HomeMy WebLinkAboutBuilding Permit # 6/23/2015 BUILDING PERMIT No�arH
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TOWN OF NORTH ANDOVER
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APPLICATION FOR PLAN EXAMINATION it
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Permit No#: 917 Date Received B,�Q�RArED
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Date Issued:
IMPORTANT: Applicant must complete all items on this page
LOCATION ® zo o d Y 51— v yN do cscf-
Print
PROPERTY OWNER 1Gr - �
Print 100 Year Structure yes no .
MAP PARCEL: ZONING DISTRICT: Historic District yes i no
Machine Shop Village yes. no
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
�•z" -xrdr r, .,� aa"�rm �a';',
++epttc ®1Nell "r' ® FloodplainOWetlands,k ❑ UVatersheci Qistnct f
®Water/Sewers
DESCRIPTION OF WORK TO BE PERFORMED:
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Identification- Please Type or Print Clearly
OWNER: Name: 5A elle y 7—kpwPSar4 Phone: E-®s=90
Address: I5® YV? _ A J<✓'
Contractor Name: ?ems u-- C t A IcVLc Phone:
Em' aiI:
Address: ;L . ere-5r- Pr`vtc )fQf td ire
Supervisor's Construction License: C$S4P /42&®f , Exp., Date: by/�/ /Y
Home Improvement License: 0�-20L to Exp, Date: ? b.ho 16
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ ®o -®a FEE: $ 42 b
Check No.: Receipt No.: 1
NOTE: Persons contracting with unregistered contra ors do not have access the guaranty fund
AllFps r�
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NORTH
Town of t E ,, ndover
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4*t . h ver, Mass, ILIJe
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BOARD OF HEALTH
Food/Kitchen
PERMIT T D Septic System
THIS CERTIFIES THAT 16 , „ BUILDING INSPECTOR
has permission to erect g d Foundation
.......................... build' s o I.�.�........ 0...�... ...4���.............
Rough
/� .1� •
to be occupied as ......eg". r...V!'................\. � . . . ........................................ Chimney
provided that the person accepting this permit 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 6 MON SELECTRICAL INSPECTOR
UNLESS CONSTRUCTION S Rough
ervice
...................... ......................................................... 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 or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
°""18� u I IIImI�IIIIiIIX
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CONTRACT FOR
PROPUCTS SERVICE WORK
��i VICES �+1-tJlAp,; `
This service is brought to you through support from your local utility
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T�?I5 rAf Y JYIG't ,I;;tS t1lr) �► =.r fiYt
Ong., -
iliefty'l htroniagatt z. Conservatatan.Sox �zces(lresttp rG';( )
11 _l�rioacty_ t -- 14ttijltG
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;..,. ., ;i411002338610 . 'W�Stboroi gh;MA01581
P lectlWN0000350967 Reg-No.-173484
Cotonlerm:C06000348819 :: iedeiml1DNo.2224571'70
ContiraotI17;20150324ING--ITU " 01aileomplPIP(lcontracttoaddressabove)
1. DESCRIPTiON OF WORK TO RE PERFORMED
Contractor will perform or arose to be performed the following work on tiles(-"Premises"in n professionat manner and hr ar:ror+Vance with are teams of
this Conitnet,including me attaeired recontmendationsiavortc order deseribin;rite-work in detail(tile"Wnrtc")which are incurtwrdted hcmin by rererenre:
Description Quantity Location
Insulate Woof!Shingle Sided WNail With 4"Dense Paoli Cellulose 1,000 Living Space $2,160.00
Insulate Rim Joist With 2"Thermal,Barrier Polylso 58 Living pace $255.20
Insulate Overhang With 2"Thermal Barrier Poll6so 77 Living Space $338.60
Insulate Interior Buffered Wali With 4"Dense Pack Cellulose 112 Living Space $258.72
insulale Open Oueritang With 6"Flberplass Bailing 77 1-10V Spaces $170.94
Insulation Removal 77 NIA 588.55
Sub Totak $3.272.21
Utility Incentive Share $2,000.00
Customer Contribution $11272.21
d 11,A
Per office use only Printed:411190/8 Page 2 of 2
11. PAYMENT ,-.
(:tlsttnller V, j'(1es to pay Gontractor for the%Wlork,the Ctistanter Share of the Conh xct f'tice.as Cnllo%vs:Payment 111:5 _ �- as a Depusil
payahic to C5(;upon signing tate Contract(not to exceed 1.13 of the otal retail cosull costs).Mcheelt&contract to CSC,11ttm RCS,50 Wasbington St.,Ste.
:3000,1Yestboxi)uA,VA OI5t31.Final Payatteilt:* -_J 9 ;Is ate filial p t}sttenr fill*the Work slndl be payable-to the Independent Installation
Contractor('riHC")capon satisract ry completion of the Work Customer undmitatnds that he/she will not be required to pay rite Utility Incentive Share or the
Coulractprice in the amount or: (i _' =Changes to individual litre,items and/or previons hneentives inay inewwse or deercase the size ofthe.utility Incentive
8hUre.
ill,DiSPUTE RESOLUTIOitI
Tha Wand aacree in,adwillm thatin the event that the III:hiss dispnle volluelt[ing lids conlrao,Ille IItJ way sub"tit sueh(11spule to A plivale a ifitrulintt
cert ice wlda It lui bets[approved by the Office of Cattsumer ArI its awd Business Itegtflulion utul Customershall be rerynhed Yo sulrntlt n>sltelt:ulYilY:ufun:tw tnm4tted in 11,G.L.e 142
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
urine d fallowing the signing of this agreement. DO T IG THIS C NTR6CT.IF THERE E ANY BLANK SPACES.
t E' � � ' ,l, sdh-„ A r 2,2015 ® ar r nsu ation
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Date
Indicate your sclecterIT,I
tiers,if applicable (op) Initial here if you%Valli
I(,r ' . Oil-,X'rom,ain to assign at
CS 'mar
atc Cale Nanta of C'.SU Representative( rinteal- ) Participating!Conhactor
toargy S
It'r6lass save PARTICIPA"NG
CONTRACTOR
PERMITAUTHORUZAT 1"N r FORM
I U, 1,
SHELLEYTHOMPSON owner of the property nerty located at:
(Owner's Name,printed)
115 MOODY ST NORTH ANDOW;R
(Property Street Address) (City)
hereby authorize the Mass Save Home Energy Services Program assigned Participating Contractor listed
belo,.A.r to act on nny behalf and obtain a building pernnit to perform insulation and/or weatherization
vvork on my property.
X
OWneils',Iianature
Apr 2, 2015
Date
FOR C-SG OFFICE USE ONLY
Conservation Services Group has assigned the following Mass Save Home Energy Services Participating
Contractor to the above referenced project:
Participating ConLracLor Date
Cffmce+;se Orly
Rev. 12132011
Fite Common of1d assadtuseas
_ Deptztftigera of rlrdtrialAccicients
,r,===�-'-�-_ -ems - - - - •---•--------------... _..
:er Office of Investigations
�i(l r� t'ttslfitzg torr
Street
5 -int _t
`�'�.-9 r IfYIFIu nZasg�Du>'dPt!
Workers" Compensation Insur aace Affidavit: Branders/Contractor:-slk,Ieetricians/Plumbers
A A Iicafit Information � Please Priest Legil}I,
Name (Business./Organization/individual):_ o htr serA r Yxs Y&a
Address: ® , 0 X
C%YState/Zip: � i d �' Phone#_
Are you an employ ea?Cheek the appropriate box: T.ype of project(required):
1.91 am a employer with -7— 4- C] I am a general contractor and I
ernploi ees{full and(or part-time).*
have hired the sub-contractors 6- ❑\ettr construction
3_❑ I am a sole proprietor or partner- listed on the attached sheet 7. ❑ Remodelins-
ship and have no employees These sub-contractors have s. ❑Demolition
m orkinQ forme in any capacih_ employees and have workers'
[Na.corkers°comp.insurance comp_insurances 9. ❑SviIdirtg addition
required.] S-❑ We are a corporation and its I0_[]Electrical repairs or additions
3-0 I am a homeowner doing alt Mork officers have exercised their I i_Q plumbing repairs or additions
mi;self_[Na workers'comp- right of exemption per.MGL
insurance required_]� t:..152 S 1(4).and etre have no 1�-n Roofrepail�s
employees. [moo workers- 13.�,Other �����Q���`�
comp.insurance required_]
°rine applicant that checks hoc=!most also fill out rite section hctoar simtaing ihcir corker compensation polio hifornratinn.
Idomemtiters-who submit this aefidatit indicating they an:doing all tt'ork and then hire outside canimaors must Iabotit a nett affidatit indicating such_
=Ccntr=or>that check this box nust attached an additional sheet shorting the name of the sub-canvaetor and state uiretheror not those entities have
eniplciwes. Iftitesub-contmetorsltateemplovza.thcY must providetlleir workers comp.poliernumber.
I rani are eFxplo '--r ileal as pravirTtYg workers'carrtpetzsration insurance for ntt-eiziploJ!eeS Belotp is the polio'ural job site
7nfOrntlitiOtl.
Insurance Company N-ame. _ @ r- U q
Policy-or Self-ins.Lic_;: �® � �' �� Expiration Date:
Job Site Address r t4`{`y apt Citv!StatelZip: A, A
Attack a copy of the workers'compensation policy declaration page(shewing the policy number and expiration date).
Failure to secure coverage as required under Section 25A of 1r1GL c_152 can lead to the imposition of criminal penalties of a
fine up to SL500_00 and/or one-year imprisonmem as well as cis=iI penalties in the form of a STOP WORK ORDER and a fine
of up to S250.00 a da-,,against the violator. Be advised that a copy of this statement may be forwarded to the Office of
Investigations ofthe DIA for insurance coverage verification_
Ido ltePebr cer8if•fFlYder lite j)t7idrs ranrl�elYQlfles of dPrjtdPl't11t11 flee F3FfC++"d?t/�P�O?411f Qt'#rlelr &L'9e`s i re rt1YGt car:ALL
Signaturewa/V
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Date:
Phone= � �0 A - '
®-ffidal rise 0111: Do nur mrite in ilds area,to be cotrrplererl Gr city or toji n tafciuL
City or Town: Pe_rmit/Licensef
Issuing Authority(circle one):
I. Board of 11cali z ?.Building Department 3.Cit /Town ClerIt -l.Ekctrieal Inspector a`.PIumbin"Inspector
G.Other
Contact Persan: phone:
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415 pJanals Ave
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��I��� MeACORD ame and logo are M €st-grad ma t34a ACORD
ellxe Zines Reg ation
airs and.
Office of Consumer -plaza r Suite 5170
10Per
Boston,Massachusetts 02116s fi®n
Home Improvement Contractor Reg, istration: 102726
- Reg
-_ Type= DBA Tr# 25224-4
Expiration: 7/212016
POLAR BEAR INSULATION CO.
VincentLeBlanc _
P.O. BOX 951
ANDOVER, MA 018`10 n, loyment [► Lost card
Update Address and return card.lark reason for change
i EE Address Renewal -__j
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DPB-GA1 0 50M-04104-G101218
BMW
C SSL-106017
pl&TER A LEBLANC
2 EAST POE STREET
Plaistow NH 03865
0412612018