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Home My WebLink AboutBuilding Permit # 3/2/2015 `. 5 NTti A ; BUILDING PE MIT, a L�oRo ,e TOWN OF NORTH ANDOVER, APPLICATION FOR PLAN EXAMINATI.Ql �" 0 1 d Permit NO#. Date RecelVed:: ,: :. ';RAORa�rED Popo �SSgCAUS77E Date Issued: IMPORTANT:A licant�nmst complete.all-items page pp � eY� I �rd� M' "Pimm— w'rse,� c es . , TYPE OF IMPROVEMENT PROPOSED USE' Residential Non Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial Alteration No. of units: D.Commercial ❑ epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other U ,I �:�,,, ;„ -,,.� � •�„y,;,. rµri�„,�r,,l"�';�n ,,�Ju err, �;�.- i io�W��:„!�fb�N,{,v�/%W^YG', - r..,,..., 9V ,�r� y„� `MpdfHiW a➢d11?wo�iGr� «,,:wpJfCi<�l�,r�//L'9/;3Y�J��%k.1"i`�"f�r�/ori'%. 1 w ,� �N�Wq i � W mW � ;��„ ' i� Se� c �o ell� r❑ � � �ds, - �1`%a�e�shecr Dist ct r �� % � r„ t/� .� �� e,.�� s DESq � IPTION OF WO .T " E.PERF_ORMED.T% �K:—' Identification- Please Type:or Print Clearly OWNER: Name: Phone: Address.. ,�>,,, ,;,,-��0/IP ,� f� / rr,.,. ,(,Yxr i',;.,,,:• ,f ,,n .,.,,. ,.. �l(%i�° fi(" i I i ,l�.•/��`rr�J/� � � � `'` � ��''��`!�%/' r k I � ARCHITECT/ENGINEER Phone Address: Reg_,,No;,. ' FEE SCHEDULE:BULDING PERMIT:$12.00 PER$1000.00 OFTHE TOTAL ESTIMATED'COSTBASED ON$125.00 PER S.F Total Project Cost: $ FETE $ ,-:<� 5 , Check No. Re`ceipt;:No NOTE: Persons contracti g with unregistered contractors;do,^"'t,'iave,:access to the g ty d �1 gnaturerofpontra ctar:�°�� m '=” Sighature ",g rim 9b NORTH _t own ot nuoversoh over, Mass, 0�01� cocmlc"twlcx 't• S°RAreo J"PA\,��(5 L1BOARD OF HEALTH Food/Kitchen Septic System PEKM� � IT -11111111110m1w LEW THIS CERTIFIES THAT ................... �. ........................................................... BUILDING INSPECTOR . . .. . .. ..... has permission to erect buildings on RA6, .. I. q.jr Foundation .... .. • • Rough to be occupied as .... ... .... .... ...... ....... .. .�1! ........................................ Chimney provided that the person accepting this permi hall in every respect conform to the terms of thea application pp 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 C® STRUCTIO S A TS Rough Service .................... ... .. ........................... BUILDING.INSPECTOR Final 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 Approvedthe Building Inspector® Burner Street No. Smoke Det. Federal ID!R RISE Engineer-inn RI Contractor Registration No MA Contractor Registration No A division or't'tiieisch Engineering CT Contractor Registration No 60 Shawonut Unit 42,Canton,MA 0202CONTRACT 339-502-6335 FAX 339-502.6345 Page i PROGRAM THIS CONTRACT is ENTERED INTO BETWEEN RISE CMA-}IES ENGINEERING AM THE CUSTOMER FOR WORK AS E I'll CI hl S E R I I`1 G DESCRIBED BELOW CUSTOMER .. ..... ... .. PHONE ... GATE cum 0 WORK ORDER Willliam Driscoll (978)857-2571 11/20/2014 406394 00003 - .. .... SERVICE STREET _.. _. ..._.. BILLING STREET 210 Raleigh Tavern Lane 210 Raleigh Tavern Lane SERVICE CITY,STATE.ZAP _.. ...... BILLING CITY,BTATF ZIP North Andover,MA 0 184 5 North Andover,MA 01845 ,JOB DESCRIPTION AIR SEALING:Provide hthor and materials to sent areas ofyour home against w"attetul,excess stir leakage. This work will be perronned in concert with the Use orspeciad tools anti diagnostic tests to assure that your home will be loft With R hiN ihful level of air exchange and