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HomeMy WebLinkAboutBuilding Permit # 12/14/2015 ................ %AORTH BUILDING PERMIT TOWN OF NORTHA OV i" , .., APPLICATION FOR PLAN EXAMINATION 0 �0 -7 Permit NoIJI, Date Received O"ArED S��c"use Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION Print PROPERTY OWNER 3 fV\r\ W� Print 100 Year Structure yes no MAP PARCEL:b(15-3 ZONING DISTRICT: Historic District yes no F Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential �— [I New Building r One family 0addition 11 Two or more family [I Industrial Alteration No. of units: 11 Commercial Aepair, replacement 11 Assessory Bldg El Others: El Demolition [I Other 10, t DESCRIPTION OF WORK TO BE PERFORMED: d=rA i r\.c4 \,\j Vtzkx- 't k hN J Identification- Please Type or Print Clearly OWNER: Name: Q� l Ll Phone:Cil'b , kO Address: Contractor Name: U Y (J),At/- Phone: 61 -M 3 4-19 3q 9 3 Email: 6NJJ4\-ir/rjr� tQ�m Address. ?Q) (3,::)x. 344 �V-zu�t ()1q36 Supervisor's Construction License:1 LS Exp. Date:_ -1 I'd Home Improvement License: ` 13 1 IQ Exp. Date: I t 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: $ S�v FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund 'q"'nf/Owner,,,- ire",6fd6riffa, tkoRTH Andover Town of �� q. L ® y. to o® C' hVAI'' Mass .rry, coc«Icwew¢x �1' x.95 RATED rP���� V BOARD OF HEALTH PERMIT T LD Food/Kitchen Septic System iL THIS CERTIFIES THATL3 BUILDING INSPECTOR ....................... ...... ...... ......... ............ ....... ... .... . .. �'� Foundation has permission to erect.......................... buildings on ........ ..........................�..... .... ...�........... ...... ....... ...... Rough tobe occupied as ....:...... .........................I..... 1.. .. .... ................................. Chimney provided that the person accepting this per 't s 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 PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO Rough Service ......... ................ .................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy By Rough Display in 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. rt N N eq T� r federal in# RI Contractor Registration No RISE Engineering MA Contractor Registration NO A division of Thielsch Engineering CT Contractor Registration No ut= 60 Shawmut Unit 42,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-502-6345 page 1 Er PROGRAM TFaD eorrTRACT rs ENTERM INTO aewtEER asE CMA-HES ENCINEERINO ARD THE CUSTOMM FOR WORK AS ENGINEERING DESCRUIF0 MOW DATE WERTY ;WIORKOADER : CUSTOMER John Willis (978)685-5663 06/11/2015 415252 00002 SERVICE STREET BILLING sTAEET •�---- .. 2 266 Granville Lane 66 Granville Lane SOMM COY,STATE,LP UILU40 CnY,STATE,ZIP ,MA 01845 North Andover,MA 01845 North Andover, _ __-----. ---JUN6 Mb JOB DESCRIPTION AIR SEALING:Provide labor and materials to$eal areas of your home against wasteful,excess air leakage.This wor will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be left with a hea air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garagos and other unheated areas(windows are not generally addressed) This will require(8)working hours.A reduction in cubic feet per minute(elm)of air infiltration will occur,but the actual number of efm is not guaranteed. At the completion of the weatherizotion 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. $690.00 AIR SEALING ADDER: (4)working hours. $340.