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HomeMy WebLinkAboutBuilding Permit # 12/20/2016 BUILDING PERMIT _�� �oRrh A Kt4EV 6 �� TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION o Permit No#:(0 i Date Received �y °R STEP S$AC H►i5f� Date Issued: ZORTANT. Applicant must complete all items on this page LOCATION MA11600 -o rent PROP T OWNERta+n��� �'� i' -ero—r f' Print 900 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg Others: LlDemolition El Other Other Z,/eq 1,Fr;2 a,�`aQ 1- ❑ Septic' ❑11Nell II Floodplain q Wetlands ❑` Ilatershed Distract E ❑WaL����eYY Li F/ /y :. .,..-.� Q'"` l DESCRIPTION OF WORK TO BE PERFORMED: ISP gar s der/vl0 Se Identification- Please Type or Print Clearly OWNER: Name: P'-, r Pr ri rt` Phone- l- Address- qS_? 701kn$I +) 50 /2- Peter 7.Pete ' Leblanc Contractor Name: Phone: Email: Address: Plaiatuw,, 114 • 0,3865 978 07-76-38 Supervisor's Construction License: 0 i Exp. Date: P11 wo Home Improvement License: t o��� G Exp. Date: � /� ARCHITECT/ENGINEER 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. F Total Project Cost: $ 1 — _d o FEE: $ _ r / Check No.: ' Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund .................................................. T ittORT"own o �2 Andover No. ver, Mass, 0-1. I 1�a W wr cacMicMew.cw 1' Ll BOARD OF HEALTH Food/Kitchen PERMIT T LD Septic System THIS CERTIFIES THAT ........?Ivlas.......kwobft...... ........ ............................................. BUILDING INSPECTOR has permission to erect .......................... buildings on ......vir Foundation N.o Aol Rough to be occupied as .... Chimney j&mo;..........so.f."Wo provided that the person accepting this permit shall in every respect conform to the terms o I e !cation 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 I NSPECTOR UNLESS CONSTRUCTIO T RTS Rough d U, Ar&� Service ....... . ..... .4. ......... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Perinit Required t® Occul2r-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. Federal to# ' RISE Enginew ing RI Contractor Registration No - SHA Contractor R Registration n No A division of Thiclsch Engineering CT Contractor Regtstratlon Na ENGINEERING 60 Shawmut tlnit#2,Canton,MA CONTRACT pIV�i�+T (401)784 3700 FAX(401)784-3710 Page 1 PROGRAM TM CMA-HES 0jCWMMo Arm Tma�CUSTOMER FOORWORK A$ oasauataUELOW CU9Y46lFR —__.__..,..-....-.�.� p"0149 nATa Cum$ WORK ORDM Monica Carpenter d (781)714-9063 01/20/2016 428113 00003 s�lvice s�raez int etwtro srp88t 458 Johnson Street 458 Johnson Street SMWIea Cn Y.STATE.Zip ' atLLma CnY.STATE ITP North Andover,MA 01845 - North Andover,MA 01845 ]�DESOUPTION P14ASE'TWO-Proposal for next yeat's weadterization project.Prices and program incentives not guaranteed. o $0.00 a ATTIC ACCESS:Provide labor and materials to insulate the hath of the attic door with 2"rigid Thernim board and seal the dear's edge with weatherstripping to restrict air Icakoge. j $73.91 STAIRWELL:Provide labor and materials to install Class I Cellulose insulation to the sheetmck or plaster ceiling and/or«ails of a stairwell-.vhich are common to heated space.through a surface drill and plug method. The holes are plunged with styrofoam plugs. and spackled to a rough finish. Any sanding and painting required are the customer's responsibility. $175.00 WALM Provide labor and materials to install blown is Class 1 Cellulose to(30)squere feet oremorior walls through an Interior suriltce drill and plug method. Plugs will be spaclded and tell with a rough finish.Finish sanding and touch-up priming/painting will be the customer's responsibility. Homeowner has received a copy of the EPA's Renovate bight Lead-Safe information guide explaining the potential risk of the lead hazard exposure from the weatherization work to be performed.Your signature is your aclmowedgement of receipt