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HomeMy WebLinkAboutBuilding Permit # 12/15/2015 N®63 Yp-g BUILDING PERMIT TOWN OF NORTH ANDOVER �� 2`' ' val xb �� APPLICATION FOR PLAN EXAMINATION In� Date Received �9RA°RgreoWPe�y Permit N®�o �SS�cwusE�� Date Issued: B IMPORTANT .Applicant must complete all items on this page a '"'s��'^'r�`; ,i:;'"Fri,�.,.:�t�? 5� .tr,.r�,:.r a::�'',,r ,, e ,;;' �r31��rt �rn',ta�'.ff t✓r' -[ a y r .:" trt ?thn� f� ,•;� y< „.�,� qt`s "r ,..� f",r��� "a,;Pflnt� � rl.�'. 'fit ',r' rrr* ,rc � ✓ -1%L' � �. ��r�`, ,,,f., ; f , ,:�r'r ,n-f�' A A "'} e- .' ,y,r- .:,rr..', a `. r :w'a„.. ”" f .. � rs- - 7 es n .&.a,=r - •r' r `,y,nx." :�,�, f."`:' JY r � r��1OO,Year-Structure�� n,r��.�r f r:;m 9�arf'<.fF"s%�nr,,,`�u�'.,i�.�r/�/I .. _,�„-n r' Ik�r,, t,J,�, 3/•Z`''�.`""�``'F�t.wr;i�;� �.��5,z. r � tri r'� '.r,,fa-.rr f'`'erCtc.,.:. r'.'.'����r r,�rfr r,.r.� =3'� h'i.,:% r� rr f � �� i rr er f n0 MAP. >1 � r.� PARCEL a�rrf ZONING DISTRICT Historic District in Shoe p Village `� .yes ,no'�r Mach TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family ❑Addition El Two or more family El In ❑Alteration No. of units: ❑ Commercial ❑ Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑;Septic ❑�Well4 „ ❑ Floodplain ❑rWetlands ❑ Watershed District ❑YVaterlSewerr : DESCRIPTION OF WORK TO DE PERFORMED: K r\,-e wgl( Z&S u la Tf-\o ! Identification- Please Type or Print Clearly OWNER: Name: - t? L-oe -e- 5 Phone: Address: '- ? f h r , Contractor Namec�7 c J` ( Y( �� rrtc Phone: �'� -Email / f F / Supervisors onstructi©n License J 1 Exp Date fir. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F. Total Project Cost: $ ® ® FEE: $ �) I Receipt No.: q- Check No.. P NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund gnature_of AgenyOvvner Signature of contractor & �®RTii Town of L . t Andover ver, ass, O L4._q6^KG 9A COCNICHa_lc( 1\� .®S RATED BOARD OF HEALTH Food/Kitchen Septic System PErxMIT L D THIS CERTIFIES THAT ............... .. .. ....... . ... ... ....... ... .... ............. .... .......... BUILDING INSPECTOR .. Foundation has permission to erect .......................... buildings on ..... ... ... ... .. . . I ..... . ........ % Rough tobe occupied as ...................... .. . ... ............................................ Chimney provided that the person accepting this permit 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final ` 1 EXPIRESPERMIT IN 6 MONTHS ELECTRICAL INSPECTOR win TI Rough s - Service .................. ..... ....... ......................................... Final BUILDING INSPECTOR GAS INSPECTOR ccupancy Permit Required to Occupy Building Rough Displayin a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal ID#0"405629 RISE Engineering RI Contractor Registration No 8186 MA Contractor Registration No 120979 F A division of Thielsch Engineering CT Contractor Registration No 620120 F ^ 60 Shawmut,Canton,MA 02021 CONTCT 339-502-5197 FAX 339-502-6345 hs �tl 4 S y; Page 1 �a: PROGRAM ENGINEERING THIS CONTRNEERIN ANDT IS ENTERED INTO FOR WO1RISE KAS CMA-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CUENTO WORK ORDER Janet Lees (978)885-1203 06/11/2015 401820 00003 SERVICE STREET BIWNG STREET 47 Marblehead Street 47 Marblehead Street J h� tt� SERVICE CrrY,STATE,LP BIWNG CITY,STATE ZJP North Andover,MA 01845 North Andover,MA 01845 JUL JOB DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work will be 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. Primaryareas for sealing include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed.) (4)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 sub-contractor to ensure the safety of the indoor air quality. $340.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Thermax board.Weatherstrip the perimeter. $60.00 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(128)square feet of kneewali area. $448.00 BASEMENT CEILING:Provide labor and materials to install(120)linear feet of R-19 unfaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $210.00 BASEMENT DOOR:Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2"rigid board that meets the sections R-316.5.4 and 316.6 requirements of building code. Seal all edges and seams with FSK tape. $72.22 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 ofyour 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 , R Federal ID#05-0405629 RISE Engineering Rt Contractor Registration No 8186 MA Contractor Registration No 120979 A division of Thielseh Engineering CT Contractor Registration No 620120 60 Shawmut,Canton,MA 02021 ®pNTRACT 339-502-5197 FAX 339-502-0345 S Page 2 PROGRAM ENGIN JEERING THIS CONTRACT IS ENTERED INTO BETWEEN RISE CNU-HES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER _ .. 'I 7 HONE DATE CLIENT tl WORK ORDER Janet Lees { �� f I"'' ` ' " J � 978)885-1203 06111/2015 401820 00003 SERVICE STREETML—LING STREET 47 Marblehead Street JUL 1 2015 7 Marblehead Street IN MA SERVICE CITY,STATE,DP D NG CITY,STATE,ZIP North Andover,MA 01845 orth Andover,MA 01845 JOB DESCRIPTION Total: $1,220.22 Program Incentive: $1,022.66 Customer Total: $197.56 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Hundred Ninety-Seven&561100 Dollars $197.56 UPON L INSPECTION AND APPROVAL BY RISE ENGINEERING"CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF 1%WILL BE CHARGED MONTHLY ON ANY UNPAIJ CE AFTER 30 DAYS.SEE REVERSE FOR IJAPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES 62 A IG URE-RISE Engineering CCEPTANCE '.. NOTE THIS CONTRACT MAY BE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE 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 WALL BE MADE AS OUTLINED ABOVE n `/ OWNER AUTHORIZATION FORM Janet Lees (Owner's Name) owner of the property located at :_ D �G&DVIR 47 Marblehead St North Andoverfill nn 4 r.; �.t. (Property Address) LVTJ ' 47 Marblehead St North Andover, ----- "`" (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. s Signature Date d rte Coiiiniomwealt11 of ill"assCFcillisetts Departnierit of 1zrClafstrirfl1jccide11t5 Office of lit ve5flgattoii5 'tom+ = 600 r%rrslriaa_tole,Street Boston, 1111'14- 02111 _tyti ti? --=`='' 1Vri�lU.}}ZCtSS 90t��C/LCf Workers, Compensation insivance AffdaN,it• Builders/-op-tractor's/Eieelrieistn§/Plsmbers A goliearit lnfarination Please Print Legibly Name (BusinessrOraanization/lndividttal): r o (Pigg ra r Zh v � tyvi C TfiL� Cit}/State/Zip: l-tf�J O U-e �>1� y`'� Phone At "r•�� �'r Are You an employer?Cheek the appropriate bo,.,,: L rj 1 am a employer wilt —174- EDI am a_general contractor and I 6- of project(required): employees 01,11 andlor pare time)." Rave hired the sub-contractors ❑lett'Ct711S[rllCC10n ?.❑ 1 am a sole proprietor or partner- listed on the attached sheet_ 7. ❑ Remodeling ship and have no employees These sub-contractors have s p ❑ Demolition working for me in any capacity- employees and bave NYorker5- [iso workers= comp.insurance comp.insurance.- 9. ❑Building addition required.] 5. ❑ We are a corporation and its 10.0 Electrical repairs or additions 3_❑ I ain a homeoMlner doing all work officers have exercised their l 1.❑Plumbing repairs or additions myself[\o workere comp. richt of exemption per MGL 12 ❑ Roof repairs insurance required.]' c_ 152. §1(4).and we have no � employees. [\o workers- 13- Other h6'd&1 P'f`d n comp.insurance required.] `_1mapplicant that chec.kS bos=1 must also fill out rile section helon•shotvin_s their.vorkers compen>ation polis--information. [iorteot�uers who submit dtis a dati it indieatine they are doingall n ork and then hit):outside contractor must subunit a nen'aftidayit indicating such_ Contractor that clle k this box must attached an additional sheet showing the tarn of the sub-contractors and state uhetheror nor tltuse entities have emniovec. If the Sub-contractors have employees_they nttut provide their corkers'comp_policy number_ I arra atr erlrploler ibrzr is proYirling tyvrkers'collrpeztsrttiolr irtsttraztce for n?I'eitzploFce� Betota is the policilzrttd job site illfol'/1ItlIinll. Insurance Company Name: p Policy-or Self-ins.Lie. P 0 lae_57sr—eqco Expiration Date: t' o Job Site Address: > f/*tA(h ed S i CiLv!State/ZipaL� Attach a coil'of the`workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section Z�tl of 1•IGL c_ I�?can lead to the imposition of criminal penalties of a fine up to S 1-500.00 and/or one-bear imprisonment,as well as ciVil penalties in the form of a STOP WORK ORDER and a fine of up to S2:50_00 a dad against the violator_ Be advised that a cop,•ofthis statement may be forwarded to the Office of Investigations oftlie DIA for insurance coverage verification. I do Irerebr certify rrrtrter the prtins ttnri peitrtlties oflzerjttt� t]zat the information prot:ifled above is trae and correct. i Signature:a'1� � t Dans J Phone ® - O ffcial use ctrl): Do,,()(tl'rite ill this area,lobe colilpleted bt•citr or torch official_ City or Town: PermitlLicense R Issuina-Authority(circle one): I- Board of Health ?. Building Department 3-CittlTown Clerk 4. Electrical Inspector- s. PIunibing Inspector 6. Other Contact Person: Phone r: I ®® CER�iFICAn OF LIAG IL1!Y INSURANCE a,Ti2/182a14» r 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 NOTCONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED REPRESENTATIVE OR PRODUCER,ANDTHE CERTIFICATE HOLDER. j IMPORTANT lfthe certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed.IfSUBROGATION 15 WANED,subject to i 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). i PRODUCER -0,511 AL1 NM1E: Automatic Data Processing Insurance Agency,Inc. "PHO (n'.c wx 1 Adp Boulevard noDREss Roseland,NJ 07066 WSUREn(5)AFFORDING COVERAGE NAICs WsuREn A: NorGUARD insurance company 31470 INSURED POLAR BEAR INS ULATION CO INC WSURER B: DBA:Polar Bear insulation CO Inc LusuRER C: PO BOX 958 ENSURER D: Andover,MA 01810 INSURER E ENSURER F: COVERAGES CERTIFICATE NUMBER: 291629 REVISION NUMBER: i THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN 155 UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD INDICATED-NOTWITHSTANDING ANY R EQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCWMENT 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, I EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. PULILYtH- LY EXP LTR TYPE OF WSURANCE WSD IVVD POLICYNUMBER (r.IKDD;YYYY) BVMJ3D.YYYY) LIMITS CQ1IMERCIAL GENERAL LIABILITY EACH OCCURRENCE S n CLA2.154.111DE OCCUR ..PR MISES IE.uttulmnm) S DIED EXP Otnyuroe iKucN S '., PERSONALEAOi INIURY i GENX AGGREGATE LB.BT APPLIES PER. GENERAL AGGREGATE POLICYrno- ❑JECT ❑Loc PRODUCTS-COt.1P,OP ACG i OTHER S AUIORZRILELIABILFTY L 181. L I 1.II S i ANY AUTO BODILY IN)URI'tPer 1xtson! S I ALL ONNED SCHEOULEU AUT05 AUi OS BODILY IH)URY'(P,r.ttidernl S HIRED At NON-0YiNEU I' 't tI Y •.1.(. ; AUTOS tPer ztuCeAU j i Uh8RELLALUM OCCUR EACH OCCURRENCE S EXCESS LIAR CL,11M5-0D1DE ACCREGATE DEO ItETENT10N i S WORKERS COMPENSATION X STATUTEERH AND EMPLOYERS'LIABILny ANY PI{OI'It1ETOtt.{bVtT1.EREXECUiIIf YIN ELEACHACCIDENT S 1,000,000 A OFFICERAEMBER EXCLUDED, Y N lA N POIVC660990 01,011L015 01,010016 i (Almdatow to NH) El-DISEASE-EA EMPLOYEE S 1,000,000 Byes-IPTIONOF 0 El-DISEISE-POLICY URIIT 5 1,000,000 1}ESCIUPTION OF 01'EIb1TlONS Ltlws DFscRtP noN OF OPERATIONS ILor_TlONS 1VEtBCLES(ACesF ORD 1(11 Ad&liorvJ Remulu Schedule,may IxatUehed irmorce is rxnuir rJV Columbia Gas massachusetts CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF T14E 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,R102910 AVTHORIZEDREPRESENTATIYE AC 1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD OP ID:S5 d= CERTIFICATE IFICATE OF LIABILITY INSURANCE �133l1�f20D�1s�� THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON TIME CESTIFICATE HOLDER.THIS CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED LAY THE POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT BETWEEN TitE ISSUING INSURER(S), AUTHORIZED REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. IMPORTANT: If the certificate holder is an ADDITIONAL INSURES),the policy(les)must be endorsed. H SUROGATION 19 WAIVED,subject to the terms and conditions of the policy,eefiain policies may rewire an endorsement. A statement on this verlif•Icafe does not Confer rights to the certificate holder in lieu of such endorsement(s). PRODUCER co NTACT Durso C,Janl{owslSi Ins Agcy LLC NAME: FAYL PHONE 198 Massachusetts Avenue AM o Eat: RIO ND' North Andover,MA 01895 Ate, Durso&Jankowski Ins.Agcy. PRODUCER CUSTOMER ID O!"�a�'1 INSURER(S)AFFORDING COUERAGE NAIL d INSURED Polar Bear Insulation CO.Inc. INSURER A:Penn America 32859 P®Box 958 INsuRERs:Safefy Insurance Co. 33618 Andover,MA 01810 1NsuAeR e INSURER D INSURER E: —SUAER 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 SHOVM MAY HAVE BEEN REDUCED BY PAID CLAIMS. ILTH TVPEOFINSURANCE R POLIGYNUMBER IIMM mmm LIO EFF YE7(P LI�SITS GENERAL LIABILnY FJiCH OCCURRENCE S 1,400,000 A COMMERCIAL GENERAL LIABILITY PAC7052023 03/24PL015 03124/2016 PREMISES Ea o=,mance S 50'000 CLAIMS-MADE )I. OCCUR MED EXP(Any one person) S 5,000 PERSONALBADVINJURY $ 11000,000 GENERALAGGREGATE S 210001000 GENL AGGREGATE LJMIT APPLIES PER: PRODUCTS-COMPIOPAGG S 1,000,000 17 POLICY 5 PRC LOC AUTOMOBILELIABILnY COMBINED SINGLE LIMIT S 1,000,000 ANY AUTO 2100926 01104!2015 01/042016 (Eaacdaent) BODILY INJURY(Per person) S ALLOWNEDAUTOS BODILY INJURY(Peracdclent) $ SCHEDULED AUTOS PROPERTYDAMAGE �t HIRED AUTOS (PER ACCIDENT) S NON-OWNEDAUTOS S S UMBRELLA LIAB 3L OCCUR EACH OCCURRENCE $ 1,000,000 A EXCESS LIAB CLAIMS44ADE PAC690M 03/24/2015 031240#16 AGGREGATE S DEDUCTIBLE S RETENTION 5 S WORIC=RS COMPENSATT ION VVC STAT TS E R ANDEMPLOYERSLIABILITY TORYl1AV YIN ANY PROPRIETORIPARTNERIEXECUTNEE.L EACHACCIDENT S OFFICERIMEMBEREXCLUDED? NIA (Mandatory In NH) r E.LD)SEASE-EAEMPLOYEE S IF yes,desalt under DESCRIPTION OF OPERATIONS belau E L DISEASE-POLICY LIMIT S DESCRIPTION OF OPERATIONS ILOCWnONS/VEHICLES(ABechACORD101,AdtWonalRemarlcaSchedule,ifmom apacoiorequired) Insulation Work-Mineral;Additional Insured for general liability,int is res ects to world performed on their behalf by the above insured is ieisch En inearing CERTIFICATE HOLDER CANCELLATION 'iiH1E4.S2 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE ThlelSCh Engineering ACCORDANCE WWiTH THE OLICY PROVISIONSE VVILL BE DELIVERED IN Columbia Gas i95 Francis Aire Cranston,R1 02910 AUrfI0A2EDAEPAFSENTATAlE 492p- @ 1988-209 ACORD CoRpORATION. Ali fights reserved. ACORD 25(2009109) The ACORD name and logo are registered marks of ACOFID office of Con,-pm ex�alr5 anti. usuLeSS 10 Park Plaza- Suite 5170 Bosto%massac - 02 syration xovement Contractor Regi Ome -- Registration: 102725 Tvpe.- DBA Tr# 2=49 Expiration: 712/2015 PC71-P►R BEAR INSULA,T(ON Co. - Vincent LeBlanc P•O- BOX g5$ ,�Iiark reason for change. ANDOVER, MA 01$10 ''Update Address and return E®ptoyment ❑ Lost Card i Address Renewal a OPS-GAY 50M44 44101216 = za �ursi JUQcd4"C�t�: l� .Ci1 1Cka E��b Crro 81 2a :�41tcGS Cumtruction S:apen ivn ;C.anse:C.C-,SL-10fio'i? " PETER A LESLAk Z EAST PIINE STREET _ piaistow NR 03865 0412812o18 CvtY>131S55tt36s�f