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HomeMy WebLinkAboutBuilding Permit # 1/20/2016 BUILDING PERMIT VaoRrH TOWN OF NORTH ANDOVER 5 ,.`'• APPLICATION FOR PLAN EXAMINATION o ' " Permit No##: N Date Received Q�flATED PPP'`4�5 �SS•gc►aus``� Date Issued: ��° PORTANT: Applicant must complete all items on this page LOCATION Prin ., . PROPERTY OWNER ° - ,k ' '"' r .w. Print 100 Year Structure ye no MAP PARCEL: t ZONING DISTRICT: Historic District es no Machine Shop Village y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building -ne family ❑Addition ❑Two or more family ❑ Industrial W-Alteration No, of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ir T BEwPER ED: FORM WORK DESCRIPTION OF W� Identification- le se Type or Prit Clearly . OWNER: Name: ' Phone: -° -p Address: ,. �. .:... . t �� .� (KA, �� .;� i � � ,_. � � Phone: ��� E" -� (-� ..P ��• .ro. .... Contractor N me: .. Email: .. , .d . Address: ` Supervisor's Construction License:_ 7c? 1A Exp. Date: ` °f Home Improvement License: '' ( Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINO PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 2-5124, 00 FEE: $ Check No.: Receipt No.: �oi' DOTE: Persons co tracting with unregistered contractors do not have access to the guaranty fund 7,- __- ^/"✓/ 'i// !i ii NORTH ' irown of Andover 0 ­�_ _i�`k to- i�-A ® V L T Z oh ver, as LAKECO[KICHEWICK �• RATED /.P �(5 S V BOARD OF HEALTH Food/Kitchen �PERMIT LD Septic System • THIS CERTIFIES THAT .. .. �. . BUILDING INSPECTOR has permission to erect g `�........ Foundation .......................... buildings ... .. ..... ..�!�,:. ....:�........ ..... ..... g Rou h to be occupied as ..:....N. .... . ... A...z. . �,.... . �..... V. y 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. % % �1� PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTI ST TS Rough Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR J 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 and Approved by the Building Inspector. Burner Street No. Smoke Det. Poderal ID at RISE Engineering RI Contractor Registration No AAA Contractor Registration No A division of Thicisch Engineering CT Contractor Registration No 60 Shawmut Unit 42,Canton,,NIA 02021 CONTRACT 337-502-6335 FAX 339-502-6345 Pape 1 PROGRAM CMA-HES enouEER111aANDTHE CUSTOMERFORWORKAS E N C I N E E R i N G DESCRIGFO aELow CUSTOMER PHONE DATE CLIENT P WORK ORDER Dorothy Dibenedetto (781)789-2709 07/13/2015 408444 00002 SERVICE STREET BILLING STREET ''..... 53 Sutton Place 53 Sutton Place SERVICE CITY,STATE,IIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas oryour home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diatnostic tests to assure than your home Will be lett with a healthful level of air exchange and indoor air quality.Materials to be used to seal your]ionic can include caulks,foams and other products. Primary areas for scaling 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(cfm)of air infiltration will occur,but Ute actual number of cfrn is not guaranteed. At the completion of the weatherization work,acid at no additional cost to the homeowner,a final blower door acrd/or combustion safety analysis will he conducted by the sub-contractor to ensure the safety of die indoor air quality. $680.00 AIR SEALING ADDER: (2)working hours. $170.00 ATTIC PI..RT:Provide labor tmd materials to install an 8"layer of 12-28 Class i Cellulose added to(900)square feet of open attic space. $1,233.00 STORAGE BARRIER:homeowner is responsible for the removal of the stored iterns blocking the installation of weatherization work in the attic. Removal must occur prior to the scheduled work start. $0.00 VENTILATION:Provide labor and materials to install ventilation chutes in(22)railer bays to maintain air flow. $44.00 BASEMENT CEILING:Provide Inbor and materials to install(164)linear feet ofR-19 unlaced fiberglass insulation to the perimeter of the basement ceiling at die house sill. $287.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible ineasures,Columbia Gas offers 75%incentive,not to exceed 52,000 per calendar year,mid an incentive of 100%for the Air Sealing measures up to the First$680 and an additional,340 if savings are justified by die auditor. For the safety and health of your home's indoor air quality,we will be conducting a Mower door diagnostic of the available air flow in your home:both before the work is begun,and after the wear ierirattion work is complete.We will also conduct a fill 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 weallicrization incentive is$3,1110. 590,00 i Federal to 0 RISE Engineering RI Contractor Registration No MA Contractor Registration No A division orTtdelseh r;ngincering CT Contractor Registration No 60 Shawlnut unit 42,Canton,NIA 02021 CONTRACT 171 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEE!!RISE ENGINEERING CMA-1tES oC5CTUDEING AND HE CUSTOMER FOR WORK AS LOW CUSTOMER PHONE DATE CLIENT s WORK ORDER Dorothy Dibenedetto (781)789-2709 07/13/2015 408444 00002 SERVICE STREET BILLING STREET 53 Sutton Place 53 Sutton Place SERVICE CRY,STATE,DP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 ,JOB DESCRIPTION Total: $2,504.00 Program incentive: $2,113.00 Customer Total: $391.00 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF *'*Three Hundred Ninety-One&00/100 Dollars $391.00 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL,INTEREST OF i'l.WILL DE GNAROED MONTHLY ON Arrf UNPAIDBALANCEAFTER ,SEERpl OR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISK)N,SCHEDULING,AND CONTRACTOR fle=rRATtON. i OO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES __ AUTHOR !lATUR. RISE /siraerillS CUSTOMS ACCE CE NO THIS COlrTR AAY DE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOV PRICES,SPECIFICATIONS AND CONDMONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE u � �� t The Commonwealth of Massachusetts Print Form Department of Industrial Accidents ��1 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 #:603-324-1974 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 I employees (full and/or part-time).* have hired the sub-contractors 6. F-1 New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑ Demolition workingfor me in an capacity. employees and have workers' Y .� 9. ❑ Building addition [No workers' comp. insurance comp. insurance.* required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.0 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.F-1 Roof repairs . insurance required.] t c. 152, §1(4), and we have no Weatherization employees. [No workers' 13.0 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 that check this box must attached an additional sheet showing the name of the sub-contractus and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I arts an employer that is providing workers'compensation insurance for my entplohees. Below is the policy and job site information. Insurance Company Name: ACE American Insurance Company Policy#or Self-ins. Lic.#:WLRC 48151553 Expiration Date:6/30/2016 Job Site Address: . �,. ._� City/State/Zip: �I%Je �.. 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 titp 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 herebp certify under the pains and enalties o per'ury that the information provided above is true and correct. Signature: .wm __. 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 Cleric 4.Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: r DATE081 4 �0 5YW) 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(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 w certificate holder in lieu of such endorsement(s). d PRODUCER CONTACT O ' NAME: Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX(ac. (800) 363-0105 0 Southfield Mi office (AIC.No.Ext): No.): 3000 Town Center E-MAIL o suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A Old Republic Insurance Company 24147 TODBUild Coro. 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 S TYPE OF INSURANCE S POLICY NUMBER POLICY O C LIMITS LTR INSD VUBI MOLIC YYYY MMIDDIYI'W A X COMMERCIAL GENERAL LIABILITY MLVZY304834 EACH OCCURRENCE S2,000,000 CLAIMS-MADE X❑OCCUR PREM SES Ea occu DAMAGE 10 RENTED MED EXP(Any one person) S25,000 PERSONAL&ADV INJURY $2,000,000 w GEN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE S4,000,000 m X POLICY ❑JET F—]LOCPRODUCTS-COMP/OP AGG $4,000,000 m 0 OTHER: r A AUTOMOBILE LIABWTY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT $5,000,000 Ea accident X ANY AUTO BODILY INJURY(Per person) Z ALL OWNED SCHEDULED BODILY INJURY(Per acddent) AUTOS UTOS NON OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS Per accident �•• t m UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAB CLAIMS-MADE AGGREGATE DED I RETENTION B WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016X STATUTE EORH EMPLOYERS'LIABILITY YIN All Other States _ ANY PROPRIETOR I PARTNER, E.L.EACH ACCIDENT S1,000,000 C OFF ICERIMEMBEREXCLUDED7 NIA SCFC4815190 06/30/201$ 06/30/2016 IMandatory 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— DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) '.. Evidence of Coverage " 7-=-J 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. 5 c�a Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBuild Company �a 260 Jimmy Ann Drive i/� ems' Daytona Beach FL 32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD -� a�rs nth Business Re ulation �r Offee of Consumer Ai_ g —' 1 Park Plaza - Suite 170 Boston; .hl4assachusetts 02116 Home Improvement Contractcv Registration Registration: 179141 Type: Supplement Card Expiration 612512016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 Vadat,,Addres}and return card.Mark reason for change. jddre ,, Rem,"al Employment Lust Card {)filce of Consumer Affair,b Business Regulation License or re�isiratian+'olid for individuJ use t>nl) =-;- before the expiration date. if found return to: t;:J„c. �-i.OME MPROVEJV•ENT CONTRACTOR pii,cc of t:ansumer Affairs and Business iteguJatic�n 17141 Type iQ;'ark PJ2Za-Suite;i ll) '.. Ex ira*jon_ $r25I2016 Supplement :ard iieston.MA 02 11 G 11LDER.SERVICES GROUP;INC. SHA.RC) SCHWARTZ O.IIt✓T1Y A.NN DRIVE YTGi:A SE CH,EL;2114 Not vaiiK'ithout signature i ndersccrttan' CS SL-105992 RICHARD SCF kVARJ'Z 195 HUNTRESS SME"'El' }Manchester NF! 113102 09126/2016 Restricted To CSSL-lC- insulatior,Contractor Failure to posses, -rent ed!lion of the Massachusetts State Building Cok -cruse for revocation of thls license