Loading...
HomeMy WebLinkAboutBuilding Permit # 1/12/2017 BUILDING PERMIT No714 TOWN OF NORTH ANDOVERio _ APPLICATION FOR PLAN EXAMINATION Qq cO[MrcanwrcN 47' Permit No#t: C Date Received �ySSgCH Hus Date Issued: 1 IMPORTANT: Applicant must complete all items on this page LOCATION �� I� Print PROPERTY OWNER P1sly Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District ye no Machine Shop Village ye 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 9 Others: ❑ Demolition ❑ Other ;-7r)5"A sr ❑Septl,c }❑Well L7 I=(aocipla�r ❑Vlletlar�tls � ❑,{11Llatershed ©i t �ct� � � r .... �✓ ..... � ',.... . .:-. .. ...M:., '�.< v", 5 " '✓� � 'w x�F it ^� i�ra°"`''cam . DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name:_�c r� d�cl le0 Phone: Address: V #fit eq V1 Contractor NamePeter Leblanc Phone: Email: 2 EaStink eet Address: 97$407®7638 Supervisor's Construction License- Exp. Date: Home Improvement License: /c))-��L 6, Exp. Date: ?1,b ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL.ESTIMATED COST PA,5ED ON$125.00 PER S.F. Total Project Cost: $ t'/000• a O FEE. $ Check No.: 0 Receipt No.: (J-'7 NOTE: Persons contracting with unregistered contractors do not have aeces to the guaranty fund g4®RmL-m dover Town of7 F� ? .1 An J* cb -714-e;al No. _. - 4 O awieE ver,9 11JLfiS�7' Jj& . COC IIIC nF WICK V I OIA17 S � BOARD OF HEALTH Food/Kitchen `+`_ PERMITA LD� Septic System THIS CERTIFIES THAT .....?w�Ad. .. .. BUILDING INSPECTOR... Foundation has permission to erect..........................buildings o ......... .....• ...................'................ • Rough h to be occupied as ...... hq* ...., .....�A i . .•...................................................... Chimney provided that the person accepting this plarmit 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 j Final PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR., LESS CONSTRUCTI T R Rough Service .......... ... .,. .......................... BUILDING INSPECTOR Final GAS INSPECTOR �.Occupancy Permit Required to Occupy 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. soft ISE 60 Shawmut Road,Unit 21 Canton,MA 020211339-502-6336 ENGINEERING www.RISEengineering.com OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at; C•' �IG C! A i //& Z (Property Address) (Property Address) hereby authorize G r is S✓C� j� , (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. E-SIGNED by Marion Mako Owner's Signature A a p Date Illix- ronjoral ID>f 06-0406629 RI contractor Registration No 8186 RISE Engineering MA Contractor Registration No 120979 CT Contractor Registration No 620120 ENGINEERING,' ISE- 611 Shalvain't Road,Canton,MA 02021 CONTRACT ENGINEEPINO 339.502-5197 li'AX 339-502-6345 Pago I PROGRAM awes coNTRACr w9 EtrTEReo wnro RWnIE 7HE CU,IOMERFOWKAS CMA-TIES DFSCflHVE0flFL0W 0 (978)685-0467 t2/15/2016 416487 28604 John Make 62 Granville Lilrie 62 Granville LOrtle North Andover,MA 01845 North Andover,MA 0 1845 JOB DESCRIPTION AIR SFALING:I)JrVide labor and maleriAIS to Seal W&i 01 his work will lie performed in $1,021),00 concelt'vViall the use ol'special toots and diagnostic tests toassule that'our homne\N ill be lell vN ull a bealtinal level urair exchange and indoor air (Inality.Materials to be used to seal your lionic can include caulks,rt)alns and Other products I'lillulay ales Io.s.c;liillg illeltale air leakage to attics,basements,attached garages and other tullicated areas(vv nruvvs are not generally adds SsCLI) 'I his Will require(12)working hours,A reduction in cubic ted per ulanae Who)of air infifiration Will Occur.hit(the actual number ofelin is not guarmaee& At the coralkiiOn Of(Ile Weallrelization work,and at noaddilrollal cost to the