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HomeMy WebLinkAboutBuilding Permit # 12/2/2016 %AORT}I BUILDING PERMIT dF��Le� ,eA TOWN OF NORTH ANDOVER Qr APPLICATION FOR PLAN EXAMINATION ~ m Permit No#: ,5 1-7 Date Receivedto) rK �r�SSacwus�S�S Date Issued: 4 i IMPORTANT: A plicant must complete all items on this page LOCATION 75 Kt..adoary Layu Print PROPERTY OWNER 'P slip 'De. kW02 Print 100 Year Structure yesno MAP 04 .5' PARCEL-60 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family Cl Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial 1K Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other `��-�� � tic, �r"��f � � � ��.foodplam� �❑Wetla �s ,N ��-�F �, : „���� W , DESCRIPTION OF WORK TO BE PERFORMED: A ct i A& l ire iA5WI r ani TO.Wor bMjs Identification- Please Type or Print Clearly OWNER: Name: P - VLCokpqAn2 Phone: 23-0011 Address: 76' l ow LArw- No4• Aidow,+' s Contractor Name: Wdha A o Phone: (3'6 5n- or Email: i Address: o los` Supervisor's Construction License: IftLI Exp. Date: US _ Home Improvement License: MLI 9Z Exp. Date: 7 rl 17-01-1 ARCH ITECTIENGINEER Phone: Address: Reg, No. FEE SCHEDULE:BULDINC PERMIT.-$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER SF. Total Project Cost: $ 2- , U36 :5 FEE: $ Check No.: Receipt No. Co C/ NOTE: Persons contracting with unregistered contractors do not have access to the a,u ra fund - — ma � No�rk own of ndover r0 h ver, Mass, 0/ wreo U BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT ® BUILDING INSPECTOR has permission to erect .......................... buildings on ..... . .......... .....4V % Foundation t Rough to be occupied as .... ..) ...,, . �. . ., ..........ftwrv,. ................. 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 CONSTRUCT WART Rough Service ....... .....................I................................... Final BUILDING INSPECTOR GAS INSPECTOR OccupypcE Permit Re uired to Qccupy,Buticlln 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 flet. `� 60 Shawmut Road, Unit 2 Canton, MA 02029 i 339-502-6335 R I S EENGINEERING www.RISEengincering.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: (Property Address) (Property Address) i hereby authorize (Subcontractdr) an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building 0 i permit and to perform work on my property. This form is only valid with a signed contract. The 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 m a ity a e completion of this work. Owner's gnat re Date 6.2016 Fedor" IIll#0"406629 RISF. Engineering RI Contractor Rogistrnt€on No 0186 6tAC0ntractor Rogislrallon No 120474 CT Contractor RDgIslralloR h€oG20120 RISE fill 4haiuynul ftond,E:nl:ion,,11,1 tl2€121 C����i� .y ENGINEERING' 3.19,5112-6335 FAN 339-5112,-63.15 Page 1 PIZOGRAI.1 1HI3 CCNTRACTLS ENTERED UMBETNEEH RISE 01111-]ILS ENCIN&ERINOAND THE CUB XWER FOR WORK AS DESCRIBED BELOW CUSM?,rR PHME DATE CUENTa wcax ORCEIt lltlilil)Decologero (503).123-6709 11/t 1/3016 44t5,15 23902 SERVICE STREET 0IW110 S•p1EET 75 Meadow Late 7�Nleadow Lahr ssERvtc ciTt,sTAlE,nr Buxrr crre,mrc.zir I r idolth Andover.MA 01845 North Andover,NIA 01S4 ,101I DESCRIMON At It SLALINO:provide Inimr and materials Io sent molls of your liumc against wasteful,emmm air leakugc. 'I•his"ork W11 be performed in concert Wt 11 the LLSR 0special tools and dlaLmom is tots to assure I lint your honic w111 W left with a healthful lev1of —_,__, air exchange and indoor air quility,\•lalcrials to le tred to seal your lsome can incline eatilks.lbams and other products. Primary Bras for scaling include,lir IC;)ktlgc to ittlics,ItFscnlciNS,altaclacd tsar e,cs and(111th 11n11L'aled areas(nindous are not genemliy uddresxcd.) This 1%ill require(9)wlirking hours.A reduction in cubic ICC€per minute(c(m)LII;lir infillrauion gill occur,btu the 11cituil number of clm is not L' aranleCd. At(lie completion of the mNahc hiation Miri_aid RI ILO'idda Itoml Cost to the houlcowrtur.a 1-mal blumr door andfor couiluNtion safely analys€s will be cotldouted by the sub-contracioT to Ensure the.rlfcly of the indoor air(Iualily. S765.Ut) DAMMING,Provide laNir and ulmertuls to install it 12" layer of R-33 unlaced liNxglass IYiiis to(30)StILrare feet for damming purposes, 561.50 ATT€C FLAT:Provide lah1F and 1Rntcriills to install an 8"layer of R-3D Class l Cellulose added to(I UDR)sgkrife rest orupen attic space. $QM.96 ATTIC ACCLSS:Provide lalxlr and materials to insulate the IXICk ul(1)alliC latch wilh 2"rigid insulatiuts tmllyd.WcMiterslrip [bo purimeler. $6D.0(t ATTIC ACCI"SS:Pruvidc latxir and nutterials to make(1) aecetis opening Pram one atl ie area lu mother€1y evu ing a ptisvicc through slicathing This access ui€l Ix left open as it is Ixmwmi two common unlicated nun I'mmullciialtic areas, $31.11 VENTILATION:Provide lalxlr and materials to inslall(I)insulated exhaust hose%tit€I roof mounted flapper vent to exhalt 1 existing hithrlom):n(s).13rom1 model#636 or c(li6valent. $118.75 VENTILATION:Provide lalxlr mill materials to insudl vent iliililln clinics in 163)rafter Mys to maintain air flow. S126.D€t RISE I'll giaeerill g%Wl apply all app€icahle,eligible€ncen€ives 14)1 his conuum You%%ill ably la:billed the Net amount. Currently, kir eligible measures,Colunibia Chas oll'us 75%incentive,not to exceed 52,000 per calendar year.and an incenl ive nI'100%,,Ibr the Air&:aline measures up it,the Iir;1 S690 and an additional 5341)irvving<tire itutified by the auditor. Pur tic s tete and licallll nI Your hune:'s indOOr slir tluillily,%%e W11€h'condnet Ing a bto%ler fluor t4agntlslie oI the available air Ilan ilt your home Nil It before.the w wl:is begun,and ullcr the t%lattherimliun%%orli is Complete.We will also conduct u full assessment of the co;nbuilimi safety ol'your Beating S7.5lenl Iu1d%v,l[cr heater.This Inis a vaita:ol'S90 and is al 1111 cost 10 yon. Total Fedoral10 9 05.0495629 RISE, Engineering RI Contractor Registration No 0106 MAContractor Ragfsiratfon No 120979 CT Contractor Rogislrafion NOOP6120 RISE611 ShawatnI ItHnif,C'uHtu6,MA 1121121 ENGINEERING' CONTRACT 339-502-4335 FA\339-5112-6345 Page 2 PROORANI CN1:�-IIFSC1ISIIEEEIRINOAACT IND'DIEcwTo&t"tMRWMEE ICnnKAS PEOCRIR£013ELO,V Ctm7c&ER PHEM DAW CHENTC WORK ORDER Philip Decolo,aero (50S}a23.6709 1111112016 441545 73902 SERVICE G3REET BIWI40 SWEET 75 Meadow)alae 75 Meadow Lane SERVICE C11Y,SAE,23P alw-m Clrf,SATE,AP North Andover,NIA 1)1&15 North Andover,MA 01845 JOB DESCRIlMON allumnlih: it)19iHccritivekS3,110. The 11crntit W11 Iv sceured by flee instilation con moth•nt no additional cost.It is 11w homcowler's responsibility to Close clot this permit by L•omact og their I1TuIii6polit1'at thr Ci111ip Iction of this%%ur1:. 590,00 If •I Total: $2,633,52 program Incentive: $2,188.89 Custorner Total: $444.63 WI-AGREE HEREBY TOFU RNISH SERVICES-COMPLETE(It ACCORDANCE Yl ITN ABOVE SPECIFICATIONS.FON THE.SVM OF "*Four Hundred ForLy-Four&631100 Dollars $444.63 UPON RIIPLltlSPECVCNAHOAPPROlALVY 114E EHGUEERIHO.C031MERACREE•'+3DnE1,9TAA"DUNTCUE IH FULL INERESTOf 1'4%-PLL BE CHARGED I.ViTILY ON MY UNPAID VALANCE AEZT-10 DAYS,SEE REVERSE!FGA SIRCR €rlYrO.'U:iRtlli Opt CLIARAIMU,9UGgn Cr RMStW,aCKEOL i11a,AIID Ctl1 SCA REGI31RAIM. o NOT SIGf1 THIS CONTRFCT IF THERE PREJ4413L71 K SP S AUDI 112E G1La EZ�Lnq[liinD CUSCEPLtItCE11CM;''MISC fui." ' AVIII BY 113WIIOTEXECUFOYMMI OATSOFACCCPIA210E pI ACCEPAIICC Dr GONIRACT-9116 ADOVE PRICES,oPEcinCA71OtIS AND CC4101910Na ARE 30SATi9PACAIRY To U9 AHO ARE HEREBY ACCEP TD,YOU ARC AUSiORIMI)TO OD 111E WCRIL DAYO. AS SPEC}NEO.PAYRENTWILL013 4"DE An OUTLINED ABOVE ' N, The Commoralvectfth €af'AllEassfaclftasel& eprarimetit of lbaalrastrialAcctderats .,. . I Coatg,rc�, ��ita'ePp� tape 100 rs5tm, MA 02.174-2017 i 1mv.ma-ss.-rrvIdira Workers'Compensation Insuranee/tffidavitt General Busiuesst . TO BE FILisl)'fal[`I't&"1't1E PERM[ TING M1"1"IiORITY, A m hcart Wleormation s; iicaficr hit Legibly Business/Or aniza#tort �lattte:M't11 City Energy 19Y Address:PO Box 5411 City/`tate/Zip:Manchester, NH 03108 phone reit:603-391-7923 zkre;roar rasa employes-'➢C Beck the apllvop irate box-, Rtasiness Type(required): 1. 1 airs a employer will) 12_.._................._employees(full arid/ 5. [J Retail or part-time).* 6, ❑Restaurant/Bi ILa€its.-Establisbment 2. 1 am a sole proprietor or partnership and have no 7, ❑Office and/or Sales(incl.real estate,auto,etc.) employees working for arae in any capacity. INo workers'comp. htsurance retfuired] [�Ston-profit 3. We art:a corporation and its officers have exercised 9. ❑ E,ntes-tainmunt their€-igl�tt of exemption per c. 1.52,§1(4),and we have too] Manulileturing no etmployces. [No m,mke:rs'comp.insurance re(jUirvdj*1 I LEJ Heallh tare -1.El wo tare a tion-profit organization,slaffed by volunlecrs. �`� with net employees.[No workers'comp, insurance m(l.] 12. Other_ ]Iv_._.,__....oA 'U, 1ny alal}lieanl that checks box 1:1 most.also rill out llus section bolow showing their workers'coarrpcusalion policy inconliation. "_lf the corpomu!offilcer..>have;csempta.d Ihcroselves,but the,erarporatiml has other i roployccs,a workers'Qmo )pensation policy is rograiwd and sw-h an strnrmimtion should check box VL . (8d9r(XPP G'FPtj)'�Ajr�r fJrddP$!S Tf�a�i(ttft aVf3R°JfG'75'R CtJFPP'JL'P7S(df70f8 fdrSPdYCdPPCC dIP'FRR)�t�PPR 7fl7)�c[?3. elow is the poliq-information. Insurance Company Name:Clark Insurance Insurer's Adlitess: One Sundial Avenue Suite 302h1 City/Statel(ip nrlanchester, NH 03102 Policy 4 or Sell'-ills.Lic.�#�JtIVtiC791S96 _T _ Expiratio€a Date:4/29/2017 ttaclr as copy ot'tlre wo€1ceP's' cornpeats atiotr policy rleehaR ation page(Showing the policy number and expiration dale). Failure to semire coverage as required under Section 25A of MGL c. 152 can Tead to tht:imposition of criminal pemalties of a line tip to` 1,500.00<andfor orae-year imprisonment,ars well as civil penalties in the form of a 5"1'011 WORK OFttt1 tt and a tint; of up to$250.00a day against the violator. Be advised that a copy of this matemc€i may be forwarded to the Office of Investigations of the I31A for insurance coverage verification. t dfo herob.r eei-10"Ill iY di iv(dFPCipE'oalf ey gf1mijurp that the igfaP'nmf on pr1314(h74y1ddbolle 15 aril(Okla coy'P'ed. l)�lf�r ..`4��.24-1-0L�,_____._---- Phone",603-396--7520 CI�`,�rsirtl rPs(r nrdly. fid)fro/as>F°ite ifP Pltir(dre«,fdJ Iie cofRrtJfcafrr!1iy cit�>car PoavrP d�lieial. City ttr Town: _.._.