The URL can be used to link to this page

46 NORTHEY ST U 1 - BUILDING INSPECTION The Commonwealth of Massachusetts Board of Building Regulations and Standards CITY OF Massachusetts State Building Code, 780 CMR SALEM Revised Mar 2011 (�1 Building Permit Application To Construct, Repair, Renovate Or Demolish a One-or Two-Family Dwelling O This Section For Official Use Only Building Permit Number: - Date plied: Building Official(Print Name) Signature V Date (�1 SECTION 1: SITE INFORMATION-` Il= 1.zperty Add :e S, 1 1.2 Assessors Map&Parcel Numbers 1.1 a is this an accepteAtreet?yes no Map Number Parcel Number 1.3 Zoning Information: 1.4 Property Dimensions: Zoning District Proposed Use Lot Area(sq ft) Frontage(ft) 1.5 Building Setbacks(ft) Front Yard Side Yards Rear Yard Required Provided Required Provided Required Provided 1.6 Water Supply:(M.G.L c.40,§54) 1.7 Flood Zone Information: 1.8 Sewage Disposal System: Public❑ Private❑ Zone: _ Outside Flood Zone? Municipal❑ On site disposal system ❑ Check if yes❑ SECTION 2: PROPERTY OWNERSHIP[. 2.1 Owner'of Record: --r d,` , v udrok , pm , �1 '1lA ata7o Name(Print) City,State,ZIP NI oAx eN ':4 %Q-60q- 96YI inwrctock�6sCglv�t No.and Street U Telephone Email AddresP SECTION 3:DESCRIPTION OF PROPOSED WORK'(check all that apply) New Construction❑ Existing Building❑ Owner-Occupied ❑ Repairs(s) ElAlteration(s) ❑ Addition ❑ Demolition ❑ Accessory Bldg.❑ Number of Units Other ® Specify: Insulation Brief Description of Proposed Work': SECTION 4:ESTIMATED CONSTRUCTION COSTS _ Item Estimated Costs: Official Use Only. Labor and Materials 1. Building $ 1. Building Permit Fee:$' - Indicate how fee is determined: ❑Standard City/Town Application Fee 2.Electrical $ ❑Total Project Cost'(Item 6)x multiplier x 3.Plumbing $ 2. Other Fees: $ 4.Mechanical (HVAC) $ List: 5.Mechanical (Fire $ Suppression) Total All Fees:$ aSgo,0() Check No. Check Amount: Cash Amount: 6.Total Project Cost: $ ❑Paid in Full ❑Outstanding Balance Due: q�2Lrn��t->-o -ro K .o . SECTION 5: CONSTRUCTION SERVICES 5.1 Construction Supervisor License(CSL) cs-075541 02/04/2017 Josel2h A Ryan Jr License Number Expiration Date Name of CSL Holder List CSL Type(see below) U 23A Sullivan Rd No.and Street Type Description Billerica, MA 01862 U Unrestricted(Buildings u to 35,000 cu.ft. R Restricted 1&2 Family Dwelling City/Town,State,ZIP M Mas= RC Roofing Covering WS Window and Siding SF Solid Fuel Burning Appliances 978-408-7832 joe(a)mvinsulation com IInsulation Telephone Email address D Demolition 5.2 Registered Home Improvement Contractor(RIC) 180506 11/24/2016 Merrimack Valle Insulation Y HIC Registration Number Expiration Date HIC Company Name or HIC Registrant Name 23A Sullivan Rd joe@mvinsulation.com No.and Street Email address Billerica MA 01862 978-408-7832 Ci /Town,State,ZIP Telephone SECTION 6:WORKERS'.COMPENSATION INSURANCE AFFIDAVIT(M.G.L.c.152. § 25C(6)) Workers Compensation Insurance affidavit must be completed and submitted with this application. Failure to provide this affidavit will result in the denial of the Issuance of the building permit. Signed Affidavit Attached? Yes .......... ® No...........