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HomeMy WebLinkAboutBuilding Permit # 3/2/2015 �ORTy a BUILDINGPERMIT. e TOWN OF NORTH ANDOVER, APPLICATION FOR PLAN EXAMINATI{J,N" M r „„ire.. �O �w�t• x ,. ' s C ATEO Permit No#t: � Date.Received �X," p SgcHusPQt Date Issued: IMPORTANT: Applicant must complete allYitems on-this page s . : t r u r TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family [I Addition [I Two or more family ❑ Industrial Iteration No. of units: ❑.Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other . ,vr�s9'`!6'" „ N�rYliG6Viik1'(4JiPullkl� X�i';>9Xsk4'Yl!/�llk%°J!/(J 11r y p r '' ° � ,b IAo ala /Uetl nds 1lYFA e ste D sir ct ��� DES RIPTION OF WOPK:TE'PERFORMED: I 5 v l u{— J v tJ Identification- Please Type or Print Clearly. ~ OPhone: fl� �� OWNER: Name: Address: o frac an g e one G m i r, pp �_ f ARCHITECT/ENGINEER Phone:' Address: Regi;No.�,.: FEE SCHEDULE.BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED'COST,BASED ON$125.00 PER S_F=- Total Project Cost: $ Re�cei t No �- _�'"1 Check No.: ,h � :.. �:.. . NOTE: Persons contracting with unregistered contractors:dmno'i-haveaccess to the ty d naturei�Of��Qilt�a`�t`Qry'��'"�� MIrIll AM F tAORTH 11 ,o",kwn ot nuover O ® 16 �p nO �„K. h ®ver, ass, a ohls COC — A" .acnew'c« 1' 4ATE1) PI? U ` BOARD OF HEALTH AN Food/Kitchen P E LU Septic System THIS CERTIFIES THAT .......T-1N �. BUILDING INSPECTOR ......................................... ... ....... ........... ................................. Foundation has permission to erect .......................... buildings on (A.... ... . . ......... .. . ................... • , Rough to be occupied as .. ... 1.... ...4.1 o��i►r ............................................... Chimney provided that the person accepting this peshall 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 UN LESS COSTRUCTIO T TS Rough Service ...................... .... ................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 RISE Engineering Federal 100 ( RI Contractor Registration No A division of'rhiclsch Engineering MA Contractor Regian No CT CC Registration No 60 Sbawmut Unit#2,Canton.NIA 02021 339-502-6335 FAX 339=502.6345 CONTRACT Page 9 PROGRAM THIS COUTRACTISENYEREDMoEE7YfE£NAXii ENGINEERING CIINIA-HES INOVIREMANDTHECUSTOMIXFORWORKAS DESCRIDW OELOW GATE CUORCI WORN ORDER Linda Hartnett (603)205-6369 12/12/2014 407599 00002 EERWCE STREET - _. - 65 Gatoil Road B enLtsND aTREEr 65 Cotuit Road B SERWCE Crrr.STATE,ZIP -_ ---- , BILLING, STATE.ZIP North Andover,MA 01345 North Andover,MA 01345 JOB IDESCRIPTION AIR SEALING:Provide tabor and m0tcrials to sLal areas ofyour home against svasteful,excess air leakage. This Lvnrk willhe peNormed in concert with ilia use ofspeciai foals and diagnostic tests to assure that your home will be loft with a hLalthful level of air exchange and indoor air quality.iviatcriats to be used to seal your home can include caulks,foams.w dtsrstripping and other products. Primary ureas for sealing include air leakage to attics,basements.attached Manages and other unheated arccas(windows arc not generally addressed.) (10)working hours. At the completion of the wendserimtion work,and at no additional cost to the homeowner.a Gnai blower door and/or combustion safety analysis will be conducted by the sub-contractor to entire the safety of the indoor air quality. ATTIC ACCESS:Provide labor and maWduls to insulnic(2) back of the knoetvall ilatdl with 2"rigid ThcmLOx boatel,and seal the S750A0 edge of ilia hatch with w^ntherstripping. S120,00 KNEEIVALL5:Provide labor and materials to install 2" F5K faced semi-rigid Fbergltass board insulation to(106)square feet of kneenvall soca. BASEMENT D©OR:Provide labor and materials to insulate the back of the basement door leading to ilio bulkhead tvidi 2"rigid S350.86 board that ITMOIS the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and scorns will,FSK tape. 572.22 Total: $1,293.05 r grata Incentive: $1,119.81 WE Total: $173.27 E AGREE HEREBY TO FURNISH SFRVICES• MP y✓mt ASOVE SPECIFICATIONS.FOR THE SUM OF ***One Hundred Seventy-Three&27/100 Dollars $173.27 UPON FINAL NCEA iONYER AND APPROVAL DYRLSEon ENO im EERlNO.CUST(WER AGREES To REWTAY,OUNTDUE IN FULL WTERESTOF t%WILL DE cHARaED LU Lye UNPAID BALANCE AFTER$0 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECaTON,aCHEDDLniO,AND CONTRACTOR REONSTRN1TN A ... ._ - HO NOT SIGN THIS CONTRACT IF THERE NY HLANK _Com- A RrtEp SIGWA E•flISEE INEERWG C N,ER ACCEPTANCE NOTE:THIS CONTRACT MAY BE LYRHORAWN BY Us IF RaT axecD,gp YATI uj DATE OF ACCEPTANCEI-j1- G✓P IACCEPTANCE OF COHMirr.THE ASOYE PRNCEE,aPBCIRiCA7ICNS AND CONDITIONS ARE DAYS. �/! AS SPECIFIEDPAYYMENT WALL DE MADE AS OUTLINED ABOVE AU9Tt EED 4O DO THE Won t � OWNER AUTHORIZATION FORM owrw of to Pmpeq boated at l 4714hembywAhorhm to I rforRISE EnqjfleMrg,to ad V behalftoobbM a bullft permft and to PMM work an my pmpov. ® s Date a 24,E i { —&–Office Of Consumer Affairs&Business Regulation License or registration valid for individul use only 14- ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: 4800 19, :x-- Type: Office Of Consumer Affairs and Business Regulation X131113tion: Private Corporation 10 Park Pim Suite E 517-0 HUGH'S ENERGY CqRJFQRAT10N"--iBoston,MA 02116`- 7; DANIEL DRISCOLL 259 MILTON DEDHAM,MA 02026 Undersecretary Not valid without siguatu��� ............................................ Setts Scary or–o -Department public u4d;1 , ;ng Re­'v ., of Safety CG1j.'jtj-U "Mror's jjjCj;z..z License: so rho maspDro AI 259 Milton sw DedhalootfteL ATA11206 = ji co . mm-�-� I Issioner t_Xpiration 10-12212016 TDII t?P ID:MR C;;I E!!I R III TIFICATE OF LIABILITY INSURANCE DATE( MroDlY" THIS CFA I I I I II: i 18 ISSUED AS A l41ATTER OF INFORMATION ONLY AN 10/06/2014 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AM(B1ID, D CONFER$NO RIC,HTS UPON THE CERTIFICATE HOLDER.THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CO mcreND OR ALTER TILE CO�/ERAGE AFFORDED BY THE POLICIES REPRESENTATIVE OR PRODUCER,AND THE CERTIFlCATE HOLDER. A CONTRACT BETWEEN THE ISSUING INSURER{Sj, AUTHORIZED IMPORTANT-aT: ff the ions tate bolder is art ADDR[ONAL INSURED,the ponoy{iesj must be endorsed, ff SUBROGATION i5 WANED,subject to the teens and conditions of the poifcy,certain poticfes may require an endorsement, A statement on this certificate doss not confer rights to the certificate holder-IN Ileu ofsueh endoraemen s. PRODUCER TYG Insuranceenvy,Inc. acr 88 Freeman Shoed Ar IR&R,MA 02474.6014 "E 7$4.644.SDp2 Ax - �RE.ss. T$1.644.3003 INSuR81j AFFORDINaCOVERAGE MATO# INSURED Ti}tnsulat;0n, nc. wsuRE A:Scottsdale insurance Company 258 Milton Street mlugms:AlnGuard Insurance Com n Dedham,MA 02026 nasur c:Arbetia Rrotection Ins ore INsuRexD- 41360 INSURER E: COVERAGES CERTIFICATE NUMBER: EHSURERPe REVISION THIS IS TO CERTIFY THAT THE:POLICIES UI INSURANCE LISTED BELOW HAVE BEEN igSUED TO THE INSURED NAMED D ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING O ANY REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE S SHO NCE AFFORD®BY THE POLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF UCH POI.IOEES CIMiTS SHOWN MAY HAVE:BEEN REDUCED SYPA►D CLAIMS. WffH RESPECT TO WHICH THIS LTR 7YPEOPINSURANCF A X CQWVdW}ALOENERA UABIUTY POUCYNUtdeER Cv usnTs CLAIA 8 MADE ®OCCUR X X CPS2020992 EACH OCCURRENT S 9,000,00 08/14/2014 08114MO1550,00 MEDEXP ArtYanepeneon S 5,00 GEMLAGGREGATEl3MITAPPLIESPER PERSONALSADYfNJURy 5 1,000,00 POLICY JEOi ❑Loc cENE3tAl AGOAEGATEc s 2,000,00 PRODUMS-MW 3 2,000,00 AUTOMOBILE LU18ILnY 5 C ANYAUTO CO BI s ALLO=Uros 1020032764 s 1,000,00 AUTOX SCHEDULED 08/1412014 08/1412015 somy1NJURY(pIwpww) S AUTOS !'r A�UTOSNCWNED BODILY INJURY(Pera dbno S PROP D ICE 5 UMSRSLLALI occuR S A EkCF.BSLNE} CLAIMS-MAUS 0044410EACHOCCURRQyCE S 1,000,0 DED X RerENnONS 10000 10/07/2014 08/1412015 WORKERSCOMPENSATION s 11000,00 AMD 010LOYMM LUIBIL ITY $ S ANYPROPREEORlPARTNERCU YIN p ATUTE ER Ma�IXCLUD7 ®N/A R2WC513035 0811212014 08/12/2095 IfYas,descrtbe antler EL FAaN ACCIDENT S 500100 OESCRIPTIONOFOP@igTtDNSbeI ELDISEASE-EAEMPLOY S 500,00 CommerclalAppllca EL DISEASE-PDUDtrtIMIT s 500,00 DFSCHIFTIONOPOPERATIONSILOCAXONSJVEH(CLES(ACDlt01Di.AGdEHonalRematksSetteatUo,mayboatteeh¢eiffmorasPseaiemq tl} CERTIFICATE HOLDER CANCELLATION ADRRCHE SHOULDANYOFTHEABOVE DESCRIBED POLICIES ISE CANCELLED BE THE EXPIRATION DAWrrH TE THEREOF, NOTICE WILL BEDFORE EL[VEREF IN ACCORDANCETHEPDLICYPROVISIOIU& AUTNORi7BD REPRESHrTATNE ACORD 25(2094101) The ACORD name and 1090 am regisfened mlaft OfACORD�CORPORATION. All fights reserved. The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Annlicant Information Please Print Legibly Name(Business/Organization/Individual): 6 Z �CjGt--� Address: i Gw City/State/Zip: Phone#: `7�/ ��066 �� (iy Are you an employer?Cheek the appropriate box: Type of project(required): -1,,Q-I-z7ffr—a employer with—4---employces(full and/or part-time).* 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. F1 Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.] 10❑Building addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. I will ensure that all contractors either have workers'compensation insurance or are sole 11.❑Electrical repairs or additions proprietors with no employees. 12.❑Plumbing repairs or additions 5. contractor and I have hired the sub-contractors listed on the attached sheet. ❑I am a general $ 13.❑Roof repairs • These sub-contractors have employees and have workers'comp.insurance. 6.❑We are a corporation and its officers have exercised their right of'exemption per MGL G. 14. ther `� '^_ 152,§1(4),and we have no employees.[No workers'comp.insurance required.] 2 *Any applicant that checks box#1 must also fill out the section below showing their workers'compensation policy information. Homeowners who submit this affidavit indicating they are 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 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 and job site information. Insurance Company Name: Am 6,, y t�—r Policy#or Self-ins.Lic.#: V� �, �, d 3 Expiration Date: Job Site Address: City/State/Zip: Attach a copy of the workers' compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by 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.A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certify under th ins nd p naltie ii er jury that the information provided above is true and correct. Signature: Date: 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#: