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HomeMy WebLinkAboutBuilding Permit # 2/24/2017 �O RTS BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION '- Permit No#: —2,6 17 Date Received C j4U Date Issued: 1WRTANT: Applicant mast complete all items on this page /T r.. LOCATION - Pit PROPSRTY &WNER Pnnt f�7D:Yea' rStre yesl no EIIIAP PARCE[_ _ ZONING DISTRICT' H�sorrc D�stnct yes no ' s Machrne.Sho V�IIa e e nfl TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. o;units: ❑ Commercial 11 Repair, replacement ❑Assessory Bldg Others: D Demolition ❑ Other /-tr`r ,,1D err.-- M . - ❑ Septic, .L7 Well C7 Flpodplain CJ 11lletlanis Ullatershed Qrstr�ct C7.1NaferlSewOrr - DESGRIPTION OF WORK TO BE PERFORMED: r Oct. Identification- Please Tyre or Print Clearly OWNER: Name. t -er Phone: F'7'- Address: [[A titer-Le dress , apervisors Contrucllpr sme Improvement L:cense ® -_, Exp; Dade r -- ARCHITECTIENG[NEER Phone: Address; Reg. No. FES sCHFDUL BUL1flV a F'E'RuIT:$92.00 PER$1000.00 OF THE TOTAL ESTI ATRD COSTBASED ON$125X9 PER S F. f -Yotal ProjeGt Cost: $� ®® . 00 FEE: $ 3 0 . ®® Check No.: Receipt Ncy,,— 7 NOTE: PeFsoyis contracting-witli unregistered contractors do not hape.ecce to e gugra ty_j d ................. ............................... .................... ................................. t4ORTij Town of Andover . 0 20bCOK6 ver, Mass� CP A. coc"Ic"j— :K IJ BOARD OF HEALTH AW in Food/Kitchen PERMIT Septic System BUILDING INSPECTOR THIS CERTIFIES THAT .... ...... Ax. ......... ire.- Arko has permission to erect .......................... buildings on ... .... mak.. d. . ..... ........I... Foundation % Rough to be occupied as .......A, .. ... .. .. 1%:. . .. ... ....... V".�� Chimney provided that the person accepting this per m1t All 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 CONSaTION Rough Service BUILDING FISP R ­'­ " Final GAS INSPECTOR OccupqgCEPermit Rgquired to Occui2v Buildin 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. Fedoral ID 4 06-0405620 RISE, Engineering RI Contractor Ratilstration No 8186 MA Contractor fletilstratiflon No 120979 CT Contractor Registration No620120 RISE60 Shownad Road,Canton,MA 02021 ENGINEERING' COKRAC"r 339-502-6335 VAX 339-502-6345 Page PROGRAM TRIS CONTRACT IS MTERIED INTO(MMMN RISC CNIA-HES Ell GINEERING AND tile CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT N WORKORDER M ichael I loye (978)618-9209 02/07/2017 400298 23906 SERVICE STREET BILLING STREET 36 Colgate Drive 36 Colgate Drive SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZAP North Andover, MA 011145 North Andover, MA 01845 JOB DENCRIrrION --XI1�SEWJNG:Provide labor nand materials toscal rircitsofy(atirbonne tigitinst wastelbl,excess airleak-age. This work,will be perf'ormed in concert with the rise ol'special tools rand diagnostic tests to assure that your home will be left with a healthful level of air exchange Rod indoor air quality.Materials to be used to seal your borne can include caulks,lontris and other products. Primary areas for scaling include air leakage to attics,bliscirlents,attached garages,and other unheated areas(windows are not generally addressed.) This will require(3)vvmking hours,A reduction in cubic fect per mingle(efin)ol'air infiltration will occur,but the actual number of'efin is not gunranteed. At flic completion ofilic ivcalhcri7njjirNj wjBk,and at no jal(litiollal cost to the homeowner,a final blower door and/or combustion safety analysis will be condlicled by tile sub-contractor to ensure the sofiety of'the indoor air(Itiality N(YIT:RIM JOIST CIIIMNY CI IASU'BASEMENTAND TOUCI I UP IN CI IASU $255.00 DAMMING:Provide labor