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HomeMy WebLinkAboutBuilding Permit # 12/2/2016 BUILDING PERMIT Noor OE�t�en "�1.0 TOWN OF NORTH ANDOVER �� yt- =4 APPLICATION FOR PLAN EXAMINATION " f Permit No;�: Date Received �SSAC Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION ? ��$� 5�-("e e 7— - - Print PROPERTY OWNER_ Cherilee C 100 e' ,y Print 900 Year Structure yes no MAP ?5 PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village 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 ❑ Repair, replacement ❑Assessory Bldg A Others: ❑ Demolition ❑ Other �?l�rFt+ ;���► w� Se fisc ❑Well , © Floadplarn ©Wetlands' © 11�atershed D1�t�ct � �� K DESCRIPTION OF WORK TO BE PERFORMED: Sda f 4 eerrJ If to Pe 5 r7toe&/i fP )EA*C affs Identification- Please Type or Print Clearly OWNER: Name: C kA f-[,eo e C1a v, e v Address: 7 Peir le"e r 5 i +'+ h ✓�/� Contractor Name: POLAR BW INSULAIM Phone: Email- PUBOM Address: Supervisor's Construction License: I o 6 o I Exp. Date: ;L.:p LE Home Improvement License: 10Exp. Date- 7 -� AE- ARCH ITECT/ENGI NEER EARCHITECTIENGINEER 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. r� Total Project Cost: $ ..0 0 FEE: $ Check No.: 77V Receipt No.: 73 NOTE: Persons contracting with unregistered contractors do not have accessto the guaranty fund NORTp� Town of Andover 0 to No. VOWT 1h ver, Mass, 10%W fib A U^K1 �' coc"Ic"Itmcm 0 %j BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System JCL A THIS CERTIFIES THAT ... 146.1.054 .... . BUILDING INSPECTOR ... ........................ has permission to erect.......................... buildings on ...... Art j,+ ,,,, Foundation to be occupied as Rough. 4.4.00. .. ........................................................ Chimney 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 CONSTRUCTION START Rough Service F...........­­'­­''­­­ Final lit B U ILD1NG1NSPE­C­T­0­'R' GAS INSPECTOR Occupancy Permit REquired to Occupv Bu Rough Display in a Conspicuous Place on the Premises - Do Not Remove Firial No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. ........... RISE 60 Shawmut Road, Unit 2 1 Canton, MA 02021 339-542-6335 ENGINEERING' www.RIS engineering.com j i i OWNER AUTHORIZATION FORM j ° (Owner's Namd) owner of the property located at: (Property Address) (Property Address) r hereby authorize -t A Yt I V rlq 7-h , Subcontractor) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform worts on my property. This form is only valid with a signed contract. Owner's Signature Date 1 i I Federal ID# JUSE, Engincering R1 Contractor Registration No MA Contractor Registration No A division of"I'McIsch Engineering CT Contractor Registration No RISE ENGINEE-IRING* 61)Shawonvt Unit 112,Conlon,XIA CONTRACT (401)784-3700 FAX 09.78,11-3710 Page 1 Fkr', 1 0 \Y/aw.RE" PROGRAM I HIS CONTRACT IS ENTFRED INTO BETWEEN IUSE (,MA-HES E DGINURING AND ME cusTOMER FOR WORK AS DESC40RED BELOW CUSTOMER PDONE DATE CLIENT 0 WORK ORDER Charlene cloncy (978)682-6304 02/22/2016 429602 00002 SERVICE!STREET.... BILLING GTREET 27 Parker Strect 27 Parker Street SERVICE CITY,STATE,ZIP VILLING Cory,StATE,ZfP North Andover, MA 01845 North Andover, MA 01845 .100 DESCAUPTION Alit—s Tr Fro,I(—to"Tiax')Tinid I-n-m er ilds to scat areas o I*yol IT Ronne lie against wastefil 1,excess it i I,leakage. 'this work wild be performed in concert with lite use ol'special tools and diagnostic tests to assure that yoln home will lie tell with it 11CIIIIIII111 level of air excloinge and indoor air quality.Materials to be Itself to scat your lionic can include caulks,bions and ollier products. Vrinnuy arcits fi)r sealing include air leakage to intics,basements,attached garages and other unheated areas(windows are not generally ilodiessed) This N01)mit ire.