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HomeMy WebLinkAboutBuilding Permit # 11/15/2016 NO}iT�y BUILDING PERMIT o��sLeo �ro TOWN OF NORTH ANDOVER �= g ``` _" '° o APPLICATION FOR PLAN EXAMINATION _ � 2 u Permit No#: / ' .. e _ / SpA�o� ,EI Date Received �� � � OTED ' r �"`,�5 4SSRCytJ��� Date Issued: i! B 4 a i(o IMPORTANT: Applicant must complete all items on this page LOCATION ® �� Print PROPERTY OWNER_, a_fViQ f Print 100 Year Structure yes o MAP PARCEL: ZONING DISTRICT: Historic District, yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building '[]--one family ❑ Addition ❑ Two or more family ❑ Industrial Ir'Afteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 0101111`� _¢�e� � �'�'� �L�J, e`. r�� � ,. , ,u...^.��/s v,✓R�l.' rs "„i,<"°v"'�'s,'..,rnc:rl” a,-""sG �. ,i^, ;, ,�. � r. r.,,. .r-✓ k; DESCRIPfArTION OF VO K TO BE tlP.yER$�F� MED: /^y 1 46LAJM I ` ■ki LZ 0 Identification- Please Type or Print Clearly OWNER: Name: .(� 8 _S W I ,9 _T Phone: • 31 lS • (9TO Address: 5J(V+ `e_— Contractor Name: Uv')f-cl at,) L• C� Phone: s' Email: IPS SCSI Address 3 Supervisor's Construction Licenser �- Exp. Date: Home Improvement License: U� Exp. Date:__.. ___ ARCHITECT/ENGINEER Phone: Address: Reg. No. FPR SCHEDULE:BULDING PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ 3 t I FEE: $ ' Check No.: 0 7 Receipt No.: 3 C NOTE: Persons contracting with unregistered contractors do not have access to the g my fund r ✓ ............. ........................................................ NORTH Town o n over A 0 To A-- _n No. U-SM.2 h ver, Mass, / • 1 s • ra ��b 0 LAKE",C COCHIC"awVIK 0'4ATEg) Jk L) BOARD OF HEALTH Food/Kitchen PERMIT T 6 LD Septic System THIS CERTIFIES THAT 1.141914hAdv......./Napic's...... BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on ........ .... .S.U.M. .x.q..#.0L......ST. Rough ..... Chimney to be occupied as .....kck...azzotir.wt.*......ca. I.vr.t ot.f........ItA 0, provided that the person accepting this permit 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 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIAONAIRTS, Rough Service ............... ................ . ..... ..... ... .............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy_Permit Required to OCCM Building 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 2 1 Canton, MA 02021 1339-502-6335 ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: (property Address) /* ----CProper-ly Address) hereby authorize ( ubcontract0f) an authorized Subcontractor for RISE Engineering. to act or; my behalf to obtain a building pr, 'This 40rm i- ()f,,Iy �,;? e contract. ,)perty, ' Iid ,,v7t�j zj signed coi permit and to perform work on my . 'Ther Permit wildbe secured by th(, insoIktion cost. it is the homeowner's responsibility to CIOS01 Out this permit by cr)jqzr(,jjrjg tllr.j! 11, -)Ietiof of this work. jnj�,;palit�, at the corill I Owner*s Siq'I"aturo Date r1-.r 1 r pDataral tb#asoaassae on No 61116 RISE Engineering MA Contractors noutslrattauan Na 120379 CT Contractor 1709fstn0h00 Na ISE60 Shaxmut ttusd,t'anton, CONTRACTENGINEERING {.1a1}7l4f-17aa t�.1C(4w)784-3710 Page t PROGRAM? TntSCaNTRACTIOCNTr'.ReDiFiroo rwEllNru3E Cht,�-IIES rNauEE1vr44ANO T ccusroUarnnwonKtiS OESCSaiED avow CIrSTON.Eit v)mhE DATE CULL ypRxofL"a 3atncsScalisi (7731)316-6787 01)11912916 438767 350Q2 SEKWE STRCEr Dn1R+G MUEET 380 Summer Street 380 Summer Street SXFIWE cITT,STAM,YIP OILUNu ctrY-aTATE,Z1P North Andover,MA 01845 North Andover.MA 01345 JOB DESCRIPTION I WARD I)ARRIt'R-` h th:t%C ldanlifiud lila[Ins=are mccNwil h4ht%preicnt in y rllir Ilnnle little„the Ecce,%cd Fights arc certified as W-rated lin,ulaaon Contact Ratedl 1%c wit ocaie a 3"1 ECarnnc spas around the li%ulre h1 using hhcrglasi blanket intulatlun a% a danvlling lilateriat.no insulation x111 he ulsualled UCRIei IhC[np and eloied ea%'illCs xhteh enmaln reecs,cd hj-,hl%%1 ill 1101 he inaulntcd. S(t-Ela ,lire SF.rl[.f\(i;Prut ide labor:old atatcrtals to.cal arca%of our ladle deaRlat wa110111.e\ccs air Ie:d,agc '1111%%%r+:k w tit he perronned in concert%s till lltc list;ol'spccial trk,k and diagnostic teat.to tn;tne that NOUr In,rnc will he fell%silk a hacdthlul ic%Ct of air exchange+std indoor air qualuy Malcriats to he nsCd ko%eal will,holtle 1::111 Include caull,%.ttl:un%and outer pr,+ducts Vfintan arcsw,lbr scaling mCludc air Icakage to ailics.I+asrmerti>,attached rlantec,and littler nnhcalca areas m indm%,are not gcnerall addre.%sed.1 l llis rill tcyuiry 181 unrklnc lualra.A re111rcfi„a in cubn:Aet 11cr nliurnc tclini arair imiitr:drnu will r Ciur.but the actual nunther,rl'Ctm is nol},narantced. AT the cuntplct'son orthe%uathcruatnnl ckorl,.and at no addilionat ant ill the humeu%sncr.a linal libmer do lr artdlor culnhus[um Snleliy anal%sis%Vill he coluitscled h\the wh-Cann.l;A1n tocn.11Ec the'clilt%Pf!lie ltid,r,lr Air 1lu:ttlf% 5690,00 AIR.SFAI.INQ:Providc Mhar and materials 111 neat awa.,of your houle arain%t 1%,Uterill.c-,ccis arc leakage I h+,%ori,1,111 be perfnTlned in concert%Tilh the Lk%c nfspecial fnois alta dlagnoslic+csfn En aa,nrc that tour home %ill hu tell utth a Ile.ithful[eccl lit air eIVchange grid indoor air qualih%Materials w he used lo seal your home c.nl inCludc caulk,lilam+arnf outer products. Primar% ares lbr sErfling include air lcaka,c to alt1C,, ::MCbcd ganlne,dela o1110 unhealed arc;v,i 1%iad,n%s are nol ttcncrail} addre„Cd.l 111'1%alll rcyulrc 0)%corking Inttlr, A raditetlotl in C%sWc tett per nllnule letnla.sdair iuliltlAwn%%ill a.cur,bin the actual nutnhcr lit clip i,not!ruarsnte�cd. At 11tH completion ofalic%1Callcrt/ahnn%%ttri„.mtl at no addionnal clot Its the f-.(JMC%);%nCG it final 11f,s1%Cr dlnlr anXar conlhot lron safest analysis x ill bG conducted h%the silt-contra,:lor it,cn%un the sald,,urlhc irtduor are yuALly. S25:.UU RF.\OW..11,111.fN(.;OVHt11 H,PL113.Di AVN S FAIRS'(IN ORDER 111('i lNS'I t WA \si f Pl -V t IVI, I)Ir.10,1AI)i tltt i S000 tb MMI1(.i:Pnl%ide labur and niateriah to unloll a 17'layer WAZ--;8 unt;lred fillet.fans hall,111 i Hifi?stilidW feet fits daltlllnll!,. purllcncs. $205.00 ,CIT[('FTM 11ruvidC labor:in,]materials to til%call a 7”layer til'R-25 floss I t',1kil ,e added I„I I rktul s,Itr:u:sae[of open air. space. 51,378.00 A't-I.1 'Fl,AT,Petit ide labor and ntateratls Its rllstall;17”la}er ul•R-_%S(fas%I t cHWow added lit 1*101 sgoara Fret u1 open attic space. SS2il.ou _k SEE' 2 o 201c s ;i FedarelIDmU6W 6629 RISS: Engineering mA ConRI tractorctor RR09i tdt tl6 No 120979 CT Contractor 1`46915"Uon No E66 sb1minut xnad.('antun.NIA CONTRACT'RIS ING (401)7114-3700 FAX(aol)78a-371U page 2 Yft()(iRAM THISCONTRACT t7 ErrrERrO,gO 6ETWEEN RISE ENGINEERINO ANDTHE CUSrONER TOR WORK AS I[•tiIA-1f1E5 OEeCRIDEDOELOW CLIENT NORM ORDER PHONG DATE 35002 CUSTOMER 04?1412016 438767 .ltun4s SCMW (781)316-6787 OILLINB STNFE7 SERVICE STREET 380 Sunttncr Street 380 Summer Strut "'LuNo CF77.5TA7E•rIP URYICE CITY,S7ATE.TSP North Andover,MA 01845 North Andover, MA 01845 JOB Dr:scwrrION ,>I"1'iC'ACCESS Protide lahur ind m3lcriDls I»install(k) Casil�tm"3;iGr nii4Rtlngiu%vill atlaw the cm e% IcE at%4C:lther sntnil flat suri.0 ofPYyytti,Td II ill hr'CrCatcd around 01C CIP nin9 ;tripping to rC>trtet air teal;agC. $237.65 an[sl- VFj 7'tt ATION:l'r Milo labor and ulalstaterH,install(23 itnula[Cd Ctllnutit hntic to e�istiug hat)na,nt tS)t)t1 fltl C(3�1�t ,ti��At N-Protide lahar and rnatetials to install 2"F ai faced.cnti•ugtd I iherFlss�hu:rrd insulDuun to[r_' (1 2 Y synnrc tLCi 01'cptntnon hall arca. S4:17(m fi,r cls9ihfcnmcrtsures'l.'ulunthall ls I.�ut uflcrc'F5°4hn,-cltt>.tc."VA to cNte d S?'tttt[}gT.:r I.alcudstr h`rhil r. d�t rnr'.`ntita of ktllW.oriur);. the Air SeahHg measures up to the liras 5690 and att additional 53an if+at oats aTC jusiifiCd by t)tC aNditoT. C air For tltc safety;'n,health 01,[hent;rklimhN jild and r t rathlr ucathzri�ti rtill he n�urStli� s tplcle t�crt Itleatso eondutet a lull�LNb!C»ut.+nt in your hLtrnL t, fot of the euNthuslion sakj%of%Jur heating s}Stent and icatcr heater Tari:h;t;:t t aloe of Strtl;:nd is at no cast to you, ti alluitahtc u•catherivalion inrxntitu is 53,1111. SWAMI Total: $3,892.55 Program Incentive: $3,025.00 Customer Total: $867.65 WE AGR F HEREOY TO FtjRNISH SERVICES-COL(eLETE IN ACCORDANCE WITH ABOVE SPECIF1CATtONS.FOR THE SUM OF $857.55 ,"Eight Hundred Sixty-Seven &651101E Dollars UPON F7NP41NSPEC7ION AND APPROVAL BYRFSf CHGW{EHIHG.CUStOMER AG"LESTOpr"'AMtAMiY s�s4 EW.L.INtEAssT*F+•ti VA"nCG1ArLOF.>3 rA7NTHL1 oN ANY uNPAto BALANCE AFTER id DAYS.sLE REVfRSt:FOR IMPORTANT T SIGN THIS CQ>tiITAAtCr IF THERE ARE ANY IBLRNK PAGE5RwcrDrt RECIsiFuito:t. CUS1 OVER ACCEPTANCE!, AUTTKtRIZEO DIONATUME•RISE En9��nnp OATC OF ACtFPTANCk NOtI�IS CONTRACT MAYBE WIYHORAYOr BY U5 SF NOT F%ECUif 6 W 17RIY ,r_r ACC{tPTANCK OF CONTRACT•THE ADOVE.PRICE9.6PECIFirA710NB NiD CONOITIONe Ali6 01 AS sPFCIFI 0 PAy"ENT VALL BE MADE AS GUWN O AOOYE K OR OTO aP VEWORK The Commonwealth of Massachusetts Department of Industrial,Accidents o office of Investigations I Congress Street,Suite 100 n Boston,MA 02114-2017 www.mass govld'ia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AMplicant Infvrinati®n. Please Print Le ibi Tame (Business/Organization/Individual): Cc IfNsQk q 'fin I Address: Imo° L)X Crit /State/Zi : 0�vj t u-s C i 1 ei 3 Phone Are you an employer. Check the appropriate box: Type of project(required): 1. I am a employer with 4. 1 am a general contractor and I employees (full and/or part-time).* have hired the sub-contractors New construction 2.0 I am a sole proprietor or partner- listed oil the attached sheet. 7. Remodeling ship and have no employees These sub-contractors have g, ® Demolition working for me in any capacity. employees and have workers' 9. Building addition [No workers' comp. insurance comp. insurance.t required.] S. We are a corporation and its 10. Electrical repairs or additions 3.0 1 am a homeowner doing all work officers have exercised their 11. Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12. Roof repairs insurance required.] t c. 152, §1(4),and we have no employees. [No workers' 13. Other comp. insurance requlred.) *Any applicant that checks box#1 must 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. 