and Dialer ials to install a 12"layer of'R-38 unruced fiberglass baths to(20)square(bet for diumning purposes. $41.00 7 17,C F—IN r:I I r—ov i d e I t 11)—or algal I na t e r—ia I s I IT'i I i"s'ra 1-111118-1 try c r of It30 Class—" 1 Ce I I t I lo's—Ma If d'e'-d tea(108)s—qt I It—re7 c I o I`o—p e IT r I t I i spaccNOTI":GO OVER F1,0010 K UFT CAT WALK, $155,52 MrICMu,"SS:Provide labor and materials to install(1) ewsily moved,insulating cover for tire title access folding stair. A small flat surtlice of plywood will be create(]around lite opening within tile attic. This will allow the cover's integral weather- stripping,to restrict Sir leakage. $237.65 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose With roof"lountcd flapper vent to exhaust existing ballroom fan(s),moan roodel#636 or equivalent. .......... Federal IU fR 0fi-t1476629 RISE Engineering ineer"ing Rl Contractor Registration No 8180 MA Contractor Registration No 120979 CT Contractor Registration No620120 60 Shaivr'aut(toad,Canton,NIA 02021 ENGINEERING" CONTRACT 339-+02-6335 FAX 339.502.63,15 Page 2 PROGRAM THIS CONNIACT IS ENTERED INTO DETVMCH RISE (,,'MA-11ES ENGINEERING AND THE CUSTOMER FON WORK AS j DESCRIBED BELOW CUSTOMER RHONE DATE CLIENT WORKORDER Michael Hoye (978)618-9209 02/07/2017 400298 23009 SERVICE STREET BILLJNO SIREET 36 Colgate Drive 36 Colgate Drive SERVICE CkTY,STATE,ZIP ....._ _.. _. ,..... ........ - _.. DILLINO CITY,STATE,ZIR_._.. _._.. Noll Atidover, MA 01845 North Andover,MA 01845 JOB DESCRIPTION ttiS l'ngincering;will apply all applicalriW,cdigiillc inecotdves ILT—this contract, Yen will only be billed the Net amount. Currently, for eligible nicasures,,Columbia Gas of ers 75';x,incentive,not to exceed$2,000 per Calendar year,and an incentive of 100%For � the Air Seating nicasures up to the fir's($680 and an additional$310 if savings are justified by tale auditor. For the safety and health of"your home's indoor air quality,we will be conducting;it blower door diagnostic of the available air flow in your Mame both bei'trre the work is begun,kind tidier the weatherization work is complete.We will also conduct it full assessment of the Combustion safely of your heating System and water heater.This has it value or$<70 and is in no Cast to yon. The Permit will he secured by the insulation Contractor.This has it value of$75 and is at no cast to you.It is the homeowner's responsibility to close out this pCi'rnh by Contacting their rnunicipality art the completion of this work.Total allowable weatherization incentive is$3,185. $165.00 a� Total: $972.92 Program Incentive: $834.69 Customer Total: $139.23 WE AGREE HERESY TO FURNIS14 SERVICES•COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE;SUM OF "**One Pllundr d T hirty-Eight& 231100 Dollm $138.23 UP 14 F UNPAID SPECTINCFA—F^"r'R"JI ra PROVAk,BY fi4Sa:EtltlOfNE'EfrkNO.CUSTOMER AOf'tE�Et4 TO REtw41r AhIOUN'r DrIE IN PULL IFdTEfYES'f'Of 1`�4 WILL Dli CrrAFZOEt)MOMTkiLY ON ANY S.SES REVERSE FOR IMPORrAN'r INFORMATION ON GUARANr'[ES,RIGHTS OF RftCISION,SCHEUWti.1.r AfiU CONVtACTOrt REGISTRATION. OO NOT SIGN THIS CONTRACT IF THERE ARC ANY BILANIC SPACES _.. ,m {IIn cuarGMER ALCEPrArca ° It E At VORIZED S11...ATURF-HISS E _. I OTE:Tri' CONTRACT MAY DE WITHDRAWN BY Ua IF NOT EXECUTED YArrIIN DATE OF ACCEPTAUCC ,.___ ,.... _.... .... ...._ ... ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIF'ICAT@ONS AND CON01oONS ARE 30SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZEO TO Be THE WORK DAYS. AS SPECIFIED.PAYMENT WILL FIE MADE AS OUTLINED ABOVE RISE Q Shawmut Road, Unit 2 9 Canton, MA 020211339-502-6335 ENGINEERING' www.RI$Eengineering.com OWNER AUTHORIZATION MIKE HOPE (Owner's Name) owner of the property located at: . (Property address) KAND VERNA. 01845 (Property,address) r hereby authorize o eco$�` - ... (Subcontractor) ...,........... ,,,.._ ,. r."" ,., .a.... .._ an authorized subcontractor for MSP Engineering, to act on my behalf to obtain a building permit and to perform work on my property. *chis form is only valid with a signed contract. Owner's Signature Date I The Commonwealth of Massachusetts Department of Industrial Accidents Office of Investigations ' 600 Washington Street .. s Boston, .IIIA 02111 wwminass.gov/dia Workers' Compensation insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant information Please Print Legib Name (Business/Organization/individual): PO BOX 955 ANDOVER,MA 09$10 Address: City/State/Zip: Phone#: Are you an employer?Check the appropriate box: Type of project(required): 1.® I am a employer with_��� 4. ❑ I am a general contractor and 1 employees(full and/or part-time). have hired the sub-contractors 6. New construction 2.❑ I am a sole proprietor or partner- listed on the attached sheet. 'l. ❑ Remodeling ship and have no employees These sub-contractors have g, ❑Demolition working for me in any capacity. employees and have workers' 9. ❑Building addition [No workers' comp.insurance comp.insurance.$ required.] 5. [] We are a corporation and its 10.El 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 a 152, §1(4),and we have no employees. [No workers' 13.7 Other comp.insurance required. *Any applicant that checks box it l must also 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 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, Y ant an employer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name: A p ti A z � v4 w?o 61 m N tAt Policy#or Self-ins.Lic.th powe, 9-16 (o I Expiration Date: d r oib?"? Job Site Address: ra City/State/Zip: Z7, Ahc/' /" 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 underthe pains and penalties of perjury that the information provided above is true and correct. Signature: 2 Date: '3 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 Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#. 1131201.7 Insurance Services CERTIFICATE E OF LIABILITY Y INS NCE DATDIYYYYI ��• 011103/103/2017 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 he 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 CONTACT NAME: FAX Automatic Data Processing Insurance Agency,Inc. aC.Ntio,Eat: Arc,No. 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURERiS)AFFORDING COVERAGE NAiC N INSURER A: NorGUARDInsurance company 31470 INSURED INSURER 9; POLAR BEAR INSULATION CO INC INSURER C: PO BOX 958 Andover,MA 01810 INSURER D: INSURER E 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 IS SUBJECT TO ALL THE TERMS. EXCLUSIONS AND CONDITIONS OF SUCH POLICIES-LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. LTR VVLK;Y W-t' POLICY EXP INSR TYPE OF INSURANCE IN5D tWD POLICY NUMBER MMI)DIYYYY MMIDDIYYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCEup-cu RENTED $ CLAIMS-MADE ❑OCCUR PfiEMISES(Ea occurrence 5 MED EXP tAnyone person) S PERSONAL&ADV INJURY 5 GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY PROJECT LOC PRODUCTS-COMP;OP AGG 5 OTHER: $ AUTOMOBILE LIABILITY (Ea acddenl S ANYAUTO BODILY INJURY(Per person) S ALL OWNED SCHEDULED BODILY INJURY(Per accident) S AUTOS AUTOS OWNED PROVERTYDANIAGE $ HIRED AUTOS AUTOS (Pet occident) S UMBRELLALIA11 HOCCUR EACH OCCURRENCE 5 EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTIONS S WORKERS COMPENSATIONOiH- AND EMPLOYERS'LIABILITY YIN STATUTE ER ANY PROPRIETORIPARTNERIEXECUTRC E.L.EACH ACCIDENT $ 1,000,000 A OFFICERRAEM13ER FXCLUDED? NIA N POWC840361 01/0112017 0110112018 1,ODD,ODO (Mandatory he NH) E,L.DISEASE-EA EMPLOYEE 5 If yes,describe order 1 000 DOD DESCR(PTION OF OPERATIONS bdow E.L.DISEASE-POUCYLIMIT $ + + _ DESCRIPTION OF OPERATIONS 1 LOCATIONS f VEHICLES(ACORD 161,Additional Remarks ScWule,may bo atrachcd If more space 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 AO 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD https:iladpia.adp.comlISExteniallapplindex.htnil?clientid=203731 S&requestFrom=run#/home 111 CERTIFICATE ®F LIABILITY INSURANCE DATE(MMIDD/YYYY) �„✓ 6/1o/aa�,6 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(ies)must be endorsed. If SUBROGATION 18 WANED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does not confer rights to the certificate holder In lieu of such endorsemen s. PRODUCER NOAMTacT Linda Bogdanowicx insurance solutions Corporation PHONE (603)382-4600 P No.(603)382-2034 60 Westville RdE-MAIL ADOAE86:lindablaisc—insuranoo.ctom iNSURER S AFFORDING COVERAGE NAIC P Plaistow NS 03865 INSURERA:West:ern World INSURED iNsunen 6 Nautilus Insurance Grow Polar Bear insulation Company Inc INSURERC: PO Box 958 INSUAERD: INSURER E: Andover MA 01810 INSURER F: COVERAGES CERTIFICATE NUMBER-CLI632326134 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. IN5R XP TYPE OF INSURANCE AD S e UMBER MMN�YYYF MNWWYYY LIMITS R COMMERCIAL GENERAL LIAOILITY EACH OCCURRENCE S 1,0D0,000 DAMAGE TO RENTM A CLAIMS-MADE Fix]OCCUR PREMISES Eaoceurrence $ 100,000 UPP0274967 3/24/2416 3/24/2011 MEDEXP(An one rson) 5 5,000 PERSONAL&ADV INJURY S 1,000,000 GENT AGGREMATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY❑JERCTT LOC PRODUCTS-COMPIOPAGG S 2,000,000 OTHER: S AUTOMOBILE LIABILITY COMBINED INGLE LI fT $ Ea accident ANY AUTO BODILY INJURY(Per parson) S ALLOWNED SCHEDULED BODILY INJURY(POT 2ccidanl) S AUTOS NON OWNED PROPERTY DAMAGE S HIRED AUTOS AUTOS Peracc den 5 X UMBRELLA UAe OCCUR EACH OCCURRENCE: S 1,000,000 $ EXCESS LIAR CLAIMS-MADE AGGREGATE $ 1 OQD OQ0 DED I I RErENTfCN$ AN026107 3/24/2016 3/24/2017 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN TAT ER ANY PROPRIETORRARTNERIEXECUTIVE ❑ N f A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandalory In NH) E.L.DISEASE-EA EMPLOY $ If yes,describe under DESCRIPTIONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Addlilonal Rernaft Schedule,may be attached)f more apace Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North AndoverTHE EXPIRAT(ON 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/SJA � ©1988-2014 ACORD CORPORATION. All rights reserver!. u ACORD 25(2814/01) The ACORD name and logo are registered mairks of ACORD INS025r�0iaan Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Repistrabon: 102725 Type: DHA Expiration: 71212018 Trw" 419291 POLAR BEAR INSULATION CO. Vincent LeBlanc P.O. BO111 958 ANDOVER, MA 01810 -. Update Address and return card_Mark reason for ebange. SCA t G sor1-0111 []Address [] Renewal E) Employment ❑ Lost Card �1�c �rr-•nrn�nnrrJru/f�of'G�llrrvrirlrsrcNs Orrlce ofConsumer.3ilalrs i�c Bns�aess)tea l�tioa License or r oistration valid for itarividual use only W� HOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: r Registration., 1()2728 Type: Office of Consumer Affairs and Snsmess Regulation Expiration: 71ti2018 DBA 10 Park Plaza-Suite 5170 Boston,MA 02116 POLAR BEAR INSULATION CO. . Vincent LeBlanc 5180.CANAL ST m5A LAWRENCE,i1lIA 137841 Undersecretary Plotvalld without signature S <'Jic^:SSaCt�Li59'�tSa !?S? .; i:C- ei'ii?tf L _ sos.7c C"3;uilcii•nv' Regulations and&i ndds'; CSSLA060'17 ;. PETER A.LEDLANC rte^ 2 EAST 3.'M STREET Plaistow Nil 0386-5 04/2812018 0