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HomeMy WebLinkAboutBuilding Permit # 8/29/2016 BUILDING PERMIT `'o RTF{ �a �T 6v L1 TOWN OF NORTH ANDOVER } `° APPLICATION FOR PLAN EXAMINATION o ' 4 Date Received Permit No# RSgACMUgQ"� Date Issued: ��: �. IMPORTANT: Applicant must complete all items on this page /, ,,, %/ / ✓r ai/iii ,,: /i / /o%i ,, ✓ r rr. / �//i /i �i, //, r // ✓, ! / /. , / , r ,,,. / rrr / ,- / / //,// /„ / /r/i /. /., r // ,.: _r r. / ✓ / ,, / r // /✓„ / / / r, r, /iii c ui / o i/,ii,, �. ,,,,,, / /r ✓/, %//�ir o�//, % ///////%//ai a�r„lir /, r,,,, rr„�i i / /,ii, / r// r r r/ ,,,,, ii./,,,, /i.//%%./ % % i /// ""N IN' OISTRICT I istorNc Disfnct yes rao :;../ / r / moi, // rG/, ,,,., ,./ /,,,,a„ / � ,Machine Shop YP!age yes no ` TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ----------- ------------ ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Li Repair, replacement ❑Assessory Bldg Others: ❑ Demolition ❑ Other ✓ �` __. -._ ❑ Septic ❑ Well ❑ Floodplarn 'D WetlandsC� Watershed District, ❑U1latbt/Sewer ' DESCRIPTION OF WORK TO BE PERFORMED: 7-0 Identification- Please Type or Print Cleanly OWNER: Name: / Phone: Address: C) 7 Contractor Name. r r 0 ///// /r ,ii 4ddress r r to W,i/l/ / ;'„'>,r i rr r,„/; /p/ %/// %rr i/////-,l r/r /iirio///i�ri//i ri / ri/ / �ii �/ % Su eruasor s Construconr �cense ,; � f ' / ' ; „fix Date %%gid/, t,,,� e ,;,,�/,.; rp/ii ri r 7M Zip/ ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE, BULDING PERMIT.$12.00 PER$9400.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $� _ FEE: $ Check No.: Receipt No.: MOTE: Persons contracting with unregistered contractors do not have access to tl guaranty fond Signature of Agent/Owner Signature of contractor k FORTH own of ndover ® C. (% h `' ver, Mass, Qg Z COC NIC Nl wIC It 41. S V BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ....MI.CA(>r!l.A.G.......�II -O:L.0. ...............:................................ BUILDING INSPECTOR has permission to erect .......................... buildings on ... .... .r. ......rro........... ,..... Foundation Rough to be occupied as . !�. ;, �iM . ..�.. ... . .t.l�Mr... ..1....... *. .. .................. Chimney provided that the person accepting this permff 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-saws 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSIRKTIO Rough Service .... ... ............... Final B DING I SPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy BuRough 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. Federal ID ft 05-0405629 RISE Engineering RI contractor Registration No 8106 MA Contractor Registration No 120979 A 11,10oo orTbi,I,,h Enginwing CT Contractor Registration No 620120 RISE 6avv 1)Shiont Road,Conton,M 02021 ENGINEERING CONTRAC"r 339-502-5(97 P'AN 339-5(12-6345 Page PROGRAM `0 113 COPi TRACT IS CMA-HES DWINEWIW AND T14E CUSTOMER FOR WORK AS DESCRIBEDUELOW ......... ——-- — - - - CUSTOMER PHONE DATE WENT 0 WORK ORDER Michad Nolan (978)239-0639 08/16/201 29602 SCRWCE STREET OULLING STRErT Z 530 Main Street 530 Main Street ............ rEarVtCE Cl T'Y,8 W C,ZIP RILLINa CnY,STAT9,ZlP North Andover,MA 0 1845 North Andover, MA 0 1845 .JOB DESCRIPTION AIRSFALING:provide labor ant]materials to seal arciv;('if your home against viastel'ol,excess Sir imUge, This word will be performed in .............. concert with the Use ol'special fools arid diagnostic tesu tow5urc that your home%Vill he left with at healthful level ofoir exchanu and indoor air quality.Miller i als to be wed to Seel your 11 ol lie Can i tic I ude caulks,foams and otlivr I)roducts, air leakage to attics,basements,attached garaecs and other unheated arcivs(Nvindows ire not generally addressed.) I'llis wilt require:(12) working hours.A reduction in cubic feet per minule(efin)ofair infiltration%Vill occur,but the actual number of elm is not guaranteed. Al the Completion of'file wealherization work,and at no additional cost to the bonteowner,it title)blovver door and/or combustion 5111'ely analysis will be Conducted by tile sub-contractor It)ensure the saf'ety of the indoor air quality.. $1,020.00 AIR SI ALIN(k Providu labor and materials to insiall Q-Ion weatherstripping and a dools"cep to(2)dow(s)to restrict uio leakage. WOO) DAMMING:Provide labor and nuacrials it)install it 12"layer off(-38 unfaced fibeiglass balls to(218)square feel for damming purposes. S446.90 A*I,r[C FLAT:Provide labor and materials to install it 9"layer of R-32 Class I Cellulose added to(1278)square I'vet ofopen attic space. 51,927.54 W1 IOLI;I IOUSE,FAN:provide labor laid leatcriak to fabricate and install n rigid loam insulating cover for the whole house fan. $209.21 ATHC ACCESS:11(ovide labor end materials to insulate the[lack of(l)attic hatch with 2"ligidThermax board.Weatherstrip the perinicicr. 560.00 VENTILATI(DI:provide.Inlo,it",rrlsatcriuls In in't",("i cdexi......t hose with wofmoumcd Ila,,,,:,vent tea cA...usl existing buthroorn fan(s), $118.75 VI"NTILATION:Provide labor laid mawriak to install ventilation chores in(100)on1cr bays,to maintain air flow. $200.00 INCENTIVE:RISE Engineering will apply till applicable,eligible bjCCjjtjveS to this Coldreet. Yon%Vill oolybC billed 11ICTIlCt ant(noll. Currently,for eligible measures,Columbia GIs oMls;tit incentiveol'75%�,not to exceed$2,000 per eldcodaryear,and an incentive of 100% flor the Air Sealing rocasurci till to 51,020 FOR A HMITEDTINIF:Columbia Gwi NO[also offer an additional S100 incentive towards die vVeadlerization work outlined in this proposal..this special Sumincr Incentive is available to homeowners%vilo beve bad their Columbia(las home energy audit before August 31,2010. A signed proposal fiv,vveatherizalion needs to be submilted by Septeadwr 9,2016 and work most be completed by September 30,2016, For tile sat'cty and health of your home"',indoor air quality,we will be conducting it blower(I(x)r diagoosk of the available air flow in your RISE60 Shawmut Road,Unit 2 1 Canton,MA 02021 339-602-6336 ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM Michael Nolan (Owner's Name) owner of the property located at: 530 Main Street, North Andover, MA (Property Address) (Property Address) herebyauthodze, 20 )(Z61PA %J/4'540 (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. form is only valid with a signed contract, Owner's Signature ..... . Date 611 012016 Previeiv:Certificates of lusuratice CERTIFICATE OF LIABILITY INSURANCE06110_a016°A' THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:It 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: PHONE Automatic Data Processing insurance Agency,Inc. AIG No.E:t: IArc,Nok 1 Adp Boulevard ADDRESS: Roseland,NJ 07066 INSURERIS)AFFORDING COVERAGE ' HAK:P INSURERA: No,GUARDInsuranmCompany 31470 INSURED INSURER B POLAR BEAR INSULATION CO INC INSURER C; PO BOX 958 Andover,MA 01810 INSURER O: INSURER E: E INSURER P: COVERAGES CERTIFICATE NUMBER: 503567 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 iNDECATEO.NOTWITHSTANDING ANY REQU€REMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHICH THIS CERTfFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS. EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OPINSURANCE INSO WVD PODGY NUMBER mvioofYYYY MMlnDlYYYYxe LIMn5 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCt: 5 CLAINS-MADE OCCUR PREMISES 1Eaaccu-) S MED EXP(Any one persnn) 5 PERSONAL 8 ADV INJURY S GENI.AGGF7EG1rTE LIlIIr nFPL1I=S PEF1: GENERAL AGGREGAI'E S PCLlCY PRO- LOC PRODUCTS.CCIMROP ACO S JECT OTHER s AUIEa r_udenl1TOMOBSLE LLA131LJTY L I..I ANY AUTO BODILY INJURY(P, s ALLO':iNED SCHEOULEO 8CDELY INJURY IPI a6n_ril 5 AUTOS AUTOS 1.'ON-05NNE6 ' INMAGLS IiIREDAUT05 AUTOS iP��:.iccnll S UMJ3ftELLA LFAB OCCUR E,1CY.CLCu EtdCE 5 E%CESS LIAR CLAILIS-MADE AGGREGATE 5 DED REIENTIONS 5 WORKERS COMPENSATION „ AND EMPLOYERS'LIABILITY 5TATUTE EH NIY PRCPRIEICR'PAHT HEREXECUTSVE YIN NEL.EACH ACCEDENT S 1,000,000 A CFFICERNEMBEREXCLUDEO? MIA N POWC772258 01!01!2016 0110112017 ELOISEnsE EneFAPLOYE 5 1,000,000 (Mandatary In NH) II yySCdczcnha undo UESCIiEPTICN W­GF OPERATIOW­ E.L.OISEASE-POLICY Ul.4iT 5 1,000,000 DESCRIPTION OF OPERATIONS F LOCATIONS!VEHICLES(ACORD 187,Addiliuml Rarnwks Schodutn,may ho attached if morn spam Is required) j �J CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St.f suite 2035 North Andover,MA 01845 AUTHORtZED REPRESENTATIVE 11 _, ©1988.2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD s' li https:liadpia.adp.conVicertef/ill/run/preview15035871900012975 111 ACORV CERTIFICATE OF LIABILITY INSURANCE DATE(MMroDlYYYY) 6/10/2016 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 a. PRODUCER NAMEACT Linda BogdanowicZ Insurance Solutions Corporation PHONEn (503)382-4600 FAX No:(503)352-2034 60 Westville Rd E-MAIL lindaWiso-i.nsuranoe.com ADDRESS: _._... INSURERS AFFORDING COVERAGE NAIL# Plaistow NB 03865 INSURERA Western World INSURED INSURER B Nautilus Insurance 8rou Polar Hear Insulation Company Inc INSURER C: _ PO Box 958 INSURER D: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:CL1632326134 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. IT TYPE OF INSURANCE INS S POLICY NUMBER POLIC�Yt,YYY t9M%6 Y EYyYIXP LIMITS LT X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 NTED A CEAIMS-MADE OCCUR DAAGETV occurr 100 OQO PREMISES Ea oceurrence $ + RPP8274967 3/24/2016 3/24/2017 MED EXP(Any one person___ $ 5,000 �. PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R [__1PPRO- POLICY ❑ LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ._ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per accident _ X UMBRELLALIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION AN026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION AND EMPLOYERS'LIABILITY YEN STATUTE ER _ ANY PROPRIETORIPARTNERIEXECUTIVE [—] NIA A E.L.EACH ACCIDENT_ $ OFFICER7MEMBER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I L DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space to required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/SJA ©1988-2014 ACORD CORPORATION. All rights reserved. I ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 r�1o14n 11 i Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 :Boston, Massachusetts 02116 Home Improvement Contractor:Registration Registration: 102726 Type: DBA Expiration: 7/2/2018 Tr# 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BOX 958 ANDOVER, MA 01810 Update Address and return card.Mark reason for change. Address [] Renewal E] Employment Lost Card SCA f *ea 20M-05M r'�%/rr-`'��'rarrrrr�c+rrrr�r�nr/f✓r c��"'�i��rrs,rrrc�m.�clls � _ Office of Consumer Affairs&Business Regulation License or registration valid for individual use only before the expiration date. If found return to. HOME IMPROVEMENT CONTRACTOR f Registration: 102726 Type. Office of Consumer Affairs and Business Regulation F Expiration: 7/212018 DBA 10 Park Plaza-Suite 5170 ", ' p Boston,MA 02116 POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO.CANAL ST.#5A LAWRENCE,MA 01841 Undersecretary Not valid without signature ,.; 9 massachUsetts -'Department of Pubhc Safety Board of Bn 0din g Regui�flon s and tarmdar s t:on%tnnnation aapvf-mNabn-SiaQa:i'd(N i iu anse: C►SL-106017 T PETER A LEBLANC , r 2 EAST PINE STREET Plaistow NH 03865 o✓-21 .,J� " ' ` C`x.p a q u°a'a?u o x~n d;�o�:nn�n sia�n nu r 04/28/2018 9 The Commonwealth of Massachusetts Department of IndustrialAccidents - Office of Investigations ' 1 Congress Street, Suite 100 Boston,K4 02114-20.17 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legib Name(Business/Organization/Individual): PO BOX 958 Address: ANDOVER,MA 0181 Cit y/State/Zip: _ Phone#: Are you an employer?Check the appropriate;Sox: Type of project(required;: 1.9 I am a employer with_ '� 4. ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 5. L]New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sun-contractors have � g. ❑Demolition working for me in any capacity, employees and have workers' i 9 ❑Building addition [No workers' comp.insurance comp, insurance.# required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 11.E]Plumbing repairs or additions myself. o workers' com right of exemption per MGL Y � p• I []12. Roof repairs q insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp.insurance required.] *luny applicant that checks box R I most also fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tconhactors that check this hox must attached an additional sheet showing the name of the suhsoxteactars and state;;,hether or no:thosa entitics have empioyees. If the sub-contractors have employees,they most provide their workers'comp,policy number. lam are emprover ilia.,is prowding worPe.s'cankpensation insurance for my employees. Belo;:-is the policy and joh site information. /� Insurance Company Name:. --f� o c(g' V A A r a ni§�n 4yL Y - Policy#or Sclf-ins. Lic.-9: ?per C ?7 a2ST7 Expiration Date: c t A, lad l Job Site address: 1_3v AVV 'i'% City/.State/Zip: j7f� qtr' Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 and%or one-year imprisonment,as well as civil penalties in the form of a STOP WOFS ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement maybe forwarded to the Office of Investigations of the DIA for insurance coverage verification. do hereby cern reader the pains rind. enaltie o er u ifirit tlae in or nation provided above is true and correct. Si natate: - "Da#a: Phone#: q V- Y o)" 7& 3 8 Of aaclal use only. Do not write in this area,to be completed by city or town officiat City or Town: PermitrLicense# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector b. Other Contact Person: Phone#: