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HomeMy WebLinkAboutBuilding Permit # 3/1/2016 BUILDING PERMIT o� %AO�T 6�w TOWN OF NORTH ANDOVER o� '6 o m APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 9CHU`-'���y Date Issued: �gSS I PORTANT: Applicant must complete all items on this page - Pnnt Print 100 Year Structure yes o MAP PARCEL ZONING DISTFI,CT Historic Distract yes no Ma cYine Shfop llae17 � 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 ❑ OtherV/ex I\®0 J/Septic 01Nell` ❑ Floodplain UVetlands o Watershed District p,laer/Sewer DESCRIPTION OF WORK TO BE PERFORMED: nn 0-7 (a7►,00 Identification- Please Type or Print Clearly OWNER: Name: 6 Tr i o(-Y :Pu i0 Phone: Address: let (, Wcty-er l �t LO Cotra.ctor Name �3-,,1-,, Address • 1'�.�i�to�, �. . �3�6 Supervisor's Construction License Home Improvement License :0�-'7 p A� ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. .� Total Project Cost: $ Y90- ® 0 FEE: $ Check No.: � Receipt No.: La NOTE: Persons contracting with unregistered contractors do not have acces to the guaranty fund Signature of AIgent/Owner Signature of contractor NORTH' i 'lown ot _ ndor% ver No. IL C% : LA"F h ver, Mass, COCHICHEWICK %' �®AERATED PP���S S u BOARD OF HEALTH Food/Kitchen rER Septic System w, BUILDING INSPECTOR THIS CERTIFIES THAT ............ki! ...... ,..................... ...... ........................ .... .................... has permission to erect i ......... buildngs on . � „ , Foundation Rough to be occupied as ......... .. . ....... �h�. �... .. .�►� ,,� . .. Chimney . 1... . ..... ......................... ............... .. provided that the person accepting this permit 11 in every respect conform to the terms .o 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIO ARTS Rough Service ............ ...... G. ....... ..............r.................. 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 or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Federal ID# n� RISE Engineering III Contractor Registration No RMA Contractor Registration No A division of Thidsch Engineering CT Contractor Registration No ENGINEERING 60 Showmut Unit#2,Canton,MA (401)784-3700 FAX(401)784710CONTRACT Page 1 PROGRAM THIS CONTRACT W ENTERED INTO eaTWEM RISE CMA-HES ENOWEERINOAND 70CUSTOMER FOR WORK AS DESCRIBED 6E1.OW CUSTOMER PHONE DATE CLIENT# WORK ORDER Gregory Irving (978)857-7924 02/01/2016 428660 00002 SERVICE STKEUT BILUHO STREET 196 Waverley Road 196 Waverley Road SERVICE CITY,STATE.ZIP EUMG CnY,STATE,ZIP .._..._-_.. North Andover,MA 01845 North Andover,MA 01845 2011-0 JOB DESCRIPTION FEB 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:'Ptiffffry'.._ areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(6)working hours.A reduction in cubic feet per minute(cfin)of air infiltration will occur,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 of the indoor air quality. $510.00 HOMEOWNER SHOULD REMOVE FLOORING IN ATTIC PRIOR TO INSULATION AND AIR SEALING $0.00 AIR SEALING:Provide labor and materials to install Q-ton weatherstripping to(1)door(s)to restrict air leakage. $58.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fibergiass batts to(126)square fed for damming purposes. $258.30 ATTIC FLAT:Provide labor and materials to install an 8"layer of R-28 Class 1 Cellulose added to(600)square feet of open attic space. $822.00 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. The cover has integral weather-stripping to restrict air leakage. $200.00 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with soffit mounted flapper vent to exhaust existing bathroom fan(s). $118.75 VENTILATION:Provide labor and materials to install ventilation chutes in(37)rafter bays to maintain air flow. $74.00 VENTILATION:Provide labor and materials to install(4) 6"X 16"rectangular aluminum soffit vents to increase ventilation in attic areas. Specify color.White or Gray. $100.00 BASEMENT CEILING:Provide labor and materials to install(114)linear feet of R-19 unlaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $199.50 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 Federal ID 9 IUSE Engineering RI Contractor Registration No Contractor stratlon No RISEN A division of Thielsch Engineering CT Contractor Reg ttstrat on No ENGINEERING 60 Sbawmut Unit#2,Canton,MA CONTRACT (401)784-3700 FAX(401)784-3710 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CKA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT WORK ORDER Gregory Irving (978)857-7924 02/01/2016 428660 00002 SERVICE STREET BILLING STREET 196 Waverley Road 196 Waverley Road SERVICE CRY,STATE,IIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION 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 • r; Total: $2,430.55 Program Incentive: $1,987.41 Customer Total: $443.14 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Forty Three 8141100 Dollars $443.14 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 7%WILL.BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. x DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES lla4z) /w/� x A..,f AUTHORUMDSIGNATURE-RISE EnSIneeft CUSTOMERACARrP rAN NOTE.THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE v /• // 3ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT KOLL 811 MADE AS OUTLINED ABOVE RISE �� 60 Shawmut Road,Unit 2 1 Canton,MA 02021 339-502-6335 ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM (Owner's Na e) owner of the property located at: (Propehy Address) M � 01 ,945, (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. This form is only valid with a signed contract... :. Owner's Si e1� Date The Commonwealth of Alasscacludsetts Department of Industrial Accidents 1 Conb cess Street, Suite 100 Boston, IIIA 02114-2017 M W"11'f!nU1SS.aoV/ilia NCorkers' Compensation Insurance Affidavit: Builders/('ontr•actors/Electricians/Plumbers. TO BE FILEI) iVITH THE PERIMITTiNG AUTHORITY. Applicant Information Please Print Legibly Name (13usIness'Organizationllrid n'iduaI): I C) (G 14 IALtA0 N ('V _17�,C , Address: P© go X 9S City/State/Zjp: A,\dou er, m/1, of 10 Phone #: Are yoo an employer.'Check the appropriate box: Type of project (required) 1 ®1 ani a emplmer with rmplol'ecs(full and'or part-time)` 7. ❑ New COiISIrUL'lI(lll '_❑i am a sole proprietor or partnership and hace no emploN ccs working for me in 8. ❑ Remodeling am capacity INo\coikers'comp insurance required J t) ❑ DCi11011tf011 3®1 am a honicowicr dung all ssork myself [No corkers-comp InSUranee required l' 10❑ Building addition •1 ❑1 am a homeowner and\sill be hiring contractors to conduct all wick on m1 property I wr11 ensure that all contractors either liute workers'compensation insurance or are sole I 1 ❑ Electrical repairs Or additions proprietors with no cmplo.ces 12 ❑Plumbing repairs or additions >®I am a general contractor and I hate hired the sub-contractors luted on the attached sheet 13 ❑Roof repairs 'these sub-contractors hate emplutces and hace workers comp insurance 6❑We are a corporation and its officers have exercised their right ofexcmpUon per Mt;L c 14 ❑Other 152.§IM.and we hace no employees [Nu workers'comp insurance required J *Aix applicant that checks box 41 must also fill out the section below slitmine their workers'compensation pohcN inlunnation I lonicowners ssho submit this affidavit Indicating they are doing all work and then hire outside contractors must submit a nese Aidatu indicating such Contractors that check this box must attached an additional sheet shorting the name ofthe sub-contractors and state wtiethet or not those entities have eniplo)ccs If the sub-contractors hace eniplo}ces.the} must protide their wotkers'conip polio number /ant all employer that is prot,iding wol'kerr'cotllpetrsatioll itlsatrance for my employees. Below is the police,anti job site it formatioll. Insurant:e Company Name.__f�__p G�v C� — Police H or Self=ins Lic # w ,-P Expiration Date bJ e �dJ7 .lob Site Address City!State/ ip Attach a cop), of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required Under MGL c 152. §25A is a criminal violation punishable by a tine up to$1,500 00 and/or one-year imprisonment-as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250 00 a dad' against the violator A Copy of this statement malbe forwarded to the Office of Im estigations of the DIA for insurance Coverage verification. I do hereby certifj•slider the pains and penalties of peljitrj'thtit the alaforlmation pror'ided above is trite and correct. Sir"'nature: pDate Phone Of lase only. Do not write in this area, to be completed bj'city or tower gfficial. City or Town. Permit/License tt Issuing Authority (circle one): 1. Board of Health 2. Building Department 3. C'ih'ft'oitn Clerk 4. Electrical Inspector S. Plumbing Inspector 6. Cather Contact Person: Phone#: POLABEA-01 JONEI LL FDATE(MDYYY)CERTIFICATE F LIABILITY INSURANCE W /6/2016Y 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 CONTACT NAME: Durso&Jankowski Insurance Agency PHONE (978)688-7000 _ F .)