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HomeMy WebLinkAboutBuilding Permit # 3/1/2016 NoRry BUILDING PERMIT 0.1 %AO TOWN OF NORTH ANDOVER 0� -J3APPLICATION FOR PLAN EXAMINATION A Permit No#: Date ReceivednORRTEDePPp` Date Issued: 3 �SSgcHuSE� IMPORTANT: Applicant must complete all items on this page l � Pnnt 100 Year Structure yes 'no MAP PARCEL �� ; ZONING DfSTRICT Histonc District ye no .Machine Shop Village:.'''ye " =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 it Others: ❑ Demolition ❑ Other .1 Septic 1/Vell ;❑ Floodplain, (JWetlands V1/atershed District 0Water/Se�nier•� ': ,�; . DESCRIPTION OF WORK TO BE PERFORMED: )'0&J X70 1/ f n-ri lgTI`® tit Identification - Please Type or Print Clearly OWNER: Name: e 0) ogle Phone Address: d 13 11 57 Contractor Marne l~� ,a L ;Phone. ' / 7G Supervisor's Constructron License 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: $ )-;F oo,o c) FEE: $ Check No.: 111-521 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of contractor NORTpf 2Town of . : : Andover ....,_ 'yam• ® `AKE ver, Mass, A COCNICNEWICK 1' RATED IPa`yr(� �S U BOARD OF HEALTH Food/Kitchen PER Septic System THIS CERTIFIES THAT BUILDING INSPECTOR LD ............... ...... .. ... ................. ... ..... .................... ..........................S"'I .. ... . ` ... ........... Foundation has permission to erect.......................... buildings on ... ....... .1... ...... ® ... Rough to be occupied as ...................... ........,ji .`....... .........�......�.�► �A. . ... chimney provided that the person accepting this permall 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 J VIOLATION of the Zoning or Building Regulatirens Voids this Permit. Rough Final PERMITI ®NTS ELECTRICAL INSPECTOR LES CTI ARTS Rough Service ............. ........e.�..... . ..: ..................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildinz 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. I Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thiclsch Engineering CT Contractor Registration No 60 Shawmut Unit 02,Canton,MA 02021 ®NTR A CT 339-502-6335 FAX 339-502-6345 E PROGRAM Page 1 THIS CONTRACT KA CMA-HCS ENGINEERANDWECUST ER FOBETWEEN WORKAS ENGINEERING OESCRISFO OELOW CUSTOMER PHONE OATE CUENT0 14ORKOROER Heather Doyle (978)270-7839 09/17/2015 418255 4000 SERVICE STREET 01WNG STREET 213 High Street 213 High Street -- --- - -- 2 2 20 - SERVICE CITY,STATE,ZJP 01WNG Crll',STATE,LP , y I 1 North Andover,MA 01845 North Andover,MA 01845 t JOB DESCRIPTION . BARRIER:A Blower Door Test will not be conducted at your home,due to the presence of asbestos. $0.00 BARRIER:The following contract is not valid unless accompanied by the Pre-Weatherization Barrier Incentive form,signed by your licensed electrician.Work will not proceed with this work until we receive a copy orate form. $0.00 BARRIER:We have identified a moisture issue in your home that needs to be addressed.Homeowner is responsible for correcting this moisture concern,prior to the installation orany weatherization work.B.DRY SYSTEM GOING IN OCT.3RD.SHOULD SOLVE PROBLEM $0.00 AIR SEALING:Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage. This wvork will be performed in concert with the use ofspecial 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 generdly addressed.) This will require(8)working hours.A reduction in cubic feet per minute(cfm)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 sub-contractor to ensure the solely of the indoor air quality. $680.