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Home My WebLink AboutBuilding Permit # 3/1/2016 BUILDING PERMIT "O°T 6�.1/0 TOWN OF NORTH ANDOVERZ. APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received � � B9 Q°Rnreo rPPy•(5 �SSACHU`�E� Date Issued: IMPORTANT: Applicant must complete all items on this page r LOCATION �O ��t��r � C"t�`G r Pnnf PROPERTY OWNER z"Uf .' Pent � 100 Year Structure yes o MAP PARCEL ZONING DISTRICT Historic District yes no `'MachneShop 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 ❑,Septic 'Well ❑ Floodplain d'Wet[ands 0 1/Uatershed District []1Nater[Seyirer N DESCRIPTION OF WORK TO BE PERFORMED: 1A Z-v Identification- Please Type or Print Clearly OWNER: Name: S -rr- v f'n Gi'. SS 0 Phone: ci 2E® Address: �� l�5 �, ��1`�1 dVfI— on tractor Name. - Phone. d Supervisor's Construction Licensee f xp ��'�, E 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: $ a-n C)0-®0 FEE: $ Check No.: Receipt No.: I NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor NORTh Town of ndover ® : � 1VLLAbla� oh ver, Mass, 241v A COC HICMIWIC. 1' 7�A�RATED f"Pa`�,6� BOARD OF HEALTH Food/Kitchen rERMIT T Septic System THIS CERTIFIES THAT . .. �... ® BUILDING INSPECTOR ............ . . ..................................................... ........... ...................... Foundation has permission to erect.......................... buildings on ... ...SA ................. Rough to be occupied as ....... .. ..... ,. ... .... .® ► ..... 116 r. ........................... Chimney provided that the person accepting this per 'Shall 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT ®NTS ELECTRICAL INSPECTOR UNLESS CONSTRUCTI? STARTS Rough Service ........... ..... .. .. ...... .... ...... ��'�r�� BUILDING INSPECTOR Final GAS INSPECTOR CCIt]JIIlZC�1 Permit e�'llll^ed� to Occupy BllZlL�lYl� 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 Approved by the Building Inspector. Burner Street No. Smoke Det. Federal io#ob-oanssm V RISE Engineering M Contractor Registration No 8188 RiSr. MA Contractor Registration No 120875 A division of Engineering ENGINEERING 60 Shawmut Unit#2,Canton,MA 02021 CONTRACT 339-502-6FAX 339-502.&MS 335 Page 1 PROGRAM CMA-HES ENNOOVAMMANCONTRACT DTTIM MER FOR WOENTERED MTO BETWEEN RK DEEIMBED ea ow CUSTOMER PHONE DATE CUENTI ;;;RK ORDER - Steven Grasso (978)337-8559 10/29/2015 425710 00002 BERM STREET 80ltNO STREET 20 English Circle 20 English Circle SERVICE CITY.STATE,DP DSUNe COY,STATE,ZIP North Andover,MA 01845- North Andover,MA 01845- JOS DESCRIPTION HEALTH&SAFETY:Weatherization work cannot proceed until the insufficient draft issue is fixed.HOT WATER HEAATER SPILLS UNDER NATURAL CONDITIONS. $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 hours.A reduction in cubic feet per minute(cfin)of air infiltration will occur,but the actual number of cfm 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 subcontractor to ensure the safety of the indoor air quality. $680.00 $0.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass batts to(64)square feet for damming purposes. $131.20 ATTIC FLAT:Provide labor and materials to install a 4"layer of R-14 Class 1 Cellulose added to(878)square feet of open attic space. $992.14 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small flat surface of plywood will be created around the opening within the attic. This will allow the cover's integral weather-stripping to restrict air leakage. $237.65 I Federal ID#050405829 RISE Engineering RI Contractor Regisbatton No 8168 MA Contractor Reglstratlon No 120979 i A division of Thietsch Engineering ENGINEERING 60 Shawmot Unit#2,Canton,MA 02021 h 339-502-6335 FAX 339-502-045 CONTRACT Page 2 PROGRAM THIS CONTRACT is wnEm WTO BETWEEN RISE CMA-HES ENGINEERING AMTHE CUSTOM MR WORK AS DESCRISEDBELOW CUSTOMM PHONE DATE CUENTp WORK ORDER Steven Grasso (978)337-8559 10/29/2015 425710 00002 SERVICE STRM SELLING STREET 20 English Circle 20 English Circle SERVICE CRY.STATE,ZIP saime CITY,STATE.ZIP North Andover,MA 01845- North Andover,MA 01845- } JOB DESCRIPTION Total: $2,040.99 Program Incentive: $1,700.74 Customer Total: $340.25 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF } ***Three Hundred Forty&251100 Dollars $340,25 UPON FINAL INSPECTION APPROVAL BY RISS 1ENGINEERING,CUSTOM AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF J%WILL BE CHARGED MONTHLY ON ANY UNPADI8AIJINCE,03PAD BAYS.SEE REVMW FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF Re=tON,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 0 StONATU E Enp rmdne CU8 ACCEPT NOTE:THIS CO CT MAY BE W.MRAWN BY US IF NOT E zCUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARC AUTHOR®TO DO THE WORK AS SPF.CIFM PAYMENT WILL M MADE•AS OUTLINED ABOVE i f 't } } OWNER AUTHORIZATION FORM (Owner's blame) owner of the property located at Lftperly Address) ver,, y404EF_ Qy8' (Property Address) —" hereby authorize (Subcontractor) an authorised sutuantractor for RISE Enggineeft,to act on my behalf to obtain a building permit and to perforin work on my property. ees Date ` ? NOV 5 2015 i The Commonwealth OfMassachusetis DeParMenf oY Industr alAcciaienls I Congress Stree4 crane 100 Boston,ALA- 02114-2017 1s')4r}I:massgovIdi a Workers'Cotnpettsation Insurance Affidavit.Builders/Contractors/1E3ectiicianslp)umbers- 'J'® ADplicaut Information 'lease Pring' Name (Busincss/Orpnization/Individual): f/t7 l/A,I', lig ;,i Address= City/sfate/Zap: I Phone if: Art you an employer?Check the approprintc bon: Type of project(segnired)-: I. I am a employer with i_��pjQyca(full and/or part-time)-- 7_ 16 Newconsit-actIon 201 am a sole proprietor or pa>tn=yhip and have no employees working for me in 8. El Rcmo&ling any amity.(No workers'comp_innuanpe required_] D=no on 301 am a home.doing nil work myself(No workers'comp_insurance:r>�cd.]t 9. �Builth g a 4-F](� ?0�i Building additiorn I am a bomenwncr and will be hiring contractor.to conduct nit work on my propcty- I will cost=that all contractors either have workers'compcosation itssuraacc or are sole I I-El Electrical repairs or additions proprietors with no cmployets 22_jr--1 Plumbing rz=palls or additions 5.01 am a general eonn-actor and I have ba-ed the sub-contractors listed on the attached sbccL 13 Roof These sub-contiactars have employers and have