HomeMy WebLinkAboutBuilding Permit # 12/21/2015 i
BUILDING PERMIT `A®RzH
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TOWN OF NORTH ANDOVER -
APPLICATION FOR PLAN EXAMINATION
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Permit N®#: Date Received ��°°RATcOWpY����
.SSACFiUS�
Date Issued:
IMPORTANT: .Applicant must complete all items on this page
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C�MAP'€k ��� ��`'' PARCEL�' � � ZONING DISp �RICT :.Histone Distnctaf�r � yes no
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TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑.New Building ❑ One family
❑Addition ❑ Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg Others:
❑ Demolition ❑ Other
❑ 5e tic ❑ Well ❑ Floodplain ❑ Wetl"ands ❑
W"-"' h-6
p
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❑�UVaterLSewer`, - -. _
DESCRIPTION OF WORK TO BE PERFORMED:
ior T 1-6 weer-`f.7
Identification- Please Type or Print Clearly
OWNER: Name: �0 J-* Y IA <i d-ef( Phone: G>� 3
Address: ,o ® fYI4,,PI"C f�
Contractor Nam"e,(fit rti C C Phone: � F
Email
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ril - 16r � ;r da'
Supervisor's�'Construcfion License G`a.� _ Exp Date r ;
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YFlomeylmprovement License ,. ,.:�c��..-�� __� _ Exp Date{ �4 ��
I
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE;BULDING PERMIT.MOO PER$9000.00 OF THE TOTAL E'STIMATE'D COST BASED ON$925.00 PER S.F.
Total Project Cost: $ 0 U. o FEE: $
Check No.: Receipt No.:
DOTE: Persons contracting with unregistered contractors do not have access to the gu ar anty fund
Slgnature_of Agent/Ownernature of contractor _ !
tg -
ttORTH
Town oft I
2 i,.
® - eA
MAndover
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LAS. h ver, ass, �-
COC KICKIWICK
V BOARD OF HEALTH
Food/Kitchen
rERMIT T� LU Septic System
THIS CERTIFIES THAT „ ............... .................. BUILDING INSPECTOR
........................... . ......... ..................... ...........
has permission to erect .......................... buildings on A041..•.... ........................ Foundation
.' Rough
tobe occupied as ............ ..... .. .... ......... ...:... ......... . !.��.. ... ........................... chimney
provided that the person accepting.
permit 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
Rough
VIOLATION of the Zoning or Building Regulations Voids this Permit.
Final
PERMITI IN 6 MONTHS ELECTRICAL INSPECTOR
® UNLESS CONSTRUCTIONSTAJn
PVk
Rough
Service
........................... . ............................................... Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough,
Display in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
Federal ID#05-0405629
RISE Engincei-ing RI Contractor Registration No 8186
IAA Contractor Registration No 120979
RISE A division on'bieisci,E.rigincering
ENGINEERING* 60 Shawinut thiii H2,Canton.INIA 112021 CONTRACT
339-502-6335 FAX 339-502-634-5
Page I
PROGRAM
THIS CMRACT IS ENTERED 11470 BETWEEN RISE
CMA-LIES ENGINEERING AND THE CUSTOMER FOR WORK AS
06SCAMEDUCLOW
CUSTOMER PHONE DATE CUEMTN WORK ORDER
Doreen Sidell (978)375-7363 09/29/2015 4119414 00002
SERVICE STREET GILUNG STREET
206 Olympic Lane 206 Olympic Lane
SERVICE CITY,STATE,MP BILLING CITY,STATE,ZIP
North Andover, MA 01845 North Andover,MA 01845
.JOB DESCRIPTION
AIR SEALING:Provide labor and materials to sell-areas ol'your home against wasteful,exec."air leakage. This work will be
performed in concert with the use orspecial tools and diagnostic tests to assure that your home will he tell with,I licalthfill level of
air exchange and indoor air quality.Materials to be used to seat your home can include Caulks,roams and other products. Primary
areas for Sealing include air leakage to allies,basements,attached garages and other unheated areas;(windows are not generally
addressed.) This will require(8)working hours.A reduction in cubic feet per ininule(cria)orair infillration will occur,but the actual
number or efin is not guaranteed.
At the completion of the wcalherization%sork,and at no additional cost to the homeowner,it final blower door and/or combustion
sorely analysis will Ise conducted by the sub-contractor to ensure the safety of the indoor air quality.
$680.00
DAMMING:Provide labor and materials to install a 12"layer of R-38 unlaced fiberglass bans to(138)square feet for dananing
purposes.
5282.90
ATTIC FLAT:Provide labor and materials to install it 7"layer of R-25 Class I Cellulose added to(842)square feet of open attic
spaccKEEP DESIGNATED FLOOD/u(ii rr CANS ARE LED.
$1,0940
MTIC ACCESS:Provide labor and materials to install(1) easily moved.insulating cover for the attic access folding stair. The
cover has integral weather-stripping to restrict air leakage.
S200.00
VE.NTILATION:Provide labor and materials to install ventilation chutes in(52)railer bays to maintain air flow.
$104.00
RISE Engineering will apply all applicable,eligible incentives to this Contract. You will only be billed file Net amount. Currently,
for eligible measures,Colunibia Gas oll'crs 75%incentive,not to exceed$2,000 per calendar year,and an incentive or 100%for the
Air Scaling measures ill)to the first S680 and all additional$340 irsaviries are justified by[lie auditor.
For the safety and health of your hoine's indoor air quality,we will he conducting it blower door diagnostic of lac available air now in
your home both before the work is begun,and aller the weatherization work is complete.We will also conduct D iiiii assessment or
the combustion safety oryour heating system and water heater.'rhis-has a value of$90 and is at no cost to You. Total allowable
weatherivation incentive is$3.110,
S90.00
vlje_I(M.-
Federal ID#05-0405629
IUSE Engineering RI Contractor Registration No 8186
MA Contractor Registration No 120979
RISEA division ofThieNch Engineering
ENGINEERING* 60 Shownitit Unit 112,Canton,NIA 02021 CONTRACT
339-502-6335 FAX 339-502-6345
Page 2
PROGRAM
THIS CONTRACT IS ENTERED INTO BETWEEN RISE
CMA-IIES ENGINEERING AND THE CUSTOMER FOR WORK AS
DESCRIBED DELOW
CUSTOMER PHONE DATE CLIENT d WORK ORDER
Doreen Sidell (978)375-7363 09/29/2015 419414 00002
SERVICE STREET BILLING STREET
206 Olympic Lane 206 Olympic Lane
SERVICE CITY,STATE,ZIP BILLING CITY,STATE,ZIP
North Andover, MA 01845 North Andover, MA 01845
JOB DESCRIPTION
Total: $2,451.50
Program Incentive: $1,953.13
Customer Total: $498.38
WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS,FOR THE SUM OF
***Four Hundred Ninety-Eight&38/100 Dollars $498.38
UPON FINAL INSPECTION AND APPROVAL BY RISE ENGINEERING.CUSTOMER AGREES TO REMIT AMOUNT DUE IN FULL-INTEREST OF 1%WILL CH 0 MO? OLY ON ANY
IUE' FU "
UNPAID BALANCE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARA)iYEFS,RIG#ITSOFRECtSIO",SCHEDUUPIG, CO__ACTOR REQ TION.
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DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLAN E
AUTHORIZED
_G SGUATU4�
.Ins
Eng,
A .4"ERACCEPTANC
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JiM
NOTE:THIS CONTRACT MAY DE WITHDRAWN BY US IF NOT EXECUTEOWHRIN DATE OFCEPTANCE
ACCEPTANCE OF CONTRACT-THE ABOVE PRICES,SPECIFICATIONS AND CONDITIONS ARE
30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO 00 THE WORK
AS SPECIFIED.PAYMENT WALL DE MADE AS OUTLINED ABOVE
10
OWNER UTH I °TI
I, 1,70re e ki 5 1 a=e 1/
(Owner's Name)
owner of the property located at
01 4 vk a
(rope*Address)
lac rV`2,V, voi Ct . c7�8r
(Property Address)
hereby authorize
(Subcontractor)
an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building
permit and to perform work on my property.
O%nees Sign
Date
COII2111atP1i'L'r£1i`tl of lel(!SS(lch£rsetts
_ c'pltl't`liic'l1i`Of frlrjt£strtr(1 4ccidellts
vfJrce of 1111,cstigation5
000 T%'(iS11117 011 Street
Boston, M;-4 02 jii
- —^''�-", iVlirli�.11Yl1SSo,9l11�Il�Ifl
Workers' Ct;M j3ensation =rst4r once Affidavit. let.-16ans/pIn,mbers
-'tatiot Please s Tint�,ca;
�$piliietti�t: �itfar tt , i7I:
rte,
. r
Name (Business60rgana` `` �a � 'i L _
n
_address: Geo
CityIStatelzip:� joug i MvA g17F.�g, Phone'
Are tion an emplover2 Glieck the appropriate bo:: ;
pe of project(required):
I. _i I am a employer N;=i� 7 4- ❑ I am a general contractor and I
— have hired the sub-contractors b- heti•construction
employees(fttlI andior pari time).
3.❑ 1 am a sole proprietor or partner- listed on the a-,Lached sheet. 7. ❑ Reinodel' -
ship and have 110 entplo�•ees T hesesub-contractors have S_ Demolition_ ❑
working for me in any capacity- employees and bave workCrs
P 9_ ❑Building addition
[No workers: cornp-insurance comp.insurance.'
required.] p 5. Ej a't'e are a corporation and its 10.[]Electrical repairs or additions
3_ I am a homeola'ner doing all-workofficers have exercised their 1 1.� Plualb-Iz repairs or 2dditions
myself_[\o workers comp. right ofexemption per MGL 12.7 Roofrepairs
j
insurance re uired ' c. I z §1(=l):and we have no
etnpiovees.[\- o workers` 13• G(Otlter
comp.insurance required_]
`an}'applicant dial cllz�cks bo_: mtr;t also all out the section helowshowin_tleirxcorktrs compensation polio•enror:natinn.
I iumeuicners alto submit this afitdavit indieatine they are doing ail work and then hire outside contractors must submit a nen-ati5da'"t indicating sttcil.
`COnlraclOrS that clte,.l:[hti hOX nitt5l aliachcd an additional sheet SilOht•1 rl!?111Clramt tl[iht:sob C011hacrofi 311d State nttetheror not tituse e1lI1lICS t1aCl'
cmpioyecs. Irate subcontractors have empiorces_thea'nits[provide their xvorker>'comp_polio number.
I rrin an empiorerMar ispro>'irlinb workers'compensrWall irrs(trurtcefornrr .Beloit,isllte poliryund job site
Ilt)`0!'lil!llt1111_
Insurance Company Name_ z
Policy E or Self-ins.Lic__ i <� �.- C' Expiration Date: _ f`ice
Job SitcAddrzss: Co 1Y n_ I\_C t./p, Cit'%Slate'Zip: p_ tq(nr,(D�rt1—
Attach_?copy of the workers'compensation.polio•declaration paDc(shaz�ing the{colic,'neniber and e"- iration date).
Failure to secure coverage as required under Section 25A of MGL c-15?can lead to the imposition of criminal penalties of a
fine up to S1-500.00 andtorone-year imprisorimem-as well as c1N_jl penalties in the font,of a STOP WORK OPMER and a fine
o%up to S250-00 a day against the violator- Be advised That a copy ofthis statement nlay be forwarded to the Office of
lnvestizations ofthe DIA for insurance coverage via ifieation.
I rte Iterebr eerYif•ander•t11e pains rand pemrrldes t fperjrrr{-that file Mformation pro sided(lboFe fs rplte gird correct.
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Signature_ 6;i a,kdfi�� �� Date'
.,r
r
Phone
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Official use gil)_ Do rater ft'rllL'in tlti5[ITL'(!.10 l3l'C0111 jllefi'(I Ill'city or ioliTlf nffcinL
Citi'or Towtr per rnit/License m
Issuinc Authority(circle one):
I. Board of Haulth 2 Building Delinrtnient 3-Citt'1Tor•tt Clerk -1. Electrical Inspector- a Plumbing inspector
G. Other
Contact Person: plioner:
op ID:
CERTOFOCATE OF LHABOLOTY ONSURANCE
THIS CER71FICATE IS ISSUED AS A MATTER OF INFORMATION ONLV AND CONFERS NO RIGHTS UPON MWE CERTIFICATE HOLDER.-a-His
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATWELY AMEND, r-jffC-ND OR ALTER THE COVERAGE AFFORDED BV MiE POLICIES
BELOW. THIS GERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A COUMC71 SEMEN Ti lE ISSUING INSUREA(S)' AMOREED
ROPRESENTA-1-1VE OR PRODUCER,AND THE CER11-IFICATE HOLDER. ............
i IS an A13011TI _,A-noW 19 WAMED,Subjee.to
... .......
IMPGRTAWa� ff-rne Certificate ONALINSURE0,1tha POEGY(les)MUSibeendare-ev.
the terms and conditions of the policy,Carialn policies nosy require an endorser eRL A stge-inefft an this r.--M-ncM does i-1014COnfe'sights to the
certiftaie holder in lieu Of Such endors=Gnt(s).
PRODUCER0 FAY,
Durso&janijowsid Ins Agcy LLC MPH 16,N I- NO--
198 Massachusetts Avenue jgjl �
North Andover,MA 01W E4ML
ourso&JankowsId Ins.Agcy PROD PA
CUSTDIMERID-FOL-A
I&ASUPER(G)AFFORDING COVERAGE IV=C
INSURED [PISURERA:pann America
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p 0 @oil 969 �t ER a;safaiv Insurance CO. 3 515
Andover,MAGI BIG
INSURER C:
INSURER
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1k;11ER
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REVISION NUMBER'
COVERAGES cr--RTIFIGATE NUMBER:
WMED ABOVE FOR THE POLICY PERIOD
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN ISSUED TO THE INSURED N
INDICATED. NOTWITHSTANDING ANY REQUIREMENT.TERM OR CONDITION OF ANY CONTRACT OR OTHER oocumENT wri-H 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.
iffiff POLfr
TVPEOFINSU CE YBP— POLICY MEM EFF MumFOUDY ERP pprny)
GENERAL UABILrn'
jjr
PREMISES
CURRENCE
S 7,000,000
=4 015 ()M4j2r/2ISU ul=jS 5D,000
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A X COMMERCIAL GENERAL UABILITy PAC7052023 0 —��6-
S 5,000
CLAIMS40ADE NIOCCUR MED EXP(Any one�PMTM
PERSONALaP
'OVINJURY S
GENER4LAGGREGATE S 21000,000
PRODUCTS_COMFIOP AGG S 1,000,000
GEITL AGGREGATE LIMIT APPLIES PER: $POLICY PRO J91 D LOC M 9 F
COMBINEDSINGLE IWIT S
AUTOMOBILE LtABILITV (Ea accident)
ANYAUTO BODILY INJURY(perpefs-)
ALL OWIED AUTOS BODILY IMJURY(P-1 acdd-W) $
PROPERTY DAMAGE S
SCHEDULED AUTOS
HIREDAUTOS (PER ACCIDENT)
NON-OVMEDALrros S
EACH OCCURRENCE s 1,00D,0013
UISBHELLA LIAS OCCUR U R
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RETENTION S TH-
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ANI>WPLOVERS'LIA911-Iry F-LEACHACCIDENT S
ANY PROPRIErORIPARTNERIEXECUTIV,-
OFFICERRASMSER EXXCLUDED? N/A
(MandatonjInNH) EL DISEASE-EA EMPLOYEE S
ifyes,describe under LIMIT I S
DESCRIPTION OF OPERATIONS belo-�j F-L DISEAS E-1?01�19—y
1 [71 7
DESCRIPTION OF OPERATIONS I LOCATIOj4S I VEHICLES
Insulation Wort.,-Mineral;Acidftional jnSUFed for general liabifitY,VU h
respects to Wort-,performed an their behalf by W above insured jeRhie1sch
Erlineerlcig
CERTIFICATE HOLDER --HIE CANCELLAMON
LS2 SHOULD AM OF THE ABOVE DESCRIBED POLICIES BF-CANCEL BEFORE
--HE -RED
g r-J(PIRATfOM DATE R-)EREOF. NOTICE VRLL- BE DELIVER[ ) IN
ThleISCh ACCORDANCE VM THE POLICY PROVISIONS.
COW nible Gas
195 Francis Ave AUTHORIZED nEPAESEWAMUE
Cranston,RI 02910
O I
1988-2009 ACORD C0,1PL2ORATI0W- AL V19i'Its reserved.
