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HomeMy WebLinkAboutBuilding Permit # 11/10/2015 0.1 yQ,yoRTH , o BUILDING �6�0 TOWN OF NORTH ANDOVER 76 --- ,;Z ' ,LICATION FOR PLAN EXAMINATIONIA— Date Received �� S CH S Permit Nom � �ssgaaus�`� Date Issued: 115 I ' IMPORTANT: Applicant must complete all items on this page LOCATION ! 0�7 U T ) - l Print PROPERTY OWNER � "� �� �` - Print 100 Year Structure yes no MAP PARCEL: e € ZONING DISTRICT: Historic District yes 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 11 Other �$V/q / Nam1,110 ile, DESCRIPTION OF WORK TO BE PERFORMED: s r7-'C- I m50r471'O Y Identification- Please Type or Print Clearly l �> OWNER: Name: ,06,t`i c e �t Phone: Address: It9 /7 v 7- e6- IT K e Contractor Name: I v,C Phone �l Email: Address: 5/— +` ® 4i Supervisor's Construction License: (0 Exp. Date: Home Improvement License: / �' Exp. Date: / d ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$9000,00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 300 Ur-- 0 D FEE: $ ►g�11(°�IC' Check No.: I'QReceipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 14ORTH Town of4 rAndover ® - ® 6115 1126 - h `� ?, ver, mass' ■ OLAK@ COC HICH@W1Cx Ia S U BOARD OF HEALTH Food/Kitchen T LD Septic System THIS CERTIFIES THAT .....PERMIJ ... ... ......... .... ...... . . .............................................. BUILDING INSPECTOR has permission to erectFoundation .......................... buildings on Awk ® ® Rough to be occupied as ..... .... .. .. .... ....... .....®. .. .......................................... Chimney provided that the person accepting this perm 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final PERMIT ELECTRICAL INSPECTOR UNLESS CONSTRUCTION T RTS Rough Service ..........:...... .... .... .................. Final ILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® OccupV BualdznRough 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. �CR �: � Federal to# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thielsch Engineering CT Contractor Registration No 60 Shawmut Unit#2,Canton,MA 02021Col -p° 339-502-6335 FAX 339-502-6345 i Page 1 EPROGRAM THIS CONTRACT 15 ENTERED INTO BETWEEN RISE ENCtN E ER1NG 8nn CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS L�.J DESCRIBED BELOW CUSTOMER PHONE DATE CLIENT B WORK ORDER O Robert Gorman r= N (978)681-5614 08/27/2015 418659 00002 SERVICE STREET CV BILLING STREET 109 Nutmeg Lane 109 Nutmeg Lane SERVICE CITY.STATE,LP LrJ BILLING CITY,STATE,ZIP W North Andover,MA 0184 North Andover,MA 01845 JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) This will require(8)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherization work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the subcontractor to ensure the safety of the indoor air quality.t FRONT DOOR LEFT DOOR. $680.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass baits to(152)square feet for damming purposes. $311.60 ATTIC FLAT:Provide labor and materials to install a 4"layer of R-14 Class I Cellulose added to(1694)square feet of open attic space. $1,914.22 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(76)square feet of kneewall area.THIS IS THE GABLE ENDS OF VAULT. $266.00 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. The cover has integral weather-stripping to restrict air leakage. $200.00 VENTILATION:Provide labor and materials to install(3)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom fan(s). $356.25 STORAGE BARRIER:Homeowner is responsible for the removal of the stored items blocking the installation of weatherization work in time basement. Removal must occur prior to the scheduled work start. $0.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net amount. Currently, for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic of the 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 of your heating system and water heater.This has a value of$90 and is at no cost to you. Total allowable weatherization incentive is$3,110. $90.00 Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thielselt Engineering CT Contractor Registration No 60 Shawmut Unit 92,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 �__.....