workers'comp_instaanc, E�1repairs 6_0 We arc a corporation and its osrteas jrave exercised their right afuQnption per rViGL e ]4.0 Other" - 152,§1(4),sod we have no employees-[No workers comp-rrssmance rcquirccLj Any applicant that checks box#I mtut also MI oat thescction below showing their-workers'compensation polity infomtatioe t Hou=w cxs who submit this affidavit indkmting they arc doing all work and tbta hire outside eoutrrrtors must submit a new atfdavir indicating sueh- ICootraaors that check this box must attaetred o additional sheet showing the nacre of tbcsubcoouactnrs and sere wbaber or pot tbose enfrtics bave cmployocs. If thcstrb cononctors have Moyne-,they muse provide their workers'comp.policy number_ 7 are are employer that 1s providing workers'compensation insurance for my employees Below rs&e policy andjob sRe fnfoi-M a£fon. s / Insurance Company Name: l G � - C �'� Policy#or Self-ins-L ic_ Expiration Dace: Job Site Address: "n City/State/`Gip: P4f�yP Attach a Dopy off the workers'comp�sation polity declaration page(sh"ving the pal3cg nulnber 22d eapirntioal date). Failure to secure coverage as required tundra'MGL c_ 352,§25A is a criminal violation punishable by a fine up to S1 500-M indlor one-year imprisonment,as well as civil penalties in the form of a STOP WORKORDER and a fine of up to$250.00 a jay against the violator_A copy of this statement may he forwarded to the()ff ce of iavestigatioms of the DIA for njg CC :overage verification. t do hereby cerd&Under the grains and penalties ofperjFuiy thatthe informer ion provided abode is L ue and correct til mature: ce j.-/ Date- -, "r - hone 0fjWW arse mrrfy. Do not iw to an this area,to be completed by city or Portree o ns City or Towyn_ pe> nit/License# Issuing Authority(circle one): I_Boated of Henith 2.Building Department 3.City/Town Clerk 4.1Electric21 Xnspettpr 5:Plumbing InspedOr 6-Other Contact Person_ phone#: POLABEA-01 JONEI LL FATE MMDDYYI)YCERTIFICATE F LIABILITY INSURANCE 0161/6/2 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 PHONEFAX 11 Saunders Street A/c No Ext:,(978)688-7000 (ac,NoZ(978)688-7001 North Andover, MA 01845 E-MAIL - - -- - — — ADDRESS: INSURER(S)AFFORDING COVERAGE I NAICB 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: E P 0 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; —iADOLSl1BR; POL(CYEFF ' POLICY EXP LTR I TYPE OF INSURANCE !INSD i WVD I POLICY NUMBER I MM/DD MM/DD I LIMITS A X COMMERCIAL GENERAL LIABILITY ' i ;EACH OCCURRENCE S 1,000,000 X ! INN538691 03/24/2015 03124!2016 i DAMAGE ISAE aecu nce) S 50,000 CLAIMS MADE OCCUR j MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY i S 1,000,000 I_GEN'LAGGREGATE LIMIT APPLIES PER- i : ! GENERAL AGGREGATE i S 2,000,000 '.. X POLICY; _PE _LOC I PRODUGTS-COMPIOP AGG 5 1,000,000 � :OTHER: -- 5 AUTOMOBILE LIABILITY j COMBINED SINGLE LIMIT S 1,000,000 Ea accident .- B _ r ANY AUTO '2100926 01104/2016':01/04/2017 BODILY INJURY(Per person) iS I ALL OWNED " XSCHEDULED � ; I BODILY INJURY(Per accident)I S i AUTOS _- :AUTOS i PROPERTY DAMAGE I -- --- --...—.--- - NON-OWNED `HIRED AUTOS K i AUTOS _ ` i_.