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HomeMy WebLinkAboutBuilding Permit # 12/14/2015 Of t%oRT#1 I BUILDING PERMIT TOWN OF NORTH ANDOVER 0 APPLICATION FOR PLAN EXAMINATION 7-)Zt Permit No#: Date Received Argo A US Date Issued: I 'Z- IMPORTANT: Applicant must complete all items on this page LOCATION _34!� Ca,I-,d_1CShQ,,- KA(LA Print PROPERTY OWNER US.I'QJ'�. W Print 100 Year Structure yes no MAP PARCEL: 25o ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building 6;6n—e family 11 Industrial 11 Addition El Two or more family [S41teration No. of units: El Commercial Repair, replacement El Assessory Bldg 11 Others: El Demolition El Other DESCRIPTION OF WORK TO BE P,URF RMED: i r S ta, twu k r\ 6\e,,e,� ) AL Ide tification- Please Type or Print Clearly OWNER: Name: Pho a — ne: ?_0 -9 b 6 LILI 15(3 Address: SA S' CkydjaH �,A Contractor Name: Phone: Email: !a" jCrjhfiuIkA­)�r,,, U Addressi Supervisor's Construction License:Tabs-to Z, Exp. Date: l Home Improvement License: 3 41 \J Exp. Date: VO �0 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: $ t lb + .4 S_ FEE: $ 2 'At 'i I � V2±� Check No.: 117 Receipt No.: � NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund e6lb Ag 0'ht OW 'Siq 'Town -oftkOR T H 2 '' Andover ® `^KE ver, Mass, coc HIc HEWICH �1• RATED U BOARD OF HEALTH Food/Kitchen PErx LD Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ................ .. .... .. .. �. .. .... ...... ... ... . . .. .. .... . . . .. .. .... ..... Foundation has permission to erect.......................... buildings on ... _ Rough tobe occupied as ..... 1. ...... .!. .. ........ ..... . . . ... ...................................... Chimney provided that the person accepting this per ' 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 PERMITl IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO R Rough Service ................... ..... .................................................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do'Not a ve Final No Lathing r Dry Wall To Be Done FIRE DEPARTMENT Until Inspected r veBuilding Inspector. Burner Street No. Smoke Det. Federal 10# Engineering Rl Contractor Registration No RISE MA Contractor Registration No CT Contractor Registration NO A division ofThiclsch Engineering, 60 Shawmut Unit N2,Canton,MA 02021 CONTRACT 339-502-6335 FAx 339-502-6345 Pago 1 �y y PROGRAM �eonrnAorisENTERED Pao aetv+�uRISE i�. E CMA-HES ENGINEERING Ana THE CUSTOMER FOR WORK As DESCRUIED 9ELOVr - ENGINEERING ._ _._. __.... PHONE DATE CUENTs WORKORDER CUSTOMER (200988-4488 04!0112015 418417 00004 Christy Lusiak — —_ __ _.___ __.__-- ----...._. elLVHo STttEET SERVICE srnees 345 Candlestick Road 1 ti 345 Candlestick Road ` UILUNO CITY,STATE,ZIP SERVICE CITY,STATE.ZIP r North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION PI IASE ONE-Proposal for this calendar year. _._. $0.00 AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,exec ss air leakage, this work will he 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 seat your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached gartgccs and other unheated areas(windows an not gctiteralty addressed.)This will require(8)Working hours,A reduction in cubic feet per minute(chin)of air infiitmtion will occur,but the actual number of cfm is not guaranteed. At the completion or the wcatherizalion work,and at no additional cost to(fie homeowner,a final blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure tite safety of the indoor air quality. $6817.00 AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage. This work Will be perfonned in Concert with the use ofspecial tools and diagnostic tests to assure that your home will he left with a healthful level of air exchange and indoor air quality.Materials to be used to scat your home can include caulks,foams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windo+vs are not generally addressed.) This will require(4)working hours.A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of elm is not guaranteed. At the completion ofthe weatherization work,and at no additional cost to the homeowner,a foal blower door and/or combustion safety analysis will be conducted by the sub-contractor to ensure the safety of the indoor air quality, $340.00 AIR SEALING ADDER: (4)working hours. $340,00 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(202)square feet of knet:wall area. $707.00 kNEEWALL FLOOR:Provide labor and materials to install a 6"layer of R-21 Class I Cellulose added to(i b4)square feet of open kneevivii floor- $196,80 ATTIC SS:ACCEprovide labor and materials to insulate(1) back of the kneewall hatch with 2"rigid'lltcrmav board,and seat the edge oftiic hatch with weatherstripping. $60.00 asily moved,insulating cover fur the attic access folding stair. A small ATTiC ACCESS:Provide tabor and materials to install(t) e flat surface ofplywood will be created around the opening within the attic. "Phis will allow the cover's inte&ml weather-stripping to restrict air leakage. $237,65 VENTILATION:Provide labor and materials to install(2)insulated exhaust hose 10 existing badiroorn fan(s). $100,00 i Federal 10# RISE Engineering RI Contractor Registration No CdA Contractor Registration No A division of Thieisch Engineering CT Contractor Rogistmtlon No 60 Shawmut Unit#2,Canton,ISA 02021 CONTRACT p�v 'pp + 339.502-6335 PAY 339-502-6345 I '�i R RHV Ir4 . Page 2 PROGRAM CMA-HES ECROWEERWOANDTHECCUSTOMERInaWORKas ENG 1NEE RINr, DESCRIBED BELOW CUSTOMER PHONE DATE CLIENTS WORK ORDER Christy Lusiak (201)9884488 09/01/2015 4 W L7 W DOOR SERVICE STREET SA-UNG STREET !._ 345 Candlestick Road 345 Candlestick Road ,%; SERVICE CITY.STATE.XIP BILUND CITY.STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 1 JOB DESCRIPTION VENTILATION:Provide lahor and materials to install ventilation Chutes in(18)rafter bays to maintain air flocs. $36.00 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 100%fix the Air Sealing measures up to the first 5680 and an additional 5340 irsavinps are justified by the auditor. For the safety and health oryour 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 it full assessment of the combustion safety ofyour heating system and water heater.'This has a value of$90 and is at no cost to you. 'Total allowable w•eatherization incentive is$3,110. S90.00 Total: $2,787.45 Program Incentive: $2,363.09 Customer Total; $424.36 WE AGREE HEREBY TO FURNISR SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Four Hundred Twenty-Four&36/100 Dollars $424.36 UPON FINAL PEC NAND APPR AL DY WE INEUING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL INTEREST OF I%WILL at CHARGED MONTHLY ON ANY UHPAR) CEA R]S DAYS.S REVE FF IMPORTANT INFORMATIOlI ON CUARAtITEES,RIGHTS OF aE=ION.ECHEDUUNG,AND CONTRACTOR REGISTRATION. DO NOT SIGN THIS CONTRACT 1F THERE ARE NY LANK 5P Ci S AU R BIDNATURE• IS agVn Ong CU8TOMEn ACCEPTANCE NOM TIt1S CONTRACT t AY WRHORAWN BY US IF NOT EXECUTEO WmON GATE OF ACCEPTANCE _- - - -_-. ----- ACCEPTANCE OF CONTRACT-THE ABOVE PRICER.SPECIFICATIONS AND CONDITIM ARE 30SATISFACTORY TO US AND ARE RMErty ACCEPTED,YOU E AUTHbRIXED TO OttTHE WORK DAYS, AS0PECIFIED.PAYMENT SE ME AS OUTLINED ABOVE T WAD OWNER AUTHORIZATION TION FOR C x t:� L ,,, S f q 1,4 � h-C� blIA14 ie Ar Owner's Name) owner of the property located at C745 �0 i !3 i 1 (Property Address) 1)' (property Address) `tl 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. Si Date Tile Conitnonweafth of,11assaeltusetts Department of Industrial Accidents Office of Intestigations I Congress Street,Suite 100 Rosion,MA 02114-2017 www.1nass.movIdia Workers,'Compensation Insurance Affidavit: Builders/Contractors/Electricians/Plumbers AoPlicant Information Please Print Ribly Name(Bu int-ss;`Ci Address; 00 130014 Cil y' Phone,statezip" W Are you an employer,Check the appropriate box: Type of project(required),, LM [am a employer with 15 4, 0 1 am a general contractor and 1 G. Nc-w construction employee,(felt and!or part-time,).* have hired the sub contractors 10 1 am a solc proprietor or Partner- listed on the attached sheet, 7. Remodeling ship and have no employees The"esub-contractors have 8, 0 Demolition employees and have workers' 9- []Building addition working ft,)r me in any capacity comp,insurance., [No workers'comp,iwurwict 50 We are a corporation and its 1011 Electrical repairs or additions required - -] officers have exercised their I I>0 plumbing repairs or additions 3,0 1 am a homeowner doing all work officers myself:LNo workem' comp. ht of exemption per MGL 12.0 Roof repairs insurance required] t c 152,§1(4),and we have no 1-1.[3 Other_ employees. [No workers' eofup.insurance *Any applicant that ehce"ix)-,41 m'wAalw fifflout the their CompCisatimpolhi"Y in ronmtinn, Hi>mtowner,;whosuirrm this afft"Ot irtdtwi-ig they are doing all WCTkar'A Thm hire kltasidc contractors Muil submit a nm affi&61 indicatinysmh. t�cxstte adim:of the aud sWe%ht!ther or noi ihosc entities haw. -actotj that check this box must-trtAcht�ti an additional 9. etrjp!Wecs� If the sub-cmtraczm have cmploymi.Chea must PnA-'dr 0-reil wi=rktls' 1111" U ItKi emplopen. Below is the policy andjob site. workers rompen-sa(ion insurancefor myI am an emph�ver that k;r"ollidi'm workers' information. Insurance Company Nance:_A _&, I mo(-A^tA i b4z1_ Expiration Darei_�_43 C) Policy#or Self-ins. Lic,ff: tljfy 0011- Job Site AddressM �_ J.-ArmCityistateizip:_w �_Ip )�D eLtV Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date Failure to secure coverage as required under Section 25.,E of MGL c, 15"can lead to the imposition of criminal penalties of fine up to 51,5 .00 andior one-year imPrisonmcnt,as well as civil penalties in tile,foforthof a S`'OP WORK ORDER and a fine 00 of up to$250.00 a day against the violator. Be advised that a copy of this statement may be.forwarded to the Offficc of Investigations of the DIA for insurance coverage verification. g I do hereby certify under the pains and penalties of perjuq that lite information provided above is true and correct. I re, ! Date: phone 01:q NIS 'S Official use only. Do not write in this area,to be completed by city or town official, City or Town: permit/license Issuing Authority(circle one); 1.Board of Health 2.Building Department 3.011/ own Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Phone Contact Person,.—_.—_. ACC>R0 CERTIFICATE OF LIABILITY INSURANCE I THIS CERTIFICATE IS ISSUED AS A MATTER OF)NFORMATION ONL:f AND CONFERS NO RIGHTS UPcH THE CERTIFICATE HOLDER,THIS CERTIFICATE DGE$NOT AfFIRMATWELY CA NE-1aATIVELY AMEND,EYTENG'OR ALTER THE COVERAGE AFFCROED OY THE.;,GLICIES BELOW.THIS CERTIFICATE Cti'INSURANCE DOES NOT CONSM'RITE A CONTRACT BETWEEN TH4 I$5VING INSURER(S),AUT-?4ORLZED REPRESENTATM OR PROOQCEA,A140 THE CERTIFICATE HOLDER, IMPORTANT:If the c*Tfif"te holder is a;AIaOjl JONAL INSURED,Rik-(oiky(ies)trust tw,endt;MCd,if S1115rOe'ATON 15 WAIVED,V=j�--d to the tertnt;and con(ftons of the polKy,certain p0c4s tray"u"on(mdorwnimt.A stater"m on tms cwVkatt',does not cent"rights to the cerffmate hVIder 10 lieu of sue» Clayton Martin J Ins Agency tric AUAL Berkity Assioned Risk Services 1649 Northampton St PO aox 989 Ho"e MA 01"I Gautivlar Irsutation Inc PO Box 344 1pavAch,MA 01938 UP)MATE MU ER: REVISION NUMBER- TRI9 is TUTMT—wy Ti-77T THE EP MURAWIE LISTED BELOW t-'.AVff--8E--N iSSUED 70 THF INSURED NAMED ABOVE OR THE POLICY PE.RIOU-- NOICAIeD,NOtVATHSTANDING ANY RfOUtREPAeN7,TET 11!Cats CONVIIIVN OF ANY CONTRACT OR OTHER DOCUMENT V4H RESPECT TO W`OCH TtA-IS CERTI]FICATE MAY BE ISSUED OR WAY PSA7AW.THE INSVRANCEAVIFORDED BY THE POLICIES DESCRIBED tIEREIN IS 5LJ4-1ECT TO N-L THE TERMS. EXC-USIC+m ANCI CONO(T1zwS OF S"H P�Iluc*, S.LWITS S4iOWN,MAY RA',U-BEEN!REDUCED BY 0A.10 CLAIMS. I W0-"fv' 03 C-1 LIM, "Tomou&tIASILM LJ Li Aw Aijo e. AROMy A1.4 ChWT0 Aowros Ad-444l 411.tA i.iFB 6:.0 9t A IN� EAvK=UAkFW-r [3 _j Lj ImTGNuAs wmams C0wp9*%ATx" AND nApwv"v uAft" YN t, ANY E Art MOW $ ty L�wz _ WKZ$vjm" Okw-"-v h W -1 $ tt*m dtsait*� DESOWTIC0.OF S EA!t•t rA C 11 M CERTIFICATE OMEN ShG=1-Alr(Ck 111k AbG',E OESCROED PUL,2t!!S BE rANCEIA-F-D KFORE Clearest& TtF-EXPIR&TrOhl DATE',f4EAEOF.,WT!CE WX 1 BE DaN'S RED sN, contrtor$vcS ACCORDANCC WfW T�413 POLiCY—Im"SONS oc 50 Washington Strout Wesftr"h,MA 01581 ACORN 25(2010105) RPAC 3139 DATE(MWOD/YYYY) A�V 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 poli soment. A statement on this certificate does not confer rights to the )must be endorsed. If SUBROGATION IS WAIVED,subject to the terms and conditions of the policy,certain policies may require an endorseme certificate holder in lieu of such endorsement(s). CONT ACT PRODUCER NAME: Nancy Usher _ PHONE 413)536-0804 TFAX (413)534-7874 Martin J Clayton Insurance Agency, Inc. A/C NoEX0: —1_W-�;- --- E-MAIL 1649 Northampton Street ADDRESS . - - P P. 0. BOX 989 INSURER(S_)_AFFORDING COVERAGE - NAIC# Holyoke MA 01041-0989 INsuRERA:Nationwide Mutual-Harleysville _ INATIO INSURED wsuRERe:Allied World Natl Assurance-Co— Gauthier ssuranceCoGauthier Insulation INSURER C:, 44 ESSEX ROAD INSURERD: —__ INSURER E: IPSWICH MA 01938 1 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 NOTWITHSTANDING REQUIREMENT, CONDITION OF ANY CONTRACT THIS CERT FICATE MAY BE ISSUED OR MAYPERTA N,THE NSURANCEAFFORDED BY THE POLICIES D SDOCUMENTTHER TRESPECTTH CRI EDHE EIN S SUB ECTTO ALLO HEI TERMS, EXCLUSIONS AND CONDITIONS OF SUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. " POLICY EFF POLICY EXP IN�SR _ AODL SUBR - LIMITS LT TYPE OF INSURANCE POLICY NUMBER �MM D Y MM OD i _EACH__ $ 1,000,000 X COMMERCIAL GENERAL LIABILITY - DAMAGE 70 RENTED 50,000 A CLAIMS-MADE C�OCCUR PREM.- E.occurrenceL $ X GL43487F I 7/6/2015 7/6/2016 MED EXP(Any one person) $ _ 5,000 -- i PERSONAL&ADV INJURY. 1$ 1,000,000 GENERAL AGGREGATE $ 2,000,000 �GEN'L AGGREGATE LIMIT APPLIES PER: I 2,000,000 1I n PRO- PRODUCTS-COMP/OP AGG $ . _ ._ POLICY Ll JECT LOC --- OTHER: COMBINED SINGLE LIMIT I$ AUTOMOBILE LIABILITY _�accidenl- _- _ --- --- -- BODILY INJURY(Per person) $" ANY AUTO ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS PROPERTY DAMAGE �N0N-OW NED _PeraccidentHIRED AUTOS AUTOS EACH OCCURRENCE $ 1_000-000 XJ UMBRELLA LIAB OCCUR _ AGGREGATE _ $. 1 .000.�0 B f EXCESS LIAB _ CLAIMS-MADE -- -" DED RETENTION BE020792125-194985 �10/18/2014110/18/2015 $ i PER OTH- WOR KERS COMPENSATION STATUTE�_ ER --_._— AND EMPLOYERS'LIABILITY Y/N E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE l."'C SER EXCLUDED? CI N/A E.L.DISEASE_-EA EMPLOYE $ (Mandatory in NH) If yes,describe under E.L.DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be 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 :,7 Daniel Sullivan/MEG _DC7 ©1988-2014 ACORD CORPORATION. Ali rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MrIu Mted with pdfFactory trial version www.pdffactory.com ., MasSach -DepartMent o1 PubEtca Board Of Building Re uimttand �ety ns� �St�rs�3ards f e �`ersst'uaa.e;�a'uc�•a�^i'a'd+�r 'sa��E�a(�� Licer€ ;CSSL-102$82 P t.Rox 344 ' I 4nwk6 MA 01 MAN 4 Curr"osio aea xPration L� n b I r. J} µT Office of Consumer Affairs and Business Regulation ` M� 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Horne Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 1011f2016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER _ P.O. BOX 344 _ _____ ._. __-.......... ___ _____. .._....._ IPSWICH, MA 01938 ....................._............ __..___ ......... . ......._..__.. Update Address and return card.Mark reason for change. 7 Address `..__I Renewal Employment Lost Card .iC,'A 1 is 20M-05,11 '-.'ffrf Y?�rrrrrrr:rrr�rtuflri r�.^lrlFr,<rrtrtt.r/f.; Office of Consumer Affairs&Business Regulation License or registration valid for individul use only '.;DOME IMPROVEMENT CONTRACTOR before the expiration date. if found return to: � ,�"Y' gistration: 173410 Type: Office of Consumer Affairs and Business Regulation $ 10 Park Plaza-Suite 51.70 �s xpiration: 16/112016 Individual v..•. Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD �• of IPSWICH,MA 01938 __ _..__.. ............. Undersecretary valid wi out signature