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HomeMy WebLinkAboutBuilding Permit # 1/20/2016 GILDING PERMIT 0 "O RT 6 TOWN OF NORTH NDVE APPLICATION FOR PLAN EXAMINATION Permit No#: � Date Received �SSACHUS�R Date Issued: PORTANT: Applicant must complete all items on this page , : Iv w E� ZO IN D ;'°xIC is or c ®s es o TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition xwo or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ,,, MIN'S WK'- d!a x..iwwnnp ;�rt rr r %'1r c lrN/i ,r Ifr xrrwry i xl//rx� ary,r, r r r Id l Y1i y/ffi pl tidalt�lg,,irJ rryir si p << r, ✓ii�rr /fr li �Jm it � Ye yry mr r r/rh M Nepl�c « 4Well I I loco,pla q Wetla al/ds "Wade shed I 'str c rrl ' � I DE CRIPTION OFWORK TO BE P FORM . V��E �" � 'L `����" ) _ 7 .(� •, _... �,.. _. Identifi atiion Please Type or Print Clearly OWNER: Name: , . -� P P Phone: 12a— Address, . , .w� .. �,,D xr„,.. ... , ,� 1..,1 ,. ,,, irvrviu- r.,I, ,.,,,, I,r„ � r�; X97 '�/I/'/ '77/r 11� '7�i l/° l l/n"i,/,,//'%%"?'%' %,%/% / (i�ywr o�fi,y,,,Y,i r./�ti.�•, wrl,"; ir.. . i I 1"%/i/. r a t o r r y r D d( es �� l I �� ICU n I II i n l v Y i" i lu J � aawi�gJNt al�,if fie Uro n�4Js exmwv,�o wis ri mwav�wa,'Nr aYaramWuu.:_ -_ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST B SED ON$125.00 PER S.F. Total Project Dost. $ m FEE: Check No.: ( 1 Receipt No.: � NOTE Persons contracting with unregistered contractors do not have access to the guar arty fund 'Town of � NORTh Andover L No. '� 18 - 20 h ver, MaSS, k3AAA0^A 704 t� C. 1' 7,9 RArED S IJ BOARD OF HEALTH Food/Kitchen 17ERMIT T LD Septic System ® THIS CERTIFIES THAT ...................... .,,.,...,..,..,..,..,. BUILDING INSPECTOR ...... .......... ............... • . Foundation has permission to erect.......................... buildin son ... ... UJ. Am.•.............. ........ . ...... Rough to be occupied as .....`.R�. . .... !... ........ .... ....w.Soo �..... ...................................... Chimney provided that the person accepting this permit shall in every respect conform 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 PERMITEXPIRES 16 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION STRT Rough Service ............................. ................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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. . i r Federal 10 0 050406829 IME Engineering Nl Contactor Registration No 8188 RISE MA Contractor Regbdrallon No IWM A division of Thlelsch Engineering CT Contractor Registraton No SM20 ENGINEOING 60 SbawmA Cauton,MA 02021 339402-M FAX339-02-6MS CONTRACT P�qe 1 Q PROGRAM nos ccruaacrisr eimammussu 0"-M eaxnrrrEatarer�tnaoawororas oescilmeaaar cuar nam I C intone: care cuavro wamronmse Sebasdim Patine N (978)729-8533 12/04/2015 424819 00002 Samoa sir costo smear 39 Hewitt Avenue EJ 39 Hewitt Avenue u Sr3r=CnY.aTArn,LV NoO OWAG CITY,STAM ZP North Andover,MA 0184 O North Andover,MA 01845 OB DESCPJMON AIR SEALING:Provide labor sad materials to seal atm 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 you 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 otherproducts.Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated attar(windows are not generally addressed.)This will require(8)working hours. A reduction in cubic feet per minute(elm)of&Infiltration will occur,but the actual number of cfm is not guaranteed. i At the completion of the weathervation work,and at no additional cost to the homeowner,a final blower door and/or combustion safi ty analysis will be conducted by the subcontractor to ensure the safety of the indoor air quality. $680.00 ; AIR SEALIlNG ADDER: (2)working hours. $170.00 ATTIC FLAT:Provide labor and materials to install a 