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HomeMy WebLinkAboutBuilding Permit # 2/27/2017 thoRT BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION _V Permit No#: Date Received Date Issued: CHU 1Mm410.RTANT-_Applicant must complete all items on this Page LOCATION 3 '3 Print PROPERTY OWNER YK e_S Print 100 Year Structure yes no MAP na ,PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential 0 New Building 4_1Sn_e_family �1-111 A ition Two or more family 1-1 Industrial ;p1teration No. of units: El Commercial C] Repair, replacement 0 Assessory Bldg El Others: il Demolition 11 Other �1//,Ogg p, DESCRIPTION OF WORK TO BEP RFORMED: ....................... Identification- Please Type or Print Clearly OWNER: Name: I -cc Phone: _b 3- T1 S123 19 Address: ------------­1.................. Contractor Name: Phone: Email: Addres_4JRL Wr"IM ?) P1 3B Supervisor's Construction License.- -Exp. Date: HomeImprovement License: -3 0 Exp. Date.- k)l ------------=1 ARCH ITECT/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. Total Project Cost: $ 1. FEE: $ Check No.: Receipt No.: 17(9,e� NOTE: Persons contracting with unregistered contractors do not have access t the guaranty fund ra r-1111111117-91 t4ORTij town of _ 1M' ��� A111 0 No. `p V h ver, MMass 9 [O[wICHE[Me CK y �.f BOARD OF HEALTH L Nor Food/Kitchen P E R T �T Septic System THIS CERTIFIES THAT ............ i . BUILDING INSPECTOR ...... ......... ..... .... ............ ..... ..........,......................... ............ has permission to erect .......................... buildings on ......... ..... ..... Foundation 1 ¢ Rough to be occupied as ......... ......... .. ... ... P. ...................... .�,f,r. ....... rdl . � Chimney provided that the person accepting this permit shall in every respect conform to fhe 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 CONSTRUCTIONUNLESS MARTS/. .........,..............., ' Rough Service ................. . ......... .. Fina] BUILDING INSPECTOR p GAS INSPECTOR cc anep Permit cid to..,,,. cc py Z$ildin Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Be® No Lathing or Dry Wall To Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. raearal mo a4o-o�a5ll� RISE EnginearingRISEro cvntractorRrsattLat Aa 0188 { r M Can�rattc�f P&&%ftWn!&00201].0 I:NC,iNEERING' f-i" au Wmwmut Ria;,Cmtun,MA 0021 CONTRACT 7396542-6335 FAX7"4U-00 Faip S FROM M CMA-HES rte eoa�"iwa in nasacaaae�r vrwre arra et�urr wawcoar�t Kellie Daum (5M)545--2319 01118nat7 443634 23602 -- 130 Wcylmd Circle 130 Weyland Circle at�BVxq crnr,avrtRar — MAM ciWm: �m NoNt Andover.MA 01845- North Andover.MA 0 1845- JOB DESCRIPTION "ALAM EtAME[tz Wo twee Idamilmd iltat ttKm are neared lights pre=t In ytnu ttaate antes the reU*%d lights ate ardkd as IC rased(irsutatior Carrtact RM j W will amen 3-deam"spcoe around the Couure by using abuom 61ant:et fimamuDn av a dmnming tnteteriat,ao intula4imt wi4 bo installed eum the top and ckad cavW=%Akh vmuato MOCA 11110 t Vdll rrat W irsulatcd- SO.40 AIR SEA13bi13:provide labor and wasteful,excess air teakikp. n s uurk will be performed in omtM with the uW of spatial toots rind dbgnW!c tots to assuae that yom home will be Will with a heailW Level of alr tatehmW sand indam air quality.Materials to be used m Seas yotu ha=car iretudo carnes,fwmts moi tnhrr pmdtaas. Ptuttmy Arras for sealing include air leakage to quiet,basa%M attached genre and other uahnatod areas!windows are ttct genaaFLy addressed.)nEs will require(10)working hours.A reduction io cubic rat permiom(c(m)ofdr Irfiltrmlon will occur,but the act=l AumW cfCfat Is rel g umutd. At rho mnpkikn efo*wtmhetiwton worst.mrd at no additirmta cast todx ttameovms,a shat btw;m dOw M&M totnbusam safety analysis will be eonduacd by the sub-contractor to enure the safety of the indoor av qualky. I I $850.00 t (3AMNIIPtCi:Provide tabor and matetirds LO halal!a 12 la}vj of It�8 tinfaacd fi6ctglus barns to(30)square feel for dm=108 I S6t.50 AT=AOCESS:PmvZ law Bad materials to insulate the back of(i)ddic botch with rigid beard at R-SO ar greaur with rhe requited lira rating Weatherstrip the pa meter. 560.00 ATTIC At7CM Provide!phot and matCr4ft w iMUt=t()back of W kamwali hateb with rigid baud m P-10 ar greater with the mqubW firs mlhlg,and sea!the odgr:of the hatch whit warthcmu*i Sfr0.40 i ATTIC ACCESS:Provide labor and rnascriaas to make(1)tcmpurtrry aGDas to an attic arca Che opcniag will ba closed with t materials sirrLitar to those eaisli+rg Finish sanditrgand painting is not itreh[ded. I j 585.44 t yF PM—ATlt3N:Provide tabor and materials to install(3)lnsulasod talraust hose with to0f mounted Flapper vcnt to exhaust j cxlstlrig ba�dttaaett fr�tl(4}.t3taatmcvlet @ b36 or equivatcnt, t I iJ�.25 Coh1MON WAU.S:Provi&Labor and traarrsials w towel!rigid board as R-10 or W=with the required fur ratlrto to(220) square feet afcwnrrtart wail arca. SM7 o 1, i yss IS Ewmaing ISE NW man.lbA a -t•' 64 Sfldwmut .I:a p�p21 S AX CONTRACT ACT PROORAM ftv rmaamw"m amaI pnossrmLrau+ CMA4= aioa�c0waestMeaaara� uR� KeftJama aiiaur a mar _ ___ (SM)M.&M1410 /11PD017 443634 9M 130 Weylmtd Circle 130 Wgdaod Chdo North Aauver a000 a9irsa ,xa: MA 01845- isortlt Ate.RSA 01845- JON NESMMUAT RLSE comf ibrtuo° a 90W =cdSZMPer aa yaw. dm e afr• tbCAtr MCMU Lip woo UM11M:A=GdQwmdSmifwbjF=pmdittjgod4 , Fadsafa&tjr®0pe�lh�yaarp�p;1�dsdaorpfir�d[q�oew8lb¢mcQa�a�SOwordoardofldeoaleatrlbsv {n yoarhanrelm�6cfioraQieaa�lcn�u�,aaQa�pr�5awr�arir�Yar++rollc Et ao �+��aa+ndata taEta elEawa66e��beoeasfirc [10. aadsaoar Rdsimsavatmeafl9Daadtsmnanaattoyea 'Eburs '�Fe+ei�hwm Oasxtuad barme �:rama4dt1 ona.8�t6o hoa�raaPo resporoctowaaacddr t �!'aaamcdag lhair�br at tha oarmia rmr�. Tat* 76 Pe�gra�m 1�11iv� $Y,04R.31 GrTaf macsme�rrorraacoa�maxcex� eav�wcanoxa�pn �+aav uvepgma�aaxuanoaRuoawaraa st rra +amyrenagaaraa�ssawaKs aataerorixwaaaEn�rmaorerni►raw�mr v�oowweekeao�raieaam�n u "=m .iarnegaP+opapaa. ym� .mrtrti�aaoo as srao.aar mwaamr MWIWACCMA t — � aRm �w�MSN�, rafR,Wmmem�q�ltks °1i1°` .srnru�rr�.as .sa �s macnar. i ISE 60 Sh"mut RMA ENGINEERING ►r►.RISiE teng fi nim ons MA OM, 3 5az433 OWNER AUTHORIZATION FORM f� Owner's Name) owner of the property located at: u Q 44opofty Address) (Propert�dremw) hereby atrtha�¢e (� � + r' fL. ��,r,...h•�r� 1 tsub=*acw) an authorized sut>cantractirr far RISE Engineering,to act on my behalf to ob#atn a building permit and to perfam work on my ProperlY.This roan is only vaiW watt a signed oontraot. the insulation contractor,at no add�nal oast it is the homeownefs The Permit will be secured by their munidpa>ity at#19comple on of this walk. oMonslbitity to dose out this permit by contaain$ Owneds Date s.�es The Commonwealth of Massachusetts Department of IndustrialAccidents = Office of Investigations I Congress Street,Suite 100 Boston,MA 02114.2017 wwwMass.gavldia Workers' Compensation Insurauce,Affidavit: 1Builders/Cont�ractors/Ejeclease?ns n�u�b lb li nt Int' rm tion Please s � � Name (Business/OrganizadonMdividual): Address: 1�• [ � '3 "� Ci /State/Zi : Sw'q Phone #: at Are you an employer Check �the appropriate box: 'Irype of project(required); 1.Ki am a employer with - 4• ® I am a general contractor and I b ®New construction employees(full and/or part-time).' have hired the sr . 7. Remodeling 211I am a sale proprietor or parM.er- listed on the atttachedachedsheectet. ship and have no employees These sub-contractors have g, ®Demolition employees and have workers' g Building addition working for me in any capacity. comp.iitsuranee (No workers' comp.insurance 5 [3 We are a corporation and its 14.[]Electrical repairs or additions required.] officers have exercised their l l.[3 Plumbing repairs or additions 3.[3 1 am a homeowner doing all work. right of exemption per MOL g p k2.[3 Roof repairs myself. [No workers' comp. c. 152, §1.(4),and we have no insurance required.] t employees. [No workers' 13.®Other comp.insurance required.] +Any applicant that checks box#1 must also fill Out the section below showing their workers°compensation policy information- ra i Homeowners who submit this affidavit indicatingthey al shite showing the name then of the re Outside sub-contractors ands to whether or not those entities s have such tContmetors#hat check this box must attached an addrtl 8 employees, if the sub-contractors have employees,they must provide their workers'comp,policy nut nber, I arra an employer that is providing workers'compensation insurance for my employees. Below is the policy[rod fob site igorrnadon. o .Insurance Company Name- 1 `� Policy#or Self-ins. Lic.#: O Expiration Date; r Job Site Address: 3 w t �� City/State/Zip: 1�(QJ r Attach a copy of the workers' cornpensatioa policy declaration page(showing the p©liey number and expiration date). imposition 0 Failure to secure coverage as required under Section 2f criminal penalties of a 5A of MOL e. 152 can lead to t nn of a STOP WORK ORDER and a fine fine up to 51,544.40 and/or one imprisonment,as well as civil penalties sn the fo of up to$250.i3D 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. verification. do hereby cen*under the pains and penalties of per,f ury that the irk formation provided above is true and correct. S' to Zho T • 3 51p' �3`l Dfflciad use only. Do not wrote in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority{circle one): 11.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector f.Other Conrad Perm: Fhane#. 7 DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 1011812016 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER. THIS s 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. 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). PRODUCERONTACT NAME: Meg Munroe MARTIN J. CLAYTON INSURANCE AGENCY INC PHONE : (413)536-0804 FAX Nn: ADDARESS: mmunroe m'clayton,com 1649 NORTHAMPTON ST.,RTE 5 INSURER S AFFORDING COVERAGE _ NAIC# HOLYOKE MA 01041 INSURER A: ACADIA INS CO _ 31325 INSURED INSURER B: GAUTHIER INSULATION INC INSURER C: INSURER D PO BOX 344 INSURER E: IPSWICH MA 01938 INSURER F: COVERAGES CERTIFICATE NUMBER: 94521 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, INT R ADDL SUBR POLICY EFF POLICY EXP LIMrrS TYPE OF INSURANCE POLICY NUMBER MM/DDIY M D/YYYY COMMERCIAL GENERAL LIABILITY EACH OCCURRENCETO RE $ CLAIMS-MADE OCCUR PREMISES Maowurrsnce $ MED EXP(Any one person $ N/A PERSONAL&ADV INJURY $ GENL AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICYd�CT LOC PRODUCTS-COMPIOP AGO $ OTHER: COMBINED SINGLE i IT $ AUTOMOBILE LIABILITY tee arclde u BODILY INJURY(Per person) $ ANY AUTO AALL UTOSED AUTOS SCHEDULED N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per aeeldenl UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LIAR CLA[MS•MADE NIA AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION STATUTE 'ER'H _ AND EMPLOYERS'LIABILITY ANYPROPRIETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED? N!A NIA NIA MAARP300327 10/30/2016 10/30I2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 Iryes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS(LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached It more space Is required) Workers`Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of insurance shows the policy In force an the date that this certificate was issued(unless the expiration date on the above policy precedes the issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www,moss.gov/twd/workers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION 5H0911-D A14Y 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, 1200 OSGOOD STREET AUTHORIZED REPRESENTATIVE NORTH ANDOVER MA 01845 Daniel M.Growtey,CPCU,Vice President—Residual Market—WCRtBMA O 1988-2014 ACORD CORPORATION. All rights reserved ACORD 25(20MI) The ACORD name and logo are registered marks of ACORD Act>R0 CERTIFICATE OF LIABILITY INSURANCE DATE s/12/2016 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(les) must be endorsed, If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certaln policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder In lieu of such endorsement(a). PRODUCER NAME: Nancy Usher Martin i Clayton insurance Agency, Inc. PHSa� (423)536--0804 'F� No),(613)334-7874 1649 Northampton Street ADDRESS: P. 0. Box 989 _ INSURER(S)AFFORDING COVERAGENAIL k Holyoke MA 0.1041-0989 INS_URERA,Nat^ionwid_e Mutual s -Harleyville _ NATIO INSURED INSURERB:Allied World Natl Assurance Cc^ Gauthier Insulation INSURER C: P.O. BOX 344 INSURER D INSURER E: IPSWICH MA 01938 INSURER F: COVERAGES CERTIFICATE NUMB ER:CL1663001850 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. INS,RR TYPE OF INSURANCE _ DL suBR POLICY NUMBER POLICY EFF POLICY ERP LIMITS X COMMERCIAL GENERAL LIABILITY E EACH OCCURRENCE $ 1,000,000 AAGTED A CLAIMS-MADE i A 4 OCCUR PREM SITS EaEo cu e, S 50,000 GL43487F 7/6/2016 7/6/2017 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ _ 1,000,000 GENT AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY JE C LOC PRODUCTS-COMP/OP AGG $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED IN LE LIMIT $ Ee acclden!) ANY AUTO BODILY INJURY(Per person# $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS _ HIRED AUTOS NON-OWNED PROPERTY DAMAGE $ AUTOS (Per accident) �_ �� X UMBRELLA LIAi6 OCCUR EACH OCCURRENCE $ 1,000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION ESu028251970 10/18/2016 10/10/2017 $ WORKERS COMPENSATION PER QT - AND EMPLOYERS'LIABILITY Y!N -STATUTE ER ANY PROPRIETORIPARTNERIEXECUTNE L-1 N/A E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ IF yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached It more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1200 Osgood street ACCORDANCE WITH THE POLICY PROVISIONS. North Andover, MA 01845 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG � ��' • ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014M1) The ACORD name and logo are registered marks of ACORD u - Office of Consumer Affairs and Business Regulation 10 Park Plaza - Sure 5170 Boston, Massac efts 02116 Home Improvement 9 ; ctor Registration Ragistraf on: 173410 Type: Individual Eoira#ion: 101'11201$ Ti# 299320 KURT GAUTHIER KURT GAUTHIER 119 COUNTY ROA© IPSWICH, MA 01938 Update Address and return card.Mart reason for clisnge. I Q Addren R®eewA [] Employment Lost Card WA C5 zar�-asri� OMw of Consumer Affairs do aas�ness R%gAD Asn Registration valid for individual use only before fife HOME ImPRO EME T CONTRACTOR espirafion date. u found reborn to: � Rsg tlaR; 10 1YPw. office of Consumer Affairs and.Rwkess Regulation 8 Inclividuat 10 Park Plaza-suite 5170 =� Boston,MA 02116 KURT GAUTHIER CSSL..102$0 1plWkh 40.A 0" x:talsett�t .aa��e�:a �i7