The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 5/9/2016 %AORTH eq BUILDING PERMIT ® TOWN OF NORTH ANDOVER pp APPLICATION FOR PLAN EXAMINATION �: ' I Date Received Permit NO: ��SSgcHus�`��y Date Issued:4 ki —P�ORTANT: A plicant,must com fete all items on this page Pant c PROPERTY OWNER77 MRP NO: PaRCEL: ZONfNG DISTRICT Historicistnct;; yes no %�lachrie;�ho V�I(a a es no, .. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑l ddition ❑Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other Septic: UUelli Flaodplarrs E VVetlartds ❑ Watershed D(striet a 1lUaterlSewer Identification Please Type or Print Clearly) OWNER: Name: Phone: 41 - S " `A ` Address: CONTRACTOR Name �� Phone Rddress ' Superursar's Construction License �-t Exp Date ' _ a Home Improuernent License Exp D ate 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: $ FEE: $ Check No.: <1 b(o Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund Signature of Agent/Owner Signature of Pohl, d , �0RT#j Town of ndover ® ® ZT — % VAI', ass, coc.uc"twicx �• I AORArEo �,j� �P MELD5 U ' BOARD OF HEALTH ERMJT Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR buildings on Foundation has permission to erect .......................... ... ... ..... .... ....... ... ......... Rough to be occupied as ....�. . . .... ... ..... ... . 4 o.. . . ....... ....A&...tv......... chimney provided that the person accepting this permit 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. % I as®� PLUMBING INSPECTORV1 I _ VIOLATION of the Zoning or Building Regulations Voids this Perml . Rough Final PERMIT EXPIRES IN-,6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service ............... ..r. ....s,.................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building 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. " G CONTRACT FOR Conser atlon PRODUCTS Services Group This service is brought to you through support from your local utility This Agreement is made by and among and Michael Asselin Conservation Services Group (CSG) 174 Greene St Attn:RCS North Andover,MA 01845-3907 50 Washington Street, Suite 9000 Site ID:S000501115" Westborough, MA 01581 Project ID:P00050127053 Reg.No. 173484 Customer ID:000050112505 Federal ID No. 222457170 Contract ID:20151027_WORK (Mail completed contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perforin or cause to be performed the.following work on these"Premises'in a professional mariner and in accordance with the terms of this Contract,including the attached recommendations(work order describing the work in detail(the"Work")which are incorporated herein by reference: Description Quantity Location Insulate Rim Joist with 6.25"Fiberglass Batting 64 Living Space $153.60 Attic Floor Open Blow Cellulose 11" - 832 Living Space $1,497.60 Propavent 2'or 4' 3.0 Attic $114.90 Hatch:Thermal Barrier Potyiso 2 Inch(Attic) 1 Living Space $41.71 Insulate vinyl Sided Wall With 4`Dense Pack Cellulose 2,004 Living Space $4,829.64 Damming 14 NIA $30.66 Replace Bath Fan Hose i N/A $24.09 Insulation Removal 832 NIA $956.80 Enclosed Kneewall Cellulose Dense Pack 4' 84 Living Space $194.04 Netting with reinforced strapping 84 NIA $55.44 Install 2"Thermal Barrier Polylso On'Kneewall 72 Living Space $316.80 Sub Total: $8,215.28 Utility Incentive Share $2,000.00 Customer Contribution $6,215.28 RU For offloe use only Printed:10/2712015 Page 2 of 2 II. PAYMENT /� l Customer agrees to pay Contractor for the Work,the Custonner Share of the Contract Price as follows:Payment N1:$_ 2 ��, b ris a Deposit payable to CSG upon signing the Contract(not 1/3 of the total retail costs).Mail check&contract to CSG,Attn:RCS,50 Washington St.,Ste. 3000,Westborough,MA 01581.Final Payment:� -5� . _ as the final payment for the Work shall be payable to the Independent Installation Contractor("IIC")upon satisfactory completion of the Work.Customer underslamds that he/she will not be required to pay the Utility Incenhve Share of the Conhact laid in the amount of 5 L�`1�-L - .Changes to individual line items and/or previous incentives may increase or decrease the size of the.Utility Incentive Share. 111. DISPUTE RESOLUTION line llC arnd Customer hereby mutual y agree nn advance that in the event that the IIC has a dispute concerning this Contract,the FIC may submit such dGspute to a primate arbit adon service which has been approved by the Office of Coustuner AOltirs amid Business Regulation amd Customer shall be required)to submit to such arbiu ration as provided in M.G.L.c 142. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third business day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES, Customer Sigr,tm' Date Indicate yo r selected IIC here.if.pplicable Initial here if you want the Program to assign a -- - -----—_—_ Lli— 11-- 1-F--� Participating Contractor CSG Sign- -t 'c Date Natnc of('S' epresentative Printed) TERMS AND CONDITIONS APPEAR ON THE REVERSE. 2200 2-115 ®o tsargy p4 mass save PA1=WAn01G CONTRACTOR PERMIT AUTHORIZATION FORM 1, michael asselin ,owner of the property located at: (Owner's Name,printed) 174 greene st north andover (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. f X .� Owner's Signature as L // Irl s Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Qq 114tte� 12 Participating Contractor Date 0fr0 0� Fcr Office Vse Only Rev. 12132011 The Commonwealth ofMassachusetts Department oflndustrialAceldents d I Congress Street,,quite 100 r Boston,MA.02114-2017 SyBV,t www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electiicians/Plumbers. TO BE FILED WITH THE PERMIT'T'ING AUTHORITY. , Applicant Information _ Please Print Legibly Name(Business/Organization&dividual): VAI RJ' Ge t Address: J,3 A S(JbW;-) City/State/Zip: <b i lG �rc; � ` Phone#: / '�'S :S Areyo 1n employer?ChecIctlie appropriate box: Type of project(x•equired): 1.0a a employerwith_� !_employees(full and/orpart-time).'•` '7• F1 New construction 2. 1 am a sole proprietor or partnership and have no employees working for me in $, [J Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3..❑I am a homeowner doing all work myself,[No workers'comp.insurance required.]t . 10 F]Building addition 4.FJ I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors either have workers'compensation insurance or are sole 11.C1 Electrical repairs or additions proprietors with no employees. 12. 0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.0 Roof repairs These sub-contractors have employees and have workers'comp.insurance.$ 6.Q We are a corporation and its officers have exercised their right of exemption per MGL C. 14.FJOther 152,§1(4),and we have no-employees.[No workers'comp.insurance required.] -. *Any applicant that checks box 41 must also fill out the section below showing their workers'compensation policy information. Homeowners who submitNs affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-ccaitraetors have employees,they must provide their workers'comp.policy number.' X afire an employer that is pi•ovidiizg ivorkets'compensation insurancefor my employees.'.Below is the policy and jab site information. r , Insurance Company Name: �� dr" ✓�� — Policy#or Self ins.Lic.#: �j//i q Expiration Date: �� r� lob Site Address: �`F��-� City CA /State/Zip: Attach a copy of the worlcers' compensation policy declaration page(showing the policy number and expiration elate). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORD.ORDER and a fine of up to$250.00 a day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DTA.for insurance coverage verification. X do hereby certify under the pains andpenatties o pejyury Haat the information provided above is true and correct. sign 0: Date: \/ • Phone#: Official use only. Do not write in this area,to be completed by city or town official.. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/'Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: W DATE(MMIDDIYYYY) CERTIFICATE OF LIABILITY INSURANCE 02/24/2016 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). PRooucErz NAM: Carolyn A Coughlin Charles J Coughlin Insurance PHON o t (g7g)957-3588 T FAX 14 Dinley Street EWc.-MAIL R O.Box 10 ADDRESS: carolyn@coughlinins.com Dracut,MA 01826 ___ _ INSURERAS)I_AFFORDING COVERAGE NAIL# INSURER A: Northland Insurance Company 24015 INSURED Merrimack Valley Insulation Corporation Joseph A.Ryan,Jr. INSURER B: Safety Standard 39454 23A Sullivan Road INSURER C: Torus Specialty Insurance Company A0159 N. Billerica,MA 01862 INSURER D. Travelers Indemnity Company of America TPC INSURER E: _ I 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 -- ---��----TYPEOFINSURANCE _-POLICY EFF POLICY EXP LIMITS LTR ISD WVD POLICY NUMBER MMIDD1YYYY NI - A COMMERCIAL GENERAL LIABILITY WS274182 01/21/2016 101/21/2017 EACHOCCURRENCE $ - 1.000,000 DAAM A GE TO RENTED- — 100, _- __000 CLAIMS-MADE OCCUR PREMISES(Ea occurrence $ _ iMED EXP(Anyone person) $ 5,000 I PERSONAL 8 ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER; GENERAL AGGREGATE $ 2,000000 000 000D- D TS COMP/O.. �--- - - - V POLICY�JECTPRLOC PRODUC - P AGG!�_^ 2,000,000 — OTHER: I �_. � B AUTOMOBILE 6205006 11/25/2015 11/25/2016 1 COMBINED SINGLE LIMIT $ 1,000,000 I(Ea accidenn BODILY INJURY(Perperson) $ ANY AUTO ALL OWNED JI SCHEDULED I BODILY INJURY(Per accident) $ V 1 AUTOS i ` //I NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS V..�AUTOS -Lftr,accidenq-_____ --__-- I i $ C UMBRELLA LM ✓j OCCUR +87593L161ALI 01/21/2016 01/21/2017 EACH OCCURRENCE $ 1,000,000 EXCESSLIAB ! ! CLAIMS-MADE ( AGGREGATE —. $_, _1'000'000 DED ! RETENTIONS 10,000 i $ D WORKERS COMPENSATION ! j 6HUB-OG09111-9-15 06/18/2015 06/18/2016 STATUTE ERS AND EMPLOYERS'LIABILITY YIN ANY PROPRIETOR/PARTNERIEXECUTNE r-- N 1 A I E.L.EACH ACCIDENT $,_ 1,000,000 OFFICERIMEMBER EXCLUDED? L (Mandatory in NH) E.L__.DISEASE-EA EMPLOYE S __ 1 000�00� If yes,describe under - - DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 j DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) JOB DUTIES:Insulation Installation:Additional insured companies respectively are Action Inc.and National Grid USA,its direct and indirect parents, subsidiaries and affiliates in addition to Community Teamwork,Inc.,ABCD, Inc.and EVEkt}uRCE CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. AUTHORIZED REPRESENTATIVE i f ! @ 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD 1`19i� ff �d' i add - �' "" exp "`Qtd '� P d Oft ice 0f('011suIII er Affatrs arrcl B3trsrrless Regulation 10 Par!,: I'1,--Izg Suite 5 170 Boston, Massachusetts, 021.16 11011]e Ir1rPr()N?e1r eat C ontracto 1.Registratitarl Registration: 1 L0506 Type: Corporation MERRMACK VALLEY INSULATION CORP Expiration: 1112412016, Tr# 26DS24 JOSEPH RYAN 23 A SULLIVAN RD BILLERICA, MA 01862 Update Address and return card.Mark roavora for elaange. Address Ren ewal rraalalogna<rnt Lost Card lOcc of0ulsiltnerArrairs 0 t1 i^ i1105C1ti ai�rw«;, tel.+lku inn License 0r rc*!strata>aa a�alid indtviduluo rlwy" 7@IMPROVEMENT CONTRACTOR 5cfarc ttc =xpiratate. If return to* Type: xpiratlon: 9°f12r/?01G Office of Consumer Affaia•s and RusinesX r�Ce�ulation Corporation TO Pack Placa-Suite 5170 iAERftMACK VALLEY INSULATION CORP 1'f05t0n.CLIA 02116 JOSEPH RYAN 23 A SW LIVAN RD BILLERICA,MA 01,362Le a ° t�utlr+.ecrclary Not valid it oralsil+,nntu.. ._ �.. re Massaa husettc -Department of Pubhc Cwtaf ty aBoard Of CSUifding ff cgWatlons and:Stand�.aatla; l`eroMt�ts sa tadxaa ��alb��r-m I�o;¢ %_lea*�uaaa: CS-0751 ' JOSEPH RYAN � f r•. Lynnfield MA, 01940 a �ff FL;/✓ b" rte* 11� �"°A Exprafio"1r dw coax aa'uti ts.ucaaaao-r 02/0412017