6"layer of R-21 Class i Cellulose added to(920)square feet of fleored attic space. j $1,637.60 ATTIC FLAT.Provide labor and materials to install a 12"layer ofR112 Class I Cellulose added to(328)square feet of open attic space. $524.80 ATTIC ACCESS:Provide labor and materials to insulate the back of the attic door with 2"rigid Thermmc board and seal the door's edge with weatluerstripping to restrict air leakage. { $7391 ! VENTIL A17ON:Provide labor and materials to install ventilation chutes in(54)rafter bays to maintain air flow. $108.00 STAIRWELL Provide labor and materials to install Class 1 Cellulose insulation to the sheetrock or plaster ceiling and/or walls of a stairwell Which are common to heated space,through a surfatx drill sad plug method.The holes are pdngged with styrolbam plugs,and spackled to a rough Trish. Any sanding and painting required are the customer's nsponstbady. $175.00 BASEMENT CMUNG:Provide labor and materiels to mstall(86)linear feet of R-19 unlaced fiberglass insulation to the perimeter ofthe basement caking at the house sill. i $150.50 BASEMENT DOOR:Provide labor and materials to insudate the back of the basement door tesdingto the bul[dcead with 2"rigid board that I meets the sections R-316.5.4 and 316.6 requirements of bmilding Code. Seal all edges and seams with FSK tape. $72.22 RISE Engineering will apply all applicable,eligible inoertives to this conhua You willonly be billed the Net amount. Cumady,for eligible measures,Columbia Gas offers 750/6 incentive,not to exceed$2,000 per calendar year,and an incentive of 100°A for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the arrdi= For the safety and health of your homes 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 after the weather tion 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 weatherimfion incentive is$3,110. $90.00 i Federal In#664405629 ® division Engineering RI ContractorRegisbagon No 8186 !f A don of TIdetsc6 Entering CT Co r o�NO= EMNEMINfi 60 S6awDTD4 4:antoD,MA 02021 CONTRACT 339-591x5197 FAIL 339-502.6345 j Page 2 PROGRAM neo CONTRACT 18 ENTERED WTO DETWEE1a HIM I CMA-HES ENWMMDANDTFSiCUSTOM FOR WORK AS DEsCRIM eELOW CUSTOMER PHONE DATE CL[ENT0 Womm CRDE(i i Sebastian Patane (978)729-8533 12/04/2015 424819 00002 { sERvxE STREET EELM STREET 39 Hewitt Avenue 39 Hewitt Avenue i 4MCE CITY.STATMMP DaLM CrMSTAMEP North Andover,MA 01845 North Andover,MA 01845 JOS DESCRIPTION Total: $3,682.03 Program Incentive: $2,940.00 Customer Total: $742.03 WE AGRM HWW TO FIIRMH SERVICES-COWLETE W ACCORMCE WITH ASOYE SPECniCATTON&FOR THE SUM OF —Seven Hundred Forty Two S 031100 Dollars $742.03 UPON FINAL lNf<PfCHON AND APPROVAI.DY MISE ENOOa�[DRQ CUSTCMFR AGRFFA li0 REiDTAMOUNTDUEIN FULL SJfHtFbT OF 1T6 YALL BE CHARGED 6IO.YTie.YON ANY UNPAID BALRN AFTER30 DAY9.SEENEVl3tSEFDaOdPQRTANT SffCIUEAnCNGN GUAaANi9�,RE6tiT80FeEClgICN,BCN�UUNO,ANDCONIRAAiORREGlBTNATUIN. i ''..... DO NOT SIGN THIS CONTRACT IF THERE ARE ANY ®BLANK SPACES r �ti�L�2�e�rt� IIT{{ SfSNATIRtG.NISEEn- - CUSTOMERACCEPTANCE I NOIETIDSCOMRACTIdAYBEWn}mRAWNDYUSWNOTEa%=T®WMaN DATEOFACCEPTANCE cc vrn by ACCFPTANCQ OP CDNTRAC'r-THE ASGVE PTttCF9,SPEC04CATTCNS AND CONOVIONSARE 30 DAV& saTi6FACTCFiYTOUEAt .HHt1$YACCt LVOUANEAUIFMROMTODOTHEWOM A9 aPEcwPD.PArrrorr W0.L EE TRADE A8 otnTsa�aeovD i f f , I i ; i ,� Print Form The Commonwealth of Massachusetts Department of Industrial Accidents @" Office of Investigations ,Za�� I 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): 1.2 I am a employer with 100 4. F-] I am a general contractor and I employees (full and/or part-time).' have hired the sub-contractors 6. New construction 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 workingfor me in an capacity. employees and have workers' Y P Y 9. ❑ Building addition [No workers' cotnp. insurance cotnp. insurance.