HomeMy WebLinkAboutBuilding Permit # 4/26/2016 BUILDING PERMIT 0ORT01
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION 0
Permit No#: Date Received TED
CHUS
Date Issued:
IMPORTANT: Applicant must complete all items on this page
0 d,, Q
LOCATION t
Print
PROPERTY OWNER R-
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
I
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
New Building One family
El P>ddition El Two or more family El Industrial
e'Alteration No. of units: El Commercial
FJ Repair, replacement [I Assessory Bldg El Others:
El Demolition [I Other
,r
DESCRIPTION OF WORK TO BE PERFORMED:
1,
J 3 1
Identification- Please Type or Print Clearly
OWNER: Name: rk Phone:
Address:
Contractor Name: V–QV � C,ouil+)`:Cv- Phone: 3 S�(b 3 4 r8
Email: " moi I rv%0 -tw)
Address: k') ()2,Q)X 3qq I D 113 G
Supervisor's Construction License: "1, L —Exp. Date: ' f �1
Home Improvement License: � ,V�\4(ko Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
Check No.: Receipt No.: r�)
NOTE: Persons contracting with unregistered contractors do not have acces to the guaranty fund
--------------- -------
Rihriafliie� ��r ontrarto
-------------- -------
ttOR
Town of Andover
No.
`, L�K� h vel-' aSS' l
0 c oc M1c nl w.c. 11'
®� RATED J'_
U BOARD OF HEALTH
PEK IT T t4eFood/Kitchen
Septic System
VLD
THIS CERTIFIES THAT ......... . . ....... ............. ...................... ... ...... . ................. ..................
BUILDING INSPECTOR
Foundation
has permission to erect ... buildings on . ... .. .... .�. . '
® ® 11 .. Rough
00'' qY ,
to be occupied as .. ... .. ... .4..... .. .R.. .. Oln"florm
. �.�. 4I�.. ..:!!�!.. .. f . Chimney
provided that the person accepting this per i all in every respec 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,Alterat' 4nd
Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
PERMIT l IN 6 MONTHS ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION �TARTS Rough
i/ Service
.................... ........... ................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occujoy Buildin Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathingor Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
Federal ID 4 05-0405629
RISE R EiighieerinContractor g RI Coractor Registration No 8186
MA Contractor Registration No 120979 I S E k division orThielsell Ellginecring
ENGINEERING fill Shavvino(Unil 112,Canton,MA 02021 CONTRACT
339-5,02-6331 FAX 339-i02.63-9.;
Page I
TH S CONTRACT IS ENTERED INTO BETWEEN RISE
CIM A-11 Es ENRINECITING AND TRE CUSTOMER FOR WORK AS
tl DESCRIBED BELOW
CUSaTOMER Bamett PHONE DATE CLUERT 0 WORK ORDER
Sndra
(978)685-2354 03/29/2016 432943 00003
SERVICE SYR EET UILLING STREET
34 Oid Village Lane A Old Village Lane
SERVICE CfrY,STATE,ZIP INUING CITY,STATE,ZIP
Waw
North Andover, MA 0 1. North Andover, MA 018,17
JOB DESCRIPTION
I JAZARD BAIM111t:We have identitied that there are recessed lights present in your home.unless the recessed lights arc certified
as IC-rated g wigUss blanket insulation asa
, (Insulation Contact Rated)we Nvill create a the fixture by using fil
thannuing,material,no insulation will be installed across the tot)laid closed cavities which contain recoscd lights will not be insulated.
$0.00
AIR SEALING:Provide labor and materials to seal areae of your home against witsleful,excess air leakage, 1-his work will IR:
perlbrined in concert with the use of special look Bad diagnostic tots,to assure that your home will lie Jell with a licalibrul level of
air exchange and indoor air quality.Materials to be used to seal your home can include caulks,fiDanisand other products. Primary
acted gang,+ and oiler unheated areas(windows are not generally
areas lot sealing,include air leaks n:toaltic, �e
g ,basements,all.
addressed.) '['his will require(10)%vorkinf,hours.A reduction in cubic feet per minute(chn)orair infiltration will occur,but the
actual number of elan is not guaranteed.
At the completion ol'the wcallierization work,and III noaddilional cost to the homeowner,a final blower door and/or combustion
sal*ety analysis will be conducted by the sub-contruclor to ensure the satiety of the indoor air quality.
5850.00
DAMMING:Provide labor unit materials to install it 12"layer of'R-38 onfiecd fiberglass halts to(1 12)Square I'M tor dammint
purposes.KEEP DESIGNATED IOX23 1`1.0012.
