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HomeMy WebLinkAboutBuilding Permit #326-2016 - 10 CABOT ROAD 9/15/2014 SC 1✓wED 23 rr BUILDING PERMIT aF NORTH -1 ttLED Ibt TOWN OF NORTH ANDOVER o� .. APPLICATION FOR PLAN EXAMINATION -_ Permit No#: Date Received 7�AERATED IPp�.(y SSACHUS� Date Issued: 'WPORTANT:Applicant must complete all items on this page LOCATION ZQ rol 5p j A d Prin PROPERTY OWNER C rQ �e >' ]_ Print 100 Year Structure yes no MAP 6�� PARCEL: Vy�� ZONING DISTRICT: Historic District y s no —7`— Machine Shop Village y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, 'replacement ❑Assessory Bldg X Others: ❑ Demolition ❑ Other Zr s(A T)o ® Se t:cY ®UUel�l ':. ❑ FYdplain� ®, � _Ulla et heel - p Wetlands 37-04719 ..T DESCRIPTION OF WORK TO BE PERFORMED: n /4 ►r5,in- /ivtei Identification- Please Type or Print Clearly OWNER: Name: �or�,,,/;� S CgSlc y Phone: C, Address: t o — 9 a v{ V- Contractor Name: Pt�c r l r (4 mx Phone: 4'17.= yv�P- ?G ?€3 Email: Address: 2 e-at ST 1p;�jAr Supervisor's Construction License: 10&a17 Exp. Date:__�d�fid/� Home Improvement License: Exp. Date:_ ARCHITECT/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: $ �;) L(oo .00 FEE: $ 21 Check No.: Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund F ' 9 7 �e � ';� ^'c- .'i3+}�'�1`:I"" ���t�����.2° -:.. E ".a •� ,- ��ao -€K4 .aa,3 sw -'_. ---- Location 1,� �d Date No. t TOWN OF NORTH ANDOVER ti .. wC�L'ED 16g6 ♦ I �-�- Certificate of Occupancy Building/Frame Permit Fee I ` Foundation Permit Fee it Other Permit Fee j - TOTAL i i Check# r 1� f Building inspector to I - i Plans Submitted ❑ Plans Waived ❑ Certified Plot Plan ❑ Stamped Plans ❑ - TYPE OF SEWERAGE DISPOSAL Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools ❑ well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Pennanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS CONSERVATION Reviewed on Signature COMMENTS HEALTH Reviewed on Signature 0 ,COMMENTS Zoning Board of Appeals:Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments Conservation Decision: Comments Water& Sewer Connection/Signature& Date Driveway Permit , DPW Town]Engineer: Signature: , Located 384 Osgood Street FIRE°DEPARTI461EN1 } 4 rx � , • � fi.; �. ��TempDumpsfieraonsite gYes.� Locatedat124iMainSfreet � y "? '" rw K µ • { Y } '; �< ffits�"e Dem yy�px ' : 93 W"; 1artment�� l g ri i 1 I Tn=� i � fatU P'e/date;�r -&°' f' 4 � '` � r #" � ` '�a � ¢ �`3. ` ��"4' �NCi� Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. Total land area, sq. ft.: ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use) i i U Notified for pickup Call Email Date Time Contact Name --------------- Doc.Building Pennit Revised 2014 I Dimension Number of Stories: Total square feet of floor area, based on Exterior dimensions. y ' j Total land area, sq. ft.: I ELECTRICAL: Movement of Meter location, mast or service drop requires approval of Electrical Inspector Yes No DANGER ZONE LITERATURE: Yes No MGL Chapter 166 Section 21A—F and G min.$100-$1000 fine NOTES and DATA— (For department use i �I I, I i I U Notified for pickup - Date Doc.Building Permit Revised 2010 Building Department The following is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits Building Permit Application Workers Comp Affidavit Photo Copy Of H.I.C. And/Or C.S.L. Licenses Copy of Contract Floor Plan Or Proposed Interior Work Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks Building Permit Application Certified Surveyed Plot Plan Workers Comp Affidavit Photo Copy of H.I.C. And C.S.L. Licenses Copy Of Contract Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) Mass check Energy Compliance Report (If Applicable) Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) Building Permit Application Certified Proposed Plot Plan Photo of H.I.C. And C.S.L. Licenses Workers Comp Affidavit Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) Copy of Contract 2012 IECC Energy code Engineering Affidavits for Engineered products OTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg. Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submitted with the building application Doc:Building Permit Revised 2014 Building Department The fol►owing is a list of the required forms to be filled out for the appropriate permit to be obtained. Roofing, Siding, Interior Rehabilitation Permits o Building Permit Application u Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses t Li Copy of Contract o Floor Plan Or Proposed Interior Work _ o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit Addition Or Decks u Building Permit Application o Certified Surveyed Plot Plan 4 o Workers Comp Affidavit Li Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract o Floor/Crossection/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) o Mass check Energy Compliance Report (If Applicable) o Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit New Construction (Single and Two Family) u Building Permit Application o Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses o Workers Comp Affidavit u Two Sets of Building Plans (One To Be Returned) to Include Sprinkler Plan And Hydraulic Calculations (If Applicable) u Copy of Contract o Mass check Energy Compliance Report u Engineering Affidavits for Engineered products NOTE: All dumpster permits require sign off from Fire Department prior to issuance of Bldg Permit In all cases if a variance or special permit was required the Town Clerks office must stamp the decision from the Board of Appeals that the appeal period is over. The applicant must then get this recorded at the Registry of Deeds. One copy and proof of recording must be submated with the building application EE Doc: Doc.Building permit Revised 2012 it NORTH Town of t EAndover V h ver Mass O A- COCMIC Ml WICK y1. 7d A�RATEO I+P��.(5 7S U BOARD OF HEALTH Food/Kitchen PER IT L D Septic System THIS CERTIFIES_ THAT ........... N.F. ,UA...... ........... BUILDING INSPECTOR .. . .... ..................... ..... .. has permission to erect ... . .............. building on ....� .....� _ ............ ...�........ .......... Foundation • Rough to be occupied as ...... .. ... .. ...�!!!. ........... te... . �.'. � ..... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the applicati 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 CONSTRUCTION ARTS Rough Service ............................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. �I Federal to# i RISE Engineering RI Contractor Registration No MA Contractor Registration No A division orThielseh Engineering CT Contractor Registration No 60 ShaTYmut Unit 42,Canton,MA 02021 CONTRACT _-� 339-502-6335 FAX 339-502-6345 R I SEPROGRAM 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER — -•_-PHONE ~�.—.� DATE — CLIENTS WORK ORDER Cornelius Casey (978)681-1106 05/07/2015 - --419 00002 SERVICE STREET Y� —_ BIWNG STREET 10 Cabot Road _ 10 Cabot Road SERVICE CITY,STATE,ZIP BILLING CRY,STATE.ZIP North Andover,MA 01845 North Andover, 5 _ ZQ15 JOB DESCRIPTION Total: $2,410.87 Program Incentive: $1,978.15 Customer Total: $432.72 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIRCATIONS.'FOR THE SUM OF ***Four Hundred Thi Two&721100 Dolla Thirty-Two rs $43 2.72 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTot AG EES TO REMIT AMOUNT DUE IN FULL.INTEREST OF 1%WILL BE CHARGED MOUTHLY ON ANY UNP7LANCEYS.SEE REVERSE FOR IMPORTANT RdFO I ON GUARANTEES,RIGHTS OF RECL41om SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SI _ IS C CT IF THERE ARE ANY BLANK SPACES le AUTEn ineed gCUSrIX; p.EPTANCE NOTE:TMS CONTRACT MAY BE WITHDRAWN BY US tF NDT EXECUTED IVRHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT.THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DOTHE WORK AS SPECMW.PAYMENT WILL BE MADE AS OUTLINED ABOVE g b Li ` Federal 1D# RISE En ineering, RlContractorRegistrationNo 'NIA Contractor Registration No A division orThielsch Engineering GV CT Contractor Registration No p�60 Shawmut Unit#2.Canton,AIA 02000NTRACT 339-502-6335 FAX 3RI S E Page 1 M TMS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING CMA-HES ENCINEERIUM ANDTIE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER --•+ PHONE -T DATE -----CLIENT I WORK ORDER�- Cornelius Casey (973)681-1106 05/07/2015 412794 00002 SERVICE STREET BR4HG STREETT-_� 10 Cabot Road 10 Cabot Road SERVICE CITY,STATE,ZIP �- BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 ` JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas ofyour home against Wasteful,excess air leakage. This work will be performed in concen with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoorair quality.Materials to be used to seal your home can include caulks,funs and other products. Primary areas for seating include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.).(8)working hours. At the completion of die weatheriration Work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis%till be conducted by the sub-contractor to ensure the safety or the indoor air quality. 5680.00 DAMMING:Provide labor and materials to install a 12"layer Of R-38 unlaced fiberglass balls to(48)square lett for damming purposcs.SKY LIGHT SHAFTIKEEP A 8X4 STORAGE AREA! $98.40 ATTIC FLAT:Provide labor and materials to install a 6"layer of R-21 Class I Cellulose added to(732)square feet of open attic space. $922.32 .KNEE WALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(110)square feet of knecwall armSKY LIG14T SHAFT/KEEP A 8X4 STORAGE AREA/ 5385.00 ATTIC IC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small Oat surface of plywood will be created around the opening within the attic. This will allow the cover's integral weather-stripping to restrict air leakage. $237.65 BASEMENT CEILING:Provide labor and materials to install(50)linear feet of R-19 unlaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. 587.50 ,I OWNER AUTHORIZATION FORM CO'RNELIUS CASEY (Owner's Name) owner of the property located at 10 CABOT RD. (Property Address) NORTH ANDVER, MA. 01845 (Property Address) hereby authorize n I (Subcontractor) i an authorized subcontractor for RISE Engineering,to act on my be btai permit and to perform work on my property. I Owif I i ees Signature Date I The Commonwealth of Massachusetts : Department of Industrial Accidents - - Office ofInvestigations • : ';_ 600 Wasliingtott Street =',` Boston, MA 02111 wiviv.tnass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information p Please Print Lellibly 'Name (BusinessiorganizatioNlndividual): 1 0 [Qf— ep r" ryN 5g. leap yl C n 7hc, Address: . D , ox City/State/Zip: Phone#: Are you an employer?Check the appropriate box: I am a general contractor and I Ty I.UK[am a employer with 7 4. ❑ pe of project(required): _ employees(full andlor part-time).' have hired the sub-contractors 6. ❑\ew construction 2.❑ 1 am a sole proprietor or partner- listed on the attached.sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have 8. ❑Demolition working for me in any capacity. employees and have workers 9 ❑Building addition [\o workers comp.insurance comp. insurance.*. required.] 5• ❑ We are a corporation and its 10.❑Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 1 1. Plumbing repairs or addif ❑ pa tons myself.[\o workers-comp. right of exemption per MGL 1 ❑ Roof repairs insurance required.] c. 152.51(1),and we have no employees. [No workers' 13.&Other �!►S�jrt i�a 0 ' comp.insurance required.] a °.\m applicant that checks boy1 must atso f111 out the section below shoring their workers compensation policy information. Homeowners who submit this affidavit indicating thev are doing all.cork 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 die sub-contractors have employees-they must provide their workers'comp.policy number. 1 am an enrploper that is providing workers'compensation insurance for nn information. enrplahees Below is!/ie polio'and job site Insurance Company Name: (` dJ Policy r or Self-ins.Lic.tk d'O —/00& S7— Expiration Date:_ .lob Site Address: '/ (k��j R d � City/State/Zi P- �! Attach a copy of the workers'compensation policy declaration page(shoving 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 SI 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 S250.00 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 rurder the pains and penalties ofperjWy that the information provided above is true and correct. Signature. te: Phone=: Cs?tel'• U 0 • 7 G? Official rise onlr. Do not write in this area,to be completed by city or town official. City or Torn: Permit/License# Issuing Authority(circle one): 1.Board of Health 2. Building Department 3.Cithlfown Clerk 4. Electrical Inspector j. Plumbing inspector 6.Other