§ required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions officers have exercised their 11. Plumbing repairs or additions 3.❑ I am a homeowner doing all work ❑ g ' p • myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.] c. 152, §1(4), and we have no Weatherization employees. [No workers' 13.0 Other comp. 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 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;vorkers'eompensation 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: � � � C,�"�t' 0 e City/State/Zip: � '• tit� "� )t '� .�a 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. I do hereby certify under the pains and pem hies of pelt y that the information provided above is true and correct. Si gnature: �.� 'f _.. - 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#: Ate®® DATEOB MfDDt�rr) CERTIFICATE F 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(les)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). PRODUCER CONTACT a Aon Risk Services Central, Inc. PHhpINE E. FAX Southfield MI office (AIC. No.Ext): (866) 283-7122 (A1C.No.): (800) 363-0105 D 3000 Town Center E-MAIL Suite 3000 ADDRESS: Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAIC# INSURED INSURER A. Old Republic insurance Company 24147 TOpBui 1 d 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 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 INSR LTR TYPE OF INSURANCE INSO WVD POLICY NUMBER MMIODlYYYY MMIODNYYY POLICY EFF POLICY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY304834 EACH OCCURRENCE $2,000,000 CLAIMS-MADE FX OCCUR DAMAGE O N $2,000,000 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— POLICY 4,000,POLICY ❑PEO- ❑LOC PRODUCTS-COMP/OP AGG $4,000,000 m '... 0 0 OTHER: r A MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT N AUTOMOBILE LIABILITY $5,000'000 Ea accident) X ANY AUTO BODILY INJURY(Per person) 0 ALLOWNED MSCHEDULED BODILY INJURY(Per accident) NAUTOS AUTOS NON-OWNED PROPERTYDAMAGE vHIREDAU70AUTOS Peraccident d) UMBRELLA LIAB OCCUR EACH OCCURRENCE L) 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 I PARTNER I EXECUTIVE E.L.EACH ACCIDENT S1,000,000 C OFFICER/MEMBEREXCLUDED? N/A SCFC4915190 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 E.L.DISEASE-POLICY LIMIT 11,000,000— T _77 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Coverage z.J i--J 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 Ann Drive Daytonaona 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 :. oCo' sumer rner Aitairs nd justness Regulation -` lice 10 Park plaza - Suite 5170 Boston; .IVlassachusetts 02116 Home Improvement Contractor Registration Registration: 179141 Type: Supplement Card Expiration6!25/2016 BUILDER SERVICES GROUP, INC. !RICHARD SCHWARTZ 110 PERIMETER RD NASH UA, NH 03063 t'odate Address and return card. Mark reason for change. !.ddret :teneKal Fntttloymer:t Lost C'nrd Of;icr of C nsumer Affairs ci Business Regulation License or registration Valid for individul use rani) before the expiration date. If found return to: 1OME 1td1PRC1{ElY;ENTC©tdTRrCTOR office of t:onsunter.Ai sirs and Business ftegulati<�n r°Z2gsstratiar.: 179141 T;pe 10 Far"-plaza-Sua�>s7U Expiraiion_ Si[5/2o;c Supplement 2rd iieston, �1.4 %2l?G JILDER SERVICES GROUP,!NC. CHARD SCi-iWARTZ YTOI:. cEr,CN.EL 32114 Not vaii♦without sign2ture t ndersccrctan' UI.T CSSL-105992 RICRARD S(,I-IWAR'I'Z 195 HUNTRESS S'rREEI' Manchester NH (13102 09/2612016 Restricted To CSSL•IC Insulation Contractor Failure to posses, 'rent edition of the Massachusetts State Building Co( au5e for revocation of ti-w;license