___. � __......__._._.. Permit/License H Issuing AuthoP-ily(ch-ele one): 9. f3lsAR OF Ilenith 2,Btailding Depen—tnm—nt 3,ci€yCt'own cle0i 4.Licensing Board 5..selecttr e"s Office 6.0""'. Contaet Person: 1'holle � iNURY,rfla55,govfdia MILLCITY-1 AGOULD AC��® DATE(MMIDDIYYYY) CERTIFICATE 4F LIABILITY INSURANCE F711912016 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 endorsement(s). Aff PRODUCER License#AGR8150 NAME: Clark Insurance PHONE 603 622-2855 _I FAT( 603 622.2854 One Sundial Ave Suite 302N (9rCAN o,Ext ) I(AIC,Nn):_( ) Manchester,NH 03102 ADDRESS:agould@clarkinsurance.com INSURER(S)AFFORDING COVERAGE MAIC# INSURERA:Arbelia Mutual Insurance Co 17000 INSURED INSURERB: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. [NSR -....___...._._,_...._..._r., ADD S BR J� _�. -..POLICY EFF POLICY EXP -- ------__-,- --- LTR TYPE OF INSURANCE INSD WVD POLICYNUMBER MMIDDIYYYY) IMMIDDNYYYI LIMITS A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 G_ O I�LKITED CLAIMS-MADE 1)(OCCUR 8500065735 0412912016 04/2812017 PREMISES Ea occurrence $ _ 300,000 MED EXP(Anyone person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY I I PRO I LOC PRODUCTS-COMPIOP AGG $ 2,000,00 JECT OTHER: AUTOMOBILE LIABILITY Ea ace deMSINGLE LIMIT $ 1,000,0{) A X ANY AUTO 1020050919 04/29/2016 04/2912017 BODILY INJURY(per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS XX AUTOS PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peracclderst $ X UMBRELLA LIAB X OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAR CLAIMS-MADE 4600065736 0412912016 0412912017 AGGREGATE $ 1,000,000 DED X RETENTION$ 10,000 $ WORKERS COMPENSATION X ANDEMPLOYERS'LIABILITY STAT_t1TE,.-_,_..._ ER B ANY PROPRIETOAIPARTNERIEXECUTIVE YIN MIWC791896 0412912016 0412912017 E.L.EACH ACCIDENT $ 500,000 OFFiCERIMEMBER EXCLUDED? NIA .-...-....-.-- (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 500,000 it yyes,describe under E bESCRIPTION OF OPERATIONS betow E.L.DISEASE-POLICY LIMIT $ 500,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 161,Additional Remarks Schedule,may he attached 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 1600 Osgood St. ACCORDANCE WITH THE POLICY PROVISIONS. North Andover,MA 01845 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION, All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD truss n hua tts De�a lment of Public aftA C nsir ucti of Supervisor _._ �. _...... ,. i�61�>GYt� fri�6p�r tlOtdl4 tl0. G%i �_._.� � � ��17�S1f 11(:il�rft �"�I. )�"rVl�.(��'1 ccpa�iuiitl'ar� ,aapal t t rrrl rct aaiictrntls of any use group which contain t.ie ease: CS-110041 less than 35,000 cubic Peet(991 cubic rracicrs)of (odaMtl°ua:'fion Suprcw»gsor enclosed 5paac;ta. MICHAEL JOY 106 JOSEPH STREET MANCHESTER N" 03102 Failure to possess a current edition of the Massachusetts State Auiichr'g Code is c arr,e for rcvcrcuticrrr ci this license. omrnissioner 08/07/2019 OPS LiCeo%ifill intw�rrrurtinn visit:W'dVM.MASS.GOVB/I)PS G 1CCb ,of 001%11mvr A hits � rk��irir°r tSetl,urhkm ioaa tsic�err�aw aar r�agrasrrutir�u��hat for tlrtrtiwitlrap 11w unit^ viql4aflon date fimnd „thrcy atlq �tiJJOME ii pPP'4 Vlwihfi2 CcailYi'tAt.1'(,)R gi�irrr�'. ffi( ( u wt�ip9�irar,�te rAffair+ttndflusirrw%q�Rei„Mni,a0m) t.ateatlarNcrn, 7d'27#2017 t;.t< Bosom, NI?a,02 116 Mlk i1 c h i y t Bvi,i"(,y r-(;, r Oi9d^Ir ti Patty' �rr .11, ''00 lJtuadlt°,r i kY i;TBtN it " 0ittaaar t,16+�R�kt:;;Wit,":kitii�,t411t� N( II p"rrrtaswearcpnr� II N,au 'twatn� � v