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HomeMy WebLinkAboutBuilding Permit # 11/30/2015 BUILDING PE t.�LEIT ,,,FD* , o� ib�"Y� _ TOWN OF NORTH ADOVER 0 : ,a APPLICATION FOR PLAN EXAMINATION ` Permit No#: Date Received <oa,TsEepw, �c Date Issued: t° IMPORTANT: Applicant must complete all items on this page LOCATION Print @ Ono . PROPERTY OWNER *. tA;Y f P�7 ( Q�SPrint 100 Year Structure yes,MAP ° PARCEL: ` ZONING DISTRICT: Historic District yesMachine Shop Village yes. 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 ki Others: ❑ Demolition ❑ Other er ��S�rla i pa V1 io w.,, „- .,., „ ,rpar' 'r,:,., ,.-;m�i„ ¢i7(CIkfN' i�IY""tildff�,' �;���/r ,acw.V �ar�f!(YFh'1'�i?�M'"m+""`G',W",,;-✓�i'rl% ') c�i �«,�pUr�or�d�^� 'i"K'!�"IVdk�fk✓,�u'+ ',".`'r:rYP✓�"i4W�"/Pl ��Ir!✓ U//i rJ)ri//��s r ept�c ❑Well °`�! �; o�''dpain � We�l�nds��'�r� � W tershed Dist ct�� � �r�///; ❑ Flo DESCRIPTION OF WORK TO BE PERFORMED: Identificatio - Please'Type or Print Clearly OWNER: Name:��"V ►r 7`to Phone: q> Address: ke qn..i S Contractor Name: r r f` /r A 14 n Phone: Errmail: Address �� I"fie i Supervisor's Construction License: 0 I Exp.. Date: Home Improvement License: /,g 1 1, 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: $ `� --'00 -d FEE: $ � Check No.: Receipt No.; 4 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund — , ri¢�/, cir�rerrrrprv/;rr,,,riiiire,+� r ,Ue,irryi Gipr,/ /i///1, r/I�i�,, .;�i/✓✓//�%i/ ///i. r �r / ; /r /, %/�%/�i _ r/i/;i//%f/,"ii//i//i//%�„/,/ i%%/ / / 1/ r �, ”, ,, i r a � �✓ f f,itl,/iil/,ri�����1a���//., t%°RT#1 I own of ndove, 0 Affl . ® 62-2ol _ i _ h ver, Mass, O LAKE Coc.. EWIC,( V A°OAriEo Pp"?' y S U BOARD OF HEALTH ER ITFood/Kitchen LU gg Septic System THIS CERTIFIES THAT . a#% �� ® BUILDING INSPECTOR ....... ...................... ..... ..............�'!� ...................... .......... ....... .. ... .. .. .... t. Foundation has permission to erect.......................... buildings on .... ........... .1��.� ............ ...... ® Rough IIr.jto be occupied as ...... .. . ..................................... ...... . ... - - . Chimney provided that the person accepting this permit shall in every respect conform to the term f 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 EXPIRES IN 6 THS ELECTRICAL INSPECTOR ® UNLESSI RT Rough Service ................... ..... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. f Federal ID tI0&0405628 l l�� RISE Engineering RICORI aetnrRegtstraeonNo81ss RISE �— 117A Contractor Registration No 1211979 A division ofThIchch Engineering ENGINEERING 60SbawmatUnit#2,Canton,MADMI CONTRACT 334.502-6335 FAX 339-W-_-6345 Page 1 PROGRAM TMCOUTPA"CMA-HES oxm*xao mrortwowt as otaaaamar�.ow `,r"`�L euaTorou - PHDNa CAM eumil - fwcinForutr7a Daniel Pietrowski (978)806-5850 09/22/2015 423144`-'�-:'; 000Ig3 73 Pleasant Street 73 Pleasant Street '< oltij J S9nV[Ca MY.STATE,ta' aalara e1Y,aTATf,ZiP i1 c l L North Andover,MA 01845 North Andover,MA 01 ; JOB DESCRIPTION L> P E ONE-Proposal for this calendar year. $0.00 BARRIER A Blower Door Test will not be conducted at your home,due to the presense of asbestos. $0.00 f BARRIER:The following contract is not valid unless accompanied by the Pre-Weatherization Barrier Incentive form,signed by your licensed electrician.Work will not proceed with this work until we receive a copy of the form. $0.00 AIR SEALING:Provide labor and materials to seat areas of your home against wastefid,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 healthfal 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 scaling 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 cfin is not guaranteed. At the completion of the weathemation work,and at no additional cost to the homeowner,a tins!blower door andlor combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality. $680.00 STAIRWELL:Provide labor and materials to install Class 1 Cellulose insulation to the sheetrock or plaster ailing and/or walls ora stairwell which are common to heated span,through a surface drill and plug method The holes are plugged with styrofoam plugs, and speckled to a rough finish. Any sanding and painting required are the customer's responsibility. $175.00 VENTILATION:Provide labor and materials to install(1)insulated exhaust hose with roof mounted flapper vent to exhaust existing bathroom far(s). $118.75 WALLS:Fumish and install blown in Class I Cellulose to(1392)square fed of vuryl-sided exterior walls.Invoicing will occur upon completion of installation. Subsequent to your payment,as an added service,RISE Engineering will return when weather permits to check for any voids with an infnu+ed scanner. Any mglor voids that may be found will be filled at no additional cost. $3,57520 CRAWLSPACE:Provide labor and materials to install(108)square feet of 6 ml polyethylene over open ground in designated crawlspacefeanhen basement areas. $83.16 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 homds 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 fall assessment of the combustion surety of your heating system and water heater.This has a value of590 and is at no cost to you.Total allowable wealherimtion incentive is$3,110. $90.00 9 Federal 10 a 054405828 RISE Engineering Rl Contractor Registration No 8186 RISEMA Contractor Regtstration No 1289'19 9:::- A division orThIetab Engineering ENGINEERING 60 Shawmat Unit A Canton,MA 02021 CONTRACT 339-502.6335 FAX 339-502-6345 Page 2 PROGRAM CMA-AESLIGAN DDTRS M As CE EEWW CUSTOM — -- - -- PHORH DATE CUEMa WWOWORDER Daniel Pietrowski (978)806-5850 0922/2015 423144 00003 SERM STPIEST — BOAM STREET 73 Pleasant Street 73 Pleasant Street SMCS CITY.STAMnP SUM GTKSTAMEP North Andover,MA 01845 North Andover,MA 01845 JOS DESCRIPTION Total: $3,722.11 Program Incentive: $2,770.00 Customer Total: $952.11 VYE AGREE HMUWTO FURIM SERVICES-COMPLETE IN ACCORDANCE WITH AWMBPEMCA1'IOHS.TOR THESUN OF "Wrie Hundred Fifty Two 8111100 Dollars $952.11 = AL HWBPEC MANOAPPROVALaYRIMENeV8fiR8U.CUSTOMAGREESTORWTAVAYLWOIGWFBLLWEREaTOF%WLLM BEOWROWU W.YONANY UNMiD SALOMM DAMSM WPOMANrM*MATWNON GUARANiUXiUOM CPRt8MON,8CHI81ln8t MMCOMRACIORREmBTRATION. '.. DO NOT SW THIS CONTRACT IF 7HEpE4WE ANY OL04KSPACES 6�zl� _ �Z�hr_ AM� TURE- E ?mttcl0 ACCWTARCE '.. NOT�THIS CONTRACT NAY88 us IFK0T878axReDVitnWN GATE OF ACCEPTANCE ACCEPTANMaF CaWPACT-TUE ABM PRICM SPECINBATIONB ARD CMMONB ARE 30QAYB. SATISFACTMTOUSASDARBREAPBYACCLOTMYMAREAUTHCROMT000WMVIM '.... ASSP I®.PAYNEMWILLOEIIAOEASounXMABDVE � Q OWNER AUTHORIZATION FORM wd fiOM vzk� (Owner's Mame) owner of the property located at ?3 (eRSa 37- Aloe, A,4pove+A oI&1� (Property Address) (may Address) hereby authorize (Subm tr dDo an authorised suboontractor for RISE Engine ft,to act on my behafFto obtain a building permit and to pmform work on my property. s Signature Date �� r. f 1� CERTIFICATE OF LIABILITY ONSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLO ER-THUS CERTIFICATE DOES NOT AFFIRMAWELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW. THIS CERTIFICA'T'E OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN R_1E ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the cerifficate holder is an ADD" UNAL INSURED,tete policy(les)muse be endorsed. O'r SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this cea aflcate does not confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER NAME.'_NAME. Durso&Jankoviski Ins Agcy LLC NPAX PHONE fRlC Ko 998 Massachusefts AvenueArc ao Ed North Andover,MA 01845 ADDRESS' Durso&Jankowski Ins.Agcy. PRODUCERFAER1CUSTOMER 0&POLAR'� INSURER(S)AFFORDING COVERAGE NAIL 8 INSURED Polar Bear Insulation(;o.Inc. INsuRtJRA:Fenn Americe 32859 P 0(8ox 9513 INSURER 0:Safety Insurance Co. 381010 Andover,MA 01810 INsuAFst a: INSURER 1), INSURER E: INSllAER 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. ILTRR TYPE OF INSURANCE POLICVNURBER MPLOmCYt�F MPOurowy y Lit=GENERAL L ABILITI• EACH OCCURRENCE __ $ 1,000,000 rA X COMMERCIAL GENERAL LIABILITY PAC7052028 0=412015 03f24f2016 PREMISES 5a n urrenceS 50,000 CLAIMS-MADE1( OCCUR MED EXP(Any One Person) S 5,000 PERSONAL FADVINJURY $ 11000,000 GENERALAGGREGATE S 2,000,000 GEMLAGGREGATE LIMIT APPLIES PER: PRODUCTS-COMPIOPAUG S 1,000,000 POLICY PRO- LOC S JECT AUTOMOBtLEUABIUTV COMBINED SINGLE LIMIT S 11000,000 10092601/04/2015 01/04/2016 (Ea accident) __ ANYAUTO BODILY INJURY(per Pelson) S ALL OWNED AUTOS BODILY INJURY(Peracddent) $ 1g SCHEOULEDAUTOS PROPERTYDAMAGE S 3C HIRED AUTOS (PER ACCIDENT) 1 NON-OWNEDAUTOS 5 S UMBRELLA LIAR OCCUR EACH OCCURRENCE S 1,000,000 EXCESS UAB CLAIMS-MADE PAC6906M 03/24/2015 03(2401`6 AGGREGATE S DEDUCTIBLE 5 S RETENTION S STATUH_ WORKERS COMPENSATION TORY IJAU E ANDS MPLOYERS'LIABILITV ANY PROPRIETORIPARTNERIEXECUTNEY�N E.LEACHACCIDENT S OFFICERIMEMBEREXCLUDED7 NIA (CfandatorV In NH) E.L.DISEASE-EA EMPLOYEE 5 If yes,describe under DESCRIPTION OFOPERATIONSbelau ELOISEASE-POLICYUMET S DESCRIPMONOFOPERATiONSILOCATIONSIvEHICLFS(Attorh ACORD 101,Additionol Remarito Schedule,ff more apace in required) Insulation Work-Mineral;Additional insured for general liability w h i Bracts;to work performed on their behalf by the above insured ishlelsch CERTIFICATE HOLDER CANCELLATION THIELS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EI(PIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Thletsch Engineering ACCORDANCE WITH THE POLICY PROVISIONS. Columbia Gas 195 Francis Ave AUTHORIZED REPRESENTATIVE Cranston,tit 02910 ©1988-2009 ACORD CORPORATION. Ali rights reserved. ACORD 25(2009/09) The ACORD name and logo are registered marits of ACORD --,yrs"-- CERWICATE OF LIAGIL" INSURANCE 0111-TE(1282014Q 1812014 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.Il'SUBROGATiON 15 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). PRODUCERA N V61. Automatic Data Processing insurance Agency,Inc. IARC Na Ext): (A..-No) 1 Adp Boulevard AgORESS: Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC INSURER A: NorGUARD Insurance Company 31470 INSURED POLAR BEAR INSULATION CO INC INSURER B: DBA:Polar Bear Insulation CO Inc INSURER 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 PAID CLAIMS. LTI1 TYPE OF INSURANCE INSD WVD POLICYNUAIBER BdII,ODYYYY) $IMAD,"Y) LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S CLiPA57dADE OCCUR PREGIISES fEa ouo MED EXP(Anyone(emun) S PERSONAL 6 ADY Inn URYS GENL AGGREGATE LiNIT APPLIES PER. GENERAL ACCREGATE S )ECT �LOC POLICY PRO- PRODUCTS-COIIP,OP ALG 5 OTHER S AUTOMOBLLELWBILIIY LUNI(Eau8INklidUn' S ANY AUTO BODILY'INJURY(Pw telso,0 S ALL OWNED SCHEDULED OS AUTOS BODILt`1N)URY(Per xuiderG) S AUTS HIRED AUTOS NON-01'iNED P ' Y , L AUi OS tPei auidenU S UN13RELLALMOCCUR EACH OCCURRENCE S EXCESS LIAR CLAI)S-?.IIDE AGGREGATE S DED I I RETENTION S S WORKERS COMPENSATION x STATUTE I I ER ANDEMPLOYERS'LJABILfry ANY PRO[')t]ETOJLPAItTAEftEXECUTtY•E Y�N/A N POWC660990 O1i011201S 01,012016 El.EACH ACCIDENT S ��0 � A OFFICER yin NH)BER E%CLU DEO. EL DIS EASE-EA EMPLOYEE S 11000,000 It Yes.SC IPRON under OFO E1.DISEASE-POUCYLIMIT S 1,000'000 DESCRIPTION OF OPERATIONS L'elwc '. DESCRIPTION OF OPERATIONS ILOCA BONS/VEHICLES(ACORD 101 A didon2J Remarl,s Schedule,may be atuched if more space is required) Columbia