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HomeMy WebLinkAboutBuilding Permit # 8/5/2016 BUILDING PERMIT �o� T�saD ,, ti6 � TOWN OF NORTH ANDOVER 6 APPLICATION FOR PLAN EXAMINATIONZN 76 Permit No#: ` Date Received �4gaa�r�u re���y sSaCHU Date Issued: PORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER kVL IN �l Print 100 Year Structure Jye no MAP PARCEL:&Z ZONING DISTRICT: Historic District no Machine Shop Village no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑ Two or more family ❑ Industrial w Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other P IM t�l°^w„k'' oodl �ni� etlands,. m.. Y " ' f S`e j �[a�� Well ❑� atershed District .,?'•a..,,-Cm„� ..r d '� ...'e,.?asv .` .. Y°. .,.."rvd ..�„wst, a ,v DESCRIPTION OF WORK TO BE PERFORMED: r s-c�n` '1', C-e ItV I ova-► � yrr, +r1 Identification- Please Type or Print Clearly OWNER: Name: L 5 Phone: 01 9 Address: Contractor Name:�(1J✓ kd'\ _r- Phone: C 1 3�� • 3''!'8 3 Email: �{cr • n lr ( ► Qwv) Address:J 3.ok 3H1­9 Nswi 61,:�i 3� Supervisor's Construction License: —Exp. Date: Z Home Improvement License: Exp. Date: ARCH ITECTIENGINEER 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.: ICI Receipt No.: 6 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund IAORTH '� owe. of ? � _ ��, b ndover O No. _ �p 4�xE hver, Mass -r CQCMIGIf�W1CK 1 ANO ED Up4a�4�� � U BOARD OF HEALTH rERM D Food/Kitchen Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ..........................I.................. .. .... ... .....,.................. ......... .. ... . .. .. .. ... .. has permission to erect .......................... buildings on �i ,, „Q Foundation • Rough to be occupied as .. . 1.... .�.`!, 4! r....�.� i�:.. .. �",!!....... Chimney provided that the person accepting this is mit 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final PERMIT EXPIRES IN &MONTHS ELECTRICAL I NSPECTO R LESST TI T�ta- Rough Service ... .. .. .... .... .. ... Final BUILDING INSP 0 GAS INSPECTOR Occupancy q ® Occupy Buildin Rough ccu a�ac �'e� tt Required t, _ Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. r'w1 /iew'� MUM RISE EngImeering to Ff)�Ragistradnn No ties IS tutACon�aatorlioglabraaon No X20979 A division ofTlvidsdt l€ugtn�ring C'1'Cotttrac6ertte$l6lratletr tQo EiNGINEERfG� 60ShawmutUnit#;:,Canton,MA CONTRACT (401)784-3740 FAX(401)7843710 Page 1 PROGRAM CMA-HSS WNEWMANDINCUnOMFORWOPAAS oneaa�oemow CUSTOM intra ccoaaaro wW*CRWM Rita Wells (378)856-0468 OWW2016 429840 00004 sotwre gfmmrlr Comm urn= 73 Cot& Street 73 ODtttit Sreet 80tvtct:ctrr,lssAMZI P Cuenca conr,67MBP Norlia,Andover,MA 01845 North Andover,MA 01945 JOB DESG'RnynON I�?Ai.TH&sAFMT:WoWnth2donvmknmwpmmduaffidw~ofcmbmdcnVaes is lie. SOAR A1RSEALING:Provide labor and matLFWS to$We=of your horn agoisstwaaft exp airiealw9k This work will be per€omted in Conceit with the use of spodal tools and diagnostic tuts to asstrro that your bome will be left with a healthful leve)of air mteber*e and indoor air quality.Matedals to be used to ural your hams can include ca Um,Raw and outer products. Primary areas for sealing include air kWmp to attita,butts,atter SmMp ad otber unheated atm(windows are not generally addrened.) 1'his wig require(5)wori ft bouts.A redue ion in cubic tit per minute(a&)ofair Wxleration will occur,but the actual number ofo3in is not guaranteed. At the oompletion of the wcatherizstion work,and at no additional coa to tort homeowner,a final bbrwer door anNor aambustion safely analysis will be conducted by the sub-cCntsaetor to ensure the saft of Oto indoor air quality. $425.00 AIR 813A1. 