indoor air quality.Materials to he used to seal your]ionic can include caulks,foams,wcolherstripping and other products, Primary areas for scaling include air leakage to tittles,basements,attached garages and other unhonted areas(windows are not generally addressed.) (12)working hours. At the completion or the weatheriration work,told tit no additional cost to the homeowner,a final blower door and/or combustion safety analysis wvili be conducted tTy the subcontractor to ensure the safety of the indoor air quality. $900.00 A*1710 ACCESS:Provide labor and materials to instull(1) easily moved,insulating cover for the title access folding stair. A small flirt surface of"plywood will lie created around the opening within the attic. This will allow the Cover's integral weather-stripping to restrict air leakage. j $237.65 ,,jltl Total: $1,137.65 Program Incentive: $1,003.24 Customer Total: $134.41 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Hundred Thirty-Four&41/100 Dollars $134,41 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AG A150 TO REMIT AMOUNT DUE IN FULL.INTEREST OF 19,WILL aE CHARGED MONTHLY Sit ANY UNPAID aAWICE APT OR 90 DAYS.SCR REVERSE FOR IMPORTANT INFORMATION ON GUARANTCEB,A101rtS OF RECISION,OCHWUU140,AND CONTRACTOR ACOISTRATION. D0 NOT SIGN THIS-CONTRACT IF THE ARE ANY BLANK SPACES ..NUR • ISNGINEBRINdAUTNOR 1TEE _. CUSTOM AC CE NOTE:THIS CONTRACT MAYBE 1VITWORAYRI BY US H'NOT EXECUTED WITHIN DATE OF ACCEPTANCE ../... ...__.__._ ._....,... ACCEPTANCE OF CONTRACT-TTtE ABOVE PRICES,QPFCIFICATIONS ANP CONDITIONS ARE SATISFACTORY TO US AND ARE HERESY ACCEPTED,YOU ARE AUTHORIZED TODD THC WORK ..._. _.... DAYS. AS SPECIFIED.PAYIAENI WILL BE MADE AS OUTLINED ABOVE �a tQanr-�>zaozcoetr�f�o��a,�ac/%usef� Office of Consumer Affairs&Business Regulation License or registration valid for indiAdul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: : 94800 Type: Office of Consumer Affairs and Business Regulation xpiration:;_=7152Q16 Pri►rata Corporation 10 Park Plaza_Su>to 5170 ® HUGH'S ENERGY CORPORA'1ION'" Boston,MA 02116 DANIEL DRISCOLL 259 MILTON STREET DEDHAM,MA 02026 ---- - a.� Undersecretary Not valid without signatu 11 Massachusetts B0ardX37 iyliiaePartrnent of public ,.2yu:ati ioi}gt+ Safety ciiG?z n � �a'CF.vt' ; j�i:iiiiSiii an�,ards License:C"S078 A- t 259 MIto %9re Dedham MA 0106 '�v.+v"� )}•1St 1� '.. Commissioner gXpiration 1012212016 P TDINS-9 Or ID.MR CERTIFICATE OF LIABILITY INSURANCEDATE(MMIDQIYYYY) THIS CERTII:ICATE IS ISSUED AS A MATTER OF INFpRMATION ONLY 90/06/2094 CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND AND CONFERS NO RISHTS UPON THE CERTiFIGATE HOLDER.THIS BELOW. THIS CERTIFICATE OF INSURANCE DOES HOT CON ' 'VMND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDENlllIL A � ��BEEN THE 15SUrhIG INSURER(S), AUTHORIZED the ter Ts an !f the�rtiflcate holder is an ADDITIONAL INSURED,the poltcy(tes)must be endorsed, It SUBROI3ATION 15 WAIVED,subject to the terms and conditions of the polFcy,certain poiictes m certificate holder in ltau of such endorsema $, may wire an endorsement: A mend on this certificate does not confer rights to the PRODUCER TYG Insurance Aenvy,Inc. co acr 80 Freeman Strai Arlington,MA 024746874 7$9.8493002 c NO:789-549-3009 RJSURER( INsuRAFPO))DIHGCOVERAGE fill 26ED Insulation, na wsuRs;A;Scoftsdale insurance Com an 259 Milton Street rnUR�ee:AmGuard Insurance Com ny. Dedham,MA p2026 fNsuReec:Arbella Protection Ins Co. uasuB eo, 41360 INSURER E: COVFSRAGES CERTIFICATE NUMBER: tntSttRFR Fs THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITION OF ANY GONTRAGT OR OTHER DOCUMIEMf WITH RESPECT TO WHICH THIS CERTIFICATE MAY Be ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBE Q HEREIN IS SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONSOF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTR 7YPEOFINSURANCE A X COMMMIALGENERALLIAB(Lny POUCYNUArBER cv o LIMTfS CLWS*ADE ®OCCUR X X CPS2020992 08/44/2044 08/441EACHOCCURRENCE S 9,000,00 2045 eo S 50,00 MED Exp one person S 5,00 GENLAGGRE(#A7EL1MIrAPpLIE$PEp Ill N%aADYtNJURy S 1,000,00 POLICY jPEAN D LOC GENGN.AGtIR>:r3ArE s 2,000,00 PRODUCTS-COMp/DPAGQ S 2,000,00 AUTOMOBILE LEARUM C S ANYAUTO GO sl E!a g ALL OWNED1020032764 08/4412014 OBht4/2045 -L.._._ $ 1,000,00 AUTOS X ASE ►uuRY(Peramsa+) s KREDAUTOS AUTOS BODILY tNJURY(ParacewanD IS PROP G 5 UUBREILALUU3 X OCCUR S A 1acOEssuAs CLNMs.h"E SM044410 FACNODcuttRevcF s 9,000,0 DED X RErFNnONS 90000 10/07/2014 0BH4/2015 A im WORKERS COMPENSAIM $ 1,000,00 ANDEMPLOYERS'IJAW ITY S B ANYPROPRlETOR1PARtNER/p�CUTNE YIN R2WC593035 STATUTE OFFICER/Mppg�E(CLUDEDI ®N/A 0811212014 06172/20717 I dd InIntIr ELEACHACCIDENT g 500,00 DESDRIPTIONOFOp Tt0Nsbebw ELDISEASE-EAEMPLOY S 500,00 CommercialApplica EL DISEAs>-POLICYUMIr s 500,00 DESCR1FnONOFOPERAT(-DNS/LOCAIIDNS/YEN[CLES(ACORDiCt.Aad(Bp�gemy�� !+�Ybosll 1!,111111!e13f211orasPareta required) ------- cERTIFICATE HOLDER CANCELLATION ADRRCHE SHOULDANYOFTHEABOVE DESCRIBED POLICIES THE E7(P M710M DATE THEREOF NOTICE CANCELLED BEFORE 1M1IILL BE D�� INACCORDANCEMM THEPOLICYPROVISIONS: AUTNOAIZED REPRESE3rTA71VE ACORD 25(2094!07 j The ACORD name and logo are registered marks of ACORD CORPORATION. Al!rights reserved. The Commonwealth of Massachusetts Department oflndustrialAccidents 1 Congress Street,Suite 100 Boston,HA 021142017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print LeSibly Name(Business/Organization/Individual): ( t '2S/ C3l/� J� �f Address: Aft/ City/State/Zip: Phone#: 7y-/ o� c� c6Jy Are you an employer?Check the appropriate box: Type of project(required): - 1 QP-aIIi a employer with— Lf--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. Demolition 3.Q I am a homeowner doing all work myself.[No workers'comp.insurance required.]t ❑ 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.Q Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.❑Roof repairs These sub-contractors have employees and have workers'comp.insurance.# P 14J;�<thcr6.0 We are a corporation and its officers have exercised their right of'exemption per MGL c. 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. I Homeowners who submit this affidavit indicating they are doing all work 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 the sub-contractors have employees,they must provide their workers'comp.policy number. I am an employer that is providing workers'compensation insurancefor my employees. Below is the policy and job site information. Insurance Company Name:_ _�� Policy#or Self-ins.Lic.#: �L W Z, j 3 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. Ido hereby certify under tlr ains ndp naltie Peijuiy 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 Cleric 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: