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HomeMy WebLinkAboutBuilding Permit # 2/3/2016 BUILDING PERMIT NORTH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: ` Date Received `°`"" " �gSSgcHUS�Ry Date Issued: A IM ORTANT: Applicant must complete all items on this page LOCATION /496 15017-A 5' Print PROPERTY OWNER ewe r Me? r", n r�-� Print 100 Year Structure yes no MAP ✓ PARCEL: O-� l 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: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other "rte'^ � 1 �.�•kt � 74 r� ,��r' ern .. �:� '� � u ��, DESCRIPTION OF WORK TO BE PERFORMED: iJ'S�4 /��9 �TTfC t'hS✓/�?�o�•%d r�P�l9 U�'dJ�'i/Gj-ior� Identification- Please Type or Print Clearly OWNER: Name:Name: Tr by P i,,-^rr a/! '-e, Phone: I Address: /4G S-91rA41 6 7— pq P dour v' Contractor Name: P- > c f- I -e A ►G o e-- Phone: y 2-263 Email Address: Supervisor's Construction License: Exp. Date: /Id?b Home Improvement License: ? G Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.•$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ L/>Cd. a® FEE: $ Check No.: -77 I J Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund { ------------------- 4. f _a4 - ;fr�.,, .,,<;, v, r,'..,..,aka :a: ..L.vra^`r.(, r.� 4,.• u!„!r NORT9y UVV t 0,k w n 0'nw nd r ® i �T P 'P , LAKE ♦ V ' `L] ss, coc"ICNEwtcmP MEN&k y1' S ll BOARD OF HEALTH ERMI �T� L Food/Kitchen Septic System THIS CERTIFIES THAT ® �A h BUILDING INSPECTOR ....................... ... ... ........ ................... ................... .... .......................... 6 Foundation has permission to erect ....................... buildings on . .. ... ............. .. ....... ..................... Rough to be occupied as ...........................A.r.,At4i.. .......'t'.... .,`H !�....�......�........ chimney provided that the person accepting this permit shall in every spect 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 PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR UNLESSTIO T S Rough 40P 1 Service .................... ..... ............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occum Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Firw' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal ID#05-0405W RISE Engineering RI Contractor Registration No 8186 S E A division of Thielsch Engineering MA Contractor Registration No 120979 R I ENGINEERING 60ShawmutUnit#2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 1 PROGRAM TM COWWM CMA-HES we arerUM �cFOR ivRMAS DESCRInm seww WOMMER FNONa DAW eumil woRKORDan Jennifer Martin (617)9704718 11/17/2015 413635 00003 SERVICE SmeMr 9IutNG STREET - - - _ 166 Salem Street 166 Salem Street SWIVICE crrv.srAM EP SUMG crrv,warn,EP North Andover,MA 01845 North Andover,MA 01846 Zp15 d JOB DESCRIPTION BARRIER:A Blower Door Test will not be conducted at your home,due to the presense of asbestos_ $0.00 AIR SEALING:Provide labor and materials to seal areas 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 your 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 sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(8)working hour;.A reduction in cubic feet per minute(cfin)of air infiltration will occur,but the actual number of efin is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 AIR SEALJNG:Provide labor and materials to seal areas 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 your 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 sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(4)working hours.A reduction in cubic feet per minute(cfin)of*infiltration will occur,but the actual number of cfin is not guaranteed. At the completion of the weatheriration work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $340.00 DAMMWG:Provide labor and materials to install a 12"layer of R 38 unfaced fiberglass bal s to(164)square feet for damming purposes. $336.20 ATTIC FLAT:Provide labor and materials to install a 14"layer of R-49 Class 1 Cellulose added to(1000)square feet of open attic space. $1,690.00 ATTIC ACCESS:Provide labor and materials to insulate the back of the attic door with 2"rigid Themtax board and seal the doors edge with weatherstripping to restrict air leakage. $73.91 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). $118.75 VENTILATION:Provide labor and materials to install ventilation chutes in(36)rafter bays to maintain air flow. $72.00 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 surface drill and plug method The holes are plugged with styrofoam plugs, and speckled to a rough fnish. Any sanding and painting required are the customers responsibility. $175.00 1/ Federal ID#05-0405029 b RISE Engineering RI Contractor Registration No 8186 R I S E MA Contractor Registration No 120978 A division of Thletsch Engineering ENGINEERING 60 Shawmut Unit#2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339502-6345 Page 2 PROGRAM THIS ENTERED�BSTINVEN KCMA-AES ENGINEERING ATRACTND THE WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLOW 0 WORK ORDER Jennifer Marin (617)970-4718 11/17/2015 413635 00003 SERVICE STREET WIMNG BTRELT 166 Salem Street 166 Salem Street SERVICE CITY,STATE,m+ BIUDIo CTY.STAMZLP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION CRAWLSPACE:Provide labor and materials to install (316)square feet of R-10 rigid Therma x insulation to the crawlspace perimeter wall up to the sill and against the band joist.FIN PIPE EXISTS IN SPACEI $1,169.20 RISE Engineering will apply all applicable,eligible incentives to this contract You will only be billed the Net amount. Currently, for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. For the safety and health of your home's 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 weatherization 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 weatherization incentive is$3,110. $90.00 .Ar Total: $4,745.06 Program Incentive: $3,109.99 Customer Total: $1,635.07 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE BUM OF "*'One Thousand Six Hundred Thirty-Five&071100 Dollars $1,636.07 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO RENT AMOUNT DUE IN FU INTEREST OF I%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER SO DAY&SEE REVERSE FOR IMPORTANT INFORMATION ON OUAP-MaEEB.RIGHTS OF RECISION,SCHED"G.AND CONTRACTOR REMTRATIOM O NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Oz � AAA AUTH SIGNA -RISE aCCPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 Apra. SATISFACTORYTO US AND ARE HEREBY ACCEPTED.YOU AM AUTHORRED TO DO TIM WORK AS SPECIFIED.PAYMENT WALL BE MADE AS OUTLINED ABOVE OWNER AUTHORIZATION FORM i r7 (Owner's Name) owner of the prop"located at (Property Addrs) (Property Address) hereby authorize (Subcorrhactor) an authorized subcontractor flor RISE Engineering,to art on my behalf to obtain a building permit and to perform work on n y property. �L< a/� �--"` Owner's Slgfuli Date . goy � The Commonwealth ofMassachusem Department©�IndustrialAccidents I Congress Street,Smite 100 Boston,HA 02114-2017 www mass gov/dia Workers'Compensation Insurance Affidavit:lauilders/Contractors/EIectsicians/Plumbers. 'I O BE FILED WITH THE PERAUTnNG AUTHORITY ; ARY)Hcaut Information Please Paint 1 b Mame (Business/Oroenization/Individual): I!\t1 Address: .- fir' ���' i= City/StateJZip: ."%Tl"V Phone Are yo®an employer?Cbedt the approprintc bos: Type of-project(required)_ J.Q I am a cniploycr with /-f) cu3pkT=(full nn&or part-time)_' 7_ El New construction 2.0 I am a sole proprietor or partnership and have no employees working for me in $. i—i Rmnodcling —y cap—ity-(No workers'comp.insuranm required] 9. Dcrnolition 3-01 am a homeowner doing all work myscIL[No workers'comp-insurance rt q,&r-d.]t 10 Building addition 4_r]I am a bomcown x and will be hiring contractors to conduce all work on my property_ I will 11_ Electrical airs or additions cu-st=that all contractors ether re ther have workers'compensation insurance or asole rep proprietors with no cmployecs_ 12.[]Plumbing repairs or additions 5 I am a gmeal coutractor and I have hired the sub conrractors listed an the attached sheet These sub-comtractors have employers and have workers'comp_in��*+cet I3.®Roof repairs 6.3 We arc a corporation and its officers have exercised thcir right ofexc apuon per itgGI.c 14-®Other 152,§1(4)�Bad we have no employees.[No workers'comp_insuzance requim&j 'Any applicant that checks box#I must also 6lt ora the section below showing their workers'rnmpeasation policy information. t Homeowners wbo submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such_ tComannctors that check this box mast arracbcd as additional sheer showing the name of the sub-cantraemrs"and sate whmbv or am ibpse entities have employers. If the sub-contractorsbave employocs,rbcs must provide their workers'comp.policy number. I am an employer that esproviding workers'compensation ntsurancefor my employees. Below is thepolicy andjob Siler fnformatlon. Insurance Company Name: i"?C, Policy#or Self-ins-Lic_#: Expiration Date: r 4//%fie)/ fob Site Address: ) Q G y I'0Wl % City/StatelZip:-. A r edoilf t1" Attach a copy of the workers,compensation policy declaration page(showing the policy number and eapiratiols date). Failure to secure coverage as required under 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 lay against the violator_A copy of this statement may be forwarded to the Ogee of Investigations of the DIA for:,,Mier^m ;overage vcsification. t do hereby cer7ify vender the andpenaldes ofperjaary that the ntformationprovided above its true and earveCt signature: < Date �— :'hone Ofjzcial use only. Do not write in this area,to be completed by city or town offiew City or Towns Permit/License# Issuing Authority(circle one): I_Boatel of health 2 Building Department 3.City/Town Cleric 4.Electrical Inspector 5:Plumbing Inspector 6-Other Contact Person: Phone#: 1112016 Preview:Certificates of Insurance DATE(MMiDDYYYY) 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 5UBROGATION 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). CONIACr PRODUCER NAIdE: PHONE Ai Automatic Data Processing Insurance Agency,Inc. rAic.❑o.Exit (AIC.t+ot t•HAIL I Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFOROING COVERAGE NAICY INSURER.: Not-GUARD Insurance Company I 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC IIISURER 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 POLICES OF INSURAn CE LISTED BELO7d HAVE BEEN ISSUED TO THE INSURED NAL;ED ABOVE FOR THE POLICY PERIOD INDICATED.NOT%VITHSTANDING ANY REOUSREL:ENT.TERMOR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT V,-:TH RESPECT TO':.HICH THIS CEP.TIRCATE I3AY BE ISSUED OR LIAY PERTABd.THE iNSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREN iS SUBJECT TO ALL THE TERLIS. EXCLUSIONS AND CONDITION'S OF SUCH POLICIES LIMITS SHOVT11'AY HAVE BEEN REDUCED BY PAID CLAa'S IN SR POUCY tF POLICY EXP i LWITS LTR TYPc'OFINSURAIICE InsD 5'ND POLICY UUL1BER IMIX13D,YYYYI II.7G1•'DOrYWYi COMMERCIAL GENERAL LIABILITY LACI- 'O'CE w i_LAILIS LVU•c El,..;LII i{it7.11�tS lc.:_t--rcr_-r! Vizlib'U LAL°.AL:-'II.JL t:]' GtI:L�tC=CiitO•:/t LIL111 AVITIE:i PEI:. ( UECER.TI, UC-hh*•;IE IiL: PG'LIC` JLC L'.:C i`IgL'CL!:IS-_GLIP.::p•;GC: ' AUTOL:OSILEUP, ILITY I VELI'It.ti'YI:I:LE LI'.111 ,:t.