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HomeMy WebLinkAboutBuilding Permit # 1/4/2016 ...,, .Y %%ORTII d 0��t6ED BUILDING IT _ TOWN OF NORTH AV ® F APPLICATION FOR PLAN EXAMINATION a - Permit NO: / Date Received gg ��ss�cwus Date Issued: i I1VIP®I�T�1 T: A licant must com lets all items on this a e TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential New Building pQne family ❑ Addition ❑ Two or more family ❑ Industrial Iteration No, of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg KOther ❑ Demolition ElOther W -- L i y lo,M.", Identification Please Type or Print Clearly) OWNER: Name: &� r -� Phone: ®� Address: ,F / R 3Yrr p F d' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:B ING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST EASED ON$125.00 PER S.F. i Total Project Cost: " FEE: $ Check No.: Receipt No.: NOTE: j'el sons ntracti a unregistered contractors do not have access to the guaranty fund i rim 0-0 NORTF{ _t own of . : Andover O ® 11Zz ® i o : L^�. h ver, Mass, cocnicnew.c.a meq. �ds R4TED - V BOARD OF HEALTH Food/Kitchen PER T T LD Septic System THIS CERTIFIES THAT04 ow&%o BUILDING INSPECTOR ............... ........ .................... ........................... ............ .................. ........ .. ... .... • Foundation as permission to erect .......................... buildings on .. . .. .......('00".4.....(0500 ...................... Rough to be occupied as ...... .. ................A-it ........��iry ............................ Chimney provided that the person accepting this permit shall in every respect conform to th rms 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCT) TA S 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 an Approved by the Building Inspector. Burner Street No. Smoke Det. ® 06/8.08/2015 12:36 9786825399 PAGE 01 Faders!ID 0 RISE Engineering R1 Contractor Reglatratlon No A dl*loo of Tbioirch EoblaoMn j CT Conbsew ROOMMUM No 60 Sbawmul Vail 102.Canton.MA M21 CONTRACT 939.502.6335 FAX 339%%2.6345 R t SE PROGRAM ' p2i0GRAM CMA-HES DOOMIUMM #000ni CWT Y Ai09tMeaR#a 15NG1NBELING DEBCFAM99LOW aiarowA " ' rwiotre oATe aieeiT• VMKCM" Maureen Roche (978)979.2070 06/022015 416115 00003 alis v"&TMT SUM aneEsr 340 Wood Lane 340 Wood Lane aatries CM.VAMi1i sum CIn.eTATILEP Noah Andover,NIA 01845 Notch Andover, MA 01645 JOB DESCRIPTION H SE )NF-P picosal for this calendar yr38t. $0.00 BARRIER:A 8bwer Door fest will roll be conducted at your home,due to the presense of asbestus. $0.00 13ARRICR:We have discovered what appears to be a motd/mildcw4tke substance in your home.This is being brought to your attention to identity it as a pre-citisting condition to the insulation and air sealing work planned ft your home.Your signature is your acknowledgement of them conditions and agreement to proceed. 50.00 50.00 A'1"rIC"r:Provide,labor and materiats to install a 9"layer of R-30 unfaced fiberitloss halts to(16)square to of attic space. $26.72 ATTIC FLAT:Provide labor and materials to Install a 14"layor of R49 Class l Cellulose added to(672)square fast of ow attic sp=AUDITOR:TYPE OVER THIS TEXT'M SHOW SPECIPtC PROBLEMS AND REMF.DIIBS FOR'rHIS HOME.)THROUGH 1,1106L IN WAbI.THERE MiOHT BE NOLD MUST BE CHECKED!!t BULKHEAD LEAKS SEASONAL WA'1TF RIN HOMF.%OTE CEILING IS BEING REPLACED DUF.TO ICE DAMS! $1,135.60 50.00 ATTIC ACCESS:Provide labor and materials to insulate(1) bad;ofttu knaewall hatch with 2"rigid Themtax board.and Sorel the cage orft haten wim weamenitnppmg. 500.00 VtiNT11,A'nCN:Provide 1000 and instals!€to Inmail ventilation chutes In(32)rafter bays to maintain air Row. 5104.00 V133NTIIAIION:Provide labor and materials to install(a) 6"X 16"rectanguler aluminum.soffit vents to increase ventilown in attic areas. Specify color.White or Grey. $200.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only he bitted the Net amount. Currently, for eligible rnessures,Columbia Gas offers 73%incentive,not to exceed 52,000 per calendaryear,and an incentive of 100%Rrr the Air Sading numures up to the fleet$680 and an Additional 5340 if savings ars jusdAul by the auditor. For the safety and health oryour home's indoor air quality,we will be amdueting a blower door diagtttsstic ofthe available air now in your mm troth Derbre the work Is begun,and oner the wwrienation work Is em mlIteic.We will atso conducl a full ussessmeni oil' the combustion safisty of your heating syomm and water heater.This has a value of$90 and is at no cast to you. Total allowahle waathtrixMion inasmiva is$3.110. Soe.no 06/68/2015 12:34 9786825399 PACE 01 FtdM1 ID 0 RISE Engineering RI cordes R gwjav4n no A devWon offft k E40ftrtcg Cir C n too 60 Shewmut Unit N2.COMO.MA 02021 CONTRACT 339.102.6J3S FAX 339-SO24S R I S E PROGRAM Pap Z T"CONTIMIMMMMMMENGINEERING CMAMES O1ATOM,WMKM 01MTGArn PHONE �� air• .. wa.OROM Maureen Roche (978)979.2070 06/02/2015 416115 00003 •TOUEpT. .............. BUM IMUT _........ . 340 Wood Lane 340 Wood Lane _...._ .. _........ .... 8iLL_.. �Al1Y10E CRY.IITATE ilP CTrY,•TATE,ItiP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIP'T'ION Total: $1,016.40 Program Incentive: $1,234.80 Customer Total: 113111.60 WE AURES MM IV TO FURMISM URVf069.COMPLETE IN ACCORDANCE WITH ABOVE SPIMIF"710ft RM THE SUM OF "'Throe Hundred Eighty-One&601100 Dollars $381.60 UlOM••IAL WIMCfiOY AMO AO•ROYAL nlAt{E LNOMRWNO.OUITOMEA AOR6EA TO AWT AMOUNT OYE M FIAT.WT6R@•T Of/4 Y L K 0MRM NOM MY ON ANY WIRAIb lA►AMCB ARER i00AYf.i�R6YERiE X11 t11P011TAM1•RORMA�IOM CN BLARANTBEO.RKMft E Oi REOt010N 6CNEQ1AMi0 AW CONTRACTOR IMSO AATiOM. Da WT SON TMta CoWMM W TMRH ecce M Y iU SvA'Cea At11 Ii0R�0 e1G%ATtMtE.RVE EapY�••AnD TOIMew ACCEPTANCE IADTii TIS aoAmTAaT MAY ec WfT11GRAMG eY w tF NGT EIIEautEallnTlMM OATH OF AMPTAMOE MXMAWA OP CUM"-THE AbM PINCU.61110R ATIOU AND 0040MOO AU �— DAM a 5PECWM.PATM�W WU OE MM AA o�YTLMM AIMM ro oG Trn Man D � �/%SMO ,JUN - 8 2015 The Commonwealth of Massachusetts I•.L -'—-- ;..__A Department of Industrial Accidents Office of Investigations °- 1 Congress Street, Suite 100 Boston, MA 02114-2017 r 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.W✓ 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 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition and have workers' working for me in any capacity. employees9. EJ Building addition [No workers' comp. insurance comp. insurance.+ 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no 1 Insulation employees. [No workers' �• ✓❑ Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. z 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. #.�Q�-{�C­6 V�_k 5_'5_3 Expiration Date:6/30/201 Job Site Address:_ •u ________ 1 City/State/Zip: N, L291 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 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 in formation provided above is true and correct. Si nature: 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#: A��® DATE06/2420115 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 'a ,on Risk Services Central, Inc. PHONEFAX Southfield MI Office (ac.No.Ext): (866) 283-7122 {AIc.No.): (800) 363-0105 3000 Town Center ADDRESS: z:Suite 3000 Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A Old Republic Insurance Company 24147 TODBUild Corn. 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 SUBR POLICY NUMBER MNIDDIYYYY MMIDDIYYYY LIMITS '.. A X COMMERCIAL GENERAL LIABILITY MIVZY304834 EACH OCCURRENCE S2,000,000 CLAIMS-MADE ❑X OCCUR AM O N D S2,000,000 PREMISES Ea occurrence MED EXP(Any one person) $25,000 PERSONAL 8 ADV INJURY $2,000,000 '.. GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,OOO,OOO X PEO- [7]LOC PRODUCTS-COMP/DP AGG $4,000,000 POLICY ❑ '.. 0 0 OTHER: r- A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT $5,000,000 N Ea accident X ANY AUTO BODILY INJURY(Per person) 0 '.. ALL OWNED SCHEDULED BODILY INJURY(Per acadent) 07 AUTOS AUTOSNED PROPERTY DAMAGE M X HIRED AUTOS X AUTOS Per accident w '........ t d W!®RELLALJAB OCCUR EACH OCCURRENCE EXCESS LIAR CLAIMS-MADE AGGREGATE '.. DEO RETENTION B WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE EORH EMPLOYERS'LIABILITY YIN All Other States ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S1,000,000 C OFFICER/MEMBER EXCLUDED? a NIA SCFC4815190 06/30/2015 06/30/2016 {Mandatory in NH) WI Only E.L.DISEASE-EA EMPLOYEE $11000,000 If yes,describe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT $1,000,000- DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Evidence of Coverage �— A—I CERTIFICATE HOLDER CANCELLATION 24 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 m� 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 1h6 Of fI�e o�C���surnei Ana—�a�rs Business Reguiataor3 �� 10 Park plaza - Suite 51170 Boston; Massachusetts 0211 Home Improvement Contractor Registration Registration: 179141 Type: Supplement Card Expiration: 6,'2512016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 t'ru32te Address and return card.dart:reason for change. 3cidre t :tencFsal f:ni(tlo,,rnent fast C'.:rcf -- Office o;t:'onsutner.�ffairs a Business Rtgulataon f,icense or registratinn valid for indiriul use c,nit before the exp=ration da+e. if found return to: IMPROVEMENT CONTRACTOR Off-Ice of Consumer A_fairs and Busines,ftegulatittn agssirzYtor: 1711 Type ftI zr PI37 Suit'r�f7U Expiration: 6125/2016 Supplement---ard Boston.MA 02 I f u -DEP.SERVICES GROUP:INC. -ikRD SCHNAIARTZ r 1IMMY HNN DRIVE TONA BEACH. FL 3-211-1Not vnfi%,A-ithout,;ig ature 1'ndersccrct2rs CSS L.-105992 RFC HARD SCHWARTZ � 195 HUNTRESS 5'rREET' -,;,,•;fry Manchester N1.1 93102 09/26/2015 Restricted To CSSLAC • Insulation Contrataor Failure to posses• -rent edition of the Massachusetts State Building Cot ause for revocation of thri;bre ns;p