The URL can be used to link to this page

Home My WebLink AboutBuilding Permit # 8/29/2016 ¢ �QRTI '$ Town ofndover _ b O ti, <."42M, 0 No. I- 2A y �5�iA-070 T Lh h ver, Mass �. 6 A_ COC.tfCKl wf[K 1' 7.4 AERATE D �`p�� '�5 S U BOARD OF HEALTH Food/Kitchen PERMIT T L D Septic System THIS CERTIFIES BUILDING INSPECTOR . Foundation has permission to erect buildings on .$�.. . .. . . ... .. Rough to be occupied a .1�it .. .,,.�..,.� .�� . .. ..,,,,�... ;` .. .. .�/� Chimney provided that the person acce tin thi ermit shall i �%tespe tL� c�irifor 11�fns np g 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_ 16 MONTHS ELECTRICAL INSPECTOR - UNLESS CONSTPftjION Rough Service ........ Final BUILDING I PECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy By Rough 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#0"406629 RISE El lighleelilig RI Contractor Registration No 0186 MAContractor Registration No 120079 A division of1hicisch Foginecring RISECompany Address,City,MA.00000 ENGINEERING' CONTRACT 401-123-1234 F`AX,1011-1123-1234 Page I PROGRAM '0415 CaoRACTIS EPCERED Vllo SETWEEU AME CNIA-1111RS ENGINEERING ARE Via CUSVMFt FOR WORK AS DESCRIBED BELOW PHOUt DATE CUPWO WORK ORDER Norman Lindquist (978)097-0525 08/09/2016 406832 Mot SERVICE SIRECT DILLMO STMET 163 High Street 163 High Street SERVICE CITY,STATE,MP UlLunal crty.wmr,ZIP North Andover,MA 01845 North Andover,MA 01845 J013 DESCRUTION IM-ALT11&SAFFTYANIO'CRAWI- SILO Alit;-EALINQ Provide labor an5m,tcriats to scud arcas oryour home against wocfal,rices air lcakage. This%Nork 011 IV performed in concert Will the ulselifspecial tools and diagnostic tests to assure that your home v%ill be let)v6th to healthful level of air exchange and indoor air quality.Materials ill IV used to sea[your home can incivie caulks,roams and other products, Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated arcus(%Nindow,are not generally addressed,) This 011 recloire(6)Nvurking hours.A reduction in cithic feet per minute(el'im)ofair infiltration Wil occur,tall the actual nualber ofefin isnot gwiranteed. At the completion or the vveatherization%Nurk,,and at no additional cost to the homeowier,a final Movwr door and/or comixisstion .safety analysis will be conducted by lite sub-contraclor to ensure the safety of the indoor air qaality. $510.00 CRAWLSPACH':Provide lalw and inaterials,to install(i 12)square feet of 1t-19 faced filvrglass insulation to the craidspacc ceilin?, $911.36 CRAWLSPACF:provide labor and materials-to install(1092)s(Ittare feat of Ca till polyethylene over open ground in designated cruv0space/earthen basciacni area& S8,10,84 INCENTIVE.:RISE L-rigincering mill apply all applicable,eligible incentives to this contract. You Wit only be billed lite Net amount. Currently,fear eligible measures,Columbia(;us offers an inecittiveol'751/o,not to exceed$2,000 per calendar year,and till incentive of 100%for tine Air Socal ing measures tip to S 1,020 FOR A LIMITED TIME:Collanbia Gas wkjll also offer all additional$100 incentive lo%wrds the%watherization vwrk outlined ill Ibis proposal,'I'll is special Sum ill er Incentive is available to ho al cov%n crs Win have had I lie ir Columbia Gas home energy audit be fo rc August 3l,2016. A signed proposal for vwai herizat ion needs Io he subm it led by ISLpt ember 9,2016 and%%ork meet be completed by September 30,2016. For thesafety and licalth of your home's indoor all-quality,w:Wit be conduct ing,a blowvui door diagnostic or lite available air flow in your home both Ix.,fore the vwork is begun,laid after the vwatherization Nvork is complete,We wwill also conduct a full aswssownt of the coulkwion-ofety of your healing system and water heater.This has a value oi*S90 and is at no cost to you 'file maximum allov%able incentive for all measures,including fair scaling,is$3,210 The Permit NNill be secured by lite insulation contractor,in no additional cost,It is lite horneowier's responsibility to close out this permit by contacting their municipality at the compiction of this wvork- $90,00 ........... I 0 V LEE; AUG I RISE4 60 Shawmut Road, Unit 2 Canton,MA 020211339-502-6335' ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION 1, /v t Y"G� c �t w c> C.)UT , (Owner's Name) owner of the property located at: (Property Address) (Property Address) " hereby authorize Y� Ot 'S 6 .,kr , (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 farm is only valid with a signed contract. Owner Signa r Date c 9XIv o//' , Office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration: 1012726 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 E] Renewal F'] Employment ❑ Lost Card SCA 1 da 20M-05/11 "5rlec ((1(1rMOirWOVAII c A�<'[�r,t.t�r�✓r��Prf/i 4-�'N Office of Consumer Affairs&Business Reguiatiou License or registration valid for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: Registration: 102726 Type: Office of Consumer Affairs and Business Regulation ...,. Expiration: 7/2/2018 DBA 10 Park Plaza-Suite 5170 > #! Boston,MA 02116 POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO.CANAL ST.#5A tk _ LAWRENCE,MA 01841 Undersecretary Not valid wathotrt signature Massachusetts Depaartrnent of PuubaB c Safety Board of Buillyddng ff egLd afiC.MS Ind Staind,,ards t:omt'rarcriom Super)kor">twCirallN I...oa,ense� CSSL-106017 PETER A LEBLANC 2 EAST PINE STREET Plaistow NH 03865 Expirifion t aurrrorerri ::s rrroa+sr 04/28/2018 r DATE(MM/DD/YYYY) AC R" CERTIFICATE OF LIABILITY INSURANCE 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 endoreement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(s). PRODUCER NOONT CT Linda Bogdanowicz A'EInsurance Solutions Corporation =.E4, (603)382-4600 (FAft No,:(603)382-2034 60 Westville Rd E-MAIL lindab@isc-insurance.com ADDRESS: ---,-- INSURERS)AFFORDING COVERAGE NAIC# Plaistow NB 03865 INSURER A:Western World INSURED _ - INSUAERB:Nautilus Insurance Group Polar Bear Insulation Company Inc WSURERC: 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. IL SR ADD S POLICY EFF POLICY EXP W LIMITS TYPE OF INSURANCE PtlLICY NUMBER M MM/D YY $ COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 DAMAGE TO RENTED 100 000 A CLAIMS•MADE .y OCCUR PREMISES Ea occurrenceL— !-0_ NPP8274967 3/24/2016 3/24/2017 MED EXP Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 ET LOC PRODUCTS $ 2,000,000 POLICY D J OTHER: I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS ---- NON-OWNED PeOra RTYDAMAGE $ HIRED AUTOS AUTOS ---- $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIABGEAIM&MAGE AGGREGATE $ 1,000,000 DED RETENTION AN026107 3/24/2016 3/24/2017 $ I WORKERS COMPENSATION AND EMPLOYERS'LIABILtTY Y/N PTATUFE ERH O ANY PROPRIETORIPARTNERIEXECUTIVE ❑ NIA E.L.EACH ACCIDENT $ g OFFICERIMEMSER EXCLUDED? (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ I1 yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ u DESCRIPTION OF OPERATIONS/LOCATIONS!VEHICLES (ACORD 101,Additional Remarke Schedule,may be attached If more space la required) u i u 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 _'_ - 7 O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS0250014011 6/10/2016 Preview:Certificates of Insurance A�Rom CERTIFICATE OF LIABILITY INSURANCE DATE I10r201`�`" OtiJOf2016 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 1S WANED,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 CONTACT NAME: Automatic Data Processing insurance Agency,Inc. PNo E . E Ert: FAX A1CHoo 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURERIS)AFFORDING COVERAGE MAIC# INSURERA: NorGUARD Insurance Company i 31470 INSURED MSURER B; POLAR BEAR INSULATION CO INC INSURER C: PO BOX 458 Andover,MA 01810 INSURER O: INSURER r: I INSURER F: COVERAGES CERTIFICATE NUMBER: 503587 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 ALC THE TERMS, EXCLUSIONS ANO CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR LTR TYPE OPINSURANCE IRSO 7770 PODGY NUMBER MWDDIYYYYI m"INYWY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 'ESJE.0 CLAMS-I.lAOE OCCUR PREMISES JE. 5 LIEU EXP{Any one fr vs S 5 PERSONAL 6 ADV INJURY 5 GEN[AGGR66ATE U1,111'APPLIkS PER: GENERAL AGGREGATE 5 FCIUCY PRO LOC I'RDDUCTS-COMPCP ACG 5 JECT OTHER- S AUTOMOBILE LIABILITY I r St IGL I I 5- IEa:ecldenll ANY AUTO BODILY INJURY IPrs -rson} S ALLO'NNEU SCHEUL'LEU BCOlLY IN}URY IPer a-r�e_rAI S AUTOS AUtGS 1,2N-OWNED ' ' •A(G S HIREUAUrGS AUTOS IPv adr n S UtORELLALIAB OCCUR &Wp CCCUr!�ENCE S EXCESS UAB CLAIMS-MADE AGGREGATE 5 DED I I RETENTIONS S WORKERS COMPENSATION �( H' AND EMPLOYERS'LIABILFY STATUTE ER ANY f'RGPRiETOffFARTN'EREXECUTIVE YfN E.L.EACH ACCRA-_NT S 1,000,000 A OFFICER-hEIIBEREXCLUUf:O aNIA N PDwc772256 01011120116 011D1lz017 1,000,000 {Mandatary Fn NH) E.L.0113EASE-EEA EMPLOYE 5 DESCRIPTION PTIONUndo COF OPERf.TlONS LNo-:r E.L.DISEASE,POLICY U7.lIT 5 1,0()0,006 s I DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(ACORD 101,Additional Ramuks Sshedule,may be attached It more space Is required) u 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. 1000 Osgood St.J suite 2035 North Andover,MA 01845 AUTHORIZED REPRESENTATIVE At 1988.2014 ACORD CORPORATION.All rights reserved. ACO RD 25(201410 1) The ACORD name and Ingo are registered marks of ACORD i https:liadpia.adp.cornlicertcf!#/run/previewl5O35871900012975 1!I The Commonwealth of Massachusetts Department oflndustrialAccidents Office of Investigations ' I Congress Street,Suite 100 ' Boston,IVA 02114-2017 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A licant Information Please Print Legibly Name (Business/Organization/Individual): PO Box 958 Address: R "' -, City/State/Zip: Prone#: F1.0 you an employer?Check the appropriate box: Type of project(required)I am a employer with 4• ❑ I am a general contractor and I employees(full and/or part time).* have hired the sub-contractors 6E]New construction.I am a sole proprietor or partner- listed on the attached sheet. ' i. ❑Remodeling ship and have no employees 'Phase sub-contractors have � 8. ❑Demolition working for me in any capacity. employees and have workers' 1 9 ❑Building addition [No workers' comp,insurance comp• insurance.t a 10.E]Electrical repairs or additions required.j 5. F, We are a corporation its 1 3.❑ I am a homeowner doing all work officers have exercised thoir 11.❑Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑Roof repairs insurance required.1 t c. 152, §1(4),and we have no ' employees. [No workers' 13•0 Other comp. insurance required.] *Any applicant that checks box 41 must also Ell out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then him outside contractors must submit a new affidavit indicating such. $Contractors that chock this hox must attached m additional sheet showalla the Panic of the sub-cor.!ractors and state -hether or ne:tho5a entities have employees, If the sub-contractors have employees,they must provide their workers'comp.policy number. p nm an ernplot er tila.is proi�!diprg tvorPe.s'co:rzoensation insurance j'or my erttployees. Selo::'is the policy and job site information. Insurance Company Name: 6 V AV A 7 $'t, yvt Policy#or Sclt ins. Lic.#: ?O\,)C 7 - Expiration Date:_, 8/ LP0 1 Job Site Address:_- {r S� - -_ - --- City/Stata,'Zip:�. -ty 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. I52 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 WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification, V do herEby cerci -under the pains and eena1dav ofperjury that the information provided above is tike end correet. Si nature: Date: S 1 G Phone#: q O�tcial use only. Do not write in this area,to be completed by city or town official City or Town: PermitfLicense# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3. City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6. Other Contact Person: Phone#: