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HomeMy WebLinkAboutBuilding Permit # 12/14/2015 i BUILDING PERMIT %AORTH Of ,ED q4,,IN "0' Q. Ic 0 TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No : Date Received ED S US Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Tvryu-R-A,-- Print (A/L 'T Of-hli PROPERTY OWNER (1-0 b+ Print 100 Year Structure yes no MAP :� PARCEL:01J�-3�-5 ZONING DISTRICT: Historic District yes no ) Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resl ential Non- Residential El New Building One family El Industrial El Addition El Two or more family � Alteration No. of units: 11 Commercial Repair, replacement El Assessory Bldg El Others: El Demolition [I Other V DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly Phone: Yb- UPjS-- W1 OWNER: Name: 13 ®1 1'r)(AA CA6, Pho Address: 'tk S4W(vn Trra---� Contractor Name: 1bJV11+-C-4(W1-h1 Phone: CI-M 3!�� ITB 3 Email: i a GLx�rn Address. ?Q 13%K SIN (((ock i Lb n AJ 61613'e Supervisor's Construction License: Exp. Date: Home improvement License: V3 31 1 Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ 3Q) 32-131 FEE: Check No.: Receipt No.: "2,ci NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund ti4hat' 'r �dAqe t%®RTH i own of Andover ® _ _ 1 � -o • n h 0 LANE COCHICMEWICK yR. p044.r S U BOARD OF HEALTH Fm R Food/Kitchen Septic System THIS CERTIFIES THAT ...................... BUILDING INSPECTOR .. .. .. ..... . .................. ....................................................... Foundation has permission to erect .......................... buildings on .. .... .......... ... 64"..... ....... Rough to be occupied as ......:.: .:....sift ...... ..... .AtIA. ..mow ... . . ................................................ Chimney provided that the person accepting this it 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 PERMI T EXPIRES IN 6 MONTYS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION S T Rough Service ............................... ............................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Budding Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be ®One FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Fedoral ip# RISE Engineering Ri contractor rRegI tratioaAon Na INA contractor Rogistration Na � CT Contractor Registration No A division of Thielsch?engineering 60 Shawmut Unit#2,Canton,l4iA 02021 CONTRACT 339.502.6335 FAX 339-502-6345 e 1 pag i �y F PROGRAM 'iNIBCONTRACTiBENTEREOINronEtWEENRrgE 1 i.7 !.r CMA-HES ENOINEERINO ANO THE CUSTOMER FOR WORK AS aESCRUIEa BELOW ENGINEERING PHONE GATE CLiBNTO WORK ORDER CUSTOMER (978)685-6293 07/1012015 - 417143 00002 Genevieve Tarrisi —.^.- BILLING STREET SMMCE STREET 21 Sylvan Terrace - 21 Sylvan Terrace _�_....�-------WWIP^ @' 3 Jean 7orrl8i Na CITY,STATE,Z SERVICE CRY,STATE,ZIPi7, �3, North Andover,MA 01845 21 Sylvan terrace North Andover,MA 01845 North Aholover, Ma 01845 j0B DESCRIPTION AIR SEALING:Provide tabor and materials to seat areas of your home against wasteful,excess air leakage. 'this work wi lt be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with n healthful level of air exchange and indoor air quality.materials to be used to seat your home can include caulks,foams and other products. Primary areas for seating 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 s number ofcfm isnot guaranteed. At the,completion of the weatherimtian 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. 6680 00 ATR SEALING ADDER: (3)working hours. $255.00 ATTIC PLAT:Provide tabor and materials to install an 8"layer of R-28 Class I Cellulase added to(1134)square feet of flaared attic space. $2,041.20 purposes. G:Provide labor and materials to install a 12"layer of ll R 1111-3111 8 unfaced fiberglass batts to(I20}square feet for damming purrposes. $246.04 SLdPES:Provide Is and materials to install a 6"layer of R-21 Class I Cellulase added to(t 20)square[eel of slope area. Wherever possible baffles will be installed to the entire length of each bay to maintain ventilation space. $223.20 ATTIC ACCESS:Provide labor and materials insulate the back of the attic door with 2"rigid Thermar board and seal the door's edge with weatherstripping $73.91 tirE11TII,ATION:Provide labor and materials to'install ventilation chutes in(38)rafter bays to maintain air flow. $76.00 pVER14ANG:Provide tabor and materials to install 9 R 32 densely packed Class 1 Cellntose insulation to(60)square feet of exterior overhang located below a heated floor area,by drilling holes in the overhang from below. notes drilled will be plugged. Plugs wilt be sealed with exterior grade spackle and lett in a relatively smooth condition.Finish sanding and touch-up priminglpainting will be the customer's responsibility. $237.00 JW JUL 272415 Federal ID# RISE Engineering RI Contractor Registration No MA Contractor Registration No A division of Thieiseh Engineering CT Contractor Registration No £ 60 Shawwut Unit#2,Canton,IVIA 02021 CONTRACT hNTpRAA T V V ^, 339-502-6335 FAX 339-502-6345 R Page 2 I S PROGRAM _ CMA-HES M40INEFMNG ANO TNENTERED( BETWEEN CUSTOMER O WEKS WORK ENGINEERING DESCRIBED eELOW CUSTOMER PHONE DATE CUENTO WORK ORDER Genevieve Torrisi (978)685-6293 07/10/2015 417143 00002 SERVICE STREET BILLING STREET 21 Sylvan Terrace 21 Sylvan Terrace SERVICE CITY,STATE,ZIP SILLNO CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,832.31 Program Incentive: $2,935.00 _ Customer Total: $897.31 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FORTHE SUM OF **'Eight Hundred Ninety-Seven&311100 Dollars $897.31 UPON FINAL INSPECTION AND APAOVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL.INTEREST OF i%WILL BE CHARGED MONTHLY ON ANY UNPAID BALANCE .SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGHTS OF RECISION,SCHEDULING,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES NATURE-RISE Enghwrhig CVT ERACCEPTANCE NOTE THIS CONTRACT MAY HE WITHDRAWN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE A130VF PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIFIED.PAYMENT WALL as MADE AS OUTUNED ABOVE 0 OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at In (Property Address) C:7 LY (Property Address) hereby authorize (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my Property. Owner's Signature C) 2- z® ! s Date The C ontinonwertlth taf jassachusetts Department of Industrial Accidents Office ttf Intfesti afions I Congress,Street,Suite 100 Boy vton,,Vr9 112114-21117 wwwnlosv.gov/dia 4Yorkcre5 Compensation insurance Affidavit. BuilderslContracto fEleecttrici print� irs A licant l nformafion I�lanle($usiteens=`t3tt�niratic»'ttsdividn?1#: Address: � �� 1 —___ Ci!L/State/zi fit)t fiy'pe or project(requ'sredY Are you an employer;Chm the appropriate box; 4, }am a general actntractt�r ttid i 6. [; ltia�v etrnstrttctlon 1. t atrt a employer i,ith ___._. have Hired the sub-contractors � _ ltemctcic}int; erceploYccs(full andJor part-time).* [tsred ori the attach (sheet_ ?, lam a aeric prvprirtcrr or partner- t hese nub-contractors have a. L7etittt}(tion sh9p incl have no'trrsp}it}Fees emptoyce-and have workers° 4. [ Building addition ti�,Ork.ing for me in any Capacity, eorrtp,in wranee.= LN, o workers'ccztnp.iMarance � � We a7C a corporation and its ld.�plUM hinin repairs or additions required]required] of�cars have.,exercised their l l.�P}untg repairs or azlditions 3. 1 am a humeok"er doing all workTightof exeniption per MGL l Roof repairs myIwll [ 'o w=r)rkets'ct�tnp. c. ]y w1(4)l and wehaVe no 1-1,0CTt}ler insurance required.]r entp oyees.[NO workers` Conip,insurance required.) Arty aPpEtsastt that checks tx?N E cctcsf al> !i!t out t1t U doing tall ttvrk and thrn httc oc ss ie c7tttnc2 m tat 4uksntt a nssw ziltct�itindicating su+h. #Hnmecsck-sem who submit this drfidaYit a3tdiCatiaS Tg1} c�tstr�ct�r that stecK this box tttut a f�c hect an a sto3}icy they »=��{ra`; txe yuh7j t znt>cs gat 3 state uia�flirr u€trot th©su rnt�tie haw ett ptay�c . [r thesvh Fczsirset,,T ti �b'S eY F t arrt an employer that is providing wnrtc�rs'rrrmpensata»in3uratte�frxr tea=��pl°y"yes, def"»=is the Airy=aid jab site, information. I -- t Insurance Cotnpan}a Expiration Policy#or Self-ins.Lc.�; _�_�'S_ _ -...- - /���yA�Vp�(� �_ —__._.__�_ t�:1t}':`,t`tater`e?i�}:�'!�!.`�'—=-1/ ,._:�Y_� Job Site address:_2.' Attach$cop- of the tisorhers'compensation policy dtxclaratlttn page(,shoving the policy tturrthcr and expiration datea imposition of crinlina Failure to secure coverage as required under See iOn 15�}} ,of�te iv t penalties ic, 152 can ll tile f,forto ltn of a S Op WORK ORDERandaffine fine up to$1,500.00 andlor one.-year irnprt of u to X250:00 a day against rite val<`rtflr Be arl�t�:eAl that a copy taf this st<ttetrient nae+, be.forwarder)to the C:t11ic�of investigations of theDIA for ins coverage verification. J do hereby certify under the pains and penatt'es of perjury4 titer the r'rrjarrrtatfotr provided above is true and correct. '91,R,ao,,..dltitire - Dat c� k W8 Phone (} cat use onfY. Ura not write in this area,to be comph tcd by eah'or town nfjicial, Permitft-icense. City or Town: l.sSuing Authority(circle one): Department d.("stt�tTowrt t"[erh 4.Electrical Itrsctr,r 5.Dumbing Inap�:clor 1,Board of Health ?.Building ti.()ther _, ., Phone Ceutact Persont__— g�p-•y CERTIFICATE OF LIABILITY INSURANCE E £3"r I'.f£3RFiwT1C3'3 Q�e�'f k.�tC CONrEAS NO RIG KTS t1rt ft THE CeRTIFICATE 14 DER,T"It, TttFS C CATS FS ISStlE�J AS 44ATT h YTEtsU OR ALTER THE COVERAGE FF C e G i3 s3Y THL?O ICIES CERTIFICATE a4ES tKaT AFiI F ATI L' CA N hT?i1 I't $9 ITU E. CERTIF' ATE THIS CERr1FF[ATE€}�FMSufEhTdCE DOES tipT CS�tt�tTttT �CONTRACT Est Y42EEfit JE SSSi)ata 4F+�1R€RtSi,Au1§i6RIZE Rt PRESEf€TATTYE Qk PRbi3t_-�<Atgo TNk CERTIP1CATE t#GL-02R. IP9PURTANT'it the c rH� homer is an A.01t1Q.A$I%SUR€II,t#�ixa€�ii<�s) must tw er%drrssd,if g6Fp;GA I'! FS WANE 7, is the tfte wins and cond4truns of tfia{al_e,cart. po= ic;as may r9v anjs @mEnt.A state ser t ar tni5 can{�94e Ae@s not canFer yt tt#icata ho d8r in{iEu Ai s enlGisnt(s3. _ fierKty+�55gned RFsk services Claytonmartin J istg Amey ttst {F3ti41634-&50 «N s (865}21`5-8118 are,is rx.+ lq�¢ M"thmpfcsn Si PCS sox 8$9 P icyse Holyoke MA 01044 r��a�a; erv��rrt 31.1 ts8uthkr lnstilmtion irrG Pt?Box 3" 1pswlCh.MA 01038 1tEVF 'F($!i NUMBER 00-1 CC3 - E€T1F1GTf ld414+iE = ti FS TG CERT Y TE#T Th=poUcIES OF IEcS Rt hCG i tYTEt�R i [)EF)8A � ACT CiE WH"E077 48E ERt N 5 Sf�t�3�f 7 T� E ERIASI H,IS TO ta41Vt�Ttt5'IP�C3 3G�T Y REflU Eti4taT. �Rld.OR C�7,";GMCN OF€�f Q�a RACT t�f��Ta ER 4€�I^�EF�Y�JiTH RF SPECT T4 V44, C P THIS GsRT4FlCATE tAhY 8E t5i L7 CNS YA,N.CHs gURCE 6 caa; 1=XC..i I,Vc*.�'a AW C( lT 'kN9 CF SLw`'ti r`�t1^�kv'E5.L :sTG '.xL 'k RA rot s e 'E 8 ;7+4 Efi}I7Y d Tr G£P+&WP:4t Es V'-0 sra�.' -e 3 m,•••:.....- CC R4 czieiaC esP6 tY r. o�xr 'lam ca�eas.aua> rsr.PCS& 34sti ow,a?:3z1 szp. i_•t. C;pS^. t AUT 13a4 .ri•' '^'� " 6uFi�.Y W.S<38.Y S »vY-�'➢ ^.+... l Wv AUTO �''�' SY €C�t�A;.� A t*s't ma3 `.i j#, a T4, eeca c^R�=S S El LirA OCN,�r haGATF Y6�R9 C Y'V3 i � s-t€,+w-r,SFfiiXF,`. '•l 7.'x`3 AA0tEtot#'YaS'61AYffi!YY .il .Q3 "yycy�Frc{E o"I-dYh>;ILEYcf3J7S UES€ `iKke pF Ga;,WiY �'pecxa ! ERTIFICATEHOL€7Eft sr?eatdt�+`(` 3E F����=sc�rafs r� BF a-Lt PasI e�rG RE C � ?5t=C,,PIR4Tr4M WE"8EAEGf*k0 a CC S -! 6Ei(�,L��e� Aa.,LGt'fi..«{C S"ttT'si'C4+ P�3_ 'Y ' Y4 ' Ytl�Qtx's W i RI-t rt,.iS�..F P' R�lj, -'�•-�, contractor Svcs { �#wt1k0Y61t�lrr ��o�r11F `'`. 'ga5�litt'�; BRAC 3139 ACc3 D 25(2010105) DATE(MMIDDIYYYY) AC40R0® CERTIFICATE OF LIABILITY INSURANCE 7/7/2015 EN THE ISSUING INSURER(S), AUTHORIZED HIS LY OR NEGATIVELY AMEND, EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES THIS CERTIFICATE IS ISSUED ASA VETTER OF INFORMATION ONLY AND CONFERS NORIGHTSUPON THE CERTIFICATE HOLDER. T CERTIFICATE DOES NOT AFFIRMATI BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT B REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. ertain policies may require an endorsement. A statement on this certificate does not confer rights to the IMPORTANT: If the certificate holder isan ADDITIONAL INSURED,the poltcy(tes)must be endorsed. If SUBROGATION IS WAIVED,subject o the terms and conditions of the policy, certificate holder in lieu of such endorsements. CONTACT Nancy Usher — -- NAME: FAX (413)534-7874 PRODUCER PHONE (413)536-0804-_ �C ncy, Inc• AIC No Ext: - Martin J Clayton Insurance Age E-MAIL — NAIC#. 1.649 Northampton Street INSURERS)_AFFORDING COVERAGE _ — - ADDRESS: _ - - NATIO --- p, O. Box 989 wsuRERA:Nationwide Mutua_1—H_a_r_1_eysville_-.