(2)working„boms.A reduction in cNiNc feet per minute(chn)of air infiltration will occur,bill tile Donal number ol,clin is not guaralliced. At the completion ot'the.weatherii4ition work,and at no additional cost to file I loll leowne r,a final blower door and/orcomliuslion sittely analysis will be conducled by file soil-contractor to ensure lite s;&ty ol'the`indoor air qualify. $170.01) 1<NN7 ,1,;WAFj- (d"!0)stimue feet ohvall. Then histoll I Fv jf�,—jas`,7 rigid board insuiation. Seat all scams,with FSK tapc. $697.00 .TM,FFXM7—Fov—idela—botand—m lite r—ial—st—oin S"l III I R-13 faced fiberglass to(170)square IM of kneckvall. Then Install 2"rigid board insoIntion.Seal all scams with FSK lope. $620.50 T—NI i3k—'Ai WIS -FIrovide Iflhor alni oliteIlls to install 2" FSK dined semi-rigid filierglass hoard insulation to(28)s(lume IM ol' kneewall area. $98.00 sM7iM( E'T—A15R-11'R:I lo—Incowner —rcit'i-mvid—elf Ute—mored items Nvoilk in the knumall areas. Removal must occur prior to lite scheduled work start, j ? $0,00 =4771 =t �—(l70)-7qonr1""fell 171,71ti—s—tyle insulation'—from ti—ic k—neewall area. 71$127.50�) A'1'1'1(.'A(.:(.'[,'SS:Provide labor and materials to Insulate the back of(I)alflm e hatch with 2"rigid Weatherstripboard,Wentherip file perimeter. smmx) IIA".1,74=,Yf CE 11-1 NG:—Provide labor and materials to install I I6)linear feet—0fR-I 9—LIDI—aced Irin.rt,lass'nsolation—lo(1—ic—pc`r—hllete-1 '--'---" of'the,basement ceiling at the hoose sill, 5203.00 Alw,°� ":5 2 ell e, Federal ID# RISS, Engineering RI Cantrartor Registration No MA Contractor Registration No RISEA division offidelseh Engineering Cr Contractor Registration No ENGINEERING' 60 Shavyinul Unit J12,Canine,NIA CONTRACT (101)784-3700 FAX(4011)784-3710 Page 2 PROGRAM THIS CONTRACT is ENTERED INTO BETWEEN RISE CAA-11 ES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENTO WORK ORDER Charlene clotley (978)682-6304 02/22/2016 429602 00002 SERVICE STREET BILLING STREET 27 Parker Street 27 Parker Street SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover, MA 01845 North Andover, MA 018415 JOB I)ESCRIPTION Total: $1,976.00 Program Incentive: $1,428.88 Customer Total., $547.13 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Five Hundred Forty-Seven &13/100 Dollars $547 3 UPON FINAL.INSPECTION ADD APPROVAL BY RISE ENGINEERING"CUSTOM CA AGREES 70 REMIT AMOUNT DUE IN FULL,INTEREST 01:IM,WILL BE CHARGED MONTHLY 001 ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON DO NOT SIGN THIS CONTRACT IF THERE ARE ANY OLANK SPACES 3 AUTITORIZ(CD SIGNATURE RISE Cnolneeling J$T E x, 'z 6, NOTE:THIS CONTRACT MAY Or,WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE A13OVE PRICES,SPECIFICATIO148 AND CONDITIONS ARE )-10 DAYS. SATISFACTORY TO US AND ARE HEREDY ACCEPTED,YOU ARE AUTHORIZED TO 00 THE WORK — AS SPECIFIED.PAYMENT WILL BE MADE AS OU ILUIED ABOVE j ............. ......J t The Commonwealth oflilassachusetts -NP aJ'tme"t q f Indusirfal Accidents Office of Investigations I C0119Fess S&eet,Suite 1(30 Boston,lsL4 02114-20-17 www-wass gov/dia Workers' Compensation Insurance Affidavit: Buildcrs/Contirsctors/Elect>riclans/Plombers App-hicant Information Please P�intt ,e 'blv Name (Business/Organixation/Individuai): Address: PO BOX 958 A I IVER A 01810 y/Sfae/Zip: Phone#: Are you ata employer?Cited:the appropriate box.- - l.rQ i ama employer with _ 4. [� I am a general contractor and I Tipe of project{rewired): employees(full and/or part-time).* have faired the sub-contractors 5 ❑New construction 2.[ T am a sale proprietor or partner- listed on the attached sheet. i i. ❑Remodeling ship and have no employees 'These sub-con�u actors have •Norlcingforme in any capacity. employees and have workers' $ El Demolition [No workers' cnmp,insurance comp.insurance. 