0-Provide labor and materials to btstall Q4*n weallmstripping and a doomweep tb(3)doors)to mtrid air kale. $225.00 DAZeM+N(3-Provide tabor and materials to WWI a 12"layer of R-38 un&ced fiberglass baits to(48)square deet for damming $98.40 ATTIC FIAT:Provide labor and materials to install an 8"layer of R 28 Gess 1 CA1Wlm added to(400)square fent of open attic Spam $548.00 ATTIC ACCESS:Provide labor and maftddsto install(1)easily owed,insulatingcover fur die attic saris lidding stair.The cover has Integral weatherstripping to t+e Met air leakage. 5200.00 ATTIC ACCESS:Provide labor and materials to insulate the back ofthe attic door with 2°rigid normax bored and seal the door's edge with weatherstripping to remet air lege. $73.91 VENTIL A71ON:Provide Mu and materials to it&W(1)inmilated adtmrn hose with tootmonuted flapper venae ordtanat existing bathroom f w(s). $118.75 VEMI A'1`IOld:Provide labor and materials to install ventilation dwtca in(18)rafie r bays to maintain air flaw. $36.00 BASSIuIBN'l'CER.ltsti:Provide labor and toatedds to inrdall(64)square tat of R-19 encapsulated ids insulation to the basero ret ceiling.There will be some exposed libagbw ftben where On Contractor will bane cut We end offt butts dwins installadan. Your signature on this contract is your ac kftowledgdneet and agreement that this installation is not Uly eacapsulated. $126.08 1tfSE Farginearingwilt apply all appliamblo,eligible incetttivss tit this wntrsot Yeu will a*be billed dwXetamanmt. Currently, f1br eligible measures,Columbia tans oMn 75%ineeatiwk notto exceed$2,000 per calendaryoar,and an kototitre of 100%Por the Air Scaling measures up to the first$680 and an aaiditicnal$340 ifnvings rico justified by dte auditor. For the safety and health ofyourbome"a indoor air quality,we wig be conducting a blower door disgaostic ofthe available air flow In 60 ShMnUt Road,Unit 21 Carrion MA 02024 0-50246835 RISE , w RISEenglneerin. �f4fciency Ef�erg�zec�. OWNER AUTHORIZATION FORM � Rita Wells (owner's Name) owner of the property located at: 73 Cotuit St (Property Address) N. Andover MA 01045 (Property Address) hereby authorize r1►�.-- .• (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. tl�' 4"��` Owner's Signature Date nLI The Conti imwe[tlth o/Ahisscrchtjsells Fe,� •� Department ref Industrial Accidents l)%/ice of'IruEctirttiota.c 1C'trttgress Streei,. ttitc /00 Boston,MA 021142017 %'W14r.ttras5•gov1dia NVorkers'Ci►mpensation Insurance Affidavit: I3ttildersf'C t)ntractut-s/Electriciantii'Plumlter4 Applicant Information Please Print Le isl j Na.me IL Inkl\'Edll��l. - '1 [ r 1WA Adclress:..ft_.-1.13, X 3,14 ttv'tit;tteltP: . . � _ _.. 1�. __ Yita�nel Are'vou an employer'!Check the:appropriate box: 1'r pe of project I regviretii: 1_ I at�i a c nplci�cr t4ith — --- 4 ® ( :art] ,a 4.�i.neral colt actnr miJ I \c•�c'con trtachon cn)pkiycrs ('Full and or psi^-tisni). na�C find 01C wh ci)tt[rt:tcsrR t' lam a tole pr,)prlctur car par(tter li,t;ri sirs rhti tttatilr.d ihcct. 17ell.cri4cli tg ship:antl 17avc no�TII[11f11'CCi I Flc c salt��carltraCtu:y lwv'c ® Demc)1ition ti{47r1 in 1, for mi: in:any t:apacity tntplc 4e ;.sled llcrc ti�€]rigs 9. ® fit:ildin aiilliriiln Ciill]p. In�ifrill[� [No wi7t" comp.comp.n CT C . It7wiaE11 C� tiC - rLtluirctl.j `. ® �t e.tsc a c-orpoi tfio t and it' l o.® L.lectrj('aR. rc.p'w of addilions lYl l� r� 11f.i�: e4 re;5c,d tlY�ir ;1. Plullr�lm" rC�am'or addifions I :aril a hon? o-m,,l r i1olne,, 3s`I st°l?dlc ® l mt,elf [NO taiirkcr�! C011111ri+_<_llt cr•`c:xomptlon -er' 1GjL I ®<RooC t,palr5 iersJr.ancc rccluired.; ' c l S? 51141,And vte#ra4c iter i+.10 i:)tllet Ctlipl(3'r l'i i. [N[.)�s't7lt�i:r��. ------------------- C0111p, lnl ilr€]n.re ri• tlircd.� `.Arlanerp4l:.aw-_sitar cIwc.:s ho,_`I nrr:�t a3.,1-11'?ut ills:..uIL-1��'L n� 4r sa.s,_.tYl t_u;1'biz c rt(z.�r:-l,�,l.I•F;I%: �n' ='In3nrlt iia �'J'e11:91:1c[L€ifa sell ;.,.•:;e0..'-'l!d.r1,1C 111_il_='t '1111Yl;i I ani un entpkit'er that is pin]^idillt�sl'+jrke'rs'crnttptrr.ctttirut irrsurunc r fnr nil.errtplu•tees. Below is thea polie_t'and job site information. Irsursn e Company N aarle: . _.�U�t�4 �����A t�� i � � kk i'ohl')' l of 5e11 ills. 1.ic. fxpirativrl Date: ' 0 l i i� �.. _ .. - ....... ..... ...... .__._.._.-..._.. N 14 ,tali Site Adda•�Lss: _._. _..__. Cin St rt'�.l1 .: mtach a cape-of the workers' compensation polies declaration page Ishovii ing;the policy number and expiratian (late). Failure xt Seiuri crlv,'i ue t.5 legllired Itndcr 5cction IS-\cls IMOL. c. 1 52 z:.m Lead ti,tl,e• map 3wloir of cr mi€al P lair ec of 3 idle ala to S1'400_00 acid-or onc-yTnipri;omHent,us iwll as Ck it pen�fllics i€3 the _off it a S'(01'WORK ORDER and a fine Of'_Ip to�2�(i Citi a'Ily against the violator. Fac;atlti i,cd that a cope csi'tlli."M'11L!neat 151" b�f !`rim arded tt:11- of-fit'c of lnvc4 igations ofr)tc'. L]1_N forimufanee rch,cl-ati.; '`sem R" CERTIFICATE OF LIABILITY INSURANCE D6� ai2o1 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 poilcy(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 NOmNE; T Nancy Usher Martin J Clayton Insurance Agency, Inc. PHONES ): (413)536-0804 FAX No:(t 413)534-7874 1649 Northampton Street MAtL ADDRESS: _ P. O. Box 989 INSURERS AFFORDING COVERAGE NAIL 0 Holyoke - MA 01041-0989 INSURERA:Nationwide Mutual-Harl�ville NATIO INSURED INSURER B:Allied World Natl Assurance Co Gauthier Insulation INSURER C: P.O. BOX 344 INSURER D: INSURER E IPSWICH NFA 01938 INSURE F: COVERAGES CERTIFICATE NUMBER:CL1663001850 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 SUER POLICY N B R POLICY EFF PO&LICD EXP LTR TYPE OF INSURANCE LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE OCCUR DAA O RENTEn PRE 5p,p00 I$ES�{Ea ocrursengg) $ X OL43497F 7/6/2016 7/6/2017 MED EXP Anyone porsoo $ 5r000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 x POLICY 11 PEC LOC 2,000 PRODUCTS-COMPlOPAGG $ ,000 OTHER: $ AUTOMOBILE LIABILITY Ea COMBINED l SINGLE_- LIMIT $ ANY AUTO BODILY INJURY(Por person) $ ALL T AUTOS AUTOS BODILY BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accidentl $ UMBRELLA LIAO OCCUR EACH OCCURRENCE__ $ — B E EXCESS LIAR HCLAIMS-MADE AGGREGATE $ DED RETENTIONS BE020792125-194985 1.0/18/2015 10/18/2016 $ WORKERS COMPENSATION PER T077- AND EMPLOYERS'LIABILITY ST UTE ANY PROPRIETORIPARTNERIEXECUTIVE YIIN NIA j E.L.EACH ACCIDENT $ OFFICERIMEMB£R EXCLUDED? I --- (Mandatary In NH) I E.L.DISEASE-EA EMPLOYE $ I€yyea describe under 0ESGIRIPTION OF OPERATIONS below I E.L.DISEASE-POLICY LIMIT $ I I F i o r DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES{ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) TET, AND ANYONE ELSE REQUIRED ARE NAMED AS ADDITIONAL, INSURED(S) ON A PRIMARY AND NON-CONTRIBUTORY BASIS TO ANY OTHER INSURANCE CARRIED BY TEX, UNDER THE SUBCONTRACTORS GENERAL LIABILITY AND UMBRELLA COVERAGE. 30 DAYS NOTICE OF CANCELLATION CERTIFICATE HOLDER CANCELLAMON SH43UL13 AWY OF THE ABO14E DESCRIBED AOUCiES BE CANCELLED BEFORE THIELSCH ENGINEERING, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 FRANCIS AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. CRANSTON, RI 02910 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©19B&2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Mr1drd5tbd with pdfFactory trial version www,odffactorv.com �► CERTIFICATE OF LIABILITY INSURANCE ETE(MM1DDJYYYY) 05/1312016 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 pollcy(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 Ileu of such endorsement(s). PRODUCER NA ACT ICa€ilyn Da sh MARTIN J. CLAYTON INSURANCE AGENCY INC PHONE =413 536-0804FAAIC Na: MAIL d ADDRESS: Sh �C 8 .Com 1649 NORTHAMPTON ST.,RTE 5 INSURERS AFFORDING COVERAGE NAICa HOLYOKE MA 01041 INSURER A: ACADIA INS CO 31325 INSURED INSURER e GAUTHIER INSULATION INC INSURER C: INSURER D PO BOX 344 INSURER E: IPSWICH MA 01938 INSURER F: COVERAGES CERTIFICATE NUMBER: 52708 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. IN LTRTYPEOFINSURANCE ADDL POLICY NUMBERFOLIC EEYF I POLIICYEXPiMMUDNYYYLIMITS COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ CLAIMS-MADE D OCCUR PREMIE aoccurrence) $ MED EXP(Any one person) S NIA PERSONAL&ADV 4NJURY s GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ POLICY 0 IRO-,CECT LOC i PRODUCTS-COMPIOPAGG S OTHER: 3 AUTOMOBILELIA13PLITY COMBNEDStNGLELiMIT $ a accident ANY AUTO BODILY INJURY(Per person) 3 ALL OWNED SCHEDULED AUTOS AUTOS NIA BODILY tW'JRY(Per acdden4 S HIREOAUTOS NON-OWNED PROPERTYDAMAGE AUTOS Per acddenl $ 5 UMBRELLA LIARFOLAIMS-MADE CCUR EACH OCCURRENCE $ EXCESS LIAB NIA AGGREGATE $ OED RETENTION S $ WORKERS COMPENSATION �/ AND EMPLOYERS'LIABILITY YIN X I PTATUTER A OF ICERIM MBREXC UDEI07ECUTIVE NIA WA NIA MAARP300327 10/30/2015 10/30/2016 E.LEACHACCIDENT s 500,000 (Mandatory In NH) E1.0ISEASE-EAEMPLOYEE $ 500,000 Iras,describe under DESCR€PTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 161,Additional Remarks Schedule,may be attached It more apace to required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B.no authorization is given to pay claims for benefits to employees In states other than Massachusetts If the Insured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows the policy In force on the date that this Certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of Insurance). The status of thts coverage can tie monitored daily IDV accessing the Proof of Coverage-Coverage Verification Search tool atMWA,mass.gOvllwd/workers.aamoensationlinvest€dationsl, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CITY OF GLOUCESTER ACCORDANCEW)THTHEPOLICY PROVISIONS. 3 POND ROAD AUTHORIZED REPRESENTATIVE GLOUCESTER MA 01930 Daniel M.Croiv(ey,CPCU,Vice President—Residual Market—WCRIBMA ©198&2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD a CX Office of Consumer Affairs and Business Regu at 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 OffEce of Consumer Affairs&Business Regulation License or registration valid for individul use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Re 9 istratien: 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 f j 44 ESSEX RD IPSWICH,MA 01938 � l.' ` ndcrsccrstarc ;"at valid wi put sihnature Board rr€c��YBoard �r urJdana f qul;r or nyr rr= r L ora s� CSSC IOZ562 f KUR'1'RGAtUWI `R P.o.8©x 344 f MA 019JR C�rnnns�tt�rs�� �Yc �ra$t�ss�y Mf7 i