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HomeMy WebLinkAboutBuilding Permit # 1/4/2016 NORTH BUILDING PERMIT o�"'I. '°'9�° TOWN OF NORTH ANDOVERa- o . ,.. APPLICATION FOR PLAN EXAMINATION * - R 19 1 Y b Permit NO: Date Received I<",� Date Issued: �9SSgc Hus�4�y MPORTANT: Applicant must complete all items on this page ME TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential P New Building pROne family ❑Addition ❑ Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg t<,Other ❑ Demolition ❑ Other41 ./i-',/,%,,,; //i. �:� /!� /// � / i./ r ;i-/%/,/.%! , /i !i:% //%//;/ //i/,:/ %/,, r/'!%•///r/�;///„ / -r%moi+�"/, //,/:�/ { 6!. Identification Please Type or Print Clearly) OWNER: Name: Phone: �, c Address: "/ ��-.. "f/,/ / ORR/ ,/. / .��/ 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. Total Project Cost: $ 1 FEE: $ •`9 Check No.: Receipt No.: 29,5-- 7 I� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner` Signature of contractor I 'Town of � NORTH Andover '� :..''` O . No. 7o— zol t� - a h Ver, Mass, ;Q/�q coc.ucntw�cK 1' '�si9S RATED H ,�5 V BOARD OF HEALTH PERMIT T Food/Kitchen LD Septic System THIS CERTIFIES THAT �/ � l M� BUILDING INSPECTOR .......................... .....................: .�`...... ... .................................................... has permission to erect buildings on . -.��.` Foundation .......................... ... .. ........................................................... Rough to be occupied as ...................1....:�C!.t../..:f.. 5.. ;�C............................................................... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and Final Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough y MONTHS PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S ARTS Rough Service ................ .... ........................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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 Approved by the Building Inspector. Burner Street No. Smoke Det. Federal ID#06-0406628 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RISEi� A division of Thietsch Engineeting ENGINEERING 60 Shawmut Unit#2,Canton,MA 02021 CONTRACT 339-5024335 FAX 339-502-6345 Page 1 PROGRAM TKM CONTRACT is EraT6TtED tiro BEFIVE N RMF CMA—HES EWINEEMG AND THE CUSTOMER FOR YORK AS DESCRISEDHELOW PHONE DATE CUFNT C WORK ORDER CUSTOMER Mary Kilcoyne (978)686-3010 11/17/2015 416921 00002 SERV=BTKEET BIWNG STREET 431 Johnson Street 431 Johnson Street sirmce CWY.STATE,ZIP BD.UNG 07Y.8TAMEP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your 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 left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed,) This will require(8)working hours.A reduction in cubic feet per minute(cfin)of air infiltration will occur,but the actual number of cfrrr is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the subcontractor to ensure the safety of the indoor air quality. $680.00 AIR SEALING ADDER: (2)working hours. $170.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts to(50)square feet for damming purposes. $102.50 ATTIC FLAT:Provide labor and materials to install an 8"layer of R 28 Class 1 Cellulose added to(1216)square feet of open attic space.KEEP DESIGNATED 12X12 FLOORI '—� $1,665.92 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thermax board.Weatherstrip the perimeter. $60.00 VENTILATION:Provide labor and materials to install ventilation chutes in(40)rafter bays to maintain air Bow. $80.00 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 offers 750A 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$340 if savings arejustified by the auditor. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and after the weatherization work is complete.Wamill also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$3,110. $90.00 205 r ! , Federal ID#054405828 \� s,/ RI Contractor Registration No 8186 vu RISE Engineering SHA Contractor Regietration No 120878 R1%j A division of lbietsch Engineering ENGINEERING' 60ShawmatUnit#2,Canton,MAt12021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM THIS coNTRACT is DrTERED INTO BEWEEN RISE CMA-HES ��oA THE CUSTOMER FOR WORK AS CUSTOMER PHONE DATE CLIENTC WORK ORDER Mary Kilcoyne (978)686-3010 11/17/2015 416921 00002 SERVICE STREET UR1dKO STREET 431 Johnson Street 431 Johnson Street SERVICE CRY.STATE,ZIP BILLING CITY,STATE,IIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $2,848.42 Program Incentive: $2,371.32 Customer Total: $477.11 WE AGREE HEREBY TO FURNISH SERINES-COMPLETEIN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Seventy-Seven 8T 111100 Dollars $477.11 UPON FINAL INSPECTION AND APPROVAL BY RISE M AAGES TO REMIT FULL INTEREST OF J54 VnLL Be MONTHLY ON HAROW UNPAID LA BANCE AFTER 30 DAY$.So REVERSE FOR WCUSTOS I ANT INFORMATION ONN GUARANI E:S,RIIGHTSUOFWRE=ION.scHEDUUNO,AND CONTRACTOR REGISTRATION. oo NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZED 81 RE-RISE ngTANCE NOTE.THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT.THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 3O SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE 90 �s The Commonwealth of Massachusetts —=-' = - Department of Industrial Accidents Office of Investigations }� I Congress Street, Suite 100 Boston, MA 02114-2017 www.mass.gov/dia 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): 1. ✓❑ I am a employer with 100 4. ❑ I am a general contractor and 1 6 ❑ New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. E] Remodeling 2.❑ 1 am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. ❑ Demolition and have workers' working for me in any capacity. employees9. F-] Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 1.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.[:J Roof repairs insurance required.]t C. 152, §1(4), and we have no Insulation employees. [No workers' 13.❑✓ Other 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 and state whether or not those entities have Contractors that check this box must attached an additional sheet showing the name of the sub employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurance for nny employees. Below is the policy and job site information. Insurance Company Name: Indemnity Insurance Co of North America Policy# or Self-ins. Lic.#. V71 S�5 Expiration Date:6/30/201 Job Site Address: � (�� City/State/Zip: 6J �d 1 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 of perjury that the information provided above is true and correct. Si gnature: Date: 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# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector 5. Plumbing Inspector 6.Other Cont2ct Person: Phone#: D[YY DATE06M24�0 5 YY) CERTIFICATE OF LIABILITY INSURANCE 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 NAME: Aon Risk Services Central, Inc. PHONE (866) 283-7122 PAX (800) 363-0105 `m Southfield Mi office (Aro.No.Ext): (A/C.No.1: a 3000 Town Center E-MAIL o Suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAICN INSURED INSURER A Old Republic Insurance Company 24147 TODBUild Corr). 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MWDDIYYYY MMIDOIYYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZYJ04834 EACH OCCURRENCE $2,000,000 CLAIMS-MADE X❑OCCUR DAMAGE O - $2,000,000 PREMISES Ea occurrence MED EXP(Any one person) S25,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $4,000,000 ,md, X POLICY ❑PET F__]LOC PRODUCTS-COMPIOP AGG $4,000,000 N 0 OTHER: r` A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT $5,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) O Z ALL OWNEDSCHEDULED BODILY INJURY(Per acddent) w AUTOS AUTOS NED PROPERTY DAMAGE V X HIRED AUTOS X NON AUTOS Per accident t-' d 4DUMBRELLA LIABHEACH OCCURRENCE 0 OCCUR _ EXCESS LIAR CLAIMS-MADE AGGREGATE '.. ED RETENTION e WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE ETH EMPLOYE RS'LIABILITY YIN All other States ANY PROPRIETOR I PARTNER/EXECUTIVE E.L.EACH ACCIDENT $1,000,000 C OFFICERIMEMBEREXCLUOED7 NIA SCFC4815190 06/30/2015 06/30/2016 (Mandatory in NH) WI Only E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under '.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000- T_ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) '.. Evidence of Coverage Y.I 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 260 Jimmy Ann Drive eta' 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 �tf;'/Y�d�l��iodPt'�Fc''�.��d��f€ L.'' ' s Office of Consumer Affairs�n Bus ness Regulation 10 Part; iPlaza - Suite 5170 Boston; Massachusetts 02116 Home Improvement Contractor Registration Registration: 179141 Type: Supplement Card Expiration 6?25/2016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 t'ndate Address and return card. Mark reason for change. 3ddrr t tent«al Ernp opmer:t Lost Card ommjce of Consumer Affairs& Business Ref,ulatinn 1-icense or regEstraiiun Valid for individul ust nnl) _J before the expiration date. if found return to: .:J�Oh1E IMPROVEMENT CONTRACTOR off:cc of Consumer.A;iairs and Business Regulation Ragistratiar:: 179141 Type t0 i'ar�Plaza tit ate i'_70 t5/2G16 and ;�o;ton, #A v?J tGExpira � _ 11LDER SERVICES GROUP; INC. SHARD SCH'A'ARTZ 0 JIMMY ANN DRIVE .YTONIA SEACH.FL 211-1 t'ndersctretan tot vaiid_wii tout Sign2ture RICHARD S(,[-I',VAR*I'Z M 67"11 195 HUNTRESS S'rREEI' Manchester NF1 (13102 09126/2016 Restricted To CSSL,I[C inmilation Cantractor Failure to posses, -rent edition of thc'Massachusetts State Building Cot a(jse for revocation of nws license