houlcowner,a final blovver door and/or col"bUslion sRIcIY aljajysjs will be conducted by tile sub-contractor to ensure tile safely ofille indoor air quality. DAMMING Provide labor and materials to install a 12"layer ol'R-38 unfaced fiberglass Batts to(74)square lect far drinaning purposes. $151.70 O() ATTIC FLAT:Provide labor and materials to install an 8"layer ot*R-30 Cliass I Cellulose added to(1324)squarc I'M Of'Open attic Space. $1,906.50 wjj()J,V:1101lSE FAN:Provide tabor and materials,n)fabricate and install a rigid foam insulating cover fertile Wrote I'Mise Ron. $2.019.21 attic access fel(fing start, A small Walt surface $237.65 cover low the a ATrIC ACCESS:Provide labor and materials to install(1) easilY moved,moved,alstll"'r' (lie ,-his wall allow be covers altegral it)restrict air tuakage, Orply\volo(I will be created around the openi"Ll,Within tile a VFNTILATION:Provide labor'told alaterials to install(2)insulated exhaust hose with roorniounted lial),jer veil,to exhaust existing bathroom $237.50 faill(s),Broan model 0 636 Or equivalent VFNTILATION:Provide labor'aid Inateriis to illslali veatilantm chores in(8 1)rafter bays to maintain air Clow. $20150 Federal to#Orr0406829 RISE Engineering RlContractorRoglatratlon NO 8186 MA ContraetorRegletratlon NO 120979 CF Contractor Reglatratlon No 620120 RE 60 Shawraut Road,CaDton,MA 02021 CONTRACT Tp p/+'f' ENGINEERING' 389.g02_g197 FAX 339-502.6345 V®N`RAC 1 Page 2 PROGRAM Mg�pcICNgCpW�RAOr NOUC& oE �TrAa CMA-HES -. John Mako (978)685-0467 12/15/2016 416487 28604 62 Granville Lane 62 Granville Lane ZLF North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently,for eligible $9D.00 measures,Columbia Gas offers 75%incentive,not to exceed 52.000 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 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 bolls before the work is begun.and after the weatherization work is complete,We will also conduct a full assessment of the combustion safety of This has a value of$90 and is at no cost to you, Total allowable wealherization incentive is S3,1 l0. your heating system and water heater. The permit will be secured by the insulation contractor,at no additional cost.It is the homeownees responsibility to close Out this permit by contacting their municipality at the completion of this work. Total: $4,056.12 Program incentive: $3,110.00 Customer Total: $946.12 WE AGREE HEREBY TO FURNISH SERVICES.COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OP ***Nine Hundred Forty-l=ive&121100 Dollars $945.12 UPCNFINAALINUWAJOBAtAkFt�A�rsaF"aaonA�RecpveAn avoaiMF�°Nren�o�ncer�a�oww�wr�sa.waKre`o'�"�A.Se °rG'Kd"aNv o aea"�inAnoK E-SIGNED by Michael Trudeau E-SIG- y arson a O NOTE:Tree COWM TMAY 6EMRDMWN BY USIF NOT EKECUTEUVW1dN DATE �OpFOA7WEPTAR��C��Epp�� R�pyVay spy ACCEPTANCEWONTRACT' 30 DAYS. A9�9PfiC[FIEEI PAYFIFlIT1DYaA,t"68 MAGOA i UTUMA00gVaEA[rt A P' btl��WOaK DATE(MWDDY Y YY) 0/2AC R CERTIFICATE OF LIABILITY INSURANCE 6/1oi6 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 AQDITIONAL INSURED, WAIVED, subject to the polloy(ies)must be endorsed. if SUBROGATION IS WA the terms and conditions of the policy,certain policies may require an endorsement. A statement on this certificate does not confer rights to the certiflcate holder in lieu of such endorsement(s). ccrlracr PRODUCERLinda: Linda Bogdanowlez FAX PHONE . (603)382-4600 No (603)362-2034 Insurance Solutions Corporation E-MAIL lindab@i8c-insuranco.Com 60 Westville Rd ADDRESS: INSURER S AFFORDING COVERAGE NAtC Plaistow Ng 03865 INSURER A W06tern World INSURED INSURER B MantiluS Insurance Grou Polar Bear Insulation company Inc INSURERC: PO Box 958 ENSUPER R D: R E Andover MA 01810 F COVERAGES CERTIFICATE NUMBER CL1632326134 REVISION NUMBER: THIS I5 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 VIM1TH 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. A 0 S aA POLICY EFF POLICY EXP LIMITS ILTR TYPE OF INSURANCE POLICY NUMBER M+ODN Y MM/D YY EACH OCCURRENCE $ 1,000,000 X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED 100,000 PREMISES Ea occurrence S A CLAIM&MADE n OCCUR 5,000 NPP8274967 3/24/2016 3/24/2017 MEDEXP Any One Person S PERSONAL B ADV INJURY $ 1,000,000 GENERAL AGGREGATE $ 2,000,000 GENT.AGGREGATE LIMIT APPLIES PER: $ 2,000,000 PRODUCTS-COMPlOP AGG R POLICY F1JPECY LOC $ OTHER: COMBINED SINGLE LIMIT $ AUTOMOBILE LIABILITY Ea accident BODILY INJURY(Per Person) $ ANY AUTO BODILY INJURY(Per actldani $ ALL OWNED SCHEDULED AUTOS AUTOSNON-OWNED PROPERTY DAMAGE $ Per accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ —ALO-00,000.. X UMBRELLA LI AB pCCUR AGGREGATE $ :L'000,000 B EXCESSLIAa CLAIMS-MADE DIED REfENTIONb AN026107 $124/2016 3/24/2017 $ WORKERS COMPENSATION PER ERH- AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $ ANY PR PRIETOR EXCLUD pEXECUTIVE ❑NIA E.L.DISEASE-FA EMPLOYE $ (Mandatory In NH) It yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OP OPERATIONSI LOCATIONS/VEHICLES(ACORD 101,Additlonal Remorke Schedule,may be attached it more space Ia required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE tiOTltt of North Andover THE E)(PIRATSON DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 1600 Osgood St, Ste 2032 North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Reith Maglia/SJAw ©1988-2014 ACORD CORPORATION. Ail rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD I1115'02b 1�nidO4V tusurance Services 1/312017 DATE(MMIDDIYYYY) A� CERTIFICATE OF LIABILITY INSURANCE 01/03M2017 THIS 8 CERTIFICATt I5 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 hatder is an ADDITIONAL INSURED,the policy(les)must be endorsed.It 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 FO Al C,NoAutomatic Data Processing Insurance Agency,Inc.1 Adp Boulevard ENSURE.I3)AFFORDING COVERAGE NAiC N Roseland,NJ 07068 31470 INSURER A: No GUARD Insurwen Company INSURED INSURERS, POLAR BEAR INSULATION CO INC INSURERC: PO BOX 958 INSURER D: Andover,MA 01610 INSURER E: pE p INSURER F; COVERAGES CERTIFICATE NUMBER: 598370 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 E INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,TH . EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS, uMl7s OR TYPE OF INSURANCE INSD!AID POLICY NUMBER MMIDDlYYYY M1Dl?tYriY EACH OCCURRENCE $ COMMERCIAL GENERAL LIABILITY E5ES CLAIMS-MADE D OCCUR MED Ea occurnrnoe ABED EXP EAnY ono person) $$ PERSONAL&ADV INJURY $ GENERAL AGGREGATE $ GEHL AGGREGATE LIMIT APPLIES PER, PRODUCTS-COMWOP AGG S POLICY❑JE O ❑LOC $ OTHER: Ea accfden1 $ AUTOMOBILE LIABILITY BODILY INJURY(Per Person) S ANYAUTO BODILY INJURY(Pa xcclderill $ ALL OWNED SCHEDULED AUTOSAUTOS $ NONrOWNED Per aceldenl HIRED AUTOS AUTOS $ EACH OCCURRENCE S UMBRELLA LUIS OCCUR AGGREGATE $ EXCESS LIAR CLAIMS-MADE $ DED RETENTIONS x WORKERS COMPENSATION STATUTE ER AND EMPLOYERS'LIAMLnV E.L.EACH ACCIDENT S 1,000,000 NJY PROPRIETORrPARTNEPoEXECUTIVE Y�N 1 A N pOY11C8a0361 01!0112017 01101121198 1 000,000 A OFFICERIMEMBER FXCLUDED7 E.L.DISEASE•FA EMPLOYE $ (Mandatory in NN) 1,000,000 IS yes,das�Abo,ndw E.L.OISFASE-POLICY LIMEY 5 DESCRIPTION OF OPERATIO bebetow DESCRIPTION OF OPERATIONS LOCATIONS!VEHICLES(ACORD 101,Additional Remarks Sobedula,May W attachad It Mora apace H raquSrod) Contractor License:CSL 108017 HIC 102726 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Town of North Andover 120 Main st AUTHORIZED REPRESENTATIVE North Andover,MA 01845 l O 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD 1!1 ISExternallapplindex.11tmi?cl ientid=2037315&requestProm=ruti#I home https:lladpia.adp.cotnl The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 www.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/El lee le se Print Legibly Applicant-Information Name(Business(Organization/Individual): PO BOX 958 ANDOVER,MA 01810 Address: City/State/Zip: Phone#: FE11 employer?Check the appropriate box: Type of project{required): employer with [j 4• ❑ I am a general contractor and 1 6 ❑New construction * have hired the sub-contractors ees(full and/or part-titre). 7. Remodelin listed on the attached sheet. ❑ g sale proprietor ar partner- These sub-contractors have g, ❑Demolition d have no employees employees and have workers' E; working for me in any capacity. 9. ❑Building addition comp.insurance.1 [No workers'comp.insurance 10.❑Electrical repairs or additions required.] 5. ❑ We are a corporation and its officers have exercised their 11.❑Plumbing repairs or additions 3.❑ i am a homeowner doing all work thyself.[No workers comp. right of exemption per MGL 12.❑Roof repairs insurance required.]t c. 152,§1(4),and we have no 13.�Other t1 r / employees.[No workers' comp,insurance required.] *Any applicant that checks box#t must 0180 fill out the section below showing their workers'compensation policy information. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. $Contractors that check this box must at an additional sheet showing the name of the sub•cootractors and state whether or not!hose entities have employees. if the sub-contractors have employees,they roust provide their workers'comp,policy number. I ant an employer that is providing workers'compensation insurance for my employees. Below is the policy olid job site information. tA t Insurance Company Name: V 19 7)iiv L C �� Expiration Date: at Policy l#or Self-ins.Lic.#: ► D t✓C } Job Site Address: arq;— �'�� City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing 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$1,500.00 and/or 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 violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under the Pains and penalties of perjury that the information provided above is true and correct. ' Date: Si nature: Phone#: rFissuing nly. Do not write it,this area,to he completed by city or town of7pecto n: Permit/License# ority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electr71n_1Pe--t0]1r 6.Other Phone#: Contact Person: Office of Consumer Affairs and Regulation 10 Park Plaza-Scute 5170 Boston,Massachusetts 02116 Home Improvement Cq ta.;actor Registration Registration: 102726 Type: DBA Expiration: 7/212018 Tri 418291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BOX 958 ANDOVER, I11iA 01810 Update Address and return card.Mark reason for ehange. ®Address ®Renewal ❑ FrnPloYffleAt Lost Card SCA 1 45 204-05111 Jfc Urdx�rnxanxurrr/f�c`c'Ffjmsrrrcfrircl(c License or registration valid for individual use only once or Consumer Affairs DuAness RegUlation HOME IMPROVEMENT CCtf4fl►AAO S t5ft before the expiration date. If found return to: Registration: 102726 Type: office of Consumer Affairs and Boslness 1teglttntiara 10 i�arkf'ina,-Suite 5170 ,. ftpiration: 712!2018 DBA76astoo,T MA 02116 POLAR BEAR INSULATiOM CO... Vincent LeBlanc m7 51 SO.CANAL ST.45A LAWRENCE,MA 01841 Undersecretary N t vniFd without signotaare 1Masssachusetts w-Department o`,•puhi is Safety ti If Bcxesac&art Sulidial Pegs,rGatlons ana"1 standards A.rr,t<-:aaaar.aa�.�'.4�tarr�iwaa- s�tu:�arti�;�' �r C SLA06017PIETERALEBLANC ? Plaistow NH 03865 �;Ei�rta'ticaa^; commrssmner 04/2812018 Q