9- ❑Building addition required.] 5. 0 We are a corporation and its ctri 10cal rwpairs or additions 3.E] I am a homeowner doing all r�ofc officers have exereised their .l,.E Ele�Plumbing repairs or additions myself.[No workers'comp. right of exemption per MGL insurance required. t c. 152, §IM,and we have no 12.El Roof repairs employees. [No workers' 13•0 Other I comp.insurance required.) *My applicant that checks box Rl must also'if out the section bebw s.%Gwing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are doing all work and thea hire outside contractors must submit a new affidavit indicatingsuch. tCvntractors that check this tux must attached M additional sheet she;vira ttte pa ernpioyecs. If the sub-contractors have nie of she sub:oenaetors:ad=into::teethe:or ne.the;e entities have employees,they mustprovide their workers'comp,policy nntnbar. ��. i atm an emPhVer iia:is pr ovidin workers'con tosnSatinr iy3SUrance f or situ e:asployees, Belk,is f se pact'at'nd job site, information. Insurance Company Name- r—GuAeA {"' rt, C4 V,re r 9 inn�4YL.y Polic,#or Scif ins.Lie.#:_ _ Expiration Date: Job Sitc Address: k v,, S i Ci rlStatelZip: n�v�I'—' ' A8 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 pe up to S 1,50n.00 and/or one-year nalties of a ear imprisonment,as well as civil penalties in the form ofd STOP BORIC rJRDER nes a fine ti of up to$250.00 a day against the violator. Bo advised that a COPY of this statement inay be forwarded to the U'Ifice of lrivestiganons of the DIA for insurance coverage verification. I do irerEvy cerci"'u;triepi-the PUirs anti penallia.ofperjury drat lite Fit orination provided above is true and correct. Si azure: 'Date: �I`30/� EM a� Phone#: cl �d y aJ~ 7& 36 ------------------ Ealt on7ffijioldin� is area,to be completed by city or town o�ciad n; Permit/License# horheartment 3.City/TownClerk 4.Electrical Inspector 5.Plumbing Inspector son Phone#: 611012016 Preview:Certificates of insurance CERTIFICATE OF LIABILITY INSURANCE DATETMMI6p1YYYY) 7H15 CERTIFICATE 15 ISSUED AS A MATT06110/2010 ER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE OLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(Sh AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate hafder Is an ADDITEDNgL INSURED,the p011c0es)must m endorsed.If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain Policies may require an endorsement.A statement an this certificate does not confer rights to the certificate holder In lieu of such endorsement{s). PRODUCER NTACT Automatic Data processing Insurance Agent:711 1 Adp Boulevard A1C.Na. Roseland,NJ 07068 RER(5 AFFORDING COVERAGE NAICPINSUREDInsurmw Comely 31470 POLAR BEAR INSULATION CD INC INSURER$: PO BOX 058 INSURER C: Andover,MA 01010 INSURER 0: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 503587 REVISION NUMBER; THIS IS TO CERTIFY T13AT THE POLECIES OF INSURANCE LISTED HELOW HAVE BEEN ISSUED INDICATED.NOTTO THE 1NSUL:D NAMED ABOVE FOR T}{E PQEICY PERIOD WITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACTOR OTHER RDOCUMENT 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 NAVE BEEN REDUCED SY PAID CLAlIti1S. L TYPE OF INSURANCE INSD YWO POLICYNUMDER MMJbD1YYYY WDdYYYYf LIMITS C016MERCIAL GENERAL LIABILITY EACHOCCURRENCE $ CLA11.15�LfA0E OCCUR E-TO�iEF.7TE 1'FiFhIISES(Ea OCCWn;n[a) 5 MEL)"P{Myon. K'r Dnl 5 ULNL AGGREGATE U1,113 APPLIES PET(: PERSOML S ADV INJURY 5 POLICY❑PRO, ❑LOC GENERAL AGGREGATE S O3tes:R: PRODUC tS-CCMP;OP AGG S AUFOPAOBILE UA61LITY $ i $ ANY nUYO IED ad 11 ALL OVeNED SCHEDULED UOMLY INJURY IPnr r4monl 5 TOS AUTOS HIRED hUF05 UO/JtU 90UILY INJURY I Pr arxdnnf 5 AUTOS IPrr�ccl�c„n s UMBRELLALIAS OCCUR S EXCESS LIAR