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HomeMy WebLinkAboutAIR SEALING AND INSULATION (4) .._ .... .... BUILDING PERMIT 0 RT TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION `- - � _ - � �0 0o wrcp Permit No#. 11" Date Received: < ssacaeus`� Date Issued: IMPORTANT: Applicant must complete all items on this page iY , llJ//,//✓r J /,/ / rr /11/ r/� ,�/l /J�i/�/ �/, / J J1,�P: ��,r / %1 / 11r r,r ,/�/ �%//r err:; v 1/1/, ,>il//% / al .11� 1 , , r r ✓,0 1 /y,r�,� , � l/, r( Ill i I F TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ,�24Iteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other „ 11/11111,r, / rm, r // rr,,,.,r r ,. ,. . / /, u rr afr///,./ r,r rrr, / /..Gr /,/ r /l� o /.�.. ",.. / r / /i / r / ds � �l,o ❑rrWa rr „ r / loo a �Wetlan / rr UUe r / Se tib ,❑ / t / / 4, r 1 Ir i // / Jar00.3 1', r � ,,,,r DES RIPTION OF WOPK T BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: Phone: Address: / r� r � //r ✓r, ;r/ , // r � / /J /'� / � i, r /rrr / l r/ / / / r, rl / / �✓ r. , l ///,/�/ r, ,f /�,,, /, � ,i,' / r // r/ l� "✓ r// / //ire//r„ � �/, r,�r�,�ii/r, r/f�,,f✓� uri///�:,���✓,,/l///r////G��� � / / /1�,,,� � �/ / r r l ll,�/� ��n :::. e fr:.-.�Y(ar rb rGf rnso -I(Nir vo ::"kn, " I���n�� � rr,: ,,r, 1�- rA��Y/Il� '/ / I If,,i ''.-a �r�����/✓l r,r r r r err , n f lr r r 11��/�/�/�����r�>�� iur, r ,.✓ J 1,1 t� %� t�// ' �,l / r,J �j//�%j 1a�iringprijf�diu�i�r�i✓,nr,i�la,TlJm�//6,a112re!/Ilr/;iUnr�liMarCi/6�,.tr Ym/�icf,,a/,,.,: n„mrr �ir69,i„�l�r,.rtr✓„rnr/--� ”�,i,/fr/. 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: $ FEE: $ ,:. u::� ��. Check No.: Receipt No:: � . NOTE: Persons c ntracting with unregistered contractors,do,not have access to the gi tynd signature of Agent/Owner Signature of,contracforr°„ �' NORTlj Town of Andover ® 410 nO L^K* hy ver, Mass, Am-)^ ;( J41'5 Jrjc oc M1c..e w.c.. 1. `7.95 RAreD P4����5 LI BOARD OF HEALTH PE Food/Kitchen Septic System R T LD THIS CERTIFIES THAT .. ,! 0® ,, N BUILDING INSPECTOR N ........... has permission to erect ..... buildings on ' OrIJ �1r0+. Foundation • • • Rough tobe occupied as ......... ..... .. ®.... ....... ...... -►."�. ......A............................... Chimney provided that the person accepting this permit in every respect conform to the terms of thea applicationpp 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 16 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRCTI T 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. `t RISE Engineering Federal ID# RI Contractor Registration No A division orT'hfelseh Engineering MA Contractor Registration No ? CT Contractor Registration No r 60 ShOWInut Unit#2,Canton,MA 0201 CONTRACT 339-502.6335 FAX 339-502-6345 PROGRAM Page 2 THIS CONTRACTIS ENTEIIED inTO BETWEEN RISE; ENGINEERING CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIDEDOELOW CUSTOMER! PHONE BATE CUENTO WORK ORDER Ryan O'Connell (978)387-0882 02/06/2015 409425 00002 senwcE STREET _— BILLING STREET 46 Thorndike Thorndike Road 46 Thomdike�Road.._. SERVICE CrTY.STATE.ZIP BILLING CITY,STATE,ZIP ......_. North Andover,MA 01845 North Andover,MA 01845 JOB DESC TION $90.00 i i=rotl:7014,0 Picogram Incentive: 2,611 Customer Total: $1,313.96 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand Three Hundred Thirteen&.951100 Dollars $1,313,95 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 200 .SEE REVERSE FOR IMPORTANT INFOR14AT10N ON GUARANTEES,RIGHTS OF RECISION,SCHEDUUNG,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES ri ., l/ i AUTH SI RE-R! EnginoaNng CUSTOMERCE NOTE:1I113 CONTRACT MAY GE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE �0 ACCEPTANCE OF CONTRACT-THE ABOVE PRIM,SPECIFICATIONS AND CONDITIONS ARE DAYS, SATISFACTORY TO US ANO ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIFIED.PAYMENT WILL BE MACE AS OUTLINED ABOVE OWNER AUTHORIZATION FORM I. C§ w c S ) sr of the propedy boded at gA(Property Adclffift) &aViL12 &AI err I (Property Addreds) - hemW authorize (subcontractoo an authorized subconbactor fbr RISE Engineering,to ad on my behaff to obtain a building pernift and to peffim work on my property. C� aSiffiristure Date n GQ� V. (9/_.o �Oaer »r��eaircoealfl o�C�/��rns�rcc�uselt Office of ConsumAffairs&Business Regulation License or registration valid for individul use only ME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: egistration: .104800 Type: Office of Consumer Affairs and Business Regulation xpiration: ;119512016Private Corporation 10 Park Plaza m Su(te 5170 Boston,MA 02116 HUGH'S ENERGY CORPORATION DANIEL DRISCOLL 259 MILTON STREET DEDHAM,MA 02026 — Undersecretary Not valid without signatu e iViassachusetts_Depart►ment of Board of Suiiding;�`�„i Public Safe” Lonstr �. gu ation--andy to^P,dard,s License:C"SO704 AN 1'faornas P.Dtomgo9te De�miton Street ' 02026 Commissioner Expiration 90/22/2096 n TDINE®1 OP ID:MR CERTIFICATE ! ! ! INSURANCE DATE(RAMWO 'YYiO �THlS CPI �FICATE IS ISSUED AS A OF IN TION ONLY AND 56R EMIRCERTl10,10s12o14 BELOW. THIS AYE D®ES NOT TE O FdAYNEAY OR FIEGATIVi:LY NCE Aw-ND, EXTEND OR ALTER T;H8 O DQE.4PFO�DED By THE POLICTH IEis S REPRESENTATIVE OR PRODUCER, THE CER CERTIFICATE-HOLDER, DOES NOT CONSTITUTE A CONTRACT EI THE ISSUING ORI)ND By HE POLICED HORIZ IMPORTANT: If the certlfl��holder is an A®®1TIONAL IN9U .fire policy{tes)must be endorsed. If Stl®RO@ATION IS WAIVED,subject to IMPORTANT.- the terms and conditions of the GridP*Iior me to policies may require an endorsement. A statEment on this certiflr.ata does not confer rights to the certiftCate holder in Ileu of such endor+aeme s. PRODUCER TY13Insurance envy,Inc. IRM Ari F68 reeman Stns 759 93002gton,MA 024746614 Ar751 9.3009 Ud8URFR[ AFFOROINI+COVERAQE NAIO# INSURE iD nsulau0n nm INSURERA:S dBle InSUranee Com On 259 Milton ' st wsURERBAInGuard Insurana®Com ny Dedham, 02026 INSUR2to: I►a P Ctlon Ins Co. wsu�Efi D: 49360 MW MRS. COVERAGESINSURER F: CERTIFICATE NUMBER;: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ..... ',,REVISION NUMBER:TO THE INSURED NAMEDABOVE OR THE POLICY PERIOD INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OR CONDITIAN OF ANY GO CERTIFICATE MAY BE ISSUED OR MAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIESDESCRIBED HEREIR OTHER DOCUMENT WITH H SU6JEC TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES'LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. �7R 7YFEOFINSURANCE X COMMERCIAL GENERAL LUANCyWtY - Icy NuraaER uulrs CLAIMS-MADE ®OCCUR X X CPS2020992EACH OCCURRENCE S 1,000,00 08!94/2094 08/94!2095 w g 50,00 MEDEW one Person S 8,00 Ge&AGGREGATE L MTAPPLIES PER PERSONAL.a ADVINJURY S 1,000,00 POLICY ED JET ❑Loc GEN@TALAGGREGATE $ 2,000,00 PRODUCTS-COMPIOPAGO S 2,000,00 AUTOMOBILE LIABRAY s C ANYAU CO EO wr ALLXOS SCHEDULED 9020032764 '�— ►� S � 1,000,00 08/94/2094 0811412015 eoDu.YtNrURYVPerP.,) S AVI MAUTOS A=r Eo BODILY MURY(Peraectdant) S PRr P 0 g UMBRMI A UAB X OCCUR S A EXCENUAB CLAIMSWADE SS0044410EACHOOCURRENCE S 11000,00 DED X ONS 10000 90/0712014 08/1412016 AGGREGATE $ 11000,00 WORIaRS COMPENSATION AND EMPLOYERS'LIABILITY �;�,, 8 ANYPROPRIETOR/PARTN(ELEXECUnVS YIN R2WC513035 P EROFFMERNEMB --- EN)EXCLUDED? ®NIA 08/12/2094 08/921,2095 E L EACH ACCIDENT S 500100 DEcAIPMONunder DEWSEL•DISEASE-EAEMPLO 5 500.00 COmmefelalAppllea ELOISEASE-FOUCYUMrr s 500,00 OEscRrFnoNO'G" A"PNSrLOCAnoNSIVENICLEs(ACORO1M,AddlB0nAIRema:us.tes ulo.maY 60 89PaMW IF MOM spate i8 re$uaed) CERTIFICATE FIOLDER CANC ON ADRRCHE SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EKP(RATiON DATE THEREOF. NOTICE WILL BE D ELRIERED IN ACCORDANCE Whir THE POUCY PROVISIONS. • AUniO12�D nEPRESENTATNE ACORD 25(2014101) ©1905 2014 ACORD CORP TION. All rigid resecUed. The ACORD na1n0 and logo am 1`6919te maft of ACO The Commonwealth of Massachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 021142017 www mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information Please Print Letribly Name(Business/Organization/Individual): L3lry Address: 151 All ) City/State/Zip: Phone#: `��l' o�j �3 �y Are you an employer?Check the appropriate box: Type of project(required): -a employer with _employees(full and/or part-time).* 7, ❑New construction 2.F]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. El Demolition 3.❑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. 12.0 Plumbing repairs or additions 5.❑I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]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 c. 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. 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 insurance for my employees. Below is the policy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: Expiration Date: 5 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 render the ins -nd p naltte erjuiy 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#: