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Building Permit # 12/14/2015
OORTH BUILDING PERMIT "T 06 TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION Permit No : Date Received Date Issued: r 1,4114- IMPORTANT: Applicant must complete all items on this page LOCATION .6ia Cova-\Ain Uu\k- rin PROPERTY OWNER Print 100 Year Structure yesOno MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resiqjential Non- Residential ❑ New Building One family [I Addition [I Two or more family [I Industrial ( Alteration No. of units: [I Commercial epair, replacement 11 Assessory Bldg [I Others: [I Demolition El Other DESCRIPTION OF WORK TO BE PERFORMED: LI'A C) 6-4 a Identification- Plepse Type or Print Clearly OWNER: Name: l4,WxCLr\.1 C I �xy)% Phone: (9 Address: Ci mbyw-, ftyJx),J(,r (IN Cr— o 3\4 Contractor Name: Gt" lb Phone: - Email: AddressJ- Vo &,-tt)yQ414 Supervisor's Construction License: Exp. Date:_ Home Improvement License: 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: $ I FEE: $ Check No.: Receipt No.: 67'79 NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund q FORTH Town ofEAndover No. 77 �. �� eeift� *616 �� h mer, li/Iass, _L 2 04 COCHIC"EWICK �® DJ?ATEED �PP�.`C2 S U BOARD OF HEALTH Food/Kitchen T LD Septic System ® BUILDING INSPECTOR THIS CERTIFIES THAT ....................PEMM !J, . ®..... .......... .......®.....:. ......................................... ,..., Foundation has permission to erect .......................... buildings on .. .. ............ ...... .... ........'................ ® Rough Chimneyy. ............. .....................to be occupied as ......... t ... Finalprovided that the person acce ting this ermiin every respect conform to the terms of the application 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 MONTHS ELECTRICAL INSPECTOR UNLESS i TIRough l ........................ Service Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Building Rough Display in a Conspicuous Place on the Premises - Do 'Not a Ove Final No Lathing r all To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. Federal 10#06.0406829 RISE En - eeri0 RI Contractor r egistrationRegistration No 8188 � � MA Contractor RegtaVattan Ho 120879 NOVA K Is EN A division of Thielsch Engineering ENGINEERING 60 Shawmut Unit#2,Canton,MA 02021 CONTRACT 339-502.6335 FAX 339-502-6345 Page 1 PROGRAM TRW CONM=raENTEWwroeaTWEENwan CMA-RES 9==M =VCUERronWORK AS PHONE OAV CLIMa WOMORDER NSTOMER el Smith (617)513-1639 10/29/2015 423903 00003 GUM STREET aMMM STrme* 990 Coventry Lane 0 Coventry Lane , BaitVICE CrY,BTATE,IIP D=NO MMSTAMZIP North Andover,MA 01845 North Andover,MA 01845 t J JOB DESCRIPTION AM SEALING:provide labor and materials to seal areas of your home against wasteful,excess air leakage. this work wit �4_.. performed in concert with the use ofspecial 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 are not generally addressed.)This will require(9)working hours.A reduction in cubic feet per minute(oft)of air infiltration will occur,but the actual number of efm is not guaranteed. At the completion of the w eatherizadon 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. $765.00 AIR SEALING ADDER: (4)working hours. $340.00 ATTIC FLAT:Provide labor and materials to install an 8"layer of R 28 Class 1 Cellulose added to(120)square feet of floored attic space. $216.00 DAMMING:Provide labor and materials to install a 12"layer of R-38 unfaced fiberglass batts to(70)squaw feet for damming purposes. $143.50 ATTIC FLAT:Provide labor and materials to install an 8"layer of R 28 Class 1 Cellulose added to(1452)square feet of open attic I COULD NOT ACCESSS OVER FAMILY ROOM ASSUMMED SAME AS MAIN ATTIC' $1,989.24 VEN7II ATION:Provide labor and materiels to install ventilation chutes in(66)railer bays to maintain air flow. $132.00 COMMON WALLS:Provide tabor and mat at to install 2"FSK faced semi-rigid fiberglass boats insulation to(130)square feet of common wail area. I COULD NOT ACCESSS OVER FAMILY ROOM ASSUMMED SAME AS MAIN ATTIC. $455.00 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 1001/0 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 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 we etherization incentive is$3.110. $90.00 Federal ID 0 050408629 RI Contractor Regtstratian No 8186 RISEV ISE Engineering MA COnuador RegtahgUon No 120979 division of ThIeUch Engineering ENGINEERING 60 Shawmot Unit 02,Canton,MA 02021 CONTRACT 339-502-6335 FAX 339-S02-6345 Page 2 PROGRAM .,o BRACT q ENTERED INTO BETWUN W8E CMA-HES BNBD,�,IGANOTHB ousToMER MRWORHAS DBBeaDED as.Gw PHONE DATE CUEET2 WMORDER (617)513-1639 10/29/2015 423903 00003 Nathaniel Smith WW?10$TRW BMW=BTRW 90 Coventry Lane 90 Coventry Lane Bu=CIrY.STATE,IIP SURVICE My,STATE.IIP NNorth Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $4,130.74 Program incentive: $3,110.01 Customer Total: $1,020.74 WE AGREE HEREBY To FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand Twenty ST 741100 Dollars $1,020.74 UPONFlNAL{NSPEOnO N AND APPROVAL DY RIBS BNONN G.CUSTOMER AGREED 10 REMIT AMOUNT DUB IN PULL WTEREST OF I%w1L.BECH=ATW0R tONWMTI ANY :4p7!! ANT INFORMATION GUARANTEES.RIGHTSOFRFlx8WN.8CNHOULlN0.ANDCONTRAOTORBEO{8TRA1I0 N THi8 CONTRACT IF THERE ARE ANY BLANK SPACES aCOEPTAWE NOTE TWs cONTRAffMAY BEWTIMWAWN BY USfF NOT Tl M W DATE OF ACCEPTANCE COWITIONS ARE ACCEPTANCE OFCONTRACT.TNEABOYB PRICHe.B YOU ARP AUTHORIZED TO OO THS WaRK =%ON9 AND 9ATi8FACTORY TO UB AND ARB NENEDYACCETTED. 30 DAYS. p88PECIFlE0.PAYMENT WIW BE MADS AS;U'T N ABOVE NOV 5 2015 i � I i OWNER AUTHORIZATION FORM a 4--hct 4-k - _ (primer's Name) ovmer of the property located at 90 Go v�e��vy Gry '(ftp"Added) Vmperty Address) hereby authorise (Sub©ontracWr) an authorb ad submtactar for RISE Engineering,to alt on my behalf to obtain a building permit and to perform work an my pmpedy. 1� ovi er's Stgnahm Data . tg0V 5 2015 The Cotnrtonuieatlh of massathusetts Department of Industrial Accidents - off re o,f in tvsd afion s 1 Congress Street,Suite 100 Boston,,11A 02114-2017 WWW.lttass.gov/dia mbers Workers'Compensatian Insurance Affidavit' Builders/Contractors/ElectPlemse I'ritxtul a ihl Applicant Information Name(Businc a'Ch��nisatitSnr[rtdisie�s�[�; �sbd�`1��` { �r itt��f: tt+`l� }�i _ Address: tib aPX 31 - -. CIY / tadeiZl \,0;(& til Phonert 1 3 . Are you an cinplo�-er`:Check the appropriate box: Type of project(required), t. 1 am a employer with � � lav a general sub-contractors et r ctor 1 G New Construction lia4'C ftlrLtl Fite Stilt i,LaF3traCtors employees(full andlor part-titrse).* luted on the attached sheet_ 7. Rcni riding 2, 1 ant a sale proprietor or partner- i hest,uta-cnstiractors have 8, Demolition ship and have no c'anphayCes e nployecn,and have workers° working fear me in any capacit% comp,insUraatix.:t 9. [ Building addition [-No worker,,'comp,insurance 10.0 Electrical repairs or additions rvquireti.j 5- C] We are.a corporation and its officers have exercised their t i.[]Plumbing repairs or additions S. ] 1 ars a homeowner doing all work right of e tete tion r MGL myself,[lana workers' coinp. � p i?.[]Roof repairs insurance required] t C. 15-2,61(4),and ohave tto t 3.C)Other e ntploYcti . [No workers' comp.insurance required.] *Anyapplicantthatehcckstx�x+>tzziustat�faitoutthese ziort kw3tiuuY�tefauoskrr>'ccna tssttc�rtP01i4ylntarzztarintz. Ramco*-nets u submit this a�davit indicating they are doing all work and'ti -hirr outside contractors mu,I'1rbmtt a new at3adaX inatzrattrtg such, ;t c»gtra t6€s that cttc this tsax anti[art'b az ti3ictzzat h t 4haiYafaz sf c n2nle of IFI suG�azt a azt aauf sGzc °h t:r or zrot donor. ntttzcs hate ettsplc5}c s. if the suis-cortraclers Fav i } >Czn7 mint Pre,r shear ws a ez ' gin .pul"zz s z:uzxittir. I am art employer that is providing workers'compensation insurance for my,employees, Below is the police and job site information. tnsur�ce Cotspany I�au�. - . Policy#or Self-ins.Lic,tt. Expiration Date. '3C1 (� C���n l cityf'state"Zip.l� 1", `� Job Site Address: _.. Attach a cop!of the workers'compensa ion policy declaration page{showing the policy number and expiration date) - Attach Failure to secure coverage as required under Section 25A of MGL s=. 152 can lead to the imposition of criminal penalties of t Fail ftp to cure�.o0 eraandge one-year irnptisOnms nt, �ti t�>cll as ciN it pedal€ins in the:.form ofa STOP WORK ORDER:incl,a fine fineof up to$250M a day against the violator. Be advised that a COPY sat this tatement tttay be,forwarded tothe Office of investigations of the D1 for insurance coverage verification. I do hereby certify under the pains and pettultres of peryul than the itiform ation provided abote is trriee acrd correct l �tccnstttrc t-- tate VL it) Official use onty. Dcr not w=rite in this area,to be COMPdctted kv citta or tow=n official, City or Town- ..�,Fw.. t=erni t/License issuing Authority(circle one): 1.Board of Ilea 2.Building Department 3,t.ty l t)wn t'tcrl; $.tllectrical ltts ctor 5,Murnbing Inspector b.tither Cootaet Pe Ftiit _ ,ICOR � CERTIFICATE OF LIABILITY INSURANCE i l i CERTIFICATE 15 7SSUE45 ASA!#ATTER t7F liFCSRNATt C?S�-'fi AMN L— ESS—RFvtG�a USN Tt� CEi,TtvtCeSTE Fi tLGER.ttf3S GERT7FICATE 7?£3ES P#C7T AfiIRAi#TtVELY C R N CATtV£Y AA1ck�,�aT�ta[?CSR ALTER THE�LJ'1£ AG'E kF=CNSUR BY THE}t 1C7ES E70tY.THIS Ct RTIFtCATE 0 SNrstliZkz#CE 3O 'OT COh,'5TITVT`c A CONTR ACe BETWEcU I,,?-1SS1j]NG t €R@RtSy>AUTHORIZED REPUSEINRATTVE t PRAt�Ep,AYt�3 Tt1C CERTIFICATE.5 HOLDER . IF4RC3RTRttT:U tib certlfitate taoic9er t an ALtsiTlt3t at 7NSE3RE£7,tt+e�1 cYx )must to s d rs el.C SUttRC3vRT3 N SS 6SAldE€7,Sut1}$ct T�tlt oedg€can hac4trtik s P t icie9 Bray reau�an rsem rnt.A etaLerx rr ar;irr 5 ce �ts:�ie©c>e5 r. S coder Siy-k'r25 to tkee $) - Ct,KjtY jgr,"Risk'Servit {� Martin J ins Agency inc e jam 634-450 W $ (6166)2IS-8111 iso ikict'ti78rnptE4n St PO R{}X 9$0 a � Policy— Holyoke MA Ott rvs ;s±rca €c�Yr 31 knre p���c,t,.��� Gaut�lxer fributaaion tl + PO ftx 3" et sa a; .......... 1pswicb,MA 0938 �<: GERTiFiG14TE iIU64SEtt REVt N47kR i; POLICY C�3 i 46 RiSUR.9,ty{E tlaT 4ls.L£i1N &v'E 9 *1 tSSC3E TG3r;'s.t?.�SLi aEt2 P:I+J A�3t}l'E OR THE OMI PE�3:is N S CI CER Tk4AT TF z F 414 iES THE TcRig i I tcAT ,p t p yT$dS7ArtDj€4 Ah ft c77?Aa£N 7NE tt ttRAh E A t t3E£k 9Y 7 c�L7LtLL IES DESCMSED 4€E N IS SU�€£T O M- I E TE f -, GERTE?iTt Pdl f9E155�u7C€iMAY FxtF_.Lf;S[i',fiF.S i4FkE7i CfTiCYFiS�SLii.H p�t�C`E�.Lt}dt"fS E#^,�'t.LY4d AF.AY li{ai/E EI`•=�RJ FEC%'CEL7 BY P,3tC7 C LAJMS, t« Y$ ct KtxL warr'�77L ns r R rxr tam 2 S !0 ca.A�+St,.�.2E L3 Aldi aury {_i t! 5 Scot Plj;irv.caa c-w.., jj Vr AUTO ..^-- r.:rras ❑s� £ s c s x aeau 5. N.5:a4icGk?E 00 rra=»5s jj�'� a r- ... k�ii23�M1'tH34'� f�. ER tK,NAso 0w.4vvAv auk" .i Y SCJ neer of v ittsx : v ARP3 vc :r h4A. t343<7 Su sG 4 5 S ti34 4iR — (xt� A c�'u�, ttarx�. r �;t�s-au « cc cu-�rss•.�t��t�ur S 0tJ 1 }L T7. f`v ..1._s'4RiG5 �.us. i� C�A`sY 6ast5,ar,S a 1 GTrR fiFiG 4TE 140 Duk Shot4D ANY°OC-IHE€.Sc_`E 01-1-1,SEE Fes`F, a_cA t€Eta KFORE TW EXpRAT SATE. 4-EAFOF,NOMM.LYS_BE{Sc.`LVEP= 4114 CiearestAt acct Iu'act LATH THF PcxicY 1pod,c'Of4s Cant actor$YCs aU a z 550 W*shington Str"t W ttwo"h,MA 0100 i9flature: WC 3139 ACORD 25(2010105) =DATE /YYYY) A�V CERTIFICATE OF LIABILITY INSURANCE 15 THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THE CERTIFICATE HOLDER,THIS TEND THECETIFIATE DOES NOT AFFIRVELY ORAMEND, EX BELOW C THIS CERTIFICATE OFNINSURANCE O SATIVELY NOT CONSTITUTE A CONTORACTTER VERAGE BETWEEN BY ISSUING F NORDED SURER(S),THE AUTHOR ZIED 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 PRODUCER NAME: Nancy Usher PHONE (413)536-0804 No:FAX (413)534-7874 Martin J Clayton Insurance Agency, Inc. tA/C No.Ext; E-MAIL 1649 Northampton Street ADDRESS:— —. P. 0. BOX 989 INSURERISIAFFORDING COVERAGE NAIC If - Holyoke MA 01041-0989 INSuRERA:Nationwlde Mutual-Harleryllesvi — — - - - — -- - - — — INSURED INsuRERe:Allied World Nat_ Assurance Co Gauthier Insulation INSURERC:_ 44 ESSEX ROAD INSURER D:— —T t - IPSWICH MA 01938 INSURER F: 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. — -- ---- ADDL SUBR POLICY EFF�POLICY EXP LIMITS INSR TYPE OF INSURANCE POLICY NUMBER MM DD YYY MM DD LTR 1,000,000 X 7AGGREGATE AL GENERAL LIABILITY EACH OCCURRENCE DAMAGE TORENTED 50,000 A S-MADE �OCCUR �PREMISES�aoccurrenr�d;:i -- X GL43487F 7/6/2015 7/6/2016 IvIEDEXP(Anyoneperson) $ 5,000 —. -- PERSONAL&ADV INJURY $ - 1,000,000 GENERAL AGGREGATE $ 2 000,000 GENLIMIT APPLIES PER: 2,000,000 I � 11 PRODUCTS-COMP/OPAGG $ .-- POLICYEJ JECT LJ LOC - $ -- _ OTHER: COMBINED SINGLE LIMIT is AUTOMOBILE LIABILITY I If(Ea accident BODILY INJURY(Per person) $ _ HANY AUTO BODILY INJURY(Per accident) $ ALL OWNED SCHEDULED - AUTOS AUTOS PROPERTY DAMAGE $ NON-OWNED mer accidence_- - HIRED AUTOS AUTOS $ g UMBRELLA LIAB OCCUR I EACH OCCURRENCE $ 1 LQ0,0 0 0 I EXCESS LIAR CLAIMS-MADE AGGREGATE $ q-000,000 B — — DED RETENTION IBE020792125-194985 10/18/2014 10/18/2015 $ PER OTH- WORKERS COMPENSATION _ STATUTE ER AND EMPLOYERS'LIABILITY YIN E.L.EACH ACCIDENT _ $ ANY PROPRIETOR/PARTNER/EXECUTIVE r 1 N I A -- - --- OFFICER/MEMBER EXCLUDED? 1 �E.L.DISEASE-EA EMPLOYE $ __ _(Mandatory in NH) If yes,describe under .L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below ....... ....... DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) TEI, AND ANYONE ELSE REQUIRED ARE NAMED AS ADDITIONAL INSUREDS) ON A PRIMARY AND NON-CONTRIBUTORY BASIS TO ANY OTHER INSURANCE CARRIED BY TEI, UNDER THE SUBCONTRACTORS GENERAL LIABILITY AND UMBRELLA COVERAGE. 30 DAYS NOTICE OF CANCELLATION CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THIELSCH ENGINEERING, INC. THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. 195 FRANCIS AVENUE CRANSTON, RI 02910 AUTHORIZED REPRESENTATIVE 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?r8rNtled with pdfFactory trial version www.pdffactory.com k Massachusetts-Department of Public Safety Board of Building Re ufmtions and Standards �"ears�tsxrc€ieeta°'aa�Iz°3�aa�zeX^.ra:a:o��t License:KTRCS.S� 107 Y R CA 1�y bit�.1:_C E i eadA.0 P.a Box 344 474 wkb MA 019 f y Expgration t �otrur���tzrn�r 0�'�17 C'CC2< yT C - ajjalk1.0%fie,//j ( Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Houle Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 10MM16 Tr# 257812 KURT GAUTHIER KURT GAUTHIER P.O. BOX 344 IPSWICH, MA 01938 -----... ........... .__._ __....__....... _--_. ._........ ..............._....... Update Address and return card.Mark reason for change. Address Renewali I Employment _ Lost Card SGA 1 as =4 0511 office of Consumer kffairs&Business Regulation License or registration valid for individul use only a before the expiration date, if found return to: SOME IMPROVEMENT CONTRACTOR y ;Registration: 173410 Type: Office of Consumer Affairs and Business Regulation � d xpiration: 10/1!2016 Individual 10 Park Plaza-Suite 5170 : Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER tt 44 ESSEX RD «� ; s"_.� IPSWICH,MA 01938 Ut a{i..d wi out igna _....__..t . ..._._.. udcrserretary "ot vasture