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HomeMy WebLinkAboutBuilding Permit # 1/20/2016 11 UILDING PERMIT ���T 0, g�� ��,h�..r ab O� TOWN O NORTH ANDOVER :;. APPLICATION FOR PLAN EXAMINATION _ Permit p mft N®f. w� Date Received � 0`R�A7E`°0 F.PR�y.gS �s'SACFlUS�4 Date Issued: 1 IMPORTANT: Applicant must complete all items on this page t i v '� �Q,'I• � '� IS`k ��� �iV��� C � ,�,r � e a ��� TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family ❑Addition ❑Two or more family ❑ Industrial 4AAIteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg .Other Gr,�rt. u-,„,.tC❑ Demolition ❑ Other /yY/ lII�Ji/%//d1Wetads e .r,.,.lirLs•Mdn1ll(i leGw✓,d d �.. u .,T 1.�.e DESCRIPTION OF WORK TO BE PERFORMED: I IV V/ I Identification- Plea T pe or Print Clearly OWNER: Name: A Phone; �� 5 � Address: I Aa .. f ME a, h9SMAJIM a t r ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$425.00 PER S.F. Total Project Cost: $ '�A FEE: $ ' Check No.: U � Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund w� fS.i,g,�n;irarr�rtruirirvecr�fo�iif�/e r%ge�iil/n„ert,/,O„w�i,rnrrerrrrreo„d<//,i�rr/iiii / ,,;: %r „�.... 7; �„ ,r....... I naNW ni7nl�r,a� i —� � NORTf•{ town of E �' ®ver O " 0 L ® 61 �c ,F soh ver; Mass,tT0&0jb" LAKE �oC"Ic"aw.cK y1. x,95 RATED r'P�,`'�5 U BOARD OF HEALTH Food/Kitchen rERM LD Septic System .. .. . t BUILDING INSPECTOR THIS CERTIFIES THAT .. .... .... ..... � Foundation has permission to erect .... buildings n ... M!� ..................... . . ............................... Rough ..... ..................................... Chimney to be occupied as ........ :..�.. . .. . . ...... ....,C�,,.,. . ....�:.r.......... . v provided that the person accepting this per, all 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. PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final ER IT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS C STRCTION TS Rough Service ........................J ..................................................... Final BUILDING INSPECTOR GAS INSPECTOR 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. Dec. 1. 2015 1,39AM No. 2262 P. 2 I// Federal tDOM440=11 1l�,J Rl CentraeteT RegietraUon No 8186 ,.-+�:RYS�1H',tlgineetripg MA Contractor Regtatratton No IMS79 RISE -' A divlaloe of Thielsob Eogkneering ENGINEERING 60 WwmurUnIN#2,Canton,MA 02021 CONTRACT 3393026335 0'16345 G7 EC-) Page PROGRAM TrNe OotaTnacr�sexrtaEo iNto eer4TEeW Cee �.M mot Eoea O OTHUMTOWMFOWWWAS CUSTOMERFROM! CATs CLW# WOMMOPM Kara Camey (978)808-5652 11/0612015 421374 00002 MV=8-MM �'eaama 9TW 122 Chadwick Street 122 Chadwick Street BeAM a",&TATE,tea GUA G env aTATA zP North Andover,MA 01845 North Andover,MA 01845, .r JOB DESCRIPTION HMTH&SAFETY:weathwhation work cannot proceed until ttw spolw of combustion grits h fixed. LZ S been +�cedl $ono ALR SEALING:Provtdo labor mid maudds to scat areas ofyour borne againstwastoM,Seeds air leakage. This sono k wlU be perfumed in concert witb rho use of special tools and diagnostle oasts to assure that your home will be left with a hoalthful Leval of air ext:bange and Indoor air quality.Materials to be used to scat your homy can iacludo caulks,foams and other products. Prlmary areas for sealing include aIr loakago to Coles,basemen%&!reeked garages and other unheated areae(windows ata not generally addressed.) This will require(7)woeft hours.A reduction in cubic feet per minute(offs)of airiatittration will occur,buttho actual number ofdlln is not guaranteed. At the completion of the weatherization work,and at no additional dost to the homeowner,a final blower door and/or combustion safety analysis will bo oonduacd by the sub-oonoreetor to am=the safety of tho Indoor air qual'0. 5593.00 13AMM1 11.Provide labor end materials to install a 12"layer ofR 38 unfeoed Obarglass baits to(2S)square&A far damming purposes. $51.25 ATTIC PLAT:Provide tabor and materiels to Install an 8"layer of R-29 Gass t Cellulose added to(580)square feet of open attic space. $794.60 ATTIC ACCESS:Provide labor and materials to Witte the back of(1)attic hatch with 2"rigid Thomax board.Weatherstrip the pair. $60.00 VENTILATION:Frovido labor and matalels to Install veattiladon chutes In(367 raftcr bays to maintain air flow. $72.00 BASEMENT C1;MG:Provido labor and materials to install(72)linear flet of R-19 unked fiberglass insulation to the perimeter of the basement ceiling at tha!rouse allL $126.00 0VU1 ANCr Prwido labor and matertats to install 10"11..97 densely packed Class I Cellulose insulation to(96)squerefeet of exterior overhang located below a heated floor area,by drilling holes is the overhang Item below. NOW drilled will be plagged. Plugs will be sealed with exterior grade spackle and left in a relatively smooth condition.DWA sanding and touch-up privaWpalaft will be rho customcrIs rosponsibility. $384.00 RISE Engiaaerhtg will apply sll applicable,eligible incentives to this contract. You will only bo billed tho Net amount Currently, fur etlgible measures,Columbia Lias olf rs 75%incentive,not to oxoecd 52,000 per oalmder year,and an incentivo of 100%far the Air Sealing measures up to the first$680 and an additional$340 if eavings are Justifled by the auditor. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of Lha available air how In your home bulb before the work Is begun,and after Lha weadtetizntioa work is comptua.we will also conducts Hill assessment of the combustion safety of your heating system and water treater.This has a valuo of 390 and h at no cost to you. Total allowable w¢athrrization faccmive Is S3,110. 590.00 Dec, 1. 2015 l:39AM No, 2262 P. 3 v FederEl IUO08.0448828 �. -', RISE Engineering RI CaMador RegtetratIon No 8188 ISEs:;" A dMilDo of 7blelach Enginurlog MA CoMmacrRegimbn No 120M ENGINEERING 60 Shawatot Unit#2,CantOD,M&02021 CONTRACT 339.501-M MUM-S"os Page 2 PILO MM OOMfRAOT US ENTEREOINIO eE7W8Hi RUlp CMA-MS ENBIN813i1N0M MEXWOR M 0MOMM OMM Cub uk" MOM OATS CUEMr9 WOUam= Kara Cagey (978)808-5852 11/06/2015 421374 00002 8MM OTRW 8IwM0 STREET 122 Chadwick Street 122 Chadwick Snot 8MUWG0M.BYATE,VP e1VW0 CRY,OTATEMP WeA Andover,MA 01845 North Andover,MA 01845 J'OD DESCRIMON Total: $2,172.86 Program Incentive: $1,800.89 Customer Total: $371.96 WSAORHSHMDYTOFURNISHSUMCFS•COMPLMINACCOROANCEWYMABDVESPECIRCATt "FORTHESUMOF ***Three Hundred Seventy-One 8 961100 Dollars $371.96 UPCNMMALM MOPAOYAL61MMEMCItO;aAiUMUSTOMMAGUM70BMW AMUTOUEWFUU-IWUMTOFMAWL e6CAieEOWMLYONANY UNPAID OAWSM FORnAORTANTIMFOHMATIONON 6"WaEEB."Map owma".80NEQ ma,"acONTRACYORREWBTRATMOV, OT VON THIS CONTRACT IF THERE ARE ANY BLANK SPACES OLL a t egM een I p tlOTETNISOONMUTMAYUWKKDRAVMBYUSIFNOT EMUTMVMIN DATE OrACCEPTMU AaQEPTANCEOP WDrtRACY•TNpA80YdPR{OEg,SPEgROAT10N,AN000NDiROMe ARe 30 GAYS. 8AT18PAC'fORYTOUBAAOARE((gtpBYAO�PthDYOUMdAUT1SORQEDTODOTMEWOAM A8 B9EOIR80.PAY1�fTVA1.L8�kA0EA80UTLNCEb A80YE The Commonwealth of Massachusetts Print Form Department of Industrial Accidents Office of Investigations I Congress Street, Suite 100 ry" Boston, MA 02114-2017 ' t 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): 1.0 I am a employer with 100 4. F� I am a general contractor and I employees (frill and/or part-time).* have hired the sub-contractors 6. ❑New construction 2.F_] 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 working for me in any capacity. employees and have workers' 9. ❑ Building addition [No workers' comp. insurance comp. insurance.t required.] 5. ❑ We are a corporation and its 10.F-1 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.7 Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] t c. 152, §1(4), and we have no Weatherization employees. [No workers' 13.7V Other comp, insurance required.] *Any applicant that checks box#1 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. lContractors that check this box most 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. #:WRC 48151553 Expiration Date:6/30/2016 " � 1, City/State/Zip: . ,� Job Site Address: ,�� , ,, C ... 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 WORD ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement tnay 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 information provided above is true and correct. Signature - 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#: ® DATE(MM/DD/YYYY) CERTIFICATE OF LIABILITY INSURANCE I 06/24/2015 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). a m CONTACT 'C PRODUCER NAME: — Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 `m Southfield MI office (A(c.No.Ext): (ac.No.): a 3000 Town Center E-MAIL ° Suite 3000 ADDRESS: S Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A: Old Republic insurance Company 24147 ToDBuild Cori). 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 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 LTR INSR TYPE OF INSURANCE INSD WVD POLICY NUMBER MM1DDlYYYY MMIDD/YYYY LIMITS A X COMMERCIAL GENERAL LIABILITY MW2Y3O4834 EACH OCCURRENCE S2,000,000 DAMAGE To CLAIMS-MADE F1OCCUR PREMISES Ea occurrence) _ S2,000,000 MED EXP(Any one person) S25,000 PERSONAL B ADV INJURY $2,000,000 cmj m GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,600 00 r7lX POLICY F]JE 0. ❑LOC PRODUCTS-COMPlOP AGG $4,000,000 m 0 rl CD OTHER: ',... A MIYrB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT `n '..... AUTOMOBILE LIABILITY Ea accident $5,000,000 , X ANY AUTO BODILY INJURY(Perperson) 0 '... ALL OWNEDSCHEDULED BODILY INJURY(Per accident) AUTOS AUTOS PROPERTYDAMAGE N U X HIREDAUTOS X NON-OWNED Per accident AUTOS t— di UMBRELLA DAB OCCUR EACH OCCURRENCE U EXCESS LIAR CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016X STATUTE ETH EMPLOYERS'LIABILITY ylN All Other States ANY PROPRIETOR/PARTNER f EXECUTIVE E.L.EACH ACCIDENT S1,000,000 C OFFICER/MEMBEREXCLUDED7 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 E.L.DISEASE-POLICY LIMIT $1,000,000— DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Coverage M d.-.J Y.I CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE RR 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 Daytona Beach Drive each FL32114 USA ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Office of Consumer Aftalrsan Business Regulation 10 Park Plaza - Smite 5170 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 i odate Address and return card. 'Bark reason for change. eldres,, Renewal Employment Last Card r,ft:'onsumer.Affairs& Business Regulation License or recEstratian valid for individul use anil before the expiration dale. if found return to: =:]HOME IMPROVEMENT CONTRACTOR office of(;onsunier Affairs and Susines,Regulation Registration: ;79141 i0 Par!,Plaza-5ut[2�'_/ tx iradOn: 6i-2512G 16 Supplement ;ard Boston,'t1A 021 H) JILDER SERVICES GROUP,INC. ARD SCi7AJARTZ 7t :1H 0.ilioiT�lY F.NN DRIVE .Gi.__... YTGt:A 81: ,CH.FL :-211 Not Yaii-"H�ithout signature i ndersecrttary CSSL-105902 ItfCkEAItU SCkiVt Aft"fL �.:,V yR•1 195 HUNTRESS S'CREET Manchester NH 113102 ✓ �� 09/26/2016 Restricted To CSSLIC• tnsu'at on Contractor � Fadure to posses, -rent edition of the=Massachusetts State.Building Co( .<iUSe for rnvo:.atum of t!ic;license