HomeMy WebLinkAboutBuilding Permit # 12/8/2015 BUILDING PERMITt%ORTH
TOWN OF NORTH ANDOVER 6
APPLICATION FOR PLAN EXAMINATION
Permit No#: z6 Date Received �ssA ED
001 C U
Date Issued:—Lz""jIL
IMPORTANT: Applicant must complete all items on this page
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building 6�06–ne family
[I Addition Li Two or more family [I Industrial
Li Alteration No. of units: [I Commercial
[I Repair, replacement Li Assessory Bldg [I Others:
El Demolition El Other
e"di'bis"t rj 6-t"'�
4,
„„N
DESCRIPTION OF WORK TO BE PERFORMED:
I
Ident M 1 t Please Type or Print Clearly
OWNER: Name: I 1M 1-6-1/L.-R'/L/ Phone:61VS35--00
Address:
v'/ 5
h'bhe,
"'IN
o
./h
...........
...........
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.,BULDING PERMIT.,$12.00 PW$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: IS FEE: $-
Check No.: (-” Receipt No.:
NOTE: Persons contracting with unre * ter ontractors do not have access to the gy n n
nature of,contractor
Signature`of Agent/Owner
'Townof Andover
0 to
No.
I
E.� ♦. 1 i 2,616
2,o( e
PER
U
BOARD OF
IT T LD Septic System
me �?Al 40. r INSPECTORBUILDING
so . .........d Zw. !t.
to be occupied ... ,
provided that the person accepting this permit sha ery 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 MRQ.4NT_"UC0;Fa_ ELECTRICAL INSPECTOR
A
UNLESS CONSTRUCTION Rough
i. Service
BUILDING
INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Bu Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathin • or Dry Wall To Be Done FIRE DEPARTMENT
SmokeUntil Inspected and Approved by the Building Inspector. Burner
Street No.
.
LV next step Living®
home energy soLutlons
This agreement Is made by and among
Next Step Living,Inc.("NSL")Ellen Finneran 21 Dryclock Avenue,2nd floor
19 Beacon Hill Blvd Boston,MA 02210
North Andover, MA 01845 phone: (866)867-8729
Site ID: 426108
30.-Oct-15
1. )ESCRIPTI NOE WORKTIQ BE PERFORMED
NSL will perform or cause to be performed the following work on the customers address above,In a professional manner and in accordance with the terms of this Contact,
including the attached recommendations/work order describing the work in detail(the"Work"}which are Incorporated herein by reference.Pricing reflected below may be
subject to adjustments in program pricing and offerings and Is guaranteed for 30 days from the date the Contact Is printed..
Description Quantity Investment
Air Sealing Rewprne,•,Iim,�, �swool�,
Work Location: +
Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 8 $85.00 Hr $680.00
Vvie7at erization Rec6nimendatioris $674.25
Work Location: +
Attic Stair Cover Thermal Barrier with Carpentry 1 $237.66 Each $237.65
Work Location:
Insulate Rim Joist With 2"Thermal Barrier Polylso 118 $3.70 sqft $436.60
Initial InVestment: $1,354'.2rl-
-100 Yo Airsealing lricenIN up to Program"M ax
:1680,00
0
75.%weatheftati, Inpeqtiy 4p to Program.Max rogra
Total Net Investment:
Estimated AnindalE 6-1 6�,V 1 176
oergy.S�Oqjrido friD fh A rrip, vemen.s
2. 'AYMENT, CUSTOMER agrees to pay NSL for the work as follows:
Payment#1: $100.00
-A non-refundable Deposit by credit card(Mastercard,Visa,or Discover card)is due at the time the Work is scheduled.Required payment Information will be collected at
the time of scheduling. Deposit Is not to exceed 113 of the total contract cost_
Additional Payments and Final Invoice: $68,56
-Additional payments for the Work shall be due upon completion of the Work and will be charged to the credit card on file within 24 hours of delivery of the Final Invoice.If
this credit card charge is declined for any reason,upon notice from NSL you will be responsible for providing valid alternative credit card information necessary to complete
payment.
�- A' ,, �' 2 — -\�(6 ��, I -1"v'
30 Oct 2015 Edward Yaracz
NSL Signature Date Name of NSL Representative A1326997
The Terms of this Agreement am contained on both sides of this page
Next Step Living-21 Drydock Avenue-2nd floor-Boston,MA 42210 0(866)867-8729 4 inqulry@nextstepllvinginc.com-www.nextstel2living,com
`
TL M 8'0 r A 0 NGF MENT
3. PROPOSED START DATE AND COMPLETION SCHEDULE
N8Lwill contact customer to schedule the Work at a mutually agreeabletime,subject to tho,availability ofsubcontractors,mmaterilluor todoleys !
attribteWeto ftweather orother events boyoodNSLbcontrol, |
4. CONTRACTOR REGISTRATION
Massachusetts law requires home improvement contractors and subcontractors to be registered 6th the Director ofHome Improvement Contractor
Registration, You nay inquire about contractor registration hywriting to Office of Comemwsr&Q@ivsand 8upivomeRe0uhaimm.Toil Park Pilxa.@mRG
5170,Boston,MA(2110.017-973-8700.
^ �
NGLmiUUoresponsible for obtaining any necessary permits asfile Cuotome/n agent. Customers who secure their own permits ordeal with nn
unregistered contractor will beexcluded hnmtile Guaranty Fund provisions co the Horne Improvement Contractor Law.
_6.1 NSL will not commence the Work prior to signing this Agreement and transmittal of a copy of Agreement to the Customer. �
6.2 This Agreement may be supplemented,amended,or modified only by the mutual agreement of the parties,No supplement,arnandment,or
roodification of this Agreement shall be binding unless it is in writing and signed by allpurtloa �
6.3 At times,NSL's weatherizatkin team discovers situations in the structure during the course of the Work that indicates a risk for a health or safety
oonomnfor residents.Such concerns can include but are not flirited to ventilation,potentially hazardous materials such as mold mosbasmmmotrumurai |
concerns. Inthe case reserves the right,per section 9£ofthis contract,to communicate concerns to �
the Customer and halt work unfit such concerns have been addressed,
8.4 The rebates and incentives available from the Mass Save@ Home Energy Services Program and amounts due from the Customer are based on the �
best estimate
—the situation inthe structure bythe N8Lhomoenergy advisor. However,at times our weetlimizaUonteam discovers situations inthe �
home during the of tile Work that i ct the availability of rebates andi nU from the Mass Save Program. |nuuch situations,NGLwill
communicate such changes to the Customer,including any impact on amount the Customer would be exi3ected to pay for the Work. The Customer will
have the option to remove from the Contract the work elements that need adjustillent,or set up a separate contract for performing the adjusted work.
6,6 NSL represents and warrants to the Custorrier that(a)the materials and equipment furnished under this Agreement will be of good quality and now,
(b)that the Workwill be free fTom defects,and(c)that the Work will conforin with the description of the Work described in Paragraph 1.
6.6 NSL may determine in tie course of pre-installation Technical Review that modifications are necessary to the scope of Work in order to ensure
professional quality of the installation, In the event of such modifications,NSL will request a written modification of the Agreement to be signed by all
pardes.In the event that Customer and NSL cannot agree oil tile modification,the Agreement may be terminated by either party.
r. INSURANCE AND REGISTRATION
NGL represents and warrants to the Customer that it has a valid Home Improvement Contractor Registration(Nn:162111)and the necessary insummoe
required by applicablelaw and normally maintained by prudent contractors in NSL's field,including,but not limited to,Workers Compensation Insurance
for all employees who will perform the Work.
8. QUALITY OF WORK,
NGL agrees that the Work will be performed in a good and workmanlike manner,and that NSL will repair and replace,at its own expense,and promptly
upon Customers request,any defects inworkmanship and materials hyNSLwhich appearuptoone year after completion of the Work orwithin
any longer period as permitted or required under applicable law,protrided NSL has received final payment as provided herein.
9. PRE-EXISTING CONDITIONS&PROPERTY PROTECTION
9.1 NSL shall not be responsible for any damages as a consequence of the Work performed in the home due to pre-existing conditions. These conditions
include but are not limited to poody fastened or broken drywall,moisture damage,non-code construction,cracked or fragile siding or shingles,old pipes
and fittings,rotting wood,etc.
9.2 NSL reserves the right not to perform Work upon the discovery of asbestos,mold,or any other potential health dsl(to the Customer. In this event,the
Customer is responsible for remedying the at-risk situation,including any necessary removal of hazardous materials and all bills for services to date shall
be paid immediately. Workcannot resume until remediation is complete.
9.3 While NSL will make best efforts to protect any property of the Customer, it is the Customers responsibililyto remove orprolect,including dust
protection,any personal property including the home itself. NSL will not be responsible for damages to or losses of any of the above mentioned property
not properly protected prior to the commencement of the Work.
10. GENERAL PROVISIONS.
10.1 NSL reserves the dghL the extent permitted by applicable law,to have,file or maintain a mechanic's or material men's lien,or to file a notice of
intention to lien,and to take any other steps to perfect and enforce such a lien,if Customer fails to pay NSL as provided herein.
10.2 This Agreement shall be construed in accordance with the laws of the Commonwealth of Massachusetts.
10.3 This Agreement forms the complete integrated agreement between NSL and Customer. The parties represent and warrant that in executing this
Agreement,they are_—relying''any_representations,warranties—terms_other—an__--ressly--contained -- This Agreementsupersedes all
prior agreements between the Customer and Contractor and may not be altered absent a subsequent writtenagreement signed hyboth parties.
11. ENERGYBENEFITS.
The Sponsoring Utility Company(the Utility)is entitled 100%ofthe energy benefits associated with all Energy Conservation Measures,excluding the
valuef energy costuvin8 the Customer,but including all rights toall associated ISO-NE Energy,Capacity and Reserves Products,N8Lagrees to
provide the Utility with such further documentation as the Utility may request to confirm the Utility's ownership of such benefits and Products.
understands12, NOTICE CONCERNING SPONSORSHIP.
12.1 Customer owlo orsub-vendor ofThe Sponsoring Utility0with
respect to the installation of an energy efficiency In the event of the failure of an energy conservationdevi: to perform as expected,
Customer's sole recourse is to Contractor and not to Conservation Services Group(CSG)or to the Utility.The Utility and its operating companies shall not
maintain,remove or perform any work whatsoever on the energy conservation measures installed.
12.2 Customer understands and acknowledges that their participation in the Mass Save Home Energy Services Program is voluntary and that they have
consented for Contractor to install the proposed energy conservation measures.
12.3 Customer agrees that it shall not hold CSG,the Utility,their affiliates or operating companies liable for Contractor's to perform its obligations under
this agreement for failure of the energy conservation measures to function,for any damage to Customers Premises caused by Contractor or for any and
all damages to property or injury to persons caused by the energy conservation measures,
13. LIMITED TIME OFFER.
The prices and incentive offered in this Contract are subject to change in accordance with The SponsoringUtility Company Mass Save Home Energy
Services Program offers.
14, CONTRACT CANCELLATION
Under Massachusetts law,you may cancel this agreement ifithas been signed hyaparty thereto ata place other than anaddress ufthe seller,
which may :whis main office n,mbranch thereof,provided you notify the seller imwriting mt his main office nrbranch kyordinary mail posted,
by ft,mvby e-mail sent n,kydelivery,not later than midnight of the third business day following tile signing of this agreement. |
Planview Diagram
Customer Adviser Name: CoA Ynra oj,
Address I fiW,1 Ove Advisor Phone #: 16-1
Town Any limitations to access by truck?
Site I® .,N0
NOTES Any work scoped outside of Best Practices?
Approved by:
'j/ Gar rz4ry 1
NO
3
3�
DO) n
The Conammnivealth of-Hassachusetts
µ = Depaiftent oflnthxstfzalAccidents
a _ �o
ress Street, Suite 100
I Cong
Boston,MA 42114-2017
Ivanv.n2ass.gov/dia
Workers' Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers.
TO BE FILED WITH THE PERMITTING AUTHORITY.
Applicant Information Please Print Legibly
Name (Business/Organization/Individual): Next Step Living
Address: 21 Drydock Ave
City/State/Zip: Boston MA 02210 Phone#: (86(3)867-8729
Are you an employer?Check the appropriate box: Type of project(required):
LE]I am a employer with 850 employees(full and/or part-time).* 7. ®New construction
2.a I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling
any capacity.[No workers'comp.insurance required.]
9. ❑Demolition
3.[31 am a homeowner doing all work myself.[No workers'comp.insurance required.]t
10 n Building addition
4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will
ensure that all contractors either have workers'compensation insurance or are sole 11.[]Electrical repairs or additions
proprietors with no employees. 12.❑Plumbing repairs or additions
5.®I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs
These sub-contractors have employees and have workers'comp.insurance.t
14.[�✓ Other Weatherizati4n
6.®We are a corporation and its officers have exercised their right of exemption per MGL c.
152,§1(4),and we have no employees.[No workers'comp.insurance required.]
*Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information.
t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such.
tContractors 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.
Y ant an employer that is providing workers'compensation insurance for trip employees. Below is the policy crud job site
information
Insurance Company Name: A.I.M Mutual Insurance Company
Policy#or Self-ins.Lie.#: AWC-400-7030025 Expiration Date: 9/30/16
Job Site Address: City/State/Zip: j
Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date).
