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HomeMy WebLinkAboutBuilding Permit # 12/8/2016 ,%ORTH. BUILDING PERMIT °F TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION Permit No#:(9 - — Date Received �SSgc+u5���5 Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION OlkawwLy— ...... Print. PROPERTY OWNER i0%ayd Lay-5m Print 100 Year Structure yes no MAP PARCEL: cot 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 V Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other N �] . t .: ❑��1�11� �� �-��-����.x ��E�Ffio�dpl�tn ��Ilvetla� sME - � .. ' .'.� � � r.� ..,,.✓ �.��.��` � �, �,, �cr,,� ami ��a��3� F � �s� ,,��,� ,�i �, � .. .,,.���� "�„-!��, ;y ., ,�" ':r DESCRIPTION OF WORK O BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: 9,i nam Lary Phone: (�!7 Address: o a o l cv otBW Contractor Name: Phone: Email. cdv,, Address: Supervisor's Construction License: it 6CM I Exp. Date.. Home Improvement License. Ig2 IZ Exp. Dater -112-'7 120 ARCH ITECTIENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED coST BASED ON$925.00 PER S.F. Total Project Cost: $ Q • 11 FEE: $ 3 �•/�' Check No.: ! Receipt No.: 3 1 NOTE: Persons contracting with unregistered contractors do not have access to the a ty fund Town of nd ® - No. C% : >,�. h ver, Mass, • COC NICMlwMR yR. U BOARD OF HEALTH Food/Kitchen SePERMIT T LD ptic System THIS CERTIFIES THAT .......... �C:....... .................................... ................................................... BUILDING INSPECTOR Ah has permission to erect .......................... buildings on .. Foundation ................... .... Rough sw tobe occupied as . .� ... .. I. .. ...................:.................................................................. chimney provided that the person accepting this permit s all 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 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough . Service .............. . ..... . .... .. .................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Putldtn 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 Bet. Federal ID#05-0406829 ME Erigineefring Rl Contractor Registration No$100 MA Contractor Registration No 120979 CT Contractor Reglatratlon No RISE 60 5hawmut Road,Canton,AIA ENGINEERING' CONTRACT '4011784-3700 7 4-3710 IJ !J 1 PROGRAM Page THIS caNrRAcr Is eturEnEO INTO BETWEEN nlsE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK As POSCRiafiO BELOW ....,..._...-_ ........... ............ _...-- CUSTOMER PIIONE DATE CLIENT# WORKORDER Ricltard Larson (617)461-4168 09/02/2016 439208 35002 SERVICE STREET BILLING STREET 20 Hawthorne PI 20 Hawthorne Pl SERVICE CFTY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01815 - -- JOI3 DESCRIPTION I(EAI,I't I&SAITTY:WeatlCriZation Work Cannot proceed until mcchanical ventilation(flat will provide(I)cam(cubic feel per nlintrtc)ofcontinuous air flow has been installed in your hollle. D J $0.00 AIR SEALING:Provide labor and materials to seal areas of your llomc against wasteful,excess air leakage. This worts will be performed in concert With the use ofspecial tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials lobe used to scat your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unhealed areas(windows are not generally addressed.) This will require(4)working(tours,A reduction in Cubic feet per minute(cfni)of air inflllration will occur,but the actual number of etin is not guaranteed. At lite completion of the weatherization work,and at no additional cost to lire homeowner,a final blower door andlor combustion safety analysis will he conducted by the sub-contractor to ensure the safety ofthe indoor air quality. $340.00 DAMMING:Provide tabor and materials to install at 12"layer of R-38 trnfaccd fiberglass balls to(20)square feet for damming purposes. $41.00 A'i'fiC I�LKV:Provide labor and materials to install a 6"layer of R-21 Class 1 Cellulose added to(670)square feet of open allic s pike, $844.20 STORAGE BARRIER:I lomeowner is responsible for the removal of the stored items blocking the installation of wcaaltcrizattoll (initials) work in the attic, Removal must occur prior to the scheduled work start. $0,00 A'I"EIC ACCESS:Provide labor and materials to insulate the back of the attic door with 2"rigid Thernlax board and seat the door's edge wllh weatherstripping to restrict air leakage, $73.91 Provide labor and materials to install R-8 fined fiberglass insulation to ale exposed heating and/or cooling ducts in certain non- conditioned areas. 'total to be installed is(60)square feel. $171.00 RtSI?Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount, Currently, Ebur eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,orad an incentive of 100%for the Air Seating measures up to the first$680 ami an addition)$340 il'savings.are justified by the auditor. For tine safety and health of your home's indoor air quality,we will bt conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and after the%veatherizatiort work is complete.We will also conduct a full assessment of the combustion strfoy of your healing system and water healer, 1,11 is ilas a value of$9©and is at no cost to you: 'total allowable wealherization incentive is$3,110. $90.00 S Federal ID#06.0408$29 RISE Engineering RI Contractor Registration No 8188 MA Contractor Registration No 120979 RISE CT Contractor ReglBtraitgn No GO SIIBTYFnIft[toad,Conten,MA �a ENGINEERING' (401)(4U1)784-3700 FAX(401)784-3710 Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO OEI WEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS BESCRIBED BELOW ......_...------- CUSTOMER PHONE GATE CLIENT 00 WORKORDER Ridlard Larso>3 (617)461-4168 09/02/2416 439208 35002 - _.._.. - --- .- -— _ ....... ... .---------------__ --- SERVICE STREET BILLING STREET 20 Hawthomc PI 20 11aw1.hoim PI _.....—_._._--- SERVICE CITY,STATE,ZIP BILLING CITY,STATE,LP North Mdover, MA 01845 North Andover,MA 01845 ,YOB DESCRIPTION( Total: $1,560.11 Program Incentive: $1,277.68 Customer Total: $282.53 WE AGREE HERESY TO FURNISH SERVICES,COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF "Two Hundred Eighty-Two&531100 Dollars $282.53 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING,CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF t%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 14 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. .......... ................. .._._..__, _. -_- - --__ .._....__. _._._.._. ............. ._.,..... .._._—_._._...__..._ _ . ... __. ..._._......._..._ DO NOT SIGN THIS CONTRACT IF THEM ARE ANY BLANK SIR AUTHORIIED SIGNATURE.RISE EilyMoering CUSTOMER ACCEPTAN i NOTE:THIS CONTRACT MAY DE VATHDRAWN BY US IF HOT EXECUTED WITHIN GATE OF ACCEPTANCE ACCEPTANCE Or CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDMONS ARE. DAYS. SATISFACTORY TO US AND ARE HeREDY ACCEPTED,YOU ARE AUTHORIZED TO OG THE WORK AS BPECIRE0.PAYMENT Wilt.BE MADE AS OUTLINED ABOVE RISE 60 Shawmut Road, Unit 2 Canton, MA 02021 339-502-6335 ENGINEERING` www.RISEengineering.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at: f k'/aWA-6av, I1P,t (Property Address) (Property Address) hereby authorize W Ekxw (Subcontractdr) 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. rE ' Owner's Signa r Date 6.2016 o 7'/je C'ilbratirtompeedih of a s° chuseils a ,�P fi1 ,Yd I Cratagress So-eel, "ite 100 flostm, MA 021,14-2017' 14w tv,1111198.got)la ala Workers'Cor per "Ifiora '6nsm,ance Affi aOt Gellffrml ljsi"as!Wa - TO BE FIffi EA)fVW'1'tff'M`fffts 1'K161U1"tTING AlH 1TQ"ffd'a"1'V. ttsailtceala,rCffr;attirltlion Nb"yrce:Itllllf C lty l ne My Address:P0 Box 6411 .i1y0 t<r16.,/i"i�>: E�rarYrr Ir IN 03108 l�k�rar�a �� 603-391-7923 Are you arr�employer?Cleckw the a pprupr 4te box: _ BuMn s, lype(ree6uhvd)_ _.._ . I. .7_ I WV a erraplcru ewafla 17 <nal� oyc�cs(Cull aanty a ���Re ta�ail or puptime).*�N M _ I �. � ustaC)tfb c,rrauacW6ora'�,uletira;1°,t�rlrllslrraar.rat ?.„•,. l sacra a serlcu rear>rMor or aaartueerashi�a and have ue�r � � (incl.real ostate,,into,01c.) employee's wor ring for me in any caprwny. � 1'l ara Ira°c>h. (No awor kc.a s'comp. insurance rc dewire,l : �,�,m�� Wo acro a Corporation and ilw ofliceis have oxerc;dsed lwWrlaaluu'm'al. their rightof exemption per c'a. l 5'?,§l(4),and we have, 10,0 maruulacrta.rrmrrt, no employce,s. (No workers,comp rusurrrnm require<l'l" �l. 4' eaarcanon-rroiitareaaraa�ari<rra fl<rk'tw.r«Ila volurrteer d2. ldearltla(�"arr,w w1b rua cruployms. ('No evc.ke°ars'<�crmy rnsurr�aaee,a.,ret;I OIdra„a.r \Maps a r alicruar ahu4 a lac€ks ho,;P l Imo,t also rttt out atae.strcrrana he.len+ howiaa;rg,4"n r r �(rrw a rauaffaerar ariran wcrrar y uurerrrnaaruars. Ifi'rlu,cm poratc of imrs hawe'.xa.mt led Uaaitusvlvc4„taut dhr+crra)au'rratiusa haat oth o.cmploy c a ;a aYofl a s auuitwna �raaun wralr¢y Is Mrparuaaal MW a.raera aAa 4r-g animation should c licck box.0l, I aatnt aaaa emljt [toyer ill cat is 1)l ovrrfnar brvorr arn°s'ear ff" srn6aetrn nra.srar aarsce/or^nna,a^'nnr;htj,e,,.s. B Belo n, a a� ..... 1. _._ fi arra rcata_.. b � .+rw ffucrleneas.r 6dzc facra"ac,)�irap`'�rnnnsra6marns. 1r)"'oo4anec,C!onapany N aauo Claark lr1$LJ1atIC,(' In sor er's Address:One d'rtrndiaal Aver)ue.Maitre 302ND r;;ityd`,hatc a ,ilr 9 d'slac'hest er, NH 0310 poa icy ej or. ell,in,1j,'. MIVffff('791896 ____..___.. _.__. . _ ..__ ........ d;xpiraaCicru T:)ate._"1B7W2W l fyttmh as aa"y 0"he lvor•Ccea°s'a arualae^rrsaa'd�atar'a pulley affoerdaoatfflarrn pa c"(rstaemavir'wp the policy number and expiration cddle;). Failure,to axmuaea Nw r e as rt°gatlwd uncle^r Sa.c,ik"25A o1'M(H.c. 152 can lead to the irrrlraa,al da'rra cr'rerindnal pmaltics off'aa fine up to:5ff,500.00 andlor onc•y(rcar boprisonnIent,;as avc.11 as civil peualA s lar Hm Mon cal as STOP VA)RK CYdtnFR and.a fir`we of up to$250,00a cfiay aWdmL trite vic'alartor. Be;mWised tlaart as wV cA this stat wrmnt r"z'asay be Coravarcicl to telae(J hce:of Investigations oftho DIA 1'or inwruaa're e, s r rrl rc ation herekv c c Plpy,sat t rsmnc6fftc an fftaa n eoJ,�rc�n/oen,gr ttrnm6 Faa dnn ✓an naarnPf�affC,�rnrrs�a�c za9araew�ea a�u6a°aa rannrt e raw'r'r u,t. Phonerid 603-396-7620 fr��nclral use aajrl4,,.ffSrr nserf rvtsAe ins,.... this anreen,to be need lVetaecff k),ea(t)tts.finvsa q1f ciaat CIO or Town: Issuing raautNrmAy(<air de ossa,;): 1, ffffunni art'HeMilr 2, BWMWg Deparnr•t�ment :3,City/Town(:"YcN t Ikowming tfoav-d 5.Selectmen's Offffa^e'a 6 ()thee, (",,outact.For•sorl. l'affaua'reff1 _....