Loading...
HomeMy WebLinkAboutBuilding Permit # 1/4/2016 ORTH BUILDING PERMIT TOWN OF NORTH ADCIV 7 APPLICATION FOR PLAN EXAMINATION n - Permit NO: ,°i Date Received _ °meq °Aare° caaug�� Date Issued: 1 4 IMPORT T: A licant must com Tete all items on this a e 021, TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building pNOne family ❑ Addition ❑ Two or more family ❑ Industrial AK,AIteration No. of units: _ ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg Other ❑ Demolition ❑ Other W gn A �.1�r �' -.g ,,, rt.; ��.'r.S" , y'.�,�if' c '' .`rr` „ !✓a , _xr., ���.rs✓��f,,�`,.!i.r.,f ������„d ark L. Ind( nLaz kn i Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: Z' � � — s - FIN , r � r F ''✓f�",.frF,-�,..r�% ��xf{ �v.Y"�z�`� �f�.'��.3 '" � �i rs���t�i� .N" ,8",?j�� .: � ".v ARCH ITECT/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: $ t FEE: $ i Check No.: Receipt No.: NOTE: .Persons contr sting with unregistered contractors do not have access to the guaranty fund j ~ fr vf.Aggtr11: rr cfdrl# NOFi fokwn of N O L++ ® ® - i NJvJWi 4.2A* o h , ver, ass, COCKiCKewICK � ADRArED s � BOARD OF HEALTH Food/Kitchen PERMIT I L D Septic System . w . THIS CERTIFIES THAT................ ..........� „ a, t.; . ,..,. BUILDING INSPECTOR Foundation has permission to erect................ .... .. buildings ......... �. 1... ..... ............... .. ................ Rough to be occupied as .......... 11�... ......Q!.................... .........lR•..S .. ...... . ................................ Chimney provided that the person accepting this permit shall in-every respect conform to 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 PERMIT ONTHS ELECTRICAL INSPECTOR UNLESSCTIO ST RTS Rough Service ........ ....� .�.................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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. r J QG CSO Federal 10#06.0401iM RISE Engineering RI contractor Registration No 0186 RISEA division of Thletsch Engineering MA Contractor Registration No 120979 ENGINEERING? 60 Shawmut Unit 112,Canton,MA 02021 CONTRACT 3 FAX 339-502-6345 CONTRACT Page 1 PROGRAM CMA-HES sxcwu "Ha rarm�xaiamm sx�As �j DESCRIBED BELOW CUSTOMER PRONE DATE CLIENT WORK ORDE7r Jeffrey Doggett tri o (617)686-2446 09/25/2015 420464 00002 svica arnaaT N sa.Lwc STREET 84 Johnson Street 84 Johnson Street ar SERviee crTKSTAM2'P BUMO CIMSTATE,IIP North Andover,MA 018 North Andover,MA 01845 0 JOB DESCRIPTION AIR SEALING:Provide labor and materials to scat areas of your home against wasteful,excess air leakage. This work will be perforated in concert with the use ofspecial tooLs and diagnostic tests to assure that your home will be left with a healthful level or air exchange and indoor air quality.Materials to he used to seal your home can include caulks,foams and other products. Primary areas for seating include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This ivill require(8)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of elm is not guaranteed. At the completion of the weatherimtion work,and at no additional cost to the homeowner,a final blower door andlor combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 AIR SEALING ADDER: (4)working hours. $340.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass hafts to(60)square feet for damming purposes. $123.00 ATTIC FLAT,Provide labor and materials to install an 8"layer of R-28 Class I Cellulose added to(776)square feet of open attic space.KEEP 16X18 FLOOR FOR STORAGE. $1,063.12 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(80)square feet of kneewatl area $280.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(t)attic hatch with 2"rigid Thermax board.Weatherstrip the perimeter. $60.00 VENTILATION:ION:Provide labor and materials to install(4)insulated exhaust hose to existing bathroom fan(s). $200.00 VENTILATION:Provide labor and materials to install ventilation chutes in(30)rafter bays to maintain air flow. $60.00 VENTILATION:Provide labor and materials to install(10) 6"X 16"rectangular aluminum soffit vents to increase ventilation in attic areas. Specify color.White or Gray. $250.00 OVERHANG:Provide labor and materials to install 10"R-37 densely packed Class 1 Cellulose insulation to(76)square feet of exterior overhang located below a heated floor area,by drilling holes in the overhang from below. Holes drilled will be plugged. Plugs will be sealed with exterior grade spackle and left in a relatively smooth condition.Finish sanding and touch-up priming/painting will be the custame's responsibility. $304.00 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 or 100%for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. Federal to#06.0405628 RISE Engineering RI Contractor Registration No 8186 RISEA division ornicisch Engineering MA Contractor Registration No 120078 ENGINEERING' 60 Shawmut Unit 02,Canton,MA 02021 pa p��+�+ 339-502-6335 FAX 339-502-6345 CON ITiV C p Page 2 PROGRAM CMA-HES ENCIM=40"DTMCONTPAMM°tRe�cu INNT.0Bo rocas DESCRfaEO BELOW CUSTOMER PHONE DATE CL[ENTO 4YOtULOROFR Jeffrey Doggett (617)686-2446 09/25/2015 420464 00002 Baimca antwT Inuf a STRwr 84 Johnson Street 84 Johnson Street SERVtce CnY.STAMVP IN'II G C"V.STATE,UP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION ror the safety and health of your homePs 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 weatherizetion work is complete.We will 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 weatheriration incentive is$3,110. $90.00 Total: $3,450.12 Program Incentive: $2,865.09 Customer Tonal: $605.03 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Eighty-Five&03/100 Dollars $586.03 RIPON FW-L 1NSPW=N AND APPROVAL 6Y R"ENGWEERWM CUSTOMER AGREES TO REWT AMOUNTOUE W FULL INTEREST OF i%W LLSE CHARGEDMONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.BEE RWMEFOR IWORTANT WFORM MON ON OUARANTE13,MGM OF RECURON.30KEDULING,AND CONTRACTOR REGMMTWN. NOT SiGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES BtONA EEnp —V � G NOTE:7HI3 CONIRACr MAY BEHTMIIRAY7N BY LLS IF NOT E%ECtrrED YAT14N DATE aF ACCEPTANCE ACCEPTANCE OFCONTMCT•THEABOVE PRICE%OPEC RUTIONS AND CONDITfOM ARE 30 DAYS. SAMP t[FtEOYToU X MEE WtMW MAGE A YOU ARR AVTHORMWTO 00 THE WORK The Commonwealth of Massachusetts -;' = - Department of Industrial Accidents Office of Investigations Y I 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): 1.0 1 am a employer with 100 4. ❑ 1 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. E] Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. F-1Weare a corporation and its 10.❑ Electrical repairs or additions 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.]} c. 152, §1(4), and we have no 1Insulation 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. 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 bot 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.#.���— -`"� ��i��< Expiration Date: 6/30/201 Cit /State/Zi r `�1 p Job Site Address: - Y P 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 itzforntation provided above is true and correct. 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#: DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INURANC 06@4!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). c PRODUCER CONTACT Aon Rl sk Services Central, Inc. PHONE FAX Southfield MI Office (aC.No.Ext): (866) 283-7122 (AIC.No.): (800) 363-0105 v 3000 Town Center E-MAIL o Suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC tF '.. INSURED INSURER A Old Republic Insurance Company 24147 TODBUild Corp. 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 Y EXP LTR TYPE OF INSURANCE INSADDD WVD POLICY NUMBER MBR MIDDfYYYY MMIDEFF D/WYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304834 EACH OCCURRENCE S2,000,000 CLAIMS-MADEX❑OCCUR DAMAGE TO 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 JE0. ❑LOC PRODUCTS-COMPIOP AGG $4,000,000 0 OTHER: A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT 15,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) Z ALL OWNED SCHEDULED BODILY INJURY(Per accident) y AUTOS AUTOS NON-OWNED PROPERTY DAMAGE 0 X HIRED AUTOS X V AUTOS Per accident .0 U UMBRELLA LIAB OCCUR EACH OCCURRENCE '. EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE EORH EMPLOYERS'LIABILITY YIN All other States ANY PROPRIETOR f PARTNER/EXECl1TIVE E.L.EACH ACCIDENT $1,000,000 C OFFICERIMEMBEREXCLUDED? NIA SCFC4815190 06/30/2015 06/30/2016 (Mandatory in NH) WI Only E.L.DISEASE-EA EMPLOYEE S1,000,000 If yes,describe under '.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $1,000,000- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Evidence of Coverage J.a+1 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. c�a Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBuild Company 260 Jimmy Ann Drive Q 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 f yrs�njdBusiness Regulation :. Of�oe of Consumer 10 Parkland - Suite 1170 . _,. Boston; Massachusetts 02 i 1 6 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 i nd3t:Address and return carts.'Bark reason for change. Addresti teneFtial }:mliioymert lost Card rft:'ansumcr Affair,cl Business Regulation License or rr�istratian s'alid for individul use anl) before the expiratitn[1ate. 1f found return to: ]HOME IMPROVEMENT CONTRACTOR Office of C:onsunter (lairs and Business ttehulatittn]HOME Type " -_ Registration: 179141 ��}3�Sr'=.'�1d2c-�i L'?IF';!�� -- Expiradon: 6/25/2016 Supplement and Boston.MA 0211'6 11LDER SERVICES GROUP;!IVC. SC '> SHARD riVtiJP:RTZ:. .' a jli+htA'!F.t`dN DRIVE YTGt:.�cErCH.FL;-2114 Not Yaii-i�-without signature Yodersctrttarti' CSSL-105992 RICRARD SCRWAR'FZ 195 HUNTRESS S'fREE-l' Manchester NH (13102 09/26/2016 Restricted To CSSL-I(C. 1;j, Contractor Fadure to posses, -rent ed,lion of The Massachusetts Statp.Building Cm ause for revocation of this hcense