HomeMy WebLinkAboutBuilding Permit # 10/28/2016 FORTH
BUILDING PERMIT pF�t4�u '6�Ho
TOWN OF NORTH ANDOVER F
APPLICATION FOR PLAN EXAMINATION
Date Received ` /y �}�Rq Lo[Mlc+e+K "
! M f�✓ 7 gRATEV
Permit No#: ®/� �ss�CKUs��
Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION c
_ Print
PROPERTY OWNER Som rte— Print 10o Year Structure yes n
MAP PARCEL: a ZONING DISTRICT: Histaric District yes no
Machine Shop Village yes no
TYPE OF IMPROVEMENT PROPOSED USE Non- Residential
Residential
Li New Building ❑ One family ❑ Industrial
❑Addition ❑Two or more family ❑ Commercial
❑Alteration No. of units:
❑Assesso Biel ❑ Others
Repair, replacement rY g
❑ Demolition [i Other ;,F s W e , ed ,y ��
DESCRIPTION OF WORK TO BE pERFOR�r e a�
1n*A1 i5 h,41 b
Identification- Please Type or Print Clearly Phone: ZS - 230
OWNER: Name:
Address: S(o Cand W k Nod v , `t
Contractor Name: Phone: ,Sb 3$2- Zog�
Address: 0 8a an
ervisor's Construction License:_^ (tbo4 __EXP Date
uP _?
S
Home Improvement License: IS7-�a Exp.` Date: 160
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: $ ��`'� • ig FEE: $ s —
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the u r ty fund
......................... ........................................... ------ --------------------------------------------------------------------------------------------------
T
IAORTH own of -Al over
0%
No.
ver, Mass,, g of•
0ArIED
U BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
THIS CERTIFIES THAT .......... .!.CA 4Z#%f...I.......................... ..................... BUILDING INSPECTOR
has permission to erect .......................... buildings on ..3410....CRAdte..v0ep*...... Foundation
to be occupied as .....J4.14........ ........1.0.1 Rough
..I ...... .......... Chimney
provided that the person accepting this permit shall in every respect conform to the terms of the application Finhi
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 CONSTRUCT NN STAR Rough
Service
............
.... .. ... . .. ............................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to QccupE BuLlding 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.
MSE
60 Shawrnut Road,Unit 21 Canton,MA 0202113394502-6335
ENGINEERING www.PJSEengineering.com
OWNER AUTHORIZATION FORM
(Owner's Name
owner of the properly located at:
(Property Add res
a1
(Property Address)
hereby authorize ,
(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.
Ther Permit will be secured by the Insulation contractor,at no additional cost. It is the homeowner's
responsibility to close out this permit by contacting their municipality at the completion of this work,
Owners Signature
Date
s,ao+s
R,co
nimeor
FAA Contracto' agftr
V Rtratlop No 1'368
RQ..;kAfqfl0R No
I ir
60 ('411milt".65A
CONMACT
Page I
"I IN r
CMA-HES 01MIMMIln I'ViD nM-IUSTOMM FOR%MIR 6U
FlIONE DATV CLIDli 4 mMi ORDMI
Somnsfir" (978)2H,2307 10101=6 439530 35002
GFA',qOE IMUMLY 77"
366 Candle#6o1-Road 366 Candlestick Road
zip,
North Andover,MA 01845
North Andov(�f,MA 01845 UD
................
130J, _PE SCRAPTION
air floW NIS bl'la'll illstillieLd In yourhome-
,
AIR SPRUNG.2rovija Jah n;-r lonta'Iiaju to ofyour horm spinst wm6u),exc�S',Ill. I'llis work-will bo
,),Y%rrmod in the tjse loslf;to asloro th0your h(mic wilt b�loft with a hQjlgifol IVM of
air vxckln'
p anal ind()QC;)6'qoill!Ly.Mpj�s-iills to bo tmcd to S(ful You t1my-io,mal filulud€:caull-1,ibnjws and nicrpTwim-r-s.
;mmfor-'-.1mlilig inuiu(k'214. to attics,bas4imeml,"Itlachcd gmVC-5 aud Wdier unheatcd are&r 6*dows nuo riot gmomafly
ndldft°ss""J') Titin sniff requiro(12)working fictim A n,,auction!in Cubic I'cq; per ffiimjte(0fin)of air infilLfadon will occur,but the
U-Nal ni'lliberofinfm i5 not pfluaulccd.
