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HomeMy WebLinkAboutBuilding Permit #268-16 - 9 DUDLEY STREET 9/1/2015 i BUILDING PERMIT NORrH O�St�eu i6q�0 TOWN OF NORTH ANDOVER 0 y�'- APPLICATION FOR PLAN EXAMINATION * _ aw.c b MA��op Permit N Date Received 7 ^Teo �5 gSSACHUS�� Date Issued: WI ANT: Applicant must complete all items on this page LOCATION ] 00da t" Print PROPERTY OWNER E&W-4141 V s P04t 100 Year Structure yes Cn MAP PARCEL: ZONING DI TRICT: Historic District yes Machine ShopVillage es - 9 y TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ne family j ❑Addition ❑Two or more family ❑ Industrial B4Iteration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑ Septic ❑Well ❑ Floodplain ❑Wetlands ❑ Watershed District ❑Water/Sewer DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: i v.�c�rc� �-c Sl. ► Phone:O� Address: Contractor Name: .,n`3Vr\% Cr Phone: C1 3 ��'U• 3A Address: p iu v Supervisor's Construction License: Exp. Date: Home Improvement License:l 3 t _ _ Exp. Date:th I U 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: $ 31 � a CA FEE: $ 3F6e) Check No.: a `6 J�: Receipt No.: �l NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund �_____ _- Signature of Agent/Owner Signature of contractor Location No. �j Date . - TOWN OF NORTH ANDOVER • LED 1696' . • Certificate of Occupancy $ Building/Frame Permit Fee Foundation Permit Fee Other Permit Fee $ TOTAL $ ' h Check 49 4L Building Inspector i'f e 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. ❑ Permanent Dumpster on Site ❑ .I THE FOLLOWING SECTIONS FOR OFFICE USE ONLY INTERDEPARTMENTAL SIGN OFF - U FORM PLANNING & DEVELOPMENT Reviewed On Signature_ COMMENTS I i CONSERVATION Reviewed on Signature I COMMENTS HEALTH Reviewed on Signature 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 a DPW Town Engineer: Signature: Located 384 Osgood Street IRE DEPARTMENT - Temp Dumpster on site yes no Located at 124 Main Street Fire Department signature/date COMMENTS r _ 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) ❑ Notified for pickup Call Email 3 Date Time Contact Name i Doc.Building Permit Revised 2014 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 o Building Permit Application o Workers Comp Affidavit o Photo Copy Of H.I.C. And/Or C.S.L. Licenses o Copy of Contract a 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 o Building Permit Application o Certified Surveyed Plot Plan o Workers Comp Affidavit o Photo Copy of H.I.C. And C.S.L. Licenses u Copy Of Contract o Floor/Cross Section/Elevation Plan Of Proposed Work With Sprinkler Plan And Hydraulic Calculations (If Applicable) a 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) o Building Permit Application Li Certified Proposed Plot Plan o Photo of H.I.C. And C.S.L. Licenses u Workers Comp Affidavit Li 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 o 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 submitted with the building application Doc:Building Permit Revised 2014 NORTH Town of 2 ndover No. 0 4 - ti h ver, Mass, q I (S_ C OC MIC«!WIC y1' �i9s Q�TEO �Pa�.(y 11 BOARD OF HEALTH Food/Kitchen PERMIT D Septic System • THIS CERTIFIES THAT ...................... BUILDING INSPECTOR .. .. ....... .. ... ., Foundation has permission to erect ........... buildings on ......5 Rough ANr' .... .................... .. .... .....................to be occupied as ........ .. ........... ....... ................... Chimney provided that the person accepting this permit s 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 CONSTRUC RTS Rough Service .......... .. .......... .................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinz 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. DocuSign Envelope ID:97C6D5CE-8308-413F4-90D1-2297244613410 CONTRACT FOR Conser atlon PRODUCTS / SERVICE WORK Services Group This service is brought to you through support from your local utility This Agreement is made by and among Ec►ward'Keisting and 9 Dudley St Conservation Services Group(CSG) North Afidover,MA 01845-360 Attn:RCS 50 Washington Street,Suite 3000 Site ID:500050020475 Westborough,MA 01581 Project ID:1`00050023330, Reg.No. 173484 Customer ID:C00050020706 Federal ID No.222457170 Contract ID:X20150723 ASEA - (Mail completed contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Premises"in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the°Work")which are incorporated herein by reference: Description Quantity Location PerformAir Sealin at Estimated 62.5 CFM50_Per Hour.....................................................................6.....................Living...Space........................................................................................................................._$505 .92......... 9............................................................................. Door Swee 3...................._N/A .............-......................p.........._................................................. $69,54......... Exterior Door Weather Stripping 3 N/A ._..._.._........ $82.77 ....... Sub Total: $658.23 Utility Incentive Share $658.23 Customer Contribution $0.00 Qf ja C For office use only Printed:7/23/2015 Page 1 of 2 II. PAYMENT Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment til:$-9-00 as a Deposit payable to CSG upon signing the Contract(not to exceed 143 of the total retail costs).Mail check&contract to CSG,Attn:RCS,50 Washington St.,Ste. 3000,Westborough,MA 01581.Final Payment:$ 0.00 as the final payment for the Work shall be payable to the Independent Installation Contractor("IIC")upon satisfactory completion of the Work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount of$-65-8-23—.Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. III.DISPUTE RESOLUTION The IIC and Customer hereby mutually agree in advance thatin the event that the IIC has a dispute concerning this Contract,the HC may submitsuch dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later thin midnight of the third siness'` ay'Following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE {ARE ANY BLANK SPACES. 7/23/2015 C Y Custo nr e`i Si n�fiue Date Indicate our selected HC here,if applicable (DKA y pp' Initial here if you want At&`Uavutery 7/23/15 Mike Varney the Program to assign a Participating Contractor CSG Signature Date Name of CSG Representative(Printed) TERMS AND CONDITIONS APPEAR ON THE REVERSE. 3/14 DocuSign Envelope ID:C91 F5D63-EA54-40F8-AF77-C4CEA379BDEF CONTRACT FOR Conner ation PRODUCTS / SERVICE WORK Services Group This service is brought to you through support from your local utility Than Agreement is made by and among EdwarO Keislin andR 9 Dudley St Conservation Services Group(CSG) North Andover,MA 01845-3603 Atte:RCS 50 Washington Street,Suite 3000 Site IM,,00050020,475 Westborough,MA 01551 Project 10:P00050023330 Reg.No. 173454 Customer ID:000050020706 Federal ID No.222457170 ContractID:,20tS0723 WORK (mail Completed contract to address shove) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Premises`in a professional manner and in accordance with the terms of this Contract,including the attached recommendations/work order describing the work in detail(the"Work")which are incorporated herein by reference: Description Quantity Location Attic Floor Openw ................................................................................................ .640LivigS ce $1,062.40.......... Attic Floor Enclosed Cellulose Dense Pack 8" 322 LivingS $837.20 ace.....P...................................................................................................................................................................... Insulate Rim Joist with 6.25"Fiberglass.Batting _ 114 Living S ace $273.60 .,....._. . .P......... .......... Dammin 14 N/A $30.66 Install 8"Roof Vent 1 Attic 2 $99.65 12"Mushroom Vent 1 Attic_ $137.97 Door:Thermal Barrier Pqlj 2" Attic 1 Living S act a $81.37 Sub Total: $2,522.85 Utility Incentive Share $1,892.14 Customer Contribution $630.71 Pre-Weatherization Incentive $250.00 ............ Remaining Customer Contribution $380.71 01`01 Deposit Already Recieved on 0 7/23/15 For office use only Printed:7/28/2015 Page 1 of 1 It. PAYMENT 126. 0 Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment#1:$ as a Deposit payable to CSG upon signing the Contract(not to exceed 1/3 of the total retail costs).Mail check&contract to CSG,Attn RCS,50 Washington St.,Ste. 3000,Westborough MA 01581.Final Payment:$-254.71 as the final payment for the Work shall be payable to the Independent Installation Contractor("IIC")upon satisfactory completion or the work.Customer understands that he/she will not be required to pay the Utility Incentive Share of the Contract price in the amount,of$_1 892.14 _Changes to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. III.DISPUTE RESOLUTION The IIC and Customer hereby mutually agree in advance thatin the event that the IIC has a dispute concerning this Contract,the IIC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit.to such arbitration as ptindded in M.G.L c 142A. You may cancel this agreement if it has been signed by a party at a place other than an address of the seller, provided you notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third 1ybu :nets'dWfbllowing the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE AR ANY BLANK SPACES. I A. .,A i��rL it 7/28/2015 r-y Customdr'9i%`nht l 6"r` Date Indicate your selected IIC here,if applicable (OK) Initial here if you want Mike Varney 7/23/15 Mike Varney the Program toassign a CSG Signature Date Name of CSG Representative(Printed) Participating Contractor TERMS AND CONDITIONS APPEAR ON THE REVERSE. 3/14 RCS PLANV1EW DIAGRAM Customer. t P��S Irt� Home Phone: ( )- Address: Yv� s� Work Phone: ( )- Town: Cell Phone: qryq Any limitations for access by large truck? No L Yes if yes,describe: Any specific directions or landmarks? No �/!/ Yes if yes,describe: Site ID: S�t10�U Z•S' Energy Specialist: rj varAel Reviewed by: t �Q ��a� p.1M �ay� tr�,���•1 f„ "C2) il� ki`J's �t>i�ti� (,�;�)i>,� Rai �n -•weG}�fi�'QP':� y` 13 fi Vol S 1 y Ad t (,�(trtr►�� Sa1)oar rfir2 �c+^j 3 =s t 4---i bdF �a5 gw,d CaA1h-4vJ Wad) • r 1p f � 't'° • � t EM v` For Office Use Only Bushes Ladder Neighbor Proximity Pocket Doors Insert Radiators e(s) Existing Conditions X=Access ❑=Vents Note Inside Square R=Roof S=Soffit G=Gable RV=Ridge Vent CS=Continuous Soffit CDE=Continuous Drip Edge T=Triangle Install O=New Access Note in Circle C=Ceiling W=Wall S=Sheathing Temp Unless Noted Otherwise =Vents Note in Triangle R=8"Roof S=Soffit G=Gable M=12"Mushroom For Access 270Ou10yY/.TSU Arm mass save CON R s.Virug4 tivoupft.ryrgir«tsd.ncy r� PERMIT AUTHORIZATION FORM I, Edward Keisling ,owner of the property located at: (Owner's Name,printed) 9 Dudley St. North Andover (Property Street Address) (City) hereby authorize the Mass Save Home Energy Se ices Program assned Participating Contractor listed below to act on my behalf and obtain a mitcung permit to orm insulation and/or weatherization work on my property. X Owner's Signature l Date FOR CSG OFFICE USE ONLY Conservation Services Group has assigned the following Mass Save Home Energy Services Participating Contractor to the above referenced project: Participating Contractor Date 0� for Office Ilse Onty Rev.12132011 L The Commonwealth of lWaesac rusetts Department of IndusowlAcc dents i Office of Investigations I CrrMM$Street,Sine 1+ Boston,MA 02114-2017 ir tcwww.masr govidia Workers'Compensation Insurance Affidavit:Bugders/Contraetorss/Electricianstt'ie mbcrs Applicant Ini' rwatio _ Please Mit.klibly Nameirxes.i�,°kpoizwmnn iuidurd): Address: Z01 344 Ct fstate/Zt P: � Phone : I TA 2 Are you an a loyir, Check the appropriate boY; Type�!project,(rcquit ti): � 1. 