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HomeMy WebLinkAboutBuilding Permit # 11/10/2015 BUILDING %AO PERMIT ".D q' O��ciLeD TOWN OF NORTH ANDOVER J APPLICATION FOR PLAN EXAMINATION _ 0 1.. Permit No#: Date Received DRA7ED SS�CHus� Date Issued: 1.1110E IMPORTANT:Applicant must complete all items on this page LOCATION R� dS? �� � ' d t-i o.yl Print PROPERTY OWNER R i r^ek- A� ®� �'�► Print 100 Year Structure yes no MAP PARCEL: �23 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 ❑ Other ��Septic3�®Well ` a � :❑ Floodplain `❑\Netlantls , �` ❑ Watershed Distnct ,X { h H 17Water/Sealer DESCRIPTION OF WORK TO BE PERFORMED: r /47`- I' C- -4=v\5vfclrl'oo To R� Y � Identification- Please Type or Print Clearly OWNER: Name: ?r,*7'rre /G 9,q7rV^ Al Phone: Address: /j® �������'��'� /1, d Contractor Name: ��� l `����� Phone: Email: Address: eq ,57- Ao-e 6>— , l��* /e td." e W. Supervisor's Construction License: fed 6, 0 l ? Exp. Date: Home Improvement License: Exp. Date: 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: $ ®ter FEE: $ s Check No.: �' Receipt No.: ) NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ignature, of contractor �i t4ORT Town of nclover cAaff ver, Mass, 10 , 24M gyp_ coca�caewecx y1. 7�AoftATE® BOARD OF HEALTH Food/Kitchen Septic System THIS CERTIFIES THAT PERM) T / I............................................... BUILDING INSPECTOR ............................ g ., j Ct Foundation has permission to erect .......................... buildings on ....... ...........�,,5.��:Y.:��:� ......... .................. Rough to be occupied as .I.qZ . s:�:' �� c ,'............................. Chimney provided that the person accepting this permit shall in every respect conform to the ter sof 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 EXPIRESPERMIT ELECTRICAL INSPECTOR UNLESS T Rough Service .................. .... ... ............ .. ..... . ........................ Final B ILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. r Federal[DO06-040ti828 RISE Engineering RI contractor Re&batkm No 8188 MA contractor Regtatration No 720879 A dhvlslon of Thlelach Engineering CT Contrarfar Registra on No 826120 60 Shawmut,Canton,MA 02021 CONTRACT 339-SM197 FAX 339-502-6345 Page 1 PROGRAM 'W redo F °L �ira Patrick BatemanI Z!5 a (978)208-1582 09/27/2015 413289 00007 15 Bradstreet Road 00 15 Bradstreet Road N O.. North Andover,MA 01851 North Andover,MA 01845 11ele-L' JOB DESCRIPTION AIR SEALING:Provide taboro your home against wasteltd,excess air leakage. This work will be performed m oonmt with the use of special tools and diagnostic tests to asstma that your home will be lett with a healthful level of air wrchange 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(cf n)of air infiltration will occur,but the actual number of ofm is not guarardeed. At the completion ofthe weatherimtion work,and at no additional cost to the homeowner,a final blower door and/or combustion safety analysis will be conducted by the actor to ensure the satbty of the indoor air quality. $680.00 AIR SEALING ADDIUL (2)working hours. $170.00 ATTIC FLAT:Provide labor and materials to install a V layer of R 21 Gass 1 Cellulose added to(864)square feet of floored attic space. $1,537.92 ATTIC FLAT:Provide labor and materials to install a 10"layer of R-35 Gass 1 Cellulose added to(196)square feet of open attic space. $288.12 SLOPES:Provide labor and materials to install a 10'layer of R 35 Cuss 1 Cellulose added to(128)square feet of slope area Wherever possible,baffles will be installed to the entire length of each bay tomaintain ventilation space. $249.60 ATTIC ACCESS:Provide labor and materials to insulate the back of the attic door with 2•rigid Therom board and seal the door's edge with weatterstripping to restrict air leakage. $73.91 VETfILATION:Provide labor and materials to install(5)8*diameter roof vents)to increase ventilation in attic areas, The vent can be supplied in(circle color)black,brown,gray or mill finish. $427.50 VENTILATION:Provide labor and materials to install ventilation chutes in(64)ratter bays to maiNain air flow. $128.00 RISE Engineering will apply all applicable,eligible incentives to this compact You will wdy be billed the Net emourrk Cumattiy,fur eligible measures,Columbia Gas offers 750A incentive,not to exceed$2,000 per calendar year,and an incentive of 1009'*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 wization incentive is$3,110. $90.00 r � Federal W0054405M RISE Engineering R,Cont actor Resisha8an No ales MA Contractor fte9bbstion No 120979 A dbidon of Thlebeh Engineering CT Contractor ft"Wratton No 620120 60 Shawmat,Canton,NA 02021 33! s-S .s197 FAX 339-502-&US CONTRACT Page 2 PROGRAM w crm�p�pg��y�g�apse CMA-AES GMS Ta02CtlarOla®i FOR AS Patrick Bateman (978)208-1582 09/27/2015 413289 00007 SERVCH STRWT Munn OW 15 Bradstreet Road 15 Bradstreet Road KrAT%ZIP OWN off.am sp North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,645.05 Program Incentive: $2,940.00 Customer Total: $705.05 WE AGREE HEREBY TO FURNSH SMWES-COWLETE al AOCORDAKCE WTH ABOVE SPED RCAMM FOR THE SUM OF ***Seven Hundred Five&061100 Dollars $705.06 menu Am nAY&S"s�`ae�wm"�e aENQVO35W&CUSTOM mrE�°+rro�r�a , CONfancrai � 0o Nor SIGN THIS CONTRACT IF THERE ARE ANY WANK SPACES MktkW Tn deau(Sep 27.2015) Signature: ha.m;ck b6mwffial /petdck batsman(Sep 28,2015 Email: baWman.pj@gmall.com NOTE T=ooNnuicrMAY eeWni UVMeYUS0'NOT EXECUTED VWT l ....... 3O bAYe A8 PAS BErr A�1�.D wn. i OWNER AUTHORIZATION FORM Patrick Bateman I, (Owner's Name) owner of the property located at 15 Bradstreet Road, North Andover, MA 01845 (Property Address) 15 Bradstreet Road, North Andover, MA 01845 (Properly Address) hereby authorize r (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. �v$at�c eeca ,tsea ze s) zs� Owner's Signature 9/28/2015 Date The Connnon►vealtli of illassachitsetts Department of Inthistruil Accidents Office of Investigations i 600 ff ashing,ton Street '?_ Boston, MA 02111 Workers' Compensation Insurance Affidavit: builders/Contractors/Elech-ici-,ins/Plumbers Applicant Information Please Print Legibly Name (Businessloreattization/lnditidual): PO lgf— tR oa r x7risy L4 ri%o an c o Address: 0 X Cit-/State/Zip: &LnJo Phone g: Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with-- 4. ❑ I am a general contractor and I employees(full andlor part-time). have hired the sub-contractors 6. [:]Ness•construction 2.El am a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling These sub-contractors have ship and have no employees These Fj Demolition working for me in any capacity. employees and have workers` 9 ❑Building addition [No workers` comp.insurance comp.insurance.= required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3.❑ I am a homeowner doing all work officers have exercised their 11.❑Plumbing repairs or additions myself. [No workers- comp. right of exemption per MGL 121-1 Roof repairs insurance required.]' c_ 152. S1(4),and we have no �����41"p� employees.[No workers- 13.R0ther comp.insurance required.] "am'applicant that checks box;�i must also fill out the section helow showine their workers'compensation policy infornation. I lomeowners who submit this affidavit indicatine they are doing all,.ork and then hire outside contractors nmst submit a newaffidavit indicalinE such. Contractor that check this box ntusl attached an additional sheet showine the name of the sub-contractors and state whether or not those entities have emplotecs_ If the sub-contractors have etuployees they must protide their .corkers'comp.policy number. 1 run an etnpli Iyer that is providing workers'compensatioit insurance for nrr entplorees. Beloit,is the policl'rmd job site inforniatfan. Insurance Company Name: U q rJ Police 9 or Self-ins.Lie.4-: p bD 0 jVJe--5_5__Z9 e7& S Expiration Date: ! ! Ifs Job Site Address: �li V �tOt 5 'e'er City/State/Zip: Attach a cope 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 51,500.00 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 cop),of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby certif•under the pants andpenitlties vfperjttrr that the information prouirled above is trite and correct Signature: =� Date: I/���/�® Phone V 0 '- Official rise only. Do not avrite in(Itis area,to be completed br city or to►etl offciul. City or Torn: Permit/License# Issuing Authority(circle one): I. Board of Health 2. Building Department 3. Cit•/Fo,%vn Clerk 4. Electrical Inspector• S. PIumbing Inspector 6. Other Contact Person: Phone#: t3P 1®:SS DATE(MMroDnmm CERTIFICATE LIABILITY 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 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 CONiACF Durso&Jankowski Ins Agcy LLC pN DIVE 198 Massachusetts Avenue A/c a Ext: FAX No): North Andover,MA 09845 DDRAte: Durso&Jankowski Ins.Agcy. PRODUCER cusTO ER :P®LAFI'1 INSURER(S)AFFORDING COVERAGE NAIC d INSURED Polar Bear Insulation Co.Inc. INSURER A.Penn America 32859 P O Box 958 INsuRERB:Safety Insurance Co. 33618 Andover,MA 01810 INsuRER C INSURER D: INSURER E: 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. -LTR TVPE OF INSURANCE POLICV NUUBER MMO/ LIOCYEFF FFA r yy UMTS GENERAL LIABILITY EACH OCCURRENCE S 11000,00 A COMMERCIAL GENERAL LIABILITY PAC7052023 03/24P2095 03/24PLOi6 PREMISES Ea omunence S 50,000 CLAIMS-MADE XI OCCUR MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY 5 11000,000 GENERALAGGREGATE S 2,000100 GEMLAGGREGATELIMIT APPLIES PER: PRODUCTS-COMPIOPAGG $ 1,0001000 POUCY PRO- LOC $ IEQ-TAUMMOBILE LIABILITY COMBINED SINGLE LIMIT S 1,000,00 B ANY AUTO 2100926 01/04/2015 01/04/2016 (Ea accident) -- BODILY INJURY(Per person) S ALL OWNED AUTOS BODILY INJURY(Peraccident) $ X SCHEDULEDAUTOS PROPERTY DAMAGE X HIRED AUTOS (PER ACCIDENT) S X NON-OWNEDAUTOS S 5 UMBRELLA LIAR X OCCUR EACH OCCURRENCE S 1,000,00 EXCESS LtAB CLAIMS-MADE A PAC6$06385 03/24/2015 03/24/2016 AGGREGATE S DEDUCTIBLE S RETENTION S $ WORKERS COMPENSATION YST nII T E'* AND EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVEYEIV EL EACHACCiDFNT S OFFICERIMEMBEREXCLUDED? N/A (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE S f yyes,describe under ISCRIRTIONOFOPERATIONS belou EL DISEASE-POLICY LIMIT S DESCRIPnl3NOFOPERATIONS/LOCATIONS/VEHICLES(Attach ACORD 101,Additional Remarks Schedule,It more apacelarequired) Insulation Work-Mineral;Additional insured for eneral liability,vu'h erspects to work ori performed on their behalf by th�above insured is Thietsch CERTIFICATE HOLDER CANCELLATION TailELS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELI EO BEFORE THE DATE THEREOF, NOTI Thielsch Engineering ACCO DANCE(OWITH THE POLICY PROVISIONS 1NiLL BE DELIVERED IN Columbia Gas 195 Francis Ave AUTHORMW REPRESENTATIVE Cranston,R102990 AA9211L ©1988-2009 ACORD CORPORATION. All rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marks of ACORD �� � ® 0.17E(MNDD:YYYY) CER i"iFICATE OF LIAR ILfTY IN5lJRAIVCI= 12/1812014 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER.THIS CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED I REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT:if the certificate holder is an ADDITIONAL INSURED,the policy(les)must be endorsed.Il'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 CONIALI NIWE: O Automatic Data Processing insurance Agency,Inc. (AC.Na Ext): (At Nok 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE L4SURER A: NorGUARD Insurance Company 31470 INSURED POLAR BEAR INSULATION CO INC INSURER B: DBA:Polar Bear insulation CO Inc L4SURER C: PO BOX 958 INSURER D: Andover,MA 01810 INSURER E: INSURER F: COVERAGES CERTIFICATE NUMBER: 291629 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 SUBJ ECT TO ALL THE TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PWD CLAIMS. INSItTYPE OF WS URANCE Y EXP LTR AWSD(VVD POLICY NUMBER PULILNYYY) LPUK.YYYY) LIMITS CEROAL GENERAL UABiLnY EACH OCCURRENCE 5 CLNMS-?.IAUE F—IOCCUR PREl.IIS ES IEa uccurmnce) 5 MEDEXP(Anyune Fetsut) S PERSOMNLBAD•d Rt)URY S GEV1.AGGREGATE LII.IRAPPLIES PER. GENERALACCREGATE S POLICYF jRO- ECT E-1LOC PRODUCTS-COMPAP AGG 5 OTHER S AUTOM1XI88.E Lu181LTtt LUM"I(Ea"Cident) I flif 5 ANY AUTO BODILY INJURY(Pet persunl 5 ALLO:VNED SCHEDULED BODILY IN]URY(Per-t—fera) S AUTOS nUT OS HIRED AUTOS NON-01'iNEU (Pet acildenU L S '.. AUTOS S UABRELLALIAB Occult EACH OCCURRENCE S EXCESS LIAR CLAIMS-ADYDE Ac6REGATE S DED I I RETENTIONS 5 WORKERS COMPENSA'noN x STATUTE I JER ANDEAIPLOYERS'LIABILnY YIN1.000.000, MY PftOI'ItIETO(t.PARTAEREXECUTI(•E E1.EACHACCIDENT S A OFFICERAEMBER EXCLUDED? NIA N POWC660990 01,01/2015 01,01/2016 (Mmtdatory in NH) E1.DIS EASE-EA Et6iPLOYEE S 11000.000 LESCRI TIONOLnLv der EL.DISEASE-POUCYUMIT S 110001000 DESCRIPTION OF OPERATIONS Ldus DESCRIPTION OF OPERATIONS/LOCATIONS IVEHICLES(ACORD 101 ArkGllunal Rem 6 SCluxlule,may be attached itmom space is requued) 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 AUTHORIZED REPRESENTATIVE A©1988-2014ACORD CORPORATION.All rights reserved. ACORD 25(2014,01) The ACORD name and logo are registered marks of ACORD f f J 01/, ,AWadWjpA I office of Consumer plaza a and7usiness Regula ' 10 Park Plaza- g�,ute 5170 . 0211 Boston,Massachusetts jstrat�on Home ~ Improvement Contractor Re Registration: 102726 Type: DBA Tr# 252249 Explmftn: 71212016 POLAR BEAR INSULATION CO. Vincent LeBlanc _ _ - P.O. BOX 958 __-------- 1810 - 0 Lost Card ANDOVER, MA 0 Update Address and return car E p�ym nt n for change, 1 Address Renewal OPS-CAI 0 50M."04-G101216 c)ard of B i4c6'e)g F�egi,iastions snot ,5tsndarris c'a;:wt7e�a�taarmaa�apaa�¢ �ttWwtam� s . CSSLAOM7 PETER A LEBLANC 2 EAST PINE STREET _ Plaistow NK 03865 P - 04128/201 S cW0mrmssic Tier