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HomeMy WebLinkAboutBuilding Permit # 2/28/2017 amu. N_-_._.'4 00"N N BUILDING PERMIT o�� , '$` W, TOWN OF NORTH _. Permit IVCD: Date Received ION APPLICATION FOR PLAN EXAMINATION Date Issued: acHUs IMPORTANT: A licant must com lete all items on this a e T pht r F"IDI=" kTT ' ICIEINe MT, AP 6, . ;P;IRCELCS {I N T fICT . /��%% ki ; i c Csti %�� I1lldeine Sfeip ilag TYPE OF IMPROVEMENT PROPOSED USE Residential Mon- Residential .1 New Building ne family F Addition 0 Two or more family C7 Industrial _VAlteratioq_V_, i n No. of units: 0 Commercial C1 Repair, replacement fl Assesso Bldg 9 ❑ Others: 11 Demolition C Other i:: h eI1 Cl Fla p ain� C!Wit Cl' Water ed f��stric€ [`' ,feted Sewer t„ Identification Please Type or Print Clearly) OWNER: fume: '. .. � .,� �. ...W Phoe 7P )'-Jn Address: 1 171011 LCI`ITRATOt Narne; _7 711 'hon z Addressor w Supervi or's c77­�7n tr dti ar Lie r e: Exp w 41 Cp Hearne Irr�►�eMen Ltcdr� e' ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.M00 PER$1000.00 OF THE TOTAL E S77MATED COST BASED DH$125.00 PER S.F. Total Project Cost: $ FEE: > ,o . Check No.--- .,. a Receipt No.: TE: Persons contracting with unregistered contractors do not have acct _ fund Signature of Agent/Owner ' ., .. Signature of contractor ' t&ORTH q Town ,. over ® ' .�r z 0% No. y � OLAKO h ver, Mass D/ COCNIc"aw1cm V ATE 1) BOARD OF HEALTH Food/Kitchen vE 'RMIT T L �ID Septic System THIS CERTIFIES THAT ....... Abb...... 444.... ........I i?. ' ' !.... ..., ...... BUILDING INSPECTOR Foundation has permission to erect ........ buildings on ............. .....7.......Ko.4A...... Rough t0 be occupied as ... .. mw '# ........... ......../... .s. �.! .i.. ov...... 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR- UNLESS T Rough Service ............ .. ..... ..... ..,... ........................ Final BUIL CTOR GAS INSPECTOR QccugancE Permit Required to Occupy BuildingRough 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. Fecloral 10 Ot 05-0406629 RI CentractOl'RegiStrAlOn No 086 MA Contractor Registration No 120979 CT contractor Registration NoB20120 2 '0'9 1 2 0 60 Shmvill"t I(Oad,01111011,MA 02021 CONTRAC RISE ENGINEERING2 Page 331•,"+112-6335 Page 339 11ROGRAM TIlIg COIIMACT is VITERCO INTO DErvicell 1110C ENDINEERING 4"D 11 r:CWTOMER POR WOR)i AS GAIA-IIES DFOCRIBED BELOW PHONE DATE CLIEW 0 WORA ORDS 02112/2017 44,11,19 23902 CLISTOIAER (978)975-7602 pejel.Bennett BII,Ljr4O STREET BERVICE OTREUT 127 Kara Drive 127 Kara Drive al"Ina CITY,STAIE,ZIP UERVICE CITY,61AMVP North AIWOM*, MA 01845- North Atl(l()Vcl', MA 018415- ,SCRIPTION VENTHWHOM:Pro"le labor and"Uncri Is 10 install(1) latc(I %vill,ronf nI,)jjjjtc(j Dapper vent In ex houst existing hathronill fan(s),13roan nndel It 630 Or equivalent, ....... x)(8(p ranter buys it)Innillwill mr 11mv.