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HomeMy WebLinkAboutBuilding Permit # 11/30/2015 thORTH 0 BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Date Received & Permit NO: ArOP J' Date Issued: —s IMPORTANT st co ms on this page TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential i l New Building Xx One family [I Addition [I Two or more family [I Industrial I Alteration No. of units: [ i Commercial X Repair, replacement u Assessory Bldg n Others: [I Demolition [I Other strict, '616 W Identification Please Type or Print Clearly) OWNER: Name: Phone: Z 113 Addres 49, 'N Z 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. /7 Total Project Cost: $ m o. FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 117 Signature ofbontraotor "'Tlfy O No. , 6W -2zl� Y' �O LAKE Town of Andover -4a .". h ver,, W.SS9 • C oC"IC ME WICK y1. �ii9s RATE® P'4�,`�� U BOARD OF HEALTH Food/Kitchen PER I �T� T Septic System THIS CERTIFIES THAT ... ... �! � BUILDING INSPECTOR ........................... ..:... .......... .................................................®. ., Foundation has permission to erect .......................... buildings on ... ..... .. �►1� ... Rough to be_occupied as ............. .. .... ..t.!!� . ..... V� .................... chimney ... .. provided that the person accepting this permit shall in 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS T CTI S TS Rough Service .............. ..... ........ ............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. cansi ) CONTRACTOR WORK ORDER Services GroL-kp 50 Washington St.Suite 3000 Printed: 11/11/2015 Westborough,MA 01581 Work Order Id: S 14170P30061 C332 ConWl6tor IMormiafion ,` Customer/Site Details ESE Carlos Guzman Email: CGUZMANMD@GMAIL.COM 52 Fitzgerald Dr 30 Amberville Rd Phone (Eve): 718-551-2173 Phone (Day): 718-551-2173 Jaffrey, NH 03452 North Andover, MA 01845-3375 Site ID: S00050114170 Total"Installed Measures' Location Description Quantity Unit $ Total $ Door Sweep 4 $23.18 $92.72 Exterior Door Weather Stripping 4 $27.59 $110.36 Living Space Perform Air Sealing at Estimated 62.5 CFM50 10 $84.32 $843.20 Damming 134 $2.19 $293.46 Living Space Attic Floor Open Blow Cellulose 7" 924 $1.53 $1,413.72 Living Space Hatch: Thermal Barrier Polyiso 2 inch (Attic) 1 $41.71 $41.71 Attic Propavent 2'or 4' 71 $3.83 $271.93 Living Space Attic Floor Open Blow Cellulose 7" 440 $1.53 $673.20 Installed Measures Total $3,740.30 WorkOrder Notes Payments - Incentive Payments Air Sealing Incentive $1,046.28 Weatherization Incentive $2,000.00 Total Incentive Payments $3,046.28 Customer Share Total Customer Share $694.02 Less Deposit Of $231.34 Customer Share Balance (Due Contractor) $462.68 Conservation Services Group-50 Washington Street Suite 3000-Westborough, MA 01581 - (508)836-9500 DocuSign Envelope ID:5FD306CC-23FC-4101-B8C9-4C6D92A01E13 ps BWi " l�Ott � o PARTICIPATING @Wass save COWRACTOR uv,�:;a4i�a,•���'J ,Pf ,i,reti:� ei1FFl�l��0�1�llVN��"� PERMIT AUTHORIZATION FORM 1, Carlos Guzman , owner of the property located at: (Owner's Name,printed) 30 Amberville Rd 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. DocuSig X own WP6F1BMFE._ 10/30/2015 Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date O�rO �I For Office Use Only Rev.12132011 RCS PLANVIEW DIAGRAM -73 Customer: C;V-,6S V.A SY%n ►ata Home Phone. ( g - `�� ` -24 ,� Address:-3o A ka en V f I t @ Work Phone: Town: Wo r`T`N -A I^cl cA,er- Cell Phone: Any limitatlons for access by large truck? No—K-- Yes if yes.describe: Any specific directions or landmarks? No /( Yes If yes.describe: -7C) Energy Specialist: j y� J�C Site 0: 90 11 ki A�t� '�?"3 Reviewed by: AfI — �` C7r�, ev��Ow � ��perSWeeiPS �OW�a�us����� 0AFL' 4 u- �w or��•iol o� 3 Z>0%VV\V'' ;V�3 - R-of 13 - 0%v ei^}s-- -71 Aitr CA k' t, -- 01\ouV- (5) 0 30 OO�� ar d 0 ® d G C 2�/ 4=R\/ as I i t O o 0 0 0 8wbaeA a 40 aka'. For Office Use Only _bushes t adder Neighbor Proximity Pocket.Doors insert•Radiators Fence(s) Existing Conditions X=Access -❑=Vents Note Inside Square R= Roof S=Soffit G=Gable RV=Ridge Vent CS=Continuous Soffit CDE=Continuous Drip Edge T=Triangle Install O=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise =Vents Note in Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access 2200-10-1/15 Ile ('1t1P111t1C111br with exf Massachavettv (� ( Depat•t1nent rad Pa cite. t°atcl. c"c"ttl arts 5� `0 �'1 1 �``crngi—ess Street, . 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(u7Jtltlte•I Irlxl.11:tticrrl 1���44'.;att•a c11rl1utat1l+n,tae(dtr"lrffie:l r"t1 tcc wr,�,cictww�e,1 tll,rn 11,y�1u of e��,a minlolr 11t.�t AI(ir : - - — -_ �.. ';i t�l tl.;rnel wvtr dttpvG'Iro cmplee•1�Qts, �;"ao ewntl�ee:. e'1r11111 1trbtlt,nwtl.^rwxlutlt�ct � " 11re.tlrrlhcatrt thar cllet h.,Crrtw to 1 iurlst rll,te V1dl,1111 the we�cu1r11 hlclt+wc ;hlrelui�;t the 11 wweu6;e.r, +.1"1,1 rc"n aaulrl aIle mltrrllr u1u11 l lc1n1c1 wvrtuux%th t,uhrrnit thug alrl".lavlt Indlcalm"!tile% ,.11e doom.all%%oa,,1n<f Own hl e11.u,1J1 euntr,t,1111,111w •,libn l¢,1 1;mole,lv,n r ,11e f1 molactorr;Thal cheek thus ho"rrun,l atun hcd an odditlorull r;hcct yhota 1np IIt1r ltuntc t1l the ,arid,taut w%hefl)01 ar txrl colittern ertltpi wcv1', Iflilt! Ihcw IMPA pr+tvldv then %wolkols r'Olop poly. nurnbel f anrr an ettntrlt?ver that iv Providing ratorkers'conapettsalion himeranc•e•%or iqr Below is the polic'r will job site iat%oranation. Irtsurancar(errrlM:urti P ;rr�lcIr National tsrr arme_1 4;c)IrtM`wy t�nr�l I_iabllily Fire llollc~ 0 or �Cff.•tlls I'll t0 V9VVC6294231 I y1'l1ralwil I7rrlc :3/8/2016 J(v 51ic t cllMrt 1)Z4 'it ,; �. ., ....� C.'etti� fttic; ltpt (13110.t �� a .1.ttaeb a eq, of Me oeorlen coniffrerrsalluru l�rolr(y dedantrou finge ohorwWg ter( Mt Ahj number auld ex lnrertu u M Iwrlwv In wcmc w r ge as regrured t.trrcler NUT c 152, 125A is a(::nmm.ri t.'u7lathm Ilurllr;h;atlllc A a WIC t1P rr1 %I"tit ril l trrldJor oll("-v kNlt Ill WrIsoltrrrcnt,uIs t wl) as mull pcllahle', Ill tllC linni two S 1'(11 W MK t lleDFR and a I`low t1k q t1t Qyl tlrl a, cl n 111:rulsl fit(, violawr A oqY atf'1hN mLrlc"rrrernt "uR 1�1tr I'nr"afakd to the°OMf`I(:ew W Imesupanons id the 01 lar Ittsrtrl,trlt:t: /do herelv cerrtif t`as r the pail, atoll 'eat ie.r o/pertaty thal the an/'immitaoat provided above av ta•a e Unci curs ec•a. I;'VIC I�lurnc ti (1(13.5;32-(334 (1-/fee"ial aver an/h. Do not write as this°area, to he completed lrrr c int'or town 141i"ieel (10 or Ton n: I'c midst/I.ir°erase 1t ImulogAutlrorit) RAW um): I. Board of health 2. IlAIchng IlkpoNront I (."I ,11 mrwrr(.'Merle •I. Fleetrkal Inspectur 5, I'lurnbing Inspector 6. 01her ("rrrrtact I'ar•»~.air:.. .,,w_..._._. ._..._._.._._. ...__........_ I'Irarre t't: 7 ® DATE(MM/DD/YYYY) A�® CERTIFICATE ® LIABILITY INSURANCE 7/23/2015 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 Karen Shaughnessy NAME: g y FIAI/Cross Insurance PHONE (603)669-3218 A/C No: (603)645-4331 A/C No Ext 1100 Elm Street ADDRESS:kshaughnessy@crossagency.com INSURERS)AFFORDING COVERAGE NAIC# Manchester NH 03101 INSURERA:West American Ins Co 44393 INSURED INSURERB:Ohio Security Ins Cc 24082 Ese Inc INSURERC:Ohio Casualty Insurance Company 24074 52 Fitzgerald Dr INSURERDNational Liability & Fire Ins Co 20052 INSURER E: Jaffrey NH 03452 INSURER F: COVERAGES CERTIFICATE NUMBER:15-16 All lines 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. INSR TYPE OF INSURANCE A L UBR POLICY EFF POLICY EXP LTR INSD D POLICY NUMBER (MM MM/DD/YYYY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE ❑X OCCUR PREMISES(Ea occurence) $ 300,000 BKW55684497 7/31/2015 7/31/2016 MED EXP(Any one person) $ 15,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY PRO ❑ LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: JECT AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident B X ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BAS55684497 7/31/2015 7/31/2016 BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccidenl Uninsured motorist combined $ 1,000,000 X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 C EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 US055684497 7/31/2015 7/31/2016 $ WORKERS COMPENSATION V9WC629429 X PTEA EMPLOYERS'LIABILITY STATUTE ER Y/N ANY PROPRIETOR/PARTNER/EXECUTIVE (3a.) NH & MA E.L.EACH ACCIDENT $ 500,000 OFFICER/MEMBEREXCLUDED? N/A D (Mandatory in NH) All officers included 3/8/2015 3/8/2016 E.L.DISEASE-EA EMPLOYE $ 500,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS/LOCATIONS/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 Town of North Andover, MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Laura Perrin/JSC � a �i ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025(9014011 Masssic�husetts - Dep airtirno,,!rut of Pu biw S,,itety B4)ard Of BLA0&riq F?egtdabons and Starvdard:s I �cense: CS-072316 CALEBAHO 492 JARMANY IUL SHARON NH 0345 ExpilMicm 12/19/2015 01/)Y YJ elf") Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 11orne Improvement Contractor Registration Registration: 161406 Type: Individual Expiration: 10/20/2016 Tr# 258803 CALEB AHO CALEB AHO 482 JARMANY HILL RD. SHARON, NH 03458 Opdate Address and return card. Mark reason for change. Address Renewal Employment Lost Card SCA I Co 20M 05,11 /A d use only 4--', ()ff'lceof(,onsitnici-Affaii-s& Btjsiiiessitegillation lAcense or registration valid for individt IMPROVEMENT CONTRACTOR before the expiration date. If found return to: ration: 161406 Type: Office of Consumer Affairs and Business Regulation tion: 10/20/2016 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 CALEB AHO CALEB AHO 482 JARMANY HILL RD, SHARON,NH 03458 Undersecretary Not valid without signature