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HomeMy WebLinkAboutBuilding Permit # 12/20/2016 BUILDING PERMIT Nary TOWN OF NORTH ANDOVER � - APPLICATION FOR PLAN EXAMINATION " Permit NoM 9-7 ! 1 Date Received ` /avi 60 °�wnrfv rP` c Ss 05 Date [slued: IMPORTANT: Applicant must connplete allitems on this page LOCATION _ _ PSS ►�rG, �v i'��T _ Print PROPERTY OWNER R,rerA f d 1,rig.oa0 - - Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:— Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition ❑ Two or more family Li Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑ Assessory Bldg .9 Others: ❑ Demolition ❑ Other wew7 ^-'r't SRT f C u I❑ 5eptc. 1]llllell ❑Floodpla�rs ❑Wetlands �i UllatershedOstnct DESCRIPTION OF WORK TO BE PERFORMED: 5 t E P r'vvi e 7-e P t Identification- Please Type or Print Clearly OWNER- Name: '�- - Phone: 5'�Y-Ln Address: a15 ,�►`rL, Sp ��o�a���' Peter Leblanc Contractor Name: Phone: Email: e PlaAddress: Supervisor's Construction License: /d&® i Exp. Date: Home Improvement License: lO-- � Exp. Date: �)- � ARCH ITECTIENGINEER_ Phone: Address: Reg. No, FEE SCHEDULE;BULDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST ASED ON$125.00 PER S.F. Total Project Cost. $ -0 O _FEE: $ Check No.: ­ F1 1 Receipt No.: Sf.3 (C__�> NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund F tAORTH own of �� _ Andover. No. t s h ver, Mass, /�• • d Dir y T O LAM! '414 coc"ICHRWI[K BRAYED s � BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT �S t� L t BUILDING INSPECTOR ..........................................�.�.�.. ....C........................... ............................... has permission to erect .......................... buildings on .,, ..... % Jt. ........... ..... Foundation Rough to be occupied as .... PA .... .,,,. �V,..®. . .............Qv ........ . .002 60W& ..........'.' 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 ST TRough 'J Service .................... . #BILD11ONG .M. ................... Final INSPECTOR 7� GAS INSPECTOR ---- r Building Rough ccuggpe Permit Required to ®ccupy �w 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 Ip# RISE Engineering RI Contractor Registration No MA Contractor Regislratton No A division orThiclseh Engineering CT contractor Registration No 60 Showmut Unit 42,Canton.MA 02021 t p NT RACT 339-502-6335 FAX 339-502-6345 IS E PROGRAM Page 1 1 T111.4 CONTRACT 46 EH7EaE0 INTO aETIVEEN n19E ENGINEERING CMA-ITES ENGINEERING TIE CU9TONEn PON WORK 0.9 OESCRlSED aELOW CUSTOMER tiff tt PHONE DATE CLIENT It VVORKORDER Richard Harrington t—! Imo, (978)686-2880 08/10/2015 421273 00004 s£RVICE!WREEr BILLING STREET 23 Ipswich Street 23 Ipswich Street ......_ — SERVICE CITY,STATE.VP WILLING CITY,STATE,ZIP North Andover,MA 01845 Q a, North Andover, MA 01845 JOS DESCRIPTION C CPJ11A�S:ETDW .� ropnsat fnr next . 'rices and program incentives not guaranteed. $0.00 BANUE-1k:We have discovered what appears to be a mold I mildew-like substance in your home.'this is being brought to your attention to identity it as a pre-existing condition to the insulation and air scaling work planned for your home.Your signature is your acknowledgement of these conditions and agncment to procecd.DARK SPOTS ON ft(30FNDECK $0.00 BASEMENT CEILING:Provide labor and matcrials to install(90)linear feet criwq unfuced fiberglass insulation to dw perimeter of the basement ceiling at the house sill, $157.50 OVERHANG:Provide labor and materials to install 8"R-28 densely packed Class t Cellulose insulation to(34)square feet of exterior overhang located below a heated floor area,by drilling holes in the Overhang from below. Moles drilled will he plugged. Plugs will be sealed with exterior grade spacklc and lett in a relatively smooth condition.Finish sanding and touch-up priminglpainting will be the customer's responsibility. $133.62 GARAGE CEILING:Provide labor and materials to install 8"R-28 densely packed Class I Cellulose insulation to(440)square feet of garage ceiling located below D healed floor arca,by drilling holes in(fie ceiling from below, boles drilled will be plugged, Plugs wilt be spackled and left in a relatively smouth condition.Finish sanding and touch-up priming/painting will be the customer's responsibility. $871.20 RISC Engineering will apply all applicable,eligible incentives to this contract You will only be billed the Net amount. Currently, tier eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive or 100%for the Air Scaling measures up to(lie first$680 and an additional$340 if savings are justiliied by the auditor. i For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air flow in your home both before the work is begun,and after the weatheriZ.9tion work is Complete.We will also conduct a full assessment of the combustion safely of your heating system and water heater.This has a value of S90 and is at no cost to you. Total allowable weatherizition incentive is$3.110. $90.00 Y ------------- q 0 9 i C , Federal 10# ME Engineering RI Contractor Registration No FrilMA Contractor Registration No A division ofThielseb Engineering CT Contractor Registration No 60 Shnwmut Unit#2,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 R I SPage 2 a1tpGltnM THIS CONTRACT IS ENTERED INTO UBTVTBEN RIBS ENGINEERINGCMA-HES GI "INaAN'WECUSYOMEAFORWORKAS DESCUSYOMFR PHONE DATE CUENTa WORK ORO" Richard Harrington (978)686-2880 08/10/2015 421273 00004 -_ _._....._.._.� — —� dEHVICE STREET dIWNG STREET 23 Ipswich Street 23 Ipswich Street SENVtCE CrrY,STATE,ZIP BILLING CnY,STATE,IIP North Andover,MA 01845 North Andover,MA 01845 SOB DESCRIPTION Total: $1,292.32 Program Incentive: $961.74 Customer Total, $290.58 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Two Hundred Ninety&581100 Dollars $290.58 UPON FINAL.INSPEC'T'ION ANO APPROVAL.BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUEIN FULL INTEREST OF i%WILL BE CHARGER MONTI1LY ON ANY WIPAID BALANCE AFTER]g DAYS.SEE REVERSE FOR IMPORTANT I9FORA%7ION ON GUARANTEES,RIGHTS OF REC€SIGN,SCHEDULING,AND CONTRACTOR Re01 TRATION, 0O NOT SIGN THIS CONTRACT IF THERE A K SPAC - NObvr Given[I t . f f} AUTFIORREOSIGNATUFtR-RISEEnginaaring T ACCEPT i1OTE:THIS CONTRAGTMAYBEWMIDRAWNSYUS IF NOT EXECUTED WITH114 DATE OF ACCEPTANCE. ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONBTTIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU AREAUMORILED TO DO TI€E P1oHK AS SPECIFIED.PAYMENT VALL BE hWOE AS oUTUIIBO ABOVE OWNER AUTHORIZATION FORM Richard Harrington (Owner's Name) owner of the property located at 23 Ipswich Street, North Andover, MA 01.845 (Property Address) 23 Ipswich Street, North Andover, MA 01845 (Property Address) hereby authorize �>0 .1 CL T�A f 7 fV-Vl (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. J— Owners Sign k9Gr-e -A— Date 0 DO EVENThe Commonwealth Of Massachaseas Department af-Industreal,4ccld'ents Of ice®f Investiga&o. .F1 I Congress swet,suite 100 BO"00,JM4. 02114-2017 Ap Workers' (Col]pens2tion Insurance Affidavit:Bid r/C®ntr2ctnrs/Blec ' licanf Informationtcaaras/'ls�ibers Please LL 'blv Name(Business/organization/individual): Address: SOX 9 Citi/Statelzip: Phone#: Are you a s employer?Check the appropriate box, - 1,,�' T am a employer with 4. I am a 'I�`, pe of project{rewired}: _� ❑ general contractor and I employees(full and/or part-time).* have Fired the sub-contractors 5. ❑New constmction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-conuactorr have working forme in as L 8. ❑Demolition y.,apaci�.f. employees and have workers [No workers'comp.insurance comp.insuranceJ 9- ❑Building addition 3.❑ required.j 5. ❑ V,{e me a carporation an.;,its lo.0 Electrical repairs or additions I am a homeowner doing all wont officers have exercised their ?l.❑Plumbing repair=s or additions Inysrlf. [No workers'camp. right of exemption per MGL j insurance required.]t c. 152, §[(4},and we have no I 12.[]Roof repair, employees.[No workers' l3.0 Other comp.insurance required.) *Ani 2pplieant thatchucks box1 must also 511 ootihe section below s,awing their workers'compensation policy information. HOmeOwners who submit this affidavit indicating they are doing all work and then biro outside contractors mustsubmita new affidavit tCnntractors than check this tiox mast at?ached at add'idopal sheet she ver;the tante af* radiating such employees. If the sub•cnntractars nave employees,they mustprovide their workers'comp.policy number. d Fite y:he�V:enc:thm entities have s nm M eMp1_ver drat is n:oUBding»arke.�'cr.�;arpnsatinka 5Esrenee f or gnu e.7rployees. �e1o::•fs thv pacy„y�dab si:•a ig!orwadon. Insurance Company Name: ('�y�i e CA VIA�eA Al Pnli;.r#or Scli`ins.Lic.#: ?0�,J C � Expiration Date: ofAdPb 1 Job 5'ItC Address;- 3 �' SlN'r`C '� _,_.., City/State,'Zip- v-e(I Att2ch a tapy of the workers'compensation policy declaration pan,(sltawting the poli:y number and expiration date). Failure to secure coverage as required udder Section 25A of MGLc. 152 can lead to the imposition of criminal penalties of a itrze up to 1,500.00 andror ane-year i*nprisannxent,as well as civil penalties in the form of a STOg 0 ORDER and a fine Of up to$250-00 a day against the violater. ire advised that a cnpy of'tlus statement may be forwarded to tfte OjEce of Lri ve-stigations of the MA for insurance coverage verification. i da hereby qErtl ldrd!!ei,the IItirS and WZIIIti v of rr,jrary i1Znt elle sn or ncBioit provided u&rive is trate and correct. Signature: Date: TZ-) a d / Phone#: >d Y a�" 7 C 3 a Fluth an1y. .13o nal write in this area,to be coj rpleted by city or toter official tiwrl: 1Permit�Liceosethority{circle one). Health 2.wilding Department 3.Cify/Town Clerk 4.Electrical Inspector 5.PI in6ipg Inspectorrson: Phone#: AC40RV CERTIFICATE OF LIABILITY INSURANCEDATE(MMrnDlYYYY) ( � 6/10/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(% AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the poiioy(iee) must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER CgOMNTEACT Linda Bogdanowic$ Insurance Solutions Corporation PHONE (603)382-4600 =All Na0603)302-2034 60 Westville RdDDRES-MAILS:lindab@isc-insurance.com A INSURERS AFFORDING COVERAGE NAtC# Plaistow NH 03865 INSURERA:Wostern World INSURED INSURER B 1latxtiluB IASuraACt3 Group Polar Bear Insulation Company Ino INSUR£RC: PO Box 958 INSURER D: INSURER E: Andover INA 01810 INSURER F COVERAGES CERTIFICATE NUMBER-CLI632326234 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 VMTH 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 TYPE OF INSURANCE DDLSUB POLICY NUMBER fPOOLICY EFF POLICY EVP LIMITS LTAX COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS�MADE �OCCUR PRfdE35aoc�cuDnce S 100,000 UPP8274967 3/24/2016 3/24/2017 MED EXP(Anyone person) $ 5,000 PERSONAL RADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 R POLICY j5a LOC PRODUCTS-COM PIOP AGO S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea acCldent ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED 130DILY INJURY(Per accident) S AUTOS HAUTOS N WNEDPROPERTY MAGE $ HIREDAUTOS AUTOS PeraccidanlDA s R UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1 000 000 B EXCESS LIA9 CLAIM&MADE AGGREGATE $ 1,000,000 DED RETENTION$ AN026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION PER0TH- - AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? ❑ N/A (Mandatory in NH) E,L.DISEASE-EA EMPLOYE $ If yea,describe under DESCRIPTION OF OPERATIONS bebw E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached If more space to 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 AUTHORI2£D REPRESENTATIVE j Keith Maglia/SJ'A ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025001140n i 611012016 Prevkly:Certificates of Insurance A J®® CERTIFICATE OF LIABILITY T IiYsuR1'iNcC GATEIMMMDNYYY0611012016 CERTIFICATE THIS CERTIFIRTIFICATE D TE IS ISSUED ASA 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 INSURERIS),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:If the certificate hoider Is an 121I715NAL INSURED,the policy(ies)must be endorsed.If SLEBROGATION IS WQIVEp,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). PRODUCER CoNrCT NAMEp Automatic Data Processing Insurance Agency,Inc. PAHrco°.tit o,E.I, 1 Adp Boulevard Roseland,NJ 07068 ADDRESS: 77M C N INSURED INSURER A: Not-GUARD70 POLAR BEAR INSULATION CO INC INSURERS: PO BOX 958 INSURER C: Andover,MA 01840 INSURER D: INSURER E: COVERAGE$ INSURER F: CERTIFICATE NUMBER: 503587 tEVlSlpN NUMBER THIS IS TO CERTIFY THAT THE POLICIES UI ENSURANCE LISTED BELOW HAVE BEEN ISSUED FO THE INSUREp NAMED ABOVE FOR TNI;ADLICY PERIOD INDICATED-NOTWITHSTANDING ANY Y PERTAIN. "TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO LVNICN THIS CERTIFICATE MAY BE 155UER OR MAY PERTAIN.THE INSURANCE AFFORDEb BY THE POLICIES DESCRIBED HEREIN f5 SUBJECT i0 ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS, MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR TYPE OF INSURANCE IHSD WVO POUCYNUMBER COMMERCIAL GENERAL LIABILITY MWODIYYYYI 1MlODIYYYY) LIMITS CLEACH OCCURRENCE 5 iVF.lS d.FAOE F-1OCCUR ' 1,FJ-MISES(E—wmnce) s MED E%P fAny mm persu.S 5 GENLAGGREW,TEL0.111 APPLIESPERT PERSONAL B ADV INJURY 5 POLICY❑JECT ❑LCC GENERAL AGGREGATE $ OTk£R: I'FOOVCIS-CGMROP AGG 5 AUTOMOBILE LIABILITY S ArtYAUTO (Ea' ChI 11 S' ALL OWNED SCHEOLIED BODILY INJURY(Pa p rson) S HI rD AUTOS BODILY INJURY fPrs scigpN} 5 NIIiEU AUTOS AUTOS'8dE0 AUTOS , _ IPv,�;.cilFradl 5 UhMBRELLALMS OCCUR S EXCESS LJAS CLARIS-MAUE EACHOCCUNRENCE S AGGREGATE S DED RETEWTIONS WORKERS COMPENSATION g AND EMPLOVERS'LIABILtTY VE YIN X STATUTE ER A OFFI EMI-EM BER EXCLUDED? NIA (Mandalaryin NH) N PDWC772258 01/0112016 0110112017 E.L.EACH ACCIDEIJT S 1,{)00,000 IfYa.;,d�•scdaaw,dM r1.DISEASE-EAEMPLOYE s 1.000,000 DescRlPrlcN pF caesn:tor.°s nam.. E.L.DISEA$t.PoUGYUnuT 5 7,000,000 DESCRIPTION OF OPERAT[ONBI LOCATIONSI VEHICLES IACORD 167,Adddional Remarks SclxduW,may ha altaUxd if morespaco Fs rcgpFrttl] CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE VESCRIBEO POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS, 1600 Osgood St.f suite 2035 North Andover,MA 0f845 AUTRORIZEDREPRESENTATiVE ACORD 25(201410 1A©1988.2094 ACORD CORPORATION.Ati rights reserved. The ACORD name and to are registered marks of ACORD V s . Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5174 Boston, Massachusetts 021.16 Home Improvement CgntTactor P.egistiation Registration: 102726 Type: CUBA Expiration: 712/2018 Tr3r' 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BOX 958 ANDOVER, MA 01510 Update Address and return card.bark reason for change. SCA 1 G 204-05111 F1 Address ❑ Renewal E] Employment n Lost Card �fc�rrrrrrrxxrrrarrrlf�c�f"'i�lrr,�arrc/rr%tclfs office or Consumer Affairs&Business Regulation License or registration valid,for individual use only HOME IMPROVEMENT CONTRACTOR before the expiration date. Iffound return to: Registration: 102726 Type: Office ce of Consumer Affairs and Business Regulation Expiration: 712/2018 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 POLAR BEAR INSULATION CO. Vincent LeBlanc 5180.CANAL ST.45A LAWRENCE,MA 0181 Undersecretary Piot valid withattt siguatura I assachusetts -'Dapartment of r ubiia Safety Board of Suhdhig RegulaUons and Standaa-ds ("'mn, raaa.Elml Sujlb'!r a r"Msca °ij7f:.it¢161 'sense: O SSL406017 PETER A LE ANC Plaistow NH 03965 --41 r p CG'S�SCkC E^on¢raa6sskaf=— 04121112010 0 1 l i