HomeMy WebLinkAboutBuilding Permit # 6/1/2016 BUILDING PERMIT o����r b�No
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ® '
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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
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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�
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Address.,
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C tt�' Stan. ap. �- .— ��� Plx tie�.. �- 3S
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you can emplocer?Check the appropriate
box: f� FYPL-of projfrt treyuirr"dt
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collip_InsulancC
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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
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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
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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
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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
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CERTIFICATE t{pLL Eft
-71 7 7
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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