$229.60
ATTIC FLAT:Provide labor and materials to install an 8"layer of*R-28 Class I Cellulose added to(1052)square feet ofopco attic
space.KETI,DESIGNXIT'D IOX28 FLOOR.
S 1,441,241
A*I-I`IC ACCESS:Provide labor an(]materials to install(1) emsily moved,insulating cover lbr the Ruic access folding stair. 'llie
cover has inlegral weather-stripping,to restrict air leakage.IM'I'LACT-11 IVRNfAI,,rF1NT.
5200.00
ATHC ACCESS:Provide labor and joateriak to insulate the back of"the attic door with 2"rigid Therritax board and sea]file door's
edge wilb weatherstripping to restrict air leakinc.
$73.91
VEXI-iLATION:Provide labor and nuacriak to install ventilation chute,in(42)taller bays io maintain air flow.
$81IM0
CONINION WALLS:Provide labor unit malerials it)install 2"FSK faced semi-rigid fiberglass board insulation it) 192)square feet of
common wall area.
$672.00
-BASEMENT CEILING:11rovide labor and materials to install(1 16)finear feet o1'R-19 unfused fiberglass insulation to the perimeter
of the NmInent ceiling at file 11011w sill.
5203.00
0VFRl IANC:Provide labor unit materials lit install 10"R-37 densely packed Class I("ClItilosc:insulation to(63)square feet of
exterior overhang localed below healed floor area,by drilling holes in the overhang from below. I lolo drilled will be plugged.
Plugs%vill be sealed with exterior grade spackle and lcfi in it relatively smooth condition.Finish sanding;in(]touch-up
priming/painting will lie file customer's responsibility.
S252.00
Federal ID#05-0405629
IZISE4 1'11gillecring RI Contractor Registration No 8186
MA Contractor Registration No 120979
R1 SE A division of'rhicIsch Engineering
ENGINEERING 61)Shass inut Unit 12,Canton,MA 02021 CONTRACT
339-502-6335 FAX 339-502-6345
Page 2
PROGRAM
I:t3 CONTRACT IS ENTERED INTO nEIVIEER RISE
CNIA-1 I 11's E�GINEERING AND THE CUSTOMER FOR V4011K AS
DESCRIDEO BELOW
..CUSTOMER PHONE DATE CLIE14T 0 WORK ORDER
Sandra Barnett (978)685-2354 03/29/2016 1132943 00003
SCRVICE STREET UILLIUG STREET
34 Old Village Lane 34 Old Village Lane
SERVICE CfTY,STATC,ZIP OR-LING CRY,STATE,ZIP
North Andover,NIA 01845 North Andover,MA 1)1845
JOR DESCRIPTION
RISE Engineering will upply till applicable,eligible incentives to this contraci, You%Vill only be billed the Net arnoutrL Currently,
for eligible measures,Columbia Gas ofTers incentive,not to euecd 52,000 per Calendar year.and all incentive of 100%for the
Air Scaling inewures tip to file first 5680 and an additional 53.10 ifsaving5 are justified by the auditor.
For the safety and health ofy(air honie's indoor air quality,we%Vill he Conducting it blower door diaproslic of the available air flow in
your home both before(lie%vort,is began, in(]after file%watherization work is complete,We Will RISO C01HILICI a 1`1011 assessment of
the Combustion surety ol'your treating systein and water healer.This has tI Value ofS90 and is 411 no cost to you. Total allowable
meatherization incentive is S3,1 10.
590.00
..........
........ .............
Total: $4,095.75
Program Incentive: $2,940.00
Customer Total: $1,155.75
VIE AGREE I rER EBY TO FURNISH SERVICES-COMPLETE III ACCORDANCE WITH ABOVE SPECIFICATION 5,FOR THE SUM OF
***One Thousand One Hundred Fifty-Five&751100 Dollars $1,155.75
UPON FINAL INSPECTION AND APPROVAL BY RILE ENG INE E RID 0.CUSTOMER AD It EEG 10 It EMIT AMOUNT OU E In F ULL.INTEREST OF I V,PALL 0 V.C)LARGED MONT I ILY 0 tJ ArlY
UNPAID BALANCE AFTER 30 DAYS.SEE REVCRSE FOR IMPORTANT INFORMATION OR GUARAOTTEES,RIGHTS OF ACC1110f),SCBEDIAPM.AND CONTRACTOR REGISTRATION.
NOT SIGN THIS CONTRACT IF THERE ARE ANY 131JgNk SPACES
AUTH �.R.UGG Itt5r,E X_ ICE
NOTE:11113 C014TIlACT MAY BE 4VITHORAWN BY US IF NOT EXECUTED VATHIN DATE OF ACCEPTANCE
ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS A140 CONDITIONS ARE
SATISFACTORY TOUSAND ARE HEREBY ACCEPTED.YOU ARE AUTDORIZE010 DO THE WORK
30 DAY5. ,SPECIFIED.PAY,,,E,,T,,,L,,MADE A,,,TU,,,,ABOVE
RISE
60 Shawmut road,Unit 21 Canton,MA 020211339-502-6335
ENGINEERING' Www.RiSEongineeriroy.(;urrt
OWNER AUTHORIZATION
1, Jfir. LSIaVq wu14e-d`
(Owner's Name)
owner of the property located at:
F-
(Proo4ty Address)
(Property Address) f
hereby authorize 4"l oj M(-cc I h..,J L"Ib r1
(Subcontractor)
an authorized subcontractor for RISE Engineering, to act on my behalfJo obtain a building
permit and to perform work on my property. This form is only valid with a signed contract.
Owner's Si atur
Date
The Cottunnnn•ealth of.11assachu.seltt
Department pf Industrial.-Accidents
y r' Ufjre€ ref hirestigatiott.i
I Congrexs Street,Suite 100
Bustin,AM P2114-2017
,'� x•irt+',ntttss.ti nt;idiu
Workers' Compensation lnsuranceAffidaNit: Builders [-ontractorsTEleelriciansiPlumhers
Auttlieant lnfarmadun Please Print Legible
',V81tlt: -
ddress: C 13_o x 31'9
C'itx� St lie lip: J '�ACjj S 3
5 r
Are on in emplo3 ?Check the appropriate box. Type of project trequiredl
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I unt un e►nplorcr that is providing,tre)rAer%'eampern%utitm imurunee•(ar n tv rmphi veer. Be(u�l is the pe+lii�'and je�h site
information.
Ou swe C o1n, q Nam" X41-6,(A i4',�6 k �s i C,-`z _
F',:[1c}' 1r . I rI IN Pt g�
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It X11 > jtl 3y b l d v tl� _ Cit: State /if , N ,u- rn vra veil
inach a cope d the porkers'compensation policy declaration page M ntiin„the pile, number and expiration Mi.
firs x.11)r;l ,.:aro+.)D:wj or[onc-_war -,• prw„n n.n:. n '.well a,en I I.r:_:;un iA file 'Aim of a 4 i(IP \\ORE.(?PDDR .nd a ,I,
t'1',11:v 1251 0 i do apao 1y to %,n Ltt,y_ He M i"I iiia'.a Lop% 1d Anw 4Lttnh�lti( nja%, h�! 1�o1'.kaldCu',O the 07'iCe ,t
lit �ti atlnn�,,r the Df 1 for C,= cra.x erl:i,311 +:t_
I tie)hrrebv certify folder the paint and penahics r1 perjury thin the inforniatiun provided abfive is true and enrrect.
� - 1
Official use onhv, Do not orite in thi,arca,to he completed by city or town o/,%it°idl.
thy or Town: - _Perntit-l.icense x----_-----_--
tssuinf:authority icircle ones:
1.Biurd of Ileabb 2.Building tkrmrtmvm ?.('itr."1'mn Clea -J.Electrical Inspector ;.Plumbing inspector
6.Other
Contact Person: _-_— Phone 0.
CERTIFICATE OF LIABILITY INSURANCE
TI I I CERT!F:C,aTE ISISSUED A�A f-t 1% C-1%L %C, 5 U--t! Z =i TI JER TH;,-,
E. - - �I T E P.T E
P�T F:C�ATC DOE=%Of AF=IRVAr:', ',E�IATA 61-',
!��Sf l';5;,R ER AL7�1 'E',
[LID,,, THIS CER-PICA�E TV,E
PF ESEN,A71,/C ISkjP, -,�P�,;V THE E.
I1• �. -ri T:If t"e A;-ICTTVI-INA_ jx;l,-y es'-,-s!t tf-r-F,,j
Ln-h
�—s SnO rcrdeUerts Cf Ir�e Ce(T�'PC�iCi-_C ly�1�1"f4 U"!,:jc"ef, nfef ng"'t-1 to-.h�
- Ic-ho-ae-,114tu c-i
a
Clayton Martin J Ins Agency Inc _Lw 1.2y"'Rs, nc-d Pt4. Ser,(,-,
1649 Northampton St PO Box 989 E Kit, b4-4 9 T'7 7,
Holyoke MA 01041
Gauthier Insulation Inc
PO Box 344
IDswich,MA 01938
COVERAGES CERTIFICATE NUMBER: REVISION NUMBE
S i S T G C E P T 1 H E P-I L! I�-S-.,F 1 L PA r�,'T f SS�,ED
Y 7-F 1, ,
FOR
P. EN TEc IM F 011!C',-,F 01,7SAl-T-,P -ER .ItE N 1 "17 1,R FS FE-7 T 7
C FRTIPIrATE?.,A BE _R VAI FE F-A N THE'NSLRA-t,_:i- K)Lic,-s�,,f -C R7 t.,1 09'i E.7 E Tt�P
Er Ui,N;;At,7 C')I-X)T:C:N8 V7;S�-C,F'--,L-'F S -;IIMT^ ;FFPI 7k(� EDo-'j51_7,1.
-7 =777—,
`4777" A-7
1�7
OCLR
_j FIIE�
WORKERS Cowt.—I-
20 1 1 1 L
hK
CERTIFICATE HOLDER CANCELLATION
Clearesult
Contractor Svcs
50 Washington Street
Westborough,MA 01581
—ignature
A6 I DATE(MMIDD/YYYY)
CERTIFICATEF LIABILITY INSURANCE 7/7/2015
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 Nancy Usher
NAME: y _
Martin J Clayton Agency,ton Insurance A enC , Inc. PHONE (413)536-0804 FAX (413)534-7874
{A/G,_Ng) ..................--
ton Street E-MAIL
1649 Northampton ADDRESS:_.. --- ...__ .......P. 0. Box 989 INSURER(S)AFFORDING COVERAGE NAIC#
Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville NATIO.__
INSURED INSURERB:Allied World Natl Assurance Co
Gauthier Insulation INSURER C: — .__ -._--
44 ESSEX ROAD INSURER D:
INSURER E.;
IPSWICH MA 01938 1 INSURER F
COVERAGES CERTIFICATE NUMBER:CL157701379 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.
_ f _—
INSR TYPE OF INSURANCE IVSDAD—DL SUER POLICY NUMBER POLDIpY EFF ... POLDDY EYP LIMITS
LTR I
X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
- -- DAMAGETO RENTED 50,000
A _ CLAIMS-MADE LX l OCCUR PREMISES�Ea„occurrence), $ ------'----—
X GL43487F 7/6/2015 7/6/20165,000
MED EXP(Any-one person) _ $_
PERSONAL 8 ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
—.... a PRO- n 2,000.000
X POLICY I�JECT El LOC PRODUCTS-COMP/OP AGG $ r
OTHER: $
AUTOMOBILE LIABILITY {EOac detj SINGLE LIMIT $
ANY AUTO BODILY INJURY(Per person) $
ALL OWNED SCHEDULED BODILY INJURY(Per accident) $
AUTOS _......... AUTOS
HIRED AUTOS NON-OWNED PROPERTY DAMAGE $
AUTOS Par accident) -....._
X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 11,000,000
EXCESS LAB AGGREGATE $ 1,000,,000-
$ CLAIMS-MADE
DED RETENTION BE020792125-194985 10/18/2014 10/18/2015 $
WORKERS COMPENSATION PER OTH-
AND EMPLOYERS'LIABILITY Y/N STATUTE .._ ER
ANY PROPRIETORIPARTNER/EXECUTIVEI NIA E1.EACH ACCIDENT _ $
OFFICERIMEMBER EXCLUDED?
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE $
If yes,describe under ..- ..-....— ......_ _... .........__
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space Is required)
CSG, NSTAR AND NATIONAL GRID ARE LISTED AS ADDITIONAL INSURED
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
MASS SAVE PROGRAM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
CONSERVATION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS.
50 WASHINGTON STREET
WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVE
Daniel Sullivan/MEG
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD
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` Office of Consumer Affairs and Business Regulation
10 Park Plaza- Suite 5170
Boston, Massachusetts 022 116
Home Improvement Contractor Registration
Registration: 173410
Type: Individual
Expiration: 10/1/2016 Tr# 257812
KURT GAUTHIER
KURT GAUTHIER
P.O. BOX 344
IPSWICH, MA 01938 -
Update Address and return card.Mark reason for change.
Address Renewal Employment Lost Card
Office of Consumer.affairs&Business Regulation License or registration valid for individul use only
HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to:
Registration: 173410 Type: Office of Consumer Affairs and Business Regulation
"I $ 10 Park Plaza-Suite 5170
Expiration: 10/1/2016 Individual
Boston,MA 02116
KURT GAUTHIER
KURT GAUTHIER
44 ESSEX RD
IPSWICH,MA 01938 Undersecretary 40tkzLre
�vtas Kusa ids
Dcpartry)
nt of Pubhc
Saarci 01 SLIOdingMcg�i s is
_,Is 'in d S,
License.: CSSL-102.562
KURT R GA UT"I'm
P.(),Box 344
IP3with MA 019j&
Exp,ratu,,11
urt'k res (tarn r 05/2512017