❑ SECTION 7a: OWNER AUTHORIZATION TO BE COMPLETED WHEN OWNER'S AGENT OR CONTRACTOR APPLIES FOR BUILDING PERMIT I,as Owner of the subject property,hereby authorize Merrimack Valley Insulation to act on my behalf, in all matters relative to work authorized by this building permit applicatio n. / see attached -i—o— 1(,:, Print Owner's Name(Electronic Signature) Date SECTION 7b:OWNER'OR AUTHORIZED AGENT DECLARATION By entering my name below,I hereby attest under the pains and penalties of perjury that all of the information contained in this application is true and accurate to the best of my knowledge and understanding. Joseph A Ryan Jr R la -l 6 Print Owner's or Authorized Agent's Name(Electronic Signature) Date NOTES: 1. An Owner who obtains a building permit to do his/her own work,or an owner who hires an unregistered contractor (not registered in the Home Improvement Contractor(HIC)Program),will not have access to the arbitration program or guaranty fund under M.G.L.c. 142A.Other important information on the HIC Program can be found at www.mass.gov/oca Information on the Construction Supervisor License can be found at www.mass.gov/dps 2. When substantial work is planned,provide the information below: Total floor area(sq. ft.) (including garage,finished basement/attics,decks or porch) Gross living area(sq.ft.) Habitable room count Number of fireplaces Number of bedrooms Number of bathrooms Number of half/baths Type of heating system Number of decks/porches Type of cooling system Enclosed Open 3. "Total Project Square Footage"may be substituted for"Total Project Cost" M f mass save COOOOO NTRAo"R sie""ftoud+nw m Wifideatyy •.�- PERMIT AUTHORIZATION FORM 1, JUDITH MURDOCK owner of the property located at: (Owners Name,printed) 46 Northey St SALEM (property Street Address) (city) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. X Owner ignature nate FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date '01 1 . ForOflice Use Only Rev. 12132011 h The Conn offivealth off Massachusetts Department of Isdustrii gccidents 0�ce of Tnvesasarions 600 WIashingtot:SU Boston, UL 02111 ym vy.mass.rpy.dia -W'orGees Compensation Insurance Affi Ialdt: Stiilders/ioa-.�,-actorsi�Electr ciar_s/Plumbers nplcaoInomou—PleasDLegibly t Nt e -Business,'Organ zaL:om_nclividuai/Oiiner:lt F +cam lj r 4 ctlws17u �v Address: Q3 A S -.tI Ar f ,'. Cit /State?ip: 'Ia+?l�ric3 . l t2 i ikh phone- - r nate nzr�her i Arel-oua3emnloper_ �revouihehemeol�e.. C`*eckiheapp_op_ 2. 't am sn employer with�empluyees(fullandior part time. I i0 _ ' - d have ao esnloves v:orl:in_a for me in am capacity. i nun a sole propr_cior or p�rirtershin s- _ lard a honteorrner daing all::•orl�myself. (yo y:-orkers compeasaiion insurance required-)_ r am s general ccniractur&:l have hired tte s: -cont.actors lined on Et+e attzched she5.. ('These contractors have workers comp.insurance and!have a��ached a cony o?:heir ins.) we are a corporation and iis officers-have exercised their right of e`Mp_on per f .,; .- - -- c�� v: rt:�tem .insurance re Hired. i i C=1.-�ereha�eaae;npIo,s-{`io -.o--_ ` p q ) o _rt-a4aiicnet that chers.`o;_=i mvz also ffd a4i thesecion below;hm:ie_=Yheirworf-:er'comp.po?iey in'orrna5oa. � +�,-y�j�clC jndiCea1ic 54th. - Conc�ctors chaE.hectahis hoz musta.^.ah nn adi itiocni sheet show•in_=_:he nano of l$e s4i�-oa.Y�•c:ms:.ad L'ieir:.ors:.rs' j compen`-..tion policy infor®adon. i Type of oroject(required): Check appropriate= � 1 6- New Construction 7 - Remodelin uo-_.DeMoi?ionQ- Bntidin zaddition j 10._iectrdcaf 11._Plumh.12._Roof 13--,L/offier :''l TCO AC1.,L I aeu an empliq'er dint is p�:idin_:rcrkers'ComaCnSation irsnr..ace-.nr my•Rnnlo.•ecs. Bctaci is the ootir•,•Sjoh sin,irra ILsura_nce-company_N- Tte: 12011cy Or 3e1_-ins.1:T_C. E.Tpi_•—i-I.on Date:__ )ob Site Address: - pinch a tom'o.vro:icers corcnensat:oa ooligdedantior.nage(sho:+�n�Jie pylic'number Ord a>pirafxon date Failara to seau-me coverage as regtii«d under Section 2]A of 1'_TLc- 152 can lead to the lunposi'mu of criminal peratda_of a uae op tp SI:00.40 nnd:'or dna year irwrisoaraci_,as•Heil as civil penalties in the form o,a _TOP WO RK, ORDER and a Upm of*_p to-5'_50.04 a da-against the violation. Be advised that a copy 0.this Cement ma:he forevarded to Lite Offc--of a=estimations of die DIA for insurance coverage v ,'Station :do hereby cer•_i %wuider die pins and oe;!alias df psr'turt chat_Fe infaanafion aroeiced aco:M is true and tonin ap- 17a.ie: Oficial Lse ou-1y: DG not write in" (?lis a:t0 be com-pleted-by,iv or to ria ohlciaL urTmom: Pest:'iice e= lssnu. ^_u YLori='%C6iec�azo) 1. Board of Iiealdi -- Buiidina Dep_ 3- tier: d- Fiectical lost. ' Pfumb f:Gas n._Oth=_ i P i CoR'.act PZY a (print)OR: ( Rf� hORe4 1 CERTIFICATE OF LIABILITY INSURANCE ^� °ATD 6H11312 3/201166 `.� 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: H the certificate holder is an ADDITIONAL INSURED, We policy(ies) must be endorsed. If SUBROGATION IS WANED, 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). ODUCER CONTACT NAME: domatic Data Processing Insurance Agency,Inc PHONE FAX ADP Boulevard Arc No Ext): A/c No: E-MAIL �seland,NJ 07066 ADDRESS: INSURER(S)AFFORDING COVERAGE NAICA INSURERA:5Star V3 AAIC American Alternative Insura IURED Merrimack Valley Insulation Corp INSURER B: 23a Sullivan Rd INSURER C: North Billerica, MA 01862 INSURER D: INSURER E: INSURER F: AVERAGES CERTIFICATE NUMBER: 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. It TYPE OF INSURANCE L U POUCY EFF POLICY EXP wm POLICYNUMBER MMR) MM/DD LIMITS GENERAL LIABILITY EACH OCCURRENCE $ COMMERCIAL GENERAL LABILITY PREMISES Ea occurrence $ CLAIMS-MADE F--I OCCUR MED EXP(Any one person) $ PERSONAL 8 ADV INJURY $ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ POLICY JEgT " LOC $ AUTOMOBILE LIABILITY - COMBINED SINGLE LIMIT Fa accident $ ANY AUTO BODILY INJURY(Perpens.) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NONdWNED PROPERTYDAMAGE $ HIRED AUTOS AUTOS Per accitlent $ UMBRELLA LAB HOCCUR EACH OCCURRENCE E EXCESS LIAR CLAIMS-MADE AGGREGATE Is DED I I RETENTION$ E WORKERS COMPENSATION X WC STATU- OTH- AND EMPLOYERS'LIBILI ATY TORY IN LIMITS R ANY PROPMETORIPARTNENEXECUTNE YNIA 9WC749118 6118/2016 6)18)2017 E.L.EACH ACCIDENT $ 1,000,00 OFFIC FVMEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE E 1,000,00 IF rs,describe under 1,000,00 DESCRIPTION OF OPERATONS be. E.L DISEASE-POLICY UMIT $ SCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (Attach ACORD 101,Additional Remarks Schedule,if more space is required) ERTIFICATE 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. AUTHORIZED REPRESENTATIVE ©1986-2010 ACORD CORPORATION. All rights reserved. :ORD 25(2010105) The ACORD name and logo are registered marks of ACORD ik�®® CERTIFICATE OF LIABILITY INSURANCE OA 02124/2AM1VD016�) 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 NOTCONSTITUTEA 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). PRODUCER NAMEACT Carolyn A Coughlin Charles J Coughlin Insurance PHONE _T ----i— -`-- 978 957-3588 1PAX 14 Dinley Street ac , ( ) INC EMAIL P.O.Box 10 ApprsEss: carotyn@coughlinins.com Dracut,IVA 01626 WSURER1SZAFFORDING COVERAGE wsuRERA: Northland.Insurance Company 24015 i INSURED Merrimack Valley Insulation Corporation Joseph A.Ryan,Jr. msuRERe: Safety Standard 39454 23A Sullivan Road INsURERC, Torus Specialty Insurance Company A0159 N. Billerica,MA 01862 _._._ msuRERD, INSURERE _. INSURERF: I —_ COVERAGES CERTIFICATE NUMBER: 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. INSRT----- AD LS aR POLICY --�--- POLICYEFF ' PGuCYE%P --- --�-- LTR TYPE OF INSURANCE I D DI POLICY NUMBER MMIDD i-MMN UMrrS A �/ COMMERCIAL GENERAL LUIBILI'rY WS274182 0112112016 '01/21/2017 EACH OCCURRENCE s 1,000,000 CLAIMSMADE OCCUR I -PRAEAYM SES�or 5 100.000 MED EXP(Anyore person) S 5.000 PERSONAL S ADV INJURY S _ 1,000-,000 GE/N'L AGGREGATE LIMITAPPLIES PER: GENERALAGGREGATE LSV 2.000,000 V I POLICY jEa LOC I PRODUCTS-COMP/OP AGG I S 2:000,000 I OTHER: is B I AUTOMOBILE LIABILITYI 6205006 111125/2015 11125/2016 1 JCEOOMBINEDitSINGLE LIMIT s 1,000,000 1 ANYAUTO _ I I i BODILYINJURY(PerpenWR) S ALL OS OWNED �'SCHEDULED I HODILYIWURY(Peraccidenn S `/I AUTOS NON-0W NED HII PROPERTY OAlMGE — RED AUTOS -V-I AUTOS - ecaEeWL-__�__ S C �/ UMBRELLA LCB •'✓' Occua 1 87593L161AL1 01/21/2016 01/21/2017 EACH OCCURRENCE 5 1.000.000 IXCESS LIAR t I t 1.000,000 CLAIM11S1aADEl 1 AGGREGATE S OED RETENTIONS 10,000 Is WORKERS COMPENSATION f D AND EMPLOYERS,LIABILITY ' JI PE TRATUTE 1 (ERµ ANYPROPRIE CRIPARTWRIE)(ECUTIVE Y/N IEL EACHACCIDENT s 1.000,000 OFFICER/MEMBER EXCLUDED? NIA (Mandatory in NH) E.L DISEASE-EP EMPLOYE__ S 1.000,000 IlySddcs aurNer 1,000,000 DESCRIPTION OFOPERATIONSW.-, E.t.DISEASE-POLICY LINOT S 1 DESCMPnONOFOPER MMS/LOCAVONSIVEMCLES.(ACORD 101,AtltliUmml RemarksSNedWe,may Ee aUac�eE if more space is rega'ved) JOB DUTIES:Insulation Installation:Additional insured companies respectively are Action Inc.and National Grid USA,its direct and indirect parents, subsidiaries and affiliates in addition to Community Teamwork,Inc.,ARCD,Inc.and-EVEF<�iUi1RCE CERTIFICATE HOLDER CANCELLATION SHOULD ANYOFTHE ABOVE DESCRIBED POLICIES BECANCPI 19 BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED W ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZEDREPRESEMATNE O 1988-2014 ACORD CORPORATION., Allrights reserved. ACORD 25(2014101) The ACORD name and logo are registered-marks of ACORD Office el COnSULn_erA-ffairs and Busmess 2eVtilation 10 Park Plazc-Suite 6170 BOston-.Massachusetts 02116 Home 1raprovement COngactorRegistration Regislmfion: 9SOS06 TV= COipof25on MERRMACK VALLEY INSULATION CORP EXPIrvion: 1st24!2o16 -erg 2e5524 JOSEPH RYAN 23 A SULLIVAN RD SILLERICA, iViA Li-,869 Updatc Address and mtum Mrd.Mark mason£urcpanec __... _ ^•ic_n _:Add.e : Reuew3l __.Employment -- Lost Cvd 01iceu:Cvosumv�iffaiaS ays�r¢nu7adav� t,icense or revisfr_tion slid£o:ivd-nidal useonFy ai'Rg IG�PROV-eE5Q4f gpry�4CTOR 6urom IIm e_pimfica date IF£aond return me i'._gislrzyon: 180586- TypM 00cc oFConsumer_Ltairs and 3usiness?tee dv;ion � iatiom ,'-42SZpt6 r_o�po�non id Pak Plaa_Sv?u557C </cHRciACK VALCF(If:SU(.ATION CDR? Boron.31-402116 JOSEPH PXAM 23 A SULUVAN RD ,�v o SlLLMGA,PdA09862 -- L—;'w. Undcs:vudn• - .. vniid c*iii�oet CS475541 _ 30SEPHA P.Y_ IN� - 200 King Bail Dr'ApC'20i� '- "-• '- -- """µ iyonfield M4 OB40 - c.-"ss;are: 02/0412097 -