ACORN 25(2(109/09) Th-e JkG()RD name and 10g)are reg!SieTed reEvIls 01 ACOFID
O �FICA
(Atn1.DD:YYYY)
A �® CER-HFICK!c E OF LIAG ILMI 6i�fS8J��ANCE
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION ONLY AND CONFERS NO RIGHTS UPON THEOLDER.THIS '
CERTIFICATE DOES NOTAFFIRMATIVELY OR NEGATIVELY AMEND,EXTEND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES
BELOW-THIS CERTIFICATE OF INSURANCE DOES NOTCONSTITUTE A CONTRACT BETWEEN THE ISSUING INSURER(S),AUTHORIZED
REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT:If the certificate holder is an AODiTiONAL INSURED,the policy(ies)must be endorsed.If5UBRO,z, iON 6 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 EO the
certificate holder in lieu ofsuchendorsement(s). !
PRODUCER LONIALI
NMIE:
Automatic Data Processing insurance Agency.Inc. (A cNaE -O_.11
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1 Adp Boulevard ADDRESS, : I
Roseland,NJ 07068 LVSURER6)AFFORDIliG COVERAGE NNC; J
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NsuaenDrGUARDInsuranCeCompany 31470
INSURED POLAR B EAR INSULATION CO INC INSURER B:
DIIA:Polar Bear insulation CO Inc INSURER C- '
PO BOX 958 LV5URER D:
Andover,MA 01810
USURER E'
LYSURER F:
COVERAGES CERTIFICATE NUMBER: 291629 REVISION NUMBER:
THIS IS TO CERTIFY THATTHE POLICIES OF INSURANCE LISTED BELOY:HAVE BEEN ISSUEDTO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED-NOTWITHSTANDING ANY REQUIREMENT.TERI.OR CONDITION OF ANY CONTRACT OR OTHER DOCUM"ENT 41TH RESPECT TOYVHICH THIS j
CERTIFICATE NIAY BE ISSUED OR%TAY PERTAIN.THE INSURANCE AFFORDED BY THE POLICIES DESCRIBED HEREIN IS SUBJ'c CTTO ALLTHE TERMS. I
EXCLUSIONS AND CONOITIOAS Or SUCH PDUCIES.LI\,ITS SHOWN\:AY HAVE BEEN REDUCED BY PAID CLAMIS.IN!& YOUR
j
LTR TYPE OF INSURANCE L`(So MD POLICYNU.1'BER @tALiX1:YYYY) C.4.1DD:YYYY)I LNUS
COMMERCIAL GENERAL 11ABLL(tY EACH OCOJItiIEKCE S !
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GEKL ACGRECATE 1-II.11r APPLIES PEII. GENERAL ACCREGAIE
POLICY PRO- PP.ODUCTS_CO'.1P.OP AGG i
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AUTOI:OnREL1A81LnY IEx 2UIdEnU i
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ALL Ot1tsED 50tEpULEU BODILY INJURY(Pt, uder_' S i
AUTOS %ui 05 I' UI't1UY .NAG
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n'er atul)ertl i
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ULBRELLALLIB OCCUR EACHOCCURRENCE
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A OFFICER'EMSEREXCLUDED: Y❑N?A N POIVCG6U99D 101110112015 0101(2016 E.L.D{SEASE-EAEMPLOYEES 1,0OD,00g
(A1mnLilorY•in tar)
It t'—s.deacnbtlmder RIIT
EL_DISELE-POUCYU5 1,OUD90U
It Vd PTION OF 01'EIG\TIONS L iu.':
OESCRIPTICL9 OF OPER.17rONS i LCGtTIONS?VE W CIES(ACORD 101?11LGIion7 Remulo Stn�ule.m:ry Hx atNched.f mnrespnce is raluutvll '..
Columbia Gas massachusetts 1
i
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN
Thei(schEngineering,Inc. ACCORDANCE WITH THE POLICY PROVISIONS_
195 Frances Ave
Cranston,RI 02910 AItrHOlUZEDREPRE5ENTATIVE '
A�19BB-2014 ACORD CORPORATION.All rights resetve+i.
ACORD 25(2014DI) The ACORD name and logo are registered marls of ACORD
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S and �nessai011
Office of Consumer 517®
10 Parkplaza- Suite
osto IViassachnses 02116tration
1 ome Ymprovement Cc n
ctor Reis.
Reg► -rVpn, 102720 Tr# 25 49
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Vincent i e (ark r�sun for change.
P.O. E3OX 958 = - LostC�ird
p,NDOVER, MA 0181 .- ,pante Address and retnra �ptoyment
Address L ►Renews
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2 T PYN1E STREET _
Plaistow NK 03865 _
0412812018
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