-- - Holyoke MA 01041-0989 --------------- S _ ------- wsuRERe_Allied World_Natl Assurance_Co -- -------- Holyoke ___ INSURED INSURER C=_ - Gauthier Insulation I -_--- NSURER D ---- _ 44 ESSEX ROAD - - INSURER E:_ -- MA 01938 INSURERF:IPSWICH REVISION NUMBER: COVERAGES CERTIFICATE NUMBER:CL157701379 Y REQUIREMENT,TERM OR CONDITION OF ANY HE POLACIESD OCRIBEDTHER O HEREIN IS SUBJECT TO ALL THE TERMS, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEET ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERI CH THIS INDICATED. NOTWITHSTANDING A __---__-- CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY Po_DY EFF POLICY ID CLAIMS. uMITs EXCLUSIONS AND CONDITIONS OF SUCH POLICIES. IMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CY XP-1 LAIMS. 1,000,000 INSR POLICY NUMBER LTR I TYPE OF INSURANCE EACH DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY PREMISES(Ea occurrence)_ --------- 5,000 A CLAIMS-MADEFX OCCUR 7/6/2015 7/6/2016 MEDEXP(Anyonaperson $- —------ -- $ X G143487F - 1,000,000 I PERSONAL&ADV INJURY - 2,000,000 GENERAL AGGREGATE $J 2,000,000— GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $_ -- PRO- LOC $ X POLICY❑JECT LL COMBINED SINGLE LIMIT $ _ OTHER: Ea accident AUTOMOBILE LIABILITY BODILY INJURY(Per person) $- --------- ANY AUTO BODILY INJURY(Per accident) $ —- ALL OWNED SCHEDULED PROPERTY DAMAGE $ AUTOS AUTOS (Per accident)_-_— ----- NON-OWNED HIRED AUTOS I _ AUTOS 1 000 000 EACH OCCURRENCE_ $—- - ' AG _ ,___.1,0001000 X UMBRELLA LIAB OCCUR GREGATE $ ------ - EXCESS LIAB CLAIMS-MADE BE020792125-194985 10/18/2014 10/18/2015 $ B PER I DED IOTH- RETENTION - STATUTE_L- ER- ------------ WORKERS COMPENSATION _E.L.E_ACH A_C_CIDEN_T _- $--. __---- AND EMPLOYERS'LIABILITY Y 1 N ANY PROPRIETORIPARTNER/EXECUTIVE N 1 A E.L._DISEA_SE-EA_EMPL_OYE (OFFICE E BERMandatory In NH)EXCLUDED? E.L.DISEASE-POLICY LIMIT $ If yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,may be attached if more space is required) CSG, NSTAR AND NATIONAL GRID ARE LISTED AS ADDITIONAL INSURED CANCELLATION CERTIFICATE HOLDER SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION TPOLICY PRETHEREOF, ONCE NOTICWILL BE DELIVERED IN MASS SAVE PROGRAM CONSERVATION SERVICES GROUP, INC. 50 WASHINGTON STREET AUTHORIZED REPRESENTATIVE WESTBOROUGH, MA 01581 �<�--•a'-��•�".�_��� Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD pri � ted with pdfFactory trial version www pdffg9t_ -com M hus is-Department of Public Safety Board of Suiiding Re ufntions and Standards 4�iSkg*i�3"$(4''Ltde d$ 'wkE�}va a��YSkr�$1§,4tte.t&4 Licenac GSSG.-1026162 KURT R.GAUMOR P.aBox 1 - 4swich MA 8191' 752 r as tsr xpir vtion santrr 06!"lSIZ'Ct17 office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type= Individual Tr# 257812 Expiration: 101112016 KURT GAUTHIER KURT GAUTHIER P.O. BOX 344 _ ....._... IPSWICH, MA 01938 _. _. update Address and return card.Mark reason for change. Address Renewal '—`, Employment Lost Card sCa 1 0 =0in-9511 l,,icense or registration Valid for individul use only Office of Consumer Affairs&Business Regulation before the expiration dam tf'found return to: �'" poME IMPROVEMENT CONTRACTOR pace of Consumer Affairs and Business Regulation '+} egistratiorr 173410 Type: 10 Park Plaza-Suite.X170 expiration: 1011!2016 Individual Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD tw ,e% _.___. IPSWICH,MA 01938 Undersecretary of valid wi aut signature