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass balls to(120)square feet for damming purposes. $246.00 ATTIC FLAT:Provide labor and materials to install an 8"layer of R-28 Class I Cellulose added to(696)square feet oropen attic spacc.I COULD NOT ACCESS OVER REAR I ST.FL.BUMPOUT ASSUMMED SAME AS MAIN ATTIC. $953.52 ATTIC ACCESS:Provide Iabor and materials to insulate the back of(I)attic hatch with 2"rigid Thermar board.Weatherstrip the perimeter. t $60.00 ATTIC ACCESS:Provide labor and materials to make(1)temporary access to an attic area. 'rhe opening will be closed with a permanent roof vent $92.42 r VENTILATION:Provide labor and materials to install(3)8"diameter roof vents)to increase ventilation in attic areas. llme vent can be supplied in(circle color)black,brown,gray or mill finish. $256.50 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with roormounled Mapper vent to exhaust existing bathroom Fan(s). $118.75 VENTILATION:Provide labor and materials to install ventilation chutes in(56)rafter bays to maintain air flow. $112.00 Federal t0 9 RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thietsch Engineering CT Contractor Registration No �u 60 Shawalut Unit 02,Canton,NIA 02021 ^®w'�b �.p. b 339-502.6335 FAX 339-502-6345 CONTRAV ISH 1 SPage 2 PROGRAM CONTRACTTHIS RISE CMA-HES ENGINEERING AND THE CUST MER FORED INTO UR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONE DATE CUENTR WORKORDER Heather Doyle (978)270-7839 09/17/2015 418255 00003 SERVICE STREET BILLING STREET 213 High Street 213 High Street SERVICE CITY,STATE,LP BILLING CITY,STATE,LP North Andover, MAO 1845 North Andover,MA 01845 JOB DESCRIPTION VENTILATION:Provide labor and materials to install(6) 6"X 16"rectangular aluminum soffit vents to increase ventilation in attic areas. Specify color:White or Gray. $150.00 BASEMENT CEILING:Provide labor and materials to install(86)linear feet of R-19 unlaced fiberglass insulation to the perimeter orthe basement ceiling at the house sill. $150.50 i Total: $2,819.69 Program Incentive: $2,284.77 Customer Total: $534.92 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Thirty-Four&92/100 Dollars $534.92 A UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMITAMOUNT DUE IN FULL IN7XREST OF HL WILL DE CHARGED MONTHLY ON ANY FTER RT UNPAID VALANCE A30 DAYS.SEE REVERSE FOR IMPOAM INFORMATION ON GUARANTEES,RIGHTS OF RECISIO,ICHEDULING,AND CONTRACTOR REGISTRATION. _ — NOT SIGN THIS CONTRACT IF THERE ARE -t Y BLANK SPACES z AUTHOZWGUATURE-RISE En cerin Cr MER CCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDmONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DOTHE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE OWNER AUTHORIZATION FORM �,__ f��4�`he►r Qo yl�` (Owner's Name) owner of the properiy at ( ►n ) . (Pmparly Address) hereby m orke ( nbacbx) an autiwdmd wboontrsctor for RISE Enghteeft,to act on my beth to obtain a buMq permd mid to perform work on my own ftnahue Date {'t� SEP 2 2 2015 The Commanweakh of jVassachmsetis Departmew qjr1ndzistrja1,4cc&en!s I Congress Sir_-e4 suite 100 Boston,M4_ 02114-2017 Workers' g&v1dza Workers'Compensation Insurance Affidavit:]Builders/Contr-actors/EleciLricians/i>lujnbers- Applicant Information NaM e; (13usincssIOi-ganizatioafludividull): /,A i�ij 5 ei It— !A (7;4 4"!6, :Z� Address: Cf City/State./Zip Phone-#-- ase you nn employer?Chc�:the apprvprbte be= Type ofprojet(,,q4reQ_- 1. FINew construction I am a employer with /Q {full nodfor part-time)_- 7- 20 1 am a sole proprietor or PW1U=Vhi0 and have no employees working for me in 8- Ranodea. any capacity-(No workers'camp.insurance -quired-I 301 h...,doirig.11wort,myself[No workers'comp_inSU%zncc,.q,&cd.]t 9- DanolitioD F-1 4_0 I am a bomcovnux-and will he hi,�g con-h-Actom to conduct all work on may props t 10 Building addition_ twill L--..) CUSUM 033t 811 cone actors Cither have WorkCM'C0MP=153f!Gn inStIfaDCt or are sole 11-E]Electrical repairs or additions proprietors With no cmpjoyccsr-1 Plumbing repairs or additions 12-1 5-01 am a general acmancLor and I have bired d=SUb-contra"OrS h9cd on the attached ShcCL 13-E]Roof repairs These sub-contractors have mvloyacs and have workers'comp-insuran=_r 6-0 We am a coxporat;on and its offic, 14.F-1 Other .,,bavc mmci5cd tb--jr right of` p,,,\,IGL r- 152,§1(4),add we have no cmplD_yc.=-,[No workers'camp_insurance rcpirt&j -P-y applicant that cbCCkS box#1 must also bit OW thesection lJc10W showing fficir workers'co-p-satin.polity infotmatioo t Homeowners who submit this affidavit idicating they arc doing all work and then hire outside contractors must submit z deco ntfida,dt indicating--b- lCoausctors that cL=k this box must attached=a zdditknml sled showing the nada orthcsu b au state_ca TxMrs a ndwb t1ber Or not tbo5c,cuti""have C:Mp1qYccs,. If the sub-contractors have=Vjoyccs�,they must provide their workers,comp.policy numbar- I air an employer thaf 1'S:.providing Worke7S'Comper,'Sadon inSUrancefor My employees. Below is thepo&y andjob site rnformadon. - 7 [assurance Company Name: 0C, Policy# or Self-ins-Lic- Expiration Date:_ 6241t'l fob Site Address: I 'Z1 9 r Q to CitylStatd7_ip Attach a COPY Of therkers'compensation poticy dedaratiou page(shoving the poNcy number e ad e3zp1jrzdon date). Failure to secure coverage asrequired ander MGL c- 152,§25A iSacriminal violation punishable byafine,p to-SI500-00 indfor one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of LIP to 5250.00 a iay against the violator-A copy of this statement may be forwarded to the Office of Investigations ofth,DIA for in--n- -overage verification. do h-0by CW-dfy wader the pains and 17enald=qFfuej5Fuiy that the informaffon proyMed awye is true and eorrgct Date: "hont; Ojffci'al use oirly. Do not write in this area,to be completed by ciky or town OfficLaL City or Townt PertnitjLkenSefi Issuing Authority(circle one): L Board ofHealth 2 Building DF-pnrment 3-Ciq/Toym Clerk 4-)Electrical IDSPe-d6r 5.Plumbing I-Wect" 6-Other Contact Person: pbone#: POLABEA-01 JONEI LL DATE(MMDDYYYY) 2CERTIFICATELIABILITY INSURANCE 1/6/ 016 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 - - - " — — FAX - — 11 Saunders Street A/c No Fact_(978)688-7000 —_ _ _(ac_NoL_(978)688-7001 North Andover,MA 01845 E-MAIL — — ADDRESS: INSURER(S)AFFORDING COVERAGE 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 P O BOX 956 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. TYPE I I LIMITS INSR i iADOL SUER; POLICY EFF POLICY EXP ' LTR I .INSD I WVD I POLICY NUMBER MMIDD ! MMIDD A I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 )C ( NN58691 03124/2015:03/24/2016 j PREM SES Ea accu AMAGE TO RtzN I o ncel S 50,000 CLAIMS MADE OCCUR 3 j i I ;MED EXP(Any one person) S 5 000 -- ____ PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER. i GENERAL AGGREGATE l )C I POLICY PRO- - i S 2,000,000 JECT LOC PRODUCTS-COMP/0P AGG S 1,000,000 i - — OTHER: i S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT i S 1,000,000 .._ j accident B _ ANY AUTO X2100926 01/04/2016 t 0110412017! BODILY INJURY(Per person) S ! ALL OWNED SCHEDULED ; BODILY INJURY(Per accident)'$ AUTOS AUTOSI _ HIRED AUTOS - )C I NON-OWNED PROPERTY DAMAGE :S .AUTOS ),(Peraccidena _ — — I $ ... _ — I UMBRELLA LIAR !)C`OCCUR EACH OCCURRENCE $ 11000,000 A EXCESS LIAR AN019284 03/24/2015 03/24/2016 — __ :SAIMS-dADE DED RETENTION 5 WORKERS COMPENSATION PER OTH- ' .ANDEMPLOYERS'LIABILITY Y/N i ;__ STATUTE ER _ - ANYPROPRIETORIPARTNERIEXECUTIVEDIN/Ai i E-L EACH ACCIDENT is _ OFFICER/MEMBER EXCLUDED? !(Mandatory in NH) I ; j E.LDISEASE-EAEMPLOYEE S If yes,describe under -- DESCRIPTION OF OPERATIONS below I EL DISEASE-POLICY LIMIT 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 g ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE _Y r !l ia0o•nAn Arlr%Ort^/ nnf1MATrdf%@1 A11-"t- ...............�.! IW2016 Preview:Certificates of Insurance 3 DATE Iri!xonzyYYYJ CERTIFICATE OF LIABILITY INSURANCE 011041ZO16 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRD41ATIVELY 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 Ute 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 COUP ACr HAIAE: PHONE AS Automatic Data Processing Insurance Agency,Inc- E.0: I Vc.Nn; I Adp Boulevard ADDRESS: Roseland,NJ 07068 IISURERIS)AFFORDIMIG COVERAGE NAIC7 INSURER A: NorGUARD Insurance Company ' 31470 INSURED INSURER e: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 988 Andover,MA 01810 INSURER D: INSURER E: INSURER F- COVERAGES CERTIFICATE NUMBER: 429703 REVISION NUMBER: THIS IS TO CERTIFY TH:T THE POLICIES OF ItJSJRAirCE LISTED BELO'l.HAVE.nEEN ISSUED TO THE INSURED NALILD A.5QvE FOR THE FOL-CY PERIOD INDICATED Ido i A`ITHSTAP-JOING ANY REOU:REi.:Et1T.T`oRL:OR CONDMON OF ANY CONTRACT OR OTHER DOCULIENT YiITH RESPECT TO%VHICH THIS CERT!FICATE LIAY BE ISSUED OR L:.+Y FERTA.(d.THE TISURANCE AFFORDED BY THE FOL=CIES DESCRIBED HEREIN:S SUBJECT TO ALL THE TERLIS. EXCLUSIO;JS AND COND)TiOP•:S OF SUCH POLIC•!ES ULI)TS SH017N WAY HAVE SEEN REDUCED BY PAID CLASP'S INSR TYPE OF DL— POLICY F P LICY 1' i Llf.IiTS LTR It 1 POLICY NUMBER (1�L4'DD.YYYY) 1f61•�O YYYYj COLIMERCIALGRIERAL LIABILITY t:.cr- clhtdtLCt L:.L'.LLI•:Ut LU: I+i;ELlr�"�It.*.�rc•_r:-•: _ ' VEIN tSEr:L i:Gr11iEG%•I't LILIr I dl7'LItS PEI:. I GEKtH:.L AGC,h ti^.I t Pi;LI;;�LIJtLI �ILC:: i;i Z1..:G1; AUTOf.:OHILE LWBILITY LI'O.ED SILCLI LI.II 1 - al' _ Al =:.1�1•; i fiLL'•IL'=If:JIli::i4"p,r-'�tt: ::LFE:VL U .H_I I;'s AL:I CS _ 1.1,C11-111 I rIF:tU AL I::_= PAu ki 13 ft 13 UM:.aRELLALUfe -L1. =ALI- ::tiI%MILL-!: EXCESS LIA9 I CLAIMS.Lc.Dt Aul-HH>:.I t '. OIL` ' RL-i EIaIP�65 11ORKERS COMPENSATION X W.1' I' AUD EM..PLOYERS'LIABILITY I SI AILIE N: Y.N 1.000,000 ):':IT:_I;I;I�II'i:'I':.Fi11.E1-:c:itLlTl':E V 1 D�I� 1 011011-7017 t` t:.t;h:•1'L1L'•tl.i �`- A :FFtdLRr ISH{ • LC•G, 1111A R P 1 772258 01101,12016 ' (Lmntlalory fin❑H) tL.ulst.Ist-ta trJPu^•tE 1,000,000 '.. ILcS:_Inrilci:cF crtr.:.ncl.s n__:: I � �t.L.ulSEast r-�.u��ur.u) - 1,000,000 DESCRIPTION OF OPERATIONS i LOCATIONS,VEHICLES 1ACOR0 101.Addib.-I Rema.kl Seh Walle.n1.J be attached it mausp—,Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN TheilsclT Engineering,Inc. ACCORDANCE WITH THE POLICY PROVISIONS- 195 Frances Ave Cranston,RI 02910 AUTHORVED REPRESEI1TATn'E Ac 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD -eo, ✓ t don sReg ()�.c 10 parkpiva 0 02116 ogton,lV� ss . . PWsuatoxo C6-fttri-!or 102'126 16 sgAmdorr. Mao -ftoN Co- POLAR FEAR 114S Vincent LeBlanc _P.O. Box 958 Q1 �� = - . - ANDoVE s MA _ _ �p�ActdrM dt�baen� � 1oy�,�r°t ❑Lost e� pddrM v Itener�a QPg.GAt �a 5RN!(}�a�f1YAi6 CSSLAWIT ?]&TER A LURLW EAV-PM Ey