__ vw�twa ur av,,alua ftR i cr I _....._.,.,.... . _..._,.. w. ....... _ _ .,_..... .... _..... . _._.... �• MILLCITY-1 AGOULD CERTIFICATE OF LIABILITY INSURANCE DATE(MMMDIYYYY) 7/19/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW, THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder Is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER License#AGR8150 CONTACT NAME: _ Clark Insurance PHONE -- ---—— - Fax__.__—._ One Sundial Ave Suite 302N C.No.Ext):(603)622-2855 (AIC,NcI: (603)622-2854 Manchester NH 03102 a-MAIL Manchester, ADDRESS:agould@clarkinsurance.com INSURER($)AFFORDING COVERAGE NAIC If INSURER A:Arbella Mutual Insurance Co 17000 INSURED INSURER 6:AmGuard Ins co 43290..._.._-_ Mill City Energy INSURER C: 106 Joseph St PO Box 6419 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 CE=RTIFICATE= 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 TYPE OF INSURANCE ADDL$ BR POLICY EFF POLICY EXP LIMITS LTR INSD WVD POLICY NUMBER MM1DD MMMD A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 RENTED CLAIMS-MADE ^ I OCCUR 8500065735 0412912016 04/2912017 AGE ° PREMISES Ea occurrence $ 300,000 MED EXP(Anyone person) $ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY[:]IRO- � LOC PRODUCTS-GOMPlOP AGG $ 2,000,00 I ..._.__............._...-COM..._._..._.-.-T.,...._...._.-.-.__-........__2,0 OTHER: $ AUTOMOBILE LIABILITY CEOM�BINE D SINGLE LIMIT $ 1,000,000 A X ANY AUTO 1020050919 0412912016 04!2912017 BODILY INJURY(Per person) $ ALL OWNED SCHEDULED _...._....._..,.-.._-_.._......_,_._.-m..._......,._,...,_.._...._....-... -------- I— AUTAS AUTOS BODILY INJURY(Per acel denl} $ X HIRED AUTOS X NON-OWNED PRO=ID AMAGE I$ AUTOS (Per I X UMBRELLAIUAB X OCCUR EACH OCCURRENCE $ 1,006,000 A EXCESS LIAB CLAIMS-MADE 4600065736 0412912016 04/2912017 AGGREGATE $ 1,000,000 DED I X I RETENTION$ 10,000 --------.—_...._,—.._ WORKERS COMPENSATIONX STATUTE ETH AND EMPLOYERS'LIABILITY B ANY PROPRIETORIPARTNER/EXECUTIVE YIN MIWC791896 04/291.2016 04/29/2017 E.L.EACH ACCIDENT $ 500,000 OFFICEPJMEMBER EXCLUDED? N f A (Mandatory In NH) E,L.DISEASE-EA EMPLOYE $ 50©,000 If Yes,describe under ---.-- _..__._.......,.__..._._..__...,_..-.. DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,00 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES tACORD 101,Additional Remarks Schedule,may be attached it more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town o€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 ©1986--2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Mssah9, ft Department of a0.fia Wtkfy, on shlcti1n Supervisor "aof Trwltsa° riw& at and"t. srrrtwRestricted Um , ked Bwkfin s o_.any use group _Which contain ... i_'rtcensc. CS-110041 lass than 35,000 cubic feet(991 cutllc nacterzi)of a,:¢snstr ur.;r&mu°a spar ';e. MICHAEL_JOY 106 JOSEPH STREET MANCHESTER NH 03102 ( Failure to possess a current edition of the Marsachurpt1s pwratAo w�, ShIto)6#uila9u 41 Code is cause for revocation tit this Iiceose. Commissioner 08107/2019 DPS l.ictenainu information Venit.WWW.MASSa.C9tYtltlDPS " f)Ylis•c�r,E'f'arrw�uraarm,ltturasw� tlrr�rfius^«�N9a1"^piwrrlrrar 4', r iµ j0PA IMf"I�OV MEN 'C,;;ON'(traaC�`t'C;If lrawi`awww Itwwe a w rwr¢alwi uwa rffraww i afaa9u^saliw)ca: ta)mg 4tffiwrrwt4`ar9a u9aaa^w , a4lwwwkwttrwwwi`„�kai on v � r11 trwr`tua9Vor'p; �r�w F� 9 i,�< $0 Park,t'lawa--Sune 170 Ctra,rtwr uw, t. 1116 a� a MOCVAtlk laws' µP��m0 m, . � kvrrbaraswrp,arw r” ith a amw aawul ieir" 6t�v tR�of i Mt af9ki V•i idt/1Gir.Will.,,ii°.l��wtJkt4ha4a.h2 hr � a