(Per accident2 I `S UMBRELLA LIAB )( j OCCUR 'EACH OCCURRENCE S 11000,000 A i EXCESS LIAB CLAIMS-TRADE; AN019284 03/2412015;03/24/2016 AGGREGATE --DED RETENTIONS ! j 5 WORKERS COMPENSATION ; PER I----70TH- ;AND EAIPLOYERS'LIABILITY i L— STATUTE ANYPROPRIETORIPARTNERIEXECUTIVE Y/N ! E.LEACHACCIDENT S .OFFICERIMEMBEREXCLUDED? DIN/A! ! i — — — - I(Mandatory in NH) I ; j i E.L.DISEASE !If $ _ If yes,describe under DESCRIPTION OF OPERATIONS below E-L DISEASE-POLICY LIMIT ;S 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 ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE -I Goa omrn nr+non It412016 Preview:Certificates of Insurance CERTIFICATE OF LIABILITY INSURANCE Da7E(t.5l.UDDYYYY) 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). PRODUCER COHrACIF HAMdE: PHO!IE A\ Automatic Data Processing Insurance Agency,Inc- (A:c_H..E:u: IArc.not 1 Adp Boulevard AMAIL DDRESS: Roseland,NJ 07068 INISURER(S)AFFOP,DIIG COVERAGE � NAICp INsuRERA: NorGUARD Insurance Company ' 31470 INSURED INSURER 6: POLAR BEAR INSULATION CO INC ' I PO BOX 958 INSURER C: Andover,rr1A 01810 ItSURER o: INSURER E: ItISURER F. COVERAGES CERTIFICATE NUMBER: 429703 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLCIES OF INSURA ICE LISTED BELO7;HAVE BEEP'ISSUED TO THE INSURED NALIED ABO.'E FOR THE FOLiCY PERIOD INDICATED (40"PAITHSTANDING ANY REOUIREN ENT.itRL1 OR CONDMON OF:.NY CONTRACT OR OTHER DOCUNJEUT`:LITH RESPECT TO'Ni-PCH THIS CERT!F:CATE t.lAy BE ISSUED OR L'AS PERTA:N.THE iNBURANCE AFFORDED BY THE POL!CiES DESCRIBED HERErN:S SUBJECT TO ALL THE TERL:S. EXCLUSIONS AND CONDITIpa'S OF SIJCH POLICES LIViTS SHOSi N L'AY HAVE 8EE-II REDUCED 8Y PAiD CLAL"S INSR PUUCY F POLICY 1' I LTR T'(PE DFItISURANCE UNSD \'ND POLICY NUEiBER (LR`DD'YYYYI 'P',DD:YYY, ULSITS CO'.U.IERCIAL GENERAL LIABILITY E:,CF. c::LI.HH.Ct CL:dL(_'.Lr:,(A 'CGCG Pi+ELIf5E�1cz�–,c•.rr••: LIEU E,V,:r..:.r._paar.: GECL AGi;IiEG%J E Ut.Ili AFFLIES PE:1. r_Elam RT,L AGGhEG 11 E i'i:LiC" nAUTOM.0011-E L1aeil-" ' r.l I:.tL—Ni-L LC.Dt .N.=A41U I i 6CL'•IL'-IIJLP.=:I wr:alt •ALL:.'.:.EL• ;:'FEULLEU 1 I.LI•r_•:.1 L'• t•kti•tt;i' l•.V.lgt_� ��HFiEU AL Ii.S I%.LS tiS Utt5RELLA LUIS EXCESS DAB LAILIS.N.L• 'lciCEa_ E - UEt: HUE:1.II+1.� WORKERS COMPENSATIONltl lE AND Er.IPLOYERS'LIABILITY YM _ 1,ODD,DDD :ar:licrnllr_ r�r:E..tc.ulra: v NI N POtNC772258 X01101120:610110112017 ELE�.cI-acC*L" A "FH ti:1.�t.16FJ4 Er.,LLC•eG1 t! (cNanaamrY:n rNH) E L Dlsb:,E t�,Er.n�L:^'Et 1,000,000 145:_Ii1P 1101:Gh Cf•EIi611C1 Sb_1.: It.t.UISEa_t t::UL uLul i DESCRIPTION OF OPERATI01i5 i LOCATIONS i VEHICLES(ACORD 101.AddiliDnar ROMWI,s Schttlule,m.1 be atmond it ni—space is rcq,ifw) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCR18ED 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 AUTHORLED REPRESEtITATIVE lit. 11L.... I A?1988-2814 ACORD CORPORATION.All rights reserved. ACO RD 25(2014101) The ACORD name and logo are registered marks of ACORD sRegdefion AfW S and ,�1 & 5170 1(�P �� 02.116 01, Remmugom Tvppz Moir Vincent LeBlanc �E �� P_CD.BOX 95F3 _ __-- -_ o,norne A�N[)oVER3 MA Ogs10 - _=up,�AAd,Mq„dTmm -SmpIoymt*, �UstQit�1 AddressI(ene�va ppS-pAt ses SOM•UAlZ1�I3'12i6 g Pr 1JCa1x A Lu81AqC ridstDW NK 03865 ..