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Home My WebLink AboutBuilding Permit # 4/22/2015 BUILDING PERMIT � NORTH �C�S VEu 6'q�/O TOWN OF NORTH ANDOVER o ,,APPLICATION FOR PLAN EXAMINATION Permit No Date Received 9RA�RRTEDWpPRy�S �sSgcHUS Date IssuedL�=411 ORTANT:Applicant must complete all items on this page LOCATION l iy ,c S LY\ \ Print P PROPERTY OWNER Ic it rt 5 eC r ` Print 100 Year Structure yes (no MAP PARCEI ZONING DISTRICT: Historic District yesno Machine Shop Village yesno TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building AOne family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other _, q , �11/e(ands i- 0 .. Ehecf ®tsfritY f �� ` IM l �� d -laf11�/ a ,I� ._. DESCRIPTION OF WORK TO BE PERFORMED: -eej Iiyj5 A-YT1 G �Zri 5 V 1ao-f w Identifiicat'on- Please Type or Print Clearly OWNER: Name: n ref cel P Phone: ('IFG- J `fid Address: 7> 8f eS Contra for Name: i�O�4 ,ea r iv�S�la?)a Phone: ?>T—OF(, Email o'%cg bj, 4r;vlSvi47-ie w A C-wtg;1. Bowl Address: ®_`box KIF P-y\Aove-i', M rf Supervisor's Construction License: cSSL� lo6a/7 Exp. Date: ybF-ho/7 Home Improvement License: 0,J- Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT:$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. 'i Total Project Cost: $ 3 FEE: $ Check No.: � Receipt No.: NOTE: Persons contracting with unregistered cont ctor do not have access to the guaranty fund �, f ` � F Iii t%O R TH Town of Andover ® ;' 0 o LAMB ver `ASS' COCNICNe WICK 41' �A04^TED BOARD OF HEALTH Pt �RMIT T LD Food/Kitchen Septic System a a THIS CERTIFIES THAT .......... ... . . BUILDING INSPECTOR 4 Ok! Foundation has permission to erect .......................... buildings on ........ ...... .......... .. ... ,`` Rough to be occupied as ........Ate%---- ................ .... o/ . . .. 0EW Chimney provided that the person accepting this permit sh 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIONAn Rough qb Service ..................... .....t....................................... 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. CONTRACT FOR Cons0eration PRODUCTS SERVICE WORK Services Group This service is brought to YOU through support from Your local Utility This Agreement is made by and among acid Conservation Services Group (CSG) Janice Piasecld Attn:RCS 77 Bridges Ln 50.Washington Street,Suite 3000 North Andover,MA 01845-2221 Westborough, MA 01581 Site ID:800002328244 Reg. No. 173484 Project ID:P00000339295 Federal ID No. 222457170 Customer ID:000000338390 (Mail completed contract to address above) Contract ED:20150123ASEAL 1. DESCRIPTION OF WORKTO BE PERFORMED Contractor will perform or cause to be performed the following work on these"Pleralses"in a professional wanner and in accordance with the terms of this Contract,including the attached reconimendations/work order describing the work in detail(the"Work")wideb sure incorporated herein by reference: Description Quantity Location Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 8 Living Sp1qt ...... 674.66 Do.or �L Sw 2 N/A 4q6 2 N/A Exterior Wi,tic_S_tal,_Cover arm Barrier with carp I Livi $260.23q_ Sub Total: $1,036.33 Utility Incentive Share $1,036.33 Customer Contribution %00 For office use only Printed:211812016 Page I of 2 11. PAYMENT 11 Customer agrees to pay Contractor for the Work,the Customer Share of the Contract Price as follows:Payment Ill: as a Deposit payable to CSG upon signing the Contract(not to exceed It3 01'e total retail costs).Mail check&contract to CSG,tlttn,RCS',50.Washbigton St.,Ste. 3000,Westborough,MA 01581.Filial Payment; as the final paynient for the Work shall be payable to the Independent Installation . f Contractor(91C")upon sa a t; corapt of the Wi rk.Customer miderstaii(ts;that lie/she will not be required to pa'y the Utility Incentive Share of the i , 9 ", 5�011 Contract price in(lie amount of$ 5,hanges to individual line iternsalid/or previous incentives may increase or decrease the size of the Utility Incentive Share. Ill, DISPUTE RESOLUTION The 11C and CwAomer hereby mutually agree in advance that in ate event that the HC has a dispute concenling this Contmet,the 11C ninny submit such dispute to a private arbitration be id Customer shall required to submit to such arbitration as provided In M.G.L.c 142k service which has been approved by the office of Consmaer Affidis and Business Regulation,al 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 b day-following -the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY.BLANK SPACES.. 1-77 Feb 18, 2015 selected 11C here,if applicable (OU) hutial here if you want Customer Signature Date liid�pte your the Program to assign a Participathig Contractor D items D e d�c CSG Signature TE,RIWIS AND CONDITIONS PAIPEAR ON TINE REVERSE. 3/14 CONTRACT FOR PRODUCTS SERVICE WORK Corisor ation Services Group This service is brought to you through support frorn your local utility This.Agreement is made ,by and among rood Janice Piaseold Conservation Services Group (CSG) 77 Bridges Ln Attn:RCS North Andover,MA 01845-2221 50 Washington Street,Suite 8000 Site ID:800002328244 Westborough,MA 01581 Project ID:P00000339295 Reg. No. 173484 Customer ID:C00000338390 Federal ID No.222457170 Contract ID:20150123 WORK (Mall completed contract to address above) I. DESCRIPTION OF WORK TO BE PERFORMED Contractor will perform or cause to be performed the following world on these"Premises"lin a professional manner and in accordance with the terns of this Contract,including the attached recollunendatiolns/work order describing the work in detail(the"work")which are incorporated herein by reference: Description Quantity Location Propayent 2'or 4' 57 Attic $218.31 Damming 88 N/A $192.72 1 ._ N/A rvWM _. $3614 Hatch Thermal Barrier Poli?iso 2 Inch(Attic) _ _ _ �1 .Living Space Install 2"Thermal Barrier Polyiso On,Knee_wall _ _ 78 Llving,§ace __ X343.20 Attic Floor Open Blow Cellulose 6'y 818 Living Space _ 81.,308.80 — Sub Total: $2,140.88 Utility Incentive Share $1,605.66 Customer Contribution $535.22 as g, For office use only Printed:2/18/2015 Page 2 of 2 It. PAYMENT p Customer agrees to pay Contractor for the work,the Customer Share of the Contract Price as follows:Payment#1:$ w+ "� as a Deposit payable to CSG upon signing the Contract,(not tri x eed ` of° le totat retail costs).Mail check&contract to CSG,Attar:RCS,50 Wnsltington St.,Ste, 3000,Westborough,MA 01581.I�`inal Payment:$ ° u„t as the final payment for the World shall be payable to the Independent Installation Hort of the World.Customer understands that lie/she will not be required to pay tine Utility Incentive Shale'of the Contractor("lIC")upon sats actor,„colprp . Contract price ill the amount of ; � Changes to Individual Pune items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. III.DISPUTE RESOLUTION Tile 11C and Customer hereby nnutually agree in advance that ill the event that the.11C has a dispute,concerning this Contract,the 11C may submit such dispute Loa piivzite altlitlation service which leas been approved by the Office of Constrainer Affairs and Business Regulation and CYistomei•small be regnit ed to stlbnnit to such lubihaUon as prcvided hrM,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 yogi notify the seller in writing by ordinary mail posted, by telegram sent or by delivery, not later than midnight of the third busines day following the signing of this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. ice r Ra cki(Feb 18,2115) Feb 18. 2015 41'15 ( applicable (OIt) Initial here if you want — pateustomer ]gnatue atc c citeyouu se ec , vele ItC n 1) to ( the Program to assign a aesentative Plral Participating Contractor CSG Signature atuue Alanle of CSG Re mm TERMS AND CONDITIONS APPEAR ON THE REVS USE. 73/14 The Convnonwealth of Allassachusetts _ Department of Industrial Accidents ". ;.' Office of Investigations 1; 600 Washington Street x _. , ' ' Boston, MA 02111 ivtvtv.;nass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name (Business/Organization/Individual): P0 ea dIq rI'O!n �57 — Address: Re. .8 O)e City/State/Zip: ;�JOJ� I�f Phone #: ��" ��® Are you an employer?Check,the appropriate box: Type of project(required): 1. I am a employer with -7 ❑ I am a general contractor and I 6. ❑\ew construction employees(full and/or part-time).* have hired the sub-contractors listed on the attached.sheet. 7. ❑ Remodeling 2.F1 I am a sole proprietor or partner- These sub-contractors have Demolition ship and have no employees 8. ❑ employees and have workers' working for me in any capacity. _ 9. ❑ Building addition [iso workers' comp.insurance comp. insurance.= 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions required.] 3.❑ 1 am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions thyself. [\o workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]' c 152. 51(4),and we have no employees. [No workers' 13. 0[�Other �hSv�4 comp. insurance required.] *t%nv applicant that checks box IT mast also till out the section below showing their workers'compensation police information. I tomeowners who submit this affidavit indicatina the\•are doing all work and then hire outside contractors must submit a nes\aftidaN it indicating such. =Contractors that check this box ntut attached an additional sheet showing the name of the sub-contractor and state whether or not those entities haN e entplovees. If the sub-contractors have employees.they mist provide their workers'comp.policy number. 1 am an employer that is providing workers'compensation insurance for rnp employees. Below is the policy and job site information. Insurance Company dame: n Expiration Date: Policy or Self-ins. Lic.#: d'® ta/�- �� p � / Job Site Address: 7 7 r r°J S � City/State/Zip:•V1. l�1dD✓�� Attach a copy of the workers' compensation policy declaration page(showing 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 S 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 S250.00 a day against the violator. Be advised that a cop),of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. 1 do hereby certifj trn�l�e��r//th��e pairas acrd pe;rallies of perjr.rt'thrrf iLe irrfornxctio;r providedvabo(ve is true curd correct. Signature �� rY7�� Date: Phone; Cj 75�" V D official use only. Do not write in this area, to be completed by city or totv►r offrciaz City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector �. Plumbing Inspector 6. Other Contact Person: Phone#: OP ID:SS DATE(MMl in"r Y) '4CERTIFICATE OF LIABILITYINSURANCEo3rlar�uls 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: B the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. If SUBROGATION IS WAIVED,subject to the terns 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 endorsements. PRODUCER NAME, Durso Durso&Jankowski Ins Agcy LLC PHpNE FAX 198 Massachusetts Avenue No North Andover,MA 01845 ADoREss Durso&Jankowski Ins.Agcy. PaooucER CuaTDMERw#:POLAR-1 INSURER(S)AFFORDING COVERAGE HAI: INSURED Polar Bear Insulation Co.Inc. INSURER A:Penn America 32859 P O Box 958 INSURER B:Safety insurance Co. 33618 Andover,MA 01810 INSURER C: 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. INSR I TYPEOFINSURANCE POLICY NUMBER POLICY EY POLICY EXP L LIMITS GENERAL LIABILITY EACH OCCURRENCE S 1,000,00 DAMAGE TURE17MD A X COMMERCIAL GENERAL LIABILITY PAC70WO23 03/24/2015 03/24/2016 PREMISES Ea 00aereooe a 50,00 CLAIMS-MADE �X OCCUR MED EXP(Any one Person S 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE S 2,000,00 GEMLAGGREGATE LIMIT APPLIES PER- PRODUCTS-COMPIOPAGG $ 1,000,00 POLICYPRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,00 B ANY AUTO 100926 01/0412015 01/04f2016 (Ea acdderd) BODILY INJURY(Per Person) $ ALL OWNED AUTOS BODILY INJURY(PeracOW0 S X SCHEDULEDAUTOS PROPERTY DAMAGE X HIRED AUTOS (PERACCIDENT) $ X NON.OWNEDAUros $ ri S UMBRELLA UAB X OCCUR EACH OCCURRENCE $ 1,000,00 A EXCESS LUAB CLAIMS-MADE PAC6906385 03/24/2015 03/24/2016 AGGREGATE $ DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WCSTATU- TH AND EMPLOYERS'LIABILITY Y M ANY PROPRIETORIPARTNERIEXECUTIVE YIN NIA ELEACHACCIDENT E _ OFFICERIMEMBER EXCLUDED? (Mandatory in NH) EL DISEASE-EA EMPLOYE $ If yes, esa dunder DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY UMIT $ IDESCRIPTIONF OPERATIONS I LOCATIONS I VEHICLES(Ahad+ACORD 1a1,AddMwW Remake sd,edule,H mora apace Is required) 1 sulation�IVor Mine al Carlson atsc�t� ice rou NSTAR pnO National Gdri�!araadditional insured on em a qty PoRy.Coverage Is rimary an on- ontr utory CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Conservation Service Group ACCORDANCE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. Contractor Services Dept 50 Washington St Westborough,MA 01581 AUTHOR¢EDREPRESENTATNE 1461P ®1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 91se _ Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 102726 Type: DBA - _--- - _ - Expiration.- 7/2/2016 Tr## 25224.9 POLAR BEAR INSULATION CO. - -- - Vincent LeBlanc- - __- - P.O_ BOX 958 ANDOVER, MA 01 810 Update Address and return card.Mark reason for change. -- Address Renewal r] Employment Lost Card OPS-CAI F® 50M-04104-G101216 i -�; ?_iil4lc i Blass c u� - 30a"G! ofii-34=f-�.S �nnstructiun Supehl""r Spccia[t� C ,SL-106017 :' PETER A LEBLANC 2 EAST PINE STREET - Plaistow NH-03865 644812018 t