Loading...
HomeMy WebLinkAboutBuilding Permit # 11/15/2016 "ORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: [ Date Received �1 j � 7 eo �SSAC Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER WEL y-w r) _ (0no Print 100 Year Structure yes MA ,PARCEL: W ZONING DISTRICT: Historic District; yes Machine Shop Village yes TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non-- Residential ❑ New Building one family ❑Addition ❑ Two or more family ❑ Industrial Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other f u 0111111, INN; ` DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: UJ 0.r Y0i_4 n Phone: 9$ �_J • 11010 Z_ Address: s LSA P�t.t l 'UVJ Contractor Name: Phone: _"S "3 T LO• 3461? Email: Address: 3 '� 4 61 61313 Supervisor's Construction License: Exp. Date: Home Improvement License: Exp. Date: Z� 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 SF, Total Project Cost: $ -3 44 • ko FEE: $ Check No.: 36 -3 -7 Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaran fund 'T � r1QRTFf oven of � 4\ ndover 61%-ami * �i ' ' ' ' h ver, Mass + •� T D LA+lE .� C oc"'C"E w1[,[ ArED S U BOARD OF HEALTH PER JT T LD Food/Kitchen Septic System THIS CERTIFIES THAT .............�� ...�. I � ��. ...... &f4W.; BUILDING INSPECTOR ..,. .... ..., ......... .. ......... has permission to erect.......................... buildings r ... .. ... Foundation Rough p .., '1.....R. ,. ......., �� .... ..fit. E. . �► .. Chimney t0 be occupied a5 .. .. r y provided that the person accepting this permit all 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION RTS4mmnm= Rough Service .................................. ..........,.....,. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildin 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. RISE60 Shawmut Road,Unit 21 Canton,MA 02029 i 339d0244M ENGINEERING wwwXISEenghwering.com OWNER AUTHORIZATION FORM i, eg e 'fir (Ownees Name) owner of the property located at: ! /'ae e /< (Property Addre 1 p3mperly ) hereby authorize qcw4VkiLr (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform worst on my property.This form is only valid with a signed contract. rs i re Date Fadb»t iC•ati#43es1 Al CnnlraFtor Ragisirattoa No OtBa RISE Engineering MAGantrsebarRWlstratlean Nn t:osatr ®® aToontmetar RagIg"don NoSM20 60 SSawmsl Rai Cstato",MA 02021 CONTRACT ENGiNEEp)AlG 339�5ti2-x335 gam+ 354-Sd�-6344 Page t PROOF AM rwaswra paltir �ral<s(� Aa CMA•INES eaten waacesuur a°70M t978)857-76A2 1017N2016 441887 23902 Howard Brown aattMo awFct tmtvroa 157 BerMiley Road 151 Berkeley)toad ----------------- swats arr.sww.xo+ °mvm rm.smr.es North Andover,MA 41845 North Andover.MA 01845 JOB DESORI t10N AIR g.ALiCt prof s}cow toots mad dispotti vide tabor;end mxferials to seal areas of your home e�it►st vastefut,excess air leaka�. This wosic will be onncert with the tee oc torts to assails that yotr home will be left with a healthful level of performed N alp exchmrga and indoor air quality.Mat0W9 to be used to seal your haQte tart that�hc�areas t�do�ws rue t� 90"YarY areas for swlEng moltde air tai to strias,gents,attached pups and addot9sad.)T his mill require(a)marking how A redrtction in eubit:foci per manse(eft)of air infdlration adll om-w.bas the sajW number of cfm is not gauanteed. At the 4wmpidion of the viratherirslion work,and at no aMitianal cost to the homoovi a final blow door anther combo2ion safety analyds will be eondArctal by the ob-contractor to enwit the safety of the indoor air gwdhy. 56$O]S2993 dQ DAMMING:Provide labor and materials to install a 12'pryer of R-19 enfeood 110MOes9 betty to(146)stltane ltd for dturrming p� ATTICPLAT:Provtdalaborandmaterialstoinstalla4'lava'ofR-14CfiCcllt�asaadded to(IQD6)sti fact ofoptnatticwam. > lea of open attic ATTIC FLAT:Provtdo labor and materials to install an 8'layer of R 30 Class I Cenultsse added to(176)sgwre Space. $241.12 ATTIC ACCM Pmvide labor and materials to tiwentheraip the perimtter of(I)aide hatolt ttith Q roil. 1;25.00 ATTIC ACCESS Provide tabor and tnatwWs to instdate the Inde of the att is dear with 2"ripid insrdalion board and seal the door's edge with weathac1ippin8 to Maria air tetkaw. $73.91 Vtw'NTILATIONt Prov*tabor and materiels to instal!(3ynsrdaiod ealtatat hose with�blt wmJl mawttexl flapper vast to alum axisi�gbathtaom fan(s). 5356.25 1111;. VENTILATION:Provide Iabor and materials to instill)ver►tilatian ehat is in(60)rafter Ws to maintain air flow 6120.00 to 36 square fest of common�wll. Then install ccih1I.I0!i WALL:Provlde tabor and mattrialn to instal!It-19 tozfaeed frba6 is of bvikljn8code SW all seamsv&h FSK tapes Z'rWd board insulation that moss the sxlions R-316.5.4 and 316.6 rein S147.60 Faaw,aEttraa�Etata� tit Contactor�i !ta 8t84 RJR Engtooft 1r"4U4M PAX&" S pap 2 PROORAM CM44M to= putts rteeserctat P709-750 ti1i7A/7At6 44107 2 aataw►Samar aw 157 Bob*14tsd ttsstat+CWW.WMA — amraaaa taa,ar�.a► VAA AudtnrEar�MA OlSG Wm&Attdov44 MA O1t34S JOB DSM 11 I 11 Niall 4rrr�da tabor atdtttasawta WWI.FSC tt�aed ado€�dli>>�eaa� ipn to(Sit)>� tbet of comma wa alas. 8t7S.00 ts1t � ► °pYi .` i�noatttaa to tbtsco>Ztna. Youva only bs triEtadtbe Ids atnaau.t]atotrttb. fare�btentcam�►Catta�Eksot�snt7S96iCoantirQ.oaatoex000d�2.0�RRap� t�lte�w�Ear. ivaafltt0l6[Eer the A Seatin8atama�W Eo the MsE13680 Or eo adtlE4>Rs1 f3s0 i[t�arhagaara tatitted by For thesaktY and bbstth atyop hOmes mdaor air adby,vta wM bsaottdka tga HWAW d M lc of the waahto sir ltaw to Your tmtrea both b ftc tete cork is beset.ad a8sr Ebe vttatbasb atam vw k i s*=qk ts.We tAi alto oattduet 8 lilt mgment o[theaambutdOaof7�+r��tiamdv�orttaatar.'Fhishar'vstazatx90sadiaa:aaaattoYdw Total atto►w5lerttt►n bt000Eiveisi!',11Q�. The Patna vt$1 ba sacta'o6by Ebe iaa�atian omtt:ectar.et ao 83Ctttuta!oomt.tt isttts hoaoovatat'stapikY tt►dog ata this pertsit bg ettttteaEsaSthei:�y at tlra osmgteti�of teiia atartc. i9tt.00 T*Wl: " t tnSt TGW: Waa.T4 wa+ taa+�.voea° "��'t �aattwRauwor '""�itR Htutdred FaElgf'Th+sO i 74!'140 DWJOVs $U&74 AM� oil eprErea n+aea +Er+re�Nt1t .taco ttrttstrt e,►atwae�amKa -�� `"�'�� .�30 p� Tile Commonwealth of Massachusetts Department of IndustrialAccidents Office of Investigations X Congress Street,Sante 100 w - Boston,MA 02114-2017 N f ;y� www.rr ass.r0�ldliCa Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers-Pleas Leib �, licant infar�natian �aY`�� (Business/C}rganizationllndividual). �� �� ��-�� ° 1 Address: 'C GOO " '1 City/State/Zi �W� LIN �'"1� X13 Phone #: �5 Are you an employer Check the appropriate box: 'Type of project(required); I. l am a employer with 4. I am a general contractor and 1 6. New construction have hired the sub-contractors employees (full and/or part-time).* 7. Remodeling listed on the attached sheet. 2. I ain a sole proprietor or partner- These sub-contractors have g, [� Demolition. ship and have no employees employees and have workers' 9. Building addition working for the in any capacity. comp, insurance.t [No workers' comp. insurance 10, Electrical repairs or additions 5. We are a corporation and its required.] officers have exercised their I I, Plumbing repairs or additions 3. 1 am a homeowner doing all work right of exemption per MGL myself. [No workers' camp. g l2. Roof repairs insurance required.] t c. 152, ees. [ and or have rr° 13. Other ._.— employees. [Na workers' Other--- comp. insurance required.] *Any applicant that checks box#I must also fill out the section below showing their workcrs'compensation policy information, f Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. TContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site irlf0twiation. Insurance Company Name: LA.. rLr''`U Policy if or Self-ins. Lie. ##:_ ' .�.�, .�-I C)C) Expiration Date: 1c)1c)�� � � City/State/Zip: � V� 6 %1814 T- Job Site Address; 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 eitile form,of a STOP WORK ORDERto the imposition of criminal penalties andof a a fine fine up to $1,504.04 and/or one-year imprisonment, as well as civil penalties n 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. I do hereby certify under the pains and penalties of perjury that the information pr-ovided above is true and correct. Date; � Si nature: Phone#: -Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License # 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#: DATE(MWDDIYYYY) AC R" CERTIFICATE OF LIABILITY INSURANCE I 1 011 8/201 6 T HIS E CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CATE DOES NQT AFFIRMATkVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORIZED ENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.IMPOTANT: If the certificate holder Is an ADDITIONAL INSURED, the policy(les) must!ie endorsed. ff SUBROGATION IS WAIVED, subject to the tms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the rMARTIN ficate holder In lieu of such endorsement(s). CONTACT CER NAME: Meg Munroe —— - J. CLAYTON INSURANCE AGENCY INC PHONE Ext- (413)536-0804 FAX E-MAIL mmunroe m Cka ton.com ADDRESS: @ i y NORTHAMPTON ST., RTE 5 INSURERS AFFORDING COVERAGE NAIC# MA 01041 INSURER A: ACADIA INS CO 31325 HOLYOKE INSURED INSURER B GAUTHIER INSULATION INC INSURER C: INSURER Q-' PO BOX 344 INSURER_F- IPSWICH :IPSWICH MA 01938 INSURER F COVERAGES CERTIFICATE NUMBER: 94521 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. ADDL UBR POLICY EFF POLICY EXP LIMITS INSR TYPE OF INSURANCE POLICY NUMBFR MM/DDIYYYY MM/DDIYYYY LTR EACHOCCURRENCE $ COMMERCIAL GENERAL LIABILITY DA A TO RENTED CLAIMS-MADE D OCCUR PREMISES €a OGCIAUEnCe $ MED EXP(Any one person) $ --'— NIA PERSONAL 8 AOV INJURY $ GENERALAGGREGATE $ GEN'L AGGREGATE l,IWT APPLIES PER: PRO" LOC PRODUCTS-C0 P10P AGG $ POLICY❑ JECT $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY tPer accident) $ AlL OWNED SCHEDULED NIA AUTOS AUTO, NEO PROPERTY DAMAG€ — $ Per accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ UMBRELLA LIAB OCCUR EXCESS LIAB CLAIMS-MADE NIA AGGREGATE $ $ DED RETENTION$ PER W ORKERS COMPENSATION �R EMPLOYERS'LIABILITY YIN EL. DENT $ 500,000 ANYPROPRIETORIPARTNERlEXECUTIVE 10130!2016 [1013:0120117gie A OFFICERIMEMHEREXCLUDEO? NIA NIA WA MAARP300327 £AEMPLOYEE $ 500,000 (Mandatory in NH) I{ es, do-left under POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS below NIA DESCRIPTION OF OPERATIONS/LOCATIONS 1 VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space Is required) only.Pursuant to dorsement WC 20 03 ala ms for benefits to employees in Istatebe s other he�han Massachusetts Massachusetts employees f the insured hies or has nh ed hose employees outside of Massachusetts.on is to pay 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 this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www,mass.gov/lwd/workers compensationlinvestigationst. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. TOWN OF NORTH ANDOVER 1200 OSGOOD STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01845 Daniel M.Crow�oy,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Office of Consumer Affairs and B s Regulation 10 Park Plaza - Suite 5170 Boston, Massac setts 42116 Home Improvement ., star Registration Registration: 173410 Type: Individual Tri 29132fl 1 �irabon: 1011/2018 �t KURT GAUTHIER KURT GAUTHIER h 119 COUNTY ROAD IPSWICH, MA 01935 � �. Atr . , Update Address and return card.Mark reason for LCard ost I ❑ Address L4 Renewal ❑ Eznptoym ❑ SCAT 0 20M W'l f e a�xy aa�rr t a CJ/ iiaaac�uaeks Registration valid for indivi&W use only before the office of consumer Affairs&BuAnw Re&I expiration date. If found return to: i HOME IMPROVEMENT CONTRACTOR office of Consumer Affairs and Business Regslatiou istralla ``,' 3410 Rey nc ,"�� Type' i[f ParkPlaza-Suite 5170 , Expirstl 11 3 I$ Individual Boston,MA 02116 KURT GAUTH t3� KURT GAUTHIER CSSL-102562 KURT RGAUTHW-R'�" P.Q Box 344 ' iE 01"S IP4wk'h MA 00A 4 M5 l7