and agreement to proceed. $60.00 WALLS:Fumish and install blown in Class I Cellulose to(465)square Icon of shingle and/or clapboard exterior walls.The butt of the upper course of your Wood siding is cut to drill holes into the well sheathing behind,The holes are then plugged and the wood siding is reinstalled using stainless steel finish nails.Touch-up painting,ifneeded,will be the customer's responsibility. Invoicing will occur upon completion of installation.Homeowner has received a copy of the EPA's Renovate flight Lead-Sane information guide explaining the potential risk of the lead hazard exposure 1Pam the weatherization work to he performed.Your signature is your acknowedgement of receipt and agreement to proceed. $860.25 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount Currently, for eligible measures,Columbia Gas offers 15%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. For the surety 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 atter the weathcrization work is complete.We will also conduct a roll assessment of the combustion surety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable woatherization incentive is$3.110. $90.00 FIJF.N 2420% ----------- Federal ID9 • RISE Engineering R1 Contractor RegistratIon No MACqntractor RaStMtfon No A division arThle1sch Engineering CT Contractor R9gtstrzUOfl NO RUSE ENGINEERING7 60 Shawmut 1:n1t#2,Canton,NIA CONT - MCT (401)784-3700 rAX(401)7"7 10 Page 2 PROGRAM THIS CONTRACT M gNTSM INTO WIMM RIME CMA-HES vmusmm An im CUSTOMER FOR wORK AS GESCRIIIHO 02" PROFIE DATE CURWO WORK ORDER Monica Carpenter (781)710-9063 01!20/2016 428113 00003 SERM ilgilii­ 111LUNG TPIRMT 458 Johnson Street 458 Johnson Street V6VICE CT4y.STATE-ZIT GUM CrMSTAMW North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIMON Total: $1,259.16 Program Incentive: . $966.87 Customer Total: $292.29 WE AGREE HERESY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WfM MOVE SPECIFICATIONS.FOR THE SUM OF —Two Hundred Ninety-Two&291100 Dollars $292.29 UPON FINAL INSPECTION AND APPROVALBY RISE E"INEERING.CMYLMX14 MWEES TO REMY AMOUNT DUE FULI-MUMT OF I%WU MCHARGED MONTHLY ONANY UNPAM WAAMMAPM So MO.881 AMM MR u0mAW WFoRmAT=439 WARANtM,RtORMoFRacMm.scHmuugG.ANoCONTRACMRCCOMWL%L 00 NOT SIGN THIS CONTRACT IF THERE ARE MY BLANK SPACES C C Nathan Weiss J 1�\ AERRGRffED WMTURE.RtSEMVa�� �N CLMTO NOM THIS CONTRACTUAV BEWFKDR�52F' EXECUTOWnUm LATE CEPTANCE 0FccNTRAcT-nMABOVE AND CONDMOMARB DAYS. MW TO US AND ARE HEMMYACcanm MARIIAMORMID TO On TIMWORK AS 3P m PmWt mLL B6 KqOZ AS OUTW=ABOVE =7P rMPA-�-ffl r KISE 60 Shawmut Road, !Unit 2 Canton, MA 02021 339.502.6335 e ENGINEERING" www.R[$Eengineering.com OWNER AUTHORIZATION FORM I, 1j j A �r ejj(r (O ner's Name) owner of the property located at: a JVIr 50A (Property Address) 4 4JI4'r-lVi A om S , (Property Address) hereby authorize ?0 C C.,r V� -e CA, ,r (Subcontractor) 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. Owner's ' nature ©ate u B 1 T'he Commonwealth ofHassachuseas Department of Industrial Accidents Office ofInvestigations I P 1 Congress Street,Suite 100 Boston,M4 021-14-2017 -- www-mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers A ;i at Information Please Print IJe "bl Name(Business/Organization/Individual): Address: PO BOX 958 ANW—VER MA 01810 City/State/Zip: phone Arc you ar ernployer7 check-the appropriate box: 1. I am a employer with 4. ] I am a general contractor and I Type ofproject(required): employees(full and/or Hart time).* have hired the sub-contractors f 6. ❑Netiv construction 2.Q I am a sole proprietor or partner- listed on the attached sheet. 7. []Remodeling ship and have no employees 'hese sub-contractors have working for the in any capacity, employees and have workers' 8. Q Demolition [No workers' comp.insurance comp. insurance.t ] 9. ❑building addition required.j 5. [� We are a corporation and its 1 10 El Electrical repairs or additions l 3. I am a homeowner doing all work officers have exercised their I I.❑Plumbing repairs or additions myself[No workers'comp. right of exemption per MGL insurance required.)t c. 152, §1(4),and we have no 12 E]Roof repairs F employees.(No workers' 13.❑Other comp.insurance required.) Any applicant that chocks box P must also=ill out the section bellow showing their workers'compensation policy infonnation. Homeowners who submit this afdavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check;this hjx moist at6ached an additiopai sheet shvwir.4 the pmie o.the sut-.onl;actors an or nc.thos:entiti�?iave stev.%etha cmpioyees. Irthe subcontractors have employees,they must provide their workers'comp,policy number, am an employer that is proiddng ivorpe.s'compematior.:;ssrrranee�ar rn�,e=�tpinyees. gdv:.is ttr_o poky andjvh site it formation, � / Insurance Company Name: r"' n, (-k Kee ,�y Folic;;4 or Scif-ins.Lie. I3xpiraiian Date: est Av b6 1 job Site Address. LitylStata/Zip: ni - jI y*p, 40 Attach a copy of the workers'compensation policy declaration page(shrwing 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 penalties of a fine up to S1,500.00 andlor one-year imprisonment as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violaror. Be advised that a copy of this statement tray be forwarded to tiro O Rrvastigations of the DIA for insure-nee coverage verification. ffice of A do herEby cerci under rhe aiirs and erialtia:of erjury bort tire iii or nation pruv�ided above is trace and correct, Si -arose: Phone M jd Yo)-------------- 7 G 00"cial use only. Do not write to this area,to be cos3apleted by city or toarrz octal City or mown: Permit/License# Issuiug Authority(circle one): I.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector S.Plumbing Inspector 6. Other j Contact Person: Phone#: DATE(MMIDDIYYYY) AC® AC� CERTIFICATE OF LIABILITY INSURANCE 6/10/2016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER($), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(lee)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 endorsemen s. CT Linda Bogdanowicz PRODUCER CNOAM A Insurance Solutions Corporation PHONE (603)382-4600 No:(603)362-2034 60 Westville Rd E-MAIL ADDRESS:lindab@iso-insurance.aom INSURERS AFFORDING COVERAGE NAIC# Plaistow NH 03865 INSURER A Western World INSURED - INSURER B Nautilus Insurance Group Polar Bear insulation Company Ina INSURER C: PO Box 958 INSURER D: INSURER E: Andover MA 01810 WSURERF: COVERAGES CERTIFICATE NUMBER�L1632326134 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. ILTR TYPE OF INSURANCE ADD SBR POLICY NUMBER IV M2nrYYYF POLICYXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 A CLAIMS-MADE �OCCUR DAMAGE TO RENTED $ 100,000 PREMISES Ea occurrence HPP9274967 3/24/2016 3/24/2017 MED EXP(Any 011e Person) 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENT AGGRE13ATELIMITAPPLIESPER: GENERAL AGGREGATE $ 2,000,000 POLICY❑PRI LOC PRODUCTS-COMPIOP AGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT Ea acckfent ANY AUTO BODILY INJURY(Per person) $ '.. ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOSAUTOS Per accident L 5 $ UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1 000 000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DEG RETENTIONS AN026107 3/74/2016 3/24/2027 $ WORKERS COMPENSATION PEROTH- AND EMPLOYERS'LIABILITY YIN STATUE ER u ANY PROPRIETOR/PARTNER/EXECUTNE ❑ N/A E.L.EACH ACCIDENT $ OFICERIMEMBER EXCLUDED? (Mandatory In NPI} E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ I DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additlanal Remarks Schedule,may be attached If more space Is requlred) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North AndoverTHE 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/SdA O 1988-2014 ACORD CORPORATION. All rights reserved. ! ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD INS025 0nlan1) 611012016 Previely:Certificates of insurance ACCwREY� CERTIFICATE OF LIABILITYINSURANC DATEIMINDbmYY) E THIS CERTIFICATE IS lSSUEO AS A MATTER OF INFORMATION ONLY ' AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOL-DERTHIS CERTIFICATE DOPS N07 AFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,THIS CERTIFICATE OF ilVSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THI"CERTIFICATE HgLDER. IMPORTANT:If the oerttflcatg holder is an ADDITIONAL INSURED,the pD11cy(ies)must he endorsed.It SUBROGATION!S WAIVED,subJ ect to in eu osucendorsement(s). the terms and cOnditlOns o[the policy,certain pDllcles may require an endorsement.A statement on this certificate Boas not cOn(er rfghts a the certiNDate holder Ilf h PRODUCER NAME: Automatlo Data Processing Insurance Agency,Inc. AIG.No.Ext l'.Adp Boulevard fAFC.Nn, Roseland,NJ 07068 ADDREss: ENSURER{SJ AFFpR01Rn COVERAGE NAIC p INSURER ENSURERA: NOF13UARO Insurance Company 31470 POLAR BEAR INSULATION CO INC INSURER B: PO BOX 958 INSURER G: Andover,MA 01810 INSURER O: INSURER E: INSURER F: COVERAGES CERTIFICATE HUMBER; 503587 REVISION NUMBER. THIS t5 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERFOD 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. LTR TYPE OF INSURANCE INSD WVD POLICY NUMaER COMMERCIAL GENERAL UABILTIY MWbOFYYYY) 1WDb1YYYY) LIMITS ClEACHOCCURRENCE s .,llL15d.1A06 ❑OCCUR '.. PREhIISlr5lEa orcurmoul S ', MED rXP(Any onu lemon 5 OENL AGGREGATE LIt.111 AN-LIES I'(_R: PERSONAL&ADV JNJURY S PCLICY❑JE O' E]LCC GENERAL AGGRECATE 5 071,91: PNOL"C IS-CCEIR'OP AGG S '.. AUTOMOBILE LIABILITY S ANYAUTO Ilia acciuEnU S '.. ALLO'11NE0 SCHEDLIED BODILY INJURY(Pa person) S AUKS Auros F:ON-OV1NkU - BODILYINJURYIPer 3c'clpenl) S HIIiEp AUFOS AUrpS ''a'tr aCcidritll 5 ',. UMBRELLALUIB OCCUR S EXCESS UAD C W LIS-hIAOE EACH OCCURRENCE S '. OED RETENTIDNS AGGREGATE $ WORKERS COMPENSATION 9 AND EAIPLOYERS'LIABILHY YIN X N1Y PFtCPRIETOFL'PARTA'EELE%ECUn41_ STATUTE rR A BER EXCLUDE[)? NIA N POWC772258 Q110112Q16 01!1)1/2017 E.L.EACH,ICCIUENF S 1,000,000 than 11k 1n NH) IIY -dcsendcundc� E.LVISEASE- DESCRIPnM OF OPERATIONS 110111 EA Er•IpLOVE S 1,000,000 E.L.MSEASE-POUCYUkfrr 5 1,000,000 DESCRIPTION OF OPERATIONS F LOCATIONS f VEHICLES IACORO 1D1,AddluGnM ROMM,Schedule,maybe aIt cAed N morn spew Is raquFred] CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBEO 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.I suite 2035 North Andover,MA 01845 AUrNORILED REPRESENTATEVE 11 1 ACORD 252014101 Afl 98882014 ACORD CORPORATION.All rights reserved. The ACORD name and 1090 are registered marks of ACORD Office ®f Consumer Affairs and business Regulation 10 Park Plaza m Bunte 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 102726 Type: DSA Expirattnn: 7121201$ Tri 419291 POLAR BEAR INSULATION CO, Vincent LeBlanc P.O. BOX 958 = . •. ANDOVER, MA 01010 Update Address and return card.Mark reason for ebange. SCAT ca 201+4-05111 Address ® .Renewal (] Employment E Yost Card etc•`t'�rr+rurrmnrr�crr/!�c*�'%'-i'�lcrr.crnc/rrccr'!s ornee orConsumer Paffnirs&Susluess fiegarlaaion License or registration valid for individual use only ' HOME IMPROVEMENT CONTRACMR beforethe expiration dates If found return to: t Registration: 1027'26 Type: Office of Consumer Affairs and Business Regulation r f Expiration: ' 7/2/20111 DBA 10 Park Plaza Suite 5170 ? T Boston,MA 02116 POLAR BEAR INSULATION CO. Vincent LeBlanc 5180.CANAL ST.*5A t: � •�. LAWRENCE,MA 01841 Undersecrelnry I4lot valid without signature f r�@'es:achaasetts -"�eiaa� asr�� 'J.tirs6l���atc�t;r y _ Board Of suilding Regulations and standards :erxsa: CSSLA06017 l PETERALEBLANC f h, 2 EAST DINE STREET Plaistow NH 03865 C xca�rz csse ara r 04/28/2010 n