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass baits to(20)square feet for damming purposes' 541.00 ATTIC FLAT:Provide labor and materials to install a4"layer of R-14 Class I Cellulose added to(1008)square feet ofopcn attic space. 5 L,139.04 81'ORAGE BARRIER:Homeowner is responsible for the removal of the stored items blocking the installation ofwcathcrization work in the attic. Removal must occur prior to the scheduled wort:start $0.04 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(228)square feet of knecwali area $798.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(I)attic hatch with 2"rigid T hermax board.WcatherstriP the perimeter, $60.00 ATTIC ACCESS:Provide tabor and materials to insulate(1) back of the kneewall hatch with 2"rigid Thcrmax board,and seal the edge of the hatch with weatherstripping. $60.00 VENTILATION:Provide labor and materials to install ventilation chutes in(22)rafter bays to maintain air now. $44.04 BASEMENT CEILING:Provide labor and materials to install(62)linear feet of R-19 unlaced fiberglass insulation to the perimeter of the basement ceiling at the house sill. $108.50 OVERHANG:Provide labor and materials to install I D"R-37 densely packed Class 1 Cellulose insulation to(56)square feet of exterior overhang located below a heated floor arca,by drilling holes in the overhang from below. Holes drilled will be plugged. Plugs will be scaled with exterior grade spackle and left in a relatively smooth condition.Finish sanding and touch-up priming/pointing will be the customer's responsibility, ' Federal ID# RISE Engineering R1 Contractor Registration No MA Contractor Registration No .« A division of Thielsch Engineering CT Contractor Registration No x 60 Shawmut Unit#2,Canton,MA 02021 CONTRACT r 334-502.6335 FAX 339-502-6345 Page 2 R1 E PROGRAM THIe CONTRACT IS ENTERED INTO BETWEEN RISE CMA-HES ENGIHEERINGAND THE CUSTDMERFORWOaK AS ENGINEERING oEscRIEED aELOW cusTONETe PHONE DATE CLIENT vvQRKonoEtT John Willis (978)685-5663 06/11/2015 415252 00002 SERVICE sTRE>=r ��NG sT� 266 Granville Lane 266 Granville Lane SFm"OTY STATE ZIP SWUNG C1TY,5TATE.7JP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION $224.00 CRAWLSPACE:provide labor and materials to install (32)square feet of R-10 rigid Thermax insulation to the crawispace perimeter wail up to the silt and against the band joist.TH1S 15 UNDER FRONT DOOR ENTRY SPLIT! $118.40 IEU D JUNI 1 5 2015 Total: $3,612,04 Program Incentive: $2,900.01 Customer Total: $712.93 WE AGREE HEREBY TO FURNISH sER1nCES-COMPLETE IN ACCORDANCE w"ABOVE SPECIFICATIONS.FOR THE SUM OF ***Seven Hundred Twelve&931100 Dollars $712.93 UPON FINAL INSPECTION AND APPROVAL BY AWE ENOINEERING.CUSTOMER AOREES TO REW AMOUNT DUE IN FULL INTEREST OF f%MnLL BE CHARGED MONTHLY ON ANY UNPNR BALAN APTM 30 DA .SEE "FOR IMPORTANT INFORMATION ON GUARANTEES,RIGMSOFRECIStOKS"EDOUNo,At-C2 CTOR REOtSTRAT{ON. _.� Do cion si Is CONTRACT iF THERE ARE s 'PAC, n oa sIGNATTt - ginxrfAg MER Ace ANC NATE:Y,itS CONTRACT MAY DE NtTNOlUfYM aYUS IF HOT E7tECUTEOWIiHN DATE OFACCEPSANCE ACCEPTANCE OF CONTRACT•THE ABOVE PRICES,SPECDICATIONS AND CONDTnOUS ARE SATMfACTORyTo US AND ARE HEREBY ACCEPTED.YOU ARE SPAUTHORIZED TO DO THE WORK PAYMENT WILL BE MADE AS QUTUNEDD ABOVE 30 DAYS. AS OWNER AUTHORIZATION FORMA T-oAu (mss ) i owner of the property bombed at '1 G� (5,rakl villa Gam- (PropedyAddress) t j • P oy e,( Yn a _ Trop" ) hereby auttsortze tsud C � an m&a twd aftmftcW for RISE EMPneedm,to ad on my behalf to butts 1 6 2015 pmyft and to perform work on my PmPeKy Date The Commonwealth ofMassachuvetts Deparhnent of Industrial Accidents office of In testigations I Congress Street,Suite 100 Boston,MA 02114-2017 wwwmass.goildia Workers"Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Legibly Name 4"_I Mir Ii-i wt&_k.i 01 k Y"A_ Address: '00 t3OX 314 City/State/Zip:_ titl t 01 3B Phone#-: Are you an employer'Check the appropriate box.- 'type of project(required). I am a employer with 15 4. 0 1 am a general contractor and 1 G. New construction mplcvycc,,;(full andlor part-tinie).* have hired the Sub-contractors 1C - listed on the attached sheet.. 7. Remodeling 2. am ash:proprietor or partner- shipand have no employees Thesosub-contractors have K 0 Demolition working for me in any capaeity. employces and have workers' 9_ [)Building addition [,No workers'camp,assurance comp.insurance.," require&j 5. We are a corporation and its 10,C)Electrical repairs or additions 3, I am a homeowner doing all work officers have exercised their I IU Plunibing repairs or additions my-sel f,LN10 workers'comp. right of exemption M MGL 12,0 Roof repairs insurance required]t c- 152,§1(4),and we have no 13.0 Other eniployees.[No workers' comp.itisurance required.] *Any applkant that chc,:k_l;box 41--ust,aLw fill out the sccdan b&iw❑hovitg iiia-if weikowcompeosatim pobcy mformatim t Homemnc"Who submit this affidavit mdkafiq.the are doing all%wrkar,41 tfen,hire outsidcconmctori mist submit a nM affi(lavit indic;ftin)4 such, "Cotltracwfs that check this box MuAl MUKhrd an rile misuse of ate 31A slate%helher or]lot thaw clttitlC5 haw unployeti. If the sub-coritractm hzv-unploy�_.'ffir.-,Mml PTovi&their wvyk'�ra'cortip,POE,S�tulllbcf: lain an employer that isproviding workerx'competnation insuranee-jor nkv employees. Below is the policy and jab site information. Insurance Company Name: (-oLs--t4 it Self-ins,Lic. Z t3 Expiration Date; Policy W ft-yj_ 0� Job Site Address:i_lk��l� CjtYtState',Zip �V OVA' ct c iL�_ ---------- Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to-secure coverage as required wider Section 25A of MGL c: 152 can lead to the imposition of criminal penalties of a fine up to$1,500.00 andlor one-year imprisonment,aiswcll a',civil penaltiel,in the,form of a STOP WORK OR-DER and a fine of up to$250,00 a day against the violator. Be advised that a copy or this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do hereby eerfify under the pains and penalties of pelyiny that the information provided above is true and correct. 15ip-AMUM I N*5 '56'U, '34 11 ..__ Ofliciul 56'U, '3411-1-- Officid use onty. I)o not,write in this area,to be completed by city or town official. City or Towm:___ Perntit/Licen—w l&suing Authoriw(circle one): 1. trard of calth 2.Building Department 3,Cityrf'own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Phone#: Acol?i ' CERTIFICATE OF LIABILITY INSURANCE TMIS CERTIFSCATE i5 ISSI3EU AS la MATTES OF YtiF(3AI9hT1G°1 t}4i iF 1.Gt?NrERS Nt F 4 tST JP NTN CERTIsIy H HCSLDESt.THIS CE TSFIC�TE f30ES fiCYr Al rS �ATI+E Y GR vE B TiVEL'$kM�ti -. ctit?DR ALTEP Tti£CZ�i F E RFRG t�t�Y Ttb[LF IOR Olm—POPTANT� tOH{.THIS CERTIFSCAiE f5F 1N5t�RA'IGE:<nS NOT CONST 71 A CGN'TRAC 3 T LE<Pd�t 1�$V1f3•a 1?t�t)�FR�S},dtlTT i4}1�IZ@Lx PREsv4TATT1fG OR PRODUCER,AfdSF iNE fERTt SfATE N4t13 tt. uV t>e endowed. $'1t3KV!OATION IS iA6AIV€�.5�BsS�tL t�;h2 If the c*d&Kate hOde # fl " tts to the tn4 and cpndetiotTS or the 6otiCV,terfatn tscbdces may MAO t'n enctxsrserr.�rtt.A statement an'ir*+5�,r4rt+fT�ate dais not crr+Eer rrg c rt lrat her in tuts cd sem+'+ r o 'at> t s. Grklty mf;,jtWA Risk Sen,ccs ( Ctsytoft hUrtitt J tits Ag ncy htc �.,,€x' { ;6-34-4, �s t866)X15 8i16 ( 9649 kodhsmpton St Po Rox 989 Pic ry b� fi Y sk carp Htt",ftMA 01041 ;s;A�� ccvfaueE 31 cwtttter InsulA0011("It ,tea Po Box 346 IpsvAck MA 91939 r. #tHV19toM NUM 8 Ct3 GE�TIf1f:AT AIU81 Ttti T Ttt^POLIOSES OF S U kt.Ce 14STED RELOtxJ kAV ScEAt tBcOEI3 TO T4� SuR€ts ti A730VE FCS TtiE O 90Y F= its TRi�v�T L��OT%-iE2T CR�^„�EPIY L'SCiE-i RESPECT T4 Yt�'ttGdi Ti�iS S!Vhi >MJ sTt45AMDtt 1 t,R£t3tJ 7 .�c":T.F S GwRT{EICATE MAY$E 155 3 7 A4hY Y E5 tt st J�yN t1A t E B Er!RC-D-C ED BY 0l�cm kws£=rt 4S SUS b£3 TU t E7tCd�Lk54C#SAtd��4t°XStTSC�1�SOsS�."�t � �:r,�, �. ,k��'ar•r�'� ti: .�vr='<s s. GEa1E.'R4L.4lAtCE.fnl :r€#A`i:5 i'a�b1 ror✓.a, CC ¢'kRGc=3.6zNu..uxax-''SY ED C Aa-tty,�T ;JP:Cr�(3 t_t JE-*a"'PaAS$AQ'1e bpy � a'+E#i A5°. �itR.t,E.LiY xPr^Lr-S-�F.'S_P.: 1148E-1TY �' � t D SCS-.£ Ttx Al,06 E7a3f1"`- f0. 9-'P iiFU��AUTO.`, (�9Y'eifi,:vba= ytygt3ffltAL" OCCUR siiG t€GATE T BRf•£48iJ1d3 a T ttr�x. MO CR is i1 ria £t£A[�,Att AM y SsC, QtS I tr34r21T8 ANY tYWFf�.�fdFTAfPIiYE�tFYi C] Is�3A..$RP r2W"i "` �',EXh1•�s'rMu"7Y L..,: }x A. r•L;.a€4e..tA ELK"6Cv't' _ a. In [_} Ell Yi-0"T.i.e;#'?9 .1"tr}-@ Sa^9LS 3'Njs,RIl7 -. ..c O ._ GERTIFICATB HLII Cr stcavtr A a t t 4£� scbaEc3 s= aY t3rst TNw EXF TrZN SAT=E f"t4E#1'0T1:E vw L 6E DF-NFRM IN Cte3testrtt ACG � R yr 1-,4,6 Pe�i PRIM"4- contractor Sven AU 50 WatS#tintetrt 5trast _ 1�.f°. wostborough3 01561 A rd Igrs�tur�. .. 80C 3130 ACORD 25(2010105) DATE(MM/DD/YYYY) ACIOR" CERTIFICATE OF LIABILITY INSURANCE 7�7�zo15 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 PRODUCER "NAME'. - —FAX -- 13)5 — PHONE (413)536-0804 -. �c Not:(a13)ssa-7a7a (A/C No Exp --— Martin J Clayton Insurance Agency, Inc. E-MAIL _ 1649 Northampton Street ADORESs _ — INSURERS AFFORDING COVERAGE _ NAIC# t P. 0. Box 989 — IC Holyoke MA 01041-0989 INSURERA:Nationwide Muual-Harleysvi_1le INATIO wsuRERs:Allied World Natl Assurance_Co . INSURED _ Gauthier Insulation INSURER D - - {— -- 44 ESSEX ROAD INSURERE: IPSWICH MA 01938 INSURERE: CERTIFICATE NUMBER•CL157701379 REVISION NUMBER: COVERAGES THIS IS TO CERTIFY THAT THE POLICIES OF INSUNT,TERM OR RANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD DIOPTS DOCUMENT OI CH THIS ITHSTANDING ANY EEAID EO ALLTHETERMS, CERTFICATE MAY BE ISSUED OR MAYPERTTANTHE INSURANCE AFFORDED Y TH OLICIEDESSCRS — — EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED CY BYjPPOLICY EXP i— LIMITS ------- -- "ADDLSUBR 1 ILTRR TYPE OF INSURANCE POLICY NUMBER MM D MM DD 1,000,000 EACH OCCURRENCE _I$ —.—.—_—. -- X COMMERCIAL GENERAL LIABILITY DAMAGE TO RENTED -- $ 50,000 —I PRE MISES1a occurrenceel T$$ CLAIMS-MADE X I OCCUR 5,000 X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person) —PERSONAL&ADV INJUR1 000,000 — �� 2,000,000 _ GENERAL AGGREGATE $ GEN'L AGGREGATE LIMIT APPLIES PER: PRODUCTS-COMP/OP AGG $ 2,000,000 POLICY JEC LOC OTHER: COMBINED SINGLE LIMIT $ Ea accident)_. — _— — AUTOMOBILE LIABILITY BODILY INJURY(Per person) $ ANY AUTO BODILY INJURY(Per accident) $ ALL OWNED I— SCHEDULED PROPERTY DAMAGE +$ AUTOS ` AUTOS NON-OWNED CPer accident HIRED AUTOS AUTOS $ EACH OCCURRENCE $ 1. 000,000 7{J OCCUR UMBRELLA LIAR 1 000,000 1 EXCESS LIAB CLAIMS-MADE - --— 1-- BE020792125-194985 10/18/2014 10/18/2015 B DED RETENTIONI PER " SOTH- WORKERS COMPENSATION — TATUTE _— ANDEMPLOYERS'LIABILITYYI IN i I I E.L.EACH ACCIDENT FU ANYPROPRIETOPARTNER/EXECUTIVE � N/A I E.L.DISEASE-.FA EMPLOYE_ $ OFFICERWEMBER EXCLUDED? —. -- (Mandatory In NH) E.L.DISEASE-POLICY LIMIT $ If yes,describe under DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/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 THE SHOULD XPIRD ANYATIIONOF H DATE ABOVE THEREOF, NOTICE POLICIES WILLL CBE CDELIE DELIVERED BEFORE MASS SAVE PROGRAM ACCORDANCE WITH THE POLICY PROVISIONS. CONSERVATION SERVICES GROUP, INC. 50 WASHINGTON STREET AUTHORIZED REPRESENTATIVE WESTBOROUGH, MA 01581 _z _ �� Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MP?rdrdStled with pdfFactory trial version www pdffactory.com Massachusetts-Department of Public safety Beard of Building egulations,and Standards �"iaab�j€'1tC ipa ttl�fk97a°3't W�,€tY�z$kA.L'ep�r1 License:CSSL-102°$82 K[7Tm R G,tvrw i., P.a Dos 344 IPWIch TNA 019 s l'ry, w\ ° . ... .# �a per Expiration AlKe M Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02 116 Home Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 10/112016 Tr# 257812 KURT GAUTHIER - KURT GAUTHIER ...................._ ....._._._ P.O. BOX 344 IPSWICH, MA 01938 _... ___..- . .__. _. .................-_... Update Address and return card.Mark reason for change. Address L�7 Renewal F7 Employment Lost Card SCA 1 u 20M-05-11 .. ...., c'Y`:irrr.reuat'&A rt"' lfr;.ar rr.:rl1: Office of Consumer Affairs&Business Regulation License or registration valid for individul use only �r,.HOME IMPROVEMENT CONTRACTOR before the expiration date If found return to: itegistration: 173410 Type: office of Consumer Affairs and Business Regulation or•r 10 Park Plaza-Suite 5I70 xpiratiarr 101112016 Individual Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD IPSWICH,MA 01538 Uuderscrretary 'at valid wi out signature