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HomeMy WebLinkAboutBuilding Permit # 1/20/2016 rosary BUILDING PERMIT TOWN OF NORTH ANDOVER p{*, APPLICATION FOR PLAN EXAMINATION Permit ` BBd'f'� mit No#: Date Received " " �•4 A°Rareo PPRw„��(5 SSACHLIS� Date Issued: IMPORTANT:Applicant must complete all items on this page r II N ONTYPE 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 a r, 1, �h�;�rd(�,,mvJ�i�f � !/CJI r % /r 1///I/r//�/e /G'( �� ,6Nr111P/r���J ra//Xd,��sl�,� ��,f /rrrc ,//I/rl r//�//�%1 r�,IPS/✓„� ,, r, i/1 ,,, h WJ/ �r,/ rr� l �A/(r%'/�/, DES IPTION OF O K TO BE PERFORMED: Identification- Plion~ e Type or Print Clearly ea OWNER: Name: . , Phone: _� ,. .. ,.. mw_ � Address: SPI hone,�� r l' low,l r,'b���,r , r a .......0ai�ilxrenN,4i�J�aPJi�w:74eei✓N� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT. $1200 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ �, FEE: $ r'M Check No.: / Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund /i rSignature ofllAgent/Owner _Signature ofcontracto 'Town oftAORTH E e, Andover L i h ver, ass � o �A�I , eCOCMICAE."[ y1 s RATED NP�,��(y U BOARD OF HEALTH Food/Kitchen PERM.. IT, T LD Septic System ak 6 THIS CERTIFIES THATINV BUILDING INSPECTOR 2�n/� Foundation has permission to erect .......................... bu' dings o . l.!4 .... .5- we � P ........... Rough to be occupied as ........... .e.. .......... ... .... �..... ... ,`�................. Chimney provided that the person accepting this permit shall in eve respect conform to the terms 3f application p p p g p � p pp 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final IT EXPIRES I 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION ST T Rough Service ............................. ..... ......................................... 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. Fadefol 10 1$ RISE, ri,n g i n e e ri n r, otion No t?t Contractor Reglotr, MA Contractor Registration No A diviRion ofThlel.1cli Engineering CT Contractor Reolstratlan No (if)81jawrant Unit 42,Conlon,MA 02021 CT 339502-6335 ONRACT F,%X 339-502-6345 - Page IS E PROGRAM tutacdwrnacT10CUtErttiorrrrnaanvaewntst CN019lignOtO A140 114GE CUSTOMP4 FOR WORK An AfiG41N Rin CMA-UES Ocstninpo MILM puoun WR Scot Credo (978)688-3773 11/20/2014 406457 00003 120 Osgood Street 120 Osgood Strcct SM11VICZ CtTTOTATE-,7SP 01WRO CAMOTAM Zip North Andover.IMA 01845 north Andover,MA 01845 JOB DESCRIPTION PHASE OWE.Proposal for this calendar year, J $0100 AIR SCALING:Provide labor and materials to seat Armq oryour home ipbim wnsttful,cxct.,;.q air leakage. This Work will be performed in conceit with The use of.qpoclol tools and ditirmitic tesir to assure that your home will lie tcft with healthNi level or air exchange and indoor air quality.MilerialA to he used to Sell vour brittle can include caulks,foams,wcillictmripping and oilier product,. Ptimury areas for sending,include sit Icnkngc to alties:W-usclucols,ntinched gtirllgeq and other unhealed areas(windows are not generally nddrc.,,ncd.) (20)worlding hours, At the cornpittinn nrthe weatherization work,and at nn indditinnal cost to the homeowner,a rmnl blnwer door and/or combustion snfcty analysis will tic conducted by the iub-contrizictor to ciipirc the safety ortbo indoor air quality. BASEMENT MCING.,Provide labor and nisterilis to install(198)linear feet of R-19 ittithocd filicrtiltm;insulation to the perimeter of the haquitlent eelling tit die house sill. 5340.50 BMEMI-INT DOM.Provide labor mid materials to in.sulnic the back ril'the basement door leading to the bulklicrid'Vidi 2'rigid board that m=the scolions R-310,5.4 and 310.0 requirements of building code, 5LD1 rill ctjgc,4 and com!i with FSK tape. 572,22 RISE FAgiriecting will apply all Applicable,eligible incentives to this contract. You will only be hilted thc*j ornount. Currently, for eligible measures.Colurnhia0m;offers 75%incentive,not to exceed S2.000 per calendar year.and an incentive of 100%for the Air Sr-qlinC trim-wroi on in%Mli. For tha.tiorely and health oryour home's indoor air quality,we will he conducting a blower door dinanostfi;of the available nit(Inw in your home both b6bretlic work is begun.and oiler the wcidicrizotion work 1.q complete.We will also conduct a hill assessment of the combustion&*jv ot'your hcnilursysicrn and water It ,ler.Thi.<has i vnitic of."O and is at nn cosi to you. Total allowable weagictization incentive is SIM. M.00 ............... Fedaret to 0 RISE Engineering RI ContTettor RgttaInWn NO FAA Conb=Wr Regftgan No A division Of Thtctseb Bng(aecring cT conbw orRegistraon No 0 61jawmat i)nit 42,Canton,MA 8202t �° PAX 3.zg•Sit2 iUS A Page 2 PROGRAM T1WC"AutoDnT oano881weasra n CMA-FiES EfMTMGEAN18Nm MCU8t0WfkFWWDRKAa nrncamcottElow � PFW*tC oATts tuttart'n 4YQflKD�TETi Scotl+redo (978)688-3773 11/20/2014 406457 00003 3fRYtCB i)TRflBY .�". -•_.._ ... .-..._...____..__. .••-^�-"...'BX.Ul3L�ST'Rf�T y.�•._...•• -...-.. -..-._ ..._ .. 120 Osgood Street 120 Osgood smet AtSRYtCEOfTY,8fAT6,� ••.-.••»•�.._._ •. - .... __.._._......»._.-.fl113dJt6ti7V,9TAT7?,YM North Andover,MA 01845 North Andover,MA 01849 JOB DES( TON Total: $2,06,72 Program Incentive., $1,67b.04 Customer Total: $329.68 WE AOnW tSMMY TO PURNIBN b6MWca-COTdPL"S IN ACCORDANCEWM AWVe8P0etMCXn0N&FOR THU 9U#QF t9A'Phrae Hundred Twenty-Nine&681400 Dollars $329.60 Ut""tA m NA AL8VftK 4MXr INa-MTOMERAGAM" AYflflMrWt t/iWU.WtGAU57Q+4Y Ls 66 CHARUE-0llObYltLY6il�iv tlxPAtn X+OA AYM#t AT00104 t3UAR�MQfiTBtlfintlCtWO/>.8C7#.�Uf,HPB,A1�1tANYRACT>N7NL�48'rAAYt077. oo NoT SIGN THIS GoNi'R V tP TMe ARE ANV aLANKSPAiES kCTt;,4Nx9 CCrlhtliGT 8$ M1 ib iF k0T t��TEO WiTf�1 CAT6OF ALCkP'fA4K:fl ....��. �--�--��� "`-.•_...- ...•.• '' ACC£AthNCA Op GONTanCT-TxE A80YGPRkf9,EPP.WMAUM 00 G1?amttt"Ant OAMz ahaO AND ARR14MM ACCa"MVWA AUtIfOStaMTO00"D WM The Commonwealth of Massachusetts Print Form Department of IndustrialAccidents Office of Investigations i� 1 Congress Street, Suite 100 �ti gip' s 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): 1.0 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.❑ 1 am a sole proprietor or partner- listed on the attached sheet. 7. E] Remodeling ship and have no employees These sub-contractors have g, ❑ Demolition workingfor me in an capacity. employees and have workers' Y p Y� k 9. E] Building addition [No workers' comp. insurance comp. insurance.'+ required.] 5. ❑ We are a corporation and its 101-1 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 12.0 Roof repairs insurance required.]' c. 152, §1(4), and we have no Weatherization employees. [No workers' 13. ✓0 Other cotnp. insurance required.] *Any applicant that checks box#1 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 iiew 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 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: g Attach a copy of the workers' co nsation 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 andpenalties of perjury that the information provided above 's true and correct. 7 Si nature: Date: r 17 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#: DATMMIDYY) CERTIFICATE OF LIABILITY INSURANCE 0612412015 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 Q7 certificate holder in lieu of such endorsement(s). d PRODUCER CONTACT "6 NAh1E: Aon Risk Services Central, Inc. PHONE (866) 283-7122 X (800) 363-0105 d Southfield MI Office (A C.No.Ext): (AFAC.No.): -a 3000 Town Center EMAIL o Suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIL# INSURED INSURER A Old Republic Insurance Company 24147 TODBUild Corr). INSURER B: ACE American Insurance Company 22667 260 Jimmy Ann DriveINSURER 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 ADDL S TYPE OF INSURANCE S POLICY NUMBER POLICY POLICY LIMITS LTR INSD WVD MWDDIYYYY MMIDD/YYYY A X COMMERCIAL GENERAL LIABILITY MWZY304834 EACH OCCURRENCE $2,000,000 '.. CLAIMS-MADE v OCCUR PREMISES(a occurrence)DAMAGE S2,000,000 MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S4,000,0 m X POLICY ❑PECT ❑LOC PRODUCTS-COMP/OP AGG $4,000,000 N 0 OTHER: N '. A AUTOMOBILE LIABWTY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT $5,000,000 N Ea accident JX ANY AUTO BODILY INJURY(Per person) Z ALL OWNED SCHEDULED BODILY INJURY(Per accident) d AUTOS AUTOS PROPERTYDAMAGE cc NON-OWNED HIRED AUTOS X AUTOS Per accident �+- t' d) UhBRELLA LIAR U OCCUR EACH OCCURRENCE EXCESS LIAB CLAIMS-MADE AGGREGATE DED I RETENTION B WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016 X STATUTE RH EMPLOYE RS'LIABILITY YIN All Other States _ C ANY PROPRIETOR/PARTNER IEXECUTIVE a N I A SCFC4815190 06/30/2015 06/30/2016 El,EACH ACCIDENT S1,000,000 OFFICERIMEMBER EXCLUDED? (Mandatory in NH) w2 Only E.L.DISEASE-EA EMPLOYEE $1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 11,000,000- DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Coverage Y=J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE RK EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Builder Services Group, Inc. AUTHORIZED REPRESENTATIVE A TopBuild Companyu 260 Jimmy Ann Drive O % TarDaytona Beach FL 32114 USA If ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD :. '= ^' 01 Office of Consumer Affairs nd Business Regulation. =_ '= 10 park Plaza - Suite 51170 Boston, .Massachusetts 02 11 6 Howie Improvement Contract(v Registration Reqistration: 179141 Type: Supplement Card Expiration6'2512016 BUILDER SERVICES GROUP, INC- RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 t tjdate Address and return card.'Bari:reason for change. 3ddre t Ren-"Hf Eniployment Lost C'.:rd O;fice of t:onsumcr ;fair,b Business Regulation License or recistration Valid for individul use unIN i= = hefore the expiration date. if found return to: J:e: 3t7rsiE IMPROVEMENT CONTRACTOR Oif,ce of t.OnsUnler Affairs and Business Regulation . r'Zegisttator: 179141 Type lO P2r P;az 511it'r 51 til - Expiraiion_ 6J25/2G 16 Supplement rd Boston_ X4.4 02 116 JILDER SERVICES GROUP;INC. CHARD SCi-iWARTZ 0 jIMrv1Y ANN DRW YTGP:A cErCH.rL 3-2114 Not vaiidtn.ithout sign2ture 1'ndersccrctan CSSL-105992 RICIIARD SCHWAR'I'Z 195 HUNTRESS S'rREET Manchester NIH (13102 09/26/2016 Restricted To CSSL-K.- Irmol3tiOr,COntractOT Failure to posses, rent edition of the MjsS,,jrhusetts State Building Cot jjtjse for revocation of mis hcense . . . ... , '.. 2 F1 01.