Failure to secure coverage as required under MGL c. 152, §25A is a criminal violation punishable by 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.A copy of this stat me may be forwarded to the Office.of Investigations of the DIA.for insurance
coverage verification. /
I do hereby certify under the pains d p :aloes of perjury that the information provided above is true and correct.
s
Signature: ,s" 1.,. Date:
Phone#. (866)867-8729
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
Contact Person: Phone#:
NEXTS-1 OP ID: EL
DATE(MM/DD/YYYY)
CERTIFICATE OF LIABILITY INSURANCE 09/30/2015
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(les) 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
McLaughlin Insurance Agency PHONE MAX
828 Lynn Fells Parkway A/c No Ell:781-665-2775 (A/C,No): 781-665-0295
Melrose,MA 02176 E-MAIL
John E.McLaughlin Jr. ADDRESS:
INSURER(S)AFFORDING COVERAGE NAIC#
INSURER A:Nautilus Insurance Company 17370
INSURED Next Step Living, Inc. INSURERB;A.LM.Mutual Insurance Co.
21 Drydock Avenue,2nd Floor
INSURERBoston,MA 02210 INSURER C:Commerce Insurance Company 34754
INSURER D:AXIS U.S.Insurance Company 15610 '..
INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 DDLD I WVD POLICY NUMBER MM/DIDY� MM/DD�Y LIMITS
LTR �
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
ECP2010198-13 09/30/2015 09/30/2016 _DAMAG`E O_RR�N7 100,000
CLAIMS-MADE OCCUR PREMISES Ea occurrence $ ����
MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
JECT POLICY❑PRO ❑LOC PRODUCTS-COMP/OP AGG $ 2,000,000
OTHER: $
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
Ea accident
C ANY AUTO 15MMBGKKDM 09/30/2015 09/30/2016 BODILY INJURY(Per person) $
ALL OWNEDX SCHEDULED BODILY INJURY(Per accident) $
AUTOS AUTOS
X HIRED AUTOS X NON-OWNED PROPERTY DAMAGE $
AUTOS Per accident
X Comp$1000 X Coll$1000 Is
UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 5,000,000
D EXCESS LIAB CLAIMS-MADE ELU783547/01/2015 09/30/2015 09/30/2016 AGGREGATE $ 5,000,000
DED RETENTION$ $
WORKERS COMPENSATION XAND EMPLOYERS'LIABILITY STATUTE EORH
Y
B ANY PROPRIETOR/PARTNER/EXECUTIVE �N/A TO BE ISSUED BY CARRIER 09/30/2015 09/30/2016 E.L.EACH ACCIDENT $ 500,000
OFFICER/MEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYEd$ 500,000
if es,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ 500,000
DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required)
FOR INFORMATION ONLY
CERTIFICATE HOLDER CANCELLATION
INFO-01
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
For Information Only THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
y ACCORDANCE WITH THE POLICY PROVISIONS.
AUTHORIZ
ED REPRESENTATIVE
f�val�_
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
" Mice ® ®nsurer Affai and Business Regulati®
, � 10 harp Plaza o Suite 5170
Ost®n9 Massachusetts 02116
Home e Improvement Contractor Registration
Registration: 162111
Type: Supplement Card
Expiration: 1/14/2017
NEXT STEP LIVING INC.
ROGER OUELLETTE
21 ®RY®OCK AVE. 2TFI FL
BOSTON, MA 02210
Update Address and return card.Mark reason for change.
Address ❑ Renewal [:] Employment host Card
l56"i;-C.� "a '$C)9 w-�Mt11i�.Crgpprt"t;.;w fi p i
ABBI'll W up°Ie"a e�F� ✓i9Nh,d�JJ'it«��4",r&4d.��' .t�
Office of Consumer Affairs&Business Regulation License or registration valid for individul use only
,HOME IMPROVL-HENT CONTRACTORbefore the expiration date. if found return to.
-, Office of Consumer Affairs and Business Regulation
J,r� r
;! Registration: _162111 Type 10 Parc Plaza SuW5190
Epcpiration: 1114/2017 Supplement Card Boston,MA 021 6%
_fes '
NEXT STEP LIVING INC. l
G,''
ROGER OUELLETTE
21 DRYDOCK AVE.2TH FL � ---- �
BOSTON,MA 02210 Undersecretary t valid without signature
Massm�,,husefts DepartrnerO ��A Pubbc S,,ifet,y
Boa,�ri i (,)I, Bufly hng Rv"'IgW ific)E�t > anc-I Staridards
(2cm0ructiorl
GJcensf,,,,„ CSSL-102811
ROGER A OVELLETT
55 STANMORE
Wandek RI 02899
(091IN2016
Restvicted To: CSSWC-Qnsuiati®n Contract®r
Failure to possess a current edition of the Massachusetts
State Building Code is cause for revocaVon of this license.
For OPS Licensing information visit: www.Mass.Gov/DPS