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Home My WebLink AboutBuilding Permit # 2/10/2017 14ORTII '9 owe. of � andover p No. IWP- 2otj ".1 -C,OR h ver, Ma . 0 COCHMMew.Cn V A04ATED as V BOARD OF HEALTH Food/Kitchen PERMIT T D Septic System THIS CERTIFIES THAT NTC `C &N BUILDING INSPECTOR has permission to erect .......................... buildings on ...........Y!1..,,, .�.�c,�, ►5� 1/ ,,, ', Foundation Rough to be occupied as ........ju.#%.....stM(.0" ......0 **#A*�................................... Chimney provided that the person accepting this permit shall .04. 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 MONTHSELECTRICAL INSPECTOR LESS C® STRCTI® STARTS sough Service ......... ... .. ............ .............. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit required to Occupy .wilding 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 fR 0"405629 RUSE, Engineering RI Contractor Registration No 8106 MA Contractor Registration No 120979 CT Contractor Registration No620120 RISE60 Sharwinut Road,Cauton,MA 02021 ENGINEERING' CONTRACT 339-502-6335 VAX 339-502-6345 Page I PROGRAM 0�13 CONTRACT M ENTFRED V00 SEMEN AM C'MA-IJES 0 OINECRING AND THE CUSTOMER FOR WORK A3 DESCRIMEO REAM CUSTOMER FROM OA79 CLIMTO WORK ORUER Leo L"Ifolid (978)407-9307 01/20/2017 4143819 23902 SERVICE STREET WILLING 0711EET 49 Richardson Averme 49 Richardson Avenine SERVICE CITY,STAM XIP OILLIN43 CITY,STATE,ZIP Not-Ili Andover,MA 01114.5 Not-th Andover, MA 0 18,15 ,JOB DESCRIPTION BARRIER A Blower DoorTust will not lie a rrrrchic9cddue it)flu:-pesense ofasbustos. S0.00, 'El ' ol'your home against wastefill,exces'sair lcatmgc, This work will bc 7777iTm—o 7lrM,-5c7ih—c, fulatelials 10 Seat aryLS peff'ontrod in Concert with tile use orspecial tools Rod dialplostic tests to assure that your 110111C will be lull wilil a 11"llalful levet of air exchange and indunr air quality.materials to be used to Seat your home can include caulks,foams Had other prorbicls, Primary, nrew for.sea inuludeair lval';op;to"Ittici,hascrimits,Mulched garaqcs an(]Other unheated are:w(windotNs are not geuvw1k addro'i _cd,) 'Mis will require(10)working limms,A rvducrion in cubic luct per millille(01m)of air iii1filtralioR will occur,but the actual number of fili is not guataniced. At tile comfilction of the we"Itherization work,and In no additional cost to the bomcowter,tI final blower door and/of combustion Safety analysis will be conducted by tile sub-contractor to unsure the sallety ol'thc indoor air quality, $8500) STORAOF BARRIER 11-fornemmur is responsible for the removal Orlin;stored items blockine tire installation okwallicrizution (iultials) work in tile little, RcrRoval rause occur prior to tire scheduled wofk start. $0,00 7M —Provide labor iRid Hi.wrta FIN,insulate�15a17 11-1 F,)am,—hatCh V11-111 1_191751_17d_WR i_()—or IT the required fire rating,Wevilherstrili tire perimeter, $60.00 vF71,11 insulated exhaust hose to existirig bathroom frills). $60,00 're"i—poRs_ih le 'M1,11're_S(Orcd'ite'llm—blocking tile install"Hion ohwatheri/atioll (11tilials) Work in tire hasemcm. Removal must occur prior to tire schedirl(A work Malt. $0,00 _.Svrovi 117:1, _127)Ifireir four ot'R-19 if"faced filwglass insolation to the perimem, ol'thc bascirlem ceiling al the house sill. $237.91) ','.......... 0 ............ Federal ID ft 05-0405629 RISE Eughleclifig RI Contractor Registration No 8106 MA Contractor Registration No 120979 CT Contractor Ratifnitratlon No620120 RISE60 Shavvinut Road,Caoton-MA 02021 ENGINEERING' CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT 0 Mcnro INTO urryievi min CMA-HES EUGMECHINGAND Ilia CUSTOMER FORWORK AS DESCARICO BELOW CUSYOMOR PHONE, DATE CtJt?IT N WORK Cavan Leo Lal[brid (978)407-9307 01/20/2017 443819 23902 SERVICE MEET na.LJOM STREET 49 Richardson Aventic 119 Richardson Averme SERVICE CITY,8tATe,Z1P 1311.0110 CITY,STATE,ZIP North Andover, MA 01845 North Andover, MA 014445 JOB DESCRIPTION RISE I"Ilgilicering will apply all applicable,eligible incentives it)this contract, )'oil vVill only be WHO the Net uniount. Currently, for eligible Illeasures,coluirlbia Gas offers 75%illucillive,Trot to exceed$2,000 per calendar year,and an incentive of 100%flor file Air Scaling nicasures Up to tilt:final S680 and an udditiolud s340 it'sayings are justified fly the auditor, For ibesat'cty and licallb ol*ycair hoine*s iruloor air quality,we will Vac c(auluciing a blimer door diapnostic of the available air How in your honto both befiac the work is liquiL and lificr the wcallicrintioll wok is complete.We vvill also condtiol it VIM as'sessirwill ofthe combumion soloty of your and water ficater,'I'lik has a value of$90 and is at IT('cost it,you. '['(),at ,1111)vvablu Acallici intion incuitive is$3,110. The 11crilit will be sucured by tlw insillation CmOlfacha,at OR)additiollill cost it is the this permit by contacting lbeir municillality.q tbt:mapiction of this vvOnk. $90,00 ............................ IA?t JlaA ...........................—.",......... Total: $1,297.90 program Incentive: $1,163.42 Customor Total: $134.47 WE ROME HEREITY TO FURiTljSIj S5f1VlGrS COMPLETE 114 ACCOMANCEWIT11 ONUOVESPECIFICATIONS,FOR THE SUM Or ***0 In Hundred Thirty-Four&47/100 Dollars $134.47 TIP UNPAM BAT MCEAVIED 30 DAYS.GEL rIEVER13F.(!Oil IMPORTAt"INFORMATIOU oil RUARmjjEOI,IUGI fT 00 N T SIGN THIS CONTRACT IF THERE I ARE,�Ay- LA IKaPACE AUTHORIZE'. SIGO TURC-RISEEng nq NOTE;Tina r0lrTAACT MAY BE WITHDRAWN BY 00 IF ROT MOB TEO VaTHIN DA1111 OF ACCEPTANCt: ACCEPTANCE OF COWRACT-THE ABOVE pAICES,SPECIFICATIONS MaICOOaHTION3 ARE SATISFACTORY 10 US AUD ARE:146REBY ACCEPTED,YOU AREAUTHORVED TO DO DR!WO91t 30 DAYS, AS SPECIFIED.PAYMENT WILL Of!MADE AS OUTLINED A130VF �f 60 ahawrmut Road,Unit 21 Canton,MA 02021 339-502-6336 ENGINEERING www.RISEengineering.com AUTHORIZATIONOWNER I, C? (Owner's Name) owner of the property located at: o4 vr-- (Property Address) c)L (Property Address) hereby authorize 7-4✓" VN ✓l a 7 B (Subcontractor) an authorized subcontractor for DISE 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. The 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. Owner's +ignature Date I . .... 6.2016 The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street Boston,MA 02111 w►vw.mass.gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly LAR 9EAR N Name (Business/organization/Individual): PO BOX 958 ANDOVER,MA 01810 Address: City/State/Zip: Phone #: 77 " CT 5-1?-5' Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with�_ 4. ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑Remodeling ship and have no employees These sub-contractors have g, []Demolition working for me in any capacity. employees and have workers' 9 ❑Building addition [No workers' comp, insurance comp.insurance.: required.] S. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL 12.❑ Roof repairs insurance required.]t c. 152, §1(4),and we have no employees. [No workers' 13.❑ Other comp, insurance required.] *Any applicant that checks box 41 must also 611 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. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workers'comp.policy number. I ant an employer that is providing workers'compensation insurance far my employees. Below is thepolicy and job site information. Insurance Company Name: V A S �T)o i v r e C Q t Policy#or Self-ins.Lic. & Expiration Date: �► .74 J�' Job Site Address: t'rA4T S t kit/ 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 unprisonment,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 parns.andpenalties of perjury that the information provided above is true and correct. Signature: - Date: All Phone#: Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2.Building Department 3.City/Town Cleric 4. Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: + Office of Consumer.Affairs and Business Regulation 10 Park Plaza- Suite 51.70 Boston,Massachusetts 02 .16 Horne hnp3rovement Contractor Registration Registration: 7 D2726 Type: DBA Expiration: 7)212018 7dr 419291 POLAR BEAR INSULATION GO. Vincent LeBlanc P.O. BO'*' 958 ANDOVER, IIIA 01810 - Update Address and return card.Mark reason for ehange. scAt 0 FOIA-06M E)Address ❑Renewal E] Employment Q Lost Caryl ��r�rv��nrr+irrrr•ri/!�of G•;��frs;rir�rrrcf�/,t Office orconsainer Affairs&Business Regulatiou License or registration valid for individual ass only 140ME IMPROVEMENT CONTRACTOR before the expiration date. If return to: Oh's I@egtstraffar: iD2728 YPe- office of Consumer Affairs tend Business Regnlation Expiration: 7I212018 DBA 10 Paris Plaza-Suite 5170 Boston,MA 02116 POLAR BEAR INSULATION CO. Vincent LeBlanc 51 SO.CANAL ST-45A LAWRENCE,MA 01841 Undersecretary Noivalid without signature y 1 MGss�cs �isL'cs = s��;;ir sn '?°.::, :a 8a Loi �t�CjLlintiG,!s :Ind S7t--n 'nrdE; C SSL406017 r PETER A LEBLANC 2 EAST PM STREET Plaistow NH 03865 04/2812018 a •`«®RDO� CERT'IFICAT'E OF LIABILITY INSURANCE DATE(MMroD/YYY1� 6/10/2026 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(les)must be endaraed. if SUBROGATION IS WANED,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 endorsements. PRODUCERCA ERCT Linda Bogdanowica insurance Solutions Corporation PHONE (603)382-4640 PtiC No:(603)382-2034 60 Westville RdE-MAIL ADDRESS:lindab@ilsr-insmranve.aom INSURERS AFFORDING COVERAGE NA1C d Plaistow N8 03865 INSURER A WOStOrn World INSURED INSURER B 3HautiluS YnSuraDCO GroU '.. Polar Bear Insulation Company Inc INSURER C: PO Boat 958 INSURER D; INSURER R: Andover MA 01810 INSURER I; COVERAGES CERTIFICATE NUMBER:CL1632326134 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 VVITH RESPECT TO WHICH THIS CERTIFICATE MAY BE ISSUED OR MAY PERTAIN, THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL TH£TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I6S R TYPE OF INSURANCE. N 0 SBR POLICY NUMBER PDWDDIY CY YF POLICY EXP LIMITS '.. A COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S 1,000,000 DAMAA CLAIM&MADE U1 OCCUR PREMISES Meocc occurrence) 100 000 P E ESES Ee accerrence S � MPP9274967 3/24/2016 3/24/2017 MED EXP(Any oneperson) S 5,000 '.. PERSONAE&ADV INJURY $ 1,000,000 GEN'LAGGREGATE LIMITAPPLIESPER; GENERAL AGGREGATE S 2,000,000 PIPOLICY 1:1PRO POLICY LOC PRODUCTS-COMPIOPAGO S 2,000,000 OTHER: S AUTOMOBILE LIAWLITY COMBINED SINGLE LIMIT 8 Ea accidant ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Paraccdanl) $ AUTOS AUTOS ON OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS ParaccldenE S 5 X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTIONS AN026107 3/24/2016 3/24/2017 8 WORKERS COMPENSATION PER OTH- AND EMPLOYERW LIABILITY Y/N A UTE ER ANY PROPRIETORMARTNERIEXECUTIVE E.L.EACH ACCIDENT $ OFFiCERJMEMBER EXCLUDED? N/A (Mandatory In NN) E,L,DISEASE-PA EMPLOYEES IF yes.describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT 5 DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES(ACORD 101,Additlonal Remarks Schedule,may be eduched I1 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 HE DELIVERED IN 1600 Osgood St:, Ste 2032 ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Keith Maglia/SSA OO 1SM2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD INS025 ooiaal n 113/2017 Insurance Services CERTIFICATE OF LIABILITY INSURANCE DATEtMMIDDfYYYY) 0110312017 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 pollcy(les)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 NAME: ONE fAX Automatic Data Processing Insurance Agency,Inc. AM,Ne,Ext): Arc,No 1 Adp Boulevard ADDRESS; Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC N INSURER A: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC PO BOX 958 INSURERC: Andover,MA 01810 INSURER 0: INSURER E; 1 11 '.. 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 CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN 1S SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. POLICY EFF _P0rICy_FxP LTR TYINSR PEOFINSURANCE INgp yyyp POLICY NUMBER idiM'DDfYYYY MfOWYYYY LIMITS COMMERCIAL GENERAL UABILITY EACH OCCURRENCE $ UTZENIED CLAIMS-MAOF OCCUR pREh1I5E5 Fa occurrence $ MED EXP(Anyone person) $ PERSONAL&ADV INJURY S GERL AGGREGATE LIM€T APPLIES PER: GENERAL.AGGREGATE PRP POLICY"❑JECT F-1 LOC PRODUCTS-COMR,OP AGG $ OTHER: $ AUTOMOBILE LIABILITY g Ea aecldent ANY AUTO BODILY INJURY(Per peison) $ ALL OWNFO SCHEOULED BODILY INJURY Per accidnnl $ AUTOS AUTOS { ) HIRED AUTOS NON-OWNED $ AUTOS Per accidenl} $ UMBRELLALUU3 OCCUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ LIED RETENTION$ $ WORKERS COMPENSATION X PER STATUTE 01H. AND EMPLOYERS'LIABILITYER A OFFICEERAiEEMBEREXCLUDEoi�UTlvt YIN N POWC840361 0110112017 01/01/2018 E'L.EACHncc€DENT $ 1,000,000 (Mandatory In NH) P.L.DISEASE-EA EMPLOYE $ 1,ti68,606 If yes.descdba under 1,860,680 DESCRIPTION OP OPERATIONS bciow E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,maybe allachsd If mors spaco Is required) Contractor License:CSL 106017 HIC 102726 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 120 Main st 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 https:lladpia.adp.com/ISFxternal/app/index,httW?cl ientid=2037315&requestFrom=run#1 home 111