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Home My WebLink AboutBuilding Permit # 2/10/2016 BUILDING PERMIT O*�°oT 6 gti TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATIONM. p Z y �j✓ A�p c w Permit No#: > Date Received 7 Q�RR7ED PP�y�GJ 'QS SACHUS� Date Issued: PORTANT:Applicant must complete all items on this page LOCATION �5"� �f-e s5 el 14 % 5-7— Print ✓Print PROPERTY OWNER Print 100 Year Structure yes no MAP - _PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Co(nmercial ❑ Repair, replacement ❑Assessory Bldg --I$,Others: ❑ Demolition ❑ Other ulC,%iati lalillvlkawo eI " ` Flo a1%U f an0d in eer " � � e�, DESCRIPTION OF WORK TO BE PERFORMED: ,-?-r L ; v15,114 i io 4 7 Q' 't Identification- Please Type or Print Clearly OWNER: Name:_ CA�rco c-t Phone: Address: 3 PrY� 5t.V1 -5 Contractor Name: P�� r{- I -e 8 (cr tri C Phone: Email Address: 2 e4S7- ,�� Si f�.s�c,✓ /,/ Supervisor's Construction License: /o G B !> Exp. Date: Home Improvement License: t'v Exp. Date: 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: $ 0, 0 C) FEE: $ c Check No.: Receipt No.: I NOTE: Persons contracting with Aregistered contractors do not have access to the guaranty fund M1111"k 711MAN , nA ( 3 v! Aot,ORTI, Town of Andover No. 1� " "dby h ver, bass, ° A- COCNICNl W.[K . 7qs RATED 00 ,�5 ll BOARD OF HEALTH M- IT Food/Kitchen Septic System rER THIS CERTIFIES THATtA LU BUILDING INSPECTOR . .. .... . .. .... .... 5Whas permission to erect . buildings on ... Foundation ® 1k1 Rough to be occupied as ........ . ...... .>�!�► li.. . .. ... . .�..� 1A�1 s ..... .......... ... . } Chimney provided that the person accepting this permit I 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 relatirIg atotnspection,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 PERMITMONTHS ELECTRICAL INSPECTOR CONSTRUCTIONUNLESS STARTS Rough ................................ Service .................:... . ..................:�..� Final BUILDING.INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. federal ID#05-0406629 RI Contractor Registration No 8`186 RISE,Engincei-ing FAA Contractor Registration No 120979 RISE 'k division oFfIlielsell I'lotilivering ENGINEERING (d)Sloovalot Unit H2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 1 PROGRAM TUNS CONTRACT IS ENICREDINTO O MWEEHMSE (..NIA-IIES GNOInEERItJONQeTffECt)tiTOMERPOnVIORKA5 DESCRIOEO BELOW CUSTO"Ell PHONE DATE Went P ViORKOM)EIR Jeff Larcome (978)502-9038 01/19/2016 424038 00002 SERVICE STREET BILLING STREET 353 Pleasant Street 353 Pleasant Street SERVICE CIFY,STA'MZIP Oft-UNG CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DEMIZIPTION AIR SEALING:11rovide laborand materials wasteful,excess air icakagc. This work will be perillnum in concert with tile use of special tools and dia"llostic tests to assurc Ilett your home will be tell with IT livalthful love)of air exchange and indoorair quality.Materials to he used loseal votir home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,allache'd garages and oilier indicated areas(windows are,not generally addressed') This will require(8)work-iol,hours.A reduction in ctjl)ic feet per minule(cfro)of air inlifination will occur,[)at[lie Mind number of crin is not guaranteed. At tile Completion of the wCallierizatioll work,and at 110 additional cost to the lionicomim It final brovver door and/or combustion Safety analysis will lie Conducted by the sub-contlaclor it)ensure tile satiety or the indoor air quality, S680.00 DAMMING:Provide labor and materials to install;1 12"layer of 14-38 unfaced fiberglass balls to(96)square feet for danuning purposes,KF IT DESIGNATED FLOOR. S 196.80 ATHC FLAT:Provide labor and materials to install an 8"layer of R-28 Class I Cellulose added to(740)square feet oropen n1lic space.KFF11 DESIGNATFE)1:1,008. S1,013.80 A*1-1'1("'ACCESS:Provide labor and materials in install(1) easily moved,insulating cover tor tile attic access Ibldint,stair. 'file cover has intoggral wevalier-stripping to restrict air leakage. $200.00 VENTILATION:Provide labor and materials to install(2)insulated exhaust hose wish soffit mounted Dapper vent to exhaust existing ballitoom fhll(s). $237.50 VENTILATION:Novidc labor and materials to install ventilation clones in(54)rafter bays to maintain air 11mv. $108MO BASEMENT DOOR:Provide Inbar and materials to insulate the back OrIlle basement door loading to the bulkhead vvith 2"rigid board that ITICCIs I lie sections R-316.5.4 and 316.6 requirements ol'building code. Sent all edges and seams wills FSK little. S7122 Federal to#05-0405G29 IZISE, Engineei-inn Rl Contractor Registration No 8106 MA Contractor RegIstration No 120979 RISEA division ol"Filielsell CoginceriNg ENGINEERING 60 Shun,mul Unit f12,Cantoo-NIA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM 7�115 CONTRACT 15 CNTCflCO INTO FIFUNEEN RISE E 4GAIESI CNIA-I I ES FUND ANN THE C US(GM CA FOR WORK AS OrSCIAOF D Aft(Al CUSTOMER PHONE DATE CLIENT WORK ORDER .Ief'l*Larcorne (978)502-9038 01/19/2016 424038 00002 SERVICE STREET OILL"Al STREET 353 Pleasant Street 353 Pleasant Strect SERVICE CITY,STAD5,ZIP CALLING CITY,STATE,ZIP North Andover,PAA 018,15 North Andover,MA 018,15 .JOB DESCRIPTION Total: $2,508.32 Program Incentive: $2,051.24 Customer Total: $457.08 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR 714E SUM OF *'*Four Hundred Fifty-Seven &08/100 Dollars $457.08 UPONFOUL INSPECTION A140 APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO 14EMIT AMOUNT DUE IN FULL.INTEREST OF 1%VALL BE CHARGED MONTHLY ON ANY VAPAR)BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION 0:0 GUARANTEES,RIG117S OF RECISION,SCHEDULING,ADD CONTRACTOR REGISI RAI ION. DO NO IGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUIII$4� DSIGNATURVRISCrteertNO NON!:THIS COUTItACTtJAYi3E�IATtIORA%V�IUYUSIFeJOT EXECUNEDWINIH GAT F' ACCEPTANCE OF CONTRACT-TnC ABOVE PRICES,SPECIFICAI IONS AND CONDI WAS ARE 30 SATISFACTORY TO US AP40AIlC HERESY ACCEPTED,YOU AAC AUTHORIZED TO no THE wonK DAYS. AS SPECIFIED.PAYMENT WALL 09 MADE AS OUILAMI)ABOVE RISE60 Shawmut Road, Unit 21 Canton,MA 020211339-502-6335 ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM r 'all 19 (Owner's Name) owner of the property located at: (Property Address) 110cl I/P,Y, XeCl , 0/ (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property.This form is only valid with a signed contract. 'Oker's SiLt Date The Corr monweakh ofMassachusetts Department ofindustrialAacidenIs UWNVorkers, 1 Congress Stree4 Sssite 100 Boston,YL4 02 1.4-2017 Is ww.massgov1d10 Cony peaasation]lnsus-anacceryAffidavit:Jaupi�ldeerrsJCOu r-ac;to(�rs�/T)Ele/ctT!Cin is/Pluwbers- ®��d':11L�.+lJ' vt'La 9A i]FL�L.Bi.I Ol-631+1��1-llV 12GVSlL C�oolasa>at Inform2tion Please Prjnl Wale (Busincss/Oraar izationtlndividual): ►� Iii t1 �� rt tt� f� i vi`" / i ri �'�' r �' �---- Address: -. � �� %= City/State/Zip- `I r;, : Phone L � Air you nn ctnploycfl Birch the appropriate bos: Type-OTproj'a(sequired)= i. I am a employer with %�v earplayeu(full and/ part-[imc)_' 7_ New contraction 20 I am a sole proprietor or par1ncybip agd bavc no®ployccs working fpr mein 8. E]Rcmodeting —y capacity-I Pro workers'comp_insu-= seNiredl 9- Ell 13cmolition 3.01 am a homeowner doing all wont my=cIt(No wor&ers'oorsrp-insurance r�nrLd]t ?0 e 3uilding addinord 4-F]I am a 6ommv na and"M be hiring contractors to eondut'all work on my property_ Twill or additions czLwm that all contractors other-have workers'contp;� ce sation insuranor ate sola 1 I-0 Elect ical repairs proprietors with no employees 12-[D Plumbing rCpairs or additions $�1 am a genal coomxtor and I have titred the sub-contactors l�stcd an t attached shed t 3_FROOf repali5 These sib-eonuuctors have employers and lave workers*comp.innnan�Y 14.�[Other 6-E]We am a corporation and its officers bavc cxaC15cd their right ofexc mptioa pa MGL e _ 152,§I(4).and we have no cmployccs-[No workers'comp-insurance rcquirad.] ,Any applicant that check box YI must also fill our thesoction below showing their workers'compensation policy information_ t Houxx canes who submit this affidavit indicatingthcy fere doing all work and tbcn hire outside contractors must subanit a new affidavit indicating s3wb tCootraetom that check this box must attached no additional sbcat showing the nater of th a sub eonwacm*s-nerd state whether or not tbose mtro'cs have cmphoyoes. If the sub-eonpactors have�-mployee:s,tbeY must Provide their workce comp-Policy numbs- 1 air an employer that isprovidhgg workers.,compensation insurancefor Isty ernplOWM Below is the policy andi0b sUe informataove. 9 Lasurance Company Name: j 0 `��: j Policy#or Self-ins-Lic.#: i 0 v 72,_ J _ Epp tion Date: c'%%='/%�J Job Site Address: 'ti S ko i Si` City/StatofZip: 16gird✓-e t- Attach a copy of the workers'comp—Dsa>tion policy declaration page(showing the�POflicy number and eltpirntiOn gale). Failure to secure coverage as required under MGL c- 152,§25A is a criminal violation punishable by a fine up to S1 X00-00 md/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK-ORDER and a fine of up to 5250.00 a Jay against the violator-A copy of this statement may be forwarded to the Office of Investigations oftlte DIA for atstu- — ;overage verification. I do h—eby cern-fps under the pains and pen alder ofperlaary that ttae injormadion provUed above is true ajsd ea�� nature �� .' �' �_, .-t-.t_, — Date: / 'hone# G�o'. r iG f �� Official use only. Do noe write in thgs area,to be completed 6y city or town 0-67 aL City or Town_ pet mit/ILSce>tse# )issuing Authority(circle one): I-Board of]Health 2-Building DWartsrlent 3.CRylroarn Clerk 4.lElectrical Inspector 5-Plumbing Inspec4oe- 6-Other COW2Ct F'ersota: Phone#: ---- POLABEA-01 JONEILL 164� FCERTIFICATE OF LIABILITY INSURANCE DATE(MWDDIYYYY) 1/6/2016 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 NAME: __ _ Durso&Jankowski Insurance Agency PHONE 11 Saunders Street g y a/C No Ext:_(978)688-7000 (A/Xc_Noj 978)688-7001_ North Andover,MA 01845 E-MAIL ADDRESS: INSURERS)AFFORDING COVERAGE— INSURER A OVERAGEINSURERA Nautilus Insurance Co. 117370 INSURED INSURER B.Safety Insurance Company_ _ 1I33618 Polar Bear Insulation Co.Inc. INSURER C'. Peter Leblanc&Steven Leblanc P O BOX 958 INSURER D__ Andover,MA 01810 _INSURER E: INSURER F: 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. -- INSR'.-- ------- iADDLSUBR, ---- POLICY EFF i POLICY EXP_ -- _— LIMITS LTR TYPE OF INSURANCE INSO WVD! POLICY NUMBER MM/DD MM/DD A I X I COMMERCIAL GENERAL LIABILITY i EACH OCCURRENCE $ _ 1,000,000 T CLAIMS-MADE i X ( OCCUR �NN538691 03/24/2015! 03/24/2016 i PREM SES Ea ocAMAGE au ante) 5 50,000 L_MED EXP(Any one person) I$ 5,000 PERSONAL&ADV INJURY ,S 1,000,000 --— - _ GEN'LAGGREGATE LIMIT APPLIESPER: GENERAL AGGREGATE 1$ 2,000,000 X1 POLICY( E C LOC f j j PRODUCTS-COMP/OPAGG S 1,000,000 OTHER: I I '$ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT I 1 Eaaccident S 1,000,000 f I((� ._- 2100926 01/04/2016 01/04/2017 BODILY INJURY(Per person) I$ B ANY AUTO ! ALL OWNED X SCHEDULED ;BODILY INJURY(Per accident)!$ iAUTOS AUT INON OED I 1 PROPERTY DAMAGE ;$ X ' WN HIRED AUTOS X .AUTOS i I_(Peraccidenl 1 $ UMBREL CESS LIAB�B' X ''AN019284 103/24/2015 j 03/24/2016 AGGREGATE(EACH OCCURRENCE S 1,00,000 OCCUR ---- - A ( �CLAIMS-MADE] I i i DED i RETENTIONS ! i PER-------70TH- 'WORKERS COMPENSATION i 4_(STATUTE _ :ER AND EMPLOYERS'LIABILITY Y/N j 1iANY ROOXECUTIVE I E.L EACH ACCIDENT ENT I $ 1OFFICMEf EREXCLUDEDIN/Ai (ME.L.DISEASE-EA EMPLOYEE $ andatory in NH) If yes,describe under - - E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS below I ! i 1 I I t i 1 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) Insulation Work-Mineral Insulation Work-Mineral;Additional insured for general liability per blanket additional insured endorsement with respects to work performed on their behalf by the above insured is Thielsch Engineering CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Thieisch Engineering Columbia Gas ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE 4000 4n4A A!1l1r3n All-...r.a..........�.....+ 1!412016 Preview:Certificates of Insurance - DATE(1.4,11B.'YYYY) CERTIFICATE OF LIABILITY INSURANCE 0110412016 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). CONTACT PRODUCER NAME: EOHE Automatic Data Processing Insurance Agency,Inc. No.E:n (AIC.No): ,N 1 Adp Boulevard ADDRESS: Roseland,NJ 0706B INSURER(S)AFFORDING COVERAGE NAIC 0 INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER e: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 958 INSURER D: Andover,MA 01810 INSURER E: _ INSURER F: - COVERAGES CERTIFICATE NUMBER: 429703 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LiSTED BELOF'.'HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED-NOT61,9THSTANDING ANY REOUIRELIENT.TERh1 OR CONDITION OF ANY CONTRACT OR OTHER DOCULIENT`ATH RESPECT TO V"HICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAiN.THE 1NSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREN is SUBJECT TO ALL THE TERLIS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SH01'{N I:IAY HAVE BEEN REDUCED BY PAID CLAIMS ILTR P LILY P LILY 05P-1 LIMITS NSRPOLICY NUMBER ( TYPE OF INSURANCE IVSD VND L16FDDiYYYY) (Mr.VDD:YYYY) COMMERCIAL GENERAL LIABILITY EACH:;CCUHHEhCE CL:ILIS IJAUL F r;CCLI, H;EA115ES IEa - LIEU PEI6C1.AL r.Ali':Il.JLIi:' GENLACCREGAI E LII-III AH'LIES PEI:: GEKERrL AGGREG I I E 5 PRC- I'RUUYJG IS-CCI.I('CI'AUG S PCUC'❑if-ClLCC i Uri-ER: UU1.1'l�tU Sll:l:L LII:iI � AUTOtAOBILE LIABILITY BCUIL+-INJLky IF,ill,-Iul 5 .V: ,W1U '.. ALLt';;t,ED SCI+EL'•LLED BCUIL•i IKJUf0 11',.-sn_cr4i S ALI I09 AUKS HIt:EU ALI OS AUKS 1P, i UtABRELLALIAB Al 61CHCUGURKENCE EXCESS UAB CLAILIS-I-11UE AUUREGAI E DELI REl Eta 1005 WORKERS COMPENSATION X < H STi,IUIE 'El; AND EMPLOYERS'LIABILITY YIN 1,000,000 a:rr3ecPlaElr_•I•P,hnA:KEx<Lf-U ni M NIA N POWC772258 01/01,2015 0110112017 EL E',c1 ,;ecluEt<1 s A C'FFiCE(td.ELIBH-'EAGLLtiE? E L DISPSE-EA 0.IPLCYLL c 1,000,000 (Mandatory in NH) II—desrnbc' -c+ 1,000,000 C•ESCIiIPiICt:CE CI'EI:i,IiC1:S b:�;: E.L.UISEi,SE-i'UUC''OI.III S DESCRIPTION OF OPERATIONS/LOCAT(ONS!VEHICLES(ACORD 181.Additional Remarks Schedule.may be IlMehed it morespace is requirld) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN Theilsch Engineering,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 195 Frances Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE -- f•. -yll iIL.,,. AC 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ` s andOf ofConsumer 11 plaza517 sachUSOM02116 �on oe o� en C � Ru® o272s DIM 71201 BEAR iN�V��toN Co - - - -=f= po�R - = Vincent LeBlanc p_o. BOX 958 ,amu for change ANDOVER, MA 0"'l o _- `"U pie Addams�d retura� t � Lost Cird Address L oP�A1 u SI1M"9A�412t6 ,� ra .-mt. .,tom.:__.-�,. vim.-._._ •' !dAl r,8 A,LEpy per+ NK 03865 _ g1Ali2iI2818