Contact Person: Phone#: OP ID:SS CERTIFICATE OF LIABILITY INSURANCE 03/131015 o3tl3xmis 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 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 endorsem s. PRODUCER CO Durso&Jankowski Ins Agcy LLC SNTACT NE FAX 198 Massachusetts Avenue Fift No: North Andover,MA 01845 E% Durso&Jankowski Ins.Agcy. ADDRESS: °RODCUS"M� #.POLAR-1 INSUR S)AFFORDBIG COVERAGE NAIL d INSURED Volar Bear insulation Co.InC- INSURER A:Penn America 32859 P O Box 958 INSURERB:S ty Insurance Co. 33618 Andover,MA 01810. INSURERC. USURER D INSURER E. INSURER F COVERAGES CERTIFICATE NUMBER: 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. ILSR OUL NOR TYPE OF INSURANCE POLICY NUMBER POLICY UCY POLICY 1 Y UIIM GENERAL LIABILITY EACH OCCURRENCE $ 1,000,00 A X COMMERCIAL GENERAL LIABILITY PAC7052023 0324x1075 03/24116 DAMAGE TO RENTED PREMISES omurence $ 50,00 CLAIMS-MADE Fx—J OCCUR MED EXP(Any one person) $ 51 PERSONAL&ADV INJURY $ 1,000, GENERAL AGGREGATE $ 2,000,00 GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 1,000,00 POLICY PRO LOC $ AUTOMOBILE UABIU Y ANY AU00926 CO(EeMBINED SINGLE LIMIT $ 1,000,00 B TO 10,1104=5 01/04x1016 BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULED AUTOS PROPERTY DAMAGE $ X HIRED AUTOS (PER ACCIDENT) X NON-OWNEDAUTOS $ $ UMBRELLA LAB X OCCUR EACH OCCURRENCE $ 1,000, A EXCESS UAB CLAIMS-MADE PAC6906M 03242015 03(24x1016 AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION I WC STATU- ANDEMPLOYERS'LIABILITY Y/N ITORY LIMITS ANY PROPRIETORIPARTNERIEXECUTNE E.L EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,desodbe under DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT $ DESCRIPnONOFOPERATIONSlLOCATIONS/VEMCLES(MachACORDIM,AddihmWRenw Schedule,Imom space isrequired) Insulation Work-Mineral;pdditionai ir�s�for a ral lability,y% w[�s cts to work performed on their behalf by th�above�nsured is Thielsch Engineering CERTIFICATE HOLDER CANCELLATION THIELS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Thielsch Engineering THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Columbia Gas ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave Cranston,RI 02910 AUTHORIZED REPRESEKATIVE 01988-2009 ACORD CORPORATION. All rights reserved ACORD 25(2009!09) The ACORD name and logo are registered narks of ACORD 9/14/2015 Print certificates:Certificates of Insurance AC O 12Baon CERTIFICATE OF LIABILITY INSURANCE nA,E( 890'4 �...� la THIS CERTIFICATE 6 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 be endorsed.If SUBROGATION IS WAIVED,subject to f the terms and conditions of the policy,certain policies may require an endorsement.A statement on this certificate does not confer rights to the 113 certificate holder in lieu of such endorsement(s). PRODUCER LUNT NAME: CT Automatic Data Processing Insurance Agency,Inc. A PHONE ExO: (Ar—NoJ 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC# INSURER A: NorGUARD insurance Company 31470 INSURED POLAR BEAR INSULATION CO INC INSURER B: DBA:Polar Bear Insulation CO Inc INSURER C: PO BOX 9S8 INSURER D: Andover,MA 01810 INSURER E: INSURER F: 1 COVERAGES CERTIFICATE NUMBER: 291629 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 SUBJ ECT TO ALL THE TERMS, 3 EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. J LTR TYPE OF INSURANCE VULILY EFt POLICY EXP INSO WVD POLICY NUMBER (MMMID 4VM,0DDAYYY) LIMITS 11 COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE F OCCUR PREMISES(Eaoccunence) S MEDEXP(Anyone person) S PERSONAL&ADVINJURY S GENLAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S POLICY PRO)ECT F-1 LOC PRODUCTS-COMP,OP AGG S OTHERi S AUTOMOBILE LIABILITYS (Ea accident) _ ANY AUTO BODILY IN)URY(Per person) S AU OS SCHEDULED BODILY IN (Per accident) S ! AUTOS AUTOS 3 HIRED AUTOS NOWOWNED TRUFERTTIMMAG AUTOS (Pet accident) E S S UMBRELLALIABOCCUR EACHOCCURRENCE S EXCESS LIAB CLAIMS-MADE AGGREGATE S p DED RETENTIONS S it WORKERS COMPENSATION AND EMPLOYERS'LIABILITY Y IN X STATUTE Ell __ { A ANY PROPRIETORIPARTNERFXECUTIVE E.L.EACHACCIDENT S 1.0M00D OFFICERt&MBER EXCLUDED? a NIA N POWC660990 01,0112015 01,01'a016cfc (Mandatory in lAd 1es,descriE.L.DISEASE-EA EMPLOYEE S 110M000 t I be under DESCRIPTION OF OPERATIONS betas €.L.DISEASE-POLICY LIMIT S 1100Q000 FFF 4 l DESCRIP71ON OF OPERATIONS)LOCATIONS JVENCLES(ACORD 101,Additional Rem Schedule,may be ateehed if morespace is required 3 � Columbia Gas massachusem i 3 CERTIFICATE HOLDER CANCELLATION SHOULOANYOF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Theilsch Engineering,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 195 Frances Ave Cranston,RI(12910 ALrFHORpED REPRESENTATIVE J�C� Ott)k 1 O 1988-2014 ACORD CORPORATION.All rights reserved ACORD 25(2014,01) The ACORD name and logo are registered marks of ACORD https://adpia.adp.com/icertef/#/run/printcerts/283910 111 a d Regulation Office of ConsumerPitS5170 s 10 Park to Boston,Massachusetts 02116 stration Home IMProvement Contracto g Registration: DBA-Type: Tr# 252249 Expiration: 71212016 POLAR BEAR INSULATION CO Vincent LeBlanc P.O. BOX 958 n for change. MA p�810 ark reaso ANDOVER, Update Address and return card, ark [�Lost Card Address Renewal DPS.CA1 ca 50M.W04.G101216 t Massachusetts =Department of Public Safety Board of Building Regulations and Standards Construction Supero isor Speciaihv License:CSSL-106017 '' PETER A LEBLAN, C r 2 EAST PINE STREETv Plaistow NH 03865 o ;., Expiration 04/28/2018 commissioner TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit N0: Date Received Date Issued: IMPORTANT:Applicant must complete all items on this age _ .' "LOCATION' 1_© �.ax �ka c�.n r Print+ �PRO;FERTY�0INNER.._. r-y Y int 10:0 Year Old'Structure?' yes, io ? MAF'NO FARCE _. _ZONING'DI;S�TRICT HistonctDistnct yes , . . - � _ _;, Machine,Sho,p Village. yes TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septics .D Vl/elli DaFloodplan� 0.1Netlands_ ❑ WatershedlDistrict DESCRIPTION OF WORK TO BE PERFORMED: Identification Please Type or Print Clearly) OWNER: Name: ,'t Phone: e\�<c- Address: r<C®.N ;RACE OR; Nam'e 'A:0 _1�' '=�`3 3 , #Address '1— - - Su ervlsor's�Co:nstruction License,: A p� bate:- p .. S3-y = Ex r Home Improvement License;. _ �o Exp ARCHITECT/ENGINEER N�A)NP-k, Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. L Total Project Cost: $ \0 Ly V u FEE: $ 2.y,y 0 Check No.: 1 7t " I o Receipt No.: 71��� NOTE: Persons contracting with unre istered contractors do not have access to the guaranty fund Slgr to urerof;Agent/®wner -_ _ gnat_ure¢o_f contracto Plans Submitted ❑ Plans Waived Certified Plot Plan ❑ Stamped Plan Location lJ OpApa a L No. 9 Date �. f . - TOWN OF NORTH ANDOVER • D ��► Certificate of Occupancy $ �— Building/Frame Permit Fee $� Foundation Permit Fee l� v Other Permit Fee $ t` TOTAL $ W9 Check# 27403 Building Inspector Plans Submitted ❑ Plans Waive Certified Plot Plan ❑ Stamped Plans ❑ TYPE OF SEWERAGE DISPOSAL ' Public Sewer ❑ Tanning/Massage/Body Art ❑ Swimming Pools o Well ❑ Tobacco Sales ❑ Food Packaging/Sales ❑ Private(septic tank,etc. ❑ Permanent Dumpster on Site ❑ THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM f DATE REJECTED DATE APPROVED PLANNING & DEVELOPMENT ❑ ❑ COMMENTS CONSERVATION Reviewed on Si nature COMMENTS I HEALTH Reviewed on Signature I COMMENTS Zoning Board of Appeals: Variance, Petition No: Zoning Decision/receipt submitted yes Planning Board Decision: Comments f Conservation Decision: Comments Water & Sewer Connection/Signature & Date Driveway Permit DPW Town Engineer: Signature: Located 384 Os ood treet FIRE DEPARTMENT = Temp Dumpster on site yes no Located at 124 Main Street . - . . • Fire Department-signatiareldate + COMMENTS NORTH Town of s ndover, O - to No. _ y - y C h ver, Mass, T O LANE 441 3. 74 14 COC HIC MI WIC. V Z1,9 A°4AT V S U BOARD OF HEALTH Food/Kitchen PERMIT T L. D Septic System • THIS CERTIFIES THAT BUILDING INSPECTOR ....\� . ........ .. .�. ..... .. ... ........................................... has permission to erect ..... .................... buildings on ..10... Foundation • ` Rough to be occupied as ... .. .. ..... .... .. ...:.i...�!.,.... ..5... .... . . .. �.. .... : Chimney oprovided that the person accepting this permit shall In every respect confrm to the terms e 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 CONSTRUCT ST S Rough Service ............. .... ...................