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HomeMy WebLinkAboutBuilding Permit # 5/6/2015 0ORT11 BUILDING PERMIT 01 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 0 1.C 4 RA rev Permit No#: Date Received .ss CHUS 0.- Date Issued: IMPORTANT: Applicant must complete all items on this page e LOCATION -5 7 Vt Y,- li-^do ti Print r2fP PROPERTY OWNER _ Q1(! Print 100 Year Structure yes no MAP Wr) PARCEL: ZONING DISTRICT:—Machine ISTRICT:—Hisistrict ye no MachineDShop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 11 One family 11 Addition [I Two or more family [I Industrial [I Alteration No, of units: Ei Commercial El Repair, replacement [I Assessory Bldg i�Others: uC El Demolition 0 Other YNI J DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly Phone: VF-(00A-LJ1_0( OWNER: Name: r-ortt4wi -t 61"QC&C141 t Address: 3-5 Y4 Pf 22 v, $ ' Contractor Name: e-f (et KC Phone: J(>F— 2 0 Email: Contractor Email ac tor SS_ f7 Address: r Supervisor's up rviso _Exp. Date: AJh- upervisor's Construction License: etq om Improvement Exp. Date: ? rLHome Improvement License: 10X ARCH ITECT/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: 110 FEE: $ Check No. l Receipt No.: NOTE: Persons contracting with unregistered contractors do not have acce to the guaranty fund 77, 'n R7 N h ��TWRU/7/�w."IUMM15711F r-nt/ O TH Town of Andover 0 ® 26(15 _ C, ver, Mass, o e AKQ .�. COC KICK@WICK V RATED BOARD OF HEALTH PERMIT T Food/Kitchen Septic System THIS CERTIFIES THAT ® BUILDING INSPECTOR .............Ue&p!...... ............................................................................. ....... has permission to erect buildings on .. ...... Foundation .......................... ... ... ..... ... . .. . ........ .....Eked ® Rough tobe occupied as ...... ... .. .R.. .... ... ... . . .......................................................... Chimney provided that the person accepting this permi 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-Lacus 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 CONSTRUCTI Tj Rough Service .................. ... ....................................................... Final BUILDING INSPECTOR GAS INSPECTOR ccupanc-p Permit Required to ccup-y Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingr Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal to# RISE 1'L ngi neetrliig, RI Contractor Registration No MA Contractor Registration No A division of"11delseh t;ughicering CT Contractor Registration No 60 Shtawnaut unit 112,(.':anion,MA 02021 339-502-6335FAX 339-502-6345 CONTRACT Page 1 PROGRAM Tr115 CONTRACT IS ENTERED INTO BETWEEN RISE CMA-11 ES ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER ._ __ ..__.. ... _... ..PHONE _.. _...DATE _..CLIENT P.._.. WORK ORDER Jeanne Bianchi (978)604-4301 02/12/2015 405135 00002 SERVICE STREET BILLING STREET 337 Appleton Street 337 Appleton Street SERVICE.CITY,STATE,ZIP SILLVIG CITY,STATE,ZIP North Andover,MA 01845 North Andover, MA 01845 ............ ........... ....... JOB DESCRIPTION AIR SEALING:provide labor and materials to seat areas of your home against wastet'bl,excess air leakage. '1"his work will be performed in concert with ale use of*special tools and diagnostic tests to assure that your home will tae lett with it laeaithftd level of air exchange Had indoor air duality.Materials to be used to seal your home can include caulks,Baanhs and other products. Primary areas i"or scaling include air leakage to attics,basements,attached garages and other unhealed areas(windows are not generally addressed.) (10)working hours. At the completion orthe weatherizatiam work,and at no additional cost to the homeowner,a final blower door and/or cornbustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality.t GIANT CHIMNEY CHASE! $750.00 DAMMING:provide labor and materials to install it 12"layer of R-38 unfnced fiberglass bans to(60)square feet liar damming purposes. $123.00 ATTIC FLAT:Provide labor and materials to install a 6"layer of R-21 Class I Cellulose added to(1078)square feet ol'open attic space. 1,2t)3.6o KNEEWALI.S:Provide labor and materirals to install 2" FSK faced semi-rigid fiberglass board insulation to(20)square feet of kneewall area. $(r6.2t1 A"T"TIC ACCESS:Provide labor and materials to install(1) easily moved insulating cover for the attic access Balding stair. A small flat surface of plywood will be created around the Opening within the attic. This will allow the cover's integral weather-stripping to restrict air leakage. $237,65 VIN"I'ILA'I'ION:Provide Irabor rand rmaterirals err irrsuail ventilation cimtcs in(34)rafter bays to maintain air flow. $68.00 RISE Engineering will apply till applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, liar eligible nhcasores,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Scaling measures till to the first$600 and an additional$300 irsavings are justified by the auditor. ],'or the safely and health of'your home's indoor air quality,we will be conducting It blower door diagnostic of tic available air taw in your home both before the work is begun,raid after the weatherizzation work is compicte.We will also conduct a full assessment of the Combustion safety oaf your heating system and water heater."Phis has a value of$90 and is at no cost to you. Tarim allowable weatherization incentive is$2,990. $90.00 Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of'rhielsch E ngincerh'ig CT Contractor Registration No 60 ShRwmut Unit 112,Canton,NIA 02021 CONTRACT 339-502-6335 FAX 339-502-6315 Page z 1>l OGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE t Ca I R I @ CNIA-1"1 ES ENGINDESCREERING ANBELOW HE CUSTOMER FOR WORK AS CUSTOMER PHONE DATE CLIENT 0 WORK ORDER Jeanne Bianchi (978)601-4301 02/12/2015 405135 00002 SERVICE STREET BILLING STREET 337 Appleton Street 337 Appleton Street SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP North Andover,MA 01845 North Andover, MA 01845 .JOB DESCRIPTION Total: $2,628.45 Program Incentive: $2,143.84 Customer Total: $484.61 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Eighty-Four&61/100 Dollars $484.61 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN F L.INTEREST OF i%WILL BE CHARGED MONTHLY ON ANY '.,. UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF R 1 LION,SCHEDULING,AND CONTRACTOR REGISTRATION. _ L.ANK SPACES _. _ A / DO NOT SIGN THIS CDNTRACT IF THERE 1" E ANY Ci., � s AUT UZEDSIGNATURE- ISE Englnee D CU TOMER ACCEPTANCE NOTE:THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE --- -- - ACCEPTANCE OF CONTRACT-T'HE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED 7O 00 THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE 7 OWNER AUTHORIZATION FORM (Owner's Name) ' owner of the property located at (Property Address) (Property Address) ' hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my propeity. � I wner's Signature 911, ,` Date ham. ®\ The Cotmnontvealth of PlIassachusetts - Department of Industrial Accidents "* Office of In �- ``1600 Washington Street -y- .; Boston, MA 02111 1VJVlV.n1ass.gov1dla Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Leeibhv Name (BL[SinCss!Organization/Indi\•idual): PO iV- A ea rnSy JA IYO!n �'b Address: A eq- R 0 X S-45 Ajkdowr I'yj Phone #: �7�-��6® �J�S' Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with^7 4. ❑ I am a general contractor and i employees(hill and/or part-time).* have hired the sub-contractors 6. ❑New•Construction 2.❑ 1 am a sole proprietor or partner- listed on the attached,sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have P S. ❑ Demolition working for me in any capacity. employees and have workers' q ❑ Building addition [No workers' comp. insurance comp. insurance. required.] 5. ❑ We are a corporation and its 10.El Electrical repairs or additions 3.❑ 1 am a homeowner doing all work officers have exercised their 1 l.❑ Plumbing repairs or additions myself. [No workers' comp. right of exemption per MGL S 1 12.E] Roof repairs insurance required.] c�I52, S` (4),and we have no employees. [No workers' 13•C�Other comp. insurance required.] .\ny applicant that checks box I must also till out the section helow shooing their •orker•compensation police information. I lonteowners who submit this al7ida6t indicating they are doing all work-and then hire outside contractors must submit a nee•afticim-it indicative such. Contractors that check this box niust attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have emplolees. If the sub-contractors have employees.the\ must provide their workers-comp.poliep number. 1 ant alt entphyer that is provitlitrg workers'compensation instirance for trip enrplgl�ees. Below is the policl•and job site i11f017natiolt. Insurance Company Name: �� �Q U 4 rt Policy#or Self-ins. Lic. : 0 IiJC- 577576ci, & S Expiration Date: !Zell& 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 for�l,arded to the Office of Investigations of the DIA for insurance coverage verification. i do berebr certify under the pains and penalties of perjurl,that the information provided above is b•tle and correct. Signature: Date Phone Official use only. Do trot write itr this area,to be completed 4r city or town official. City 0r C011Ii: 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#: .SC R ® CERTIFICATE OF LIABILITY INSURANCE DATE(MM/DDNYYY) 04/28/2015 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. A"2 o Exf: FAX No): 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC# INSURERA: NorGUARD Insurance Company 31470 INSURED INSURERS: POLAR BEAR INSULATION CO INC INSURERC: 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. LTR TYPE OF INSURANCE SD WVD POLICY NUMBER MMIDISR CY FF (MMID POLICY P LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CLAIMS-MADE FIOCCUR PREMISES Ea occurrence $ MED EXP(Any one person) $ PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMIT APPLIES PER: I GENERAL AGGREGATE $ RPOLICY❑JECOT- [71 LOC PRODUCTS-COMP/OP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINEDSINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILYINJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE HIRED AUTOS AUTOS Per accident $ $ UMBRELLA LIAR OCCUR EACH OCCURRENCE $ EXCESS LUIS CLAIMAGGREGATE $ OED RETENTION$ $ WORKERS COMPENSATION XPER H- AND EMPLOYERS'LIABILITY STATUTE ER YIN N ANY PROPRIETORIPARTNER/EXECUTIVE E.L EACH ACCIDENT $ 1,000,000 A OFFICERIMEMBER EXCLUDED? ❑Y N/A N POWC660990 01/01/2015 01/01/2016 (Mandatory in NH) E.L DISEASE-EA EMPLOYEd$ 1,000,000 If yes,describe under 1000 DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT , S ,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached If more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POUCIES 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 --_)C )tt_)k_ A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD OP 1Ds SS DATE(MMIDDlT" LIABILITYCERTIFICATE OF 03/1 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 BEEN THE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: ff the Certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed. if SUBROGATION IS WANED,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 CONTACT NAVE Durso A Jankowski ins Agcy LLC 198 Massachusetts Avenue PHONE X FAN® North Andover,MA 01845 E-NUM Durso&Jankowski ins.Agcy. ADDRESS: CRO-US—MUC—ODER ID s:POLAR-1 INSURER AFFORDING COVERAGE NAIC 0 INSURED Polar Bear insulation Co.Inc. ,NSuRERA.Penn America 32859 P®Box 958 INsuREa a:S Insurance Co. 33818 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 CLANS. iLdSR TYPEOFUISURANCE POLICYNUER I POUCYEFF RIPS EXP U GENERAL LIABIL ITY EACH OCCURRENCE $ 1,000,0001 A COMMERCIAL GENERALUABIUTY PAC7052023 OWW2015 09/20=16 PREMISES Es oeamence $ 50100 CLAIMS-MADE ®OCCUR MED EXP(AnY ona PS—) S 5,000 PERSONALBADVINJURY $ 1,000,014 G£NERALAGGREGATE $ 2,000,00 GENLAGGREGATEUMITAPPLIESPER: PRODUCTS-COMPiOPAGG S 11000,00 POLICY PRO LOC $ AUiOMOBILELWBIUrY COMBIIF ED INGLELIMiT 5 1,000,00 B ANY AUTO 100926 01104,2015 01,04,2016 BODILY INJURY(Per person) S ALL OWNED AUTOS SCHEDULED AUTOS BODILY INJURY(PeraWdent) S PROPERTY GE $ X HIREDAUTOS (PERACCEN7) D X NON-OWNEDAUTOS 5 S UMBRELLA UAB DXOCCUR EACH OCCURRENCE 5 11000,00 EXCESS LiAR CLAIMS-MADE AGGREGATE 5 A PA 09,24,20'15 03,24,2016 DEDUCTIBLE $ RETENTION S $ WORKERSCOMPENSATIONVUCSTATU- H AND EMPLOYERS LIABIUTY Y I ANY PROPRIETOR/PARTNER/EXECUTiVE YIN EL EACHACCIDENT S E-1OFFICER/MEMBEREXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOY $ Ifyas,descnIn under DESCRIFnONOFOPERATIONS below E.L.DISEASE-POLICY LIMIT S DESCRIFnDNOFOPERATIONSILOCA'nONSIVEHMLES(AUaehACORDICI.AddWwalReScWua,"more speolarequInd)Insui topefapnthnrir�afat �adieasuiit with orniedoeibfby hbove MU is Thielsch rntrneering CERTIFICATE HOLDER CANCELLATION THIELS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE: THEREOF, NOTICE WILL BE DELIVERED IN ThlelSch Engineering Columbia Gas ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave AUn10RQED REPRESENTATIVE Cranston,RI 02910 XAW ©198&2009 ACORD CORPORATION. All rights reserved. ACORD 26(ZMffi9) The ACORD name and logo are registered marks of ACORD d usiness Regulation Office of Consumer to 170 10P Boston,Massachusetts 02116stration ome Improvement Contractor Reg istra6on: 102726 II Reg Tvpe: DBA Tr# 252249 Expiration: 7!212016 POLAR BEAR INSULATION CO- _ Vincent LeBlanc _ P.O. BOX 958 change- ANDOVER, MA 01$10 'Update Address and return card.Mark r nt°�rL 6� Address Reost Card newal J Employment DPS-CAI Z`i 50M.04I04-G10/216 9 . M issa ila� tt n Dep artrn int n of ub �' cn��iSafety fe d G ra;�rd of Bina i_iuw;ense: C►SL406017 PETER A LEBLANC 2 EAST PINE STREET Plaistow NH 03865 0412812018 C;rcairan���aaa¢no�cwa,