A',Ific campletit)yj of die vmri)s,and ai no add itioiiij east to'dic i rynal b1mvu Joor Rud/ur uumbumiop
%yiIIN,conduawd.by fizz Riab-cojilrjIctor to erasure t1u:�i-'Afuy urthil iulloyur 13!rktullfty'
A[R SRALNC;
DUCT SEALTNGProvide lsfoy and mmicrials to seal ftcaflot;end/or iuoljotr ducts withol 11-'sipWfj UoN'Acd areas, Iflis-work'Nell
tic kit Um ratu of,'�75 prTmul per hmir,which i1whidn mmefirds, (4)%vorkb)g JIDlIts.
33(jom
ME:I—layer pi—ft rglu_.,z' —(SO)qi—im=HA)e dam in—ing
Porpo5cn.
$102.50
AI-PC TIAT:Providr labor and mimrials to hmmll a 51,11"Iyor 0"R-18 Class I Cifluloso Mdcd to(1332).sqvatc fml of open attic
Spam
S2,216,7?
tMIC ACCESS:ProvidQ labor and jiiajejuls to hmilute the back of(l)irtir hatch wigi 2"rigid I(loirillu NaM..Wcaffievilvip she
A711C ACC-2�,.';:Provid�t In!)orIlId mn��F;ak to make(1) ac=5'�01)Ullkig I`r0M 0110 MR,'MCII to MlOtbr by C-114RIS Ft]=M12e
through!�ht!afliing. This uecc-n Will ba fluopi'n ou it is hztw,�011 two common un1wmtcd jwn fficwallod afflu
iVITIC ACCE.13'j,Provide labor mid mflIcriRIS fo i"Mall(1) CasilY viloyed,insulating cover for thoMlic am�,q affil rig stair. A
sl-,1,111 flat are of I
pjyVjGyj ivill bw matcol around tlio upening%wiGn tate Attic. ThLq wffl allow tie cover's imi�,PT-A w>,afipr_
stripping to remdot lit le-AnIp.
$237.65
FadWM rO 0 0544DSM
RIM Engineering lu ConhWor Regtahatton No 8180
MA Contractor tt"Wmtlon No 120878
CTContractor�Rge9,�1s6�aan No
atf
So 8hawmat Road,Canton,MACONTRACTIEFVGIN£ERING'
(101)7843709 VAX(491)79"7914
Page 2
PROGRAM
IM CMA-RESAtm i16R qK A6
Geaegt�n aarnw
OtiaTOdtPR Norm DAM - CLmYTa VAMOMM
Somashree Templawn (979)258--2307 10/0112016 439530 35002
agrAve 9TRW Gomm aTwiRt
366 Cwdlestlok Road 366 Candleatidt Road
7MVM MY.8TAMVP mum 0",GTAMZP F
North Andover,MA 01845 North Andover,MAO 1845
JOB(DESCRIPTION
VEPT R AMN.Provide Inbar and matotisis to install(2)insulated exhaust hose to existing bathroom ihn(s).
$1GO.DO
VENTILA't'0N:Provide labor and materials to install vartilation dwtes in(I 19)rafter bays to maintain air flow.
S23b.0G
RM Engincortng will apply all applicable,cltgihle lneentive9 10 this contnrOL You will only be Wed the Net amount CutteatlN
for eliole measuras,Colurnbla Oss oftn 75%inoenuve,not to exceed 52,000 per ealeadar year,and an inocadve of 1 Go for
the Air Sealing measu m up to the first$680 and as additional$340 if savings are jusddled by the auditor.
For tim shy and health ofyour home's indoor air quality,vie will be ponding a Blower door disgrtostle offt AvaMA eir flow
In your hom both bAw the wont is b*m,and after Elco weatherLu on work is eomlttele.We wr71 also conduct a ha wasstow
offt combustion stay ofymc hating*at=and wafer heat:Thts hes a vacuo of$90 end is st no cost to you. Total
alwable wlvetlt rh2don incentive Is 53.110.
$8000
Total: $4,x,18
Program Incentive: $3,110.00
Custome3rTofaI: $1,454.18
WE AMM WMW TO FtrnNisll aexturese-COMPLM W ACOMDARM wtrti Asova SPMFtawnONEL FORM MW OF
*'"One Thousand Four Hundred Fifty-Four&181100 Dollars $1,464,18
UPONPMLIxQF6r MAtaMAPPROYALOYw96MGMMWC.BUaTOMMAGar£eTONFOiTAXOW0UaWPILI.er MW Or7%Wq.i.OaCW020MOM'ne.YOOAW
UHPAIOOaLAN06 APrP.a i00AYA eP�t @ POit WPORTAM IriFa1L%ATIOFitlM QUARA 011 MOM OP nC-01aM GCN6r1l LM.AMID COWMAOM RGtaYAAT00M.