=�_� PROGRAM Page 2 THIS CONTRACT IS ENTERED INTO BETWEEN RISE ENG1NE£R,NC CMA-HES ENGINEERING AND HE CUSTOMER FOR WORK AS DESCRIBEBELOW CUSTOMER PHONE DATE CLIENT# WORK ORDER Robert Gorman (978)681-5614 08/27/2015 418659 00002 SERVICE STREET BILLING STREET ------- — 09 Nutmeg Lane 109 Nutmeg Lane SERVICE CITY,STATE,ZIP -BILLING C"Y,STATE,ZIP ----��------------�— North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,818.07 Program Incentive: $2,770.00 Customer Total: $1,048.07 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand Forty-Eight&07/100 Dollars $1,048.07 UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 11%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE AFTER 30 DAYS.SEE REVERS FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. O NOT S THI CONTRACT IF THERE ARE ANY BLANK SPACES AUTHORIZEDG TORE-RISE Enginecring CUST ER ACCEP—TANEE NOTE THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE OWNER AUTHORIZATION FORM 1, ®bev- -r C-2ev, te_ , (Owner's Name) owner of the property located at (Property dress) tJ leo U e t/" P40. O�� (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. LJkAe� Jipl�� s Signature q��f Date =�\ The Commonwealth of Hassachrtsetis �,. Del.7artment of Ilrrlristi-iltl Aceideltts • + - "` Dffrce of lnvestig ations 600 Xl%ashington Street Boston,AM 02111 1V iviv.111ass s ovIrll rt Workers' Compensation Insurance Affidavit: Builders/Contractors/Eiectrici ins/Plumbers Applicant InformationPlease Print Lmibly \acne (Businessroreanizatiot>/mdiyidual): PO i zr A s2P Address: ® p t Cit3rlState/Zip: t JOY,tr4I Phone 9: Are you an employer?Check the appropriate box: Type of project(required): I. I am a employer with 7 `t• ❑ 1 am a general contractor and I employees(full and/or part-time)." have hired the sub-contractors 6- ❑New construction ?-❑ I am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees These sub-contractors have S. Q Demolition working for me in an),capacity_ employees and have workers' q El Building addition [No workers= comp.insurance comp.insurance' required.] 5• ❑ We are a corporation and its 10.0 Electrical repairs or additions 1 Q 1 am a homeowner doing all work officers have exercised their i LIM Plumbing repairs or additions myself.[No workeW comp. richt of exemption per MGL c_ 1 ll2. S i 12-❑ Roof repairs insurance required.] (4),and t��e have no employees.[No workers- 121ROther MAI,1A p 0 4 comp.insurance required.] `Ain'applicant that checks box z�i must also fill out the section helow showing dreir N+orkers-compcusation policy information. r i tomeowners who submit this affidavit indicating they arc doing all Work and then hire outside contractors must submit a new affidavit indicating such, =Contractor that check this box must attached an additional sheet slto+rine the name of the sub-contractor and state whether or not those entities have entplovees. if the sub-contractors have eniplavees_they must provide their workers'comp.policy number. I[!1)1 all enlpl, rer Mat is proY&ling;Porlfers'compensatlair lttsurance far n)r enlpIar'eex. Beloit,is the policy and7ob site infarnruion. Insurance Company Name: 9. Policy 9 or Self-ins.Lic. : tl'0 We— V� �� Expiration Date: Job Site Address: �t0�'1�/t u P�yt ('� L V1,t�i City/State/Zip Attach a cony 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 Si,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 S230.00 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 Jo hereby cert fy untler the pains and penalties ofperjurr that the information pror red above is trite and correct. Signature: /�MA A Date: t I ZI Phone: 1 ?1_ V A i- 2&3 a Official rise onlr. Do)rat irrite in tltis areti,to be co111pletetl fir citta or tolon official City or Town: Permit/License Issuing Authority(circle one): 1_ Board of licalth 2. Building Department 3_City/Tomm Clerk -l. Electrical Inspector $. PIumbing Inspector 6. Other Contact Person: Phone ff: OP ID:SS DATE(MWDDIY1rvY) CERTIFICATEI 1 1 INSURANCE 03/132015 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 terns and conditions of the policy,certain policies may require an endorsemenL A statement on this certificate does not confer rights to the Certificate holder in lieu of such endorsement(s). PRODUCERyE Durso&Jankowski Ins Agcy LLC PDDIRESS. E F 198 Massachusetts Avenue NO North Andover,MA 01845 Durso&Jankowski ins.Agcy. III,� ,POLAR-1 INSURER(S)AFFORDING COVERAGE MAIC S INSURED Polar Bear Insulation Co.Inc. INSURERA:Penn America 32859 P O Box 958 INSURERB:Safety Insurance Co. 33618 Andover,MA 01810 INSURER C INSURER 0: INSURER E: NSURER 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. ISR TYPE OF INSURANCE POLICY NUMBER POLIC EFF LIC EXP LIMITS LTR GEN ERALUABILnY EACH OCCURRENCE $ 1,000,0001 A X COMMERCIALGENERALLIABILITY PAC7052023 03242015 03/242016 PREMISES Me0=ffl nce $ 50, OCM CLAIMS-MADE XI OCCUR MED EXP(Any ale Person) S 51 PERSONAL&ADVINJURY $ 110001 GENERAL AGGREGATE $ 2,000,00( GENL AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 1.000,00 POLICY PRO LOC $ AUTOMOBQB LIABILITY COMBINED SINGLE LIMIT S 1,000,00 B ANYAuro 2100926 01/042015 01/04/2016 (EaeWdent) BODILY INJURY(Per person) $ ALL OWNED AUTOS BODILY INJURY(Per acddent) $ X SCHEDULED AUTOS i PROPERTY DAMAGE $ X HIRED AUTOS (PER ACCIDENT) X NON-0WNEDAUrOS S 5 X OCCUR EACH OCCURRENCE S 1,000, EXCESS A u CLAIMS MADE AGGREGATE $ A UrdaRELLA LUlB PAC6906385 03242015 03242016 DEDUCTIBLE $ RETENTION S $ WORKERS COMPENSATION NIC ST�Tltl• TH- AND EMPLOYERS'LIABIUTV - ANY PROPRIETORIPARTNERIEXECUTNE Y/�N N/A EL EACH ACCIDENT Is OFFICERIMEMBER EXCLUDED? (Mandatory In NN) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTION QF�O TIONS/LQcn TIO /VEHICf ES{Attach CORDtpl,AddidenalRemarksSd�edule,Mmomspace laregulted) insulation WOr Mineral•�pdd�itiogr�al inpu��chr eperai labii �s cts itn wD parlor on the r behalf by th�above�nsu�is Thielsch n�ineering CERTIFICATE HOLDER CANCELLATION THIELS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE Thieisch Engineering ACCORDOLI ANCE WITH THE PRLL BE DELIVERED IN OVIS ONS Columbia Gas 195 Francis Ave AUTHORIZED REPRESENTATIVE Cranston,R102910 4601 L ®1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD �•y--�® pTTE(AfA1,ODNYYY) CERTIFICATE OF LIAG ILtTY INSURANCE 12/182014 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 f REPRESENTATIVE OR PRODUCER,ANDTHE CERTIFICATE HOLDER. IMPORTANT:If the 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 lieu of such endorsement(s). PRODUCER IAL( NMtE: Automatic Data Processing Insurance Agency,Inc. nc N.Eau: (nc tbx 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 LYSURER(S)AFFORDING COVERAGE NAIC.. L14SURER A• NorGUARD Insurance Company 31470 INSURED POLAR B EAR INSULATION CO INC INSURER O: DBA:Polar Bear Insulation CO Inc L95URER C PO BOX 958 WsuRER D: Andover,MA 01810 WSURER E: W5URER F: COVERAGES CERTIFICATE NUMBER: 291629 REVISION NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUEDTO 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 I CERTIFICATE:MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJ ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOT:N MAY HAVE BEEN REDUCED BY PAID CLAIMS. LIR TYPE OF WSURANCE 04SD tVVD POLICYNUMBER (-MhlOD,YYYY) a-%IDD:YYYY) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 ETDT cc.'U 1--'rt CLNL(S-i.(AUE �OCCUR PRE).115E5 Ilia cttwrcel $ LIEDEXPtMvvnep—cr..I S PERSOfaLEAOv U.JUItY S G Ett AGGREGATE LIMIT NY'LIES PER. GENERALACCRECATE S RPOLICY❑JECT LOC PRODUCTS-COAIPA(•,MGG S OTHEIt AUTOMDRUA LIABILnY tEa attidenU MY AUTO BODILY INJURY We,wson) 5 r ALL OWNED SCHEDULED BODILY(NJ URY tl`v auideNl S AUTOS AUTOS NON-0YYNEU P L t L G 5 HIVED Al._OS ,YVTOS (Per atudenU 5 UM1BRELLALIAB Occult EACH OCCURRENCE 5 '.. EXCESS LIAe CLAIMSd.L1DE AGGREGATE DEO RETENTION S 5 WORKEtu CMIPENSATION X STXT UIE ER AND EMPLOYERS'WBILITY1,000,000 ANY PItOPIUET01t34VtTtERFXECUTt(•f Ya 0-EACHACODENT A EXCLUDEDC66390 O101(zD5 OlUlL016 (hl-dawyI.UK) D. EL_DISEASE-EAENJI'LOYEE SS 1+000.000 It Yes.destnbe-der E1.D156LE-POUCYUk11T S 11000,000 DESCRIPTION OF OPERATIONS L'eluc DESCRIPTION OF OPERATIONS!LOCATIONS!VEHICLES(ACORD 101 AddliuwJ Remado Schedule,may be attached if more spate is req.'W) 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 Theilsch Engineering,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 195 Frances Ave Cranston,RI 02910 AUTHORtUDREPRESENTATIVE AG 19B6 2014 ACORD CORPORATION.All Tights reserved. ACORD 25(2014,01) The ACORD name and logo are registered marks of ACORD E i a 4,� usiness Regulation er.Affairs and Office of Consulu 10 Park Plaza® Suitts 02116 - Boston,Massachus� istration ome Improvement Contractor I2eg Re istratton: 102726 H Type: DBA -r# 252249 Expiration; 71212016 POLAR BEAR INSULATION CO. Vincent LeBlanc - P.O. BOX 958 - 1810 r toy 0 Lost Card ANDOVER, MAO t]pdate Address and return car E partcm nt n far change. # Address Renewal _ OPS CA1 €5 50M4W04 G1012t6 Bnard of BuaWing ,etgWa Ons Inc` Standards C,SL-106017 " PETER A LERLANC 2 EAST PINE STREET _ Plaistow NH 03865 �" � 04!2812018 �.:C3 V"G1Y"V38 ab �YP—r '...