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HomeMy WebLinkAboutBuilding Permit # 6/4/2015 BUILDING PIT �aosarH O��.ryED TOWN OF NORTH ANDOVER o APPLICATION FOR PLAN EXAMINATION I p� it Date Received �Rq°�greo ne�y '3 Permit No#: �ss ceauS � Date Issued: IMPOR ANT:Applicant must complete all items on this page LOCATION .. 4,>-(") (J f �°; , , . �,.... Print PROPERTY OWNER - Print 100 Year Structure 6no MAP PARCEL: ZONING DISTRICT: Historic District yesMachine Shop Village yes. TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition ❑Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other 'T,- YI q�y O n Mi 2f/SeUV 1 lli, DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: h o c y Phone: - `- Address: Contractor Name: r ( Phone 261 Eiimail: Address: ' 5 7— °, Supervisors Construction License: c Exp. Date: Y / Home Improvement License: C t C Exp. Date: 41>10, d.lI ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST SED ON$925.00 PER S.F. Total Project Cost: $ 2-,100, 00 FEE: $ Check No.: Receipt No.: NOTE: Persons contracting witli unregistered contractors do not have access to the guaranty fund a ,.. . ,��e ,r ,. �. r r ai r„n tr,.nri �ro ii r i .,�i�,i-iri . ii��rrrrwl wfv;:�»�.npr .wp� , '"DUiriururlNa��J nr A /,rJ r/%////////%%////, �/�%/%/f/// .:. ,/ .f m v �.:', (�/4 _. fTrrr ////,/,/r, / /r, %x/%//%/19//, r oORTH Town of ndover 0 0 • ® • ,?• _ _ ® LMH• ver' aSs' COC HICH!W/CH � �QO'�gTED Pk S � BOARD OF HEALTH MIT LD Food/Kitchen Septic System THIS CERTIFIES THAT ....... . .. BUILDING INSPECTOR Foundation has permission to erect .......................... buildings on . ........I%t� .. ....... ................ ® A Rough to be occupied as ........ ... ..� .. .... .. .... ........... � Chimney ..... ... ............... u provided that the person accepting this permit shall in ery 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 16 MONTHS ELECTRICAL INSPECTOR LESS CONSTRUCTIO Rough Service ................. . ....... .. ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired to Occupy Buildinz Rough Display in a Conspicuous Place on the Premises — ®o Not Remove . Final No Lathing or Dry Wall ToBe Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thicisch Engineering CT Contractor Registration No 60 Shawmat Unit 112,Canton,INA 02021 �e 339-502-6335 FAX 339-502-6345 Page 1 . I S E PROGRAM Taa3 conTRAC'r Cr ENTERED acro aENJECn RISE ENGINEERING CMA-alt S ENGIDESCRIIIED v� TnEcusTotaEnFOR vranxns LOW CUSTOMER ...... _... ...... PHONE _ DATE .. ..WENT WORK ORDER Nancy Dowc (978)685-5772 01/29/2015 409689 00002 SEWCE STROFT _..... 811"to STREET 250 Middlesex Street 250 Middlesex Street SERVICE CnY,STATE,ZIP BILLING CUY,STATE,LIP North Andover MA 01845 North Andovei-,MA 01845 Jf®R(DESCRIPTION � BARRIER:A Glower door Tcst will not be conducted at your(tome,due to the presense of asbestos. $0.0 AIR SEALING:Provide labor and materials to seal art„as ofyour home against wasteful,execs%air leakage. This work wi 1 be perfonned in concert with the rise of special tools and diagnostic tests to assure that your home will be len with a healthfir Of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foatrts,weatherstripping,and other products. Primaryareas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows arc not generally addressed). (7)working hours. At the completion ol'thc weatherWition 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 ofthe indoor air quality. $525.