00 HOT StISN THM CONTRACT IF THEREARE AMY BLANK SPACES
..&urghb.
AUTHoie�osl9HAnaie-wonen9rao+naa otwTaa�nAtcNr'rANc¢ �1 r ref ---._—._�
srora,vane}a�+rraAarrMAY�wmcoMAwr�erucwivaxaxsouraenmtu� oATaaraccerraicx ,3J�-- --���r��ol`}��.
3" AGOEPTAMea OF COMM=-TMS ASOW PM=%aP6M"1100MW COMOMOM ARE
V �y� 9ATIRR4MM TO tie AhM ARG URNM AOC{WTMVGU ARUAU7HOdmTO 00 TH9WORK
Aa ORMIM PAYMM V"GS KOO AS GUMB EOARM0
MILLCITY-1 AGOULD
AC®A®n
CERTIFICATE OF LIABILITY INSURANCE DATE{MM1Di71YYYY17r19M2o1s
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 endarsement(s).
ACT
PRODUCER License#AGR8150 NAAME:
Clark Insurance PHONE ,._ FAX
One Sundial Ave Suite 302NNa, x>I_�843)822-2855 � q No):(603)622-2854
E-MAIL ould clarkinsurance.com
Manchester,NH 03102 ADDRESS:a 8
INSURER(S)AFFORDING COVERAGE NAIC#
- ......_._.__...
INSURER A:Arbelia Mutual Insurance Co 17000
-------_.
INSURED INSURER B:AmGuard Ins co 43290
Mill City Energy INSURER C
106 Joseph St _.__....-_._.... �_._.._.....__.
PO Box 6411 INSURER D
Manchester,NH 03102 INSURER E:
INSURER F:
COVERAGES CERTIFICATE NUMBER: 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 EFF POL€CY EXP
LTR TYPE OF INSURANCE IN p y�rylp POLICY NUMBER MMIDD MM1ODfYYYY LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00
�X� 8500065735 0412912016 04/2912017 eAMAGE TO(TENTED 300,000
CLAIMS-MADE _ OCCUR PREMISES Ea occurrence}__
MED EXP(Any one person) $ 5,606
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRD- .�..._.__.___..._....-------
11
POLICY 1:1JECT D LOC PRODUCTS-COMPIOP AGG $ 2,000,000
OTHER: $ —
AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,000
_ 1=a accident _
A d-X ANY AUTO 1020050919 04129/2016 04/2912017 BODILY INJURY(Perperson) $
ALL OWNED SCHEDULED BODILY INJURY(Per ace€dent) $
AUTOS AUTOS
X NON-OWNED PROPERTY DAMAGE $
HIRED AUTOS AUTOSPet accident
X UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000,000
A EXCESS LIAR CLAIMS-MADE 4600065736 0412912016 0412912017 AGGREGATE $ 1,000,000
DEO X I RETENTION$ 10,000 $
WORKERS COMPENSATION X
AND EMPLOYERS'LIABILITY W_,,,,STATUTE ER
B YIN
ANY PROPRIETORIPARTNERIEXECUTIVE MIWC791896 04129/2016 04/29/2017 E.L.EACH ACCIDENT $ 500,000
OFFICEPJMEMBER EXCLUDED? N❑;N I A ___.._..-...._.__..,....,_._—
(Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE•POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addltlonal Remarks Schedule,may be attacked If more space Is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
Town of North Andover MA THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
ACCORDANCE WITH THE POLICY PROVISIONS.
1600 Osgood St.
North Andover,MA 01845
AUTHORIZED REPRESENTATIVE
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
I
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Ac dress'PO Box 64'11
:'dt � taatt�w/ i :l uainr C ,lir, NH 03108 ('hone Cd.f1C)3..;y"11 /923
Are you n employer?
