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HomeMy WebLinkAboutBuilding Permit # 6/1/2016 II BUILDING PERMIT OF To°r b�wo TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: , Date Received CRATE Du pew�� gSSgCHus�`� Date Issued: o PORTANT: Applicant must complete all items on this page LOCATION � � C,. fin^c� S l� Print PROPERTY OWNER C �S O' 0,--�nne.l I Print 100 Year Structure yes o MAP "1 10 PARCEL: O ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building One family ❑Pyddition ❑ Two or more family ❑ Industrial CtrA' Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other k 4 � -;a m3ti 4r r lo F N ,k l r r� r �r rJ r � y ✓ ;"dvY/r %Ef� �& r 1 r� '�r r F`<I,,/r, :ir � ,Se[)tic{ ❑Well otl Iain r ❑1/Uetlantls X,❑ Watetshed Dlstnct r 1 a u ,�i rl„ a � ,m✓t`s" �.f �✓,;�...�,�a l F-. .r-,�;'f1, rr' u /%Y. 7rry�'d;n 5 ✓. r' k ,.r.,:f k- �L '�9!r 'r' sf k l S„ „ L�u�,. J r .:�,": ,,...,.. w.:l� lY-.�. fr t.?i�4� $vim,} r r.1 .�:✓rF' '.rJ .If. �i,," .�u� ��,r�"Lr�..� rn r. ;w 7�r �1;�,7. :.�` r .G� ap, ,.., ,�:�f,r �. ,,.; e,.� :>-.� � �' -d..,x' n.... ,,•�dfc` ��i ,� .� r' �'..�.!b ,��. 4� srx f,r � fri^ �- ...:,err -.:r t DESCRIPTION OF WORK TO BE PERFORMED: C.t J r s-e �� 1,�L - i r Z C�, �'� V C I\k;lcvb 0 Identification- Please Type or Print Clearly OWNER: Name: CK&f-\J-S (�)'(J0 nrNcl 1 Phone:q l'(� k"Y 'l— OL12" Address: I. lS- ao. �S Contractor Name: V—Q('t G 0,Jkk1 Phone: cA- Y(2) 3 S� 3`1b3 Email: 1 t,�i ns�t �� �yv�u ill Address:'Po 9,, 3`1,1.1 Supervisor's Construction License: Z' Exp. Date: Home Improvement License: C � 34 m Exp. Date: I I �to ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT;$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ -3 Z 4 1 FEE: $ Check No.: Receipt No.: �1� NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund It4®RT'H Town ofeAndover �,. 0% 0 I ® T C a.- ver, Mc IkAejeass,OC•AKQ IMCKWICKC 0RATD �Pa��� U BOARD OF HEALTH / Food/Kitchen PERMIT T% LD Septic System THIS CERTIFIES THAT .......... ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,e., BUILDING INSPECTOR has permission to erect ...... buildings on .. k' Foundation ® ® ' Rough to be occupied as .... .. .. .. ..PWA, .. .. ... .... .... .. .. ..... .. .. .. .... ......... chimney provided that the person accepting this ermit 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. PLUMBING INSPECTOr Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS Rough Service ....... ....... ........... ... ......................................... Final BUILDING INSPECTOR GAS INSPECTOR ccu2ancy Permit Required to Occupy Buildin Rough Display in a Conspicuous Place on the Premises - Do Not Remove Final No Lathingr Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal In 0 05.0405629 RISK Engineering RI Contractor Regiutra0on No 8180 MAContractor Roglatra0on No 120078 A division af'MICIsch Engineering RISE60 Showmut Unit 112,C inion,MA 02021 CONTRACT N1"'SACT 339-502-6335 FAX 339- -6345 Page 1 " iTOORAM C�1A-1IFS E at axaeaau o�AND HE IS CUS na wORK AS UESCS1aEn aEtAW CUS'0&R PItCPaE SAI: CUEm'W WORK ORDER Charles Q donnellVff (978)777-6653 (M/22/2016 434388 00003 r , . SERVICE WPM u.I IG SUEET 125 Coachntans Lane Coachnians Lane SERVICE CITY,SAIF,ZIP atuino CIN,Swii,ZIP North Andover,MA O45--- North Andover,MA 01845 �— JOS DESCRU TION PHASE ONE-Proposal for this calcndar ytaar. $0.00 HAZARD BARMIEl 44e 7huve identified that there are recessed lights present in your home.unless the recessed lights arc eertificd as