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HomeMy WebLinkAboutBuilding Permit # 1/20/2016 BUILDING PERMIT o�NLeD "��, T F NORTH ANDOVER ®� � ::,. ...:,, $ o APPLICATION FOR PLAN EXAMINATION Permit No#: - Date ReceivedAroo ON �SsgcaaUS�� Date Issued: I PORTANT:Applicant must complete all items on this page LOCATION ' ... Pn ' t PROPERTY OWNER Print 100 Year Structure yes Lno MAP l PARCEL: 1 ZONING DISTRICT: Historic District yes Machine ShopVillage es g Y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building JSQpe family ❑Addition ❑Two or more family ❑ Industrial ,nRQeration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg CWOther ❑ Demolition ❑ Other L _ Gr ,. _W9 „, r „n '6`/A „N ll'D�l�f� PGrCN.k,VJ f. ?,11,r////nf U..,ff/!! iI I ,.19,. I( 1 C U'11CI1i ,;,�:9(;l� ,.lG i,.✓lir, o ,i i,w.t.. ,r rU ✓ ,//1%-U, j., Ir Se {i t u�c Well/ jjl �i yC( j j,( Flood anijWet i � ,,, � ,d..��J�l�1����; (��❑��,Waters ed D�stnct/,,���(��rl ON OF WORK TO BE PERFORMED: -. (,., . enti kation- P lease TypeTTIVVI,:1 r Print Clearly OWNER: Name: .j., Phone: -- Address: w v, Contractor Name: ° LA,,i �.,4 Phone: 4PC - � l Email: �:�. w. � .:d Address: - ._. .n , , mm Supervisor's Construction License: S-'? -D, Exp. Date: Home Improvement License: L- Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. T !� _. otal Project Cost: $ . �7 FEE: $ "`� 171 qCheckNo. Receipt No.: NOTE: P1'ersons c n racting with unregistered contractors do not have access to the guaranty fund NORTH 4\A 0 WVV 0 nciover ® ' ye No. W-q 5A Qy� to SSC vlrl N. Co"IC"&WICK �' S U - BOARD OF HEALTH Food/Kitchen PER T L D• Septic System THIS CERTIFIES THAT .................... �NQ.......... ............,5....... ............CA ..,�.....it..................... 04* BUILDING INSPECTOR Foundation has permission to erect............. ............ buildings on . ....:. '... ..., ... .............. Rough to be occupied as ...... 1 . .. ..*............ .... 1 . . .. . ..�.►....... .......... 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 the Inspection,Alteration an 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 CONSTRUCTION STARTS 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 and Approved by the Building Inspector. Burner Street No. Smoke Det. Federal ID 1105-0405629 IZISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 RISE A division ofThicisch Engineering ENGINEERING' 6().Showinut tinit 1l2,Canton,MA 02021 CONTRACT 339-502.6335 FAX 339-502-6345 Page 1 PR06RAM THIS CONTRACT 16 ENTERED INTO BETWEEN RISE CMA41ES ENGINEERING AND THE CUSTOMER FOA WORK AS DESCRI13ED BELOW CUSTOMER PHONE DATE CLIENTA WORK ORDER Elaine Christman (978)569-5600 12/01/2015 410505 00002 SERVICE STREET BILLING STREET 25 Copley Circle 2.5 Copley Circle SERVICE CITY,STATE,ZIP SILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01815 3OB DESCRIPTION HAZARD BARRIER:We have identified that there arc recessed lights present in your honic,unless the recessed lights tire certified -I , blanket insulation as a s IC-rated(Insulation Contact Rated)we will create It 3"clearance space around the fixture by using fiberglass damming material,no insulation will be installed across the top and closed cavities which contain recessed lights will not be insulated. $0J)o AIR SEALING:Provide labor and materials to seal areas of your home against wastefi l.excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests toassure that your home will be loll with heahliflul level of air exchange and indoor air quality.Materials to be used to sea]your honic can include caulks,lbams aiul other product,;. Primary areas for scaling include air leakage to attics,basements,attached IIaTagcS and other unhealed areas(windows are not generally addressed,) This will require(8)working hours.A reduction in cubic feet per minute(efin)of air infiltration will occur.but the actual number of*efin is not guaranteed, At the complvtion oftlic weatherization work,and at no additional cost to the homeownera final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the salbty oI*Ibc indoor Ifir quality. $680.00 AIR Sl"Al-ING ADDER: (4)working hours. $340.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 mitheed fiberglass batts to(36)square feet for damming purposes, $7180 ATFIC Fllabor and materials to install a 6"layer ofR-21 (.']its,, I Cellulose added to(612)square feet of open attic space.Tl ItS INCLUDES SLOPES OVER MASTER BEDROOM VAULTY. $771.12 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(86)square feet of knemall area.*rl IIS ALSO INCLUDES MASTER BEDROOM I.,Ni)Of"'VAULT. $301.00 ATrIC ACCE.SS:Provide labor and materials to insulate the back of(Dalfie batch with 2"rigid Thenum board.Weatherstrip the perimeter, $60.00 ATI'IC ACCESS:Provide labor and materials to insulate the back of(I)attic hatch with 2"rigidThentiax board.Weatherstrip file perimeter, $60.00 VENTILATION:Provide labor and materials to install(3)insulated exhaust hose to existing bathroom $1.50.00 RISEEngincering,will apply till applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Columbia Oras oilers 75%incentive,not to execed$2,000 per calendar year,and all incentive of 100%for the Air Scaling measures tip to the first$680 and an additional$340 il'savings are justified by the auditor. For the sately and health of your home's indoor air quality,We will be conducting a blower door diafy,iostic of the available air flow in your home both before the work is begun,and after the weatheri7ation work is complete.We will also conduct it full assessment of the combustion safety of your heating system and water heater.'this has 11 value of$90 and is at no cost to you. Total allowable wealherization incentive is$1,110. Federal 10##0"40&629 RISE Engineering R1 Contractor Registration No 8186 MA Contractor Registration No 120979 RISE A division of"I'hirisch Lngincering ENGINEERING' 60 Shawntut Unit 02,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CNIA-11JES ENGINEERING AND THE CUSTOMER FOR WORK AS bESCRia£O BELOW '. CUSTOMER PHONE DATE CLIENT it WORK ORDER Elaine Christinan (978)569-5600 12/01/2015 410505 00002 SERVICE STREET BILLING STREET 25 Copley Circle 25 Copley Circle SERVICE CITY,STATE,ZIP BILLING CITY,STATE,Zip North Andover, MA 01845 North Andover,MA 01845 JOB DESCRIPTION S90.00 Total: $2,525.92 Program Incentive: $2,171.94 Customer Total: $363.98 WE AGREE HEREBY TO FURNISH SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'Three Hundred Fifty-Three&98/100 Dollars $353.98 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE 30 DAYS,SEE REVERS•FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. _* T'SW iGN THIS CONTRAC T IF THERE ARE ANY BLANK SPACE AUT R ONATURE RISE E 11w(If CU T-1 NOTE:THIS CONTRACT MAY HE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE. ACCEPTANCE Of CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED 10 00 THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE ThCof The mmonwealth o Massachusetts Print Form Department of Industrial Accidents .......... 12 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.F,/_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 g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y p Y• ' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.+ required.] 5. ❑ We are a corporation and its 10.El 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.❑ Roof repairs insurance required.] c. 152, §1(4), and we have no -1Weatherization employees. [No workers' 13. ✓ Other comp. insurance required.] *Any applicant that checks box#1 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. ¢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. lam 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: w r I ' L—I -�� � �� Cit /State/Zi � Attach a copy of the workers' compensa on 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 gains and penalties of perjur•1 at the information provided above is true and correct. s � � 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: A��® DAT (MMIDYY) CERT'IFICAT'E F LIABILITY INSURANCE D15 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 °f certificate holder in lieu of such endorsement(s). m PRODUCER CONTACT '6 NAME: Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 Southfield MI office INC.No.Ext): (,AX -a 3000 Town Center E-MAIL o suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURERS)AFFORDING COVERAGE NAIC(3 INSURED INSURER P: 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 LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER MMIDDIYYYY MMIDD/YYYY LICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY KIZY3048 4 EACH OCCURRENCE $2,000,000 OCCUR DAMAGEO RENTED S2,000,000 CLAIMS-MADE ❑Xoccurrence) '.. PREMISES Ea MED EXP(Any one person) S25,000 ',.. PERSONAL&ADV INJURY $2,000,000 m GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,600 ,a X POLICY �JE0. ❑LOC PRODUCTS-COMPIOP AGG $4,000,000 m 0 OTHER: A AUTOMOBILE LIABILITY MLYrB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT $5,000,000 '.. Ea accident X ANY AUTO BODILY INJURY(Per person) 0 ALL OWNEDSCHEDULED BODILY INJURY(Per accident) y AUTOS PROPERTYDAMAGE L) X HIREDAUTOS X NON-OWNED AUTOS Peraccidenl Ii. Q UMBRELLA LIAR HOCCUR EACH OCCURRENCE V EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE ETH EMPLOYERS'LIABILITY YIN All other States ANY PROPRIETOR PARTNER, E.L.EACH ACCIDENT $1,000,000 C OFFICERIMEMMBEREXCLUDED 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,may be attached if more space is required) Evidence of Coverage Oki J.J YJ 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 26(2014/01) The ACORD name and logo are registered marks of ACORD — Office of Consumer Affair,hand Business Regulation << I art: Plaza - Suite J 170 Boston; .Massachusetts 02116 Home Improvement Contractor Registration Registration:: 179141 Type: Supplement Card Expiration6.'25/2016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NAS H UA, NH 03063 t'Mate Address and return card.'Bari:reason for change. "-.ddre t Rencttal Enwloyment Lust C't;rd Orfice of C:unsumer Arfairs s Business Regufaieon License or regEsiratiun Valid for indiF idol use anl� ^-<. before the expiration date. if found return to: .t';:'1;1jME imPROVEMENT CONTRACTOR office of Consumer A;airs and Business ltegulatit>n :r'Z2gistratiar: ;79141 Type tt} pjr't Plaz2-Suite 5?70 Expiration. 6,25/2016 Supplement -ard Boston.11A 02116 JILD=P.SERVICES GROUP:INC. ;HARD SCHWARTZ 0 j1WAY ANN DRIVE ' tot vniid;H•ithaut sigp.2ture .YTONn 61 ACH. L 2114 t'nderscrrttar}' CSSL-105992 RICRARD SCRWAR*I'Z 195 HUNTRESS S'rRI:E•:T' ManchesterNH 113102 09126/2016 Restricted To CSSLIC Invflat"M COntra'JOT Failure to posses, -rent edition of the Massachusetts State Building Cot Muse for revocation of tiw; license