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HomeMy WebLinkAboutBuilding Permit # 11/30/2015 — %AORTy BUILDING PERMIT 0 �T`�° 16q��CJ TOWN OF NORTH ANDOVER. ® , APPLICATION FOR PLAN EXAMINATION �- o �•�AKe „ 1> Permit No#: Date Received �ArED Date Issued: IMPORTANT:Applicant must complete all items on this page LOCATION ����"' 15,7— Print Print „����:���,�. PROPERTY OWNER �`� ted` f,Pr0. Print 900 Year Structure yes no MAP PARCEL: .. ZONING DISTRICT: Historic District y s no Machine Shop Village ye no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑-New Building ❑ One family El Addition El Two or more family El Industrial El Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg 11 Others: Tvk5El /���yyy` �1��r �I ❑ Demolition b Sceptic Well;, r ❑ Flom,; x `� �� ��', ❑ Wate � �i e 111 0AI 0-11111111111111111 DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: .o r 5 Phone: 7 = Address: t b, 5 Contractor Name: ?erlc ir �-c 0% i 4 C Phonet� - c/a7 Email: Address � 7" 1 Supervisor's Construction License: �- r ' Exp. Date: `f Home improvement License: t o o% 7a Exp. Date: 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: $_ "{�� FEE: $ 241 Check No.: Receipt No.: NOTE Persons contracting with unregistered contractors do not have access o the guaranty furze i �"�1..g-Q„aau—;rOn�i;��///,cr��rr./��O�r r�/r�r�r rrr, -n�mrJ�,lrar�rrr�,;,rr.,... a�/,sir/ii.ir//ii:i/,D�/�l/�,o�s,or•/;.r/r//r i rr//r///i„iii/i r/i.✓;�:///a��d i�/i/.//%r��/7//J/////r. /I.///c.,.. .r,�,i, Gii,_;//r/;r�; �,i�.t/r,r;,�/:G,i„o/%>/,/.G/�li7,�I�%Ir��l�/i,�,/�,%I�/�Jid'/r/.�,r.,.i,lYl� /r1�/���//—/�- e�/l11���I� ✓ NORTH Anc'tover 1, _t own ot 0 ® ® 261 1 - h ver, Mass, 3D Y Q ".r. ! COCHICHEWICK ��S RATEO P4a�,�9 U BOARD OF HEALTH P E T Food/Kitchen RM I Aff Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ........ . ............ .®.......... +.►..! ............!�11" 1�. ... dol 0% Foundation has permission to erect ...... buildings o .. .. ,�, ,5,�•o, ® ® .. Rough to be occupied as ... .... . . . . a .. ...A............ ��. .. ... ............................ Chimney provided that the person accepting this per ' ..II 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 EXPIRESIN 6 MONTHSELECTRICAL INSPECTOR WX .. .. RTS 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 Approved by the Building Inspector. Burner Street No. Smoke Det. V411 5-0 04a) Federal In 0 y` RISE Engineering nl contractor RegistraBon No OAA Cotdrador ReglstraHon No A division of Thletsch Engineering CT Contractor Rgo*ation No __ 60 Slrawmut Unit#2,Carton,MA 02021 CONTRACT 33 FAX 339-502.6345 .-. :S E age , j PROGRAM ORERMSITOBETIMMIUSIB CMA-HES � MAS ENGINEERING tr onmw CUSTOMN PitetSi OATS CUENTO wOMMER Richard Harrington r= u, (978)686-2880 08/102015 421273 00003 smtvxa srrumTL eauxa STREEEr 23 Ipswich Stt+eet 31 Ln r—, 0 i; 23 Ipswich Street smMee etTY.arATe ZIP ewueo em.STA7�nP North Andover,MA 0184• If—I{� North Andover,MA 845M)r:" JOB DESCRIPTION QCT RASE ONE-Proposal for this calendar year. , L-:: $0.00 BARMI We have discovered what appears to be a mold I mildew-like substance in your home.This is being brought to your attention to identify it as a pre-existing condition to the insulation and air sealing work planned for your home.Your signature is your actrnowledgement of these conditions and agreement to pmcecd.DARK SPOTS ON ROOFNDECK $0.00 AIR SEALING:Provide labor and materials to seal areas ofyour home against wasteful,excess air leakage. This work will be performed in concert with the use of special toots and diagnostic tests to assure that your home will be left with a.heaithfitl level of air exchange and indoor air quality.Materials to be used to seat your home can include caulks,foams ad other pmducls. Primary arras for sealing include air leakage to attics,basements,winched garages and other unheated areas(windows are not generally addressed.) This will require(8)working hours.A reduction in cubic feet per minute(efin)of air infiltration will occur,but the actual number of efm 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 sub-contractor to ensure the safety of the indoor air quality. $680.00 AIR SEALING ADDER:(4)working hours. $340.