IC-rated(Insulation Contact Rated)we%Sill crate a 3"clearance space around Ute fixture by using fiberglass Nanket insulation as a damming material,no insulation will be installed across the top and closed cavities nhieh contain recesa„d lights will not be insulatcd $0.00 At SEALING:Provide labor and materials to seal areas of your home against wusleful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic teats to assure that your home will he left with a healthful level of air exchange and indoor air quality.Materials to be used to seat your home can include caulks,foams and other products. Primary areas for sealing include air leakage to all ics,bascments,attached garages and other unheated areas(windows are not generally addressed) This will require(12)working hours.A reduction in cubic feel per minute(cfm)orair infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door andror combustion safety analysis will be conducted by the sub-contractor to ensure thesafety of the indoor air quality. $1,020.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass Batts to(114)square feet for damming Purposes. $233.70 KNEEWALL&Provide labor and materials to install 2" FSK faced semi-rigid fib Lrglass board insulation to(128)square feet of knccwull arca. $448,00 KNEEWALI.FLOOR:Provide labor and inatcrials to install a 12"layer of R-42 Class i Cellulose added to(256)square feet of open knecwull noor.OFFICE ROOM,I COULD NOT ACCE,4"4 $373.76 A`rl`IC ACCESS:Provide labor and materials Io insulate the back of Ilse attic door with 2"rigid Therm ax board and seat Ilie door's edge with weatherstripping to restrict air leakage. $72.22 AT"T"IC ACCESS:Provide labor and materials to make(I) temporary access to an attic area. The opening Wil bre closed with materials similar to those;existing. Finish sanding and painting is not included. 585.00 VEN`f ILA'rION:Provide labor and materials to install(2)insulated exhaust hose with roof mounted flapper vent to exhaust existing buthroom fan(s). $237.50 VENTILATION:Provide labor and materials to install ventilation chutes in(66)rafter buys to maintain air flow. $132.00 Federal 10 4 0"405629 RISE En ince ring RI Contractor Registration No 8106 MAContractor Registration No 120979 A division of"Ibicisch Engineering RISE61)Shawrnut Unit N2,Canton,NIA 02021 ENGINEERING* 339-502-6335 FAX339-502-6345 CONTRACT Page 2 PROOMM IRS COMACTIS EIVEREDIMOOMWEEN RISE CINIMIES ENCINEERINO AND 1HE CU31"R FOR WCFU(AS DESCRIBED BELOW CUSXXMER PACUS DATE CUEMN WOMOROgR Charles 0 donnell (978)777-6653 04/22/2016 4.34388 00003 SERVICE STREET MAID STREET 125 Coachnnans lane 125 Coachirkins Lane SERVICE CoY,S1A1E,aP BILILING CIIY,SIA-M,MP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIMON VE-1,11"ILATION:Provide labor and materials it)install ventilation chutes in(66)roller bays to maintain air flow. $132.00 VENTILATION:Provide labor and mutcriuls to install( 17)4"X 16"rectangular aluminum soffit vents to increase ventilation in attic areas.Specify color:White or Gray. $425.00 RISE Enginccring 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 Smiling measures up to the first$680 and an additional$340 if savings are justified by the awlitor. For the safety and health of your home's indoor air quality,we will be conduct inga blo%ver door diagnostic or the available air flow in your home both Wore the work is begun,and aller the%vootherization work is complete.We will also conduct a full assessment of the combustion safety of your heating system and