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building 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. i �1 AC40RQ® OATE(MMro D/YYYY) f CERTIFICATE OF LIABILITY INSURANCE 7/17/2013 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 REPRESENTATME OR PRODUCER., AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)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 NCONTACT AME: M P ROBERTS INS AGCY INC ac°No EXt: (978) 683-8073 Z):(978)683-3147 1060 Osgood Street L-MAILEss:s �@IRjJrobertsinsurance.com North Andover, MA 01845 INSURER(S) AFFORDING COVE.-AGE NAIL# INSURER A:PROVIDENCE MUTUAL INSURED KEVIN MURPHY BUILDING & REMODELING INSURER B:MERCHANTS INSURANCE 169 BOXFORD STREET ; INSURER C:GUARD INSURANCE NORTH ANDOVER, MA 01845 INSURER D: INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 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 ADDI sUBR POLICY EFF POLICY EXP IVSD trove POLICY NUMBER MM/DD MMIDD LIMITS X COMMERCIAL GENERAL LIABIUTY EACH OCCURRENCE $ 1,000,000 CLAIMS-MADE ®OCCUR PREMISES Ea ocamence $ 500 000 TJ MED EXP(Any one person) $ 15,000 A BOPI068945 11/22/12 11/22/13 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER GENERAL AGGREGATE $ 2,000,000 � POLICY�JECT PRO- El LOC PRODUCTS-COttpiop AGG S 2,000,000 OTHER: $ AUTOMOBILE LIABILITY -CDMBTRE Ea accident I $ 1,000,000 ANYAUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED MCA7013608 01/23/13 01/23/14 B AUTOS X AUTOS BODILY INJURY(Per accident) $ I HIRED AUTOS NONAUT-OWNED PRO RTY AMAG Per accident) $ $ UMBRELLA LIAB $ EXCESS LIAR OCGtIR EACH OCCURRENCE s 1,000,000 CLAIM;-MADE CUP9145304 11/22/12 11/22/13 AGGREGATE $ 1,000,000 DED RETENTION$ WORKERS COMPENSATION x T $ AND EMPLOYERS'LlAB!LITY YIN I STATUTE ER ANY PROPRIETORIPARTNEPJEXECUTIVE C OFFICC tory In SE EXCLUDED? ❑NIA KEWC4224 67 07/01/13 07/01/14 E.L EACH ACCIDENT $ 500,000 (MandIf yes,describe under E.L.DISEASE-EA EMPLOYE $ 500,000 DESCRIPTION OF OPERATIONS below E.L.DISEASEPOLICYLIMIT $ 500,000_ DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule.may be attached if more space is required) CERTIFICATE HOLDER CANCELLATION TOWN OF NORTH ANDOVER BUILDING DEPT. SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN NORTH PROVER MA 01845 ACCORDANCE W(TH THE POLICY PROVISIONS. AUTHORIZED REPRES A r` I ©1988-2013 ACORD CORPORATION. All rights reserved. ACORD25(2013/04) The ACORD name and logo are registered marks of ACORD I The Commonwealth of Massachusetts Department of IndustriqlAccidints Office of Investigations VV 600 Washington Street Boston,MA 02111 www.mass gov/dia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name(Business/Organization/Individual): Address: C,>6 k-t '_ s City/State/Zip: Vj,, , Phone#: q!1'V 31 '13 3 Are you an employer?Check the appropriate box: Type of project(required): 1.DI am a employer with_` 4. ❑ I am a general contractor and I 6. F]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.t T-Wemodeling ship and'have no employees These sub-contractors have 8. ❑Demolition working for mein any capacity. workers' comp.insurance. 9. ❑Building addition [No workers'comp.insurance 5. ❑ We are a corporation and its 10.❑Electrical repairs or additions required.] officers have exercised their 3.❑ 1 am a homeowner doing all work right of exemption per MGL 11.❑Plumbing repairs or additions myself. [No workers' comp. c. 152,§1(4),and we have no 12.❑Roof repairs 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. T Homeowners who submit this affidavit indicating they aie 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 their workers'comp.policy information. Aram an ovid that employer is r ' in p g workers'compensation insurance for my employees Below is the policy and job site information. Insurance Company Name:. ( >w,`off ��,NS ct.,, Policy#or Self-ins.Lic.#: �_L�l•-��. �'L2.�-��"Z. Expiration Date: Job Site Address: 1:t7 City/State/Zip: U VP Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as requiredunder 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 maybe forwarded to the Office of Investigations of the DIA-for insurance coverage verification. Ido hereby ertfy under the pains and penalties of perjury that the information provided above,is true and correct - Si ature: Date: \,0-3 l 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#: 4 ��� ur h0 98 K� Y'� �A I ,, � � � i N iy � North A�ntdove street 01845 __ PH:978-688335 Building Contractor • FAX:97 X88-7207 Proposal To: Neil Casey 0 Cabot Road All Home improvement Contractors and Subcontractors engaged in tome improvement contracting,unless North Andover, Ma 01845 specifically exempt from registration by Provisions of chapter 142A of the general laws,must be registered with the Commonwealth of Massachusetts.Inquiries about registration and Status should be made to the Director,Home Improvement Contract Registration,One Ashburton Place, From: Kevin Murphy Room 1301,Boston,MA 02108.(61-1)-727 8598 cc: Date: 4/3/2014 Job: Siding/Door Date of plans: None Architect None Location: Same i Section I-Work Schedule Contractor will begin the work or order the materials before the third day following the signing of this agreement, unless specified here in writing contractor will begin work on or about 4/1/14. Barring Delay caused by circumstances beyond Contactors control,the work will be completed by 5/30/14.Ttie owner hereby acknowledges and agrees that the scheduling dates are approximate and that such delays that are not avoidable by the Contractor shall no be considered as violations of this agreement. Section 11-Wamanty The Contractor warrants that the work furnished hereunder shall be free from defects in materials and workmanship for a period of 1 year following completion and shall comply with the requirements of this Agreement. In the event any defect in workmanship or materials, or damage caused by the Contractor, his subcontractors, employees or agents, is discovered within one year after completion of any job, including cleanup,the Contractor shall,at his own expense,forthwith remedy, repair correct, replace,or cause to be remedied, repaired,or replaced, such damage or such defect in materials or workmanship. The foregoing warranties shall survive any inspection performed in connection with the agreed-upon work. Section III-Scope of Work Page 1 of 4 Kevin Murphy�'P Y P ae2of4 Building Contractor g 98 Forest Street North Andover,MA 01895 PH:978£88-53.x,5 FAX 978688-7207 General Proposal is to strip and reside right side of existing house and replace front door unit. Building permit will be obtained by contractor. Demolition Existing cedar clapboards will be removed and disposed of. Building New front door unit will be supplied and installed. An allowance of$1200 has been included for door unit. Any rotted trim will be replaced with Azek. Wall will be wrapped with Tyvek or equivalent. Hardie plank ( cement based clapboards)will be supplied and installed. Waste Removal All construction related debris,will be disposed of by contractor. Painting No allowance has been made for any painting. c Kevin Murphy Page 4 of 4 Building Contractor 98 Forest Street North Andover,MA 01845 PH:978688,3% FAX 978688-7207 Section IV-Price Schedule We hereby propose to furnish material and labor-complete in Accordance with above specifications for the sum of... ... ... ... ... ... ... ... ... ... ... ....$ 10,000 Payment to be made as follows: Percentage/item Description Amount 1 Siding complete $6500 2 Door installed /job complete $3500 Total 2 $10,000.00 Notice:No agreement for Home improvement contracting work shall require a dawn payment(advance deposit)of more that one-third of the total contract price of the total amount of all deposits or payments which the contractor must make,in advance,to order ardor otherwise obtain delivery of special order materials and equipment,whichever is greater Contractor: Kevin Murphy 98 Forest Street No.Andover, MA 01845 Registration No: 101874 Section V—Acceptance Acceptance of Proposal—I have read this document and accept the prices, specifications,and conditions stated. I understand that upon signing,this proposal becomes a binding contract.You are authorized to do the work as specified. Payment will be made as outlined above. You the buyer may cancel this transaction at any time prior to midnight on the third business day after the date of this transaction cancellation must be done in writing DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Signature Date Signature Date