Check tile anlrrrka laae. Business1 na �rarawaa):
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rsr f,rarl truss.).'"� Cf. 1. ttcstauraauY/CSarfl rtirrf;f st<atriislnunern
2 1 rrrn rr sale pnrrVr ic°trar or fa<rrtner•,,lnlp rrarrl have no 7, ..�01Gf'a„wrnailrrr S"r1s.+(incl.mal estate,a;auCrn„ef<,)
employces working for rune,in any(mp acity-
[Nk)worl,r�,rs'' e anal,). iu aatrrrrc�c rc(juiretl] _ 1 Da'aa°a larcndif
3. 'sWas am a e;eaM¢rMi<n arra HS aalMem hwo rMear°c,6wd 9. �..� CSntcrtrairsnnryrni.
users riyr,lnt rrf'cxcarrnlntion per s,. 152, §t(t),and wc,haavr Y C').�„ fvlsauall;rckuHIILY,
no c^rnplaryces,[No e%ork r 7'a;anllrin insuraricc renquir dl"
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arra employees.roM urr.�atrrarr �,twaflrrC by wRanlurnta awns,
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\n}'nprttlfr°,aar;ri Itrad tact k larix,APt itarr k,;Asea fill tr at Ilrc r.a;tsarra gay taati sliuvairrpr.,Ow k workev damwiprc,�ra alion proali<y 61fionivaion,
Me vo paaarute uAk em tr^rw c crrcrragr d rtaw;awrt^Vw%R ktre.e°caMr>rtznm Us rato croptarycc.w;w,"od"e:rs'sraarrrpaeensaatian p olir;y i rergraircd mid sarch an
earppurua r^nicarr Md d Wk Nm 0 f,
I(arrr wwwn emplgyer,thtie rarIwo vidlarg tiarorkerv'rerrwape n,rrafarrnn dra.w°rrrdtrwrx,`irw asap e nalrlgjpe s, crlcrarr r,a dlemt ryvfra f,lrfparrwanraVlavrn,
lusumnr.e ta"earul mq'N rr'nr,.(:^lanrlc lu warme
hisurer's Adrlra,s:C:,)tne Sundal Avenue tiuRe 302N
(:,iwy/s,trategilr: Manchester, NFI 03102 __ .. ......
t:'c k,M err°5 a l€inns.l.,rr, if MM4CMIM6 d^;atfnir;ntkm I wattY_4Qc.li2M 7
SfC;naat a a:a:rl,ayr rnl"thrs an�ann°faa,rs uvea>ualaeaasaafltuan lanrlley el -aflern huge(shraawiuff the tru'8icy>naarubor lulu expiration date)
FalWm tar smure cov rK ge as required under CCedicrn 25A of MUL c. 152 can lead to ou;lrngasiticrrn crfersurunl lsr nnraltia:.s vrd
One up W°1;1,5C)C)00;anrJa'o cme-ycaw irnKiaao nrr enq as well as dvii trc,ikaieg 6 Ne li,,rraa o n STOP WORK ("ntnpM W as fine
Ofnt)tel$2,500)as d',Ayy arpyaniMt to Mum. Be;arWd tlirlt;a c;"y of this stat.einent may be forwarded to tore;(Afice of
fuvestig ations ofthe DIA for insurance coverage verifieatianrn.
1 do here 4r a:a r°CCtp,u � 1„ amus rarrd pe ntxl"wea gf1yerianrp that the igparr°ar,raation providett above na h we and correct,
rrr7,rtror ... f:)atr . .._t��..2Lg..�.. lb.. ...,, _...._.._._.._..
Mono it 603-396-7520
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6,Other
C:'anutaettwasrsaan...,......_.. ..... - ..... ._.. _ _ twlratraelf __..a.,_.
�%4assachuse"s UepaMment of PUblic 13afety Consitruction Supervisor
Board of Building RegWMkms and Standacct s Restricted to:
LAvesh Bed-Boildips of any kme grool)which contain
Lkemw C5110041 less than 35,000 cubic feet(091 cubic meteri�of
ConsUiUmn Supennsor enclosed space-
MICHAEL MY
106 JOSEPH STREET
MANCHESTER NH 03102
Failure it)possess a current edition of the Massachusetts
Expimban: Stan;BWWrg Code a
is cause for revocation allUds license.
Commk&wwr DIPS LWmuhq kMwmMWn vish:VMNWRASSAOWDPS
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L co registrat iou v�flid for iwik ithl i ww mily
b&"e Mv rq4mhn ante"" It Awn!r0mv W
f ijoMr IMPROVEMEW GONI RAG fOR
1015
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10 Pnrk Plum.Suhe 5170
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VIVIAVY LIQUOW,UA, I F
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MANCHbS IEK,NH 03IN
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