muter Treater.'chis has a vatic of$90 mid is at no Cost to you. Total allow mcallicri7ation incentive is$3,1110. $90.00 Total: $3,249.18 Program Incentive: $2,714.39 Customer Total: $634.79 WE AGREE HEREBY TO FUR141SH SERVICES.COMPLETE IN ACCORDANCE WITN ABOVE SPECIFICATIONS.FOR THE SUM OF '"Five Hundred Thirty-Four&79/100 Dollars $534.79 UPC"R_ - =LBYIN DAPPROVA36 ENGEERINCIL CUSTOMER AGREES IOREUTAMUNTOUE IN FULL.MIERESTOF 1%WILL '" 06 CHARGED VIDNLY ON ANY UNIPAID.W.1ar.DAYS.SEE BE FOR IMPOMMOIFORIMION ON GUARANTEES,Me"OF RFCI;40K OCHEDUUMAND CMMC=REGISIFLAVON. DO NOT SIGN THIS CONTRACT IF THERE AljeANY BLANK SP Ar71'010MWRE-7dm 40-ERACiPM, NOTE:IfISCCNVMTFA%YD2WITHDRAWN UYUSIFNCrrEXEGUEDWiltiN DATE OFACCEPMCS - ACCEPTANCE OFCONIRACT-101 ABOVE PRIM,SPECIFICATIONS AND CONOMO143 ARE 30 DAYS. SATSFACIDRY TOUQ AND ARE HEREBY ACCEPTED.YOU ARE AUVIMMO 10 DODiE WORK AS SPECIFIED.PAYMIENTVALLBE ME AS OLRUNED ABOVE RISE 60 Shawmut Road, Unit 21 Canton, MA 02021 ( 339-502-6335 ENGINEERING" www.RISEengineering.com OWNER AUTHORIZATION M (Owner's Name) owner of the property located at: (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. Loa Owne Signat 5 Date The Communwealth ii Massachusetts - Department of IndustrialAccidents �= f)ffice raf'Ittre>stigations r I Congress Street.Suite 1011 Boston,MA 02114-1117 �,--i-,,�•k�: ib'H'k'.111 a�1'.�z)1'r[l t[t NVorker%'Compensition Insurance affidavit: f3trilder Cr}ntractvrs Electricians Plumhers applicant Information Please Print h,ep-iblti _— _.- :ai_idre s:: 60 a o X S14 Cite-stale Zip: -� moi) ( t� � Phone 3 S-to` 34'� 3 , r Are you an ctnph}ser7 Check the appropriate box. � l"ape oi"projet t i re'yuircd) � empic+t 11--.0(.:r: ridOrnsrx terra. a -'.0 hired pit ail iflilt Jet)rS t" ®\t" itm4lT;a'lia�Z �. )3'tt 3 tit iii IS?pf rCtJI�3r rtC--tsr_ 11,1,al on thti 1t,Ad' i ,3mCt'-t. .c3Y'S tiCiln s{14j?ii Slit h"wki lit, ire?plo eel lir d rix,e +, forixr�' Lc;}rkr t= t�lr nle r. tit rprtatti. >. [)B-t;i1di_n�adlti*iort �'4f i14t6 �l'L: Con-p. Ir1S r1<�t}�� .:irnp r,ala rte ' ` �y u-,,i — C] '4 i" Irl I ��•r tr a-I d rrh )rs ale: llit l�rep,r. -or,�ddit{t�ri- . i:17!l:3{�iIFI'r U�4-ItCi I.�c{ti3 S tn2 rC{d)s,or ri.,h' 'ss r3 fitr�:r r NIGL ' ,w; it t\ia%xorr::r� .4Ymp, _ 9 .®ah_o", rrpairs 1 irr'+itl:ineC rvi{U>Nd j '- 151 i3'{I acrd Ati ha4t!w comp ?ra 3I�u tc cjrrrre .� I uln alt p)YYpIDi't'r ihl7!!_i pFnl°iehJr�}t't7PliE:rS'Ca Jnlil'IIlaltY}fJ lnikrtltlCC�Ur nJ,t`[pipit}t'er'f. Below is the pezhr_Y andjob site tJ{ftlr)nation. C,olm';rti. \m ,_meq p ( t�j�l lbt r`Gl.^t� y (rte i..ic, ..3.%;r0_3...3d..JF-1�4ti:lPEtl'.1 D'Ite __ 1 N 6 h0li yie ddre;: 12S WGL.�I ...fL A-S L0.*,\A_ C lit stat:Iii,; , T r t� KsAV�V1 1��4 4T Attach a cope of the workers'compertution pt}licp declarathm pate:'(,sfroering the pone} number and expiration date-). i mhire'.o sccL&te _5'C[ 1 iQ+6T i im&r Soinit n 25A },'`r;OL C. i 5',:jri !,:A;el ti:r m1p),rtrilat t# 3`.rYLr._i pcnah C; m f;l litre,r4 r if{ani tyr i T 4 rT iinV-,i,on n n;,its wAJ1 a i:d pt'r,:rth,�: lir lire(:sirs of I w ()P WORK ORDER and a'hilt ;`{ ;R. tt-S�`'l+W) 1 ldav Igaint<t.`?„ " hitoa. 9i:ids iKCd thd!.is COPpt l" ?}r{�StdmiS lit 1113ti b) (orNand o to the .}Ytcc o il3L•v ;I 1[,:i'tf)i .1r T)?c t}i'S t'or in,�i.,r4nc,:i:m,r3t:C 5•Cri.I'_J11 1 I do here'br certify under the paim and penallici rrf perjtrq that lite btfeirmatims provided ah+}Ye is true and correct. Official rise only. iia kni}wilt-in this area,iv be completed ns'rity or lown o fjit'ial. City or Town: Permit/License# _ (,suint Authority(circle onet: 1.Board of Health 3.Building Department 3.Cihr Fo"n Clerk 4.Electrical lit-Vector ;,Plumbing inspector 6.Other Contact Person: _ Phone V. _. I =(MWDD/YYYY)ACERTIFICATEF LIABILITY INSURANCE 015 ltts� 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(les)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 NAME: Nancy Usher Martin J Clayton Insurance Agency, Inc. C No Ext)_ (413)536-0804 ac Not:(413)534 7e74 1649 Northampton Street r oRless: _ - -------- ----- 0. BOX 989 INSURER AFFORD COVERAGE NAIC i/ ---- ._ _R ..._ Holyoke MA 01041-0989 INSURER Mutual-Harleysville NATIO ....._._..._.. - INSURED INSURERB:Allied World Natl Assurance Co Gauthier Insulation INSURER C: -_-___— ___ ._. 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. ILTR -----"---- TYPE OF INSURANCE ADD SUBRPOLICY EFF POLICY EXP LIMITS POLICY NUMBER1Y X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 � �,, � DAMAGE TENTED 50 000 A CLAIMS-MADE n l OCCUR PREMISES(Ea oceurrence),,,, $ X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person) $ 5,000 11 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 PRO- ��I -- -- -........ ............. — X POLICY JECT a LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOS AUTOS BODILY INJURY(Par accident) $ TY NON-OWNED PROPERDAMAGE $ HIRED AUTOS AUTOS Per accident)_, X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 11000,000 DED I RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N _ STATUTE.. I ER_,,, ANY PROPRIETOR/PARTNER/EXECUTIVEf 1 N/A .E_L_EACHACCIDENT $ OFFICER/MEMBER EXCLUDED? a (Mandatory In NH) E.L.DISEASE_ -EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe 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/MSG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MMMIJ with pdfFactory trial version mn . '? ' ¢ Lrc u cll CERTIFICATE F LIABILITY INSURANCE 4 -I C. i..=ER'IF(':a'E I>.S�c. ..- -`A7TcG_ .G.iPY G '.,'�;`•� ERS`t(.s . C, FT=r""ATE.: G. •-0t AFrl',V.A __.'+.1 R. c l- -..F;. -hT E 7!d>Ukk":C:e..t 7. "r,a 9T6 .-ET .�_ _, UL._ , iyT+,_F.iZEP F17PRE;ENT .TIVE Gam:PP,0' .;=..F; N- THE EK7 I=IC, H [ ° F .NT If he -r` t hvo :n A t c C r,=+1 GFI� r.T- LIfr'-' 1 't Er, A_.cCeT_rF :n Cf. ,, v d:9 .i� r�,, $r-r.� C�t0.h= �'FCe:E h Nl' !^!iEU C _Tr zt5d Clayton Martin J Ins Agency Inc 1549 Northampton St PO Box 989 Holyoke MA 01045 �;� Gauthier Insulation Inc PO Bax 344 u�} Ipswich.GEA 01938 t COVERAGES CERTIFICATE NUMBER: REVISION NUMBER: I h I IS T0C c F. rE FOt I fAt, r I cd =SY c<.,Ej c K" N tV r_C E..0 Fr1P I ert _ T Ei. rt', c Ft �, � l ATE MAI N q` r 4 THE y KI t r 7+'t P).1 t E C i t.G N,l r9_j ] :2__t -ITF +' t- 7d i=[:. cU .,A110-1 � -. t - 1 4 _ I ;6107II8CtYl§ILE Jk& rTY ' - "-`Vi' E ii :3 � K'uRJc.ER tfNrePEN2AtHM I j m I i I Ahr,fwp✓ l lR I144k, Y I , 64m[fc+l-wy kw .. 1 f'1 i CERTIFICATE HOLDER CANCELLATION Clearesult -hE n,.T4 7 E NE :_D Contractor Svcs % , =I'. = c u. 50 Washington Street Westborough,MA 01581 S�r7ature: I AC-ORD 25 12011-D,'05' 4PAC 1 :9 aemmtof y;Safety ) « yam eamGM . . 9 ,macsaAsoma� [ . , La\ CSS -25& KURT a c4UTHOR 801344 2 r� hmwm9 ! cm_ex 0512512017 � r ' Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Horne 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 Office of Consumer Affairs&Business Regulation License or registration valid for individur use only i HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 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 Undersecretary 4.ti4signature