_(978)688-7001 11 Saunders Street ac No _ Ext North Andover, MA 01845 E-MAIL — ADDRESS. INSURERS)AFFORDING COVERAGE NAICS _ 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_ G P O Box 958 — -- —- --- Andover,MA 01810 INSURER E: INSURER F c 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. --- - - -- --- POLICY EFF POLICY EXP LIMITS INSR TYPE OF INSURANCE �ADOLISUBR POLICY NUMBER ' MM/DD MM/DD LTR .INSD WVD f A ; X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 CLAIMS-MADE j I OCCUR INN538691 03/24/2015 103/24/2016 j PREM SEAMAGE TO occu RENTED ncel S 50,000 - - _ MED EXP(Any one person) S 5,000 PERSONAL&ADV INJURY `S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER j GENERAL AGGREGATE 2,000,000 ( J PRO- 1{ POLICY JECT LOC PRODUCTS-COMPIOPAGG S 1,000,000 OTHER: I S AUTOMOBILE LIABILITYj I COMBINED SINGLE LIMIT S 1000,000 i r-LEa , accident_— _. - B _ ANY AUTO X2100926 01/04/2016 01/04/2017 BODILY INJURY(Per person) S ALL OWNED , X i SCHEDULED I BODILY INJURY(Per accident)!5 I AUTOS ;AUTOS I X ; NON-OWNED I PROPERTY DAMAGE S 'HIRED AUTOS AUTOS ( ! Per accident Ii .._—. -- S UMBRELLA LIAR ){ OCCUR 'EACH OCCURRENCE S 11000,000 A ; EXCESS LUiB CLAIMS-MADE{ AN019284 03/24/2015 03/24/2016 AGGREGATE _ _ I S DED RETENTIONS Iis WORKERS COMPENSATION ; PER OTH- :AND EMPLOYERS'LIABILITY Y/N; �!-STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVEE.L EACH ACCIDENT S ;OFFICERIMEMBEREXCLUDED? DIN/A; ± -- -- - (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S If yes,describe under - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT i S i ! t 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,R102910 AUTHORIZED REPRESENTATIVE rnl-1000 nni n A(+A011 r1r1Dnf%M ATIAAI All�..-L.F..-....�„....J 111/2016 Preview:Certificates of Insurance CERTHFICATE OF LIABILITY INSURANCEGATE(id01/04(201641ZO16 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 Elle certificate holder in lieu of such endorsement(s)- PRODUCER CONTACT NAG1E: Automatic Data Processing Insurance Agency,Inc. PHONE cn.EMI: t• 1 Adp Boulevard ADDRESS: Roseland,NJ 07066 IIISURERI5)AFFORDING COVERAGE MAIC d 1NsuRER A: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 956 Andover,MA 01810 INSURER 0: INSURER E: INSURER F. COVERAGES CERTIFICATE NUMBER: 429703 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICES OF INSURANCE LISTED BELO'Yl HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE FOL°CY PERIOD INDICATED.NOTb'11THS'TANDING ANY REOLPREL.ENT.TERN!OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT Y)ITH RESPECT TO:;`HIGH THIS CERTFtCATE LIAY BE ISSUED OR L1:,S'PERTA:1.1.THE iNSURANCE AFFORDED BY THE POL!CiES DESCRIBED HEREN;S SUBJECT TO ALL THE TERL;S. EXCLUSIONS AND COND)TIOPIS OF SUCH POLICIES LIMITS SHO1Jh)NAI'HAVE BEEN REDUCED BY PAID CLAIfdS INSR TYPE OF RISURAtICE POLICY NU),10ER 1' LI'Y F POLICY P I LTR I is VND Itd65DD,YYYY) 21L7•'DwYYYYi I LVAITS COMMERCIAL GENERAL LIABILITY I:HELCE r_L'J1.13-LI•:O � C!IL PRELU5tS fc:Jcec%a.=^: LIEU 6:•.F � PETS t.:.L?.AO'f If.Jl.ii'. GECL TG'FECA i E DLIII APFUtS PEIi. GEKEf•+L hGGhtGa t PCC 1'IiL% L:)C JECI UPiiOCi:C iS :_:vl.11'.::P•:G 1 Ftr.: AUTOW,OBILEUA ILITY "I. .EG Sll:ll LII.III .'.t:: ALL C:u.EI' SLtcPLLEU AUI CS B::UIL':IRA.yi=d'«rsa_crJi 1.,'';:1.h HREU AL.I t:S :.CICS Ut:BRELLALIAB _'.:LFI b:C!-CCGCP?at.Lt EXCESS UAB ,L:d1.151.1%.UEIT %+GGIiN_41t GED HL-tEk IICt.S V40RKERS COMPENSATION X SI:,ILIE EP~ ANDET.IPLOYERS'LUiBILITY Y;17 1,000, A 000 ;a: l"i-3 wa6n 1 R:lal.ErE:a!Cll':E a NIA N POIIVC772258 01101,12016 01(011201? EL A:JP:.ccmtl.l FFILE(:i.eL16F1:E•.tiCLt•G EL!•IScASt t%•ELIPLr.YtE 1,000,000 a. ::es_•rtu.n_ Ctsu:umcl:oFCPth;,Nc1sL,,:,;: t.L.l'13a•5t P::uc�ut.u1 1,000,000 DESCRIPTION OF OPERATIONS;LOCATIONS f VEHICLES IACORD 101.Additional R-ks Sehpdule.may be attached it more Space is required) 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,RI 02910 AUTHORIZED REPRESENTATIVE I A;1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD esS iC9u - BI 4 ic, 10-P 1 `te 5170 - 16 e, Boston,� loatloll -R ` tor y TVPe_- DBP, 2 pOLAR BEAR INSO ,Tt N "Vincent LeBlanc ANDOVER, MA 0�g1C} - �:.":=tjpda*Addr�sandre�ura��®p�loyment [�LostCird _ t Adam . q-C14'L216 -- v' 1pi&SERA LUBL EAST PM _ i t