1 employer with 4, (11 am a general contractor and 1 t slcoy (full and/or part-time), has a hired the pub at€�c#�ar t'- New co truct inti 2. 1 am a sole:proprietor or partner listed on the attached sheet. 7. Remodeling ship and have no mployces `7hct;c Sub-cos tars have S. [Mmlition working for me its any capacity, canployces and have workm, No workers`corms,iss uranc comp.insuratsce,, �, 1'loct ica additions required.) 5. We are a corporation anti its 14-0 l lcctrscal repairs or additions 3.10 1 arts a hcorneoaxner doing all work officers have excrcised their l l_[I Plumbing repairs or addittntss Myself tNo uvrk 'comp. tight of exemption per MCTL 1213 Roof repairs insurance.required.] C. 152,§1(4),and we have net employees,[lo v orkeW 13,Q men_ comp,insurance t rotted.l "Any aNticamthatchecks box*.t mesas s xo fill aw the action below���tluetr w4YTke 5'rx aaa azrnts �Y i��inmsatia�. l+a xaxx neer�rtrts wbtnit this arhdavit indac sthqy nee day aII,axe wTd z}=hive a taew Affidavit indicaftng saach- tf<'Mtra rs that check this box mug s#xdvd an Witmnat x xt c>viog the mum of Ifi r wb-canmactm,,and s aa�camas rsr�t hc�e entities 3sasv csM14ems. tf tic-x rcuf 4etcn have ,thcY mug PvOvxk TbW U'4kr °«s ,W nUMbe,. a t'suer air crrrpda}aes*that es prvrv8dr'>v�'rrdrers'er►my*,eartion oro�rec,for mp rrnspto;}� . Itefirrn�i<r rile p�lacc�Died jar s�'e insurance,Company 1Vamee4 Policy t#or Sclf4ns.Lic.#VC-10LO t of tois l .,._. Expiration Date-_A 9 Job Site Address:� '�J�1 C��L C'ityl'�tttef2ip;�b�,{� `+���►1 �t�� Attach a copy of the workers'compensation policy declaration page(showing tate polls numb"and expiration date). Failure to secure coverage as required under Section 25A of MGL c,. 1.52 can lead to the itis ition of criminal penalties of a fine rap to V.500.00 andtcsr one-year imprisonment,as cell as civil penalties its the fonts of a STOP WORK ORDER and a fine of up to S250M a day against the violator. He advises that a copy of this statement may be fomanied to the Office of Investigations of the f31A for insurance coverage verification, d do hereby cern y under Mt paters and penalties ofperfury that the information provWd aAqVW a hwe and causer: SUNIMMe t 3 431 , 7�L' re,only. Do not write in this arae,to be completed by city z r down official, Town- Perrait/License uthority(drde one): f Health I.Building Dgmrtmeot 3,C thr/Town Clerk 4,h leetr l laspector 5.Plumbing twpector erson• Pirate#: I DATE(MWDDNYYY) AC'� �� CERTIFICATE OF LIABILITY INSURANCE 7/7/2015 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 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 CONTACT Nancy Usher Martin J Clayton Insurance Agency, Inc. PH (413)Ext): (413)536-0804 T(A�Ne)_(413)534.7e74 1649 Northampton Street ADDRESS: P. O. BOX 989 INSURERS AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 _ INSURERA:Nationwide Mutual-Harleysville NATIO INSURED INSURERB:Allied World Natl Assurance Co Gauthier Insulation INSURER C: I 44 ESSEX ROAD INsuRERD: _ INSURER E: IPSWICH MA 01938 INSURER F: COVERAGES CERTIFICATE NUMBER:CL157701379 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 TYPE OF INSURANCE ADDL SUBR ' POLICY EFF POLICY EXP LTR POLICY NUMBER D LIMITS X I COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 -DAMAAGETO RENTED A CLAIMS-MADE X OCCURPREMISES Ea occurrences $ 50,000 X GL43487F 7/6/2015 7/6/2016 _MED EXP(Any one_person) $ 5,000 _PERSONAL&ADV INJURY _$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: _GENERAL_AGGREGATE_� $ 2,000,000�PRO- l� -—�--------- — X POLICY JECT LOC PRODUCTS-COMP/OPAGG $ 2,000000,000 OTHER: ---- -- ------ $ - — -- AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ __. (Ea accident) ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS _Lr acciden)------ - $ X UMBRELLA LIABOCCUR EACH OCCURRENCE $ 1 000,000 B EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000_ DED RETENTION BE020792125-194985 10/18/2014 10/18/20151 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY Y/N __— STATUTE__ _. ER ANY PROPRIETOR/PARTNER/EXECUTIVE D E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? N/A - - -"—'- -" - - -" ---- -- (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 If more space is required) TEI, AND ANYONE ELSE REQUIRED ARE NAMED AS ADDITIONAL INSUREDS) ON A PRIMARY AND NON-CONTRIBUTORY BASIS TO ANY OTHER INSURANCE CARRIED BY TEI, UNDER THE SUBCONTRACTORS GENERAL LIABILITY AND UMBRELLA COVERAGE. 30 DAYS NOTICE OF CANCELLATION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THIELSCH ENGINEERING, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 195 FRANCIS AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. CRANSTON, RI 02910 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD fig' Fb'b5tbd with pdfFactory trial version www.pdffactory.com LJ 10 1'H^ 1L/10/2014 1 :21 :37 PM MAGE 2/002 Fax Server i CERTIFICATE OF LIABILITY INSURANCE F 'n"`ML l 12/10/2014 THIS CERTIFICATE IS ISSI.JFO AS A MATTER OF INFORMATION ONLY AND CONFERS Ito RIGHTS UPON THE CERTIFICATE HOLDER, THIS c ER'1'7FIcnTE u0E5 nOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTENT) Olt ALTER THE COVERAGE AFFORDED I3Y THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURHt(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,At 9D THE 'ERTIrICATE HOLDER. IMPORTANT: If I.he cerlJ6cate holder If.an ADDITIOt'IAL INSURED,the poficy(les)must:be endur:.P-d. If SUBROGATION IS WAIVED,subjc><:L to the LPrrns and cundillnn!� of the pokr.y, CM_'i:ain policies may require an endorsemenL. A ;ial.ement on this certificate does not: confer•r4ghtr. Lo the certilicate holder in lieu of such endorsement(s). I - Clayton Martin J Ins Agency Inc k Berkley Assigned Risk Services 1649 Northampton St g-o 800834-4589 IA. Nei R66 215-8.118 PO Box 989 no R-Is PolicyServicesGherkleyrisk.a)m I Hol oke MA 01041 k'u,:ER z A;'r"U ulNc ccvERncr Nrol;A i �NbU RF Ci Gauthier Insulation Inc Ns u7 Re. PO Box 344 INS JR FR C' Ipswich, MA 01938 INSURER,') INS IriER E COVERAGES Ns a7 EI.r CERTIFICATE NUMBER: REVISION NUMBER: THIS -'-^-T"CERTIFYIT THAT THE POLICIES OF INSURANCE E LISTED BELOW HnVE BEEN ISSLED TO THE "ZSURED NAMED ABOVE FOR THE POLICY PERIOD If1UIC:ATEO, tJOTy�'ITHSTAtJOING ANY REc]UO2Eh1ENT,TERM OR CONDITION OF PIJY CUNTRA(.T OR OTHER DOCUMENT WITH RESPECT TO WHICHTHIS CERTIFICATE MAY BE ISSUED OR MY PERTAIN, THE INSURANCE AFFORDED BY THE POLR:IES DESCRIBED HEIIEM . EXCLCCIONSAND QONDITIONS OF SUCH POLICES.LtirTS SHOWN AIAYHAVE BEEN REDUCED BY PAID CLAIMS. IS SUBJECT TO ALL THE TERf15. TYt F lT(i 10P rf:IIf,Y NIlMPFR fl, GENERAL LIABILITY IN$R VdVO klkKID/YYYY) ktk5,D 17fYYYV'. 1.1 k'!TS AUTOLIOB/LC LIAMLITY I WORKERS COMPEIGATION AND EMPLOYER s'LIABIL ITY Y.'N ANYAR�r:IFTfg7irA171 NFRJE%E:'U TIVF © I Tpt7Y Cl,fl;5 FR _ A 71'rItX,114CM11rR I Xi1_UP1.01 NIA ❑ WC-20-20,0018(;1.00 1013012014 I10l30/20't5 F`trnclr M.c10FN1 $500.000 IM-1.1-V i1,Nt/y ;'1-1,d"l—be.."r.J91 r'11y,RIP1 r_N Or 6PFi4•t'l l!>NS Daiaw I :IG.. F, n-NtP: E 500,000 Coverage Election Category Elect.Status Natne States) _All Entities/Locations Officer Exclude Kurt Gauthier Officer include BrittnieAiello MA Gauthier Insulation Inc 44 Essex Road Ipswich,MA 01938 C L CANC ILLATION SHOULD ANYOF THE ABOVE DESCTiIBEDPOLICIES BE CAW,ELLEJEFO11C THE EXPIRATION DATE THEREOF,NOTICE WILL BE DELIVE Maas Save Program/Conservation Services Group,Inc ACCORDANCE WITH THE POLICY PRUVISIC/NS. 50 Washington Street West Borough,MA 01581 ACORD 25(20i0f0,) BRAC 3139 i 1 Board Building e nt of Putole Sooty Oftna and Standarox License. E-t tty � R .: P-Ck SM344 I, !fit 0"- COMMIT .................. ..._. .... Y Office of Consumer Affairs and Business Regulation A` 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement CRegistration Registration: 173410 Type: Individual } Expiration: 110/11/2016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER __ P.G. BOX 344 IPSWICH, MA 0193$- �s ......_...... .. . .�.._ _............. Update Address and return card.Mark reason for change. - I " Address Renewal i.._.! Employment C..m� Lost Card SCAI G 2OM-0Wtt dT11r�f ranrxrz{a ruOtt r f l�rrS..rc tr.rflY Office of Consumer APiAirs,&Business Regulation License or registration valid for individul use only 1 OME IMPROVEMENT CONTRACTORbefore the expiration date. If found return to: egistration: 173410' Type: Office of Consumer Affairs and Business Regulation plration :1If1 12016. Individual 10 Park Plaza-Suite 5170 Boston,MA 42116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD IPSWICH,MA 01938 Undersecretary Not valid wi out signature I I Date./,aZ/ . .. .. r r Of.HOR Try 1,t, ` o� TOWN OF NORTH ANDOVER 41 ; PERMIT FOR GAS INSTAL ION s . y SACH AE This certifies that . . . f�!! . . �. Gh �(. . . . . . . . . . . . . . . . has permission for gas installation . . v".`!:... . . . . . . . . . in the buildings of . .. . . . . . . . . . . . . . . . . . . . . . . . . . . at . . . . . . . . . . . . . . . .. North Andover, Mass. Fee. c/3. . . . . Lic. No.!./. t. :. . . � . . . . .1 �- . � �. : . . . . . . (1aAS INSPECTOR Check# 5845 MASSACHUSETTS UNIFORM APPLICATION FOR PERMIT TO DO GASFITTING (Print or Type) T � A10 �iurb4'E'e2 Mass. Date /.2— ��/ — Hutu' Permit# _ Building Location 9 J(/.)461 _5-1_r_Ee7_ Owner's Name ,Scout— MOY-OTOjj Owner Tel# i Tyre of Occupancy New Renovation ❑ Replacement ❑ Plan Submitted: Yes ❑ No-11;<1, FIXTURES s 54 U z <_ w x '- 0 x F z m F w O O O Ox v [S] Q W r, W W' < U) to U' U W Ln Z ¢ a O p u Z w W W Z 4 = WW W Z W F- W = a FO O w Q = O = w 3 Q v �� a > a o W r SUB-BSMT BASEMENT 1sT FLOOR r 2ND FLOOR 3RD FLOOR 4T"FLOOR 5T"FLOOR 6T"FLOOR 7T"FLOOR 8T"FLOOR Installing Company Name STARK &CRONK PLUMBING&HEATING Check one: Certificate Address 308 MAIN STREET, GROVELAND,MA 01834 � ��(, 19 Corporation ❑ Partnership Business Telephone# 978-372-6981 ❑ Firm/Co. Name of Licensed Plumber or Gas Fitter INSURANCE COVERAGE: I have a current liability insurance policy or its substantial equivalent which meets the requirements of MGL Ch. 142. Yes A No ❑ If you have checked yes,please indicate the type coverage by checking the appropriate box. A liability insurance policy �p Other type of indemnity ❑ Bond ❑ OWNER'S INSURANCE WAIVER:I am aware that the licensee does not have the insurance coverage required by Chapter 142 of the Mass.General Laws,and that my signature on this permit application waives this requirement. Check one: Owner ct Signature of Owner or Owner's Agent I hereby certify that all of the details and information 1 have submitted(or entered)in above application, e- and accurate to the best of my knowledge and that all plumbing work and installations performed under the permit iss fCaws.s Iica n I be in compliance with all ertinent provisions of the Massachusetts State Gas Code and Chapter 142 of the Ge By Type of License: (/_ 1 •-Plumber �ig`nature of Licensed Plum as Fitter Title •-Gas fitter ••Master License Number 11027 City/Town ••Journeyman APPROVED(OFFICE USE ONLY) Location - 1 BUILD NORTH 2 ANDOy of NoDTh Dat �� RECORp ER' MASS. Date / OF O moa►?.! ;•�,�c TD /�// , (�_ wNERgHIP * ^ WN of N �� PURPOSE OF OA-re PACS 1 *o Certlflcat �RT/,J A ± NO. OF STO BUILDING aooK PAGE a °f 0C N�0 RIES I�I 7S �C#4 •r�"� BUlldi cuPanc ER BASEMENT O S,�'/IUSES� ng/Frame P y $ � SIZE OF R SLAB SIZE - FO�ndation P ernlit Fee Q i SPAN FLOO/t TIMBERS 1ST Other Perrnit ernlit Fee �_ DIMENSIONS =ND Sewer Fee % -_F SILLS 3RD W connect F ` ., POSTS Ater n ee G' ERS _--- a 1 i I, Connection Fee $ � HEIGHT OF FOUNDATION D W `_ t SIZE OF FOOTING V` 1 • MATER;gL OF THICKNESS 'S BUILDING CHIMNEY X ON SO Qad®�C�P Bulldh IS BUILDING CONN LID OR FILLED LAND Allgt$GP 91nSPector IS BUILDI ECTEp TO TO NG NNECTE WAI TER SE, Bp�h ''•-,- PUt)llr; IS BUILDING CONNECT D TO TOWN EWER PAGE Wor TED T PAG 1 FILL OUT SECTIONS 1 _ k3 / O No GAS LINE 3 1 3 PAGE 2 FILL OUT SECTIONS 4 PROPER ELECTRIC MET EP ' 12 LANA C08T TY rNFORMATr S MUSTOil EST, aLOG. ON �S MED GARAGES MUST CONFORM ON OUTSIDE OF BUILDING EST. BLDG CO 8T II DATE FILED BE FILED AND APPROVED BYSTATE FIRE REGULATIONS EPT BLDG. COST PER ROD V. of ED 4� / BUILDI TIC PERMIT M NG INSPECTOR 4 NO. SIGNATUR / APPROV FO NER O Ep BY AU IZED A NT EE 7 PERMIT NTED OVVVER TEL.# CONTCONTR. TEL.k,��oZ /�`� BOARD pF HSL t s� R.11C.#_'-'-�-._� rN PUNNING BOARD &OARD OR SELECTMEN bul I PECTOR I ,TORT/, OFFICES OF: . . fir' �°a T0wn Of 120 Main Street APPEALS NORTH ANDOVER North Andover, 13UIIa� hu ING ;i .�°-',0 M�r5tiF1<' SCtis 01845 Ss, " U�4 (6 17)685-4775 CONSEItVA'1'I0N ` " DIVISION OI' H EAL"I'H i PLANNING PLANNING & COMMUNITY DEVELOPMENT KAREN 1 LP. NELSON, DIREC'1'0R i In accordance with the provisions of MGL c 40, S 54, a condition of Building Permit Number T(Sy is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c ill, S 150A. The debris will be disposed of in: (Location of Facility) Signature of Permit Applicant Date NOTE: Demolition permit from the Town of North Andover must be obtained for this project through the Office of the Building Inspector. :CONSERVATION —SINAL SW / INAL LANNING FINAL ` owe ot 6 n Over ►- ''. No. 450 DRIVEWAY ENTRY PERMIT er, Mass. 1 �� C MEWICK ooR PP�� SS PE IT T 0 BOARD OF HEALTH THIS CERTIFIES THA ..�.... , . .. . ....................... ............. BUILDING INSPECTOR has permission to erec ..................... buildings on .�r........ `j�, i�...`,. ;,. Rough to be occupied as....... .... ..�� Chimney ..�i�� Final provided that the person accepting this permit shall in every respect conform to the terms of the application on file in this office,and to the provisions of the Codes and By-Laws relating to the Inspection,Alteration and.Construction PLUMBING INSPECTOR onstruction of Rough Buildings in the Town of North Andover. PERMIT FOR FOUNDATION ONLY Final VIOLATION of the Zoning or Building Regulations Voids this PeREGULATED BY PARA: 112.7 S.B.C. PERMIT EXPIRES 1 6 •ONTHS DATE: FEE PAID: ELECTRICAL INSPECTOR UNLESS CONS UCT S ARTS Rough Service Final ... . ........ . BUILDING E OR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Final Display in a Conspicuous Place on the Premises FIRE DEPT. Do Not Remove Burner Pio Lathing to Be Done Until Inspected and Approved by Smoke Det. Building Inspector ERHIT NO. APPLL19A ON FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP 4-40. LOT NO,� LPU RECORD OF OWNERSHIP (DATE BOOK ;PAGE ZONE -I-SUB DIV�LOT NO. f I I — I LOCATION OSE OF BUILDING � a✓-aye OWNER'S NAME uOn OF STORIES SIZE O v Q OWNER'S ADDRESS I� j�.�` BASEMENT OR SLAB ARCHITECT'S NAME (�( ! SIZE OF FLOOR TIMBERS IST 2ND 3RD BUILDER'S NAME V 1t Se �1�, e /VC SPAN DISTANCE TO NEAREST B^U 11LDING ,^ DIMENSIONS OF SILLS DISTANCE FROM STREET "' POSTS DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT ) FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW `/•1 SIZE OF FOOTING X 19 BUILDING ADDITION /, MATERIAL OF CHIMNEY IS BUILDING ALTERATION nQ, r IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE „/��+ IS BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY J IS BUILDING CONNECTED TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION LAND COST . SEE BOTH SIDES EST. BLDG. COST +I 1. FILL OUT SECTIONS 1 - 3 EST. BLDG. COST PER JQ. FT. 'T SECTIONS 1 - 12 EST. BLDG. COST PER ROOM SEPTIC PERMIT NO. "`N OUTSIDE OF BUILDING 4 APPROVED BY C "+STATE FIRE REGULATIONS '`IG INSPECTOR ♦ i , Ss,CNUS out ING INSPECTOR Sew,- — OWNER TEL.M O?All C Water CL T— // '/7 CONTR.TEL.M l6, 7 30 TOTAL --�-- CONTR.LIC.# In's X 31 7 ag Inspector J —7] tttC L ! V a H.I.C.X / ! / 6 Div. Public Works Ilfrr NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE 1 MAP ��0. I LOT NO 2 RECORD OF OWNERSHIP (DATE BOOK ;PAGE _ 20NE SUB DNO.IV�LOT I I LOCATION / 1 /Q v PURPOSE OF BUILDING �Q r ��Q✓.� e OWNER'S NAME - NO OF STORIES SIZE O y D OWNER'S ADDRESS BASEMENT OR SLAB ARCHITECT'S NAME v SIZE OF FLOOR TIMBERS 19T 2ND 3RD BUILDER'S NAME �^ ; e-, �lC, e SPAN DISTANCE TO NEAREST BJ ILDING ,_ DIMENSIONS OF SILLS— DISTANCE FROM STREET • POSTS -- DISTANCE FROM LOT LINES- SIDES REAR �� " GIRDERS AREA OF LOT IS BUILDING NEW FRONTAGE HEIGHT OF FOUNDATION THICKNESS l��` V SIZE OF FOOTING X IS BUILDING ADDITION 0 MATERIAL OF CHIMNEY IS BUILDING ALTERATION �P nQ /'r IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /to C IS-BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY J IS BUILDING CONNECT60 TO TOWN SEWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS 3 PROPERTY INFORMATION ------------- SEE BOTH SIDES LAND COST EST. BLDG. COST /n PAGE 1 FILL OUT SECTIONS 1 - 3 — �/ �" �• UO EST. BLDG. COST PER IJQ. FT. PAGE 2 FILL OUT SECTIONS I - 12 EST. BLDG. COST PER ROOM ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING - SEPTIC PERMIT NO. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4 APPROVED BY PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED � / 7�40 _ SIGNATURE OF OWNER OR THORIZED AGENT ■UI ING IHSP[CTOR FEE OWNERTEL.1 PERMIT GRANTED CONTR.TEL 1 19 CONTR.LIC.# S 17 t H.I.C.# 11 J.176 I I 13t1T NO. APPLICATION FOR PERMIT TO BUILD — NORTH ANDOVER, MASS. PAGE I MAP t•40. LOT NO 2 RECORD OF OWNERSHIP (DATE BOOK PAGE ZONE I SUB DIV. .Cg NO. LOCATION �I I PURPOSE OF BUILDING �/� OWNER'S NAME —too,Y�I{.� NO OF STORIES SIZE O O OWNER'S ADDRESS _L BASEMENT OR SLAB ARCHITECT'S NAME _J Cy - SIZE OF FLOOR TIMBERS 1ST i 2ND ARD BUILDER'S NAME -D ^ ; Se �iC• e T SPAN DISTANCE TO NEAREST BA IILDING DIMENSIONS OF SILLS , DISTANCE FROM STREET POSTS -- DISTANCE FROM LOT LINES - SIDES REAR GIRDERS AREA OF LOT FRONTAGE HEIGHT OF FOUNDATION THICKNESS IS BUILDING NEW Irl SIZE OF FOOTING x IS BUILDING ADDITION MATERIAL OF CHIMNEY IS BUILDING ALTERATION ,v l�. nQ, /`� IS BUILDING ON SOLID OR FILLED LAND WILL BUILDING CONFORM TO REQUIREMENTS OF CODE /P C > IS-BUILDING CONNECTED TO TOWN WATER BOARD OF APPEALS ACTION. IF ANY IS BUILDING CONNECTED TO TOWN 6EWER IS BUILDING CONNECTED TO NATURAL GAS LINE INSTRUCTIONS a PROPERTY INFORMATION SEE BOTH SIDES LAND COST EST. BLDG. COST L// p /��t PAGE i FILL OUT SECTIONS I - 3 Q EST. BLDG. COST PER ip. FT. PAGE 2 FILL OUT SECTIONS 1 - 12 EST. BLDG. COST PER ROOM ELECTRIC METEPS MUST BE ON OUTSIDE OF BUILDING - SEPTIC PERMIT NO. ATTACHED GARAGES MUST CONFORM TO STATE FIRE REGULATIONS 4 APPROVED BY PLANS MUST BE FILED AND APPROVED BY BUILDING INSPECTOR DATE FILED SIGNATURE OF OWNER OR THORIZED AGENT sUI R ING INSPECTOR i FEE OWNERTEL.1 PERMIT GRANTED ? CONTR.TEL IF 3O iB CONTR.LIC.I H.I.C.1 t NoRr F Town of - Andover No. o fo 39s .- dover, Mass., 19 -- 0 � I�KE 00KICEWICK 1• - '9S Oq r ATED P �G BOARD OF HEALTH PERMIT T D Food/Kitchen Septic System 140 BUILDING INSPECTOR THIS CERTIFIES THAT...........................................................:�... . .. .. ..,5'. ...................... ...:... ................................ Foundation has permission ......... buildings on .........-...��..............- .�.Z.. ...�!..... ................ Rough t0be Occupied as.................................................. ... . ..,-. .% �.. ................. E��l�. ........................ Chimney provided that the person accepting this permit shall in every respect conform to the terms of the application on file in Final 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 PERMIT EXPIRES IN 6 MONTHS Final UNLESS CONSTRUCTION STAR ELECTRICAL INSPECTOR Rough ........................................ _ Service ... ......... . ..... .. ........................................ DING INSPECTOR Final Oc=cupancy Permit Required to Occupy Building GAS INSPECTOR Display in a Conspicuous Place on the Premises — Do Not Remove RougFinal No Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burne Street No. Smoke Det.