335 FAX 339-502-6315 Page 2 PROGRAM THIS CONTRACTM ED U410 BEEEN RISE CMA-11ES ENGINEERING AND THEME CUSTOMER FOUR WORK AS ENGINEERING DESCRIBED BELOW _.__........... CUSTOMER PHONE DATE CUENTP WORK ORDER Deidre Rock (978)852-1170 07/23/2015 411175 00003 SERVICE STREET SILUNO STREET I I Francis Street I I Francis Street SERVICE CITY,STATE.?JP .._.. ._... ORLINO CITY,STATE.ZIP '...,. North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total; $3,041.15 Program Incentive: $2,515.86 Customer Total; $525,29 WE AGREE HEREBY TO FURNISH SF -S-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ,"Five Hundred Twenty-Five&29/100 Dollars $525.29 UPON FINAL.INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES 70 REMIT AMOUNT DUE IN FULL INTEREST OF 1%VALL BE CHARGED MONTHLY ON ANY ,.UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR RECISTRATIOIC DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES r AUni SIGMA RE•RISE Engincednq _... Ct)S C NOTE THIS CONTRACT MAY BE VATHDRAWN BY US IF NOT EXECUTED VATHIN DATE OF ACCEPTANCE . -.,_..!"' +.✓!.'. _._.... .......____....._,_...... ACCEPTANCE Of CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIFIED.PAYMENT PALL BE TRADE AS OUTLUfED ABOVE The Commonwealth of*Massacliusetts _-A Department of Industrial Accidents Office of Investigations ?�A 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): I am a employer with 100 4. ❑ 1 am a general contractor and 1 6. ❑ New construction employees(full and/or part-time)." have hired the sub-contractors I 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] Building addition [No workers' comp. insurance comp. insurance.'- 5. F] We are a corporation and its 10.[:] Electrical repairs or additions required.] officers have exercised their I I.n Plumbing repairs or additions 3.❑ 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' comp. c. 152, §](4), and we have no 12.[] Roof repairs insurance required.] employees. [No workers' 13.Z Other Insulation comp. insurance required.] *Any applicant that checks box 41 must also fiI I out the section below showing their workers'compensation policy in fionnation. t 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 shect showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have ernployees,they must provide their workers*comp.policy number. I am an emplQ1,,er that is providing workers'compensation insurance for tij,employees. Below is the polic�),and job site information. Insurance Company Name: Indemnity Insurance Co of North America Policy 4 or Self-ins. Lic. Expiration Date:6/30/2016., City/State/Zip: �7 V1 An ' Job Site Address: 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 under the pains and penalties ofpeijury that the�i�forn�ation provided above is true and correct. Si nature Date Phone 4:603-324-1974 town of Of .1 riciaL Official use only. Do not write in this area,to be completed h�jl cill, or City or Town: Permit/License 4 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 4: DATE(MM/DDNYYY) CERTIFICATE OF LIABILITY INSURANCE I 06124/2015 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). c PRODUCER CONTACT Aon RI SIC Services Central, Inc. NAME Southfield MI Office AC..NNo.Ext): (866) 283-7121 (AIC.No.): (800) 363-0105 m a 3000 Town Center E-MAIL o Suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC tl 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 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 INSR ADD] SUER LICY EFF POLI11�Xp LTR TYPE OF INSURANCE INS[ VD POLICY NUMBER MN WDDIYYYY MM DNYYY DLIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304834 0 1S 06/30/201b EACH OCCURRENCE 52,000,000 CLAIMS-MADE _' OCCUR DAMAGE TO RENTED S2,000,000 PREMISES Ea occurrence MED EXP(Any one person) S25,000 PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $4,000,000 m X POLICY ❑PE ❑LOC PRODUCTS-COMP/OP AGG 14,000,000 m 0 OTHER n A MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT `n AUTOMOBILE LIABILITY 15,000,000 Ea accident -. '. X ANY AUTO BODILY INJURY(Per person) 0 ALL OWNED SCHEDULED BODILY INJURY(Per accident) N AUTOS AUTOS X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE U AUTOS Per.cadent d UMBRELLA LIAB OCCUR EACH OCCURRENCE C) EXCESS LIAB CLAIMS-MADE AGGREGATE DEO RETENTION B WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016X PER 0TH- '.. EMPLOYERS'LIABILITY STATUTE ER YIN All Other States ANY PROPRIETOR/PARTNER/EXECUTVE IE.L.EACH ACCIDENT S1,000,000 C OFFICER/MEMBEREXCLUDED' � N/A SCFC4815190 06/30/2015 06/30/2016 (Mand.tory in NH) WI Only E.L.DISEASE-EA EMPLOYEE 11,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 51,000,000 '.. DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Coverage gT� 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. _r Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBUild Company '.. 260 Jimmy Ann Drive S�. 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 s�"i(,: 01 � o C nsunne: .ii_a3_s �35d Business Regulation ;; Park Plaza - Suite 5jj 11 7�J Boston .Massachusetts 02 116 Hone Improvenint Co,,itractor Registrat m Regis?ration:. 179141 Type. Supplement Card Expiration 6!25!2015 BUILDER SERVICES GROUP, INC. IRICI-IARJ SCHWA,R i Z 110 PERIMETER RD NAS H UR, NH 03063 E :urate Address and rerun:card.Mari.rewun Or change. Ren"NNu1 Emrl!mfilenI Lust .ard Cj,il{i or'+5'_'i7fl :�if::i:' l L'S1nCSS ICC ll!l,i:/in I iCt'P.c tin rent lr:iili3n 121i for ifidJl'iUu]UtiC ii 11\ -' a— "JTRAC T OR 1efJre the e it;r%ativn date. If found Urn to: oifi;ce of C oiisurler ,1--irs and Y,udwo Regulalk!) 179,141 Typej{}:�4r�,pI:+zii_viii i'c /0 t:YPiraij0r: 6,rZ5/2016 Su lem.eni .a d � <'i •4 2 GP o gin.;�:A i, iC; ALDER SERVICES GROUP 1NO. CHARD SCri?1 AR T Z U JIP.Ai.IY ANN ii(RIVL MONA BEACK =L 32?1= got mid i ithoul sigr•.alur{' 1 ALt r}CC r-,I;,3't � f r C L-105992 C1 r� tancl;ratrt ^1T i1;i1f12 09/26/2016 I Restrid3i To CSS!. °C. t t t I t 's 1 ; t lure to p:Sr,r,y:. r; ed.t .-.ren c it i W State Building Cot sue fr,r rr- acatron of th p €