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HomeMy WebLinkAboutBuilding Permit # 5/6/2015 BUILDING PERMIT C) TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received CHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION 3 (' �® I&---e e Print PROPERTY OWNER ytia CA,:v/ e we 5n Print 100 Year Structure yes no MAP PARCEL: QQ, "7 ZONING DISTRICT: Historic District yes no Machine Shop Village yes no ) TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building [] One family [I Addition El Two or more family [I Industrial El Alteration No, of units: El Commercial El Repair, replacement Li Assessory Bldg Others: [I Demolition [I Other 1111, �/io 11, If 111 IN '�'01,1913 F�fingoY I WE"I'll % DESCRIPTION OF WORK TO BE PERFORMED: 9:-0- LC Dm- 5-44 L I'D Lo A7 1 f-57,-q f"Me Identification- Please Type or Print Clearly OWNER: Name: fir ,",tkoet 140 See Phone: Address: 3(o Cefqct? C- Contractor Name: P t-�?- e%r- I e (ce AU-C —Phone: Email: Address: P, evff'r- hv-,e r PJ41,5u/ 0 Supervisor's Construction License: Exp. Date: Home improvement License: V.A Exp. Date:. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDINGPERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ -?)b Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ifz//�111 ,011 /0 ttORTH r C&ver vpqk d xj Town of ® ao5 O LAKE ver GlDL7' COCNIC NE WICK ��' U BOARD OF HEALTH Food/Kitchen PEKIT T Septic System THIS CERTIFIES THAT ........ ... . .. BUILDING INSPECTOR 4. Foundation has permission to erect .......................... buildings on ....... ............... .�At' ... .. ....... ................ ...4® ... o Rough to be occupied as ..............�. ... ......... .......... ........�� ®...... .................................... Chimney provided that the person accepting this permit shall in every respect conform to th erms 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 UNLESS I S Rough Service .......... .............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough 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. Federal 1D 9 RISE Engineering RI Contractor Registration No AIA Contractor Registration No A division of Thielseh Engineering CT Contractor Registration No 60 Shawmut Unit 112,Canton,DIA 02021 339-502-6335 FAX 339-502-6345 --...._I PROGRAM Page THIS CONTRACT IS ENTERED INTO BETWEEN RISE J.'vTG� '� RIi�G -CMA-RES ENGINEERIINDESCRIBEDBGA vTHECU57OMR EFORWORKAS' CUSTOMER PHONE DATE CUENTq WORK ORDER Michael Hoye (978)618-9209 01/15/2015 400298 00002 SERVICE STREET r BIWNG STREET 36 Colgate Drive 36 Colgate Drive SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP ' North Andover,MA 01845 North Andover;MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor-air quality.Materials to be used to seal your home can include caulks,foams,,weatherstripping and other products. Primary areas for sealing-include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (6)working hours. At the completion of the wcatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $450.00 DAMMING:Provide labor and materials to install a 12"layer of R 38 unfaced fiberglass batts to(40)square feet for damming purposes. $82.00 ATTIC FIAT:Provide labor and materials to install an 8"layer of R-28 Class I Cellulose added to(200)square feet of open attic space. $260.00 VENTILATION:Provide labor and materials to install.ventilation.chutes in(15)rafter bays to maintain air.flow. $30.00 BASEMENT DOOR:Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2"rigid board that meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and scams with FSK tape. $72.22 OVERHANG:Provide labor and materials to install 10"R-37 densely packed Class 1 Cellulose insulation to(40)square feet of exterior overhang located below a heated floor area,by drilling holes in the overhang from below. Holes drilled will be plugged. Plugs will be sealed with exterior grade spackle and left in a relatively smooth condition.Finish sanding and touch-up priming/painting will be the customer's responsibility. $160.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to$600. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the available air now in your home both before the work is begun,and after the weatherization work is complete.We will also conduct a full assessment of the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$2,690. �? (� $90.00 11 ,.,....�'" F E t1 2 5 2015 Federal ID# I RISE Engineering RI Contractor Registration No MA Contractor Registration No A division otThicisch Engineering CT Contractor Registration No 60 Shawmut Unit 112,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 PROGRAMI THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING -CMA-HES ENGINEERING THECUSTOMER FOR WORK AS ED CUSTOMER PHONE DATE CUENTfI WORK ORDER Michael floye (978)6I8-9209 01/15/2015 400298 00002 SERVICE STREET BILLING STREET 36 Colgate Drive 36 Colgate Drive SERVICE CITY,STATE,ZIP _ BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $1,144.22 Program Incentive: $993.16 Customer Total: $151.06 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Hundred Fifty-One&061100 Dollars $151.06 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMITAMOUNT DUE IN FULL INTEREST OF IY WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. '.. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZED SIGNATURE- 91n"6n9 CUSTOMER ACCEPTANCE NOTE: CONTRA MAYS TI RA�IFNOED WITHINDATE OF ACCEPTANCE ---.-,/�—�� --- - ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE C c,S Fa ele' /1 1 . i OWNER AUTHORIZATION FORM 1, 14 i C kqe1-----��v., (owners Name) owner of the property looted at G� P rty Address) (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtal a building pennit and to perform work on my property. b 2015 Owneeb s gnatu Date The Co►mnonivealth ofMassachusetts . - Department of Industrial Accidents Offtee of Investigations 600 Washington Street = Boston, MA 02111 www.mass.-ovIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information q- Please Print Legibiv Name (Business!Organization/Individual): PO 14f' �Ca ry\5 J Ig r)"o o1 /Address: ®1 � A 0 X I'S— City/State/Zi : �Ou� !11 Phone #: �7�' �F(v- 15-14? Are you an employer?Cirech;the appropriate box: Type of project(required): 1. I am a employer with_ 7 `l ❑ I am a general contractor and I 6. ❑New construction employees(full and/or part-time).* have hired the sub-contractors 2.❑ 1 am a sole proprietor or partner- listed on the attached_sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. E] Demolition working for me in any capacity. employees and have workers' 9. E] Building addition [\o workers' comp. insurance comp. insurance.- required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 1❑ 1 am a homeowner doing all work officers have exercised their i 1.❑ Plumbing repairs or additions myself. [\o workers' comp. right of exemption per MGL 1 ❑ Roof repairs insurance required.]' c. 152. 51(4),and we have no employees. [No workers' 1�•�Other �hSvI�Tp2 vt comp.insurance required.] *An\ appliennt that checks box a must also till out the section below showing their workers'compensation police information. Ilomeowners who submit this affidavit indicating the\•are doing all work mud then hire outside contractors trust submit a new affidavit indicating such. Contractors that check this box must attached an additimtal sheet showing the name of the sub-contractors and state whether or not those entities have employ ecs. If the sub-contractors have employees.the\ nest provide their workers'comp.police number. 1 ain an einploper that is providing workers'compensation insurance for mt'emphl-wes. Below is the polio'and job site information. Insurance Company Name: U��� �Gi q rJ Policy f or Self-ins. Lic.;I: P p We— $—,�j—" gep � 5 Expiration Date:�� 16 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 do hereby certify fuirler the pains and penalties of peritay that the information provi!/ed above is true and correct. Signature: Date:. Phone : Cf"?�— V a >- Of icial use onil•. Do not write in this area,to be completed Gr city or town official. Cit•or Town: Permit/License# Issuing Authority(circle one): 1. Board of Health 2. Building Department 3. City/Torn Clerk -i. Electrical Inspector- 5. Plumbing Inspector 6. Other Contact Person: Phone#: OP ID:Se CERTIFICATE OF DATE lMMrunnwv) LIABILITY 15 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 BN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT. ff the cerfiTft�te holder is an ADDITIONAL INSURED,the poticy(ies)must be endorsed. ff SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement an this certificate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER cT Durso A Jankowski ins Agcy LLC PHONE F 198 Massachusetts Avenue Eat' North Andover,MA 01845 EMAIL Durso&Jankowski ins.Agcy. ADDRESS: PRo uERID#:POLAFt-7 INSURER(S)AFFORDING COVERAGE MAID 6 INSURED Polar Rear inSu ation 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 I5 SUBJECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLANS. ADOL TYPEOFINSURANCE POUCYNUMBER (AMM LK:YE>(P Unum GENERAL LIABILITY EACH OCCURRENCE $ 11000,00 A COMMERCIALGENERALumiuTY PAC7052023 O&%M15 03124FA16 PREMISES Eeoavrten�e S 60,0001 CLAIM"ADE ®OCCUR MED EXP(Any one Persal) S 5,0001 PERSONAL& DViNJURY S 1,000,0 GENERALAGGREGATE $ 2,000, GENL AGGREGATE LIMIT APPLIES PEm PRODUCTS-COMPIOPAGG $ 1,000,00 POLICY PRO LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 ® ANY AUTO 100526 01/04 015 01/04/2016 (�acddenl) BODILY INJURY(par Person) S ALL OWNED AUTOS X BODILY INJURY(Peraxident) $ SCHEDULED AUTOS PROPERTY GE S X HIRED AUTOS (ERACCDENT) X NO"WNEDAUTOS S $ UMBRELLA UAB ftXOCCUR EACH OCCURRENCE S 1,000,00EXCESS LlAB LAIMS AAADE AGGREGATE S A PACS906M 03/24/2015 03/24/2016 DEDUCTIBLE $ RETENTION 5 $ WORKERS couPENsATKINWCSTATW H- AND EMPLOYERS'LLA RJTY RY ANY PROPRIETORIPARTNERW=UTNE VIN NEL EACHACCIDENT S OFRCERIMEMBEREXCLUDED? D N/A (MandetmyInNH) E.L.DISEASE-EA EMPLOY 5 [fie s, dee under elay --T ELDISEASE OLICY LIMIT S DSCRIPTION OF OPERATIONS b iDESCRIPTION GF OPERAITONSI LOCA I VEHICLES(Atffieh ACORD 101,AddRional Rems,ke Sct+odute,if man speea IS MgUWM Insulation Word Mineral;idd tional i ured for a ral pabil h rnrinre-'e'ring ortc perforrrmd on their be calf by th�above InsuM is Thfeisch CERTIFICATE HOLDER CANCELLATION THIELS2 SHOULD ANY OF THE ABOVE:DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATiON DATE THEREOF, NOTICE WILL BE DELIVERED iN ThielSCh Engineering Columbia Gas ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave AUTHORIZED REPRESENTATIVE Cranston,R182910 AA9JP- o ACORD CORPORATION. Ail rights reserved. ACORD 25(2409109) The ACORD name and logo are registered marks of ACORD CERTIFICATE OF LIABILITY INSURANCE DATE(MMIDDNYYY) 1 04/2812015 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(ies)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). NAME: PRODUCER Automatic Data Processing Insurance Agency,Inc. PHONE HO No Ext): ac No): 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC N INSURERA: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER C: PO BOX 958 INSURER D Andover,MA 01810 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. LTR TYPE OF INSURANCE ISD WVD POLICY NUMBER ADDLSUBR MAONDCY FF MID LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ TED CLAIMS-MADE FIOCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY❑JECT LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITYCO B NED S N E $ Ea accider:t ANY AUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NPROPERTY DAMAGE Per acci HIRED AUTOS AUTOSUTOS D dent $ $ UMBRELLAUAB OCCUR EACH OCCURRENCE $ EXCESSLWB CLAIMS-MADE AGGREGATE $ DED RETENTIONS $ WORKERS COMPENSATION X P R OTH_ AND EMPLOYERS'LIABILITY STATUTE ER ANY PROPRIETORIPARTNERIEXECUTIVE Y/N E.L EACH ACCIDENT $ 1,000,000 A OFFICER/MEMBER EXCLUDED? �Y NIA N POWC660990 01/01/2015 01/01/2016 (Mandatory in NH) E.L DISEASE-EA EMPLOYEE S 1,000,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached It 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 GROUPS ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET Westborough,MA 01581 AUTHORIZED REPRESENTATIVE ©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD it 0 Office of Consumer Affairs and usiness Regulation + 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 102726 Type: DBA Tr# 252249 Eicpiration. 7/2/2016 POLAR. BEAR INSULATION CO. Vincent LeBlanc — P.O. BOX 958 ANDOVER, MA 01810 _ Update Address and return card.Mark r ri.n for o Lost Card f Address El Renewal J Emp y ❑ DPS-CAI 0 50M-04104-0101216 1 ;�SS,,,AC"iauset°iF, -'Department cit pu bHc Safety (`'ujvanic icon Suapen isoor t peciaaii;y I-Vc".s'use: C+SL-106017 °yr PETER A LEBLANC „ 2 EAST PINE STREET Plaistow NR 03865 l x ratao n 04/28/2018