HomeMy WebLinkAboutBuilding Permit # 6/1/2016 BUILDING PERMIT 0. TaoRrH pp''
'Ct LED 76�•yO
TOWN OF NORTH ANDOVER =
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APPLICATION FOR PLAN EXAMINATION ' p
01
Date Received RgoR
Permit NO�:
SSACNU`��
Date Issued: r �'
IMPORTANT: Applicant must complete all items on this page
LOCATION 2 Vi�9�\ e�a� Mf(-z
Print
PROPERTY OWNER e& � C fig- T—kax,Lo h C L,
tint 100 Year Structure yes no
MAP r® PARCEL: � ZONING DISTRICT: Historic District y n
Machine Shop Village y n
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
El New Building C�One family
❑Addition ❑ Two or more family ❑ Industrial
Iteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
/,r2 �' Nr�,r^ ,n;",.,+� ``„��,. r � u ✓ / s� i.':..;/d".�IrSu,s,".`���d 4 ,. s� { .�I /f F�7 `. f l,�r��;;rff •i Fe�i i r;,',
k��,�[] Se tLc �Y+��Well ,�„h� � '���f, ,��,,�fn`x❑ Flood I�� ����fWet�antls�, � ��,� �� d Watershed p�stnct ��:�����:
I PL mx -f �.a,., W-+?�,i ,�: 9” r�r.. i 4.f_ ;.�A. d r..v sM✓r, ..fir:v�'.Ns�� .A y.,v t %z�,��" .u✓��.�'-.. r .fl` ,.'i /'� F
� w:" ;::..,.. ,. �.!fr<a•,�. ,wr,rr ,^�t���, ��.....rnx'.�a`n{„Yir� f,';� .... / ,n.r�a'.rHr� 4 X. ..r �'. .; rsv.F:�M"✓ r... l..r .r 1 ...�.,,
DES RIPTION OF WORK TO BE PERF S-C”1 1% MED: r
Identification- Please Type or Print Clearly 3 ®�
OWNER: Name: Pat,Y` Ca Gk.. I�1k_c p h e C— Phone:
Address: Z V P1 6k ` r\ (u�
Contractor Name: (1 G r.L.,jl'hd Phone: � ' 3 3`'t
Email: q c � C r i sub"ate teat
Address: 0 6tau 31'1 lesviiVIN0036
Supervisor's Construction License: O S� �— Exp. Date: �� I
Home Improvement License: Exp. Date: r I I
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.: 2— Rece No.:
DOTE: Persons contracting with unregistered contractors do not Dave access to the guaranty fund
i
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t%O R TH
Town ofIAndover
�O �e ' aSS'ta"
COC LAKe
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04
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BOARD OF HEALTH
LD Food/Kitchen
PER Septic System
THIS CERTIFIES THAT .......... ... .�. . ,,,,,,,,,,, ,,,,,,, ,, ,,,,,, BUILDING INSPECTOR
... ... ................ .. ........... ................
Foundation
has permission to erect.......................... buildings on . ............ .. ..... ... ... . ......
...
ft..
® Rough
to be occupied as .......... . .... .. ... ... .. ....... ........ ......... ... . . ... ... Chimney
provided that the person accepting this per shall in every respect confor the ter of the applica n Final
on file in this office, and to the provisions of the Codes and By-Laws relating to th Inspec 'on,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 ELECTRICAL INSPECTOR
UNLESS CONSTRUCTION STARTS Rough
Service
................................................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathingr Dry Wall ToBe One FIRE DEPARTMENT
Until S ec e and Approvedthe Building Inspector. Burner
Street No.
Smoke Det.
Federal
deral ID"0"405629
RISE Engiuming Rl Contractor Registration NO 8 186
rMContractor Registration t10'120979
A division of''Ibicisch bigintcring,
RISE ('ompall)Address,(AtY.'M 000110
ENGINEERING' 401-123-1234 FAX-101-123-1234 CONTRACT
Page I
PROGRANI
THIS CURRACTIS EUMAEO IHM GETNEEll RISE
('NIA-I I FIS ENGINEERINGANDTHE CUSTOWER I'LPRWORKAU
DESCRIDEOSEM
SUS"Pu"Elt PRONE DATE CUENTS VICAR ORDER
Patricia klacphee (97800-30)(k 04/27/2016 431012 WW5
SERVICE SHEET EPWRO WREET
27 I-fi_A Plain Road 27 1 Iih Plain Road
SERVICE CRY,STATE,71P 131111140 cl TY,SVO-.,zu,
North Andover.NIA 018,15 Noah Andover.NM 01845
.JOB DESCRIMION
PI IAM:()NE-Proposal for this calendar your.
AIR SEALI NG:Provide latvr and materials to anal areas of vour home aminst wasteful,excess air lcakak.'Q. 'Phis work%%ill IV
perlornicd in concert k%ith the we of special tools anal diagnostic toisto assure that your liolue%kill be left%vilh a licallillid level III'
air exchange and Indoor air(judilk.Materials to K:kt-,cd to seal your hotne can incluk caolk,tbarni and other products. PrifflilrN
areas for WAftlg include air lCakagv to attics.basements,and ached varat,,cs and other are not cellerally
inkiresscd,) This%kill require(9)wukijij.,hours.A reduction in cubic 1'ect per minuic def n i of air infiltration N01 occol,but lite acoul
ntunber ofel'in is not Luaranteed.
At lite completion of the%watherization%%ork,and all III,additional cost to the hoincoNvoef.it Imal blo%wr door andtor coml-Aistiol)
sal'cty analysis will Iv condocted by lite milcontractor to ensure lite safety ol'the indoor air quality,
S765.00
51'01ZA(;I-'HARRIER:I lorneowier is responsible for the removal or lite stored items blocking[lie install,ation ofueatherization
work in the attic. Removal must occur prior lo the ,,kduled weal'.start.
VENTI LAT101,11:Provide labor and materials to Install(-I)insulated exhaust hose will rool,mounted!tapper Vent to exhatut
S237,50
GARAGI:CFJHNIGprovide 1alx)r and materials to install 9"R-32 dQnsch, packed ClasI Celltdow insulation to(550)sq tare feet of
prage ceiling located f-kIowa heated floor area,bY drilling holes ill lite ceiling from Mow. Holes drilled will tx:plu=vd Ilues will ha
spackled and left in 11 relatively Imoolli condition.Finish ending and lowfl-up prinl4nllpahuing will be lite ctworner's respollsibilily.
S,1,094,50
RISE Engineering k%ill apply all applicable,eligible incentives to Ibis contract. You will(in ly lv,hilled the Nei amount. Currently,
for eligible measures,Colurn[)in Gas otters 75Mnumn ive,not i o exceed S2,000 per calendar year,and an incool i ve of 100%liar the
Air:5ccling measures tip to the first S680 and an addil ional$.;,Ill il'slvifoii are itw i ltcd 11,1 the auditor
For the s fety and licalth ol'your home's Indoor z6f qtKilit y.we will be conducting it 1,14 om ckmr diat-Riost ic of tlie available air Mow in
%olly home toi It 1- fore the w,rk is tvgtm,and alter the kwai herizat Ion work is complete 'Ne\Nill aW,condwt a fall
the Colubw;l[oil".Ilete of your heat cot and%kutct heater.T 11 ihats a volu,",of S90 i1nd is w no Cost to coo I ot Rl allowable
\%vatherization incentive is53,1 10.
RISE Hnginecring Will apply a credit ol'S101)towucti this contract,in acknoWedgeolent of the(L-posit you made to NC\l 14cp
towards your orieimd twallieriiation conuacu
WOO
............................. ...........................
FO daral ID 9 05-0405629
RISE Enginceiing RIContractor Registration No a166
A division of-1111H.Sch FAL'inecriNg MAConfractor Registration No 120979
RISEConlimny %ddress.City,%1LA OR000
II - 4111-123-1234 FAX 401-123-1134 CONTRACT
Page 2
PROGRAM
'rWS CUMACT13 EIPMRSDINKS BEWISEN RISC
CA L -I INN EN"ECRINGAND THE cusiaMca FC Emaarx AS
DESCRIBED BELCW
CUS"AER I'MC94E DATE CUENTV OxTK-ORDER
Patricia Macphee (97800-30)(5 04/27/2016 431012 (X)(1C)5
SERVICE STREET IIIU-RIG STIEET
271 ligh 111ahi Roml '17 1 ljL
- ?,I)111ah)JZOrjjj
SERVICE CITY,STA7F,7JP UIWW.1 CITf'Sjjr"'7jp
North Andover,MA 018,15 North Andover.NIA 01845
,JOB DESCRIPTION
Tota 1: $2,187.00
Program Incentive: $1,954.00
Customer Total: $233.00
W E AGREE HEREBYTO FURNISH SERVICES-COMPLETE IN ArCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***Two Hundred Thirty-Three &00/100 Dollars $233.00
UPUI FINAL INS PECICH AND APPROVAL DY RISE ENGNEERING.CUSrJ,T-R AGREES 10 REPATANOWIrDUE IN FULL.VIIERESTOF V!,HILL EIC CJtARGEOr,'ZiltLYotiAtiY
UNPAID BALANCE AM-R:O 0AY5.SEE REVERSE FOR V`4OR1AIffVIPCR)A%=fCn
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY SLNIK SPACES
AURHCRI N)SIGN ne.1113C- "I"
T.A 11 1
.':
(V9 1
Nry
c
DAIEACCEPIANCE
3
ACCEPTAIJCf-,CFC(VInACt-�OtF.AUGVEPMCF SPECIFICATUiSAtICIIIM'ZIIISAIII 0 DAYS. SA1nFACMYT0USAND ARE HEREBY ACCCP3
AS-PECInED�PAYt�EtM'VILLSEtA�I)EA3 CU r4D,YOU IM
ARE AUMIND TOD01W
15 ORK
VJNEDABOVE
.............
j 1_'.!I
RISE60 Shawinut Road,Unit 21 Ca'nton,MA 020211339-502-6335
ENGINEERING' www.RISEengineering.com
OWNER AUTHORIZATION FORM
(Owner's Name)
owner of the property located at:
H e
(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.
-AA ckeX,
Own-idr's Sign ure
-1-7
Date
The Cnintnim wealth ref Massachusetts
_ Departmem of Industrial Acc idents
.�.,<() ee rItIrtresti ta gatioits
' ,�
i I Congress Street,Suite 100
_ Bot ton,.IIA 02114-2017
=` ib ww,ma':s,glt t'F d to
Workers,'Compensation InsuranceAffidavit: BijildersfC-ontractors,''ElectriciansrPlumbers
Annlicant information Please Print Leaihlz
Name (&,j
Address: 0 L�gx 311
City Stale,Zip 1. �� lb-11A ,�_� Phone s 1p` Y-i 1� 3
Are%on an..mplo:er,' C'hech the appropriate box-
PC of project+required)
7 l am a miplk ,cr aitlt
- ha%c hire.i he
LPilht4lt { do .aic}-QC pa7 t+Flt--�_
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1 ani e tial pr"T-11:t Sr Or pa tk:i_ .l�t:il tri t13� in aLl i_{?*itC�t. �GIY`-U1ll'hdiL''
ship ami Nave ilk, ilyittt' i if 5 t l `f t { t .w 3t i4'ti k ® �4titt t;t;itl}
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;srQ a :ory trc trot and is ` ol]L.loill al. rBl};t f:.w-additions
1 am a nt�tr uta cr ts±ttE a;: ..� ,0 t 1a- JTIml�
1 Plumbing t r •ai.,r=
np rt_li` ,. L`ScI2'd}'tie.I 2. .+
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ut:..4 _titts rt+';: ,. _ uta,,=oaf-,.x._ki.�, ,.•nn_ ,...c:c, ._a:...�...
c:a A� gun,i•gtct c:e `� c..tt ti.ttr.:.,.t 3hn at
1 tan►an empiq-twr that is providing workerscompematiun imurunce for nrt'a inphnveo. Below is the pcitic;r andjob site
information.
!rt ur nacC'atrl} ne!i.r;: A__ t-�o_ l't so117,. wo ; L -------
l h p1`i afN N t'llq p1r�`'i�
Joh Site:s�d�e:, 2
Attach a cope of the workers'compensation polici declaration page(showing the polici number and expiration date).
}':iilitrt'. itt�l.`i drC L_�'.[a t 1>tt.1!{If�i} i?Eli'lt:C Smlo d 5A o M(ii.L 1` .:drl k:,id to 11:C 3rnpo!+I o?i UI:S•1tTllr:;,}�ictlah_s4b 7 i
12G'al'tit +i, iK1,k)1.I;trhl Lei >jg ;1F t?}'t�i3li;Tt.lt,:!` t (I 3i itiii ltQri:siti: !:l ilk'..;Citi t1 d S 10 P��C�RK�}}DER and a tin
of;i;,ttr s ii-)00 a day agaiit thc i-1 ttlato7' RL;:d% wc':{013.;:cojl% t•' ittlti st.;t--mcnl titabthe of
lste stf at,t?t}s t'r`ipe DM fi-,r in, rant: cmcrt i kCrl i�tiiisar.
