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HomeMy WebLinkAboutBuilding Permit # 1/20/2016 GILDING PERMIT ®� �n oTH yy'��� �nb46 OL � TOWN OF NORTH ANDOVERti - APPLICATION FOR PLAN EXAMINATION M _ n0 myy Permit Not#: ( � ' Date Received t �SS.scHusE�c Date Issued: I ORTANT:Applicant must complete all items on this page y S TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 45Qne family ❑Addition ❑Two or more family ❑ Industrial „ Iteration No. of units: [I Commercial ❑ Repair, replacement ❑Assessory Bldg F] t ❑ Demolition ❑ Other N iF erei:or .r%n, r r . i r r e/ ,/G m rri, r WqAM, rlJ f / r r ,//> !'/', r I°,I lJO U. /l� .! �. /"d h:✓ 0J/-rr r r�r /;,"'r/.: e pi� nrrtu.fin,/7,,. y f !rl,a/ !/,rq�. 1. %,l�y(h a1/l/F; (,alr,r,/O�a/r�,.//1111 dea Y1��Y1�Jd��Orfm,.D�ri 1, l DESCRIPTION 9F WORO BE PE7,FO M D: IT eni icatPrint Clearly °~� OWNER: Name: , �On- se y or � Phone. "-)-'7-- . C& .� e� Address: sL/k - . :22, a 'All I,,V �!1 /pyo 11 �l,P ifi�a.hOli1,2/llrf�lJ ! rG/ Il� �, �1r �I � I I➢°Y ! 71 i vui�wuu uu ,m u�l� uwoi�i�u�lrersu�wam�m" " ".. -1�1�� 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. Total Project Cost: $ a FEE: $ /r ' Check Na.: � I `7 � Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty,fund —,' �.,/�o/� rd/"/ '',r /.r/ .//.r/ ,;, ,r� %9iji///f/� /ii �Signature,of;Agent%Owner : ,/ _ gnature,af,;,,contractor ,,,,///,,,,,,, i town of Andover NORTf-1 _ No. . 47 h ver Mass VI. 41 0006 O LAKE COCMICKEWIC.t V1 �ds RATED U BOARD OF HEALTH Food/Kitchen Septic System LD �' ' THIS CERTIFIES THAT PERMJ „ ,,,,, ,,, ,. . BUILDING INSPECTOR ............ .......... .... .. .......... ........... .. Foundation has permission to erect.......................... buildings on ... ..... . . . .....!.. ............ khatJ01rhm. .. • Rough .to be occupied as ....... . .... ...�,�ves.Q.4.... ........................................... chimney provided that the person accepting this permit shall in every respect conforn 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTION ST S 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. Federal to# RISE Engineering MA C o or Res to actor u n No A dtvislon of TWtb h Engineering CT Contraotor Roglatraltan No 60 Showmat Unit#2,Canton$MA 02021 CONTRACT 1 Y+'� 339.502.035 FA7►339-502.6345 l�.,eb i�! 4d -�( Pago PROGRAM xrasrxiuraauzr oreoasrwmraaae CMA-HES =E=K,0 aueen♦rr roawoa�tmo Jordan Ronkin (857)201-1067 03J18/2015 415201 soca$ r r•� 387 Sutton Street t 387 Sutton Street k , North Andover,MA 01845 � -� ' North Andover,MA 01845 4013 DESCRIPTION t AIR SEALING:Provide labor and metmials to seal areas ofyour bom"o against wastdtbi,excess air leekago. '[his work wil l be pedormod in concert with the use of special tools and diagnostic tests to assure thatyaur 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 scaling include air leakage to attics,basements,attached geragos and other unheated areas(windows are not generally addressed.)(8)wanking bows• At the completion of the weal wiz Son work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be twnductsd,by the sub-contraoau to ensure the safety of the Indoor air quality. $680.00 AUDITOR'S NOTES DRYER HAS VENT BUT GOT DISCONNECTED,HOME OWNER WILL RECONNF.CTiI i/KEEP 14X20 FLOOKFORSTORAGEIIt $0.00 i ATTIC FLAT:Provide labor and materials to install a 6'layer of R-21 Class I Colluloso added to(340)square feet ofopen attic spatw.AUDITOR'S NOTES DRYERHAS'VBNT BUT GOT DISCONNECTED,HOME OWNER WELL RECONNECTi11/KEEP 14X20 FLOOR FOR STORAGEI I i 5428.40 KNEEWALLS:Provide labor end materials to inmall 2' PSK faced semi-rigid fibargiass board immIalion to(240)squaw fed of knruwall area $840.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(2)attic hatch with 2'rigid Thormax board.Weatherstrip the Perimeter, $120.00 ATTIC AOCFSS:Provide labor and materials to inswlt(1) easily moved,insulating cover for the attic access folding stair. A small flat surface of plywood will be created around the opening within the stile. This will allow the cover's integral weather-stripping to restrict air leakage $237.65 VENTILATION:Provide labor and materials to ir>W1 ventilation chutes in(16)rafter bays to maintain air flow. $32.00 RISE Enginwingwfll apply ali applicable,ellgibla lncenoves to itds coMmOL You will only be billed the Net amount. CXaundy, for eligible measures,Columbia Gas offers 7S%incenavo,not to exceed$2,000 per calendar year,and an Imndve of IWA for the Air Sealing measwca up to the first$680 and an additional$340 if savings are justified by the auditor. 1 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 betbre the work is begun,and after the we0wization work is complete.We Nvill also conduct a fWi assessment of the cambustion safety of your heating system and water heater.This bun value of S90 and is at no cost to you. Total allowable wtathuisnion incentive is$3,110. 590.00 r RM In&eering w CorbadwRookb an No tMA Canted-Reiman No A dWoo of ViWKb&&aft cT conftft"w Ro wmtIcn No 64 Sba mat UnUfM Cows,MA 02021 CONTRACT 339450Z-633S FAX 3P.502.6345 Pae 2 PROORAM TM CMA-HES t Pit= VAM WWI Jordan Ranlria (8S7)201-1067 03/1812015 41S201 00002 ram In= IBM 387 Sutton Street 387 Salton Street North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $2A28.08 Program Incentive: 4013.64 Customer Total: $414.61 weAcute rTo a .CCWMEMACCCRDAMwnnA MSNMCAYM&FMrrmsaxCr *"Four Hundred Fourteen&611100 Dollars $414.61 wa�uaneattaMum eeooaasJM0M0MA=Mi0XWMMWMMCM eaar wsun eaa rowan ioa�uaxat a raeaw�avawroa watsowawawtw ,aaReo+asoaaw, .umoaa�uoroa larsoNCC CT w wmi H Am MW MAWMAM n wonaooKsa�orw,►raevrnmaw�+eYaeneNnsm� o�ta �aaroar°�oo '�w¢�w �evnso� ma�wo�ot 30 DAra, aewemmpAVmffw Emwnmaoeru� i Print Form The Commonwealth of Massachusetts Department of Industrial Accirlents I Office of Investigations � �r i 1 Congress Street, Suite 100 �;7��r�r 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 am a general contractor and I 6. ❑New construction employees (full and/or part-time).* have hired the sub-contractors 2.❑ 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' [No workers comp. insurance comp. insurance. 9. Building addition required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 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.❑ Roof repairs insurance required.] c. 152, §1(4), and we have noWeatherization 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. r 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 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 far 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. e,4. 1 - City/State/Zip:A 0('a.._ AM �IN 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. Ido herebl certify under thep anus andpenalties o�fperjughat the information provided above is true andcorrect 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 Clerk 4.Electrical Inspector 5. Plumbing Inspector 6.Other Contact Person: Phone#: DfYY DATE0(6124/2015 YY) 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). dI PRODUCER CONTACT '6 NAME, Aon Risk Services Central, Inc. PHONE (866) 283-7122 FAX (800) 363-0105 Southfield MI office (ac.No.Ext): (ac.No.): 32 3000 Town Center E-MAIL o suite 3000 ADDRESS: _ Southfield MI 48075 USA INSURER(S)AFFORDING COVERAGE NAICN INSURED INSURER A Old Republic Insurance Company 24147 TOPBUild 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 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 MWDDIYYYY MMIDDFYYYY UCY EXP LIMITS A X COMMERCIAL GENERAL LIABILITY MWZY3048 4 - EACH OCCURRENCE S2,000,000 CLAIMS-MADE X❑OCCUR DAMAGE To PREMISES Ea occu RE-OED $2,000,000 MED EXP(Any one person) $25,000 PERSONAL&ADV INJURY $2,000,000 m GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $4,000,000 m X POLICY ❑JE 0. ❑LOC PRODUCTS-COMP/OP AGG S4,000,000 0 OTHER: A AUTOMOBILE LIABILITY MWTB 304835 06/30/2015 06/30/2016 COMBINED SINGLE LIMIT 55,000,000 `n Ea accident _ -, X ANY AUTO BODILY INJURY(Per person) 0 ALL OWNED SCHEDULED BODILY INJURY(Per accident) d AUTOS AUTOS NON-OWNED PROPERTY DAMAGE X HIREDAUTOS X AUTOS Per accident t.- m UMBRELLA OCCUR EACH OCCURRENCE 0 EXCESS LIAB CLAIMS-MADE AGGREGATE DED RETENTION B WORKERS COMPENSATION AND WLRC48151553 06/30/2015 06/30/2016X STATUTE OTH EMPLOYE RS'LIABILITY YIN All Other States ANY PROPRIETOR(PARTNER/EXECUTIVE E.L.EACH ACCIDENT S1,000,000 C OFFICERIMEMBEREXCLUDED? 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 E.L.DISEASE-POLICY LIMIT $1,000,000- DESCRIPTION OF OPERATIONS below '.. DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Evidence of Coverage ' A_J YJ CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE JR EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. cam. Builder 82rVlCeS Group, Inc. AUTHORIZED REPRESENTATIVE �y A TopBUild company u 260 Timmy Ann Drive /ie cam^ Daytona Beach FL 32114 USA Y ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ��� �,j �i 7a'i �t�i� sf; r .�;�{��+1 s'���• ��(T i`}t�J:rf 1� Office of Consumer Aitairsan business Regulation -_� 10 Park Plaza - Suite 17 _.= Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration:: 179141 Type: Supplement Card Expiration 6/25/2016 BUILDER SERVICES GROUP, INC. RICHARD SCHWARTZ 110 PERIMETER RD NASHUA, NH 03063 t'tidate Address and return card.'Bari:reason for change. 3ddre t Renewal Employment Lost Card {);;cr r,{t.'vnsemerAffairs a Business Regulation License or regisiratinn Valid for indi�'idul use onii --==-- before the expiration date. If found return to: J;OME IMPROVEMENT CONTRACTOR Oi�;ce of{:onsumer Affairs and Business Re�ulativn 'Registration: `,7914 i Type i0 Pa Ht Plaza-Su:r< -- Expiration_ &255/2016 Supplement Card Bo stun.MA 02 11 JILLER SERVICES GROUP;INC. CHARD SCi iJtirARTZ O.iliJii�fl'! At+1N DRIVE YTGT:. cE't FL 32114 1'ndersccrttan !'ot vaiidtn ithout signature !I,TI ,I I till Iii 1* rt,: "I C k f t CSSL-105992 RWHARD S(,I-IWAR'I'Z 195 HUNTRESS Nianchesict-NIH 113102 09/26/2016 Restricted To CSSLAC -(nsul..)tIor,CO(WaCtOl Failure to posses, -rent edition Df 111(' State.Building Cot .cruse for revoc-allor,of tl)lt*,I,cense