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Home My WebLink AboutBuilding Permit # 9/15/2015 tkORT11 BUILDING PERMIT E D TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION .77 Permit No#: 27,6`,- 7,ek Date Received AT. ""b4� Date Issued: "MORTANT:Applicant must complete all items on this page LOCATION — 10 C!?? Prin PROPERTY OWNER c") - �e Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District y S no Machine Shop Village y s no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building El One family El Addition El Two or more family El Industrial El Alteration No. of units: El Commercial 0 Repair, replacement El Assessory Bldg k Others: El Demolition 11 Other 5V1q X10 0 y1f 0❑HBe0,01,14L a g,gi ffil ol V W"I gai U 10 g& ,gk Hd DESCRIPTION OF WORK TO BE PERFORMED: A y 5— Identification- Please Type or Print Clearly OWNER: Name: Cvrg6tellu S C y Phone: Address: to 9\ A)V-e r Contractor Name: I r-re r I e 8 tq PLC- Phone: el- 7.F- Vey?® 710 ?(3 Email: A Address: :2 P/-?t'5/-0 L,,/ X14 ,leo Supervisor's Construction License: CL- o&vJ';> Exp. Date: gp Home Improvement License: e 0). C, —Exp. Date: b ARCHITECT/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. C11 Total Project Cost: $ L(00 00 FEE: $ Check No.: 1XI Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ---------- SlituEe--Qf 01 _g IAORTH 0"T M00% VVII Ut ndover J_ 0 . _n . —2-0126115- %14 14L 4 �Q LANE h \y ver, Mass, • COCMICNEW.CK 41' A®pA'rE0 U BOARD OF HEALTH Food/Kitchen PER I T L D Septic System THIS CERTIFIES_ THAT ........... . .. .. .. .. ... 1. ...... ................. ..................... ...... ....................... BUILDING INSPECTOR Uja Foundation has permission to erect ... . .............. building on .... ....... .... . ................ ...a........ .......... Ibm Rough to be occupied as ...... .. ... .. ....... ... ...�!!!...... ......... .. ... ... .... ®. ..... Chimney provided that the person accepting this permit shall in every respect conform to the terms of the applicati 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 EXPIRESPERMIT I 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION RTS Rough .................71�1 ...................................... 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 o Lathing or Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal ID# RISE Engineering RI Contractor Registration No MIA Contractor Registration No A division ofThieIsch I.nginceri E CT Contractor Registration No 60 Shament Unit 0l2,011111111,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 Page 2 THIS CONTRACT IS ENTERED INTO BETWEEN RISE 1� "y( EE '("a CMA-1'1ES DESCRIBE ENGINEERING AND DELONHE CUSTOMER FOR WORK AS CUSTOMER PHONE DATE CLIENT WORK ORDER Cornelius Casey (978)681-1106 05/07/2015 �l�„2ti �; 00002 SERVICE STREET .. ... ..BILLING STREET . 4 . u' w«« 10 Cabot Road 10 Cabot 1toItL1 .SERVICE CITY,STATE,ZIP............ ... _.__ .. .BILLING CITY.STATC,ZIP � _ North Andover, MA 01845 North Andover, „01 5r °I ” .1013 DESCRIPTION Notal: $2,410.87 Program Incentive: $1,978.15 Customer Total: $432.72 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Thirty-Two&72/100 Dollars $432.72 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CU370ME�AIFES.T'o REMIT AMOUNT DUE IN FULL,INTEREST OF 1%WILL BE CHARGED MONTHLYON ANYAYS.SEEnevEnsE FORIMPORTANT RANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION.00 NOT SI C RACT IF THERE ARE ANY BLANK SPACES AUTHORIZED NATURE-RISC En inttrfnp CUSTOI RACCEPTANC[ 71/ NOTE:TIRS CONTRACT MAY IfE NATIIDRAWtd DV US IF NOT EXECUTED IY0I11N DATE OF ACCEPTANCE L tI ---- ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREDYACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WALL BE MADE AS OUTLINED ABOVE �odBral to tl � � �+T► IIiCC1'ITtti }' Rl Contractor Registration No NIA Contractor Registration No #a]ivisianrr af'I'hiclsch Engineering CT Contractor Registration No t h 6 ka�� M:'.,. 