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HomeMy WebLinkAboutBuilding Permit # 12/14/2015 OORTH BUILDING PERMITa D .." .06 4% TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received ATED �ssaetaus�t Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION V CtA �-4C;tk Print PROPERTY OWNER k6-uuma Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Res*d ntial Non- Residential El New Building One family El Two or more family El Industrial ,ddition Alteration No. of units: 0 Commercial p eR Dair, replacement El ri Others: eplacement Assessory Bldg [I Demolition El Other Milli rr � l J / 1 / � � / // DESCRIPTION OF WORK TO BE PERFORMQ: OL ir I s r` C,Vh Identification- Please Type or Print ClearlyPhone:q-M �Ob�0 '7,Vi� OWNER: Name: ��QLCAJC�Z Address: q 0 Contractor Supervisor's Contractor Name: Y-/J A-G-0,J Phone: C1 3 34 3 0 ntr' Email: "Vy\ Email Address-"/?0 6,3t Ig h A- 0111310 Sup Supervisor's Construction License: Exp. Date: Home Home Improvement License: l Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ ILD�-U . OcA FEE: $ Check No.: I Receipt No.: NOTE: Persons contracting with unregistered ontractors do not have access to the uar my fund t%ORTII ctover f An ' ® ., . ® ✓ C% h Ver, SSS' C1� coc.ucNewcx �1' p®RATED �S ll BOARD OF HEALTH PE Food/Kitchen Septic System�Rm D ® BUILDING INSPECTOR THIS CERTIFIES THAT . ""° Foundation has permission to erect buildings on ......... A °" Rough A %.. ® .......................................... Chimney .. .. 10 IS* . to be occupied as ......... .... Final provided that the person accepting this permit II in every respect conform to the terms of the and on file in this office, and to the provisions of the Codes and By-Laws relating to the Inspection, PLUMBING INSPECTOR Construction of Buildings in the Town of North Andover. Rough VIOLATION of the Zoning or Building Regulations Voids this Permit. Final ELECTRICAL INSPECTOR PERMIT EXPIRES IN 6 MONTHS Rough UNLESSCTI ,° TS Service .................. ...... .. ... Final BUILDING INSPECTOR GAS INSPECTOR _ ccuancy Permit Required t® Occupy Building Rough Final Display in a Conspicuous lace on a Premises —' Do of Remove FIRE DEPARTMENT No Lathing or Dry Wall To Be ®one Burner Until inspected and Approvedthe Building Inspector. Street No. Smoke Det. Z. z1 Federal ID S 08 0405bzg Rt Contractor Registraton No 0186 RISE Engineering KA Contractor Registration No 120975 CT Contractor Registration No 620120 A division ofThieisch Engineering y���+a 60 Skawalut,Canton,MA 02021 CONTRACT 339-502-5197 FAX 339-502-634 ��yr a�ys Page 1 3i v PROGRAi4I r}p5 CONTRACTI,EMRM"go sent/ aME ENGINEERING CMA-HES E»cuira�+ AWICCMTO+enraxvmaxAs oEOCn�En BELOW pnONE DATE CUMTI worut OOom cu"OHER {478}686-2244 06/t0l2015 405553 4000 Sebastian Iacono BW.Wo 5YBEEY sEnvICE sTREEr 40 Meadowview Road 40 Meadotivview Road eu.ulra coy,STATE,LP sMYice CnY,STAM21P North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Pl iASE ONE-Proposal for this colendar)scar. AIR SEALING:Provide labor and materials to seat areas of your home against wasteful left w air healkmkathfc.ul This work will h performed and in in concert with the use of special tools and diagnostic tests to assure that your home will bO left with a heaitht'ut revel of air c+dlanbc and indoor air certify.Materials is be used to seal your home can include cauil:s,foams and other products. Primary areas far seating include air leakage to art"tcs bosentntts,attached garages and other unheated areas(windows are not generally addressed.) This will require(8)working hours. A induction in cubic feet per minute{elm}of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion ofthe weatherization work,ad at na additional Iasi to the homeowner,a tart blower door andlar combustion safety analysis will be conducted by the sub-contractor to ensure lite safety at'thc indoor air quality. $680.00 AtR SEALt1�IG ADDER: (4}working hours, $340.00 DAMMING:Provide labor and materials to install a d 2"layer of R-38 unf-aced fibcrgiaSs batts io(130)square feet for damming purposcs. S266,50 ATTiC FLAT:Provide labor and materials to install a 4"layer of R-32 Class I Cellulose added to(2113)square feet of open uttic space. S3,021,39 ATTIC ACCESS:Provide labor and materials to install(1)easily moved,insulating cover for the attic access folding stair. lite cover has integral weatherstripping to restrict air leakage. 5200.00 VENTILATION:Provide labor and mate is to install ventilation chutes in(26}rafter bays to maintain air dols. $5x,00 RISE EngiColumbia ening W111 offers 75%incentive nolt to exceed$2,000 per calendar yen, nu d an t'naeintivelof loo°lo forthe Air tSealing measures meast up to the first$680 and an additional 5340 if savings arc justified by the auditor. For agnastic t both before tite beg �,and after the weatherizzu nalth oryour holes indr air quality,%Vc lwork is compictc.blower will also conductavaijabla air home a full lrassessment Of Ole a in your combustion safety ofyour heating system and water heater.I'his has a vatue OC$90 and is at no east in you. Total allowable weatherization incentive is$3,1 to. S90.00 Federal ID#OS-MS629 RI Contractor Registration No 8186 RISE Engineering MA Contractor Registration No 120979 A division ot'i hietsch EngineeringCT Contractor Rogistratirnt No 620128 60 Shawmut,Canton,N 02021 CONTRACT 339 502-5197 FAX 339-502-633a Page 2 SE PR0GRANI TTIIS CDMRh=B ENTERED INTO eETYtEEN'ME ENGINEERING CMA-IIES ERcurErssulCam IIEcoaTWERFORMAXAS DEscRmmee.ew PHORE DATE CLIENT WORK ORDER CUSTOMER, 015 405553 000133 Sebastian Iacono (978}686 2244 (16I ansnsa STREET smv"STREET 444 Meadowview Road 0 Meadowview Road °� }(}{� r.STATE,ZIPtti U q 1 (_ L 0 SERVICE Clio,STATE,rtP CIT Notch Andover,MA 0I 845 North Andover,MA 01845 JOB DESCRIPTION Total: $41650.09 Program Incentive: $3,099.99 Customer Totat' $9,630.90 WE AGREE HERESY TO FURNISH SERVICES•COMPLETE IN AccoROANCE VATH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand Six Hundred Thirty&901100 Dollars $1,630.10 UPON FINAL WSPEGTiON AND APPROVAL BY Rt5£VXDIFFANd.CUSTOMEn A11111TOIL£a ,RICi nUE 01 FULL INTEREST-OF 1%vsLL.6£CIUfRGEO AION11tLY ON Alf! UNPAn)BALJWC£AFTER IO TIAYS.SEE pE'1tFnSE FOR tEdPORTANT II#ORIdATWIt ON OtiARAHTEEsit1GI1T9ofAEC131QN,SCN3WLINO.AND CDIfTRACTDR R£GZ3TRATHIN. DO NOT lblun THIS CONTRACT IFTHERE ARE ANY BLANK SPACES J l� DNERACCEPTANCE .� TURF•NSE En9icentin0 NtrtE:TIL4 CONTRACT IrAY S£vATHDRAVRI aY I15IF NOT E%ECLFTf1IVATfDN DAT£OFACCEPTANCE ACCEPTANCE OF C012TRACT.THE ABOVE FRKFS,SPECIFICATIONS AIM CONINneNS ARE IM ARE HEREBY ACCEPTED- 34 DAYS, AS 5_P£CIFTED.PAYIdENTVALr-eE.ktADE AS OiIT WT£O OAeOV£AUTNOR¢ED TO DO THE We" OWNER AUTHORIZATION FORM (Owner's Name) owner of the property located at (Property Address) P. A r-tb&'� VkA� uS �-3) (Property Address) t /p 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 Date EUVE jUN 1 2 2015 Fite(,tofntnonweallh o Massachusetts Department of Industrial Accidents office of Intfestiatt`ttrts I Congress Streel�Shite 100 Boston,MA o2114-20I7 www.mass-90VIditt '4#crrkcrs' �,mpensation insurance Affidavit•. Builder:�i o>3tractorslElePleose Print� ihl A ties--information Nc'tfYie 31intt'Itadia- 1131); Address-' .00 OX 01 Phone el: ` City/-#a# tr i :. 4t1 T .i y pe rsf protect(required)` .Are you i n employer`,Check the appropriate box, #. [3 1 am a s4 neral contractor and I [ New construction 1. 1 am a employer evith. ' __._.__. hd4e hired the Sub-contractors _ emplt>pce,-(full antvor part-time),* Iisted on the attached sliest. 7. � tterrt€7dz:{irtg . I arra a sole proprietor ur partner 1 h�,e huts-coluractots have 8, C)DetnolitiOn ship and have nes trnplisyccs emptc�}a:c�and have workersg. [3 f3uiidin x adclitictn working for mc'in any capacity°. comp.insurance, o woricsr5'camp,in uitco 1Ch[ h_lectrieat repairs or additions S C) we ars.a c�rporatttxt and its requiTcd.] officers time exercid seAsir 1I,[ Phtntl?in repairs car additions 3. 1 am a homeowner doing all Work right tii c Xempfic>n per MGL 12,(3 Roof repair: myself.LINO worker"'' ct>tnp. c 152, 1(4),and We have no 1 I.[)t)ther insurance required.]t etttptoyecs_[No Workers, uirsd. t-otraft.insurance fK1tl (itis' mR'm3tiLS?p.. ;Anyapptie zrharchecks4av t1m aim' fill out cGcnnntaltiShutsiiE tt�arcw�#c€� Eomff: p Y I.h eahi�w¢ta the Statrte of arta�ytb surata s tc a�ate state whether ar itoa th�sv cnstttss hra r B c,nrtaax what qub-ni tht affidavit1m i ��a�ata a�.doing all�s,k.and t�.n hm em'16 C c tmrsctnr4 mint submit a n�aflxd��'it it lx ct,n}�u h. erriitractors that check this ba',snub attache+ urs toy _ If the ontta�rs ha'c rp#np xs<racy Munk prinisir f-wi' nci, tis'corp-p 3icy 3,c�utha, tib site layer that h I,rntidirtlr Hctrkerti'crattrpen-Vad an insurunee fir Rk employees. Below is the�ctticy andjob to an an ern P information. _ Insurance company Matte: [_A. 't 1ST� ► �� i L� Expiration DAte;A Policy#ar Self-ins.tic. r: ' _ r 1 (1 �n .(1 i.� \�l L P� \ �Q Job Site Address:"I�/ l. t'ttAch a copy of the rt orE:ers'COMP en ptstiCy declaration pale{show�tnl�rite policy number and expiration date). sirion of Criminal Failure to securer coverage as required tinder nein 25A Of Il:s\4civil penxi c3 t le tic ooto rs�trOra�S1 Op WORK OPMERtand ies a fine litre up to SI,Stlt).t0 andsor ane-year itnprt,_v of up to$'5Ci.tlll a day against the violator. Be advised t tic�n.eop�'`sf this statenrettt rosy be fc�ruarded to tlzc�l�tce of investigations of the DiA for insurance coverage � __est under the pains arty!penalties rxf perlurt itsar the infrartnatt®rt praakcttea'abut e is trite a+tu�,,, I do hereby certify F (g "i ilia Lure: Phone 4� (yfcial use rainy. Do nut ti,rrte to this ares,to be ccsrnpleted by city or town Official. Permitll,icettse City or Town: IsiIttfrirrtc one): t.Board Authority tt 2. le on - impartment 3.cityrrown Clerk .I tcctrieat incpeefor 5.i'tumbin Iusts kvr 6.tither Phone — contact AC"RO CERTIFICATE OF LIABILITY INSURANCE Tri CECERTEFICATE IFS.IYfSi r"tRA^A N ELYT EG 'i E YT.I°1E , (it'i i3RION ONO!MID ,V *ALTER-fti£Co EP4 E cFr`GRtlFE3 EC�TS iY THE POLICIES 35 GERTIFYCATE DOES 6ELOW� THIS CERTIFICATE CF SNS 7 E GotR FDC,S€5 NOT Oti ET€TtfTC Q CONTRACT B��i6#E #d?YE 1 5 tNG tt St)REP(S),At1T�{SRSZED tv?Lft� RtESDER E#TA?TY€DPL CRt3ULiLR, iMP{4RTE NT:If tt c�rtff?'ata Irk e c ¥S TTSC} k t u m encf serrQnt A Cafem r#en itt' t fYf ® dots o ccs f r tights to the terms and candet�ons dt tf e�6kY. �` c tt+Ecata halder in lieu OfSuche�zto earsent(s}. _ vt3€ BCrki�+Y A;siti*d Risk Servlc@s Clayton Martin J Ens Agency h- 4d U}634588 n r (866)215-8118 i #sten St PC]BOX 989 s r� dot cy �&kcvm Holyoke MA 01641 n rvs< t ck�a�� deg r G&Utj"r Insult On IrtG a c_ pO Box 344 Ipswich,MA 01038 CU CEFtTiP3 AT£ SII B£R. #tEiti$K?-i CVE R: H: iS a c Ti�AT Ti,_ii�s QF�a�u �e Ls� eta t �k>tv�s�sa,�su�D TC T,e a �u�in ago ix�Icv� IDIS aDiGA' 7,t+ND'i l'1R7t45`TAIv'Dtf+`a AkY R $YA 3 7}i 8 9:RAfaCly¢ D EiY 7 E f"�I.a S DESCRIBED E'�l`d S SUgjE. STO�+Lt..�H:E TEPiA�c+�t$ GERTi>iGATE tdAY 8E 1s5tds t bt# EC''CED RY i�,41i5€�".Aa4.t._�. ¢t t R eP;fu�£s;�cia ,rue - GL:k�t�Re,c:s-crueePc":.u�sarh° C7,dS-i.?E t __. _ � P3#f7•Y".'"#-f'O�"'`.x'31,=.`� ILAMAY 6+.i4.v WJ'a.', Y Isar G4tG e' $ AUTP .4ik O#'Ei'� @tzba.v d+!:s..*"�;�a+aCYRfs°+�i it§ TKSFO�a ❑S��`i{ Et A005 ^v Y ryaesar.:� tFCN-G'AtF45� fit a9�`t ALM& sFNKir&tiL'�29� [l OCCkr iR tLa� L- r,Cva£Csa?F T E%C€31FAM Eli itl #9 C.QFTr4re yet cLE,�x.aC�r.1.�:`. f Y:s.t�?J:� Aj,y �L at txt v �? —7 t9A4RP 7 Sa'si:k15 '.'3 121211 snra4 ca.. .,acs='vt ' S [ 9X5G*'i�''•gN PFCd;;rzAY++Ssa"S6 1 .-}L _ �?, tRdf&h < ;.5, Mi.a*x*¢a:ti',a�-ir.��•rs s'rA_c=t'F#.*"c1F ��rGfi CaeerAay ks�s•.0:?ad4 3 pp yy �y f� G 7i'~ICATE titrl DER si,cwtz�nur`�t�€ 3��l�sc�i�€a>� �_�s s�z a r BEFORE EW#,5tWo"ugq1h1, WT CENl8ETHE astn+;Y c ra. rast 6151 l r 'k igttature: 8PAC 3139 AtORi3 25(2010105) DATE(MWDDIYYYY) ACQR®® CERTIFICATE OF LIABILITY�NSUoRANC�EHE CERTIFICATE HOLDER. THIS RTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY A AUTHORIZED THE CERTIFICATE DOES NOT AFFIRMATIVELY OR NEgANVE CONSTITUTE A CONTORACTTBETWEENOTHE IISSUINGFNSURER(S)TAU POLICIES BELOW. THIS CERTIFICATE OF INSURANCE DO REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. 77 policies may require the endorsement. A statement on this certificate does not confer rights to the IMPORTANT: If the certificate holder is an ADDITIONAL INSURED,the policy(ies)must be endorsed. If SUBROGATION IS WAIVED,subject o the terms and conditions of the policy,certain p CONTACT Nancy Usher AX---- ---------- certificate holder in lieu of such endorsements. y - ---------FAx NAME -. 80 (413)534-7874 PHONE (413)536 0804 -__I1AIC No)_ ------- PRODUCER g y Inc _(AIC No Extl ------------ _------- Martin J Clayton Insurance A enc , EMAIL - -- -- ___- r ADDRESS__. --- NAIC#--------- --- __. 1649 Northampton Street INSURERIS)_AFFORDING COVERAGE- -_ - _ --- `NATIO P. O. Box 989 INsu!ER atignwide_Mutual-Harleysville-- MA 01041-0989 —_— - - --- - Hol oke -- ____ __—-------------- INsuRERs_Allied World Natl Assurance Co_ _ _ -- -- INSURED INSU RER C_-__._---------- - - t Gauthier Insulation INSURER-Pt-------------------------------------- L 44 ESSEX ROAD -- --- -- INSURER E_____.------------ MA 01938 INSURER F: IPSWICH REVISION NUMBER: COVERAGES CERTIFICATE NUMBER:CL157701379 IOD REQUIREMENT,TERM OR CONDITION OF ANY CONTRACT oDD�CRIBEDOHERE N IS SUBJECT TO ALL THE TERMS, THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR TECT HE POLICY PER INDICATED. NOTWITHSTANDING ANY REQ -_-- -- CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURANCE AFFORDED BY THE EFF POLICY EXP LIMITS EXCLUSIONS AND CONDITIONS OF SUCH�DDL POLICIES.LIMITSLIMITS SHOWN MAY HAVE BEEN REDUCE DD BY MM DID CLAIMS 1 000,000 INSR POLICY NUMBER TYPE OF INSURANCE EACH OCCURRENCE ---- -- LTR _-------- LTR DAMAGE TO RENTED 50,000 X COMMERCIAL GENERAL LIABILITY $- PREMISES(Ea occurrence 5,000 r CLAIMS-MADE X]OCCUR 7/6/2015 7/6/2016 MEDEXP(A_nyoneperson) ---1 000,000 A I —I — — X GL43487F r �PRODUCT PERSONAL&ADV INJURY $ 2,000,000 LI GENERAL AGGREGATE 000,000 I--� S_COMP/OP AGG $------- PRO- --2 -GEN'L AGGREGATE LIMIT APPLIES PER: I ---- ---- $ X POLICY O JECT LOC COMBINED SINGLE LIMIT $ - OTHER: I l�Eaacciden�_ —. - _ - -- AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ BODILY INJURY(Per accident) $ ANY AUTO _ _ ALL OWNED SCHEDULED PROPERTY DAMAGE $ I _ AUTOS SPer accident_--_-_— ---- _ AUTOS — NON-OWNED I $ HIRED AUTOS AUTOS 1 000 000 t- $----�--i-_-. EACH __.—_ 11 AGGREGATE ---- .000,000 44 X UMBRELLA LIAB �_- OCCUR --- - I $ EXCESS - 1--1 CLAIMS-MADE 10/18/2014 10/18/2015 OTH- B II —_-- I BE020792125-194985 DED RETENTION STATUTE _ ER ----- - WORKERS COMPENSATION I E L EACH ACCIDENT-._ -$-- --- -- AND EMPLOYERS'LIABILITY YIN E.L.DISEASE EA EMPLOYEE$__ -.-.------- ANY PROPRIETORIPARTNER/EXECUTIVE ( NIA OFFICER/MEMBER EXCLUDED? -- E.L.DISEASE POLICY LIMJ$ (Mandatory in NH) If yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS I LOCATIONS I VEHICLES(ACDRD 101,Additional Remarks Schedule,may be attached ff 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 THEACCEXPIRATION WITH HE POLICY PROVISIONS. SERVWILL BE DELIVERED IN MASS SAVE PROGRAM ICES GROUP, INC. 50 WASHINGTON STREET AUTHORIZED REPRESENTATIVE WESTBOROUGH, MA 01581 : Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD MPIMMbd with pdfFactory trial version www pdffactory-Com k Massachusefts-Department of Public Safety Board of Building Regulations and Standard License:t�5��tq�582 P.a Dox 344 Ipmkh MA 0I93� r �r 4 Expiration f Office of Consumer Affairs and Business Regulation ` 10 park plaza- Suite 5170 Boston,Massachusetts 02116 Home improvement Contractor Registration Registration. 173410 Type: Individual Trig 257812 Expiration: 10/1/2016 ..... KURT GAUTHIER _ ." ........... KURT GAUTHIER . e _. P.O. BOX 344 IPSWICH MA 01938 Update Address and return card.mark reason for change. Address `.._ Renewal 7 EmploYmeut i_..._{ Lost Card SGA 1 *:x y,: .orriuciru.'c ( r ^!l r.usr rrul License or registration valid for individul use only Z,' Office of consumer Affairs&Busiuess Regulation before the expiration date. if found return to: IilOME IMPROVEMENT CONTRACTOR Type office of Consumer Affairs and Business Regulation egistration: 173410 IO Park Plaza-Suite 5170 Individual expiration: 10I1I201ft Boston,lvIAOZ116 KURT GAUTHIER KURT GAUTHIER r 44 ESSEX RD -JL IPSWICH,MA 01938 Undersecretary of vali4wit ntsignature