I du hereby certify tinder the p
a
ins and penalties of perftnry that lite t'ttfurituition provided above is true and enrrect.
�17)ltuta 'J 's�'. _i• ltatc.�
Official use nnit•. flu not write in this area,to be completed hY eiA,or town ntficiai.
Cit or Town: _. .. . :.-- Permit%License #
issuing authority(circle onei:
1.Board bC 11calth 2.Building Department ?.C;itt I'mim Clerk 4.Electrical inspector S.Plumbing lnsporto r
6.Other
Contact Pems m- Plane :
I DATE(MWDDNYYY)
CERTIFICATE 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 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 endorsement(s).
PRODUCER NAME: Nancy Usher _
Martin J Clayton Insurance Agency, Inc. PHONE (413)536-0804 �NC
on nsua
y A Q,_N. ,Nod (413)534-7874
--. ....... --- -- -.... _ ._ ..
1649 Northampton Street ADDRESS:----
P.
DRESS.__P. O. Box 989 IN5URZER S)AFFORDING COVERAGE __ NAIC#._
Holyoke MA 01041-0989 INSURER A Nationwide_Mutual Harleysville NATIO
INSURED INSURER B:Allied World Natl Assurance CO
Gauthier Insulation INSURER C: ....._.... ........_-- _.._...__ _....._ ..
44 ESSEX ROAD INSURERD
INSURER E.'
IPSWICH MA 01998 1 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- _... ........----- ...._.....—...._._. ADL SUBR ----.___.__.— _._...._._._ ...........-POLICY EFF... POLICY EXP .......-- LIMITS ...
LTR TYPE OF INSURANCE INSD WVD POLICY NUMBER D (MMIDDfYYYYt
X COMMERCIAL GENERAL LIABILITY ,EACH OCCURRENCE - $ 1,000,000
--- (-,,-� DAMAGE TO f2ENTED
A -,l CLAIMS-MADE L""J OCCUR ._PREMISES-�Ea occurrence)_ $ 50,000
--
X GL43487F 7/6/2015 7/6/2016 MED EXP(Anyoneperson) $ ,000
............___ ._... .._.._..- - ..._—....._. .. ___ 5........_._..._.
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000_,_O 0_0
PRO- 2,000,000
X POLICY PRO- .._. LOC PRODUCTS-.COMP/OP AGG $_
$
JECT
OTHER:
AUTOMOBILE LIABILITY Ea aBCcideDISINGLE LIMIT $
_ ANY AUTO BODILY INJURY(Per person) $
—.._.. __....-- ---- ._------. ......
ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $
".....__ AUTOS AUTOS ----- - .._-
HIREDAUTOS AONOSWNED PerOaCcid nth AGE $
x UMBRELLA LIAB _ OCCUR EACH OCCURRENCE $ _ 1 0001000
EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1.,0�000
DED L i RETENTION BE020792125-194985 10/18/2014 10/18/2015 $
WORKERS COMPENSATION 71 STATUTE pRH
AND EMPLOYERS'LIABILITY Y/N -- - ---- -
ANY PROPRIETOR/PARTNER/EXECUTIVE -""" E._L EACH_ACCIDEN_T $
OFFICER/MEMBEREXCLUDED? f l N/A
(Mandatory in NH) -- E.L. ISEASE-EA EMPLOYE $
If yes,describe under _.._.. ---_........ ............_.._- ----......---
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $
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 ""`
(J 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
IF?t5tbd with pdfFactory trial version � ttlt
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_Washington___ ' �
Board Ot Buuldang
-111d Stancjjro,
KURT R CA U7-jfjj��R
L�ccmse� CSSL-102562
R.0.Box 344
Ipswich MA Ol9jR
�Xpiii xuon
df0 if
Office of Consumer Affairs and Business Regulation
10 Park Placa- Suite 5170
Boston, Massachusetts 021116
Home Improvement Contractor Registration
Registration: 173410
Type: Individual
Expiration: 10/1/2016 Trk 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 individul use only
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
('ndersecretary of valid wi out signature
IPSWICH,MA 01938 `