HomeMy WebLinkAboutBuilding Permit # 1/6/2017 BUILDING PERMIT NoRrH
0�{,rLE�
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ',
permit [loft: Date Received
RSSRCHUS��
Date Issued: I�
TMPORTANT:Applicant mast complete all items on this page
LOCATIONA a
Print
P-ROPERTY ®WNER
Pnnf i DD Yeer Structure:; yes no
MAP tJPAR6EL-°- _ZONING DISTRICT.
Machine S
` Htstarrc Distract ye:5 no
hop Vrllag yes no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non Residential
❑ Ne`n+ Building 'One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
)'Repair, replacement 0 Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
F77Septic 1Nell D I`loodpfain n Wetlanai5' ` ' 0 Watersl ed brstr b-t
0.Watbrtseiver..
DESCRIPTION OF WORK TO RE PERFORMED:
kir gatnj , ; w ino f �fli' CMInlin +va,11f 44114$ inSWI
U 61
wi Qus� ham Pyxis - 4, 6 n . ' WIVer+ +I c when r ra
Tdentification- Please Type or Print Clearly'
OWNER: Name: IT n& P It' c� Phone: �y X87 -lot
Address: 18 incvi✓ C vrf 064 oYtx M4 018q5
Contractor Narrie° 'ct1ae,1 r Phone-
Add
hone. 3
Address: fb . 111 Mu. - MH 631.x$ .
Supervisors Construction License:..__. _ COH I Exp. Date .. 2011). ..
Home Irnpravemerit Lrcense 1$21712 Exp; Date:: `t. Z&>t7.
ARCHITECTIENGINEER Phone:
Address: Reg. leo.
FEE SCHEDULE.B ULDINO PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S F
r. ,1-atal Project Cost: $ FEE: $
Check No.: Receipt No., 1
NO'T'E: Persons contracting with unregistered contractors do not have.access to the r an farad
�i "naturo of:A _erilOwner - _ Signature of contractor'
9 _- _W-..J - - - - - . . ... --:._..
BUILDING PERMIT �oRry
Q`{T.LED 16'9
TOWN OF NORTH ANDOVER -
APPLICATION FOR PLAN EXAMINATION
permit bio#: n(A L- 2-
" � Date Received � VrEDO4 �
Date Issued:
�SSRCHUS��
TM-PORTANT:Applicant must complete all items on this page
LOBATION � . _. Cau►�- _
PriiSt
PROPRTya._
100 Year Structure yes no
MAP _ PARCEL:_ZONING DfSTRICT: Historic Dfstnct yeas no
-
Machine Shop Village yes no
N.�
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building )V'One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
'Repair, replacement ❑Assessory Bldg ❑ Others:
❑ Demolition ❑ Other
Dp
S tic Weft Floodplain C V11etlands" 0 Watersleel bstrict
11 Waterlsewe' r.
DESCRIPTION OF WORK TO DE PERFORMED:
R.ir "nm in a�f a fi' n a[!s ails' r
w1 �d PSC ham e1xi5
' 6 n ' i lk V 'I civ chwh�s r ra
Identification- Please Type or Print Clearly
OWNER: Name: Phone: (q7d 6,87 -1063
Address: 48 knuk &144- > A- 0Vtx a SyS
ontracfor Nane. Phone:: 3U-26V
_
Address: Po Zox 691(iHand—w-&c. NH 03165
Supervisor's Construction License:..._.. _ fJD�If Exp. Date: $.1 -7-1 2o1) .
Home itnpr merit License: Exp: Date `1. zo1-7.
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDINO PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125-00 PER 5 F
r. ,T'otal Project Cost: $ 7(� 7. FEE: $
Check No.: Receipt No,_
NOTE: Persons contracting with unregistered contractors do not have.access to the ran frond
5�gnature af:AgerifiLOvtirner� S[gnature of contractor'
NORTh
Town of
Andover
O "'•
o h , ver, Mass, 140 do to
0/
.Q
coc��c.�lw�cr 'L'
S t!
BOARD OF HEALTH
Food/Kitchen
PERMIT T LD Septic System
aft
THIS CERTIFIES THAT 01.1 C.j!* ..........J. .y.......... BUILDING INSPECTOR
�
has permission to erect .......................... buildiggs on ...J.)........C..���!„�.�w.4Foundation....,,.�!.�..�..,,, i
Rough
to be occupied as ! 0 .... .. ...........
p ........................ ......................�. .,.... . .�..�..�.�.�..�,..... ..���, � Chimney
provided that the person accepting this permit shall In every respect conform to the terms of the application Find
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 CONSTRUCTM ST RT Rough
Service
........ . .......... ...... ..,.,....................................
Fina
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildink 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 ID#05-0405629
RISE Engitieerhig RI Contractor Registration No 5106
MA Contractor Registration No 120979
RISE A division of Thicisch Cngincering C7 Contractor Registration No 6.20120
FN61NEERING
(,t)Sliamnnt,Canton,NIA 02021 CONTRACT
339-502-5197 FAX 339-5026345 1
Page 1
PROGRAM
�ti rj THIS CONTRACT is ENTERED INTO nETWEEN RISE
CMA-HES ENGINEERMO AND THE CUSTOMER FOR WORK AS
DESCRIBED BELOW
CUSTOMERC3 PHONE DATE CLIENT# WORK ORDER
C'7
Jennifer Pollina (978)687-1063 01/19/2016 427962 00002
SERVICE STREET BILLING STREET
18 Chestnut Court Is Chesin[it Court
SERVICE CITY,STATE,ZIP RIWNG rITY,STATE,ZIP
1:57
North Andover, MA 01845 North Andover, MA 01845
3 DESCRIPTION
AIR SEALING:Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage. This work will he performed in
concert Willi the useofspecial tools and diagnostic tests to assure that your Erorne will he Icll with a healthful level ofair exchange and indoor
air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for scaling include air leakage
to attics,basements,attached garages and cuter unheated areas(windows are not generally addressed.) This will require(8)working hours.
A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed.
At the Completion of the wealheri7anion work,and at no additional cost to lite homeowner,a f final blower door andlor combustion safety
analysis will be conducted by the sob-contractor to ensure the safety of the indoor air quality.
$680.00
Alit SFALING ADDER: (4)Working hours.
$340.00
Alit SEALING:Provide labor and materials to install Q-ton weatherstripping and a doorsweep to(3)door(s)to restrict air leakage.
$225.00
DAMMING:Provide labor and materials to install a 12"layer of R-311 unfaced tibergImss balls to(42)square feet for daruming purposes_
$86.10
A'1.1'IC FLAT:Provide labor and materials to install a 10"layer of R-35 Class I Celhtlose added to(1040)square tcet ofopen attic space.
$1,5214,80
A'I-1'IC FLAT:Provide labor and materials to install a 13"layer of 14-45 Class t Cellulase added to(184)square Iccl of open attic space.
$299.92
AT-HC FLATProvide labor and materials to install a 14"layer of R49 Class I Cellulose added to(96)square feet of upon Attie space.
$162.24
AT"t'IC ACCESS:Provide tabor and TtiateTials to install(t) easily nloved,Instdatiti6 cAiver for the attic acc ss folding stair, A mall flak
surface of plywood will tie created around the opening within the attic. 'this will allow Ilse cover's integral weather-stripping to restrict air
leakage.
u
V
$237.65
VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with Toof niounted flapper vent to exhaust future
bathroom fan(s).
$237.50
VENTILATION:Provide laborand materials to install ventilation chutes in(I 11)rafter bays to maintain air flow.
$222,00
COMMON WALLS:Provide labor and materials to install 2"FSK faced semi-rigid IibergInss board insulation to(I I8)square feet of
common wall area.
$413.00
BAST MENT CEILING:Provide labor and materials to install(140)linear feet of R-19 unlaced fiberglass instllatimi to the perimeter of the
bawnicat ceiling at the house sill.
$245,00
o:
Federal ID#05.0405629
RISE Engineering RI Contractor Reglstratlon No 6486
MA Contractor Registration No 120979
A div€Sian of Fidelselr t.nginecring CT Contractor Registration No 620120
R 1:43"E
ENGINEERING
60 Bhawmut,Canton,MA 02421
CONTRACT
3311-502-5197 FAX 339-502-6345
Page 2
111ROGMM
THIS CONTRACT
CUTEFOEEN RISE
CMA-HES E GINEERINAND n;E SOMR R WORK AS
DESCRIBED BELOW
CUSTOMER PHONE DATE CLIENT b WORK ORDER
Jennifer Pollina (978)687-1063 01/19/2016 427962 00002
SERVICE 6TREFT DILUNQ STREET
18 Chestnut Court 18 Chestnut Count
SERVICE CnY,STATE,ZIP � ----�---. BILLING C",STATE,ZIP
North Andover,MA 01845 North Andover, MA 01845
JOB DESCRIPTION
low t-riginecring will apply all applicable,eligible inccntiVes to this Contract. You will Only be billed die Net amount. Carrcnily,for eligible
tneasures,Columbia Gas orlon 75%incenlivc,not to exceed$2,000 per calendar year,and an incentive or t00%for the Air Scaling measures
tip to tits first$680 wid an additional$340 ifsavings ore justified by the nudilor.
For the safety and healtb of your home's indoor air duality,we will be conducting a blower door diagnostic of the available air clow in your
hone both before the work is begun,and after lite weailieriiation wort;is completc.We will also conduct a rull assessment ofthe
combustion sarety of your heating system and water heater.This has a value of$90 and is at no cost to you, Total allowable we'll lterization '..
incentive is$3,110.
$90.00
L oci
Total: $4,767.21
Program Incentive: $3,110.00
Customer Total: $1,657.21
WE AGREI;HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECtFicATIONS.FOR THE&tim OF
'One Thousand Six Hundred Fifty-Seven& 211100 Dollars $1,557.21
UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMQUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONIRLY ON ANY
UNPAID BALANCE AFT 30 DAYS,BEEREVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,nIOHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION,
Do NOT SIGN THIS CONTRACT It:THERE ARE ANY BLANK SPACES
AUTHORIZED SIGNATURE-RISC EftinftaN Cul. ER ACCEPT ICE �J
NOTE:T1118 CONTRACT MAY DE WITTIDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE `
ACCEPTANCE OF CGNTRACT•THE ABOVE P=0,SPECIFICATIONS AND CONDITIONS ARE
30
DAYS. SATISFACTORY TO US AND ARE HERESY ACCEPTED,YOU ARE AUTHORIZED To DO TIM WORK
AS SPECIFIED.PAYMENT WALL BE MADE AS OUTLINED ABOVE
�V
R E
IS i-�
60 Shawmut Road, unit 21 Canton,MA 020211339-502-633501
ENGINEERING" www.RISEengineering.com
I`V
OWNER
�a
C7'7
U iF l�
AUTHORIZATION
Jennifer Pollina ,
(Owner's Name)
owner of the property located at:
18 Chestnut Court, North Andover, MA
(Property Address)
(Property Address)
hereby authorize CWX-
(Subcontractdr)
an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building
permit and to perforin work on my property. This form is only valid with a signed contract.
d nets Sig ture
/0// --/ )0/(,
Qat
i
I
i
;', The Corr mort€ve,`aftlt of Massach.rasefts
DepartrrteW oj'1nth4S1tafft1l cciffertts
7
r iF r� Brasftm,HA 02.114-2017
Workers' Compensation Insurance Affidavit:General Rushlesses.
lis a � aaf �ttl iof� Please Print Le gi l
BusinesslOrganization Mill City Energy _.-... _ -------
Address,PO Box 6411
City/St-,j Manchester, NH 03106 I']�can�#:603-391- 923
Ar•e you an employer?Check the appro priaate box- l�usira4,ss Type(req oired):
t.E/1 l an a employer 3vifir 12_...._._._._.___cnrployees(full and/
5. El Retail
Or pari-tirne).* 6. 0 itcstauearrtlt3arll eying Establishmeof
2.[�
I.am a sole proprietor or partnership and Dave no 7. I--j ofl.-ice a ndlor Sales{incl.real(tstate,auto,etc.)
employees working R)r sire in any capacity- Non-profit
(Ho workers' comp. insurance required]
3-0 We aro a corporation ar3d its officers have exercised 9. ❑ >r3tertaailasncnt
their;mitt of excillptioil per c. 152,§i(�3);and we have 10.E] Manu#actui irrg
no employees. (No workers' comp.insurance roquiretd-- 1 i.� l�lealth Care
We aro a non-profit ori- nizaation,staffed by volurrtcers,
~villi no elr3ployces.(i�lo wc>rl.ers' conrp,insuranc,c reel.] 12. C)tlrer 1r�,�.o .�x±.Zl�l.oi1
Any applic�mni tllat cheeks box n'1 Irnlst also fill out the scerir�Fr booty shoaline tlu.ir w;xl�ers'compel}�saliain policy infGrrrustio�F.
"If rhe car;,arFrte oi'ticcrs have excmpled ihenrscly s,but Shr;r<rpnsaurn}has other c;;�li4oyees.a:.nrt;ers'compen5.4ion policy is reeluircd and srlc:h era
i� ani'rution stFou.ld check box'i.
. @RlPR ldfd�EfFfJfO�IE'Y ftf(Et t,,4 7P'E1N(1tftP r rr�OY r('P",4''COtfdf3L'PRSfdfdOPF t1'85(EY(REFL'6 t7Y PPt�r L'iPd,(7lP}3Pe5. f'tYow(S file Policy F'ifivftiation.
i. Insurance Corrrharty blame:Clark Insurance
Insurer's Address:One Sundial Avenue Suite 302N
Manchester NH 03'102
Citylslate.7..ip
Policy It or Self-iris.Lic.t#MIVVC791896 � _Expiration Dacc::4129f20 l7
Attach:i copy oI'tlae Markers'corsrpearsatioaa pokey cleclaraalion Page(Sholvidg the policy lieamber and expiration d,ate).
I
i; Failure to secure covera-ge as required under Section 25A of MOL c. 152 can lead to tint;imposition off-rimilaal penalties oi'a
file rap to$1.,500.00:and/or one-year imprisonmem,as well as civil penalties in the tome of a S' OP W 1121<f}RDFR and a tine
oC up to`E250.00 a day apinst the violator. Be advised thasl a copy of dais statement may be forwarded to the Oflice of
Investigations ofthe I31A for irisin-ance coverage verification.
C elf)I(L'@'(:b3}L,'('Yft��,it L!'Pt.4((}P(f�7Bltld(fdE?'Of)1'YJtEFj�Mat the dAt f13FFdd!!(!F)!t )l"Il4�If C,+[t above!S trite and(.'!)d•Yeet.
€]ate:
1?h{sne fr;603-396'7520 l
Official use only. Do isot write in this area,to he completed by ei(y or fown gjyieial.
€ ity or Town: hermit/License#_,_.__.....__..�
Issrairag Crrtlrc>r•ity(circle orae).
i. Board of'Health 2.Building Department 3.Cityff'own Clerh 4.f..iceaasirag„110aud 5.Selectraterr's ol£ce
6.Other
contact Person. Phone#.
�VIVI'S'.E7rFFti5.t7U�'fril2r
MILLCITY-1 AGOULD
ACRO DATE(MMIDOIYYYY)
CERTIFICATE OF LIABILITY INSURANCE 7119/2016
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 on this certificate does not confer rights to the
certificate holder in lieu of such endorsement(s).
PRODUCER License#AGR8150 NAME:
Clark Insurance PHONE -- FAX
One Sundial Ave Suite 302N _IAI No.E><t) {603)622-2855 Arc No):(603)622-2854
Manchester,NH 03102 E-MAIL agould@clarkinsurance.com
INSURERi5�AFPORDING COVERAOE NAIC fi
INSURERA:Arbella Mutual Insurance Co 17000
INSURED INSURER B!AmGuard Ins co 43290
Mill City Energy INSURER C:
106 Joseph St — _......._.. .._._
PO Box 6411 11"URER0,
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.
_ _ _
!LTR — --TYPE OF INSURANCE !NSD NAlD POLICY NDMBER MMIDDYlYYYY MMlDDY ExP LIMITS
A X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000
DAM GE TO RENTED
CLAIMS-MADE X OCCUR 8500065735 0412912016 44129!2017 PREMISE& Ea occurrence $ 300,000
MED EXP(Any one person) $ 5,000
PERSONAL&ADV INJURY $ 1,000,000
GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000
PRO- �
POLICY D JECT L_.�.1 LOC PRODUCTS-COMPIOP AGG S 2,000,000
OTHER: _. _$
COMBINED SINGLE LIMIT
AUTOMOBILE LIABILITY Ea dcddertt} .,__-� $ 1,000,000
A JX ANY AUTO 1020050919 04129/2016 04/2912017 BODILY INJURY(Per person) $ALL OWNED SCHEDULED BODILY INJURY(Per acddent)AUTOSAUTOS X NON-OWNED PER DAMAGE $
HIRED AUTOS AUTOS
$
X UMBRELLALIAB X OCCUR EACH OCCURRENCE $ 1,000,000 ''..
A EXCESS LIAR CLAIMS-MADE 4600065736 0412912016 04129/2017 AGGREGATE $ 1,000,000
DED I X RETENTION$ 10,000 $
WORKERS COMPENSATION X PER OTH-
AND EMPLOYERS'LIABILITY STATUTE ER .._.—
R ANY PROPRIETORIPARTNERIEXECUTIVE F NMIWC791896 04129/2016 04129/2017 E.L.EACH ACCIDENT $ 500,000
OFFICERIMEMSER EXCLUDED? N/A
------.._........ —...._ ,,
(Mandatory In NMI E.L.DISEASE-EA EMPLOYE $ 500,000
If yes,describe under
DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000
DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Addlt€oval Remarks Schedule,may be 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
O 1988-2014 ACORD CORPORATION. All rights reserved.
ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD
Massachusetts Dep erhinont of Public 'fin M- y Cd)nshi1C",fion Sldpeivisor
fRomcd of Buuildiatt Regtfla loos mid Stanclwds Restricted to
Uin(shicted Buildings of arty use grOUl)whrch contain
Ue nse: C9-110041 less than 35,000 cubic feet(999 cubic meters)of
4„u�nstructmn ;.r19i:14?r"+�GM�or
enclosed iJa('e.
MICHAEL.JOY
'106 JOSEPH STREET
MANCHESTER NH 03102
0 M'acture to trossess a current edition of the Massachusetts
h� ..-... E-Xp iiration: State Buildii 9 Coder is cause for revocation of this license.
Commssionar 08/07/20'19 ()PS Liceiming information visit:WWW.MASS.GOVICPS
ct�rla^
Officv of(oroviru�u�r r +att 'n, � tCn�rtwa�,rtrg l tion t.icermea*u�r't LNr°stied�uli t for irru it�ialrai rr Ua uprt�°
ifCMN,tMPRCt9t MLN'f i,'Cttt"f`tAC tCH luu^t"asr rtue ar tau atiuuu . It trrrrrrrt rrlrrr"e to:
wi r u r to tie��u: ytee; Offire ofCorlstittle rAf(Air�And tfwiues,�Iteg1,011rl(oil
10 Park f'kzm ,S
LLC rsit¢5170
f.aapirart6or. tt eF� t't
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