Gas Massachusetts CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIB ED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Theilsch Engineering,Inc. ACCORDANCE WFrH THE POLICY PROVISIONS_ 195 Frances Ave Cranston,RI 02910 AUTHORMEDREPRESENTATNE i /f_a.. A©1988-2014 ACORD CORPORATION.Ail tights reserved. ACORD 25(2014,01) The ACORD name and logo are registered marks ofACORD J The Cominlonivealtll of Massachusetts Deptirbizent of Influstrial Accrtlents Offtce of jtnle5lii9 atiotz5 +r 600 T-f ashin�ton Street - - Boston,IVA 02111 "`'� �i--'�; tv3r�z+�lilrrss.9 ov/rlitr Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AppIicalit Information j Please PH— I1t:aibl�° �am� (Business/Organization/individual ' U�o �qll p Address: C_11-1State/Zip== -ttlJ®U-ff- M,k DIFIQ Phonel-: Qom, 6gn— Are you an employer?Check the appropriate box: Type of project(required)_ I. I am a employer with ❑ I am a general contractor and I employees(hill and[or part time)." have hired the sub-contractors b F1 Zeit eottstruction ?_❑ I atn a sole proprietor or partner- listed on the attached sheet. 7. ❑ Remodeling ship and have no employees Thesesub-contractors have S_ Demolition working for me in any capacity"- employees and ha-\--e Nyorkers- 9 ❑Building addition Ito workers' comp.insurance comp.insurance' = required.] 5. E] Frye are a corporation and its 10.[1Electrical repairs or additions 3_❑ I am a homeolvner doing all work- officers have exercised their 11.❑Plumbing repairs or additions myself.[\o workers` comp. right of exemption per_MGL 1210 Roof repairs insurance required.] C. 152.§1(4).and tve have no employees. [No workers cotnp_insurance required-] *Any applicant that checks bax=i must also fill out the section helow showinc their corker;compensation policy information. i lomeoovtters who sabntit this affidavit indicatine they an doins alland then hire outside contractors tiros[submit a nen affidavit indicating such- Contractor-that chcdk this hos must attached an additional sheet showine the nanie of die sub-contractors and state ahetlteror not those entities have entniovecF. if the sub-contractors have entplovees-they must provide their Nvorkers-eomp-poliev number. 1 tuts an eutpAoyer that is pro>'itling workers'compensation.insurance for Hi emplorees Belo to is Lite policy anti job site I11f0!'IllrttiOlZ Q Insurance Company Name: j ,rP Police=or Self-ins.Lie.�z: 3�0 Vit—6—S—Z90 Expiration Date_ P bb& Job Site Address: _ ro ti Sq W7- ,��" City/StatelZip: f7. /9Y1 o�dt/t 0' Attach a copy of the workers'compensation policy declaration page(showine the ltolicti number and expiration date). Failure to secure coverage as required under Section 25A of�IGL c- 1.52 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 do hereby cettif antler the pains ant/penalties 0fperjttr-r that the information provided above is true«tul correct. Sisnature: � Date Il D�I� Phone= Official use only. Do tun write in this aretr,to be collipleted bi•city or town official City or Totirn: Permit/License Issuing Authority(circle one): L Board of Health 2. Building Department 3-CitylTo wn CIerk -l. Electrical Inspector S. PIumbing inspector G. Other Contact Person: Rhone : n , d us ss Regulation office of Cansumer Affairs an 10 Park Plaza® Suite 5170 Boston,Massachusetts®21e�stratlon Home Improvement Ccntxactor Registfa6ain: 102726 Type: DBAy52249 Expiration: 712/2016 POLAR BEAR INSULATION Co' = Vincent LeBlanc ._------- P.O. BOX 958 1810 Mark reason for change. ANDOVER, MA® Update Address and return ca E®ploy�ent [] Lost Caird i y Addeess Renewal DPS,CAI c`5 5GM•XMa1012te 'a:rds Clin"tructiOn Sui ur,i'Mr C. L-10601? PETER A LEBLAN� 2 EAST PINE STREET Plaistow Nf 103865 M 0412812018 vf�¢i»4�"4H5sd(3P8�:