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass balls to(40)square fact for damming purposes. $82.00 ATTIC FLAT:Provide labor and materials to install a 10"layer of R-35 Class I Cellulose added to(416)square feet ofopen attic space. $582.40 SLOPES:Provide labor acrd materials to install a 6"layer of R-21 Class I Cellulose added to(128)square feet ofslope area. Wherever possible battles will be installed to the entire length ofeach bay to maintain ventilation space, $2.38.08 A'I-rIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid'nccrmarx board.Weatherstrip the perimeter. $60.00 VENTILATION:ION:Provide labor and materials to install(I)insulated exhaust hose with gable wall mounted llapper vent to exhaust existing bathroom fim(s). $118.75 VEN`rILA'nON:Provide labor and materials to install ventilation chutes in(32)rafter bays to maintain air(low. $64.00 BASEMENT CEILING:Provide labor and materials to install(112)linear feet orR-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $196.00 BASEMENTDOOR:Provide labor and materials to insulate the back of the basement drum leading to the bulkhead with 2"rigid board that meets ilia sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and scams wi0a FSK,talo:. $72.22 WHOLE HOUSE I-AN:Provide labor and materials to fibricutc and install a rigid foarn insulating cover for ilia whole house Earn. $209.21 RISE Engineering will apyall applicable,eligible inccntivus to this contract. You will only be billed the Nut amount. Currently, for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of I UO%for the Air Scaling measures up to$900. Federal to RISE Engineering RI Contractor RegistrztJon No MA Contractor Registration No A division ofThicisch Engineering GT Contractor Registration No 60 Shawmut Unit 112,Canton,NIA 02021 CONTRACT 339L-507-6335 TAX339-502.6345 R I S E Page 2 PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN ME CMA41ES ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING CUSTOMER PHONE DATE CLIENT 0 WORK ORDER Nancy Dowe (978)685-5772 01/29/2015 409689 00002 SERVICE STREET WWNG STREET 250 Middlesex Street 250 Middlesex Street seavict:CITY,STATE,ZIP HQ1MG CITY,STATE,ZIP North Andover, MA 01845 North Andover,MA 01845 ---- ------ JOB DESCRIPTION ror the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic orthe available air flow 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 ofyour heating system and water healer."fids has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$2,990. $90.00 Total: $2,237.66 Program Incentive: $1,831.99 Customer Total: $405.67 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Five&671100 Dollars $405.67 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILLBSCHARGE)MONTHLY ONANY UNPAID BALANCE AFTER 20 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDUUNG,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES AUTHO S-H -R ifi 9" 1 CUSTOMER ACCEPTANy 17 NOTETRISCONTRACT MAY Be WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE Of ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPC-CMCA-nOUS AND CONDITIONS ARE 30SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DOTHE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE OWNER AUTHORIZATION I, W (Owner's Name) owner of the property located at rcycl 1,e (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 property. Owner's Signature QI V,b Date The CoMmompealth of Massachusetts ; Depai Yinent ofI/1(fLlSt!'irrl AccfrfeLits ----- ------- -r` -i ''r— -• Office of Investigations 600 Mashutgton,Street " Boston, MA 02111 '4,3i.- lvtvtu. LIILLSS.,Q OV1(fLt! Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Al2plicant Information Please Print Legibly Nalne (Business../Organization/individual): o tqr Jeo(` r,5,J M Z:'®n 0 _ _ Address:. 0 X F,M City/State/Zip: &J o Phone#: Are you an employer?Cheel:the appropriate box: Type of project(required): 1. 1 am a employer with `I- ❑ I am a general contractor and I employees(fu!(andior 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 ship and have no employees These sub-contractors have 8. ❑ Demolition working for me in any capacity. employees and have workers' 9 ❑ Building addition [\o xvorkers- comp.insurance comp. insurance: required.] 5. ❑ We are a corporation and its I O.❑ Electrical repairs or additions 3-❑ I am a homeowner doing all work officers have exercised their I l.❑ Plumbing repairs or additions myself.[\o workers' comp. right of exemption per MGL 1 ❑ Roof repairs insurance required.]T c. 152-§1(4).and we have no employees. [Ito workers- 13.&Other _r&i1JJ�J p�� comp.insurance required.] .*film applicant that checks bog=1 must also till out the section helow shoving their workers compensation polio•infonnation_ 1 ionteowners who submit this affidavit indicating they are doing all work and then)tire outside contractors must submit a new affidavit indicating such. `Contractor that check this hos must attached art additional sheet showing the name of the sub-contractors and state whether or not those entities have entplovees_ If the sub-contractors have employees.they must provide their workers'comp.polio-number. I am an enlplojer filar is providing porkers'compensation insurance for nir eniphtpees Below is tine polio'and job site information. Insurance Company\ame:1 ,V f—a U Q iral Policy':or Self-ins.Lie.r: ® ujc— Lib Expiration Date: ! Job Site Address: City/State/Zip— Attack a copy of the workers'compensation policy declaration page(shmtiing 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-gear 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 tine Office of Investigations of the DIA for insurance coverage verification. I do hereby cerlif'unller 1/;e paitrs a�ttl pe::aiLies of perjrrr•LIPitL t{ie fflfarfii[FiiFiii provided above is true andcorreri. Signature: Date Phone k V D>- l� Official use oah: Do rrot trrite in this area,to be canpleted br eitr or town official City or Town: Permit/License# Issuing Authority(circle one): I_ Board of Health 2. Building Department 3- Cit}/Town Clerk -l. Electrical Inspector 5. Plumbing Inspector 6. Other Contact Person: Phone#: ® CERTIFICATE OF LIABILITY INSURANCE OATE(MWDD)YVY1f) 01/06/2015 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"CONti E:d: JU No): 4 Adlr Boulevard 1046- Roseland,NJ 07068 INSURERS AFFORDING COVERAGE NAIL# �A: NorGUARD Insurance Company 31470 INSURED POLAR BEAR INSULATION CO INC INSURERS: 513 CANAL ST INSURER C: PO BOX 958 INSURER D: Lawrence,MA 01843 INSURER E• INSURERF: COVERAGES CERTIFICATE NUMBER: 295670 1 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 LTR TYPEOFINSURANCEAVOL BUSH PoueyUr NSp POLICY NUMBER MWD ¢F) JMWDR= LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ CIAIM"ADE r-1 OCCUR PREMISES fEa owff=ce S MED EXP(Any one person) S PERSONAL&ADV INJURY S GEN'L AGGREGATE LIMIT APPLIES PER: GENERALAGGREGATE $ RPOLICY❑JECT LOC PRODUCTS-COMPIOPAGG S OTHER: S AUTOMOBILE LIASMITYi En $ Ea acada ANY AUTO BODILY INJURY(Perperswi) $ OYMED SCHEDULED AUTO$ UTOSBODILY INJURY(Per aWdent) $ NON-OWNED PPrReDGE $AUHIREDAUTOS TOS adri S UMBRELLALIAB OCCUR EACHOCCURRENCE 5 EXCESS LAB CLAIMS-MADE AGGREGATE 5 DED I I RETENTIONS S WORKERS COMPENSATION �( E AND EMPLOYERS'LIABILITY Y/N STATUTE I I ER A ANY PROPRIETORIPARTNERIEXECUnVE E.L.EACH ACCIDENT S 1,000,000 OFFICERIMEMBEREXCLUDED? ®NIA N POWC660990 01/0112015 01/0112016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYE S 1,000,000 it mdesrnteunder 1,000,000 DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION OF OPERA71ONS I LOCATIONS IUMCLES(ACORD 101,AddMonal Remarks Schedule,may be aUndsed R more space Is required) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CPLUMBIA GAS ACCORDANCE WITH THE POLICY PROVISIONS. 