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HomeMy WebLinkAboutBuilding Permit # 1/20/2016 BUILDING P taoRr�i IT ®��kOR TOWN OF NORTHANDOVER ° APPLICATION FOR PLAN EXAMINATION o Permit No#: Date Received —Are.CHU ppR ^5 R Date Issued: Lp I ORTANT: Applicant must complete all items on this page N LOCATION _,.... PrVil PROPERTY OWNER rh t 100 Year Structure yesno MAP PARCEL:-6672'0ZONING DISTRICT: Historic District ye no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other °`rl,Nilllll( Septic :I Well f /�li l r FNood a IIprr Ullet,l,ands ,r ® Wates, ed D,s l,ct; r o-,lka�a,�v��Sre,11V,e1%�J����,7�r/,�i�r1,!Jr,,(, r.:,.;Ill �r n, 'f I,l ,.9� r:F,r ll� DESCRIPTION OF!ORK TO BE PE RFORMED' E,l �C tLX6CY0 el ry 61 A Ventificaflon- Please Type or Print Clearly OWNER: Name: - Phone: , w Address: �:_ T-.. ,, - ( - ,. Contractor Name: -,M iS g,� Phone. " �" Email: &2 t" ;' .,p N , Address. _ � . .-._ ' Supervisor's Construction License: a � � Exp. Dater Home Improvement License: °,`. 4 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ -" FEE: $ Check No.: r✓ Receipt No.: NOTE: Persons ca tracting with unregistered contractors do not have access to the guaranty fund -To.wn ofNO R TFt . tAndover ver, Mas C, COCNICNl WIC.[ RATED U BOARD OF HEALTH Food/Kitchen PERM L D Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .................. .......... . • Foundation has permission to erect .......................... buildings on ............ ... ... .... .... . ..... .. ... .... Rough g to be occupied as .....�.1�# ... ....... ...+i .. ...... .. � .& . AL........ Chimney provided that the person accepting this permit shall in every respect conform to the terms okhe application Final on file in this office, and to the provisions of the Codes and By-Lawrelating to the Inspection,Alteration and Construction of Buildings in the Town of North Andover. S ��f PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final ER IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIONS Rough AService ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Islay in a Conspicuous Place on the Premises — Do Not Remove Final ® Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Federal ID#0504005629 RISE Engineering Rt contractor Registration No 8186 MA Contractor Registration No 120979 A division of Thielsch Engineering CT Contractor Registration No 620120 �. 60 Shawmut,Canton,MA 02021 VOti�tl po p� d RAWT 339-502.5197 FAX 339-502-6345 E Page 1 PROGRAM ENGINEERING CMA-HES ENGINEERING IS � GAND IS ENTERED INTO FORWORKKAAS DESCRIBED SE CUSTOMER PHONE DATE CLIENT a WORK ORDER Peter Baylies (978)685-7931 07/31/2015 415559 004(}2 SERVICE STREET 131LUNG STREET '.. 61 Brightwood Avenue 61 Brightwood Avenue SERVICE CITY,STATE,ZIP B1UINO CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the Use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing 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 the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 AIR SCALING ADDER: (4)working hours. $340.00 AIR SEALING:Provide labor and materials to install Q-Ion weatherstripping and a doorsweep to(3)door(s)to restrict air leakage. $225.00 KNEEWALLS:Provide labor and materials to install R-13 faced fiberglass to(92)square feet of kneewall. Then install 2"rigid board insulation.Seal all scams with FSK tape. $335.80 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(70)square feet of knccwail area. $245.00 KNEEWALL FLOOR:Provide labor and materials to install a 14"layer of R-49 Class 1 Cellulose added to(70)square feet of open kneewall floor. $106.40 KNEEWALL FLOOR:Provide labor and materials to install a 9"layer of R-31 Class i Cellulose added to(110)square feet of open kneewall floor $143.00 KNEEWALL FLOOR:Provide labor and materials to install a 9"layer of R.-30 unfaced fiberglass batts to(36)square feet of kneewalt floor space. $60.12 ATrIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thermax board.Weatherstrip the perimeter. $60.00 ATrIC ACCESS:Provide labor and materials to install(2) new,finished plywood,kneewall space access hatch.The hatch will be insulated with code compliant 2"rigid Thermax board,weather-stripped,and held closed by eye hooks. (Wood surfaces will be unfinished. Prime coat and/or paint is not included.) $240.00 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with roofmounted flapper vent to exhaust existing bathroom fan(s). $118.75 VENPILATION:Provide labor and materials to install ventilation chutes in(11)rafter bays to maintain air flow. $22.00 Federal ID#054405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 A division of Thielsch Engineering CT Contractor Registration No 620120 60 Shawmat,Canton,it9A 02021 CONTIONA CT " 339-502-5197 FAX 339-502-6345 VV 1I�� Page 2 PROGRAM E NGIN IEE RIN GTHIS CONTRACT is ENTERED INTO BETWEEN RISE CMA-RES ENGINEERTNO AND THE CUSTOMER FOR WORK As DESCRIBED BELOW custom R PHONE DATE CLIENTS WORKORDER Peter Baylies (978)685-7931 07/31/2015 415559 00002 SERVICE STREET BILLING STREET 61 Brightwood Avenue 61 Brightwood Avenue SERVICE CITY,STATE,DP BILLING CITY,STATE,LP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION BASEMENT CEILING:Provide labor and materials to install(120)linear feet of R-l9 unlaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $210.00 BASEMENT DOOR:Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2"rigid board that meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and seams with FSK tape. $72.22 RISE Engineering will apply all applicable,eligible incentives to this contract. You wilt only be billed the Net amount. Currently,for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 pLi calendar year,and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional$340 ifsavings are justified by the auditor. For the safety and health of your home's 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 atter the weatherization 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 weatherization incentive is$3,110. $90.00 Total: $2,948,29 Program Incentive: $2,488.72 Customer Total: $459.57 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Fifty-Nine&57/100 Dollars $469.57 UPON FINAL INSPECTIMANO APPROVAL BY RISE ENGiNEERINO.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILT.BE CHARGED MONTHLY ON ANY UNPAID BALANCER DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIOHTS OF RECISION,SCHEDULING,AHD CONTRACTOR REGISTRATION. DON GN THIS CONTRACT IF THERE ARELA ACES t. ;iUTHOI&MO SIGNATURE•RISE En910"ring CUS MER ACCEPT 4CE NOTE:THIS CONTRACT MAY BE WITHDRAWN 8Y US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE � �.- ACCEPTANCE OF CONTRACT-THE ABOVE PRICES.SPECIFICATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations ress Street, Suite 100 k 1 Cong mm 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): LZ I am a employer with 100 4. ❑ I atn a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8• ❑ Demolition working for the in any capacity. employees and have workers' �. 9. F-1 Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. F-1Weare a corporation and its 10.❑ Electrical repairs or additions 3.El am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. tight of exemption per MGL 12.❑ Roof repairs insurance required.] ? c. 152, §1(4), and we have no Weatherization employees. [No workers' 13. ✓❑ Other comp, insurance required.] *Any applicant that checks box#I 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-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 jab site information. Insurance Company Name: ACE American Insurance Company Policy#or Self-ins. Lic. #:WLRC 48151553 Expiration Date:6/30/2016 Job Site Address: "` �' J City/State/Zip: s (S.t(`- a copy of the workers'� pensation 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 enalties o perjury that the information provided above is true and correct. Signature: Date: l 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#: DATE0(/24015 ) 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). c PRODUCER CONTACT Aon Risk Services Central, Inc. PHONE FAX Southfield MI office (AIC.No.Ext): (866) 283-)122 AIC.No.: (800) 363-0105 3000 Town Center E-MAIL suite 3000 Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A Old Republic insurance Company 24147 TODBUild Corr). 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 ADDL SUER POLICY NUMBER MMIDDIYYYY MPOLICY EFF MIDDIYYYY Y F:XP LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY3 83 EACHOCCURRENCE $2,000,000 CLAIMS-MADE OCCUR AM G O $2,000,000 PREMISES Ea occurrence MED EXP(Any one person) $25,000 PERSONAL 8 ADV INJURY $2,000,000 io GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,0 X POLICY [--]�E T ❑LOC PRODUCTS-COMP/OP AGG $4,000,000 co 0 OTHER: o n A MWTS 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY / S5,000,000 Ea accident BODILY INJURY(Per person) C Ix ANY AUTO Z ALL OWNED SCHEDULED BODILY INJURY(Per accident) pl AUTOS AUTOS HIREDAUTOS X NON-OWNED PROPERTY DAMAGE U AUTOS Per accident w it d f..) UMBRELLA LIAB OCCUR EACH OCCURRENCE '. EXCESS LIAB El CLAIMS-MADE AGGREGATE DED RETENTION '. 8 WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE GRH EMPLOYERS'LIABILITY YIN All Other States — - C ANY PROPRIETOR I OFFICER/MEM ER XCLUDED?TNER I EXECUTIVE N NIA SCFC4815190 06/30/2015 06/30/2016 E.L.EACH ACCIDENT $1,000,000 (Mandatory in NH) WI Only E.L.DISEASE-EA EMPLOYEE $1,000,000 if yes,descuibe under DESCRIPTION OF OPERATIONS below I I E.L.DISEASE-POLICY LIMIT S1,000,000— DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Evidence of Coverage M 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. Builder services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBUild Company 260 Jimmy 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 airsn e of Consumer Ai Business Regulation �-, 0ffie 10 Parr Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Reqistration: 179141 Type: Supplement Card Expiration: 6125/2016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 t'ndate Addres>and return card.Mark reason for change. Addre t Renewal Employment Lost Card Office o.t:'onsurner Affairs b Business Regulation License or registration valid for individul use nni% IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Of-.cc of t:onsumcr Affairs and Business Regulation .'Regiistration: 179141 Tyne 10 park Plaza-Suite 5170 Expiration: 6/25/2016 Supplement Card Boston,MA 021 lb JILDER SERVICES GROUP, INC. ARTZ CHARD SChi DRIVE 0.71A/ivlY ANN DRIVE .. =4,%.•..;.*::"�.__.... r•''w •XTONA BE,^,CH.FL 32114 t'nder>ccrztan Not valid ithaut sirnaturc F ,:!!�t{(a tin Fl `U to t':it,:r'�+ItcY t.la`• CSSL-105992 RICHARD SCHW ARTZ 197 HUNTRESS STREET Manchester NH 03102 09/26/2016 Restricted To CSSL•lC-Insulation Contracts' Fatture to posses rent edition of the Ntassachusetts State Building Cot _ause for revocation of t.hv;license . ... . . . I. I ..—— .. lr,.Px