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HomeMy WebLinkAboutBuilding Permit # 6/1/2016 BUILDING PERMIT o����r b�No TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION ® ' n �> .® O�Qq coc.ii<newn V Permit No#: �� Date Received �qs oArED S Date Issued: IM ORTANT: Applicant must complete all items on this page LOCATION Qq ((V1Ck n Print PROPERTY OWNER CiO'�0�4i (` C,V CA ►'` Print 100 Year Structure yes no MAP l O PARCEL: �� ZONING DISTRICT: Historic District y s no Machine Shop Village y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial ❑w4teration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other a �.s,�,l✓,v eN..r �.�F/,� ,r f ,; ✓gx If ' � r'u,r �e✓,, / x ❑`Sept c�. ❑ II� � ;❑ Floodplain �❑Wetlantls f ' f� , ❑ Watershed District F ��x i+.,i' � rr f,;/,,,_ .•,�.1. W r �..�„„ ...n r ,t"r r-F,✓ k .!�� x.ry,'�,.? ,�,. "�, � ,� ,�f� :;". '•" sr r,ll �'r�'� 5✓,as.,� .,,r. r "�:{'"?�"'ra ✓- ;.� a. :: v^ ,rr ,r?�'f" .., . ,..�.�d7< �` ✓7..;.v-�,'/,� "�"'f,•Y" f � r ✓:%sr-.„u� f �R`. rf �y Tb�� �6 ,�:; 4'a�i�' x.'n�...�', ..� x�'. sr�b �' ui/, �l j L� � t 1.:..�$ rr ? P d 3 r -G�.,I lG 'f-,vt F"4 r` �. .��.f(Y ✓.r'{r �'r 3✓Y � N-:/,.7.;; -rvl f DESCRIPTION OF WORK TO BE PERFORMED: v I C ' � O C L b "L i. uti C-f- I t Identification- Please Type or Print Clearly OWNER: Name: f� (�c�-t� rA V u,G �t Phone: ��� '�� Address: � Oq L rv-\, Contractor Name: 0,J C-r" Phone: 3 Jin 3 `t 93 Email: Address: P b 13,zz�x 311`1 itL7 vJ&*N r1A ()1ct �I Supervisor's Construction License: L Q ? �- Exp. Date: Home Improvement License: J 3 `j L� Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT:$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ZS h �° ' ® FEE: $ Check No.: Receipt No.: 3 1 y' �— NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund [ — --- - - - — — - - - � - — —' aJ t%®RTH Town of Andover 0 ® / T MIA b COCNIC NQ W.CN BOARD OF HEALTH Food/Kitchen PERM. IT D Septic System E BUILDING INSPECTOR THIS CERTIFIES THAT ............................R............. ....... ..... ........ .......... ...... ....................... 0'4 has permission to erect buildings on .... Foundation .... .... . . ... .. ® ®, Rough to be occupied as .... . .. .. ........ ...... .... ... .... ............... Chimney provided that the person accepting this rmit sh II 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES I 6 MONTHS ELECTRICAL INSPECTOR UNLESS Rough Service ............ ....... ........ .... ......................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Perinit Required t® Occupy Buildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal IU 4 05-0406629 RISE Entyinceriiig RI Contractor Registration No 8186 MA Contractor Registration No 120979 RISE k division ol"I'lliclsell Vilginvering, c*r Contractor Registration No 620120 ENGINEERING 60 Shawmid, ':Illtrnl,NIA 02021 CONTRACT 339-502, 339-M12-63-15 Page IT06RAIM THIS CONTRACT 19 ENTERED INTO BETWEEN HISE GNI A-1 I ES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW _.CUSTOMER / PHOnE DATE CLIENT a WORK ORDER Michael Meveih o„N (978)685-5309 03/14/2016 430585 00002 SERVICE 57REET BILLING STREET 109 Lyman Road 109 Iinan Road ?13 SERVICE CITY,STATE,Z111 DTLLING CITY,STATE,ZIP N -fli Andover, North Andover, MA 0 1845 of MA 0 1845 y r ...........”,.............................. OB DESCRIPTION AIR SEALING:Ilrovide labor and materials to seal area,;of your home against waslefill,excess air leakage. This work will be perfimNed in concert%%fill the use ol'spcCial tools and diagnostic Iola to assure that voill,hoille will be fell with if healthful lvvel ol*air exclunqu mal indoor air quality.Materials to Inc used it)seat your home Can include caulks,fballis and other producls. NilllarN areas for scaling,include air leakiwe to attics.hascmenis,attached uaravcs and ollicr Indicated areas(%%indo%%s life not gellerally addressed.) fins will require(8)working hours.' A reduction in cubic lCet per minute let.fit)ol*air infiltration will occur,bill the actual number ol'clin is not gtjaranlecd. Al the Completion of,111C\\Caillcri/alion work.and at no additional cost to the honreo\\tier,a final blower door and/or combustion safety analysis will be conducted by tire sub-contractor to ensure the saletv ol'the indoor air quiditN 5680.00 KNHAVALLS:Provide labor and materials to Install 2" PSK firced semi-rigid fiberglass board insulation to(144)square feet of,kneewall arca. ti504.00 KNEUMALL FLOOR:provide labor and materials to install all 8"la.%cr of'R-28 Class I Cellulose added to 1180)square IM atopen kneewall floor, 5226.90 ATTIC A(VFSS:Provide labor and materials to make(3) lempormy access to an attic area. The opening will he closed with materials similar(is those exisirill,,, Finish sandill,and painting is not included. $255.00 VI-IN'l ILATION:Provide labor and materials to install ventilation chide,In(27)faller bays to maintain air $54J)10 HASINIHN F(TM ING:11tovide labor and materials to inswil(1 171 lineal lect ot'R-19 unlaced fiberglass insulation to tile porimeterot'llie basement ceiling al the house sill. S 190.00 k F N 1(A'Al.:Remove(62)square Icct ol'baill st\Ic insmiat ion from the bascment area $40,50 R I-1A I I I VA L: Remove(108)square feet ol'ball A.0c insulation IT ami life cE awlspacc area, $120.00 k\TS I'Acl::11jo\,tile labor and materials to install (105)square reel of'R-10 rigid'I hermax insulation to tire crim Ispace perimeter wall ill)to the sill and if!ainst the hand joist Rlsk hwiflecring will apply all applicable,eligible Incentives to this eoldract. You will Only be billed the Net around. Currently,for eligilTie measures.Columbia(ias ofiers 7515,,35 incentive,not to exceed 52,000 per calendar\car,and an inceinke of 100'%)for the Air Scaling,measures ill)to the.first WO and all additional 433.10 il*savings are justified If%-tile auditor. For[lie safety and health ol'your home's indoor air quality,we will be conducting,if bitmei door dimmostic ol'the available air flow in your horlic both before(lie ma-k is begun,and idler the weatherization work is complete.We will also conduct it 111111 assessment ol*llie collibustiori safely of your licating system and water heater.'iIns has it value ol'590 and is at no cost to you. "I o(al allowable\%eatherilidion incentive is 5:3,110. Federal to ft 06-005629 RISE Engillecring R1 Contractor Registration No 8186 PAA Contrar Registration No 120979 RISER A(fivisioll of"I'llicISCII EvIgincerhu" CT Contractor Registration No 620120 F.11 G I(,I EER I N G' (it)Slummul,Canton,NIA 02021 CONTRAGT 339-502-5197 FAX 339-502-6345 Page 2 PRO(iRX\I YIK$CONTRACT 13 ENTERED INTO REMEED RISE CN I A-1 I ES IGINEERIRO AND-INECLAITOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE 0A TE CLIENT 9 WORK ORDER Michael Mcwi111 (978)685-5309 03"14/2016 430585 00002 SERVICE STREET BILLINO%IRFFT 109 Lyman Road 109 Lyman Road SERVICE CITY,StATE,ZIP MUM CITY,STATE,ZIP North Andover,NIA 01845 North Andover, MA 019,15 .1013 DESCRIPTION Total: $2,566.80 Program Incentive: $2,117.61 CustomerTotal: $449.19 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ""Four Hundred Forty-Nine&19/100 Dollars $449.19 UPON FINAL INOP05G110N ADD APPROVAL By Rise rNciNExfvNT;,custoMER AGREE!;TO REMIT AMOUNT DOE In FOLL.INTEREST OF M.WILL BE CHARGED MONTHLY On ANY _LILIPAUT 30 UAY3,3EE REVERsc FOR IMPORTANT INPOP"ATION ON r(JAPANMES,RIGMIS OF CONTRACTOR(070,1SIRATION. DO-140f-SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZED SIGNATORE 1115r,E.ISm,,,,i,,q Cull) NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT rACCUTED Wilmn DATF,OF ACCEPTAN'Cf AMPTANCEOFCONTRACT•THE AUOV'E.P./1"'P.CIFICATIONS AND CONDITIONS ARE 30 DAYS, SA715^AC TORY 10 ITS AND ART L HERESY ACCEPTED,YOU M E AUTHOUVED I Ono TREWORK - As SPECIFIED.PAYVENT WILL BE MADE AS CUTUNCO ARM'. '+1J/' F 60 Shawmut Road,Unit 21 Canton,MA 020211339-502-6336 ENGINEERING www.RISEenginsering.com Etcicncn,r_,izL OWNER AUTHORIZATION _ I Michael McVeigh (Owner's Name) owner of the property located at: 109 Lyman Road, N. Andover, MA (Property Address) (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. ; C Owner's nature _ b Date The Commonwealth arf Alassachuselts Department of Industrial Accidents In re:stigatioll s i I Congress Street,Suile 100 Roston,.VIA 07114-2017 wwaswntasv.gorldia NN"orkers`Compensation Insurance Affidavit: Bit ilders./Contraitors/Electricians, iPlumber �A imlicant Information yp,, ,� ( Please Print Lexi, hl� :Vi��176YY\ !J(,n1 1 C k 1sy,(6, Qt- r1V�,,— ... _ Address., zi 34S 3 C tt�' Stan. ap. �- .— ��� Plx tie�.. �- 3S -Lo- you can emplocer?Check the appropriate box: f� FYPL-of projfrt treyuirr"dt 1. t Berl a cmpt lN.r'. ilii -v. d.d {31;i t I:Tai ♦Wit1V� lt� 11ii t I - � h--.c hlCtt, ;?l 0 Ncv.ti3j c45Sie hte7rS _ it�R5tl at'Itt+� lrllj?iflc� t �h .yid or Sr- t.i234?-� l a"rl 3(flc pr;4prii!lof ar pdrlil;!r_ (It�.j.ffi Ill::ax..i�ja4.! 4Li t. Cdi tail'jf 311 =hijl:aiui has:c no CII' k+ a+, r d a,d°,e tic+r�.el v:�;r#ilrrg !'or m;_+ is 3m irtC114- [No lt'11r 44Fri Citll'.i?. !rist1Cc.taCC cti11IIp .fz:t`."d`icl Q„rte a ct rp+r:a}-t a a,td iis 11ar13 ai+llTl:i➢'+t i?i:f iofIn l.::S't rk: 7ilu: ,>jla t 4 t4'+s%:d tii::.r j,�pltll't'�I.rI2 r:t'iiass ?r;`+..:.Itf.�S,i ir;:il'- t �CXtia' tat:a`_?tT �[_�� �llt• jt iti1>+.L.trr,-r: ts�rtir. t j :y.®Roof repair 1n>urant r�:qu.rvd j' c i s ,lff4 t.and%,c ha. M) 13.®Other eta?p n-tiey. (\I+�1'�It<n' � s collip_InsulancC en._ a..._. .__*s^ t { };_ ra r--,{ r•.m,:,t.ah ., ..-_._ttidati! tili'...w: mal }l. •}''. 'Fits ..i;,.:: t.i.,?..-,�:.,} - '„ G -.. . - ,..s;. i�.t,L:7:v,iJ:i. �....+iC _ 7 i..,.,., S:-1.-;l.0 5.:�-i'iC�Y.1_i t�t�^--� r It.t+t-:::,•. rr,t:,.t+n,,eei _ t' 1 une an emphger that is prep=idirr,,e workers'conipe elution irnurunce jor nf�v emph�t•ees. Below is the police'andjob site is fartuatirna. jr-ur:n C'zxarp<tai'~; 4 anw: t "4 i oh,--v =or sc 'ivs, I te. X1 1 r 1 Vit- 3,t�J�J_3 �i��C 1 Joh So,"_'tddr-ts I r`�'L(L" 1 W C"il+ wi<itc Itj>:N +{�lleiCJ� C W aL4 .Attach a cope of the workers'compcn+:ation poli" declaration page(.honing the poli+`} number and expiration date}, j'iljtirc ic}etc te C: 'CC '>I"quiTvd ii dcr :[tj. _ 15-'._dai itiad to[i;t iat3j t)w}?li+?!Vt tl'21Yti[„'.( 1c;17jt : ':.:l title v to w r..Ut)(A) Ln!ol-r•r;t: t ar iallp,r,..r n lt, 3ti Well a ei,,il per:i4tics i!I tiie riaa o a`+j(V -ORK ORDER +.Zd.,'tt, of-j”,to S2?,O !i i::hi}' *114 +,wlat=,,r. De ad+Ji ed that it cope o''"his SL. micni raid.. or ,Cc of, jlat�>ai`,'itli]a)Y t+'- iIIC jai` t<ir1?l� C::;7ci:i:e±�t:CJLe' �tirtit :3tti'+.'1. I do hereby certify under the pains and pe=nalties of perjurer that the itt(cirination taro vid d above is true and correct, Official use onA% Do not write in this area,to be completed b�v cit!'or low"official. City or Town: PermlVl.icensc Issuing Authority icircle one,-. 1,Hoard of health 2.Building Department ;.Cilyl':Town Clerk 4.1 lectrical lnspector -,Plumbing inspelvlor 6.Other Contact Person: ____. ._., _ __ Phone#, I DATE(MM/DD/YYYY) CER �TIFI T F 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 pclicy(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 endorsements . PRODUCER CONTANAME: Nancy Usher Martin J Clayton Insurance Agency, Inc. PHONE 9­_Ext) (419)536-0804 Gac,rlo):(413)534-7874 .—_.. ........__. .......__.._.__-- 1649 Northampton Street E-Riess: P. 4. Box 989 INSURERS)AFFORDING COVERAGE NAIC R Holyoke MA 01041-0989 INSURER A:Nationwi_de_Mutual-Harleysville NATIO INSURED INSURERB:Allied World Natl Assurance Co Gauthier Insulation INSURERC: 44 ESSEX ROAD INSURER D: INSURER E: IPSWICH MA 01938 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 ADDL SUBRI- POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER D DD LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 A CLAIMS-MADE X OCCUR PREMISES„LEaoccurre_nce) $ ........._. ......._... 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 X POLICY Cl PRO- ECT LOC PRODUCTS-COMP/OP AGG $ 2,000,000 J OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ (Eaaccident) --- ____ ___._... _ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _ AUTOS _ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS APier accident), ............... ...._..— ..... ..._........ _.....__ $ x UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 EXCESS LIAB CLAIMS-MADE [AGGREGATE $ 1,000,000 DED RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N ____ STATUTE ER _ ANY PROPRIETOPIPARTNER/EXECUTIVE - E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? �....... NIA .......... .....__—._... ......_ ....._. (Mandatory In NH) E.L DISEASE-EA EMPLOYEE$ 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 CONSERVA'T'ION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET WESTBOROUGH, MA 01581 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG cU 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MP9rM9tbd with pdfFactory trial version �LffjgEy co rr ACCWEI� CERTIFICATE OF LIABILITY INSURANCE I_,IISSUL,'A-" fMeTEK 3- CNL 4,%�;C,D%;Eqs lic k:" CN ! _CFP.-o-I 1s C-,PTF-'ATC DOES NO I A4FZP'A7 "k',E Al A 1- I - I —F-S 'i,77r, LLTZR,T3,E Ar�c T �C, 1— H1S CEPT T BE LL A PF ESE147A7T'VE 1-o DG lvi tT AND TH, !ERII-ICA- -1 1 . .1 -E'L. v": MuLt tE endri�'-'l ;f �S .1;A[ �,j N-ct 'hA t"N'-E ri�'7zt�i hol,�t - A'D 17 1,-NA -n'� cr-i't-'or's cftt- Ceuta P P "ert A tZtelsrt .:n'r— to h� ho-ce,"h4'(i Clayton Martin J Ins Agency Inc 1649 Northampton St PO Box 989 Holyoke MA 01041 Gauthier Insulation Inc PO Box 344 1psmich.IVA 01938 COVERAGES CERTIFICATE NUMBER REVISION NUMBER: Hi 1, CFR-!i7'i 7�t; C�F �T,�',f�� Tr �L7 E' N! SS'L'ED k. FlNAPEU,ACCFCIP - -TNCING N -T' 'RFSFF�-'l 1,'-ATE t 69 � 71 b 1'i-'-- THE t F '-CP-N lS 4(,19,'EC T T,") a E Ex , S T Y-A rC f:'._ c(1 it A E4 r 77 i .� � I � .._ i i e CERTIFICATE t{pLL Eft -71 7 7 El 17 7 IS CANCELLAT!ON I 1C�L:, L, t F C i� 1 f: E Z&--F Clearesult E I A Tel-l't 4 A F E E, Contractor Svcs 50 Washington Street Westborough,MA 01581 slanature: la-"-ChOsepts Department cif PLIW4-Satety t5nard Ot SLA' lmg (�sLgaalWlOns and t:r;y;arcs. License_CSSL-102562 KURT R GAUTIf" I P.n.Mx 344 lPswlrh MA 019-* 1, �„ �" Ccn'arv�p+slc.Tike`f 05125/2017 E� ; 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 i! t, Office of Consumer Affnin S Business Reg ulation License or registration valid for individul use only -,s HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 0, Registration: 173410 Type: office of Consumer Affairs and Business Regulation Expiration: 10/1/2016 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD IPSWICH,MA 01938 Undersecretan4.t valid wi out signature