-1's,,,— r VENTILS11ON:Provide labof"Ind mulerillk to Install voltillifil jI;n ---------- tI, --------- trctite cequired file rali 156) C NINI()N WAM� atIOC and it ,to iostall rigid bmi l t t it-l0 carAS 11r(o)VIdu Unerials siltuirc feel(WO)"I'lln"%"'ll' $600,60 aE+i°8f88 RIU a ng SA FERMI CJI CONTRACT PitOGRAM „"aa to a ria CMA-086 r�e�twaaia ._.�._.___._.._.._.____._..�._..... . .�.��. (978)97-4-76a 02107=7 r444149 23902 $ PeEorSa _ cum ayr eaeaae aaen+r 127 Kers Drive 127 Ksia Drive _........w__ �._ _._.... ....._�__.,___. .. se�a0 e�r4sr ra• Norl11 Andover,MA 01845- WOM Aadaver.MA 01843- ---�--�- _� JOB DEScRUMON RLQ b ivestuV&0gSU%1.Ywv►Mc*bAbWtheMan NdamOesd . � �73S6Ia0auhr�pat w o�aaaotlisA�E����and en»of E0096 for upcsdseffbad6B4godanedditlo0e1t34Qii �d►0 �ortaeeae6eq►aod�aStb ofy0ut dome's iadeos sirga+tttY.are vrW beoaod0�8s E�naerdo0rdtfeo€dmaveiiabkair tio�v myoar tao0oaba�la!?,rasbe vrw1E is Eat arplaAartEas����WOvrrftEE abaooad0cl sildl Otf� �'�7� ��tMGYIII�Cf.ThIfI1RiA� �if��la0Q6iSAyEfY. 7U01 by tda issWalios lM id a vat s�S�at"N+ k.� Tod alb gymdosa0attbFsyar�b7► � �; iaf3.183. f E1SS�fO TOW: ." CasumaTow. 1f676AS � r�o�uaWei+ - �a��`�"�°veranavae>NesMoa SIX Hand"•" k S 09H00 Dolkis $878A3 answw�.a�ararar�wa�aa0 aaaxr iAbMfAfllp4ie41q�pm a�lsialt � rppiPrW aCla�taM�a,plmaOM .�-_. - u�oraaaeurar OOtlei're�aN?f8t<COtfIRllCrtF71i�AA1rAt1Y pCrB warm'nreaaMn�wrriwaaras+mara�e+►mvaora�nm+ianm� n � �. �aeaa+ao�w�trel�►nw.aa�aaot�sa0rma4o�ears �..�.0 f adoral ID if 06.0406629 RI Contractor RefilRtration No 0106 RISE 'En itleedl1g MA Contractor Roglatratlon No 120970 CT Contractor RegIntrallon No020120 FRI S F- Eft SbIllvnlul Rond,C.mnton,NIA 02021CONTRACT RISE ' 339-502-6335 hA ti 33'1-502-63.15 t Page I'RC)Cx1tAM TloO COMPACT In anlamca VITO 13"VrCCa TROE 1 nrrallrueRRro nno'rna CanTola@R rorr worm An f:'MA-Ilf?S onacnmaoaELOV4 PHONE. DAT....R_ CLIENT U WORK ORDER ..cusTOrdart 1'�tcr I�swwntfctt � (978)975-7602 02/12/2017 441411ill) 23902 0'` 'f 11l6Urto 31RUT ..__.. SERVICE STREET l`,` i I27 127 Kam Drive Kant Drive aII.Ullo CITY,OTATG,ZIP SERVICE CITY,11TATa,ZIP Ncrrltt Andover, Mil(')18415- North Andover, MA 018415- JOB DESCRIPTION re I IAZARD BARRIEM:��e Iltive idanllllcd ll,ai tllC e4rj'41r CIeilTillYea k5pillifeI1rUUn11 ll,alPl rllrc byr lionle, tIlSlrlg fillrglassjlc�ss,(lie ebi nket�insulationea"i tLti Il.'^fSItCr1(IIISIIlml14)It'�'lblllttel I'tr'blCd)4V'C will+,r4 C a IC-rated &IIIIIlire nultur ilio l ODIMtl Killed) will tic ilfstmlled across Ale top and clowd cilvilic rvlYickt colttidn recessed lip�hts will nut Ile instllatcd. �0.ntr IISICIII be AIR St?AIA1 ,IU Friwide labor arlrl rIl Itrrials to scal ar dli l�"nostic lcstw tei)�isslurettl,mt your lmmnc tvillllYcktcit sviillllrl hRlt�bblltlevel of perllbnned in t h colicerill,the Ilse 0i special tools:Ind air excllambre mad inllm I air duality,Mfaatials to be used to weal your home eaa illelude cmmllts,I1)III1ps end other products. Primary Itteas for sealinkg inclulte slir IciA.ap;c Iu e0ius,birwcmcnt4,atlached gar; ,es itlltl outer unheated arclls(vvindtbws ilru not 1)enunllly addressed) This will re(plirc(8)working hours.A reductio"in cubic I'cct Per nlitultc Will)OI'mir itlPiltration will occur,but rile actual ntunllcr 01'dl"nl is not k,umrttntacd. At ale cornplelfon of Arc tivcatitcrifaYliott work,trod at 710 ada.AA0lnl1 cost tot'Ile ItOnler)tvllcr,m Iinal blower dour rotator eJIRdTrrstiorY satcly aRlllysis will be conducted by file stlb-contractor to costrrc tits srll"Illy of tile indoor air quality. "$6)30.00 l7AMCw INOC provide labor enol inaterirds to install a 12"layer of R-38 lntl'ilced libergllss balls to(60)square feet for damntirlk; purposes, `ti 123.[)0 .ti0,00 FLAP:Provide labor and ma(criAs IO install:15"layer(WH-19(.lbs I Cwetllikbse added to(176)square feel 01*01101 attic Space. $121 t'l.,A i:Ibrt)Vide labor and InalCllldli f<)ills list li lilyer'rrl R-301,b is I C:eIl1aU"re ral(led Il)(,3441)stitaire 6"t Ot(Well attic splice. wFlrt)5.36 1±.r11:I�WAl..1. IAC ImbOI'SUId ITi111CTItAS to fl�,id board Ikt It-1t1 Clr 13rerltCr tV 111l ItIC Tk:41111rY:fl flTa ridill�!to t(41b)tiglliTre Puct of"l:neuswull lrre;l. 4509.80 ' KtJ1C"z4vA1.1.FLOOR:Provide lal)r')r and matcriuls to insttlll aS"layer 0f It-I r1 C lass I('."ullulr)su InlYlcd to(I7fi)sgaare Icer al'apcm kneevull floor.. $221,76) A"lTrtC ACwC.ESS� provide labor and it lterials u)iusulaie etre lxlel,of the mlttc door with rilzid bored:it lk-10 or presser will)the oor's edge will,wuathcrstrippbll;it)restrict air leakage. required Peru rmAnkt and surd tile d ;til R7.371t Canton MA 02021 RIS 60 Shawmut Road,Unit 2� 339.502--6335 f ENGINEERING www.RISEengineering.com i OWNER AUTHORIZATION FORM 3 (owner's Name) owner of the property located at: (Property Address) (Property Address) hereby authorize t 12EU 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. The Permit will be secured by the insulation contractor, at no additional cost. it is the homeowner's y contacting their municipality at the completion of this work. responsibility to close out this permit b I� Owners Signature Date 8.2016 ' The Co►nma mvealtlr of Massachusetts Department of Industrial Accidents € - Office ofAvestigatiorrs —i 600 ffashington Street t Boston,IIIA 02111 `�?�'��'� rt�►vrs:rtrass.gua�/clia NVorkers' Compensation Insurance Affidavit: Bill ilders/Coriafactors/Efee tricians/Plumbers A y Acant Information 'lease Print IJe ibEy Name (Bus iness%Organiration!lrid ividual): irfo A DA SAF 1 y_ 1__Pxy6: 4,-o 1411FAT '( 1rX24r OALI Adtit'css; 33o_ 1/`c7 `? lb _- Arr/c&Rc Zk,4 OA-70y' C'if}i tatel il�: �7-T/�13U�v . ° 03 pljoue #: hof- �tsl _ � Are you an emplt)yer? Check the appropriate box: Ty pc of project (required): 1.K1 acct a employer%vith _ _ `l' ❑ 1 ant a general contractor and I ctttpfitsrecs(lull attsl�or part-time)." have (tired the stab-contractors C' El New canstricetion ?.❑ 1 ant a sole proprietor or partner- I listed oil the attached sheet. 7. ❑ Remodeling ship and have no These employees subcthave ave 8 p ❑ Demolition working for nee its any capacity. employees and have xvorkers' 9. ,❑ Building addition [No workers' camp.insurance comp. insurance. $ required.] 5. ❑ We are a corl3oration and its 10-❑ Electrical repairs or additions 3.FI alit a homeowner doing tt[I work officers have exercised their 1 I_❑ Plumbing repairs or additions my�selF. INra workers' comp, right of exemption per MGL 12.[] hoot'repairs ittsttrance required.) t c. 152,§I(l),atilt we have no i employees. tNo workers' I Otlter ,s GL 7,to�►s - conip.insurance required.) �n ;tl�pliCant that checks box, t must 315o fill tint the svetion below showing their 3vorkers'comps isation potfc}'inf'orniation. klnrrufneners whit submit this affidavit indicating they are doing all stork anti tlien hire usitside contractors mustsubltlit a neviat37rlsait indicating such. poor tracior5 that check this bas must attached an additional sheet shoti'ing the name(if the sub-comraclors aria smote wlictlier or nm those entities hove employees, 11`ttrc mil)-c ldraetors have employees,they must provide their workers'comp.policy number. 1 ant an employer that is prrn'iditrg workc�E:c'compensation insuraerc'e for nkli,empitkj,ees. Beloit'is lira policy acrd job site irrf orrrtrrtir�rr, lnsurange Company Nance: , Gam• AA,,, G Policy it or Self ins. I_ic. Jr: � (3 _ -_�_ __._._ Expiration Date:_ - `� CitylStatclZ.ip:_. AaucAJ Jade Site; Address. 2 I�# 1.1 � 1!� vt —L. Attach a copy'of the workers' comp ensa(loll policy declaration page(showing the pulley number atul expiration t ate . Failure to secure coverage as required tinder Section 25A of MGL c. 152 can lead to the imposition of criminal penalties of a fine up to S 1,500.00 and/or one-year imprisonment,as well as civil penalties its the form of a S1 E7I'i�©ltK ©(illi[�and a fine of up to$250.00 a day against the violator. Bo advised that a copy of this statement may be forwarded to lite Office of Investigations o#'the DIA for insurance coverage verification. Z du here+ht'e rte i,under tiff'pains acrd penalties_of perjttly that the irrfoi'ruatiott provided above is true and correct, 11=— a I-_l 5 - - _-()l cin!rrs'e ri►rJt'. I)n►rot IvFlieir-711 fs rrrcit,to hto hc,completed b�'citta or torr1rl ofjlcial. City ol-Town: __ I'crsiiiifl3iccnsc _ lssiiing Authisrky (circle ane)/ 1. Biuret of Health 2, Building Department 3.Cifyrro►4Er t:lerlt 4. Electrical Inslrcc.tor S. PluEtilrirtg Illspcttnr 6. Other t:'pittttrt E'ersoit. Phone U: a DATE{MMlDOlYYYY) ACC> CERTIFICATE OF LIABILITY INSURANCE �i27i2o�7 TH RTIFICATE 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. to IMPORTANT, conditions of the pahecertificate l cyer€ceitas an Anpol cOesAmay requireINSURED, ,the p an endor emont.A statement on this certifust a endorsed. If i cate does not ON IS conferDrigh rights totthe the terms a certificate holder In lieu of such endorsement(s). CONTACT Steve Moran PRODUCER NAME: PHONE (4Q1)723-8510 FAX 14011728-1820 Loiselle Insurance Agency -MAL 279 Dexter Street .stave@loiselleinaurance.com INSURERS AFFORDING COVERAGE MAIC# P. 0. BOX 1148 Pawtucket RT 02862-1148 i INSURERA:M to ers Mutual Casualt Co 1415 INSURED INSURERB:BeaCon Mutual Insurance Co 0035 AFFORDABLE BUILDING & WEATHERIZATION, INC INSURER CAr onaut Insurance Co Go 92 SUN 'VALLEY DR INSURER D INSURER E: CUMBERLAND RI 02864--3241 INSURER F COVERAGES CERTIFICATE NUMBER. pdate 16/17 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 POLICIE5 DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. I i�7 R WBR POLICY EFF POLICY t3XP LIMITS TYPE OF INSURANCE POLICY NUMBER MM DlY YY MM1DD YYY 1,000,000 EACH OCCURRENCE $ GENERAL LIABILITY 100,000 PRE ISES Ea occurren $ X COMMERCIAL GENERAL LIABILITY A CLAIMS-MADt OCCUR X D28935 /8/?016 /8/2017 MED EXP(pn onepersan $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GENERALAGGREGATE $ 2+000,000 PRODUCTS-COMPIOPAGG $ 2,000,000 GEN'L AGGREGATE L1MIT APPLIES PER: $ X POLI CY PRO LOC cDlVIBIINEDSINGLELIMIT 1 000 000 AuroMoaaE LIABILITY Ea accident BODILY INJURY(Per person) $ A ANY AUTO /8/2017 BODILY INJURY(Per accident) $ ALLOWNED X SCHEDULED X E28935 /8/2016 PROPERTY DAMAGE $ X I-IIAEDAUTOS X ATOSED Peracc3deni Uninsuredmoloristcombined $ 1 000 000 EACH OCCURRENCE $ 2 r 000,000 X UMBRELLA LIAR OCCUR 2,000,000 AGGREGATE $ EXCESS LIAR CLAIMS-MADE A /8/2016 /8/2017 $ DED RETENTION 328835 WC STATU- OTH- B WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y/N E .EACH ACCIDENT 3 500 000 ANY PROPR€ETOR/PARTNER[EXECUTIVE OFFICER/MEMBEREXCLUDED? NIA 0308 9/17/2016 9/17/2017 E.L.DISEASE-EA EMPLOYE $ 500,000 (Mandatory In NH) Ifs,describe under E.L.DISEASE-POLICY LIMIT $ 500,0 DESCRIPTION OF OPERATIONS below 9/17/2016 9117/2017 $;0o,0oor55ao,00f$3oo,oaD C MA work Comp 0928068403534 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES {Attach ACORD 101,Additional Remarks Schedule,If more apace Is requlrad) National Grid is named as an additional insured on the general and business auto policies as required by signed written contract. 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. National Grid 50 Washington Street AUTHORIZED REPRESENTATIVE Westborough, MA 01581 Steve Moran/STEVE ACORD 25(2010105) ©1988-2010 ACORD CORPORATION. All rights reserved. IN5r125 onionm ni Tha af:rlUn npma and lehnn arw raniefarnri»marlre of ar npn CSSL-106019 TODD LEDUC 95QUEENSSTRELT-93 East Greenwich R1 02818 07128!2018 Restrieted To:CS5L-EC-insulation Contractor Failure to possess a current edition of the Massachusetts State Building Code is cause for revocation of this license. For PPS Licensing information visit: www.Mass.GPv/DPS i,icensc or registration valid for individual use only z office of Consumer Affairs&Business Regu[ahon before tate expiration date. If found return to: �1' r HOME IMPROVEMENT CONTRACTOR Office of Consumer Affairs And Business Regulation Registration: 179572 Type' 10 Park Plaza-Suite 5170 ! Expiration, :::8l9812Q1.8 Corporation n ,r' Boston,MA 02116 AI FCSRDABLE BUILDING..8 WEF1411ERIZATION INC TODD LEDUC 330 VICTOR RD.SUITE A' ATTLEBORO,MA 02703 Undersecretary Not valid without signature