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HomeMy WebLinkAboutBuilding Permit # 2/3/2016 BUILDIN0 G PER t%ORT fid TOWN OF NORTH ANDOVER IN 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received Date Issued: IM ORTANT: Applicant must complete all items on this page LOCATION 3 Print PROPERTY OWNER 'vl rQ V'VI t y Cq Print 100 Year Structure yes rn -b(3 PARCEL: ZONING DISTRICT: Historic District yes MAP no o Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building [I One family 0 Addition L1 Two or more family El Industrial El Alteration No, of units: Li Commercial Li Repair, replacement [I Assessory Bldg g( Others: El Demolition F-1 Other -Fr\ so t A a W 4 DESCRIPTION OF WORK TO BE PERFORMED: ,fq I'�fq 6'V1 9 47je P,'q V' t--/,7// Identification- Please Type or Print Clearly OWNER: Name: lkn-U/-Y\ (,q r rq-e Phone: Address: lvleiro (d Contractor Name: P(>-rd- 141,qoe Phone: '-/O;> -,7>6;3,R' Email: Address: rA57- pl,/170 5i /a"s i-q W /,q, /v. Supervisor's Construction License: —Exp. Date: Home Improvement License: 9o,, 2d- 6, Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT. $12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 000- ea FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Si /irnature r.uve o n w 4-� 71, IR _q NORTH firujown of2 ', „ nuover ® J ffi C h ver, ass T d LAKE 1 COCKICMEWICK � ' Rgreo U BOARD OF HEALTH PERM.. I T U Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ........................ .. .' ............ .. � .... ........ ................ . .. . . .. ......... ..... - Foundation has permission to erect buildings on .... ..... .. .. .. .. . ... . . ................. Rough tobe occupied as .......... .. .. ....... .. .......... ......... .��.............................. Chimney provided that the person accepting this per hall in eve 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough iA Final PERMITI 6 MO S ELECTRICAL INSPECTOR LES C1 i000* 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 o all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Federal[DO 0&0405629 RISE Engineering RI contractor Registration No 818 RISE MA Contractor Registration No 1210979 A division of Thlelach Engineering i ENGINEERING so Sha t1s nrona� ,,`02021 CONTRACT G 339-5l�"""� F 339-502-6345 —�--� Page 1 PROGRAM LO teEDWOBEMEMFnE CMA-HES ErMEER XiA MCUSCUSTOMFOR AS a DEBcmeMBELOW GtaTOYet PHDNE DATE CUMTS WORK ORDER Kevin Carney �' (978)413-0303 0923/2015 421810 00003 SOME SrFJWT t—. BUM STFJMT 39 Harold Street o 39 Harold Street BERM cnry.STATE,VP MUM er.STATE',MP North Andover,MA 01 North Andover,MA 01845 JOB DESCRIPTION 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 seating include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed_) This will require(2)working hears.A reduction in cubic feet per minute(cfm)of air infiltration will ocou,but the actual number of cfin 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 ofthe indoor air quality. $170.00 AIR SEALING:Provide labor and materials to install Q-Ion weatherstripping and a doorsweep to(2)door(s)to restrict air leakage. $150.00 WALLS:Furnish and install blown in Class I Cellulose to(1440)square feet of shingle and/or clapboard exterior wails.The butt of the upper course of your wood siding is cut to drill holes into the wall sheathing behind.The holes are then plugged and the wood siding is reinstalled using stainless steel finish nails.Touch-up painting,if needed,will be the customers responsibility. Invoicing will occur upon completion of installation. Subsequent to your payment,as an added service,RISE Engineering will wtum when weather permits to check for any voids with an infiared scanner. Any major voids that may be found will be filled at no additional cost. $2,664.00 RISE Engineering will apply all applicable,eligible incentives to this contact. You will only be billed the Net amount Curse tjy; 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.Ibis has a value of$90 and is at no cost to you Total allowable weatherhation incentive is$3,110. $90.00 4. Federal to#OS4405629 RISE Engineering RI Contractor Reglsba@on No 8186 RISEN MA A division of Thletsch EngineertBg Contractor Registration No 120979 ENGMEMING 60 Shawmnt,Canton,MA 02021 CONTRACT 339-502-5197 FAX 339-502-&M5 Page 2 PROGRAM THISCONTRACTISENTERPDarr0BETTYM NTaeE CMA-HES EN604M NO AN6THECU8TO/�R V0E0f= DESCP M BELL CUSTOMER PHONE DATE CUENTO WORKOROM Kevin Carney (978)413-0303 09/23/2015 421810 00003 SERVICE STREET 8ML=STREET 39 Harold Street 39 Harold Street SERVICE CRY.STATE,IIP BIWNO CTMOTATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,074.00 Program Incentive: $2,260.00 Customer Total: $814.00 WE AGREE HEREBY TO.FURNISH SERVICES-COMPLETE IN ACCORDANCE VOTH ABOVE SPEC=A nONS.FOR THE SUM OF ""'Eight Hundred Fourteen&001100 Dollars $814.00 UPONFINAT. AMAPPROYALDYWSEENOUtEBWMCUSTOIERAGItMTOR1 WAMOU MMINFU1LB MM"OPISVM.BECHAROEDYONRM.YONAW uNPuo aFTERsoDAYs.BEEREVERSEPORB�ORTAMSffORMA700NOR GUARWMM.RI MOFe&asMR MMULDr,.MWCORTRA=MRWmwAUK DO NOT SIGN THIS CONTRACT IF THIOLE ARE ANY BLANK SPACES CUSTOMER ACCEPTANCE NOTE:TM CONTRACT MAY BEWTTHDRAM BYUS IF NOT EXECUTED WRNW BATEOFACCEPTANCE /laq/go/5 ACCEPTANCE OF COMPACT-THEABM PRICES.8PEMCATIONS AND CONDnwm ARE 30 DAY& SATISFACTORY TO US AND ARE HEREBYACCfPTE0.YOUARE AUTHORIZED To DO THE WORK AS SPECREO.PAYMENT WBL BE MADE AS WnJNEDABOVE OWNER AUTHORIZATION FORM I Nick Brings (Owner's Name) owner of the property located at 39 Harold Street, North Andover, MA 01845 (Property Address) 39 Harold Street, North Andover, MA 01845 (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. Owner's Signature Date The CoYlamonrdealj*ofMassachusem Department of-IndustrialAceidents I Congress Stree4 S aite_700 Boslol<p AM 02,?-7.I 20-Y7 }1 ww.mas&g&v1dirt NVorkers'CompensationInsurance Affidavit: �ill�Idery�0II47Sf$9I5/�S¢sC3lClHAS!]�I11D11� - 'S®;aJ� AnolicanF Irlftornaa$lora �'leasePnt� 1i ' Name (Business/Organizatio&ladividual): l� I%`t 1 1�'t i tt j� j v f• i; ;i /' r Address: City/Stam Zip: Art yam nu employer? theappaprlatebos: Type oTproject(required)- 1.E I am a employe with —,,ply=(full nna/oz part-time)_- 7_ y New consuuct1on 2•0 I am a sole proprietor or parteusbip and bnv a no®ploycrs working for me in g. Remodeling any Kiri(No workers'cora.inswunce reNire&l t 9_ ��nolition 301 am a hommwncr doing nll wort myscI=[No workers'comp-insurance rcgt&cd_J ]0�'Building addition 4_❑I am a bomcowner and will behiring 000ft—tom to Conduct H)l work on my property_ I Gill ca um that all contractors other have,workers'camp=5-ioninsuranceora=Sole II_F]Electricalrepairs oradditions proprietors vritb no employed l2_[]Plumbing repay or additions 501 am a garc-al contractor and I have bired tha sub-cont2ctors listed on the attached sheet_ 13.1--IRoof repairs The=sub-contractors have employers and havcworkcrs'comp_insuran—t 6-0We arca co tion and its oI$ees bave exercised their ri t of et Other 6_ rpora gh emptioo per MGL e- 152,§1(4)�snd we bavc oo employees.[No workers'comp.instnanw rogttim&j -Any applicant tbia nccclr box#I must also fill out thescction below showing their worker romprnsation policy information_ t Homeowners who submit this affidavit indicsting they arc doing all work and then hint outside 00ou2ctnrs mtsY subamt n new allidavit indicating such- tCoatnn ors drat check this box must attached ao additional rhea sbowiag the name of the rut•L onmg ^t Hod sate whubcror not those entities have employees_ If the sub-contrnctors have employ.they mus[provide their workers'cutup.policy number_ 7 am an e7nployer-tfaat Is providing Wvrkty-s'compensation inswance for my emPloyses. Below is the rwliey andi0b site irafor oration. 1 Insurance Company Name: U Policy#or Self-ins-Lic_#: �� 0 t/ 7/�•�' JT Expiration Date: lob Site Addrtess: � rn p (� ti r City/State/Zip: k1 . [�/'t 6(0 kanch a copy of the workers'compensation policy declaration page(showing the jlalicq number and eapirntiOn date). Failure to secure coverage as required under MGL c- 152,§25A is a criminal violation punishable by a fine up to$1500-00 md/or I500- md/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to 5250.00 a Jay against the violator_A copy of this statement may be forwarded to tite Office of"investigation ofthe DIA for insurer"' :overage vcsification- r dry hereby certify mnder dW Dain andpenalties ofperjaery that the Information provialed abate is tPate and correct- iitntature: lute: > A r hone#- r / o 0jraciad arse only. dao not wrote in this arm W be completed fry rias,or tniwn 0# ML City or Town_ Per mit/)C,icense# Issuing Authority(circle one): 1_Board of Health 2.Building Dep2rtment 3.City/Tovm Clerk 4-Electrical Inspector S.iPitsMbing I<nspeetor 6_Other Contac$Person: Phone#: 11412016 Preview:Certificates of Insurance FOATE IidttiODYYYY) CERTIFICATE Or LIABILITY INSURANCE 8110412016 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 NAME: :i CONI- PHONE Automatic Data Processing Insurance Agency,Inc- rAiC.Na ETslr ii+c.uoi t•,IUL 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFOP•DINGCOVFRAGE NAIC7 NISURER A: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER C: I PO BOX 958 Andover,MA 01810 INSURER 0: INSURER E: INSURER F_ COVERAGES CERTIFICATE NUMBER: 429703 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLI GES OF it 1SJRANCE LISTED BELO'Id HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POU CY PERIOD INDICATED.NOTV.11THSTANDING ANY REOUREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCULIENT Y:'TH RESPECT TO':YHiCH THIS CEP.TIF;CATE LIAY BE ISSUED OR is AY PERTA:N.THE iNSURANCE AFFORDED BY THE POL'C!ES DESCR!BED HEREN:S SUBJECT TO ALL THE TERLSS. EXCLUSIONS AND CONDIT;OfdS OF SUCH POLICIES LIMITS SHOWN UAY HAVE BEEN REDUCED BY PAID CLA%I.".S INSRAME 5011171POLICY F POLICY EXP i LU.11TS LTR TYPE OF INSUR.VICE INcD VNO POLICY NUMBER 'POLICY Q.1G1•DO YYYYi COMMERCIAL GENERAL LIABILITY I t:.Ct- C::Li.REi.Ct :�p F-1 "Ll.L AUCR ECA I E Lit-III;WFLIES I'EhE L'EM:i',L AGGI LUA l t HL" 1.111, I�CLIC"❑JI't(.l LCC l:-:i:iS-__.t.11-:;i':.(iC AUTOMOBILE DABILI7Y I 1.1 It.t-•.�.Il;llt Ll;.Il1 t VJIti � 6COILer II:JLIi'-a-:'p.r.an: i .LL L'cU �LrtL%LLEO Bt,UiC�ILp_h•IFv.._cam�'r1. D ll ;, nLIC5 - i�I.C!'.I:tl 1'l:tl•thl''L'.+f.l:,lt I' UL:BRELLA LIAR H', CitLAUC- L.LI t:4. EXCESS UAB CLAII.IS t.V,l•t ',(Y_1:Ec- IE LED I.LIEL11:-1.=. I i I, WORKERS COMWE1ISATION Y ttic r-tr AND EL7PLOYERS'LUiBILITY SAIL It Elt Y i N 1,000,000 ;,L:'I3::_PHEu_I:PaI:n Rt:.tccu.E ry—)INIA N POITC772252 0]/01.'20:6 0110]2017 tL t.c}:.cacrr.I A :PaCel:eini6ttit:LLttO? I tLD15cA5E-tAtEmD^'tE i 1,000,000 (htantlatory in UH) it. ::ecn:'r '-- 1.000.000 1111 DESCRIPTION OF OPERATIONS;LOCATIONS I VEHICLES(ACORO 10I.Additional Remaks Schadvie,may be atoehed it mmesPace u required) CERTIFICATE HOLDER CANCELLATION SHOULDANY 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 AUTHORLED REPRESENTATIVE i A^1988-2014 ACORD CORPORATION.All rights reserved. ACO RD 25(2014101) The ACORD name and logo are registered marks of ACORD POLABEA-01 JONEILL CERTIFICATE OF LIABILITY INSURANCE DAT1/61/6/1 DOI20166 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 98 88-7000 Fax ( ) 11 Saunders Street ac NyE�:-� 7)6 _ ._ �(a/c,No)- 978 688-7001 North Andover,MA 01845 E-MAIL ADDRESS: INSURERS)AFFORDING COVERAGE_ j NAIC# INSURER A:Nautilus Insurance Co. _ J17370 INSURED INSURER B:Safet Insurance COMpanV 33618 _ Polar Bear Insulation Co.Inc. INSURER C: Peter Leblanc&Steven Leblanc PO Box 958 INSURER D: I - - - -- -- -- 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 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR I iADDLISUBR; PO/DLICY EFF I' POLICY EXP LTR I TYPE OF INSURANCE I INSD WVD! POLICY NUMBER I MMD MM/DD ! LIMITS A X COMMERCIAL GENERAL LIABILITY j EACH OCCURRENCE '$ 1,000,000 -� I DAMAGE TO RENTED CLAIMS-MADE 'I) OCCUR NN538691 ; 03/24/2015;03/24/2016 PREMISES Eaoccurtence) -.$ _ 50,000 ---- ! I MED EXP(Any oneperson) $ 5,000 — _ PERSONAL&ADV INJURY I$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. I GENERAL AGGREGATE $ 2,000,000 ' R f POLICY j JET ' LOC PRODUCTS COMP/OP AGG ;$ 1,()00,()00 i j I _- - - - — OTHER: ( f ( I $ AUTOMOBILE LIABILITY I COMBINED SINGLE LIMIT !S 1,000,000 y Ea accident _el .. B _ ANY AUTO I 2100926 01104/2016:01/04/2017 BODILY INJURY(Per person) $ JALL OWNED j�( SCHEDULED i j I ;BODILY INJURY(Per accident) $ AUTOS x NON X AUTOS I i PROPERTY DAMAGE $ HIRED AUTOS AUTOS i L(Peraccidena - i� $ I ; UMBRELLA LIAR 1 i X OCCUR I s 1 000,000 EACH OCCURRENCE , A I EXCESS LIAB I CLAIMS-MADE j AN019284 03/24/2015 i 03/24/2016:AGGREGATE DED 1 RETENTION$ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY I ER ANY PROPRIETOR/PARTNEWEXECUTIVE YIN' i I ! E.LEACH ACCIDENT - $ _. OFFICER/MEMBER EXCLUDED? �I N/A —— (Mandatory in NH) I I E.L DISEASE-EA EMPLOYEEI$ If yes,describe under DESCRIPTION OF OPERATIONS below I I EL DISEASE-POLICY LIMIT i$ I j 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 9 9 ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE- j y� .r ntinoo •]n7n A f%fNnr%l�f100AOA TI^KI A11..,-ht................1 sRegdafio". es of 10 pa&plam S-C&M 5170 �©Imprp cci�.=._ tar gi . pion n-- 10272-6 om Maoir Off L,p,Tldl�t�Ct_ ,Vincent LeBlanc for chma P_d.BOX `,�p �g� a �` _ P,NDO ER, MA 0 i 8 1 - jJ 1 t�[E55 grid YId1XiCl1 o tQ �$ D�bS��`9rd iJW Addr"s `y—s RenetVdI ogs-.�Ai �snnn °1�e C„ML406U9T ?F,TER A PM SME' i