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HomeMy WebLinkAboutBuilding Permit # 6/1/2016 OORTH BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date ReceivedArgo w R, A Date Issued: nt I 41 — .T, PORTANT: Applicant must complete all items on this page LOCATION k'A r\%t3r� ( ,J Print PROPERTY OWNER Print 100 Year Structure yesno MAP Z i WD PARCEL: ZONING DISTRICT: Historic District Yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE `y Residential Non- Residential One. [I New Building m One family [I Addition [I Two or more family 11 Industrial eAlteration No. of units: 11 Commercial El Repair, replacement El Assessory Bldg 0 Others: El Demolition El Otrlher ,011 t-100"d 0 r, rap "Y Ingl Se an, Novi DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: S� wr-,o,_ all s Phone-.q U 9 ,S Address: 1 k r-\5s ) ( z�J Contractor Name: Vjo 4-W fx- Phone: Email: vv\-C , (zbn Addrese Supervisor's Construction License: � �O-L- Exp. Date: Home Improvement License: L Q) Exp. Date: 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.: Receipt No.: 7-5 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund —7�----—------- nt/()1A/`n' tbr SianatureLof-G6aiianr , NORTH Town ofI Andover ® 0% �qwqww_ O LAN@ ♦ e , ass' LAA COC NIC M@WICK �• S � BOARD OF HEALTH Food/Kitchen PER T Septic System LD THIS CERTIFIES THAT ......... . .. .. ...... ......... ... .... ................................ .................. BUILDING INSPECTOR Foundation has permission to erect ... .................... buildings o .. .:. ....... .. . . ... ....: ........ ....®.............. ® Rough t® be ®CCupied aS ........ ..... ..............o.......... ......... . . .. ... .. ... .... ... . ........ Chimney provided that the person accepting this permit shall in every respec 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 EXPIRESPERMIT ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO ARTS Rough 40 Service .................... ... .. ........................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy BicRough Display in a Conspicuous Place on thePremises — o of Remove Final No Lathing r Be® Wall o one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. JW MAY - 3 `N116 4' Federal ID#0"406629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 A division ofThielseh Fugineering CTContractorRegistration No620120 60 1` ENGINEERING Shawmut,Canton,MA 02021 CONTRACT 339.562-5197 FAX 339,502-6345 Page 1 PROGtAM 113= 399MrlNED DNI'm 81,R49E CMA-HO sw CUSIGRPoR WORlf AB DESCMEDGELOW CUSWLLR PHONE DAIE CL10NTO WORKOROER Shauna Rollins (978)685-7039 04/22/2016 432121 00004 SERVICE STREET Slum S9tEET 19 Robinson Court 19 Robinson Court SERVICE WY,SV IE,aP ODLHO MY.STA9:1aP North Andover,MA 01845 North Andover,MA 01845 JOB DESC PTION PHASE ONE-Proposal for this calendar year. $0.00 WALLS:Furnish and install blown in Class I Cellulose to(1289)square feet of vinyl-sided exterior walls.Homeowner has received a copy of the EPA's Renovate Right Lead-Safe information guide explainingthe potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your acknowedg ment of receipt and agreement to proceed. $2,384.65 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently,for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional$340 if savings are justifted by the auditor. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic mf the available air flow in your home both before the work is begun,and after the weatherization work is complete.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$3,110. $90.00 Total: $2,474.65 Program incentive: $1,878.49 Customer Total: $596.16 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***l=ive Hundred Ninety-Six&161100 Dollars $596.16 UPON FWALUJSPEC110N AKD APPROVALaY RISE ENdHEERTN4 CU11MRAOREES 10REALTAL1XWDUE 01 FULL W1ERESTOFI%WILLER CHARGED RI NDD.Y ON ANY UNPAID BALANCE AFMR30 DAYS.SEE REVERSE FORWOROMMYOWAIMON GUARANOtE3.RIOHBOFREg3KJN.SCKEDULUAAKDCONWACWRRE019VtA=K DO NOT SIGN THIS CONTRACT IF THERE ARE ANJBNKZSPACES bI .RLE EtplromiaB CUSIOGER 7 NOM:'Me CONRIACTMIY BE WITHDRAWN BY US IF NOTEXECUTEDW190N DAMCFACCEPTANCE /ACCEPMU(CE SAWFAOTORY W US AARD�HER�Y AMEPI&Y�AAVOM I)TODOW WORK 30 SAYS. AS SPECIRED.PAYNENIWU BE LADE AS OUNNED ABM 4 A RISE ' 60 Shawmut Road,Un[t 2 Canton,BAS►020211339-602-6336 ENGINEERING" ' . www.RISEengineadng.com OWNER AUTHORIZATION FORM Shauna Rollins (Owner's Name) ' owner of the property located at: 19 Robinson Ct, N. Andover, NIA (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. A4f::6 �E.LZG Owneeb Signature �7�©�� Date i MAY 3 2016 The Commonwealth of Masstichttsetts v Department of Industrial accidents �= QfieV of Inve.stigotio►ts I Congress Street Suite 100 Boston,.11,4 02114-2017 hw H,.mtis s.go t•l dia 'Alorkers' Compensation Insurance MUM; BuiltlerslContractors11lee(ricianslPlumbers Applicant information y Please Print Legibl,47 Nam i1Cii ss. ( o X —--- ---- - City State-'7i ev C)19 3 e� Phony cj- J` S-Lo` 3't� 3 Are)-on an employer? Check the appropriate box: F%Pe of projtct(required t� n,a criaal mrrt�tGt :rfd I I. 1 ;am a cnipi.��r V61_ ® a � r; ?tictc u>mtruc•ii¢)n empioyc t d! and or panlime, a nage him dw sunmumloun 1 3m a s«lc n-c;pnnor or p trtncr- hstecl on the 3ti3cL�!di sheet. j LZGna;d�fin<<. ,Fup and haNc m?':.,7pioycc, [ftc_<.c h ,:ol;irjcto€% fr te k_, C?crti�-�•[io�� cirpknvc,and tet.e iv.or cr_' r nri in_� for me 1�sn�• captcii�, rt. ittildln l,iiiizOn . ulm;�. lr�arasit r \t %t-=,rker,• comp in,ur:inct ��yy 1A c arc a corpor cion and ir. 4 Cr.� �lecn lea' repairs or additions rcarnred.J - 6�d a li:�.` h c th ri wd thea I, P in .i'g rC lam to ,ESlikv—s ?,� 1 am a hotr�•cl,tittcr duim� r � .�.�u;N:. ) Itio right o exeni im ser MGL na�,�lf- �Eurl� r' ci,trt�. t i 12-0 �'c6t rrpairs C_ 152 �;i-lt.aid tic Iiatie Fio ln;urancc r�•yutr�d-] ` i CiYlplo ces. [No"oActs' Conip. lns'mancc iitlCred j n =Ct.i are!hs,.h._'sh.,+ -n•.uti:i llauit,i...� i.,ni .I_.k >I±: i,cna , .., ,, ,�. ,-n.t t.• :n at�:,n.w Hr c , uhm;:l . a1'1d �r 1 sr .- .'d•;� I�fnrt ,( ��r i .,,.rami ns3_td�r,n�,. arF7._^cec_ idi,it� �, ir_tiC�_ ,.r a Mm.:.luk t;:fin run v w _n ex.,. ^si J-,=.&map Te nom t .r..-.d,, a,fir 1 y -t --a m r ,rt Qn_ t,."nt wnw ,h nv c- ti.. nmm pr,i l,.,a —Ans ._,t too?,. twill.m unt an etnphover that it providing warkert'compen.catien insaranre fur Be tura is the policy and job cite injnrrnatiun. 1 in.;wamc cbmpanti Police or Sc_Ams. 1.,t,Atte.~addr .s 16� Attach a copti of the trorhers'compensation police declaration page tarot+ing the police number and expiration date). F311llra. 10�,cCitrc Co',el3ge as requircd under 4ticti,•rn HA<r-`ML c. 152 can laid :o the ur po,it m creamM puaitws Ka Am up w wi.M(!00 and br onto ar imp-iwonmem. as yell 3,dr„1 penAtics in the :igen o a NNW"'i)Itli (ADER wd 3 fins E,l ap to S25(),00 a day apirtst the"Amor_ Rc M tsrd(hat a c”, o t}us Witcnictit niat lie to the Oil'ce of tnwA gat ms Ake DtA fru insr_rancc cowmy %nifical0i, I du here>fry cent ftp under the paint and penahies of perjury that lire information provided above is true and conect. Phone•V 61 Nil 5�-U Official use onty. Do not write in this area.to be completed by cite•or town o(fciaL (Ty or Town: Penni[/License Issuing Autbori" )circle mw i: 1.board of health 2.Building Department s.City mmn Clerk A Electrical Inspector -5.Plumbing inspwor 6.Other Contact Person: __ __ � Phone #: A � CERTIFICATE LIABILITY INSURANCE pATE(Mhtlpp/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 NAME: Nancy Usher -- — - Martin J Clayton Insurance Agency, Inc. PHONE (413)536-0804 No1:(413)534-7874 1649 Northampton Street E-MAADDRESS: IL P. 0. Box 989 INSURERS AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURER A:Nationwide _Mutual-Harleysville NATIO ........ ----- INSURED INSURERB:Allied WorldNatl Assurance CO ...._... __..----- ......_.. _......... ...--- - . Gauthier Insulation INSURER C: . _ ....... ._-.....--- -.......... ...........----------- -- 44 ESSEX ROAD INSURERD: 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 ADDLSUBR� POLICY EFF POLICY EXP LTR TYPE OF INSURANCE POLICY NUMBER (MM/DDNYYXI 1MMLDP.,XYXJ) LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 50,000 A _ CLAIMS-MADE X OCCUR PREMISES(Ea pccurrence) $ X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 X POLICY „) PRO- ECT RO ] ]LOC PRODUCTS-COMP/OP AGG_I$ 2,000,000.1 ._ ..... _ PRO- ..__._ If OTHER. $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ LEa,accidenfl_......... 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 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ _1,_000,_o00_ DED RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATION PER AND EMPLOYERS'LIABILITY Y/N STATUTE_ ER_........ ANY PROPRIETORIPARTNER/EXECUTIVE E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? �l N/A (Mandatory In Ni """""""-" E.L_DISEASE-EA EMPLOYE{f$ describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT I$ DESCRIPTION OF OPERATIONS I 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 PrdrdNtbd with pdfFactory trial version ..11�W f t) .cgrj! ACC)R CERTIFICATE OF LIABILITY INSURANCE [uT:F:C,TE IE S L. l AA MA—EL `v. CS `,cC. Cl-P,T:F:CATEC),,',E� f.ritA�;l�.,"AT'-',�- -,$z."L-:-�t,!l���-, �Y77N--- TIE I - - I - .R -1� --1-- --1 _I T CK- 1 1 E Q-IFI E'-A, cr!!0--,URAN C, T 1 TifT F NTP----0,CT�,1, E 1 E R IZZE D ELO.ly Tti!� IIFP�ESENIATIVE G5i rN-'1HE CER! ICA-- tor's rf 1!,,'04, rfer Igt5 to:h -K�rt!Fca'e hoce,i�keu r� Clayton Martin J Ins Agency Inc 63, 1649 Northampton St PO Box 989 Holyoke MA 01041 Gauthier Insulation Inc PO Box 344 1psmchl VA 01,93a COVERAGE$ CERTIFICATE NUMBERREVISION NUMMER: H�IF TFj CER',C7Y T,,-, PCUCJ�S ^,[ '7 EZ N 7, Y, .7�,4, T :�7-ER N I JAT Y FE A7�,,^' �Tf lAIE MABE R i THLRF, RDLECTIEED-CRI-N fS EI T S V-A �'- S -i�" -T— =7 Ai S wZ-AEr's lowc.!W— A+ fW IZIVA (jAlk�, F-L F Li _—Z' L L jZ CERTIFICATE HOLDER CANCELLAT'ON iE'-r 9 r Clearesult I Thr7 E_* Contractor Svcs 50 Washington Street Westborough,MA 01581 r-':a t u L- AC-ORD 2S'201,-j/OS� BPAC 3 i 39 « as a BuNdmq 9m mow wd St, \ ) \ \, . Erna:CSs� 562 , «va� �2 � « � [ K TRG4E�$R . _ ` ; I P-R A.#4 z S\/ \ / ( I, h«4 m% 1 \ ( 05/25/2017 [ ( 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 (?fare of Consumer Affairs S Business Regulation License or registration valid for individul use only ii HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 173410 Type; Office of Consumer Affairs and!Business Re-ulation Expiration: 10/1/2016 Individual 10 Park Plaza-Suite 5170 Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD a Lit IPSWICH,MA 01938 Undersecretary Not valid wire