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HomeMy WebLinkAboutBuilding Permit # 1/20/2016 �oRT� BUILDING PERMIT o� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 7,a1 p°R.4reo r4��.(GJ SSgCHus� Date Issued: IMPORTANT:NT:Applicant must complete all items on this page LOCATION L ... Prin PROPERTY OWNER .Ft. � Print 100 Year Structure yes0:no MAP PARCEL: _ZONING DISTRICT: Historic District yeMachine Shop Village ye 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 ` ,Others: ❑ Demolition ❑ Other ' % lG.irioY u N 11 tnf � r it r Nii i r r/ir. rrt. nr. r. Ell Yi. , , ., , l r l�i'!U/l�ri pY��.H„716G1. ( ;rr- ; f/r f� i10, rf , %, �/f /N � `� N !U JJ�% � , u'^Se {e ���� UUell � �9 :r�F�ood .l,n� �wJ�Wetd' �1 �bW ESC IPTION OF W RK TO PERFORMED: � .. Identification- Please Ty e or Print Clearly OWNER: Name: - -V< Phone: Address: : Contractor Name: ._._ Phone: , :v Email: 'y dike, �~ w Supervisor's Construction License: - c Exp. Date- Home Improvement License: ` ( Exp. Date: . ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST B SED ON$925.00 PER S.F. Total Project Cost: $ - FEE: $ Check No.: Receipt No.:_ Cfl NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund NORTH .q Town of ndover 0 No. 100000- h ver, Mas 1�PwkA 46P 0 L^KIE 2ba2 cocNIc..ew.c.c 1' A- o P`y41 7,95 R^Teo rP �(5 ll BOARD OF HEALTH Food/Kitchen PER T D Septic System THIS CERTIFIES THAT ........!.........!.. ... . ............. ...... ...... .................................... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ... .... .. .�.......... • • ., �� Rough to be occupied as ... �...... .. . �. �..�..... . . .. ... ......... ........... 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 he Insp ction,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 I 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION T RTS Rough 1000fService ..................... ....................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildin:; 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 4 05-0405629 RISE Engineering RI Contractor Registration No 6106 NIA Contractor Registration No 120979 RISE A division ofThielseh Enginccring ENGINEERING' 61)Shawnnut Unit 112,(:anion,AIA 02021 CONTRACT 339-502-6335 FAX 339-502-6315 Page 1 PROGRAM THIS CONTRACT tS ENTERED INTO BETWEEN RISE CMA-HE'S ENOINEERRlG AND THE CUSTOMER FOR WORK AS DESCRMFD D£LtSY/ CUSTOMER PHONE DATE CUENTY WORKORD£R '.. Tannny Griffin (978)208-1422 10/15/2015 416647 00002 SERVICE STREET DILUUG STREET 249 Carleton Lane 249 Carleton Lane SERVICE CITY,STATE,ZIP DILLINO CITY,STATE,IIP North Andover,MA 01845 North Andover, MA 01845 ,JOB DESCRIPTION AIR SEALiNG:Provide labor and materials to seal arcus ol'your home against wasteful,execs air leakage. This work will be pertonned in concert with the use of spacial tools told diagnostic tests to assure that your home will be left with a healtht'ul level of air exchange and indoor nit quality.Materials to he used to seal your home can include caulks,#bans and other products. Primary areas Iitr sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not genamliy addressed.) ]'his will require(8)working hours.A reduction in cubic Icct per minute(Cala)orair infiltration will occur.but the actual number of chn is not guaranteed. At the completion of*life wcalhcrirrtion work,and at no additional cost to file homeowner,a final blower door rind/or Combustion safety analysis will be Conducted by the sub-contractor to ensure the safety of the indoor air quafily. $680.00 AIR SEALING A0DrR: (4)working hours. $340.00 DAMMING:Provide labor and materials to install if 12"layer of R-38 unfaced fiberglass bails to(128)square feet for damming purposes, $262.40 A1TtC FLM':Provide labor and materials to instal]a 7"layer oi'R-25 Class I Cellulose added to(1512)square feet of open attic space. $1,965.60 KNEEWALL,S:Provide labor and matcritds to install 2" FSK fiaced septi-rigid fiberglass board insulation to(236)square feet of kneewall area. $896.00 KNE(WALL FLOOR:Provide labor and materials to install a 7"layer of'R-24 Class 1 Cellulose added to(288)square feet of open kneewaii floor $357.12 A-I`1'IC ACCESS:Provide Tabor and materials to insulate the back of(I)attic hatch with 2"rigid Themutx board.Weatherstrip life perimeter. $60.0(1 A171C ACCESS:Provide labor and materials to install(1) new,finished plywood,kneewall space access hatch.]]ac hatch will be insulated with code compliant 2"rigid Theminx board,weather-stripped,find held closed by eye(rooks. (Wood surfaces will be unfinished. Prime coat and/or paint is not included.) S120.00 VEN]]LA"rION:Provide labor and materials to install(2)insulated exhaust hose with roormounied(hipper vent to exhaust exfsling bathroom ran(s). $237.50 VCN]]LA'i-ION:Provide labor and materials to install ventilation chutes in(64)rafter hays to maintain air flow. S128.00 RISE Iaugincering will apply till applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Columbia Gas oflem 75°/ti incentim not to exceed$2,000 per calendar year,rind an incentive or 100%for the Air Scaling ntcasurLs up to the first$680 and an additional$310 if savings arojustified by the auditor, Federal ID#05-0405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RISE A division ofThietsch Engineering ENGINEERING 60 Shawniul(Jail 112,Canton,NIA 02021 CONTRACT 339-502-633-5 FAX 339.502-0345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCIIHIED811LOW CUSTOMER PHONE DATE CUEOr 9 WORK ORDER Taminy Griffin (978)208-1422 10/15/2015 416647 00002 SERVICE STREET BILUNG STREET 249 Carleton Lane 249 Carleton Lane SERVICE C"Y,STATF-ZIP BILLING CITY,STATE,?JP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION For the safety and health of your home'.,;indoor air quality,we will be conducting blower door diagnostic of the available air flow in your home both belbre the work is begun,and after the wentherimflon work is complete.We will also conduct a full assessment or the Combustion safety of your healing System and water heater,'rhis has a value of$90 and is at no cost to you. "Total Allowable -weatherization incentive is$3,110. S90.00 Total: $5,136.62 Program Incentive: $3,109.99 Customer Total: $2,026.63 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'Two Thousand Twenty-Six&63/100 Dollars $2,026.63 UPON FINAL INSPECTI AND ROYAL BY RISE ENOWEEFUNG.CUSTOMER AOREES To scmir Amount DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY 0 S* LANK 8 a UNPAJDDALN�JCE H30 SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANIEES,RIG14TSOPRECISlot),SCHEDUU)10,AtiOCOtiTRACTORREOISTRATIO?I. DO NOT SIG Tws`CONTRACT IF THERE ARE LANK SP AUTHOR -0 ONAYURC-RMIE11III('40 I ICUS�OMFR 7ACCE�PTANcr 110111:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHW DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30SATISFACTORY 10 US AND ARE HEREBY ACCFPTED.YOU ARE AUTUORVED TO 001HEWORK DAYS� AS SPECIFIED,PAYMENT WILL BE MADE AS OUTLINED ABOVE s The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations 1 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): guilders 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. ✓0 I am a employer with 100 4. ❑ I am a general contractor and I 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 working for the in any capacity. employees and have workers' ' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.'+ required.] 5. ❑ We are a corporation and its 10.E] Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11,❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.7 Roof repairs insurance required.]' c. 152, §1(4),and we have no Weatherization employees. [No workers' 13. ✓V Other comp. insurance required.] *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. �Contractois 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 ani an employer that is providing workers'compensation insurance for my employees. 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: v:) a., e n .. t n e City/State/Zip: �„• r ��r t ` 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. Ido hereby certify under the pains and penalties of perjury,l tat the information 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��® DATE06/24/22015 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 Q1 certificate holder in lieu of such endorsement(s). c PRODUCER CONTACTa NAME Aon Risk Services Central, Inc. PHONE FAX Southfield MI Office (AIC.No.Ext): (866) 283-7122 (ac.No.): (800) 363-0105 a 3000 Town Center E-MAIL O suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC q 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 0: 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 INSR LTR TYPE OF INSURANCE DDINSM U13 POLICY NUMBER FOLICY EFF YYYY POLIOY EXP�MMID /YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304834 - EACH OCCURRENCE S2,000,000 DAMAGE O RENTED $2,000,000 CLAIMS-MADE X❑OCCUR 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-COMP/OP AGG S4,000,000 N 0 OTHER: A AUTOMOBILE LIABILITY PIWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT $5,000,000 N Ea accident X ANY AUTO BODILY INJURY(Per person) 0 Z ALL OWNED SCHEDULED BODILY INJURY(Per accident) ALTOS AUTOS00 X HIREDAUTOS X NON-OWNED PROPERTY DAMAGE Per accident t:9 AUTOS . '.. C d) UMBRELLA LIAB OCCUR EACH OCCURRENCE U EXCESS LIAR CLAIMS-MADE AGGREGATE DED I RETENTION 8 WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE DRH EMPLOYE RS'LIABILITY YIN All Other States ANY PROPRIETOR/PARTNER f EXECUTIVE E.L,EACH ACCIDENT S1,000,000 C OFFICERIMEMBEREXCLUDED7 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 I E.L.DISEASE-POLICY LIMIT S1,000,000- DESCRIPTION OF OPERATIONS I LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) 7..( Evidence of Coverage J.r 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. c..a Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBuild Company 260 3immy Ann Drive 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 t/Oh f€ {%•f ai'l tzrE' 'ft .Ef <` c. `✓ 2:t_{.:�,� ��,:fr � ' { foe of Consumer Ajtairs hand Business Regulation —` - 10 Park Plaza - Suite J 17i , Boston; Massachusetts 02116 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`ttdate Address and return card. Mark reason for change. 3ddre>t Rew' al Employment Lust C'artf -- ice of consumer Affairs& Business Regulation License or re�stratian valid for indi�'idul use f),1anl� before the expiration dale. if found return to: IMPROVEMENT CONTRACTOR Oii;ce of Consumer Affairs and Business Regulation 'Registration: ,79141Type lo'ar' P!Yza-tiutrr 5170 Expirauan: Sr[5/2G16 Supplement aid Boston.MA 0211, JILD=P.SERVICES GROUP;INC. CHARD SCH'1%'ARTZ o Jli+MY ANN DRIVE .YTONA SE CH.rL�211� 1't,dcrsctretan Not Y. art ithout sign2ture t 1, 1* 1;,,h CSSL-105992 RICHARD S(.I-IWAR'I'Z 19-5 HUNTRESS s,rREEl' Manchester Nil 03102 0912612016 Restricted To CSSLIC- Insulation COr)traCtOr Failure to posses, -rem edition of the Massachusetts State Building Cot 'ause for revocation of thlc;ilcerlsf?