60 Shawmut knit 112,Canton,DIA 02021 339-502-6335 FAX 339 _•r CONTRACT Page 1 RANI THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENGINEERING CMA-HCS nSCRIBEDBEiow"EcusrorrEnronWORK As CUSTOMER PHONE DATE CLIENT 0 WORK ORDER Cornelius Casey (978)681-1106 05/07/2015 412794 00002 SERVICE STREET BILLING STREET 10 Cabot Road 10 Cabot Road SERVICE CnY,STATE,ZIP DILLING CITY,STATE,ZIP North Andover, MA 01845 North Andover,MA 01845 JOB DESCRIPTION AIR SEALINQ Provide labor and materials to seal areas of"your home against wasicrul,excess air leakage. This work will be perfonoed in concert wilh the use of special tools unit diagnostic tests to assure that your home will be fell with a heallhfol level or air exchange and indoor air quality.Materials to be used to sea]your home can include caulks,towns and other products. Primary areas for scaling include air leakage to attics,,basements,attached garages and other unhcaluil areas(windows are not generally addressed.) (8)working hours. At the completion or Uro weatherirxaion work,and at no additional cost to the homeowner,a bruit blower door and/or combustion satiety analysis will be conducted by the sub-contractor to ensure the sarcty or the indoor air quality. $680.00 LAMMING:Provide labor and materials to install al 12"layer of R-38 unl'aeed fiberglass baits to(49)square reel for damming purposes.SKY LKH IT S11AF17KEEP A 8X4 STORAGE AREA/ MAO ATTIC FLAT:Provide labor and materials to install a 6"layer orR-21 Claws I Cellulose added to(732)square rect ofopen attic space. $922.32 KNEEWALLS:Provide labor and materials to install 2" FSK Breed semi-rigid Fiberglass board insulation to(I 10)square feet of knemall area.SKY LIGHT'SLIAFf/KEEP A SX4 STORAGE ARI A/ $385.00 A"FITC ACCESS:Provide labor and materials to install(I) easily moved,insulating cover for the attic access folding stair. A small flan(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 BASEMENT CEILING:Provide labor and materials to install('50)linear r1cl of R-19 unfinced fibcrglaas insulation to the perimeter orthe basement ceiling at the house sill. $87.511 0 s OWNER AUTHORIZATION FORM 1, CORNELIUS CASEY (Owner's Name) owner of the property located at 10 CABOT (Property Address) NORTH ANDVER, MA. 01845 (Property Address) " o hereby authorize , (Subcontractor) ,to act on my be btai�uidding an authorized subcontractor for RISE Engineering,g permit and to perform work on my property. Ow er's Signature Date The Cominompeala, of Massachusetts Department of hithistrialAccidents Office of Ini,estigations :.`'= 600 Washington Street Boston, MA 02.111 IVIVIV.111ass.govIdia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians[Plumbers Ap121ica n Information Please Prig!Le ibiw *t Narne(BLisiness/Or�-eanizatioiLllndividual): 0 lqr S.V V1 Address: 0 X City/State/Zip: A-Adfowr Mg— tytno Phone 9: ct Are you an employer?Check the appropriate box: Type of project(required): 1. 1 am a employer with '7 4. E] I am a general contractor and 1 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. El 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 [No worke& comp,insurance comp. insurance.� required.] 5. EJ We are a corporation and its I O.n Electrical repairs or additions 3-❑ 1 am a homeowner doing all work officers have exercised their 11.n Plumbing repairs or additions myself[-\o workers-comp. right of exemption per MGL 12.n Roof repairs insurance required.] c. 152.§1(4).and we have no 13. Cher rAI-J/47400 employees. [No workers� comp.insurance required.] *Any applicant that checks box-I must also fill out tile section below showing their workers-compensation policy information. Homeowners who submit this affidavit indicating tile%-are doing all work and then hire outside contractors must submit a new affidavit indicating such. :Contractors that check this box must attached all additional sheet showing the name of the sub-contractors and state whether or not those entities have emplovees. If the sub-contractors have employees.they must provide their workers comp.policy number. 111111171femployer Ilitilisproviding it,orA-ers'coitipeit.,F(tlioiziiistirtiticefor nti-eitiploj.,ees. Beloto is tile polio'any!job site, fitforntation. Insurance Company Name fG U f Policy'–'or Self-ins.Lie.;:: 0 _620& 6— Expiration Date: Mo R_ Job Site Address. /0 City/State/Zip: q 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 t10 hereby certif y rattler the PaMs andpenallies of1wrjwy that the Mforniatioii provided above is trite wideorrect. Signature:-_-P,J) Date_ Phone�: >- Official rise ojily. Do not ivrlte in this area,to be completed hl-cifl,or tolvil official City or Town: Permit/License 9 Issuing Authority(circle one): L Board of Health 2. Building Department 3. City/Town Clerk 4. Electrical Inspector i. Plumbing Inspector 6.Other Contact Person: Phone#: OP ID:S'S CERTIFICATE LIABILITY DATE(MWDDlYWY) ® ' 03113/2015 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 WANED,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 CONTACT Durso A Jankowski Ins Agcy LLC HONE Fax 198 Massachusetts AvenueA�No North Andover,MA 01845 E-MAIL ADDR Durso&Jankowski Ins.Agcy. PRODUCER SME r:POLAR-1 .CUINSURER(S)AFFORDING COVERAGE NAIL C INSURED Polar Rear Insulation Co.Inc. 1NSUBERA:Penn America 32859 P O Box 958 INSURER S.Safety Insurance Co. 33618 Andover,MA 01810 INSURERC: INSURER D: INSURERE: 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 CLAIMS. ILTR TYPE OF INDDL BUSH SURANCE POLICY NUMBER MM ELICY FF MWD POLICY EXP LIMITS GENERALUABILITYEACH OCCURRENCE $ 1,000,0001 A X COMMERCIAL GENERAL LIABILITY PAC7052023 03124/2015 03/24/2018 PREMISES Ea occurrence $ 50,00 CLAIMS-MADE ®OCCUR MED EXP(Any one person) $ _ 5,00 PERSONAL&ADV INJURY $ 1,000,00 GENERAL AGGREGATE $ 2,000,00 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 1,000,00 POLICY F I PRO- LOC $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ 1,000,00 B ANY AUTO 2100926 01/04/2015 01/04/2016 (Ea accident) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per accident) $ X SCHEDULEDAUTOS PROPERTY DAMAGE $ X HIRED AUTOS (PERACCIDENT) X NON-OWNEDAUTOS $ $ LUAU X OCCUR EACH OCCURRENCE $ 1,000,00 EXCESS uAe CLAIMS-MADE PAC6906385 03/2412015 03124x2016 AGGREGATE $ A DEDUCTIBLE $ RETENTION $ $ WORKERS COMPENSATION WC STATU- OTH- AND EMPLOYERS'LIABILITY R IMI _ IN ANY PROPRIETORIPARTNERlEXECUTIVE YNIA E.L.EACH ACCIDENT $ OFFICERIMEMBER EXCLUDED? - (Mandatory(nNH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS I LOCATIONS VEHICLES(Atlach ACORD 101,Additional Remarks Schedule,if more apace is required) Insulation Woric Mineral;Additlonal rnsu�edyfo enerai iability,Frith ieisch ra C"Iring or erfarmed on their beha f b t1iaabove nsured is Th CERTIFICATE HOLDER CANCELLATION THIELS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRADATE THEREOF, NOTICE Thie1sch Engineering ACCORDANCEION WITH THE POLICY PROVISIONS. WILL BE DELIVERED IN Columbia Gas 195 Francis Ave AUTHORIZED REPRESENTATIVE Cranston,R102910 ' 4640- @ ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD 9/14/2015 Print certificates:Certificates of Insurance ACCOR" CERTIFICATE OF LIABILITY INSURANCE m =MNYYY) 12'/lm8)2014 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:Ifthe 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 lien of such endorsement(s). PRODUCER CONTACT' NAME: PHONE FAX Automatic Data Processing Insurance Agency,Inc. Nk,Ext): (A/C,Not 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAI:# INSURER A: NorGUARD Insurance Company 31470 INSURED POLAR BEAR INSULATION CO INC INSURER 8: DBA:Polar Hear Insulation CO Inc INSURER C: PO BOX 958 INSURER D: Andover,MA 01810 INSURER E: -INSURER F: COVERAGES CERTIFICATE NUMBER: 291629 REVISION NUMBER: THIS 15 TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISS UE D 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 S UBJ ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. ADUL PULILYLPV P INSR F INSURANCE POLICY NUMBER (MM=,YYYY) (MMDD/YYYY) LIMITS Lilt TYPE 0 INSD WVD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLAIMS-MADE E]OCCUR PREMISES(Eamcurrence) 5 MED EXP(Any one person) 5 PERSONAL&ADV INJ URY S GENL AGGREGATE LIMIT APPLIES PER: CE NERAL AGGREGATE S I POLICYJ ECT PRO- F-1 LOC PRODUCTS-COMPPP AGG S F OTHER; S AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT' S (Ea accident ANY AUTO BODILY INJ URY(Per pe,so.) S ALL OWNED A NID F---1 SCHEDULED BODILY INJURY(P.accident) S AUT AU 05 NON-OWNED PROPER I Y DAMAGE S HIRED AUTOSAUTOS (P&accident R S UMBRELLACIAS OCCUR EACH OCCURRENCE S EXCESS LIAR HCLAIMS-MADE AGGREGATE S DED I IRETENTION5 S WORKERS COMPENSATIONX IIER AND EMPLOYERS'LLABILHY STATUTE I JER Y/N ANY PROPRIEIOR/PARTNERjEXECUnVE E.L.EACH ACCIDENT S 1,000,000 A OFFICE I KNIBER EXCLUDED? LyJ N/A N POWC6609W 01,01/1015 01)01/2016 (Mandatary in TIN) E.L.DISEAS E-EA EMPLOYEE S 110001000 II es describe urder f7ES yes, OF OPERATIONS k*IM E.L.DIS EASE-POLICY LIMIT S 1+0001000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD JOE Additional Remarks Schedule,may be attached Wrnore space Is required) Columbia Gas massachusetts CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Tliellsch Engineering,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 195 Frances Ave Cranston,RI 02910 AUTHORIZEDREPRESENTATIVE AID 1988-2014 ACORD CORPORATION.All rights reserved ACORD 25(2014,01) The ACORD name and logo are registered marks of ACORD https://adpia.adp.com/icertcf/#/run/printeertsl283910 1/1 s and usiness Regulation = Office of Consumer Affair R 10 Park Plaza- Suit OZ O 13oston> Massachusettsistration ome Improvement Contractor Reg Registration- 102726 (vpa. DBA Tr# 252249 Expiration, 7/212016 POI-AR BEAR INSULATION CO- ___ Vincent LeBlanc _ ------------- P.O. BOX 958 —_.``- ANDOVER, MA 01810 Lost card Update Address and return car E p�oyme t nOr change- i Address Renewal _j DPS4A1 sa 50M.04104-G101216 1Massacilusetts Department of pub��C Safety Board of BuHd6ng Regu,dafiW1s and standards _€cen ses C;ISL406017 PETER A LERLANC 2 EAST PINE STREET Plaistow NH 03865 �, »- 04/2812018