-AI,I" B'.'UIL'�II:JLE:::i_V=rr'�Il; .:LL L.W.LU SLFEL-LLED B::UIL'd IICp;ICf W, =_rciJi 1 Vii.U I:hU 1'I:i l•t II'-li,:i.1,1t_t HHEU AL 1AUi CS Ur!BRELLA LIAB LI-CL.LI kti:Ct > EXCESS LIAR ggq.15 Li;.C•t ( tliEi I t OLD S WORKERS COI APENSATIOH AND EMPLOYERS*LIABILITY 'I:.iLIE Eli v i I+ 1.000,000 At li i U,Ila E Irl FA t;u_I;E.<ECLt:.t 1�,r.A N P-OWC772258 01;01:2076 01!01!2017 ELE%.cF r,CLlLtr.i A FI H tet t6ef E ALL (r I (Mandatory in t+N) 1--'1f•" I E L L'L'EA51:-EA ELIPLCYEE 5 1,000,000 L•cStH(PnCi:Lit CPtliAliG:S tr:r�r. EL.ULL'•�E-1'C LI:Y Ot.ul 1,000,D00 DE5CRIPnOt1 OF OPERATIONS;LOCATIONS I VEHICLES IACORO Ini.Additional Remarks Schedule m.y he alticF.ed it more space 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,R102910 AUTHORLZED REPRESENTATIVE_ I ACD 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD POLABEA-01 JONEILL CERTIFICATE OF LIABILITY INSURANCE DATE(MWDDNYYY)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 HON (978)688-7000 �a.No):(978)688-7001 11 Saunders Street — - North Andover,MA 01845 p DRESS* INSURER(S)AFFORDING COVERAGE I NAIC A INSURER A:Nautilus Insurance Co. 17370 INSURED INSURER e: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. _ INSR -- -- iADDL SBR POLICY EFF POLICY EXP LIMITS LTR TYPE OF INSURANCE INSD D( POLICY NUMBER MM/OD TMMlDD A X COMMERCIAL GENERAL LIABILITY [_EACH OCCURRENCE $ 1,000,000 CLAIMS MADE lu OCCUR NN538691 ( 03/24/2015 03/24/2016 pDR tm SES{Ea occiEb occurrence) !$ 50,000 - - — - I I MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1 000 000 GEN'LAGGREGATE LIMIT APGENERAL AGGREGATE $ 2,000,000ffPLIESPER: I i ! _ X POLICY(�JECTLOC PRODUCTS-COMP/OP AGG $ 1,000,000 - — P AGG -- OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000 I Ea accident — BANY AUTO 2100926 01/04/2016 01/04/2017 BODILY INJURY(Per person)-Is ALL OWNED FX_ SCHEDULED ' BODILY INJURY(Per accident) $ AUTOS AUTOS — -- -- NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accidence__ i_ XI X —i is i I I I UMBRELLA LI EXCESS ABAB X OCCUR 03/24/20151 EACH OCCURRENCE $ 1,000,000 A r I L.OCCUR AN019284 I 03/24/2016!AGGREGATE $ -- --_ - DED i I RETENTION$ $ WORKERS COMPENSATION PER � ' 0TH- ! AND EMPLOYERS'LIABILITY STATUTES_ ER ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N I I ELEACH _ACCIDENT ____ _$ OFFICER/MEMBER EXCLUDED? N/A (Mandatory In NH) r E-L DISEASE-EA EMPLOYEE $ If yes,describe under —— -- DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I I i 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 Thielsch Engineering Columbia Gas THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g 9 ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE r,,,inoo nnin Al�AOI>!-AO0A0ATIA41 nu-...t.f..............A (:jN24 .v asst�� �Pla�a S and Q office 0-ft911 10� - �®�116 s�h L Boston, star UIDU. Conics 6 rov _ Regi°n' 1�D272 _ - Type-- L1�A Tri n_ Tf2fZ�1� ,ON CO- ppLAR BEAR IN U VincenO C95l$nc _ =_- __ rea enfiorchang P.O. 8 i$10 to ent Q Lost Csrd ANDOVER, MA 0 = .. - .= updshe Address and return vmp Address Renewal :_j - _. op�cat w �„�,A.�a�2rs diil7E:�ttaY3.C�Ly`.L`3"dl*'n75i`��'�3:L'.�:3�x �i i2tq P"ETER.,JXRI T plow NU 03865 . �✓;:ass:35:�518: