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HomeMy WebLinkAboutAIRSEALING AND ATTIC INSULATION AM VkORTH v e r own oi Anuu ® ® ® T- s h ver, ass, COCHICHl W]CK S V APm9LBOARD OF HEALTH LD Food/Kitchen Pt I IT T Septic System • THIS CERTIFIES THAT ............................... BUILDING INSPECTOR .................. .......................... .IM►.......... ... has permission to erect .......................... buildings on .... .... .. ........4,p�. ..AA+*f- . ie�.......... Foundation ® , Rough to be occupied as ..... .. ...... ... . . .®... ..... ......® 1. ......................................... Chimney provided that the person accepting this pe shall 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 T ELECTRICAL INSPECTOR UNLESS CONSTRUCTI TRough Service ............... .................................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy PuildinRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. ipu,,., r� �tuw• CONTRACTOR WORK ORDER C t"_1". 50 Washington St.Suite 3000 Printed: 5/1/2015 Westborough,MA 01581 Work Order Id: S65236P68222C238 Contractor information Customer/Site Details Polar Bear Insulation Nathan Smith Email: 3slnpublic@mindspring.com Phone(Eve): 978-681-8543 PO Box 958 192 Lacy St Phone(Day): Andover, MA 01810 North Andover, MA 01845-3309 Site ID: 500002065236 Total Installed Measures Location Description Quantity Unit$ Total$ Living Space Attic Stair Cover Thermal Barrier with carpentry 1 $260.23 $260.23 Door Sweep 2 $23.18 $46.36 Exterior Door Weather Stripping 2 $27.59 $55.18 Living Space Perform Air Sealing at Estimated 62.5 CFM50 12 $84.32 $1,011.84 Attic Propavent 2'or 4' 5 $3.83 $19.15 Living Space Attic Floor Open Blow Cellulose 8" 840 $1.60 $1,344.00 Living Space Attic Floor Open Blow Cellulose 6" 338 $1.47 $496.86 Damming 58 $2.19 $127.02 Installed Measures Total $3,360.64 Road Blocks Type Status Notes Moisture FIXED signs of staining on roof deck, customer has had ice dams in the past had roof replaced havent had ice dams in years. no mold growth WorkOrder Notes Payments Incentive Payments Weatherization Incentive $1,490.27 Air Sealing Incentive $1,373.61 Total Incentive Payments $2,863.86 Customer Share Total Customer Share $496.76 Less Deposit Of $165.58 Customer Share Balance(Due Contractor) $331.18 Conservation Services Group-50 Washington Street Suite 3000-Westborough, MA 01581 -(508) 836-9500 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 (vid Nathaji Smith Conservation Services Group (CSG) 192 Lacy St Attu:RCS North Airdover,M-A 01845-3309 50 Washington Street, Suite 3000 Site ID:500002065236 Westborough, MA 01581 Project ID: P00000068222 Reg. No. 173484 CLIstorrier ID:000000075255 Federal ID No. 222457170 Contract ID: 20150417ASEAL (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"Preirdses"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 $1,011,84 Perform Air Sealing at Estimated 62.5 CFM50 Per Hour 12 Living Space At I fie Stair Co I ver Thermal,ial Barr I lei-with I h carp.enlry 1 Living Space $260.213 Door Sweep 2 N/A $46.36 Exterior I . Door Weather Stripping 2 N/A Sub Total: $1,373.61"' Utility incentive Share $1,373.61 Customer Contribution $0.00 MR, W. For office use only Printed:4/1712015 Page I of 2 Ill. PAYMENT vni as a Deposit Customer agrees to pay Contractor for the Work,the CrksoinerShare of the Contract Price as follows:I a enL#I:$— payable to CSG upon sigithig the Contract(not to eed 1/3 of the total retail costs).Mail check&contract to CSG,Attn:RCS,50 Washington St.,Ste. 3000,Westborough,MA 01581.Final Payincrit:$_--.. as the final payment for the Work shall be payable to the Independent Installation Contractor("HC")upon satisfa t x -ed to pay the I hility incentive Share of the ymt(lo '1r)f the Work.Customer understands that he/she will not be required in, - ininay increase or decrease the size of the Utility IncentiveContract price in the aniourij I s to indi-vidual line items and/or Share. III. DISPUTE RESOLUTION The HC and Customer hereby mutually agree in advance that in the event that the 110 has dispute concerning this Contract,the 11C may subirdt such dispute to a private arbiti'ation service which has been approved by the Office of Consumer Affairs and Business Regulation and Customer shall be required to submit to such arbirnation 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 than midnight of the third business day following the signing ofthis agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. 7PI-17 lic here,e,if aIt late Initial here if you want Ens In t art D t 111diC I y selected p 'ruy se eet V/ the Program t0 assign a p payticil Ming Contractor CSG Signature ate Name of'CSG IZopi-eseiitativo(T'i-inter]) TrRIWIS AND CONDITIONS APPEAR ON TIIE ItEVE RSE. 2200-2-1/16 ConsOGCONTRACT FOR eration PRODUCTS SERViCE WORK Services Group This service is brought to You through support from your local utility This Agreement is made by and among (und Nathan Smith Conservation Services Group(CSG) 192 Lacy St " Attn: RCS North Andover,MA 01845-3309 50 Washhigton Street, Suite 3000 Site ID:S00002065236 "�`Westborough,MA 01581 Project ID: P00000068222 Reg. No. 173484 Customer ID:C00000075255 Federal ID No. 222467170 Contract ID: 20150417.WORK (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"Promises"in a professional manner and in accordance with the terms of this Contract,including the attached reconninendations/work order describing the work in detail(the"Work')which are incorporated herein by reference: Description Quantity Location Attic Floor Open Blow Cellulose 8" 840 Living Space $1,3.44.00 Attic Floor Open Blow Cellulose 6" 338 Living Space $496.86 Damming 58 NIA $127.02 Propavent Z or 4' 5 Attic $19.16 Sub Total: $1,987,03 Utility incentive,Share $1,490,27 Customer Contribution $496.76 HA Eml For office use only Printed:4/1712015 Page 2 of 2 [L PAYMENT $ Customer agrees to pay Contractor for the Work,the Customer Share of the Contact Price as follows:Payment#1: as a Deposit payable to CSG upon signing the Conti-act(not t ed 1/3 he total retail costs).Matt check&contract to CSG,Attn:RCS,50 Waslibigtort St.,Ste. 3000,Westborongb,MA 01581.Final Payment: as the final payment for the Work shall be payable to the Independent Installation Conti-actor(1111C")upon tsatish nift 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$T= 1Ganges to individual line items and/or previous incentives may increase or decrease the size of the Utility Incentive Share. 111. DISPUTE RESOLUTION The E[Cand Customer hereby mutually agree inaftance that in the event that the[IC has a dispute concerning this Contract,the RC may submit such dispute to a private arbitration service which has been approved by the Office of Consumer Affains and Business Regulation and Customer shall be required to submit to such arbitration as provided in M.G.L.e 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 business day',following the signingof this agreement. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES. ............ ............... C) J Customer 1340'1 re )I eclefted 1if applicable Initial here if you want, at hicic��e s �Icreain to a11the Program assign a Participating Contractor ai of CSG Representative(Prinature Date aiCSG sigm )fted) qMrVP1VQ Altm r"AT"IWw"Mr. AIMMITAIP WE!14119V IrTIMICAPCIP 9011"1)111 r. ttiarillr mass save ��a sWvqs thMugh*P*W«icsnCy '"iIII1111111111111111► PERMIT AUTHORIZATION FORM 1, NATHAN SMITH ,owner of the property located at: (Owner's Name,printed) 192 Lacy St NORTH ANDOVER (Property Street Address) (City) hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed below to act on my behalf and obtain a building permit to perform insulation and/or weatherization work on my property. Owner's Signa 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 a��Cl For tifrice Use Only Rev. 12132011 The Common wealth of Massachusetts Department of Industrial Accidents Office of Investigations 600 Washington Street y =�_ Boston, MA 02111 w1V1V.111(tSS.gOV/dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Lel4ibly Marie (Business/Organization/1ndi\•iduai): PO IV- A erA d 14 1j"®!ll Address:_. & R O)e <'y .5' City/State/Zip: nd pLhem Phone 6tFt,— 15—lff S' Are you an employer?Check the appropriate box: Type of project(required): 1.XI am a employer with_ 7 `I• ❑ I am a general contractor and I employees(full and/or part-time).* have hired the sub-contractors 6 ❑dew Construction 2.❑ i am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling shipand have no employees These sub-contractors have P S. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [\o workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.❑ Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself [\o workers' comp. right of exemption per MGL 12.0 Roof repairs insurance required.]' c. 152. §1(4),and we have no employees. [No workers' 13•[4�,Other comp. insurance required.] Ana applicant that checks box#I must also fill out the section below showing their\\'orkers'compensation police information. I lomeowners who submit this affidavit indicatins they-are doing all work and then hire outside contractors must submit a new affidavit indicatine such. =Contractors that check this box must attached all additional sheet showins the name of the sub-contractors and state whether or not those entities have entpiovees. If the sub-contractors have employees,they must provide their workers comp.police nunnber. I am an emplgyer that is providing workers'compensation insurance for my employees. Below is the policy and job site information. Insurance Company Name:�n Policy#or Self-ins. Lic. we_ ��— b � 5 Expiration Date: I � 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 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 copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I rho hereby certify under the pains and penalties of perjw y that the information provided above is true and correct. Signature: Date: Phone;: q?,?– UO > l Z Ofricial use only. Do not write in this area, to be completed by cite'or town official. City or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Town Cleri: 4. Electrical Inspector 5. Plumbing inspector 6. Other Contact Person: Phone#: OP ID:SS 'A4C ' ° 1 CERTIFICATE LIABILITY Y I �1=06 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATNELY 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: H the certificate holder Is an ADDITIONAL INSURED,the pollcy(ies)must be endorsed. If SUBROGATION IS WANED,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 C �CT Durso&Jankowski(ns Agcy LLC 198 Massachusetts Avenue PHNEOFax No): North Andover,MA 01845 �r LS Durso&Jankowski Ins.Agcy. PRODUCER POLAR-1 INSURE S AFFORDING COVERAGE NAR;aB INSURED Po a Bear Insulation Co.In-C. INSURER A;Penn America 32859 P O Box 958 Andover,MA 01810 INSURER e;Safety Insurance Co. 33618 INSURERC: 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. NSR TYPE OF INSURANCE POLICY EFF POLICY EI(P LTR POLICYNUMBER MURI HIND LIMITS GENERAL LIABILITY EACH OCCURRENCE $ 11000,00 A X COMMERCIAL GENERAL LIABILITY PAC7052023 03124/2015 031242016 PREMISES Ea acaurerlce $ 50,00 CLAIMS-MADE a OCCUR MED EXP(Any one Person) $ 51 PERSONAL&ADV INJURY $ 1,000, GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PEk PRODUCTS-COMPIOPAGG $ 1,000,00 POLICY PRO LOC I $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT B ANY AUTO 100926 01/042015 01/042016 (Ea accident) $ 1,000,00 BODILY INJURY(Per Person) $ ACHEDULED AU OS BODILY INJURY(Per acddOM) $ X SCHEDULED AUTOS X HIRED AUTOS PROPERTY DAMAGE $ (PER ACCIDENT) X NO"WNEDAUTOS $ 3 UMBRELLA LIAR X OCCUR EACH OCCURRENCE $ 1,000'Wo EXCESS LIAB CLAIMS-MADE AGGREGATE $ A PACS906385 03/242015 03242016 DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION WC STAN- TH AND EMPLOYERS'LIABILRY YIN YPER ANY PROPRIETOR/PARTNER/EXECUnW❑ EL EACH ACCIDENT $ OFFICERIMEMBEREXCLUDED? N/A (Mandat-V In NMI EL DISEASE-EA EMPLOYE $ If yyes,d DESCRIPTIONesaft under OF OPERATIONS bebw EL DISEASE-POLICY LIMIT I$ IDESCRI N F OPERA�j NSI L ATIONS/VEHICLES(Attach ACORD 101,Additional Rensrke Schedule,H more space is required) IIDSU1 t 1 �AVOr i ne aloe rdservat�c�t� V ce lroueSTAR pnd National Grid a add tconal insured on enera Liability po Cy. verage Is Primary and Non--uontr�butory CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Conservation Service Group Contractor Services Dept ACCORDANCE WITH THE POLICY PROVISIONS 50 Washington St AUTNORD ED REPRESENrATNE Westborough,MA 01581 m 1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD ACC>R" CERTIFICATE OF LIABILITY INSURANCE041128!201DATE281201YYY, 5 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(les)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 NAME: Automatic Data Processing Insurance Agency,Inc. AICONr o Ext): A//C No): IL 1 Adp Boulevard ADDARESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 958 Andover,MA 01810 INSURER D INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 338194 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 POLICY EFF POLICY P LIMITS LTR INSD WVD POLICY NUMBER MM/DD MM/DD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DA AGE ToRENTEG_ CLAIMS-MADE 1-1OCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑PRO- JECT ❑LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED 91-0-CE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON OWNED DOPER Y DAMAGE $ HIRED AUTOS AUTOS UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X _ AND EMPLOYERS'LIABILITY STATUTE �R ANY PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 1,000,000A OFFICER/MEMBER EXCLUE ❑Y N/A N POWC660990 01101/2015 01/01/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE $ 1,000,000 If yes,describe under E.L.DISEASE-POLICY LIMIT b 1,000,000DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICE GROUP5 ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET Westborough,MA 01581 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD ` usiness Regulation office of Consumer Affairs and 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116stratia Home improvement Contractor Reg istn ion: 102726 Rig Type: DBA Tr# 252249 B,xpiration: 7/212016 POLAR BEAR INSULATION CO. Vincent LeBlanc _. --- P.O. BOX 958 _ _ --- ANDOVER, MA 01810 Update Address and return card.Mark n forLQ t Card Address ❑ Renewal ❑ Employment ❑ DPS-CA1 da 50M 04!04.6101216 _ . > C ass:�jc wsetts -''De aiirtme 1t a)jPLA)h C If'iy Board raI BuHrling a egWafiiOfls and St,���ndards 6._tensa: CSSL-106017 r PETER A LEBLANC 2 EAST PINE STREET Plaistow PIH 03865 Expr it«,��'0 c>n ✓ 04128/2018 (:oc'c°wrnisscrie