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HomeMy WebLinkAboutBuilding Permit # 4/26/2016 tkORTH BUILDING PERMIT %,r 0 06,6 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 LOCATION Ko, o- ��- Pint PROPERTY OWNER Z'1,UrWJ mm I-bt'�C—', PAnt 100 Year Structure yes (n co MAP PARCE3 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential Li New Building K6ne family -Cl Addition [I Two or more family F-1 Industrial Iteration No, of units: [I Commercial [I Repair, replacement Ll Assessory Bldg El Others: [I Demolition [I Other DESCRIPTION OF ORK TO BE PERFORMED: J Identification- Please Type or Print Clearly L) OWNER: Name: D6r\(-"I A Phone: Address: N th-'%M Contractor Name: Vu✓� C-1 ` z Phone: 91-8 Email: q &_uVk�-r-rn 50 M�'o v% Address: -?� G )- S41 t(QS C a% t'l A 4 '3 8 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIT.$IZOO PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ -C)t3 FEE: $ Check No.: Receipt No.:.....i b2 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fungi .....................------------- f fn'n'+rcx'r4nr nwnizr,- %4®RH Town of Anc'lover . ®� IIILAKI � h ver, MassgAfwl COCMICM1w1C1t V Q�R�tED S tl BOARD OF HEALTH Food/Kitchen PER NT Lao Septic System .� BUILDING INSPECTOR THIS CERTIFIES THAT .................. .. .. . . .......... ... .. . . ..... .............. ......................... ® Foundation has permission to erect ..................:....... buildings on ... ... . ......... ... . IV40.... .. ............ ....... ,41C ® • ® � Rough % to be occupied as .. .. . ... .. .. . . .... .. .klv.. .. .. .�. .. 4.1.... ...1 .. .......0�°... . .. Chimney provided that the person accepting this p it shall 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 Ins ecti n Alteration and Construction of Buildings in the Town of North Andover. PLUMBING INSPECTOR Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough zService ........................T...:.... .: .........,... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Fina' No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. RISE Figginaggring RISE A di.11jurg ar,rhlab4b K.Al—Itigg OT Cpmramlcwn Nd ENGINEERING' 60M.4Mul N1.16 CONTRACT (401)70,1-1700 IIAX(401)7044710 Page I'MiRAM (:AIA-111M ""Yoore nese We Donald Markey (978)682.2408 02/19/2016 420732 00004 .."o 61141\ 233 Main Slum 233 Main Strm -t t C"'Isymm veargs amnAteiv North Andover.MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIRSHALINC, labor aM—loust,to ram orm—.t)our hormsigg"lut iottUML axau air famurp6a.This wdh"Ill be m*mcJ in MOM.0 the w"SpIdal Wh MW dgapo.fic gol$W-SU10 thmY 3661Inaeaa wilf ba Ian wiib a I.Cwthfw I"d df incloer air plilwy ares fpr waling ludt air k*Upo to cd(K*bosanmix,all-bod'"WW Other unho4erl terms jUgodOM argenot pragilly W I ON)of air VAI'lluallon wIll oc4ur,but the"loall ill tqu1m47)mork1n#bouri Aroductionlacu tolotparminift( At the cangplet"" safely wd)si.vvill be conductal by Ow mtbaontrmor tot...the safety orthd in*xw air quam) $S93.DD AMC FjNp prj4*klg­and materials iwal a 10•lrow.fR-3!I CI—I COMA-WrIolu)(630)square red oropm WK apaaa $926.10 wo. S1.2"Ju ATTIC ACCESS:PtovWg lobar wW rpegaigg6le,I—lotdw back ofUra mile d000ith 2*gilod"thconax Weid ww seal ON dows edge.1th wvathauripplav td otsia air lo*,ue. S221.73 VENTILATION:Pm Idt kdw and mwerials I.lmtW I millation chutes in('12)taller ba)v to maintain art nmv. 11ASENIFS I MUNfL P—Id.L*ri anJ n Waled-to trog.11 149)her.Wor R-1 9 w4wd Mae]—firsolmim to the Plk--w of the b..Mcrmi g6lirgg 04 the house%,11. 5260.75 E VE �t,cz r L13 P6dSrd 10 Y n IpXTwlwn RISE:S:ngineering per ww.weal.usuwl No ,�dm lnn urT bwKh F,.gInorrinp, Ci'OwMra+:tor nealptl6aon No ENGINEERINISEG 6G:hRwmut Vnh N&C6aan.M,\ CONTRACT (401)789.3700 rAX(401)7844,0710 Page 2 PR(X)ItAM Twraowrn�T�oanTKaso amwa+wnKK CMA-11F.9 Tla owTaua era+ re ellrw.. My-MR r111fHR Wlw 00004 Donald Markey. (978)682-2908 02/1912016 429732 611w,"6t"t, BUM 6n1pR 233 Main Street 233 Main Street "*w 0".$TATE Kw _MM6 py.s,.mKV North Andover.MA 01895 North Andover.MA 01845 JOB DESCRIPTION Total: 83,366.09 Program incentive: 82,696.09 Customer Total: 8770.09 VIS Austad""M To rURMM IWAVICSa-Co"PKSiS IN A000"AN09 MM11 ASOVM SpteIN J1TwaS.son Tae SUM Of • Seven Hundred Sevsnty 3 081100 Dollars WI1TGPlwpiM6Nt.NK41KCp[KHttTWYAnKK1IW4AITFpM.{WppAA4KwYTP.dwK6r[V1a01fMactKm/N!.pKpY Tq�6pT/+1m4Y W 8770.06 ==., .,4YVaY"wR .TwT=e=nx 00 NOT SIGN THIS COWACT Nn @ aK SPACES '�y'}./I14��'f/'I,�� ryIrTOWAAWCKYTxNG6 IYTwOwYpD K00�TI�R.MN KQpuM+W1 �����/ wOf6eTmY K1w(TµtiT MAY pp rwM1WwAMM pTUp VnwT pwpcMT114gKIlY+I MTp Ow MtrrwlNiCK� !/�,y'* wKC[wTAWp qt'KpwIwACT•TW 1WWW MwW.prpKiwM1ATMNK KMe aawltnwr AM pATa wA pMKNMq.PwnYWwrvwLL NK Mnbt..MOVn.M ®pWW A4MUaYttw Tn Wf/M'lYf4n% 4 I ppWUSW�"Kw I nwi w RISE60 Shawmut Road,Unit 2 1 Canton,MA 020211339-502-6335 ENGINEERING- www.RI$Eonglnoering.com OWNER AUTHORIZATION FORM '.—Do�'aQ trv�orl(clvl — (Owner's Name) owner of the property located at: PA k a C7(Prop;iiy Address) .1 tqc,-- (Property Address) hereby authorizo--&-^" r-,- (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 Signature Date C-E- The Com mon irealth of Massachusetts Department of IndustrialAccidents `v Qf/tce of Inv sttt,>tatlons 1 Congress.Street,Suile 100 e,W Boston-VA 02114-2017 �` ii'tt't4',lll a ti s.;;a l;gid t!a Workers'Compensation Insurance Affidavit: Builder �C-ontractors,"Electricians"Plumhers � 1 licant Information ii Please Print Lep-ibh Name IBJ-1 i C%r._unrI'll a dtS1 u I Addre� s: 0-6-130,x 31 1 l'itx State 7i p� L 19 Oo Phcltie 3'-1 ii 3 Are.,ou an emplm er°('heck the appropriate boy: 1'%pe of project i required r L 1 lm a c 7pi Iy_r'.�i111 ® i.m', r€Icr�21 .n tutu and i. Llllp'lr}�. I"AL an�CT p,.T. lUi-C? !ht':v IrLd t11c 4111 ltUVlr,I.(:;r - olc s r:'p-mtur l_'T;.Irl€ir: I t l'.<n th 1.1L1 t..,itr,a R n Ic lrlc ,hlp.Ind 11.3,c Ilk. orkm for nt. :d;3ra : pa.Ill. cirpIL.CC, it'd ii; LAC t T ® ;raiii2 i�add2 u,n I;t, I' rl thtul.a' m r.I .trs; iiiticn; N,iuu: JI IA '.an t<.�rh,u�ata,, ► I 1 I.®4 il)!`;`Itl' r-lr;w,gr A.* 11F49:91tt r(i'�arsi t;.r i.�illfi�.t.- .l�(. r ti.,; muran.� rr.iu:r�d., ' qtr.� , c.'.41,and ho,I:ar 1� `��'n-:_ si_^,•n �,Iti��c t. � r11�., !,.. -_r ..� .. 'f�.. r� - r .•.i(. �re;• r,m:.t-.nh �,. .._„ .:!idr-i- h..,•. -_�i '.. . t -8i .t. .... ..�..,: I'.._Ali ...,.t-. 1'L':.I tiI I !i I ran an eltrl>/over that is providint, insurance tor n1v emplut'ec-s. Below is the polity and job sitt- iajnrntetion. i Inur12 (0112, ;n+. l,il --_t {[) tL iYlSvrd�.sec i ( _ _ i?t titji�: Zip A1NcQ.,ovcr ( t ✓� O"8L Lttacll a,;opF of the orhers'compcnlation polis} deetarttion pu;e 1.huc4im-,ate policti number an(]expiration date I. J eilurr :r sCiwri I'll-", As rt',Lttrr;i ;.�,icr`,t��tn''n '�� �.`�.i(fi.� I:�_.,.ITi t...el ll.c Imi'ii,t;l,ia _,f :I'll :t,in;r,�t tint• 1;�ti.`�;.iutl�iU attd ar���c - a. :-,prl,,,r.�Ir.nt, s.�'.cell ,I:rr•.al t7�r;�(u�s r;€t6v: :.ar,,.':�a ti ttJl' tt�t 1ltb�C>[tI)�R a�i2i.I ;t'� ,.�t�.ly•t„1;'�11.{lil g:i;�F !'i7lEl tit if)C` V I,lla1 J'_ iiC .i�l'.hL'cl ll;.il:'-Ct�p1 l�l�lt[tY hl�;l:IliCilt iT71'�. lr. l;'7 It_tlliC�'O tilC(2 :�CC .21 '.. It21'..h rltsim: �;th�� f)i.\ torMr U;c:u':.,':�ra.'r I do hereb}'certify wider the pante and penaltid s of perjure that the itrJ'ernnativit provirlfrl allin'e is true,and carrect n 31 Official use only. Da not"rite°in tlm arca,to be Compieted by rill'or town nflirial (-its or Tarn: __.._-- —Perntit'l.'tcense ___-- _ Issuing:kathorits teircle onei: l.Board of Health 2.Building department 3.f'ih;'l oce In Clerk 4.Electrical inspector 5.Plumbing Inspector 6.Other Comact Person: _ __—-- Phntte CERTIFICATE OF LIABILITY INSURANCE 'Hi q''ERTTF'-CATE 15 IISSuE'- A f4A'TEP. %C --CIN—E f7--;JIF:i=AT- N01 API-Rt`A T:V-'—`�J FRT T-1E T,,[ C�11'1-7[cl GEL A -ti!S UP C,P!NURA NCa DCE'-',-'�T CC IITAu-- FFPRESPVA-IVE OP kIND TH,,'�ERTIIC.A— -,-7 I`i31='P7-NT: If in an A--"-,!-,1,-NA, ED PI-,}:ES:Must b,a 15 t3'he � an,cc'd-to-ns f H-a poi�' ce(la r PCJ':'�� A Z�ZtE­�Pt cn�E r,g�ts W the i 'CT-nFcate h"')der in liFil 0! Clayton Martin J Ins Agency Inc h 1,2 L 1649 Northampton St PO Box 9139 34-46P9 Holyoke MA 01041 Gauthier Insulation Inc PO Box 344 1psmich-MA 0193$ COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: IHI�IS TO CERTI�Y T��'�'�E POUILIES0,-N ANC; —7iW 0! _�R DC' VErO �',M,�ZFSP- A)O �T - I: C J�' -T- I ER 1 7, C-RT!Plr-ATE MA i BE ;}R VA7A�N THE, ,:SVRY 1-E DESCRIEZ-n-1-R-N IS SUD)zCT Tr)P T'��4 I.'s C. K�!,Nr)Cc NCI T "I z - YA N REF,:_ Er)S",P A �7 —7 ;7 '8L lt: DF 3 =7-L-Lill AUTUNICat'LE UAaALMY o:CuR L�tl cowe s 1— 'Y"I L -N 711 77 L CERTIFICATE HOLDER CANCELLATION Clearesult TI,- �4119'HE--:4 �E Contractor Svcs 50 Washington Street Westborough,MA 01581 :Cli ACORD !S 4 P.A.C 3139 A CERTIFICATE LIABILITY INSURANCE DATE,MM,DD/YYYY) 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 Insurance Agency, Inc. PHONE (411 13),536-0804 —- FAX_ No,.(413)534-7874 1649 Northampton Street ADORIess: P. 0. Box 9B9 _INSURER(S)AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual..-Harle ssville NATIO INSURED INSURERB:Allied World Natl Assurance Co Gauthier Insulation INSURER C: 44 ESSEX ROAD INSURER D: INSURER E: IPSWICH MA 01998 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. — .. ................ -- INSR TYPE OF INSURANCE ADDLSUBR ppLICY NUMBER POLICY EFF POLI pV EXP LIMITS LTR 1XCOMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 �l -DAMAGE TO RENTED 50,000 A CLAIMS-MADE I " I OCCUR PREMISES{Ea-ocwrronce $ X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 .._ .. PRO- ---- _.. X POLICY 1-1 JECT El LOC PRODUCTS-COMP/OPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ...----- ..........__ .._....._..__...._--- AUTOS AUTOS BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS (Per accident_-_,_ — — $ — X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1 000 000 '.. $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,,000,000 ......_.._._- _.._.._.. _ ._._. 1 DED RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATION PEROTH- AND EMPLOYERS'LIABILITY YIN ......"..STATUTE_ ER,,,,,_ ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT $ O11ICERIMEMBER EXCLUDED? _J N/A ---- - (Mandatory In NH) " ""- E.L.DISEASE-EA EMPLOYE $ If as,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 1$ DESCRIPTION OF OPERATIONS f 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(2014101) The ACORD name and logo are registered marks of ACORD MPIU bd with pdfFactory trial version www.p ffaTt tgry. �� � Board ) /\ ,©m gm#ow aasea CSs/f22� ` KURT#G4eTH t m » P R%.344 2 \ §\ fr hMA 019JR a « I GW51a# ( � /dd l{;J6 fid'<'{,✓r /I Office of Consumer Affairs and Business Regulation -` 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 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 l: r r fi •,,,, ".,, rG Office otConsumer Affairs A Business Regulation License or registration valid for individul use only 3 HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Re istration: 173410 Type: Office of Consumer Affairs and Business Regulation Ya , 9 Expiration: 10/1/2016 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD IPSWICH,MA 01938 Undersecretary of valid wi out signature