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass batts to(40)square feet for damming purposes- $82.00 ATTIC FLAT:Provide labor and materials to install an 8"layer of R 28 Class I Cellulose added to(I 150)square feet of open attic ice•' 51,575.50 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small flatsudboe of plywood will be created around the opening within the attic. This will allow the covees integral weather-stripping to restrict air leakage. $237.65 ATTIC ACCESS:Provide labor and materials to make(1) temporary access to an attic arca The opening will be closed with materials similar to those existing. Finish sanding and painting is not included. $85.00 VENTILATION:Provide labor and materiels to install ventilation chutes in(38)rafter bays to maintain air flow. $76.00 VENTILATION:Provide labor and materials to install(10)4"X 16"rectangular aluminum soffit vents to increase ventilation in attic areas.Specify color.White or Cray. $250.00 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 754 incentive,not to exceed$2,000 per calendar year,and an incentive of 100%far the Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor. Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registratlon No A division of Tbielseh Engineering CT Contractor Registration No 60 Shawmut Unit 92,Canton,MA 02021 CONTRACT 339-502-6335 CAX 339-502-6345 r l r Page 2 E, PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS ENGINEERING DESCRIBED BELOW CUSTOMER PHONEv� W DATE CLIENT WORKORDER Richard Harrington (978)686-2880 08/10/2015 421273 00003 SERVICE STREET — BILLING STREET _-------- 23 Ipswich Street 23 Ipswich Street SERVICE CITY,STATE.LP BILLING CRY.STATE,LP North Andover,MA 01845 North Andover,MA 01845 JOS DESCRIPTION Cor 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 weadicrization work is complete.We will also conduct a full assessment or the combustion safety of your heating system and water healer.This has a value of$90 and is at no cost to you. Total allowable wcathcrization incentive is$3,110. $90.00 Total: $3,416.15 Program Incentive: $2,839.61 Customer Total: $576.54 WE AGREE HEREBYTO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ";Five Hundred Seventy-Six&541100 Dollars $576.54 UPON FINAL INSPECTION AND APPROVALOY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.yy EST OF e%WILL BECHARGEO MONTHLY ON ANY UNPAID BALANCE AFTER70 DAYS.SEE REVERSE FOR IM PORTANTINFORMATION ON GUARANTEES.RIGHTS OF REGLStON.3 EDULING.ANDCONTRACTORRE STRATION. DO NOT SIGN THIS CONTRACT IF THERE, RE ANY BLANK SP Rotart Givan - - AUTHOFRMDSIGNATURE-RISE Engin—ing CUSTOM RACCEPTA CE I NOTE:THIS CONTRACT MAY OE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ------ ACCEPTANCE OF CONTRACT-TRE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO DO THE WORK DAYS. AS SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE OWNER AUTHORIZATION Richard Harrington I, (Owner's Name) owner of the property located at 23 Ipswich Street, North ,Andover, MA 01845 (Property Address) 23 Ipswich Street, North Andover, MA 01845 (Property Address) I i hereby authorize (Subcontractor) 1 an authorized subcontractor for RISE Engineering, to act on my behalf to obtain a building permit and to perform work on my property, Owner's Signa ure IZ,52 '� ., Date � . � 7 J " i I ® OKIE 01h19D:YYYY) CEI -FIFICATE OF LIAG11-1-!Y I�ISIJI�d NCE 12/--I: 162014 THIS CERTIFICATE fS 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 REPRESENTATIVE OR PRODUCER,AND THE 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 ;91 PC I Automatic DataProcessing Insurance Agency.Inc. (A.. c NM EXO: 1 Adp Boulevard ADDRESS: Roseland,NJ 07068 INSURERCS)AFFORDING COVERAGE NRIC A INSURER A. NorGUARD Insurance Company 31470 INSURED POLAR B EAR INS ULATION CO INC INsuRERB: DBA:Polar Bear Insulation CO Inc INSURER C.- PO PO BOX 956 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 FOA THE POLICY PERIOD INDICATED.NOTWITHSTANDING ANY REQUIRENIENT,TERM,OR CONDITION OF ANY CONTRACT OR OTHER DOCUM,ENTWITH 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 TER MS. I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES_LIMITS SHOWNMAY HAVE BEEN REDU CED BY P AID CLAIMS_ LY FRF- LTR TYPE OF INSURANCE INSD rYVD POUCYNUMIBER R.1ht YYYY) 0•DD.YYYY) 0195 OMMER GENERAL LIABILITY EACH OCCURRENCE S CL,IUiSaPREMISES dAOE , i OCCUR rt.acmrcrse) MED EXP I Wy ure re,­0 S PERSOM-IL E ADV INJURY i CEI.'LACCREGATELIt.11TAPI'LIESI'Elt_ GENERALACGREGATE i POLICY[:]JECT LOC PRODUCTS-CmtP,OPAGG 5 OTHEtt. AUTOLIORaE LIABILm IEa•aLcidentl• 11 S ANY AUTO BODILY INJURY(I'e+IxoaO S ALL O:'WNED ED SCHEDULED BODILY INJ URY[Per xccider1 S AUTOS AUTOS 1' U•t U Y ,.4 G i HIREDAUTOs NON-0YiNED :Pet student ,lU i OS t Uh2AEW1LU18 OCCUIt EACH OCCURRENCE EXCESS LIAR CLNIas4.IIDE AGCR GATE S 5 OED I I RETENTION WORKEItS COSIPENSATON X 5T)\TUTE ERH ANDEMPLOYERS'LIABILITY YIN 1,000 000 ANYWt OPNETORRARTMEft EXECUTIVE ELEACHACUDENT S A OFFICERAtENBER EXCLUDED? Y NIA N POWC660990 01;01/2015 01,0112016 0,1-datmy in NH) El.DISEASE-EA EhII'LOYEE S 1,OOD,000 Ilya.desenbe larder E1.OISE+15E-PODGY URIIi S 1,000,000 ISESCRIPTION OF OPEIblT10NS bila.': OESCRU"BONOFOPERATIONS?LOG%nONS!VEHICLES(ACORD10LAd&t;. JRemMl Schedule,mayhe.tUchWifmarespaceisrequired) 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 W17H THE POLICY PROVISIONS. 195 Frances Ave Cranston,RI 02910 AUTHORIZEDREPRESENT\TNE ' y A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014,01) The ACORD name and logo are registered marks ofACORD DIS ID:SS CERTIFICATE F LIABILITY INSURANCE DATE Q4= —iHmCERTIFICATE IS ISSUED ASA MATTER OF INFORMATION ONLY AND CONFERS NO SIGHTS UPON THE CEFTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY TIME POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S), AUTHORtpED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER_ IMPORTANT: If the certificate holder is an Awn IONAL INSURED,the poltcy((es)must be endorsed. SIIBROCzAI tON IS WAtVF�,subject to the terms and conditions of the policy,captain policies may require an endorsement. A statement on this certificate does not confer rights to the certificate holder in lieu of such endorsernent(s). PRODUCER co Durso tit Jankowsid Ins Agcy LLC NAME: PHONE 198 Massachusetts Avenue A/c ro Eat North Andover,MA 01895 AUDREss: Durso&Jankows[d Ins.Agcy. PAODUC61 is®I AR_1 CIISTOFAER 10 E• INSURER(S)AFFORDING COVERAGE NAIC a INSURED Polar Rear Insulation C, Inc. INSURERA:P�'Rn ArrtePiCa 32 59 P 0 Bolt 958 INSURER 0.safety Insurance Co. 3361t3 Andover,MA 01810 INSURER C INSURER D INsuAER e 2NSllAEA F- COVERAGES CERTIFICATE NU BER: REVISI®N NUMBER: THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE PQt1CY 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 SHO in MAY HAVE BEEN REDUCED BY PAID CLAIMS. rAT( TVPEOFINADDLSURANCE R POUMVNUUBER 1MIIDDCY� MMMDPI M L[SJTS GENERAL LIABILITY EACH OCCURRENCE S 110001000 COMMERCIALGENERALLIAeiuTY PAC7052023 03/24P�015 03124@01(3 PREMISES Eaa S 50,000 CLAIMS-MADE1C OCCUR MED EXP(Any anePemen) S 51000 PERSONAL 8ADV INJURY $ 1,000,000 GENERALAGGREGATE S 2,000,000 JECT GENLAGGREGATELIMITAPPUESPER: PRODUCTS-COMPIOPAGG S 110001000 POLICY PRO- LOC S AUTOMOBILEUABIUTV COMBINED SINGLE LIMIT S 1,(100,000 ANYAUTO 2100926 0910412015 01/04/2016 (Eaaceidenl) BODILY INJURY(Parpensen)-------------- S ALL OWNED AUTOS BODILY INJURY(Peracddent) S SCHEDULEDAUTOS PROPERTYDA&IAGE S 1 HIREDAUTOS (PER ACCIDENT) 11 NON-OWNEDAUTOS 5 5 UMBRELLA IJAB OCCUR EACH OCCURRENCE S 1,000,000 EXCESS LIAR CLAIMS41ADEPACssO& AGGREGATE 5 A 385 03/24/2015 0�1Z412�16 DEDUCTIBLE s RETENTION S _ S WORKERS COPAPENSAMON TORYAIrH r E AN?EMPLOYERS'LIABILITY ANY PROPRIETORIPARTNERIEXECUTIVE Y/N EL EACH ACCIDENT S OFFICERRAEMBEREXCLUDED? ❑ N/A (Mandatary In NH) E.L.DISEASE-EA EMPLOYE S If yes,describeunder DESCRIPTION OF OPERATIONS below EL DISEASE-POLICY LIMIT S DESCRIPTIONOFOPERAT(ONS/LOCATIONS/VEHICLES(AUachACORD 101,AdditionalRemultoScheduto,Ifmom apacorafequlmd) Insulation