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HomeMy WebLinkAboutBuilding Permit # 1/4/2016 0ORT11 0 BUILDING PERMIT °�"`� ;6aa o TOWN OF NORTH ANDOVER ® R APPLICATION FOR PLAN EXAMINATION lI � Permit N®: Date Received � Ave ACHUS Date Issued: IMPORTANT; A licant must com late all items on this a e .y xs/ TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑ Two or more family ❑ Industrial Iteration No. of units:_ _❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg WOtherpi [I Demolition 11 Other � 6 die, W111— 1- `1EIra ` 0 1111"10117 0,a C, ®` Identification Please Type or Print Clearly) cI OWNER: Name: 1` Phone: Address: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULEWING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: FEE: $ Check No.: X11 Receipt No.: NOTE; Persons contracting with unregistered contractors do not have access to the guaranty fund I OORTH AMW" ff%f A ®ver O No. 2 * zh Ver Mass AWV O • LAME ICK CO[WCHE W �iQs RATED U BOARD OF HEALTH E� R T LD Food/KitchenT , Septic System THIS CERTIFIES THAT Ni ,,e. , ...... .... .. ...... BUILDING INSPECTOR ............................................... C... ........ ................... Cap) Foundation has permission to erect .......................... buildings on ....... ...... ........................�:"x5..................... Rough to be occupied as ....... ..... .. .. .. .e..... ...... .f�!..., �rtr. .......................................... 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS C S CTIO RTS Rough Service ............. . ... � ................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to 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 anApproved by the Building Inspector. Burner Street No. Smoke Det. k Federal Mf RISE Engineering R1 Contractor ReBftbTfi n No MA Conhict:or Regtisbadon No A dMston otThidsch Finglaening cTContrador Rsgfsbagon No 60Sh wmatUnit#2,Canh%MA02021 CONTRACT 339602L335 FAX 339-902-6345 Page 9 L.✓ PROCsRAM nsecoxrnneswestsri MrMRWM ffie CMA HES mai-a�Daurraearatoaastvaavrorurae Julia Roache �' (617)894-0076 08232015 413171 00003 0 OWN 200 Coachman Lane t� N 200 Coachman Lana North Andover,MA 0 184161 1 1 North Andover,MA 01845 B DESCRIPTION PHASE ONE-Proposal fortbis $0.00 HEALTH&SAFErY:Weadmizahon work cannot proceed until the msoffiaed draft issue is fixed H0T WATHR SPILLS FLUE GASIII $0.00 AIR SEALING:Provide labor and materials to seal areas ofyour home against wastefid,exp air lealmge Tbis work will be performed in concert with the use of special tools and diagnostic tests to assure thatyour homewill be left with a healthtbl level of air eta hmp and indoor air quality.Materials to be used to seat your home can include csuilks,foams and other products.PrWamy areas for seating include aaleakage to attics„baseman%att aped 8aragm and other unheated areas(windows are not generally addressed.)(8)woridng bourn. At the completion of the weatlmimtion work,and at no additional cwstto the homeowrw,a final blower door and/or combustion safety analysis will be conducted by the sir to eaanna the saft of the indoor air quality. $680.00 AIR SEARING:Provide labor and materials to seal areas of your home againd westioK proess air leakage.This work will be paformed m concertwith the use of special tools and diagnostic tests to assure that your home will be left withahealthful level of air excbanga and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary anal for seating mdade air leakage to attics,basornmus,attached garages and other unheated area(windows are not gemally addreed-)(4)walft hoM& At the completion ofthe weathmization work,and at no additional cost to the homeowner,a final blower door mud/or combustion sa&ty analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $340.00 AIR SEALING ADDEEL (4)working hours. $340.00 DAMMG Provide labor and materials to install a 12"layer of R 38 unfaced fiberglass baits to(76)sgnara het ford—in g Purposes. $53.30 ATTIC FLAT:Provide labor and materials to install a r layer of R 25 Class 1 Cellulose added to(1948)square fact of open attic space- $2,532-40 STORAGE BARB m•Homeowner is responsible for the removal of the stored items biocidng the i,rstallatiaa of w aftriestion work m the attic. Kemov81 must 00W prior to the wheduled work start $0.00 KMEEWALLS:provide labor and materials to install 2" FSK faced semi-rigid fiberglaaa board h>suistian to(110)square fixe of Imeewall area. $385.00 Federal 0)# RASE Engineering RI Conbactor Realshation No tilACorT edwRegisbuffen No A division of Thlelseh Eughxuing CT Cont udw Regb6a m No 60 3hawmatualtb2'Canton,ltrfA 02021 CONTRACT 33 35 FAR�i9-502-045 Page 2 PROGRAM TROCONTN"ISIDUU>: MMUCCrs�+Rma CMA HES De ®�asrTRsaurarcasETiPORawoaicAe cupomm Mom 03ffd# WOW Julia Roache (617)894-4076 08=2015 413171 00003 200 Coadmim Lane 200 Coachman Lane North.Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION AT17C ACCESS:Provide labor and materials to hm ate the rack of(1)attic hatch with r rigid The®au board Weatherstrip the per- $60.00 VEIVM A71CN:Provide labor and materials to install(2)insulated exhmist hose with soffit mounted Sappervent to exhwst existing both—fim(s). $237.50 VENTILA71ON:Provide labor and materials to install ventilation chums in(22)rafter bays to maintain air flow. $44.00 RISE Engateering will apply all applicable,eligible incentives to this contract You will only be billed the Net amount. Cam*, for etigiblo measures,Columbia Lias offi'm 75%incentive,not to oweed 52,000 per calendar year,and an rive of 100%for the Air sealing measures up to the Sant$680 and an additional$340 if savings are justified by the auditor. For the safety and health ofyour homds indoor air quality,we will be coathufing a blower door diagoostiooftho available air flow in your ham both before the work is begun,and after the weatherization workis complete.We will also conduct a hill assessment of the combustion safety of your heating system and waw heater.This has a value of$90 and is at no cost W you.Total allowable waathmizaion incentive is$3,110. $90.00 Total: $4676220 Program Incentive: $3,110.00 Customer Total: $1,662.20 WE AGREE HErMY TO FURMSH -COWLEiE tN AWORDANM VM ABOVE SPECIMATtONB.FOR WEE SUM OF '**One Thousan be Hund fifty-Two&701100 Dollars $1,662.20 UPOHFDMLDZBPECTMAHDAPPRoi AORMTO AHOtWWMt FUU-UffWU TWISWaLDatlltr={IDMRLYONANY WW,M V&= 7WHOH RICHIBWRECO M, .AHDCDHrRACTOit,OWSTRATeH. THIS t:T[F THERE ARE ANY SPA NUMTWBCOWRACTRAYSEVAO AAM UNUB HCT VISM DATQOPACCUTAHCa ACCEPIANCIOP CONTRACT•TtMAaMSj FYWUXUMAR=AMD CONUM8ARa 30 a+d assc PAnr>� epMADB Oi;®TOD07HUWOM The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations I Congress Street, Spite 100 Boston, MA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legible 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. ❑ 1 am a general contractor and I 6 ❑ New construction employees (full and/or part-time).* have hired the sub-contractors listed on the attached sheet. 7. ❑ Remodeling 2.❑ 1 am a sole proprietor or partner- ship and have no employees These sub-contractors have 8. [:] Demolition employees and have workers' working for me in any capacity. 9. F-1Buildingaddition [No workers' comp. insurance comp. insurance.+ 5. F-1Weare a corporation and its 10.0 Electrical repairs or additions required.] ❑ officers have exercised their 1 l.❑ Plumbing repairs or additions 3. 1 am a homeowner doing all work [No workers' comp. myself. right of exemption per MGL 12.❑ Roof repairs required.]insurance re C. ]52, §I(4), and we have no Insulation q ]-r employees. [No workers' 13.21 Other comp. insurance required.] *Any applicant that checks box 41 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. *Contractors 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 am an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: Indemnity Insurance Co of North America Policy# or Self-ins. Lic.0A)LrC:-i$kS t55 Expiration Date:6/30/201 r Job Site Address: f � �1 t'1M.1 V11 ! isy1� City/State/Zip' 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 sins and penalties of perjury that the information provided above is true and correct Signature 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 Contact Person: Phone#: ��® ® DAT 6M 4IDD15 YY) CERTIFICATE OF LIABILITY INSURANCE O 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 °7 certificate holder in lieu of such endorsement(s). PRODUCER CONTACT 'C NAME: Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 d Southfield MI office (A/C.No.Ext): /Arc.No.l: 3000 Town Center E-MAIL o suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAC# INSURED INSURER A Old Republic Insurance Company 24147 TODBUild Corp. INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann Drive INSURER C: ACE Fire Underwriters Insurance CO. 20702 Daytona Beach FL 32114 USA 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 INSIR ADDI R POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSD WVSUBO POLICY NUMBER MWDDIYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304834 EACH OCCURRENCE S2,000,000 '.. CLAIMS-MADE X❑OCCUR DAMAGE O RENTED $2,000,000 PREMISES Ea occurrence) MED EXP(Any one person) $25,000 '.. - PERSONAL B ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,000 X POLICY [:]JE O- ❑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 un Ea accident X ANY AUTO BODILY INJURY(Per person) Z ALL OWNEDSCHEDULED BODILY INJURY(Per accident) 2 AUTOS AUTOS NON OWNED PROPERTY DAMAGE to X HIREDAUTOS X AUTOS Per accident w C d7 UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND lIqLRC48151SS3 06/30/2015 06/30/2016X STATUTE EORH EMPLOYERS'LIABILITY YIN All Other States ANY PROPRIETOR I PARTNER r EXECUTIVE E.L.EACH ACCIDENT $1.,000,000 C OFFICEWMEMBEREXCLUDED? N N/A SCFC4815190 06/30/2015 06/30/2016 (Mandatory in NH) WI Only E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCFUPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT S1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Evidence of Coverage " .IJ IJ CERTIFICATE HOLDER CANCELLATION ai 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 /J �j- 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 Offic-e of Consumer Affairs fan Iusiness Reguiat�on . - Y Park Plaza - Supe 170 I Boston, Massachusetts 02 i 1 Home Improvement Contractor Registration Reqistration: 179141 Type: Supplement Card Expiration6125/2016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASH UA, NH 03063 i tidate Address and return card.Mark reason for change. "-.ddrest Ren-w;d Ernoloymert Last Card Om,,ce of Consumtr Affairs a Business Regulation License or registration t'alid for individul use nnl) -=;- before the expiration date. If found return to: :t� IMPROVEMENT CONTRACTOR Office of C:onsumer.A airs and Business Regulation 'Registration: 179141 Type 10 Porn-P:aza -Suitei'_10 - Expiration: 6i2r,/2016 Supplement ::ard Boston,'SIA 02116 11U,cR SERVICES GROUP:INC. SHARD SCH,A'ARTZ 2 6 NTONA aE CH.rL c114 t'ndtr>ecrttar% ?ot vaiid w'ithaut sign2turc :Jlt% CSSL-1059 92 RICHARD S(.[iWAR*I'Z ag 195 HUNTRESS SME"El' Manchester NH (13102 09/26/2016 Restricted To C.SSL.I('. insuiattor Contractor Failure to posses, 'rent edition of the I'AasSaChuSerts State.Building Co( -awse for revocallon of this I,censo �r,Oa