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Home My WebLink AboutBuilding Permit # 2/3/2016 a 1 BUILDING PERMIT 0, VkL D b�tio TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit NO#; Date Received �RA�RgTEo PpP`iy �Ssac Hus�c Date Issued: �l IMPORTANT: Applicant must complete all items on this page LOCATION R 1� Print PROPERTY OWNER ��,n off® 42v%ro-s ] Print 100 Year Structure yesCjno o MAP �"7i PARCEL: ZONING DISTRICT: Historic District yes Machine Shop Village yes TYPE 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 91 Others: ❑ Demolition ❑ Other ��S v 14%r 0 N ry oe e lie ell Flo d �ai�r ®Wetl�andst 1Ir/aters'e ®steric x°u " Ss DESCRIPTION OF WORK TO BE PERFORMED: ✓ i,J'S�e,lio5 TAi C Li'\ sy1gP;-t'0M 7-0 "`�! _ Co/r.h ii Iri�Dlq Identification- Please Type or Print Clearly OWNER: Name: S g n d do dv,'/'u S Phone: Address: A"I T d' U Contractor Name: �Y>r� I�� c Phone: f2.P- 763 Email: Address: 9- Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.•$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ />oo_0 v FEE: $ Check No.: � 1 �� Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Hull _ Sg ° i. � NORTH Ai-ELIO& ov v, y., 46 icwj"� r O No. ��' abjy �,oh ver, ass, Jaw cocNIcncw1c.c �qs RATED 00��S U BOARD OF HEALTH PERMIT T LU Food/Kitchen Septic System THIS CERTIFIES THAT ,...vir�, ....... BUILDING INSPECTOR has permission to erect ..V...1..... Foundation .......................... buildings on ... .. ��........ ........................... A® Rough tobe occupied as ....... .....� ........ ...... . ® ......... ...... .0 ................................ chimney provided that the person accepting this permit all 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 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR ® UNLESS CONSTRUCTIONATA Rough Service ......... .................... .. .............. . BUILDING. INSPECTOR. Final GAS INSPECTOR Occupancy Permit Required to ®ccuny 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 Approvedby the Building Inspector. Burner Street No. Smoke Det. Federal ID 0 05-0405629 RI contractor Registration No 8`186 RISE Eijgineerin� MA contractor Registration No 120979 RISEA division of'I'llicisch Emgi ricer!ng CT Contractor Registration No 620120 ENGINEERING 60 Shavvioul,Caldou,NIA 02021 CONTRACT 339-502-5197 FAX 339-502-6345 Page PROGRAN-1 THIS CONTRACT IS to I EREDIN 10 BE IM Ell RISE H CNIA- ES E RGINEERING AND THE CUSTOMER Fort 6�iGRK AS Rc,'3CRTaE0 BELOW .................. ............... CUSTOMER PHONE DATE CLIENTS WORK ORDER Sandro Quiros (617)955-9268 12/08/2015 426693 00002 ----—------- ------ ....... SERVICE STREET SILLPIG SIREEI 22 Ir vino Road 22 Irving Road 5ERVbCBRAXIG CITY.STATE,ZIP E CITY.STATE.ZkP North Andover, MA 0 18,15 North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:provide labor and inaleriak to Seal areas of your holue against wasadill,excess;lie leakage, 'rhis work will be perl'ornied in concert%vill,lite use ofspecial tools and diagnostic tests to assure that your lunne will be lull with a berdthrul level of air exchange and indoor air quality,Materials In be used to seal your lionle call include Caulks,follne,and other products, primary arew;fair scaling include air leakage to attics,baseloculs,attached garages and other unheated areas(vvindovviare riot generally addressed.) 'Illis will require(4)vmking hours. A reduction in cubic feet per Inioll le(Cfin)of air infoitration vvjjj occur,but the actual litilliber of Chu is not guaranteed. At lite Completion(If'tile vvealherilation work,and at no additional cost in the houlcowner,it final blower door and/orconibus(ion sallely sorely analysis will be conducted by(fie sub-contractor In ensure the s, or tile indoor air quality. 5340.00 ATHC ITAT:Provide labor and materials to install it 12"layer of R42 Class I Cellulose added it)(312),quarc leer ofopen attic space. 5499.20 SLOITS:Provide labor and materials-t I o install it 8"layer of ft-2D Class I Cellulose added It) s(I'l8re luct ol*slope area.Wheiever possible battles will be installed to the entire length ofeach bay to fullinulin ventilation space. 5496.0 ATI IC ACCUSS;Provide labor and materials to insulate the back of(I)attic hatch with 2"ri,-,id'I hermax board.\Veatherstrip the perimeter. $60.00 i1mvide labor and materials to io'.aatl vetil lotion Clinics in(36)c-,dlQr buys to taWintain air 11cox. S72.00 BASEMENT CEILING:provide labor and materials to install I I il)linear feet of R-19 unlaced fiberglass insulation to the perimeter ol'ifie basement Veiling at tile house sill. S206,50 JUSH l7tiginecrint,\vill apply all applicable,eligible incentives to this contract. You,75 ionly IR,billed the Net mount U 111�Yfor 11WE 1 11,for lite Air Sealing Inelcitires nivasailej,(.*oInjohin Gas ollurs 75%,incentive,not to esoced$2,000 per calendar year,and an incentive of 1001. lip to the lieu$(ISO and an additional$340 ifsavillgs are juslitied by tile auditor. J.'or the saluty arid health oryour homes indoor air quality,vve will be conducting as blmw door di agnostic of the available air flow in your horse both before the work is bcgon,and alter[lie wCallierilalion mels is complete.We will also Conduct a full wo;"milent of the combustion safety ol'yoor licating System and vvalcr heater.This lilts a value of$90 and is at 114)CIKI it)you. allowable%wailieriZalion incentive is 53,110. S90j)() Fedani ID 1105-0406629 RISE Engineering RI Contractor Registration No MG MA Contractor Registration No 120979 RISE division orl"llidsch Engineering CT Contractor Registration No 620120 ENGINEERING 60 ShasynUH,Contion,NIA 02021 CONTRACT gyp- 339-502-5197 FAX 339-.502-63-45 Page 2 11ROGRANI Tuts ,; CONTRACT 13 ENTERED VITO BETWEEN RISE CNIA-11ES ClO4CGf25fiGA14DI)JECLISTOI,IEHFOIZWOiIKAS DESCRIBED DELON CUSTOMER NIME DATE CUE14T 0 WORK ORDER Sandro OHiros (617)955-9268 12/08/2015 426693 00002 ................. SERVICE STREET BILLING STREET 22 Irving Road 22 Irvino Road L, ................. SERVICE CITY,STATE,ZIP IULLRIG C17Y,STATE,ZIP North Andover,MA 01845 North Andover, MA 01845 ,JOB DESCRIPTION Total, $1,764.30 Program Incentive: $1,430.72 Customer Total: $333.57 WE AGREE HEREBY TO FURNISH SERVICES.COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "'Three Hundred Thirty-Three&671100 Dollars $333.57 N HLY MIT UP MAL INSPECTION MO APPROVAL BY AMOUNT DUE WFULL UNERE&T OF 1W,VA "Al"'111110 1, IIIAL'tISIICCIIIIIIIAIIIIAPPRIIVI ON UAL�AMNIC�EAFTER340NYS.SEF C ACES, DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANI;zpelc-lrl`� .......... �,T A =AUTIIOI X051 WAS. RISE E1194 inn CUSTOMER ACCEPTANCE NOTE:THIS COR TRACT MAY US WITHDRAWN BY US IF ROT UXECU rED VATHIR DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT THE AIIOVL PRICES,SPECIFICATIONS AIM CONDD 10143 ADS 30 DAYSSATISrAC TORY TO US AND ARE I IEREDY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE VIOUK . AS SPCCIFIED.PAYII.EU r WILL BE MADE AS OIJULNEO ABOVE OWNER AUTHORIZATION FORM Sandro Quiros (Owner's Name) owner of the property located at 22 Irving Road North Andover MA (Property Address) 22 Irving Road North Andover MA (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to on my behalf to obtain a building permit and to perform work on my property. Ow er s Signature Date The Commonwealth of MassachuseM Department of 1ndustrialllccttden1S I Congress Streel;sprite 100 Bosion,M4 0.2II4-2017 www.maass gav/dia Workers'Compensation Jusurance A zf idavit.]Builders/Contractors/Electricianstplumbers- Atooliearl2 ilxafioranPeion '?teasek'sine IL�l'�r blame (BuszncsslOrgatiization/individual): (� I��11S t`t ti j !� /. %i (Pi Address: C. eft City/State/Zip: t:• Lll/: .//J'/i✓ Phone r Art you nu employer?Qxccit tale appmprfatc bos: llypeoTproject(,required)= I. I am a employer with 11) toy—(full aodtoi7 pari-tim)_* 7- E]New constmction 20 I am a sole proprietor or parinaybig and have no employees working for me in 8. Remodeling _y capacity-[No warkcs comp.insruanrr rnqutrtd_j 30I am a homeowner doing all work myset=Pio workers'comp_insurance rcquired_j t 9_ Buil Olga( 1 t)�;Building addition 4.❑I am a hornow,ner and will he hiring cooft—tors to conduct 1311 work on my proptsty_ I Will air msruc that alI eonanctors caer either have works'oomper,sation insurance or art sok: i I_�Electrical reps or additions proprietors with no employe 12_n Plumbing rcpaus or additions 5C I am a grncal contructor and I have biral tha sub-coewactors fisted on th`attached sbocL j 3_FIRoof repairs "ihcsc sub-contractors have anployccs and bavcworkcrs'comp.instsancct 6_n We are:a corporation and its ogiic=bave cxc ri%cd their right of cccrappon per MGL C- 152, 1�_ Qtllt 152,§1(4),and we have no cmploytx5-[No workers cotnp_insurance rcqukc(Lj `Any applicant that checks box#I must also fill out the section below showing their workers cornpensaiica policy information- I Homcownas who submit this aff`sdavit indicating they arc doing all work and then hire outside oontractors must submit a new afruhvit iodicatwg such tCootractors that chck this box must attaeh as additional sheer showing the name of the sutrcoatractors and sate whctbcr or not those mtidcs have cmployccs_ If the sub-contractors have employees,they must provide their workers'comp.policy numb=_ /air an employer loaf ss providing Worfters'coms venation insurance for My erraploye�u below is the policy and ob 5:e r�afor,�:atiove. 9 Insurance Company Name: rj U Policy#or Self-ins-Lie-#: Jy(iJG 7/r3 J Expiration Date-. e J//el Job Site Address: 12 `t N1,04- r� City/State/Zip: n . )o Irld4jtf-e✓ Attach a copy of the Workers'compensa en policy declaration page(showing the policy Dumber and espimtioudate). Failure to secure coverage as required wWcr MGL c_ 152,§25A is a criminal violation punishable by a fine up to$1,500-00 md/or one-year imprisonment,as well as civil penalties in the form of a STOP WORKORDER and a fine of up to$250.00 a iay against the violator_A copy of this statement may be forwarded to the Office of Investigations ofthe DIA for""" ce :overage verification. r do hereby ramify under thepains andpenalties ofperjury that the tnformadonprovided abave is L-aae and corn e—* - Date: 'hone#: G =j u f ' OJficiad arse only. Ao not n7ite in this ares to be completed by ciry or Down ofjWaL City or Town_ )Pet nit/License# Issuing Authority(circle one): 1_Board of lRealth 2.Building Vlepartrueut 3.City/Town Clerk 4-Llectdcal Insklectas 5-- Plumbing Ruspector 6-Other Contact Person: Phone#: 114/2016 Preview:Certificates of Insurance DATE(ri!.I;DDiYYYY) CERTIFICATE OF LIABILITY INSURANCE 01/0412016 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 15 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 NAL1E: PHONEL Automatic Data Processing Insurance Agency,Inc_ IANC.No.Exiv (11C.11D)) t•..AI 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC9 INSURER A: NorGUARD Insurance Company I 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER C: I PO BOX 958 Andover,MA 01810 INSURER D: INSURER E: INSURER F: - COVERAGES CERTIFICATE NUMBER: 429703 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURAIICE LISTED BELOY:'HAVE BEEN ISSUED TO THE INSURED NALIED ABOVE FOR THE POLICY PERIOD INDICATED.NOTV:'ITHSTANDING ANY REOU;REr ENT.T ER1.1 OR CONDITION 0;ANY CONTRACT OR OTHER DOCULIENT VJ'ITH RESPECT TO WHICH THIS CEP.TIRCATE MAY BE ISSUED OR I AY PERTAR T THE iNSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN S SUBJECT TO ALL THE TER1.IS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES LIMITS SHOWN WAY HAVE BEEN REDUCED BY PAID CLAILIS INSR POLICY tF POLICY EXPLR.1ITS LTR TYPE OF INSURANCE INSD vivo I POLICY NUMBER IIA?XDD,YYYY) (M1M1,1DDFYYYYii COMMERCIAL GENERAL LIABILITY I tato, CL.;Ir.IS Ll.;lit �C�.:L Ic r'liEl.1I�E.:It.:,�__•%r:_•: L=tf:L i.L=Li:tC•:1 E LILA I APPLIES 1'EH. Litt:EP J,L A iUhLUA i E [`CLIC i'IiL: �Jtl„I I°I:rJCti r role AUTOMOBILE UABILITI' I `I.I Il.tl`SII:LIt Llt.il i .V.'=:d11'.'. BCOIU`II,1LIi'r ALL r':.V.EU S':FE'LLED S .iLICS AL•ICS 1:.:1.^t'.I:tU I'1;�1-tltt'U%.LIAL•t FIlitO ALI[,S .:l i':S I' T.-RELLALIAB - CCF. LAO-CLCUI?aT.:t EXCESSUAB CL;,17.151.1:.1it AGGGtGAit ULD HL-IELIIIA.5 VJORKERS COI APENSATION X Ft` 1 t r AUDEMPLOYERTUARILITY �i�.f L'It Ili Y e!1 1,000,900 ;a_rHa_I'Iaticrpaliu P:t:mLU11.E oLJA' N' POt:IC772258 01;01:2016 01101;201? ELEACI-AcClukl.I A --HCE; tlleFJ t ttc 6 1,000,000 I(rt tl l ym NH) I EL LISc at ti L-N RCM 5 )I 1S 1,000,000 LcS._I:11'NCI.LF LF�IiAlIi:1:S'v::�:: t-L.DL t.._t-1'.:Uti'Ul.tll 1 DESCRIPnOtt OF OPERATIONS;LOCATIONS I VEHICLES IACORO 101.Addili—al Remwks Schedule.may be att Oh.d if--p——pace is requited) 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,Rl 02910 AUTHORLED REPRESENTATIVE I AC 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD POLABEA-01 JONEILL CERTIFICATE OF LIABILITY INSURANCE DAT1/6/2 DnYYY, 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 Durso&Jankowski Insurance Agency NAME:PHONE - - — FAX 11 Saunders Street ac No E„t_(978)688-7000 _ (ac,No):(978)688-7001 North Andover,MA 01845 E-MAIL ADDRESS: --INSURER(S)AFFORDING COVERAGE I NAIC# INSURER A:Nautilus Insurance Co. 17370 INSURED INSURER B:Safety Insurance Company 33618 Polar Bear Insulation Co.Inc. INSURER C: Peter Leblanc&Steven Leblanc INSURER D: P O Box 958 - - 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. ILTll - — _ _ R TYPE OF INSURANCE ANSD 5WVO POLICY NUMBER MMlDD EF�MM%DCD EXP LIMITS COMMERCIAL GENERAL LIABILITY BCH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED - - I A X CO CLAIMS MADE �(OCCUR NN538691 103/24/2015 03/24/2016 PREMISES(Ea occurrence) ($ 50,000 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 --- — —- GEN'L AGGREGATE LIMIT APPLIES PER I GENERAL AGGREGATE $ 2,000,000 (( PRODUCTS-COMP/OP AGG $ 1,000,000 POLICY L�PE° j�LOC I - OTHER: AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 Ea accident f AUT B ANY AUTO ;2100926 101/04/2016 01/04/2017 BODILY INJURY(Per person) $ ALL OWNED ��( SCHEDULED BODILY INJURY(Per accident) $ AUTOS __ AUTOS I — -- NON-OWNED PROPERTY DAMAGE X HIRED AUTOS X AUTOS i .(Per accidentZ__. _i_$--.._ -___.._ I— i $ EACH OCCURRENCE $ 1,000,000 � CLAIMSauIADE !-------- ----- _..---- UMBRELLA LtAB X A EXCESS LIAB �AN019284 03/24/2015 03/24/2016 (AGGREGATE $ DED RETENTION$ i $ :WORKERS COMPENSATION PER I OTH- AND EMPLOYERS'LIABILITY �-STATUTE ! ER ANY PROPRIETOR/PARTNER[EXECUTIVE Y/N i E.L.EACH ACCIDENT 1_$ OFFICER/MEMBER EXCLUDED? N/A __II (Mandatory in NH) ( E.L.DISEASE-EA EMPLOYEq$ - ;Ifyes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT $ I i i DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be 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 Thielsch Engineering Columbia Gas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 9 9 ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave Cranston,R102910 AUTHORIZED REPRESENTATIVE I � n�000 on�n Annnn fnnonnA"f%Kl An..,.ts...............� -4 ItQ , Ao^ �� sinsRegdafion consumer - AfW&and 10 P182a- S�je�2116 S2lD �1�5 r Boswu, ti C�C►ZidII 140mD 102726 D'BA Ttr# 2=49 =-s Ecpiratiarr Mao"' OAR BEAR iNSVLP`T(COI�I CO. P Vt[1CeC1t -eB7aT"!C - _ fir, onfaccIiange. P.O.BOX 95$ A WW 1810 - and return ent Lost Card ANDOVER, MA 0 UpdAddress TRUptaym Address al OPS-'�At u S9Nt�'�412t6 v [m P x ?]&T W A7ZAVpMSMET piafirstow NK OWS