HomeMy WebLinkAboutBuilding Permit # 6/23/2015 BUILDING PERMIT Nosary
TOWN OF NORTH ANDOVER 0
APPLICATION FOR PLAN EXAMINATION
0 4:
Permit No#: lo 61"-A Date Received 0"?ArEV 0
Date Issued:
IMPORTANT:Applicant must complete all items on this page
LOCATION
)�Im d/O tllef-
A 70 5!5--I� 517
Print
PROPERTY OWNER 70see ' q e^(f
Print 100 Year Structure yes no
MAP PARCELw-< ZONING DISTRICT: Historic District yes no
0
Machine Shop Village yes. no
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
El New Building El One family
El Addition 0 Two or more family El Industrial
El Alteration No. of units: El Commercial
El Repair, replacement El Assessory Bldg 11 Others:
0 Demolition El Other
,W V
' a
Spwe
DESCRIPTION OF WORK TO BE PERFORMED:
Identification,,- Please Type or Print Clearly
OWNER: Name: 10
$ Pl,-,- Pexc r Phone:
Address: /!�--O 51AeW 5'1—
Contractor Name: PC-rv (- 1eb(-hbAC- Phone: f2,F-, f 292-7 0,9
Email: a
Address: .5 u,,/
Supervisor's Construction License: l6)60f? -Exp. Date: A/
L Home Improvement License: L Exp. Date: 2
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE:BULDING PERMIT:M00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ y49,0 '0,3 FEE: $
Check No.: -� 2A Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
V
NORTH
own o . t E ndover
0
- �
No.
T � h ver, Mass,
o L^K. 1.
COCKIC HlWKK
DR^TED ►'QA`��5
s U
BOARD OF HEALTH
Food/Kitchen
PERMtT T LD Septic System
v ��Ac�-
THIS CERTIFIES THAT BUILDING INSPECTOR
.. ...... Foundation
has permission to erect ....... ................. buildings on A�� .�........<�.. . . . ...� �04.
Rough
to be occupied as ........ ` .....:*(.-.Slr41. .. ...... ....�.N ......................... Chimney
provided that the person accepting this permit shall in ez. 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 MONT S ELECTRICAL INSPECTOR
UNLESS CONSTRUCT S TS Rough
Service
.............. .0................ ...... ..................... 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.
r
Federal ID#
RISE Engineering RI Contractor Registration No
MA Contractor Registration No
A division ofThiclseh Engineering CT Contractor Registration No
61)Shawmut Unit Q.Canton,MA 02021 CONTRACT
339-502-6335 FAX 339-502-6345
Page 1
PROGRAM
THIS CONTRACT IS ENTERED INTO BETWEEN RISE
ENGINEERING CNIA-FIGS IIGINEER114G Alto THE CUSTOMER FOR WORK AS
SCRIBCUSTOMER PHONE DATE CLIENTO WORK ORDER
Joseph Pace (978)975-1686 05/13/2015 403156 00005
SERVICE STREET - - -- - BILLING STREET ( tJ L
150 Salem Street 150 Salem Street
SERVICE CITY,STATE,ZIP -- - BILUNG CIN,STATE,ZIP - - -
North Andover, MA 0 1845-30 13 North Andover,MA 01845-301
JOB DESCRIPTION
AIR SEALING:Provide labor and materials to seal:areas oryour home against wasteful,excess air leakage. This work w 1
performed in concert with the use ofspeciad tools and diagnostic tests to assure that your home will be tell with it healthful level of
air exchange and indoor air quality.Materials to he used to seal your home can include caulks,foams and other products. Primary
areas for scaling include air leakage to attics,basements,attached garages and other unheated area,;(windows are not generally
addressed.) (4)working hours.
At the completion or the wealherim ion work,and at no additional cost to the homeowner,a Final blower door andlor combustion
satiety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quatity.THIS IS WI[ERE IST.FL..
13ATIi VAULT INIF:F I'S 2ND.FL.BEDROOM....EVI-IDENCE OF AIR SEALING DONE!
$340.00
DAMMING:Provide labor and materials to install a 12"layer of IZ-38 unfaccd liberglass baits to(76)square feet for Jamming
purposes.
$155.80
ATTIC FLAT:Provide labor and materials to install a G'layer of R-21 Class I Cellulose added to(720)square feet of open attic
space.
5907.20
KNEEWALLS:Provide labor and materials to install 2" PSK faced semi-rigid fiberglass board insulation to(252)square feet of
kncewall arca.TI IIS IS WI IFRE IST.PL.r3A'rli VAULT MEETS 2ND.FL,13EDROOM....EVEIDENCE OF Alit SEALING DONE!
$882.00
A'1-ITC ACCESS:Provide labor and ntulerials to wealherstip the perimeter of(I)attic hatch with Q-Ion.
$25.00
RISE Engineering willapply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently,
for efluible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%Ibr the
Air Scaling measures up to the first 5680 and an additional S340 ifsavings are justified by the auditor.
For the safety aid health oryour home's indoor air quality,we will he conducting a blower door diagnostic ofthe available air Flow in
your home both before the work is begun,and atler the wealheri7:ation work is complete.We will also conducl a fill assessment of
the combustion safely oryour heating system and water hrdcr.This has it value of$90 and is at no cost to you. Total allowable
weiataerization incentive is$3,110.
$90.110
Federal ID#
RISC Engineering RI Contractor Registration No
MA Contractor Registration No
A division or'niioso,Gngincering CT Contractor Registration No
60 Shnwmut Unit 112,Canton,MA 02021 CONTRACT
339.502-6335 FAX 339-502-6345
Page 2
PROGRAM
THIS CONTRACT IS ENTERED INTO BETWEEN RISE
ENGINEERING CWIA-111-5 enGINEERIN EAND714E CUSTOMER FOR WORK AS
DESCRIBLOW
CUSTOMER PHONE DATE CLIENT a WORK ORDER
Joseph Pace (973)975-1686 05/13/2015 403156 00005
SERVICE STREET DILUNG STREET
150 Saleni Street 150 Salem Street
SERVICE CIri,STATF,ZIP BILLING LITY,STATE,ZIP
North Andover, MA 01545-3013 North Anclover, MA 01845-3011
.JOB DESCRIPTION
` Total: $2,400.00
1i
Program Tncen Ive:' 1,907.50
Customer Total: $492.50
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF
***Four Hundred Ninety-Two&501100 Dollars $492.50
UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%VALL BE CHARGED MONTHLY ON ANY
_UNPAID BALANCE AFTER TO DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AILD CONTRACTOR REGISTRATION,
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES
A /OI ONA7URE-RISE[nproccrin0CUro..RACCEPT C - -
NOTE;THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE
ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECIFICATIONS AND CONOM014S ARE '..
30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUT14OR VED TO 00 THE WORK
AS SPECIFIED.PAYMENT WALL BE MADE AS OUTLINED ABOVE
OWNER AUTHORIZATION FORM
I, p2 ee -
(Owner's Name)
owner of the property located at
9I%
1,5o
(Property Address) LJ
/V - I4/,/D 0 uev, ty-a
(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.
044 is Signature
�J
Date
Tlie Foga monivefalfla of iWaassraeltaaseffs
Department of lrarlttstrifal Accidents
Office of 'rvesPie ations
600 T-Mashington Street
Boston, 1111A 02111
iviviv.nzass goltlelifa
Workers' Compensation Insaa-ance Affidavit: Buflders/Conti-actors/EIee-tricians/Plu bers
Anniicarit Information _ Please Print I ecibli,
Name (BusinesslOrganiratioillndividual): P0 i Sf '� el
Address0 X ers—a
Citty/State/Zip: A-AJOLAer MO, oLffly Phone 4--
Are
:Are you an employer?Check the appropriate box: Type of project(required):
LrAl.am a employer with 4- Q I am a_general contractor and I
eployees{fttli andlor part time)."
have hired the sub-contractors 6 E]tecc'construction
2.Qtn
I am a sole proprietor or partner- listed on the attached sheet. 7. Q Remodeling
shipand have no ern lc}gees These sub-contractors have
P S. E] Demolition
% orlcinlr for me in any capacity- employees and have workers- g Q Building addition
[No worke&comp.insurance comp.insurance a
required_] 3. ❑ We are a corporation and its I O.Q Electrical repairs or additions
3-Q I am a homeowner doing alt.cork officers have exercised their 11.Q Plumbing repairs or additions
myself. _'o workere corn right of exemption per MGL
� P c_IS? cl I2•Q Roof repairs
insurance required.]' (�):and acre have no 13 Other 5�I p h In
employees. [No workers
comp.insurance required.]
Troy applicant that checks box#1 must also fill out ate section below showing their workers-compensation polio•informatio,
l iontemmers,kyho submit this affidavit indicating thcr are doing all utuk and then bine outside eantractors must submit a neer aftidalit indicating sueli_
=C-ontmctom that check this box must attached gut additional sheet showing the name of the sub-contactors and state.dtctteror not those entities bare
emplo-ees- If thesub-contractorshatie employees_they must provide their workers'comp.poliLynumber.
I tull all t�61i��0}rG'F �lfd�is t7F11V1l�Fl�tCOFIiCrS'C(Iftll7eltiQPdOl1 dRsl[PF1f1CL'�Ur f78F eaarlslnt�ees Belaty is glee polio'grid job site
i6%fOPrt1ldliflSl.
Insurance Company dame: UqrA.
s
Policy'or Self-ins-Lic_1--: ® w 0 G 9 Expiration Date: 1//A&
Job Site Address-.. - '
City/State/Zip: A, y¢K4( ee
Attach a copy ofthe workers'compensation policy declaration page(shoca•ing the gloliet'.number and expiration date).
Failure to secure coverage as required under Section 25A of MGL c_133 can lead to the imposition of criminal penalties of a
fine up to SIa00.00 and/or one-year imprisonment_as Weil as civil penalties in the form of a STOP WORK ORDER and a fine
of up to 5250.00 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.
!do herebl-cerdli-ander Me pants and nnrrrrlr or nr erj«_.�r_f et e..F.<...<: r_r--r- •__
ryec eeeJurrrrtruGil piui'iuefr UhoLe Is artlee!118[1 Cor'!ed
SignatureMA
�-
Date
Phone=:
Offrciaal rase 0111: Do lion uerite!rr tlri.F urea,to be eorrapleaerl Gr citta yr tot a offrcirr!_
Citi or oto tt: Permit/License
Issuing Authority(circle one):
I. Board of Health 2. Building Department 3-C41/T01Yu Clerk -I. Electrical Inspectoi- i.Plumbing Inspector
6. Other
Contact Person: Phone!:
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dlrs d Business Regulation
Office ®f Consurn�k�aza S to 5170 .
F 10P
Boston,Massachusetts 02116
Dome improvement Contrdctorl�egistration
Registration: 902726
Type: DBA Tr# 252249
= _=_ Expiration: 71212096
POLAR BEAR INSULATION CO.
Vincent LeBlanc
P.O. SOX 958
A, D®VER, MA 01810 Lost card
Update Address and return card.M�hme t n for change.
—E Address U Renewal J Epp
DP$CA1 e, 50M-04104-G101216
9 A $ "A .sa c lS -3 1
�'�:I14 I IICClt i S1117JI5-i
_.._.. C SL-106017
PETER A LEBLANC
2 EAST PINE STREET
Plaistow NK 03865
0412912016