CLAIMS-MADE EACH OCCURRENCE S OED RS_7E1J7ION5 AGGREGATE S WURRERS COMPENSATION S AND EMPLOYERS'LIASILnY Y7N X STATUTE ER A oxrlEri Et.ISETniEaciu �Ecu)! Y�H(A N PDWC772258 (Mandatory in NH) 01/01/2016 01/01/2017 E.L.EACH ACCIDENT 5 1,000,000 UIIETSc,,dscr}bPT ICIJ OrslaP CPEftATI0I:5 duo::xfcr EL.OISEASE-EAEfiPLOYE 5 1,000.000 CRI E.L.DISEASE-POUCY UaIIT s 1.000,000 DESCRIPTION OF OPERATIONS!LOCATIONS f VEHICLES(ACORD 101.AddhFanal Remmks Seheduta,may Uo alf,chod it morrspaaa Is roqulicd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE I)ESCRIBEI)POLICIES BE CANCELLED BEFORE Town of North THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood SL ACCORDANCE WITH THE POLICY PROVISIONS, I Suite 2035 ui North Andover,MA D1845 AUTHORIZED REPRESENTATIVE —lI, ACORD 25(2014/01) AO 198E-2014 ACORD CORPORATION,AEI rights reserved. ) The ACORD name and 1090 are registered marks of ACORD Ac®® CERTIFICATE OF LIABILITY INSURANCE DATE(MhVDDIYYYIf) 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 an this certiflcate does not confer rights to the certificate holder In lieu of such endoreemen s. PRODUCER CONTACT Linda Hogdanowicz insurance Solutions Corporation PHONE (603)382--4600 A No.(603)382-2039 60 Westville RdAD» Ls.liadab@iso-insurance.com INSURERS AFFORDING COVERAGE NAICA Plaistow NH 03865 INSURERA:Western World INSURED INSURERB:Nauti.lUS Insurance (iron Polar Bear Insulation Company Inc INSURERC: PO Box 958 INSUflERD: INSURER E Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER:CLi632326134 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, WLTRSR TYPE OF INSURANCE ADD S B POLICY NUMBER MMILpIpYI YY MhWQ�1 EXP LIMITS X COMMERCIAL GENERAL LIABILITY 1,000,000 EACH OCCURRENCE $ A CLAIMS-MAGE OCCUR DA AGE 100,000 PREMISES Eaotturrence $ NPP9274967 3/24/2016 3/24/2017 MED EXP(Any one person) 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER; GENHRAL AGGREGATE $ 2,000,000 POLICY LlJE7 F]LOC PRODUCTS-COMPIOPAGG $ 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBI ED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Peracckien4 S AUTOS AUTOS NON-OWNED PROPERTY DAMAGE WIRED AUTOSAUTOS Per ccklent $ 5 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 11000 000 B EXCESS LIAR CERINS-MApE AGGREGATE $ I 000 000 DED RETENTION$ AN026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION I PER I I OTH. AND EMPLOYERS'LIABILITY Y/N STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE OFFICERIMEMBEREXCLUDED? N/A E.L.FACHACCIDENT $ (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Addttional Remarks Schedule,may be allached If more space Is 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 O 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marcs of ACORD IN802501114011 &3L Wolmnwmve�l?, Office of Consumer Affairs and Business Regulation 10 Park plaza Suite 5170 Boston, Massachusetts 02116 Home 1i pravement Contractor Registration "rRegistration: 902726 Type: DBA Expiration:. 7/212018 Tr# 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BOX 959 ANDOVER, MA 01810 Update Address and return card.Mark reason for change. scn r as tem-osm [� Address F1 Renewal ® Employment (] Lost Card ��e�ruinnax�rnFr�fll rx�'s'!�jn.�.trrc�rite/!„� mfflee of Consu[nerAtTairs&BusinessRcgulation 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 Regnlntion i14 Park Plaza-Suite 5174 . expiration: 7/2/2014 DBA Boston,MA 42116 POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO.CANAL ST.45A LAWRENCE,MA 01841 Undersecretary V V Piot valid without signature is. Massachusetts -71spartment of Public Safety Se w-d otSuHdhig Regulations :and Standards _.u;erse: CSSL406017 inti x�' PETER A LEBLANC Z. 2 EAST PINE STREET Plaistow NH 03965 Yw,3Vla6 1 rru�rbo-ssea�oa r 04/24/2019 c i i