Loading...
HomeMy WebLinkAboutBuilding Permit # 12/2/2016 NORTFI BUILDING PERMIT pf��'F_° 6�tio TOWN OF NORTH ANDOVER F ` ';; - . 7 APPLICATION FOR PLAN EXAMINATION * A Permit No#•�- d .7 Date Received SSaCHUS Date Issued: iJ_ — IMPORTANT Applicant must complete all items on this page f as v r " �17Rt �`"rl✓' r � a � iF,� � f �%�-�'�'d�"''� �� r r Pf1F] Efr 1O'tB3r.�7'tr{lGlJ(e C YE9 r, 0 fu'IAF PARGEL ZG DISTRIOT H ONIN �sor�c D�strct � �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 Af Others: ❑ Demolition ❑ Other W eA r kv t ,2�;►� ❑ Se tic ❑We11 ❑ Floadplam Wetlands UAW ❑ Watershed ❑istrict p ❑VllaterlSewer: DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: W'0B A i'°- Phone: Address: Eantractor.Name. 'Pnone ' Email. Address ri r ExDatelil G Supennsor's Construction LEcense p Horne lrnprouement.License , .1�?����. . . . � .. . . . ,.P ...... F•. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEB SCHEDULE:BUL.DING PERMIT:$12.00 PER$1000.00 OF THE TOTAL.ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ I ° d D t1 FEE: $ Check No.- Receipt No.: ; NOTE: Persons contractine with unregistered contractors do not have access o the guarantyfund Signature of AgentlOwner! Loot S. nature of coritractar g _ - � �aRTn over 'T sy own of 2 �.. : : f, 6 Oy - �+ No. C7 LAKE h ver, Mass, �► d coc Mlc Ml WICK TE O w �5 Lf BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT �� � 60A I. j �I�� � w� BUILDING INSPECTOR ....................................................... has permission to erect.......................... buildings on .... :&....... �tA.4„4........S7a...... Foundation �. ....... .�� .,... Rough to be occupied as ....., .. ...... ..... . .. . .... .. ............... 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 CONSTRUCTIOT RTS Rough Service ............... ......... .......... ......................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy 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. s RISE 00 Shawmut 1604 Unit 21 Cwt n,MA=21 13U-50243W ENGINEERING wwM►•RISEetegpnecdng.c m OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at o 1 cd (Pmperty Address) /V -13, hlOo if yr, M a © Lej. :V1 +Y�"AJJ I hereby authorize l S�/ Z! Vk -eckr T-V Sv/k �tl (Suboontractor) an authorized subcontractor far RISE Engineering,to act on my beW to obtain a bulldtng permit and to perform work on my property.This form Is only valid with a signed contract. Ther Permit wiit be secured by the Insulation contractor,at no eddlttonal cost. It Is the homeowner's responsibility to dose out this permit by cordecthrg their munidpaiity at the completion of this work. s Slgnature UAN Date B.�tB Fedora!10�a1-acaaaaa RISE Engineering Rt contnsetor ftfixtration No etas VAContractor Rogiatrotlon no t CT Connector RealonRaalttts0 RISE ESR�Ntwa' 60 Shawmat Road,Conlon,MA O2021 EMN339COWRACT .5 35 F`AX339�Sax S .... e,_.. !sage q pp PROGRAM CMA-11th a Pam VA^va cLsara UNMORM W1H Hart (978)273.9399 10/12/2116 439514 23902 aaaav=esctatt CALM avrsar 56 Hmtd Street 56 Harold Street Cas ortr,atats r 00404 ctnr,atans,atp North Andover,Ml q 5 f > !north Andover,MA 01845 JOB DFSON 14EAL.TH dt SAKI" t :. 54.40 AIR L IN(l Provide liber and materlais to of ynra barna lest dll, olr nge. 1'hIs work w01 be pariaMW in can with the of Lal taxis anal dI rrstia tests to that yoar home wnl be tai!with a h«dihfbl lavd or sir exabango and indoor ott gr�lity.Materis,s to be to your home can incitslc u�rlks,rooms and otherpm s. Primary far lingwt sir! a toatlirs, cnts,attacltod ra unheated (teandawsare not eraily Thisvmrking horns,A kin in atdde Meet pe minrac(crm)of air infiltration vd11 occur,but the M namher or Ls net t At the campicthan of the wcalheriation work,and at no alltional cost to the homeamocr,a final!lower door wwbr caorkmion atfudy analysis wi116o conducted by the contractor to ensary the safely of the indoor air qualify. $680.00 KNEEWALL.S:ProvWc tabor rurl materials to inma112" F9(raced seml-risM fibelglan board inndation to(130)squrc foal of knomll am. $433.00 e*orthew! ,Provldetocaranulmatetialsta,ntRlsto(2) afth krr lhatch vMh2"rigid ThemnaxbowAand the or the with hripphrg. 5120.00 EAME,dT CnitriNO; Provide labor and materials to Enna!,(30) feet of Rai9 fa r i tion to the eat oahing $40.00 RASI ME,4T I LIR Provide latsrr and materials to in to the hack or the cat door Wng to the balkhead with 2"rigid board that mecisthe scalonsW316.5.4and 316.6 rerlaircarentsofbadldlagwde. Scal all e*sandsornsvAthFSxtape Si2.xx ' RISE Engin ringwill appCy ail oppl` o,etigitlo Ifte""'ves to Ihlseomtract. You will only ba t3nedthe Flet amonart. tty, Mar ctigr? a rn Coltaair�(las offers 7S%Ines Ive,not to ex 52,000 per year,and an live of 14096 for the Air Ing m W to the rlrst 0 and an =loan,5340 ii-mvinp orainstilled by Ibo auvkitor. For the sarety and health oryore Names Indoor air qxdIty.at will be conducting a blower door&Wogleof the available sit now In your home tenth before the work is bMm,and oiler the watherizatlon work is complete We w(ii dso conduct a fail augment of the comkm Ion Barmy oryotrtreating system and meter heater.This has a value of 390 and is at no am to you Total allowable wrath ion Incentive Is$3,110. 590.00 Fsdad to 6034 RISE tlaeerieg ems rt�t "Room apprssaoyyamrpp//��//�� RISE Komm 6a Shpra�ngp!ltoad,Csstoa.MAB2021 L��r[P"ii�rT U"02-GUS FAX339.5024M pap 2 PROGRAM CM44M ooszs� wtmQ eae clam waeta WEbinHan L9mm939St IV1212016 439314 2= 36Hat m Sava 56142rold Stet so=enr sw+e,w Mum a mfumar Naafi Andam,MA 01845 North Andover,MA 01US JOB OFSCETON TSI: x'1,4" Program Iamatift: s1 mAl t udder Tilrl: $173.81 +pAwaaee�rr�aRatrQa�elewwmesaa��raAM$e�rwar 'Orge HMred 80veattt--TW"881/100 Dallam $173.81 WN 30 �!IIaT9lgl17iti9 aat,�cYrr 111EAg1lE&IflYBLNIK SPACRB ACi4!l1N�d p� sawsrtsaarasessouwowr� �� 1 6 6�� ate. The Commonwealth oflVlrassachuseitts Deparhmut of 1'nraustrialAccidents . Office of InvesUgadons 1 C049ress Street,Suite-100 Bourton,.14M 02.E14--2017 A www.may's gov/dia Workers' Campensation Insurance Affidavit:Builders/Contractors/Electricfams!!'lvaiat ers F A licant Information Please Pr,utt�.,e 'blv Name(Business/organizaticn/Individual): Address: PO BOX 958 AN 1=0 MA 418, City/State/Zip: Phone#: A reyou an araployet°?Check the appropriate box: =------_--� am a employer will(� 4. ❑ I am a general contractor and I Tie of project(requ=redE):employees(full and/or part time).* have hired the sub-contractors 6 ❑New Construction am a sole proprietor ar partner- listed on the attached sheet. i. ❑Remodeiing ship and have no employees These sub-contactors have S. ❑Demolition working, for me in any capacity. employees and have workers' [No workers'comp.insurance comp. insurance.t 9• ❑Building addition 3.❑ required.j 5. ❑ Wre are a corporation and its 10 Electrical:spai„rs or additions I am a homeowner doing all work officer,,:have exercised thoir 11.❑Plumbing repairs yr additions [No workers'comp. right of exemption per MGL insurance required.]t c. 152, §1(4),and we have no 12 Q Roof repair employees. [No workers' 13.❑Other comp.insurance required.) *Any applicant that CIiCCkS i1pX TMl must also 1l1 out the section below showing their workers'Compensation policy information. Homeowners who submit this affidavit indicating they are doing al!work and thea hire outside contractors must submit anew affidavit indic ti tcontractors rharcheck this box must attached an additional sheatshowina rt Ft a urgsuch. empioyees. If the sub-cOntreetors have employees,they must provide their workers'comp,Policy' erumbd� he�V no, o'er entiaw haw an'aft ernphtyer that is providbig sporke.s'cr.apensafi r.hi-s£trl'"Re for my a;'tployees. Below is floe panty and job site ir_formadon. Insurance Company Name: Y t< t' Kit 44t2r Policy#or Sclt ins.Lic. Expiration Date:_ eq �b f job Sitc Address: `G Rio rd Citi/Stata/Zip:num ��1 Vy�,r er A tta rh a copy Of the workers' and compensation policy decl�ar:tion page(showingt Failure to secure coverage as required under Section 25A of MGL c. 52 can lead to the OH zine un is$i,50t1,500.00 and/or one-year imprisonment, as well as rivil peimpoS tin hof criminal t enalties f nalties in the form of�STOP�OR,K ORDER and a fine of up to$250.00 a day against the vmlaror. Be advised:flat a copy of this statoMent may be forwarded to the Office of Lrwe�stigations of the DIA for insurance coverage veriheation. A do hereby cern under the pahis alzei en alti&.of erJury that the iia or station provided above is trae and correct. S' Date: Phone#: C N a)— 7& 6 f3f tcioC use only. o not write to this area,to be completed by city or town officirrt City or Town; PermitiLicense# Issuing Authority(circle on 1.Board of Health 2.Building Department 3.City/Town Clerk �4.Electrical Inspector 5.Plumbing Inspector 6. Other DEED Phone#: 611012016 Preview:Certificates Of InsDranee CERTIFICATE OF LIABILITY INSURANCE 0A7E€MMGf31YYYY) THIS CERTIFICATE i5 ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOt ER?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 INSURERI AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER IMPORTANT:If the cart lflcate holder is an ADDITIONAL INSURED,the pellcy(lesl must be ondorsed,IF 5U13ROGATION iS WAIVED,subject io the terms and conditions of the Polley,certain policies may require an endorsement A statement on this cerlitt certificate holder in lieu of such endorsementjs). cato does not confer rights to the F' N NAME: ocessing Insurance Agency,Inc, AIG.No.Eat: A14 Nu8 ADDRESB: VI SURER(S)AFFORDING COVERAGE NA[C# INSURED INSURERA: Nornc UUARDImuraecompany 39470 POLAR BEAR INSULATION CO INC IHsuRER a: PO BOX 958 INSURER C; Andover,MA DI DID INsuRERD: INSURER E: COVERAGESINsurre�F: CERTIFICATE NUMBER: 503587 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE EISTEp BELOW HAVE BEEN ISSUED TO THE INSURED NAMEp ABOVE FOR THE POLICY PERIOD CERTIFICATE NOTW€THSTANDING ANY REO PERTAIN, THE TERM OR CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO LYHICH TMIS CER71F€GATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE AOLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERM$- EXCLUSIONSANO CON01710N$OF SUCH POLiCfES,LIMITS SHOWN 41AY HAVE BEEN REDUCED BY PAID CILAfMS. LTR TYPE OF INSURANCE IRy YND POLICY HUMeER COMMERCIAL GENERAL LIABILITY MM+DDIYYYY .1MfOplYYYY LIMrrS Cr.AU.15F.lADE ❑OCCUfi EACtiQOCUHRENCE S E PF1EMiSES IEa dccurn;nccJ S Il EXP(Any un,W,ol 5 l:E1JL AGGREC),TE L1l.11Y APPLIES PER: PERSONAL 8 AOV rf1JURY S PCI❑3E Q LOC GENERAL AGGREc E S orf,ER: PROIJIICrS-COMP:CPAGG S AUTOMOBILE LIABILRY S IdiY Huta IEa neciamllS $. ALOS'ANEO SCHEDLIED eUDILY INJURY IPr rr.-ony S AUUTOS AUTOS WHEUAUTOS ro"ll'WIEU, 80€13LY IHJURY{Pvarcidcral S AUTOS L FPcs xcitlmll S UMBRELLALIAS OCCUR S EXCESS LAB CLAJI,IS-AIAOE EACH OCCURRENCE S DED RETENTIONS AGGREGATE g WORKERS COMPENSATION S AND EMPLOYERS'LUIBILITY YIN NJY PROPMETOR'PARThEREXECLn IW X STATUTE ER A UFFiCERL¢f.IBEREXCLUDED? NIA N POWC772258 09/0912016 01!0912097 EL.EACHACCtDEwf s 9,D00,000 tMandaldry in HH) '.. UESCdescnhc raider UESCRIPTIQH OP OPERATIONS E.L.DISEASE-EA EI-rPLOYE 5 1,OOPERATIONS G[4o�ir E.L.Dilil E-POUCYULUT S 11000,000 DESCRIPTION OF OPERATIONS 11 DNS I VEHICLES[AGGRO 101,Addlllanal Remarks Schodute,may In,altached t1 Moro s W W is rcqulretl) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE THE EXPIRATION DATEVTHEREO)FENOT CE WID POULICIES LL BED LIVERED ED RN Town of North Andover ACCORDANCE WITH THE POLICY PROVi51ONS, 1600 Osgood St,I suite 2035 North Andover,MA 07845 AUTHORIZED REPRESENTATIVE ACO RD 25(2014101) The ACORD name and logo are registered marks of ACORDaRD CORPORATION.All rights reserved. ACCORV CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDD/YYYY) 6/10/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE. OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), 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 endorsemente. PRODUCER CONTACT Linda Bogdanowicz Insurance Solutions Corporation PHONE (603)382-4600 J� No:(603)382-2034 _ 60 Westville RdE-MAIL ADDRESS:lindab@isc-insurance.oom INSURERS AFFORDING COVERAGE NAIL# Plaistow NB 03865 INSURER A MOStern World INSURED iNsuRER B Nautilus Insurance Group Polar Bear insulation Company Ino INSURER C: PO Box 958 INSURER D: INSURER E Andover to 01810 INSURER F COVERAGES CERTIFICATE NUMBER:CL1632326134 REVISION NUMBER: THIS IS TO CE=RTIFY 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. NSR TYPE OF INSURANCE, AO SBR POLICY NUMBER POLICY YEF PDLECY EXPLIM" LIR COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1.•000,000 A 7 CLAIMS-MADE ® PREMIDAMAOCCUR ETORENTED 100 000 PREMISES Eaaccurrenc r $ NPP9274967 3/24/2016 3/24/2017 MED EXP(Any one rson) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 POLfCY❑PET LOC PRODUCTS-COM PLOP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED ', AUTOS AUTOS BODILY INJURY(Per accident) 5 NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccident $ X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIM&MADE AGGREGATE $ 1,000,000 DED I I RETENTFON$ AN026107 3/24/2016 3/24/2017 S WORKERS COMPENSATION PER OTH- ANDEMPLOYERS'LIABILITY Y/N STATUTE I ER ANY PROPRIETORiPARTNERIEXECUTIVE ❑ E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? N/A -- (Mandatory In NH) E.L,DISEASE-EA EMPLOYE $ It yes,describe under '.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) '.. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Torn of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE OELIVERED IN 1600 Osgood St, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/SJA raj ©1488-2014 ACORD CORPORATION. All rights reserved, ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD NS025 r9ntan t OfCioo of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 102726 Type: DBA Expiration: 71212018 Trg 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BOX 958 ANDOVER, MA 01810 Update Address and return card.Mark reason for cbange. SCA t 0 2OM-0511i �]Address (]Renewal 0 Employment E( Least Card ��c•�i`"rdixrarrrrnrrrrrrr�l�a�Crerlrrrinr•�rirellc office oeConsumer AtOnirs Business Regulation License or registration valid for individual use only HOME IMPROVEMENTGONTRACTOR before the expiration date. If found return to. Registration: 102728 'type: office of Consumer Affairs and Business Regulation Expiration: W 2018 DBA 10 Park Plaza-Suite 5170 i ^ Boston,MA 02116 POLAR BEAR INSULATION Co. Vincent LeBlanc 51 SQ.CANAL ST.415A t r LAWI ENCS,MA 01841 Undersecretary paotvalid without signature 1 'iassacioa.ssetts -' epar-b-nent rye,public Safety s Board of SuHding RegWations and S"tandsrds C m¢a°Pius tl as°'upvr;!,,;IDr'1M. lan11;x' _,r,ensa: CSSL-106017 °: w P' .2 EAST PINE STREET Plaistow NH 0390 Commissioner 0412812018 t I 8 t