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. font an employer that is providing wortcers'compensation insurance far my employees. Below is the policy and jolt site information. Insurance Company Name: NadaL t 1a"\ Q f \U, Policy# or Self-ins. Lic. #:_^ � � d O Expiration Date: 10 10 i V Job Site Address: 0 ,Q(hfk(r �1c City/State/Zip: 1Ay�t �w 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 farm aa 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. I do hereby certify under the pains and penalties of perjury that the information provided above is true and correct. Si nature; Date: 10 i J i v Phone#: '� - ' J�0' �' 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 S.Plumbing Inspector b.Other Contact Person: Phone#: F ii ACC> 1n1181sCERTIFICATE OF LIABILITY INSURANCE DA12 1YYYY) 12o16 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(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). C NTA PRODUCER NAME:CT Meg Munroe PHONE TAX MARTIN J. CLAYTON INSURANCE AGENCY INC Arc Ext: (413)536-0804 AJC Nom _ E-MAIL mmunroe m cla ton.com ADDRESS: G �Y 1649 NORTHAMPTON ST.,RTE 5 INSURER S AFFORDING COVERAGE _NAI #� HOL.YOKE MA 01041 INSURER A: ACADIA INS CO 31325 INSURED INSURER B: GAUTHIER INSULATION INC INSURERC: L R D: PQ BOX 344 R�F_: IPSWICH MA 01938 : 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 SUBR POLICY EFF POLIC!EXP LIMITS ILTR TYPE OF INSURANCE POLICY NUMBER MM/DDIYYYY MM/DD/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE: $ DAMAGE TO RENT 71 CLAIMS-MADE D OCCUR PREMISES Eaoc. rranca1 $ MED EXP(Any one person) $ NIA PERSONAL&AOV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY JE O LOC PRODUCTS-COMPIOP AGG $ DTHER: $ COMBINED SINGLE LIMIT ccid AUTOMOBILE LIABILITY Ea aent BODILY INJURY(Per person) $ ANY AUTO ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE NON-OWNED Per accident $ _, HIRED AUTOS AUTOS $ UMBRELLA LlAB OCCUR EACH OCCURRENCE $ EXCESS LIAR CLALMS-MADE N/A AGGREGATE $ OED RETENTION$ v =EERSCOMPENSATION !� STATUTE OTRH- ANOEMPLOYERS'LIABILITY Y/N ANYPROPRIETORIPARTNERIEXECUTIVE E.L.EACHACCIDI NT 500,000 $ A OFFICERIMEMBEREXCLUDED? NIA NIA NIA MAARP300327 10/30/2016 10/30/2017 E.L.DISEASE-EA EMPLOYEE $ 5130,W0 (Mandatory In NH) If es,describe uOFnder E.L.DISEASE-POLICY LIMIT $ 50,000 O�SCRIPTION OPERATION$below N/A DESCRIPTION OF OPERATIONS 1 LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may he attached If more space Is 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 this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.mass.gov/lwd/workers-compensation/investigations/. 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 AUTHORIZEDREPRESENTATIVE NORTH ANDOVER MA 01845 Daniel M.Crowley,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 l% Office of Consumer Affairs and Bus s Regulation 10 park plaza - Suite 5170 Boston, Massae setts 02116 Home improvement r Registration Registration: 173410 r Type: individual Tr# 291320 eairabon: 1011/2018 KURT GAU�TN ER HIER KURT GA 119 COUNTY ROAD IPSWICH, [VIA 01938 A ' Update Address and return card.Mark reason for change. Address ❑ Renewal E] Employment ❑ Lost Card i . SGAI 0 20134W11 c� I e Tpaa�eta�xulea�l c�C3� � Registration valid for individual use only before the office of Consumer AfWrs&Sussaees Regulatlou expiration slate. if found return to: solation HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs and Business Reg Re9iatratlo3414 10 Park Plaza-Suite 5170 Expiradonz $ individual Boston,MA 02116 KURT GA"iER KURT GAUTHIER 901 mu+ 4mmlaAAw saw y ^ �®« CSSb10256 § i KURf■GAuTIJIgR \ \ « [ PO Box 344 1, ©icb NA 0192 d \ • u v va 05/251017 ( �