Worts-Mineral;Additional insured for general liability " hh, respects to work perforated On their behalf by the above insureol rS 0 lelsch CDrineePin� CERTIFICATE HOLDER CANCELLATION THIELS2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE T(91C'ISCh Engineering TILE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN g g ACCORDANCE WITH THE POLICY PROVISIONS. Columbia Cas 195 Francis Ave AUTHOnM REPRESENTATIVE Cranston,81029'10 416-op (01988-2869 ACORD CORPORATION. Ali rights reserved. ACORD 25(2009/09) The ACORD nape and logo are registered marks of ACORD The l_onunonw(.,a1t11 of Massachusetts Dal)trrtlnent of.I'nthistrial Accidents Office of Investigations =k600 rflashin ton Street �. Boston, IVA 02111 i'���-•�' wtaliv.1?I(rss.9 oto/ilia Workers' Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information _ 'Please PH-4—S�e6iI�I�° Name (Business2'0rganization/individual): Ptd i4f- r Address: CIt}:/State/ZiP-_,&a&JQ0f r— Mj ,p V Phone A: Qom, Are you an employer?Check the appropriate box: Type of project(required): I am a general contractor and I 1. I am a employer with Q 6_ Q New construction entploYees(hill andlor part-time).* have hired the sub-contractors 2_❑ I am a sole proprietor or partner- listed on the attached sheet" 7. Q Remodeling Thesesub-contractors have ship and have no employees S_ Q Demolition working for me in an-,'capacity-_ employees and have corkers q Q Building addition [No xvorkcers= comp.insurancecomp.insurance_- required_] 5. Q Vire are a corporation and its I0.Q Electrical repairs or additions 10 1 am a homeowner doing all work officers have exercised their i 1.1]_ Plumbing repairs or additions myself[\o workers-comp. right of exemption per VIGL 12"Q Roof repairs insurance required.] c_ 163.§1(4).and we have no employees.[No workers' 11 Other Kb 515 q B�0 comp.insurance required.] °:\oxapplicant(lilt checks box=i mast also fill out the section below showin:their oorku compensation polis."information. i fomeowners.rho submit this affidavit indicatina they are doing all--cork and then hire outside contractors must subutii a new affidavit indicating sttdi" =Contractor that chtcck this box newt attached an additional sheet sltowille the came of the sub-contractors and state whetheror not dtuse entities leave cnrplorecs. if the sub-contractors lace etuplovees_they oust provide their workers-comp_poliev number. 111111 an enlploper chat is proYitling workers'coarpensatioir insitratice for reel'emplol:ees Beloit,is file policy and job sire illfol'111((11011_ Insurance Company Name: ` 10 - U Policv E or Self-ins.Liu. IP p We—6-5-1 V Expiration Date: t' /h& Job Site Address:— �SW ►�('� KLA CityiState1Zip:�J. �Vld t9vPV` 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 N4GL c_ 1 52 can Iead to the imposition of criminal penalties of a fine up to S 1,500"00 andlor 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 for\v arded to the Office of Investigations of the DIA for insurance coverage verification. 1110 hereby Call)` the pains and penalties of perjtill that the information pro(iderl above is tette and correct. Signature: gam:-,,�dlD�j Phone 2 C, Offrcial rise only. Do nut(mite in tlils area,to be completed 1�1'city or tomll official_ Cin'or Town: Permit/License m Issuing Authority(circle one): I_ Board of Health 2 Building Department 3-CitylTown Clerk 4. Electrical Inspector _4;, PIun-lbing inspector G. Other Contact Person: Phone r: office of Cortsumer Affairs and �SjneSS Re$�.at10Il 10 Park.Plaza- Suite 5170 0 6 Boston,Massachusetts 14,m 1,nprovement Conor Registration - Registration: 102726 - Type: DBA T 252249 Expiration: 7I21L®16 POLAR BEAR INSULATION CO- _ Vincent LeBlanc P.O. BOX 958 ANDOVER, MA 01810 _._ rd,Mark reason for change. Update Address and return Y:mploymeot ❑ Lost Card t Address Renewal op"A1 49 m4WO44101MG UV �A,-jssety aaGhusst s -. P-PPl..� �r��0,T public�� ���s � sucE cafwccGi as2��st:esra a:a _;Cense:CI'•SLA06017 DETER A LEBLANC 2 EAST PINE STREET _ Plaistow NH 0386 0 9114, , atra 11,1 .J 04/2812018 Corn iss=ar