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HomeMy WebLinkAboutBuilding Permit # 12/14/2015 t%ORTH BUILDING PERMIT Q- • 6 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received k- Date Issued: LA ,. IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER Print 100 Year Structure yes 0 MAP 0 PARCEP�C) ZONING A— DISTRICT: Historic District yes no Machine Shop Village yes n Do TYPE OF IMPROVEMENT- PROPOSED USE Residential Non- Residential El New Building PrIbne family ❑Addition El Two or more family [I Industrial Alteration No. of units: Ll Commercial [9"Repair, replacement ❑Assessory Bldg [I Others: 11 Demolition ❑11 Other Erg, 1711,111,111111-11,11 DESCRIPTION OF WORK TO BE PERFORMED: I I i in bo- Identification- Please Type or Print Clearly OWNER: Name: RUAA. 6rh-c) Phone: Address: I Z,6� & Contractor Name: VA) V uW 14A if Phone: ;Tlo Email: Addres Supervisor's Construction License: 1k3-bVJq —Exp. Date: Home Improvement License: 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: $ Z11 FEE: $ ✓ Check No.: 70 Receipt No.:171-1-1 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund J Siq ' na Sip! gaORTH Town ofPAndover 'r. ® -z 0 NOO ' 9a Z4115 t _ n h . ver, SSS' LAK. F o cocM1cHew�cx UBOARD OF HEALTH PERAr 41 Food/Kitchen T L mumok Septic System THIS CERTIFIES THAT ............. BUILDING INSPECTOR. RFoundation has permission to erect.......................... buildings on ..... • ...... .......... . . ..... .... .. . ..... .:............... ® Rough tobe occupied as ...... .... ...... .. .. ........ ..®. . . .. .. .......................................... Chimney provided that the person accepting this permits all 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 I IN 6 MO TIall S ELECTRICAL INSPECTOR PERMIT EXP UNLESS 1 Rough ON Service ................................................................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Buildin,:; Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final Lathingor Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. ib# RISE Engineering qC C r dnrizealstraticnNo A division of Tbidsch Eagintering AUG2015 R�isonNto 605bawm t o t 1 C TRACT 334-502 5 �+ Page 1 R S y. PROGRAM G no cottrnncrrs0rrmr oINTO natwaEtt wsr � CMA-HPES nMIESU OS OUMMsrobt PORIxNMAs ENGINElERIhIG CNBTtlMEn PHONE DATE 01.090 WORKCAmEa Mark Bethel (978)979-2207 08/07/2015 421034 00003 3 sranne>=.sem` � awNa srnE�r 129 Moody Street 129 Moody Street Sow=cnY,STAT r2a' w"c cnY.5rAM-MP North Andover,MA 01845 North Andover,MA 0 1845- JOB DESCRIPTION HEALTH&SAFETY:Weatlteriration wort:cannot proceed until the insufficient draft issue is fixed.BOILER SPHIS FLUE GAS! $0.00 AIR SEALING:Provide labor and materials to seal areas ofyour bomc against wasteful;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 healthful 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 sealing include air leakage to attics;basements,attached garages and other unheated areas(windows arc not generally addn:ssc&)This will require(8)working hours.A reduction in cubic feet per minute(efin)of air infiltration will occur,but the actual number of efin is not guaranteed. At the completion orthe weatlterization work,and at no additional cost to the homeme,a fmai 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 rDAM EALING ADDER: (2)workinghours. $170:00 IA NG:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass butts to(2o)square feet for damming purposm- $41.00 ATTIC FLAT:Provide labor and materials to install an 8"layer of R-28 Class i Cellulose added to(1126)square feet of open attic spare.BOILER SPILLS FLUE GAS/THE TOP 3"LAYER OF ATTIC IBSULATION HAS THE VAPOR BARRiOR FACING UP, THE HOME OWNER HAS SLAHED THE VAPOR BARRIOR/ $i,,534;4t1 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(28)square feet of kneewall area.THIS IS GABLE ENDS OF VAULT. $98.00 VENTILATION:Provide labor and materials to install(2)insulated exhaust hose with soffit mounted flapper vent to exhaust existing bathroom Ian(s).ONE IS A KITCHEN VENT. $237.50 VENTILATION:Provide labor and materials to install ventilation chutes in(28)rafer bays to maintain air flow. $56.00 BASEMENT CEILING:Provide labor and materials to install(28)linear feet of R-19 unlaced fiberglass insulation to the perimeter ofthe basement ceiling at the house sill. $49.00 RISE Engineering will apply ail applicable,eligible incentives to this contract You will only be billed the Net amounL Currently, for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100°/0 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 nit quality,we will be conducting a blower door diagnostic ofthc available air flow in your home both before the work is begun,and after the weatheriration 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 weatheriration incentive is$3,110. $90.00 Federal 100 RUSE Engineering RI Contractor Registration NO NIA Contractor Registration No A division orThielseh Engineering CT CoMrartaN RagFsbtitsR Na 60ShowmutVolt 02,Canton.HA02021 CONTRACT 339-502-6335 FAX 339-502-6345 1r RF[Lr Page 2 PROGRAM CMA-HES ENNb ANOMCUS FnariwRKKAATM S ENGINEERING nEsau O ow CUSTOMER PHONE OATS CLMM# WORK ORM Mark Bethel (978)979-2247 08/07/2015 421034 00003 SEMCe numG 5T�REEr 129 Moody Street 124 Moody Street sawce CDY.STATE.DP WIND CTM3TAW ZW North Andover,MA 01845- North Andover,MAOI 845- JOB DESCRIPTION Total: $2,955.80 Program Incentive: $2,459.93 Customer Total: $503.98 wa AGREE HERESY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE VM ABOVE SPECIRCAnONS.FOR THE SUM OF 'Five Hundred Three&981100 Dollars $503.98 UPON FONAL DISPECTtON AW APPROYALOY NUKE ENWttEMM CMCMER AMUMg TO W WAMOUNT DUEUNMLL OITMM$TOF t%YALLEBCNAHCED NTT-ON ANY UNPA9NEALAhtCEAPTEf't30CAYS6EEi VER$EFORtbb'ORt'AHTINFOTUTATIbNdN GUARANTEES,RSORTSOFREMOKSCNEDIJUNO;ANDCONTRACTORREOWTRAT= DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES Robe�(,1.92WS) ✓ t AUf110Rfti:DBhTNATUAe•RLSEEaOimetiey CUSTOMERA ANCE NOTE:T96 CONTRACT MAYSEWITHDRAINN UYU3 IF NOT E7tEGitTEn%IWM DATEOFACCMANCE ACCEPTANCEOF CONTRACT-THEASMf-iUO N,SPECIFICATnON9 ANu CONOMM ARE 30 OAM SATOVACTORY TO US ANO ARM HEREHYAC+CEFIEU.YOUA"AUTROMW TO OOTRE WORK As Spwmw..PAYMEKTmmm MAnEAs ouTu mABOVE i OWNER AUTHORIZATION FORM (Ownses Name) f owner of the property located at (Property Add ) • I✓l� wed, 472c? (Properly ddress) hereby authorize (Subcontractor) an authorized subcontractor for RUSE Engineering,to ad on my behalf to obtain a building permit and to perform work on my property. &-04 G + owner's Signature ` Date The Cf)mr onwealth of Alasstrchusetis Department ent of Industrial Accidents Off,ce of/tttjestigatt`rtns 1 Congress Street,Suite 100 Boston,MA 02114-2017 yf www,nllass.gov/dia worke"'CCompensation insurance Affidavit: Builders/ContractorslElci'1easeai'rint Le i it Applicattt liifarmutiou Name(Busin�ssJClrk�rt fatroit`�<��iri�u�t�; { fi t 1 � YIA, — cit}/Statei 2i W I ' l PilC3i3t< � Are you an employer"Check the appropriate boat l'ype of project(required): 4. 1 am a general cunt�ctt r and t G, []Ncw construction I. 1 am a employer with_ ______ have hired the sub contractors employcc:(full andfor part-tiltae).* listed oil the attached sheet. d Remodeling ?, 1 am a sc7ie proprietor or patterer l hL+e pub ccttrtiaito€-s have ;, 0 Demolition ship and have no a.mplbyee-8 ern loyceN and have workers' .working for me in any capacity n Vit. [ Building addition caimp.insurance.° [�To wrrrkerc'comp-insurance y. We are a corporation and its 10,C)Liectrical repairs or additions required_] officers liavc exercised their 11. Pharabing repairs or additions 3'a 1 arcs a homeowner doing all work right t7t exemption r MGL � my%ell:{No work,!M'cotnp. p 12.[)Roof repairs c 15"61(4),curd w have no 13,0 Cather insurance required.]t rtrtploy'es.[No workers' corttp,insurance t'equirecl.] 'Any applicantthat e6eck lx x t must also fill out the---ti<nr txlu��showing Their werkcf�'co"T;nfatiOn Pohcy irrion"ation, *lttrrrr�rrw€rers�A shcck';this aflittuvii incl c tiizr�tl ey,are doing all work and igen/tire}asst°iiz r�ntrtcraes trru t cul snrt a nc� rffi leant insircating sex h. tCcnitracton drat cock th» a t�in atm h n a Iefrarotntt sh:ea shown g the nme Of the sub--cu�:rai`toM 3W stste Whertrer oc rrta those cnrutcs has=c employe m If the sura-contractm la�v rm,len:,t-hey m+i+t Provide cher »uri€er 'cowp.Wic}nuinb, far my emplrrtees. veto» is the policy and joh site I am an employer that is Providing workers'compensation irxsuranee. infortttatinn. Insurance Company Nartte:_ ExpirationL ate: Folic.}#or Self-ins,Lie. �.� C•itl'State%Zip:10 - Job Site Address. Attach a copy of the workers'compensation policy declaration page(showing,the policy number and expiration date). Failure to secure cover-age as required niidT Scetion nrtta nt as.v ll aof s,c,i l pet3 ltics in the form of GL c 152 can lead to the a STOP ositioll of!�criminal t�TtD R and apenalties lfine fine up to 1,500.00 and/or one ycal-lmpn.,o of up to$250,00 a day against the violator. Be acre tsc�t dr t a copy ui thi statement inay be forwarded to the t�fftce of Investigations of the Cil# for insurance coverage verification. _ I do hereby rerhfy under the pains and,penalties of perjuty that the information provided above is true and correct, tcztaturr � Photic t4 I V15 10,SU- 34 a .. .__ t)fft777Meial use r�ntt iJr,not tc,rite in this area,eo be c-onepte#ed by city or town official. (,Ity or Town' Permit/l-icense bluing Authority(circle one): it}f 1.Board of health 2.Building Department }.Cl`or+n Clerk t,Electrical Inspector 5.Plumbing 1nsp�tor 6.other -. Phone , + CERTIFICATE OF LIABILITY INSURANCE NCE Tots C CITE t EssUE� S A 44ATFER JF 1kff3Rk hTiQN+�`+I-•t M1,CONFERS NO RIGKTS u N BtaE CEfET4rtGATi (iJzO�R.taiES CERTIFICATE DOES a:01 ATF10RA';'Ole GA rE Gkh T CC3kt�5TITiT7 A CONTRACT BETWEENHC ISS)Earn INSi RRf•5XTElg,OR ALTER THE Al y AUTHOR17ED BELOW.THIS CERTIFICATE 04 ENSLlk CE THECERTIFICATE ttG-LDER RET'EESE€TTATIVB Det?RUDGC€R, tis re w5t be �PSed.it SV6kUaxATftiN i5 L+JATVeI7,s ta#ett tYr taPz. IPEf 3RTANT:It tae testlf1Psat* r P§aa,AEa E7ED 4AL IhSU SEC.tib I N7 MU- 'tPts and csPnd4tr►tugs Of the pot Ya certam pcI es r'Y(,quP-an er ssament:A statement an th E;eert?tas�tN dots i c-cnf r Piaja,ts taa tfr? cer#s€ca p horser an lieu at r eer nt(s?• BeeKldy k3igtred Risl�Services Clayton Martin J Ins Agency h,c ($25C�j 634-&68B �Na S [86G)SFS 8FF9 a3 1849 ptan St Pt18e%989 t y � ta6iI.1A 9kOhm ' gny..a�:: kAA:S Holyoke MA 01041 � s:usca s mrc€u•.n.A 3132 Gauthftr InSulatlprl Inc F10 Box 344 Ip$wltt+,MA 01938 Cn CEFITIFIGAT hlil $ER t FYI It7E N EId FI Nis I TOC TtAT Tts„1 ud M IE Gf Gc$URA3.t I°aTED� OW KAVE E d aONT TC T� I$ SURE 'U-V (} V41H O 1CY PETHZ RIOD ,N0jj,I 4 TEt f3E 5 s it FAAY RTA#£Nj�tT 4S 4fi E A Fi4 8 7 E UES DES RIEE0 f R£NN IRu SUS RESPECT SL E Tc3?a £x .taStCm€SAhsCC ?fT"SOF5€cH oCTS.LitBtT� reC4YttitiA?=€�L1�9 £t!PC€:�EU9Yt�AiCS€�Ai?rS, t 'ts ter titin uxarcr a,A °«a r:ka vx a er'r s i s TTP. C�#l3€.5 iia c^re%ceI_, FfFo8.1ra4Y.A ALN H11;Xik atw --gm P Sl#SPL V i �.. i ANN ALTOEl �.. }2 5c•;i0R;tsV kf706 �v •IDatw._e .�.. El E £. t Lh LHRH OCCUR z Dnp I�eFk{�1Fj�i$ {—': '�.A• 3Ch OTN. Amon c6 Ar t"makmr r rLE �>£3. x a:3c°ti'? kryroe z€rwr�rrsty=_yam>rnte L� R4l4AF3CS <i 4s3G'. 415 1S.3tr64b - r. ...._ ..7 L ^p.FY.a ". � u�`aca xa;i 5_s. �.,at:�r+•a•*x:rf�3.�R„�s sisa s•>`�-`<c5p ... .W s CAits CERTIFICATE MULJJE st,0VI D 4NY c srt b hE C.Escsc,aE®€-U_;;tEs BE ex €t scFr C THE r,44'ATK*LATE.TtC 14 -SO E cleanest ADc4Rcmzr w?FKTHE Pot ,,, con weator P,sYGB au,o R 50 W80ingtOn Street yyeatborpEx�ttP#�iA 41581 l grl�tur�; , BRAC 3139 ACOdtA 25(2410/05) DATE(MMIDDIYYYY) AC-OR" CERTIFICATE OF LIABILITY INSURANCE 7/7/2015 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(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). CONTACT Nancy Usher NAME:—..— - ----- PRODUCER _. PHONE (413)536-0804 FAX (413)534-7874 MAI Ext _ AIC No): --..— Martin J Clayton Insurance Agency, Inc. EMIL—1 ADDRESS_.— - -- - 1649 Northampton Street — —— INSURER(S)AFFORDING COVERAGE NAIC# P. O. Box 989 —_ — — Holyoke MA 01041-0989 N URERA:Nationwide Mutual-Harleyville — NATIO ---------- - - INsuRERB:Allied World Natl_Assur_ance_ o .—� -- INSURED INSURER C: - - 1— _------- Gauthier Insulation — — 44 ESSEX ROAD — INSURERD ---- — - _ INSURER E: _ - - ----- IPSWICH MA 01938 INSURERF: COVERAGES CERTIFICATE NUMBER:CL157701379 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. -- -- - --- — -- r POLICY EFF POLICY EXP LIMITS INSR TYPE OF INSURANCE POLICY NUMBER MM D Y MM DD YY LTR ,EACH OCCURRENCE _ $ _11000,000-. X COMMERCIAL GENERAL LIABILITY -DAMAGE TO RENTED 50,000 PREMISES(Ea occurrence) --- A CLAIMS-MADE rx,OCCUR 5,000. X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person)— $ .---- --- PERSONAL&ADV INJURY $ _ 1,000,000 GENERAL AGGREGATE _ $ 2,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG�$ C�PRO- D LOC --- . $ ____2,000,000.—._ JECT X POLICY OTHER: COMBINED SINGLE LIMIT--7$ (Ea accidence--. ------_--._—_ -- AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ _ ALL OWNED SCHEDULED — _— - -- AUTOSAUTOS PROPERTY DAMAGE $ 11 NON-OWNED Lr accident --- HIRED AUTOS — AUTOS 1 $ EACH OCCURRENCE $_---_.1,000'000 X UMBRELLALIAB OCCUR1,000,000 _ AGGREGATE $ -_— — - EXCESS LIAB _ CLAIMS-MADE_ -- B — — — BE020792125-194985 10/18/2014110/18/2015 $ DED RETENTION S PER IOTH- STATUTE - WORKERS COMPENSATION AND EMPLOYERS'LIABILITY y/N E.L.EACH ACCIDENT I$ ANY PROPRIETORIPARTNEPJEXECUTIVE N I A DISEASE-__FA EMPLOYE $ E.L. OFFICER/MEMBER EXCLUDED? _ - (Mandatory in NH) 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 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN MASS SAVE PROGRAM ACCORDANCE WITH THE POLICY PROVISIONS. CONSERVATION SERVICES GROUP, INC. 50 WASHINGTON STREET AUTHORIZED REPRESENTATIVE WESTBOROUGH, MA 01581 Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. Alt rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MFIdrNtled with pdfFactory trial version www.Pdffactory.com Massachusetts-Defaartment of Public Safety Beard of Building Reguiationt arvd Standards �"'=a.-tvdt��rek4iraa a�sra�v'a�+a;-�ara^a aatfl�_ License-,t SSL 1��58� t�yy. A'jt'§1 4 gy dKT A GA 7Ji$Wkh iA 019A i Expiration C ✓ Q /�12 ?lZ2(' 'C � l C {:, �1Cllt�i`f% ?G11 ° t1 i J w Office of Consumer Affairs and Business Regulation r 10 Park Plaza- Suite 5174 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 TVpe: Individual Expiration: 1011/2016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER P.O. BOX 344 __ .._. _ _.._.._ ....__. IPSWICH, MA 01938 _....... _W._ ................... ___. ............ Update Address and return card.Mark reason for change. Address ; i Renewal Employment Lost Card SGA 1 0 26M-G5+'11 - f�n 7`nr;,aur>irrnuf/�r f f�rr,.rrr!rt.;../, Office of Consumer Affairs&Business Regulation License or registration valid for individut use only n before the expiration date. If found return to: ,SOME IMPROVEMENT CONTRACTOR � � ; a istration: 173490 Type: Office of Consumer Affairs and Business Regulation fl 10 Park Ptaza-Suite 5170 zpiration. 101112016 Individual .r Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RIDS IPSWICH,MA 01938 Undersecretary `ot valid wi out signature