195 FRANCIS STREET Cranston,R102910 AUTHORIZED REPRESENTATIVE A©IM-2014 ACORD CORPORATION.All rights reserved. ACORD 26(2014101) The ACORD name and logo are registered marks of ACORD OP IN 88 CERTIFICATE OF UA131LITY INSURANCE .. F a3il is 7HISi CERTIFICATE IS ISSUED ASA MATTER OF INFORMA17ON ONLY AND CONFERS NO HISM UPON THE CERWICATE HOLDER.THIS CERTIFICATE DOES NOT AFRRMATIVELY OR NEGATIMMY AMEND, MMD OR ALTER THE CO OE AFFORDED BY THE POMIES BELOW. THIS CERTIRCATE OF INSURANCE DOES NOT CONSTTTM A CO CT BETWEENTHE MsUiNG INSU (SA AWHORMN REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. INIPORT : If the Cut licca h®tder Is an ADDITIONAL INSURED,the poncy(te$)must be endomed. if Sufi 7'i0N IS WAWA subject to the term and conditions of the policy,certain policies May reilutre an enders erntutt. A statement on this cerilliceW does not confer rights to the certtttcm holder in ifeu of sugh endoMMAS1 PRODUCER 09FAW Dur&Janko AAvenassachusettsUge LLC PHONE FAX North Andover,MA 01845 Durso&JankowsM Ins Agcy. ADDRESS. PROR cusyMmfO _PO1 =ffit AMRDIN(GCOVERAGE MAKS UMURED Polar Bear l5 ®n .InO. INSURMAMennAmedca 32859 P®Box 958 MURER 13*Selew Insurance13 Andover,IVIA 01810 IuRERC: INMER D- Ngsuaw E. F• COVERAGES CERTIFICATE NUMBREVISION 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;TERRA OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT vM 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, EXCLUSIONSAND CONDITIONS OFSUCH POUCIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLMS. L TWEOF POLLgY EO r F PO EiLP 11W EACH OCCURRENCE S 1,000,00 A X COMMLRCIALGEmRALLNBILI7Y PAC7052023 03MMS 03PA4=6 PREM S 5 S0, cLNMS4=E®OCCUR MED EXP(Any one Iersa+ S 5.000 PERSONALBADVINJURY S 1,000, GENERALAGGAEGATE $ %0001000 GENIAGGREGATEUMRAPPLJESPM PRODUCTS-Cc)UPIOPAGG S 1,000,00 POLICY PAP; LOC $ AUMUORRELLABIIRY ComawDONGLEUMIT s 1,000,0® (ea Ino 13 ANYALRO 00526 5 O11104=16 BODILY NJURY(per P—) S ALLOWNEDAVMS 13013ILYINJURY(PerBcddmt9 5 X SCHEOULEDAUTOS PROPERTYDAMAGE S MREDAUTOS (PERACCIDEN7) X NON4)Wd1EDAUrOS S S UMBRELIALUMB x OCCUR EACHOCCURIMPE- A EXCESS LIAS CLAIMSAAADE PACMW6= GROV=5 03M41=6 AGGREGATE s DEDUCTIBLE S RETENTION S S WORKERS YIDN YyCSTATIY AND EMPLOYERS'LL46WIV E ANY PROPRtETQWARFr4ER1E7CE4 YIN O CERIGtt-nemEXCWDELY/ D N/A F-LFACHACCIDENT $ EL.OISERSE-EAEMPLO S DESCRIPAON OFOPERATIONS bek, EL.DISEASE-POUr-Y LIMIT S OESCR[PTTCbT FOPE3TA tY8/LCCA7iQTTom�_�/�{/E�`,LE5(A gOAD71J1,Aa��� g�J�Ig,ti�atest6fF�tty� Insulation�Nork- �rLeral;AttttiiiD alt U o a rat Iabl dto Wor1(partOd on tale r be by V �nsu Is islsah n nee nin CERTIFICA711 HOLDERCANCE TIQN lELS2 SHOULD ALITYOF!TMABOVE DE RIeWpOUCMOrECANCELLEDBEFORE ThI THE MWIBATH)N DATE THEREOF, NOTICE WILL BE DFJNERED IN Thie h EItgI biaGat> ng ACCORDANCEWITHTHEPOUCYPROVIMONS 195 Francis Ave AunloRLaED REPRLSENTATNE Cranston,R1 02910 AA9k ®1885-2009 ACORD CORP® 'NON. All rights nerved. ACORD 25( 9) The ACORD name and top are riEffietsoad nwft of ACORD 4 jirs and UsjneSS Regu Office of Consumer 10 Park PAffa Suite 5170 r` Boston,Massachusetts 02116 Hdme Improvement Contractor Registration Registration: 102726 Type: DBA Tr# 252249 Expiration: 7!212016 POLAR BEAR INSULATION CO Vincent LeBlanc _ - P.O. BOX 958 __________ ---- ANDOVER, MA 01810 ------ Lost Card Update Address and return gar Employment reason change- ANDOVER, i Address Renewal ,� DpS-CAI 0 5OM-04104—G101216 y- €?6 ansa:hUreas -'Department of pu bi ir1 5 Sr1a a°ri as yau0 inn �?a���:,iW aaflons and Standards ,,,11^aaruction saag ere i�gnr-dens a&1" f_cp;u se: CrISL-106017 w PETER A LEBLAPtC 2 EAST PINE STREET Plaistow NH 03865 Ex{.raN°aukrOru 04/28/2018 CA carw�c1 xu.�stu er ra as r