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HomeMy WebLinkAboutBuilding Permit # 2/23/2017 t%ORTH BUILDING PERMIT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No � Date Received........... &S us Date Issued_:__ IMPOWfANT: Applicant must complete all items on �age LOCATION Print PROPERTY OWNER (7 Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT:._.__ Historic District ye y no 0 Machine Shop Village ye no TY PEIMPROVEMENT PROPOSED USE Rnsid 'al Non- Residential [,-.1 New Building I U One family 11 Industrial [I Addition E Two or more family F.1 commercial Iteration No. of units: FJ Repair, replacement 0 Assessory Bldg D Others: El Demolition 11 Other ��; �r,�'����rSe�,/e�,����//,,,fir'-��%��„//�/��%D/,///%,��� DESC Identification- Please Type or Print Clearly Phone: (,B OWNER: Name. L r\ 1 6- Address: "1-3V1”( Contractor. Name: ati Phone: c� 3 Email D14 Add res 1-3 NLI I V-)S� �MJ\t�-1 I Supervisor's Construction License: —Exp. Date: l�1 � Q I k I Ip Supervisor's Exp. Date: Improvement License: I ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE. BULDING PERMIP$12.00 PER$1000-00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 3�) _ Total Project Cost: $ FEE: $ , V Check No.: 7q,) Receipt No.: fund NOTE: Persons contracting with unregistered contractors (to not have access to the guaranty ............. R", CA� i Sana= t4ORTH ver ji own ot ® = e�+ No. �O LNN■ " ver, bass, ,3• ,p / 7 COC Nr<Rl w1[R 1' 1E D Q \ S � BOARD OF HEALTH Ell Food/Kitchen An 17 E M T T Septic System THIS CERTIFIES THAT .......... ........�.1���.r ��.... ..... ... ......... .. .. ..... ... BUILDING INSPECTOR has permission to erect ....... ,....... buildings on ..... �..... ,il�� Foundation to be occupied as ... ....�. ....... 6 ...� 60wrN. ... �...... ��1� �� ugh............ .. ... ... ..... ..... Chimney provided that the person accepting this permit 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 Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR. UNLESS I T Rough Service .........,. . .. .............................1....................... Final BUILDING INSPECTOR $ GAS INSPECTOR ccu2crnc� e� ... it Required t® c, ,,ca�uildi a Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final 1fY No Lathing or Dry all To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. Federal 010:084M 29 RISE Engluneerr�wg Rt Conbul or Regisurathm No Sift Cr Conimt toriteyltstWon 0 1209 0 RISE A divlalon of Thialsclr t3ngiaee[idg' CT Catttratxar KsglsRnrlian iYa62a12A EMUNEEMING 60 Shawmut,Canton,MA 02(al 339-50"lam w _ FAXW9402-045 CONTRACT age PROM" i ..,�..�. 'fHl9 C6tJtpldtr 186Ntta�Uiti,fiE1t�N RiEt✓r i S O i� rt i CMA MS euaT at�ewowras x Ct1STOStr.�i ` PUM DAM Ctwo vYOpIr GRDEft Sebastian Iacono -.._a {978}686-2294 11/27/2015 405553 00004 smica l E (;V B4.1i1r9$tRPiET 40 Meadowview Road cc 40 M,eedowviezw Road �;c w wMM crSY.WAMW u" all,#.nffit aMSTATt M North Andover,MA 018 �`t t North Andover,MA 01845 JOB DESCIUR ION xlase o- for aetot year's mon projtx�Prices and pta�rarh131rmet:ta'ves not gtraTanteed. - $0.00 SASI dv>ENT CEIC.I 10,Provide labor and materials to WWI(44)lifter{ee#ofR-l9 w6oed 6beq#ass Insulation to the perimeterofthe basement ceift at the house sift. $77.00 GARAGE CFA,IN .Pmvido tabor and makdals to install 40 R-14 dawly paced Class t Cdllulase insulation to(720)square feet of garage ceiling located befow a healed floor area,by drifting holes in the wKing f m below. Holes dn'ffedwill be phWA. flags wifl be spackled and loft Ina relatively smooth condition.Finish wading and touch-up priminglp WOug will be the custaafeft a*oas bility. $1,332.00 RISE Enoueerb g v A apply aA w1inable,eligihle l ves tniiate oauact.You wall oatybebiW*&Net weus&Omeody,for dWbk rncasurcs,Columbia Chas offs 7S%itma�iv0,not to oweed$?,000 per year,and an lnoentive of 10M far the Air Seating measures up to Iite f A$6110 and an additional$340 if savings ate justified by iia auditor. For the safetyand health ofyour home's iruloorairgratity,we wlll be conducting a blower door diagnostic of theavamlvair now in your home both berm the work is begA and aft the man work is complete.We will also conducts full assessment ofthe combustion safely ofyour heating system and water heater.This has a value of S90 and is at no cost to you. Total allowable melon incentive is$3,110. MAD Tont{: $,SAW.00 Program incentive: $1,146.76 Customer TO& $352.25 WF AGREE HEREBY YO FtaitMH SERVICES.COMMIN ni At;COpDA1tCEWi'R AUM SPECIRCA't UL FOR THE Snit OF ***Thmee Hundmd Fft Tutu&251100 Dollam $352.25 ''.. uPaw ADIbAt'I�tGYALBYR�H9d4U .W1&70h18tAiY?RtY+]TAGkpl;l'i1'trblfiiRL.atiEi�870F1a�.FlSC1lR14A�lgIgY061AfiY UrWAEO AFIRa�OAYffi.SEEREVaR98PanTAgTHit�lA7bNQM�RiRdifaOFB�N@sKWWH1ANCfWtk!'�GffiTRA7S07A. 00 Wn Slti4t THIS CONMCTIF THERE AREANY BANK SPACES Ault! Wn. P.�xpbtlostpp fAMOn�RAGC7EPrAk4C8 '... HOTE:tMCCUTRA"VAYMVArrMRAWMBYrl WNBrE>ORanDV4R V! RAIMCFACCEFTA€M ....,�,•l- ' AsctPTawcaot<aarshtAnr-t�AeavaPrars�.a�ueaAr<ar�oamnsnnesAAr 30 oars. carr efrtr+® a Aunra+dmEamaon+awoaxes OWNER AUTHORIZATION FORS! I, (Owner's Name) owner of the property located at !� V(etj (Property Address) (tS , (Properly Address) hereby authorize � f�-� ►�-� � i+�� v L�Un + � � , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. - /bz Gam-f '� owner's Signature ©ate The Commonwealth of Massachusetts Department of IndusttWAccidents m Office of Investigations s 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass govldua Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers li ant Inf rm bio leas Prl L lbl Name (Business/organindon/Individual): Address: '• BOX -34N ci /State/Zi : r sW 4 (A r11A 3 6 Phone #: 3 Are You an employer Check the appropriate box. Type of project(required): 1.E 1 am a employer with_Lk- 4. [] I am a general contractor and I d ®New construction employees (full and/or part-time).* have hired the sub-contractors 2.® 1 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.durance required.] 5. We are a corporation:and its 10.C] Electrical repairs or additions 3.0 I am a homeowner doing all work officers have exercised.their 11.[,]Plumbing repairs or additions myself [No workers' camp. 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*1 must also till out the section below showing their workers'compensation policy information, t Homeowners who submit this affidavit indicating they ars doing all work and then hire outside contractors roust subIIait 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, I am an employer that is providing workers'compensation insurance for my employees. Below is the policy andlob site infonnatlon. Insurance Company Name: --- Polley#or Self-ins. Lic.#: O D Expiration Date: b 3c► 0 t ,lob Site Address: ��4 w city/State/zip. N 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$1,500.04 and/or one-year imprisonment, as well as Civil penalties in the form of a STOP WORK ORDER and a fine of up to$.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 cenVy under the pains and penalties of perjury that the ir►formation provided above is true and correct. Si t a 2 Pho a : Official use only. Do not write in this arca,to be completed by city or town official. City or Town: PermitlLicense# Issuing Authority(circle one): I..Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#. ` r ® DATE(MMIDD/VYYY) A►�C>Ra CERTIFICATE OF LIABILITY INSURANCE 1011812016 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 certlticate holder in lieu of such endoreement(s). PRODUCER COMP NAME• Meg Munroe MARTIN J. CLAYTON INSURANCE AGENCY INC PHONE (413 536-0804 All No: ADDRegs: rnmunroe@rrljclayton.COm 1649 NORTHAMPTON ST.,RTE 5 INSURER S1 AFFORDING COVERAGE MAIC# 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. ILTR TYPE OF INSURANCE I= U o POLICY NUMBER (MM/DD/YPOLICYEYLM MM1DPOLICY EXry LIMITS COMMERCIAL GENERAL LIABILrrY EACH OCCURRENCE $ CLAIMS-MADE OCCUR PREM S 5 Eeaccur encs $ MED EXP(Any one person) $ NIA PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER; GENERALAGGREGATE $ POLICY 0 PJECTRO LOC PRODUCTS-COMPIOP AOG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SI GLELIMIT $ Ea ac'd ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED NIA BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE HIRED AUTOS AUTOS NON-OWNED NED Per accident $ $ IHUMBRELLA LIAR OCCUR EACH OCCURRENCE $ g EXCESS LIAR CLAIMS-MADE NIA AGGREGATE $ DED RETENTION$ $ WORKERS COMPENSATION X STATUTE ERH AND EMPLOYERS'LIABILITY ANYPROPRtETORIPARTNERIEXECUTIVE YIN E.L.EACH ACCIDENT $ 500,000 A OFFICERIMEMBEREXCLUDED7 I WA NIA WA MAARP300327 10/30/2016 10/30/2017 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 50Q000 if yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEA51 -POLICY LIMIT $ 500,000 NIA DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may iso attached If more space Is required) Workers'Compensation benefits will be paid to Massachusetts employees o"ty.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 on 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.mass.gov/lwd/workers-componsationlinvestigations/. CERTIFICATE BOLDER 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, 1200 OSGOOD STREET AUTHORIZED REPRESENTATIVE r , NORTH ANDOVER MA 01845 Daniel M.Crowley,CPCU,Vice President—Residual Market--WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD DATE(MMMDIYYYY) ACCOR" CERTIFICATE, OF LIABILITY INSURANCE 8/12/2016 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 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 Ileu of such endorsement(s). PRODUCER NAME: T Nancy Usher Martin J Clayton Insurance Agency, Inc. PHONEltLl: No):(A13)534-7874 P (47.3)534-7874 rUCTNo 1649 Northampton Northampton Street -MAIL P• 0• Box 989 _— INSURER(S)AFFORDING COVERAGE _NAIC p _ Holyoke NIA 01041-0989 INSURER AMationwide mutual-Harleysville NATIO INSURED INSURERB;71111ied world Natl Assurance CO Gauthier Insulation INSURER C: - P.O. BOX 344 INSURER D: INSURER E IPSWICH MA 01938 IN URER F: COVERAGES CERTIFICATE NUMBER:CL1663001950 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. INSR �vLT, TYPE OF INSURANCEL BR M4 wvn POLICY NUMBER POLICY EFF POLICYTYPEEXPP LIMITS X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE $ 1,000,000 DAMAGETO R NTS E6 A CLMMS-MADE X OCCUR PREMISES Eaocrusren 50,000$ _ OL43487F 7/6/2016 7/6/2017 MEOEXP(Any one parson) $ _5,000 _ PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ A 2,000,000 X POLICY 0 PROJECT E LOC PRODUCTS-COMPIOPAGO $ 2,000,000 OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ EA accident) _ __ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BOD)LY INJURY(Per accident) $ AUTOS AUTOS HIRED AUTOS _ NO-OWNED ROPE R e DAMAGE $ X UMBRELLA LIAR OCCUR EACH OCCURRENCE $ 1 Oq- 000 B EXCESS LIAB CLAIMS-MAGE AGGREGATE $ 1 00_0 000 DED RETENTION$ ESU02a251970 10/18/2016 10/18/2017 Is WORKERS COMPENSATION AND EMPLOYERS'LIABILITY STATUTE ER YIN ANY PROPRIETOWPARTNER/EXECUTIVE ( N/A E.L.EACH ACCIDENT $ OFFICER/MEMSER EXCLUDED? u (Mandatory in NH) E,L.DISEASE-EA EMPLOYE $ If yes dasoribe under DEet IPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS!LOCATIONS/VEHICLES (ACORD 101,Addlllonal Remarks Schedule,may be attached It more space Is required) u CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Totem 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 1; Daniel Sullivan/MSG ` " ©1988-2014 ACORD CORPORAT70N. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD ........ ......... ........ - office of Consumer Affairs and Business Regulation 10 Park Plaza - Suite 5170 Boston,masswetor 02116 Home�nprovememt Registration Registration: 17341{1 Type: Individual epiratlon: 1011no18 Tr# 291320 KURT GAUTHIER KURT GAUTHIER 119 COUNTY ROA© IPSWICH, IATA 01538 Update Addrep and return card.Mark reason for change. Address Q Renewal [] Employment ❑ ]Gast Card �p t di 2aM-o5t11 Cpome�reonuai a ' a office of Gossamer Afthira&Basmesa Regulation Heg�on Valid for individual an only before the HOME tl1AP EfiIENT COAITRACTQR e=xpiration date. If found return toe i HO 1p Tye: office of Consumer Affairs and-Booms Regulation Explratl 8 IndiAlua! 10 park Plaza-Sane$170 Boston,MA 02116 KURT GAl1THILcR'_ GAUlTnMHER Ki3R1' ek&»k» s .Cv--P'ulm_!« mm my } KURT aG rm" p-O an$" - evt� aw4 , / 7� � . �f /