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HomeMy WebLinkAboutBuilding Permit # 1/4/2016 V%ORTH "'a. "6. BUILDING PERMIT ao0 TOWN OF NORTH ANDOVER 73 APPLICATION FOR PLAN EXAMINATIN, Permit N01-7 46 Date Received Date Issued: W MONIMPORTANT: ficant must complete all i age k ""MIN TYPE OF IMPROVEMENT PROPOSED USE Residentia_L_ Non- Residential New Building ne family wo'or--Mffiore family Industrial 1,-AlteAra*�? INo. of units: Commercial Yeplacement Assessory Bldg Others: Demolition Other �✓ gm n 1111"111, 0"Of 105" U, S Capt r 4 11 -Y', _ Identification Please Type or Print Clearly) OWNER: Name: Phone. D!LF3 Address: 1 -CA 2J ,�N ✓ 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: $ Zqct 1-i - 01, FEE: $ ;(4 — Check No.: Receipt No.: "Mck-16 NOTE: Persons cot iWcWt1g with unregistered contractors do not have access to the Fguaranty fund "n ttORTH _ ''own over --Won .llq -- 2w6j� O 4 h ver, ass, 'E< o ' �E 1 oi^j "-A COC N.CK!..0K �.�A°RATE® P �(y � u BOARD OF HEALTH Food/Kitchen PE �RMIT T %90 Lft�w 1 Septic System THIS CERTIFIES THAT BUILDING INSPECTOR ............. .. ..... . .................... ........ . . ...................................... ........ '0VW� j Foundation has permission to erect.......................... buildings on .... ......... ............................. ...................... Rough p � `.l� Y,R. , A&'A.... Chimneto be occu led as ..... .. . ......... .. .1.... . .�.1!!� �. 1..... y provided that the person accepting this per shall 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. W PLUMBING INSPECTOR VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough S Final PERMIT EXPIRES IN 6 S ® ELECTRICAL INSPECTOR UNLESS CONSTRUCTION TS Rough Service ..... .. ........... ................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. A0%, RISE Eo ineerita FDdera I ID 0 RI Contractor Registration No A diviviols Air 1j,111clavil 9119luvoritig MA CGIV080tor Agglattration No CT Contractor Registration No 60 Sh"011it(Juit#Z,CHAtutt,MA 0.1021 CONTRACT 33VA02-6 Page i I S E PROGRAM THIS WFMACY 16 ENTERED INTO DRYWEEN Mail CMA-HES 9NOINWINOAXDYtIECUOTOMFA$:ORWanNAV MoRiBEDGELOW PHONE OA79 CLIENT Stephen Moutzukls0. wOAK ORDER (978)273-2482 04110/2015 404887 00003 693 Johnson Street I"'".Ornael 693 Johnson Street UILUN4 CITY,STATIL rjp North Andover,MA 0 1845 rfRII�fU North Andover,MA 845 tLf2: mm SOB DESCRIEPTION AIR-SEAZINQPIVVIK labor and'inatcrills 143 Soal ureas cifyour hoinoagaitut '41.OX-0s air—1.ukage'—This'work will—b, portlimled in concert with tho use orspeoial 10019 and dial osdo tests to tuiSurd that your hone will K,left air oulvinge nod IvIlb a healthful(CV01 of areas for sealing I Indoor air quality'MutrAtils to be used to SOW your home can include caulks,(owns end A thee products. Primary of nOludo air leakage to attics,11118011ftents,attached gamtit*and utter tudionted ureas(windo ns am not genuraily addressed.) (Ii)working hourv. At the Completion of the weatherlyIstion work,and or no additional cost to the hon,cowrtcr,a find blower d,of and/or combustion Safety analysis Will be coriduutod by tho Sub-cuntractor to ensure tile sulory of tho 111duor Air quality. MOM DAMMING:Provide laborund;ZZIStain Purposes. blia-irlayer ofR-38uni�eedfiborglassbaW(0(20)squ(L'Zzc(nfur damming ATTIC FLAT.Provide labor and motorists to fin-stat—la 12"layer�of R-42 6"71 Cella $41.00 space, loss I Cellulase added to(840) lure feet of open attic KNBEWAUS:Provide lubor and materials(O-install 2'PSKfuMs'""i-rigid 11liorglass board insulation tc'(6i6);1;Qu7urmFeet or 51,344,00 knoswall orojoly FAMILY ROOM CABLE VAULT TG GAUGE! .........qpp�, d� ATTIC ACCESS:Pruvide'labor and mutt:6 to—*Wsululo lite back of sills hard With 21,rigid Thcrmax b�,aru.Wcatriciscrip the $231.00 porlmotor, VENTIL"N�:Pnvid-a labor and materials nia I oxltu.u..o..t..h..a..i.r...wilt . so M.,).a..r..t...d...lappejvent exhaust XIaust11..... ................ $60.00existing buthroom fal(s). VistdLO'lON:Provide labor an'dimatcrials to install $118-75 1 vulitilutiOn Chutes in(24)ruftcr w, L MIMMENT CELLINO:Provide—labor and materials to instal $48.00 1(1,46)line" Of the basement Wing at the home 3111. feet of R.19 uI�IfdfibZTless ins HAL-11 to the pfunctor OVSOMGProvidetabortuid matariais to install 8"R•28 dcnsajaoked Class I Ce)luj exterior overhang located below a heated floor"68,by drilling lise insulation to(3 2)squaro feet of 118 hOlCs In the overhung 1jurn below. !Mules drillud will be plugged. Plugs will bV SaUlod with exterior grade Spackle and JCfi In u relatively smooth condifion�Finish sending priminglinlinfing will be the custOITICY's 1`00unsibility, and ti uch-up JUSE Budinvering will—apply all ap I P-1109ble,eligible i6c—endvoq to this con al%Auw" S1,25,76 tract. You will only be—billed the Not VQuy* for clIgiblo measures,Columbia Gus ours 75%incoa tivc,list to QX(:ccd$2,000 per oftlundar year,and an In cc, ' "AHT Air Sealing measures up to the first$680 and an addlUunal$340 Jfsuvings aru justified by the auditur, 'live of t00%for the For tile safety and health of your homes indoor air Quality,WO will Do conducting a blower door diagnostic of t H;available air flow in Your bottle both before the work is begun,slid after the Wcurbeeizution work t the 00mbustiOn salary of your hcating system and Water hector. is Complete.We will also vojiduct.i full assussmaet of L This hus a value Of$90 and is ut no cost to you. Total allowable* 60/10 39vd S1 Sd3NIdVd 66069ZLL19 S5:60 6TOZ/61/0T .?0021\ RISE F.D&eering FedorW 10 0 R1 06ftbaeW RegIoUnan No A dh4jilon of IhIcISCI,EugWinriLij, MA Convismi,ftaletfton No OT GontraeW Racal-aMn No 60 Shgwmut Wit 02,C110IMN MA 02021 FAX 339402-" CONTRACT R I S EPRIDUAM TMOGNTRWIS FJfT91RG on effroem Sligo 11INGIN8111UNG CNA-HES PM Stephen Mouzakis F DATE (978)273.2482 04/10/2015 404887 00003 -ava-cliiii;r— I— — — —I --- .-- -- — -- — — -— ..-- .—. — —., —,. .—. 693 Johnson Sum Wums Waggy 693 Jo Z�W6 hmon street North Andover,MA 01845 North Anxtover,NA 01845 JOB DESCRIPTION w4a9wizadon TIOM—fivais$3,1110, Total: $2,994.01 Program Incentive: $2,438.01 Customer Total: "56.00 Wr'AM""""O'U'M'M"R"'B-COMPLETOtNACCoRmMegW"WAMI[SKOWAr*N&fIORTm&Sura CF 'Five Hundred Fifty-Six&001100 Dollars $556.00 YPONFlNALWNYNPA�e"—LSpqL7t*N DAM MALev 6 UMNS"M=TOM OR AGREW US ROW AMOWO&g LIgoQWtttEoHaNflK,reMAHr -S, 00 NOT NOT THIS CONTRACT(F TJH46RE —Ott= 14 oATaoPAoara,TAsoe _.. .,� �,,� ,�'�._ �. _ 30 Ulm eo/ze 39vd SI S63N-L6ld 66069ZLLT9 99:168 9T0Z/61/10T OWNER AUTHORIZATION FORM (owner's Nam) ' owner of the Properly(orated at (Property Address) A/- Ajtyo V {Property Address) hereby authorize (Subcontractor) an authorized suboontractor for RISE Engineering,to act on my be ,haff to permit and to perforin work on my property. obtain a building .r-�— Own s re DaDe e� SUM 39Vd SI Sa3NINVd 66069Z44T9 99:60 9TOZ/6T/0T / The C"r_ammonweaith of iWassarhusetts Department of Indusbial Accidents C7ffice of Investigations I Congress„Street,Shite 100 Boston,AIA 02114-2017 www mass.govidia Woken Compensation insurance Affidavit: Bui tiers/C✓o>tractors/Eiectncians/Plumbers ipnlicant Information Please Print Yfe�ibl�r Name{Susincss;th�ttaicalic>n,''t;�divi�aaai}: t 1t It � �L1�4�fx i t�►"i ' �Y,,,t— city/state/zip: U i t phone : _ I S"to• 34 Are you an employer?Check the appropriate bort; ripe of project(required)` LH I arts a employer with 'i. [] I aro a general contractor and 1 6, New cons(Tuct on In loycc (full andjor part-time),* have hired the sub-contractors c2,C) am a sale proprietor or partner- listed on the attached sheet. 7 Remodeling ship and have no tTnployecs i npl sols.and a have have ,. Dentolition c mpiosees and have worker' w�arking for the in any capacity. 9� �1_??ttilditt�;addition [No worker,,'comp,insurance comp,insurance. rcyuired.] 5. AVe are a corporation and its M(]Electrical repairs or additions 3,0 1 arra a homeowner doing all Nvork officers have exercised their 11.0 Plumbing repairs or additions Tight of exemption per MGL myself,t"do workers'comp, 12.0 Roof repairs insurance required.] fi c. 152,§I(4),and we have no employees-[No workers* 13,C)tither cutup.insurance required.] 'Thiry applirantthat chw4 box€tl must also Fill out the scc€ion talon Aw%vulg lyeat wuticrs` inforrnation, Ho tetm-nm who submit this affidavit indicatint the are,dots e all lvc*rk and Tram hire otmidc cmirmeam. must cubtmit a new affidmit indicating such. *cm uacto[s that eh€*this box trust auachcd an aMititrnat sheet,hr3mng the;Taloa of the snit-<(zluUTuiS a:uf state%i)etir r or tial those"tints haw cmptoy cam, tf'the sub-cor.trdvwrs lia-x crrpttxa" ,.,they must pnnidr dleir tV'uAvs'comp_Italkcy tetullba. I ani an employer that is providing w rkers'eompen_sation insurunce,for my emptrryet-. Below is the policy and job site information. In:urarreeCrrrnpatyAtatrre: i_ �if`1StJt'"' �- 1 .... Policy#or Self-ins. Lice t;; ' }$# _. 55 Expiration Date;Vp l a t I4dt Job Site Address:�_t 3 D 11'�.� cityi`State%Zip:j n Attach a cop}of the Workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under Section 25A of MGI,e, 152 can lead to the imposition of critrunal penalties of a fine up to$1,500.00 and/or one-year imprisonment,as Nvcll as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a day against the violator. Be advised that o copy ofthis statement enay It. forwarded to the aG e-,of Investigations of the DIA for insurance coverage verification. I do hereby certifyunder the pains arta penalties;of perjun2 that the r'nfortna ion provided above is trite and correct, S, t.�_""„stun• �_ `""�"` �,Q�':°�`°"..'',4„ _- I3at e' �1�' Phone t>:q N'S S-u' Official use only. Do nor write in this area,to be completed by city or loran official. City or Town: permit/License Issuing Authority(circle one): 1,hoard of I3calth 2.Building Department 2.Cityf o%a n Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other Contact Ntersont _.,..._. .— __.. Phone#. ", ..... ACC.7Rr-> CERTIFICATE OF LIABILITY INSURANCE +zttc�x0l� THIS CERTIFICATE IS ISSOJED A5 A KATTa OF)NfORMATION ON9 Y AND CONFERS NO RIGKTS U110N THE CERTIFICATE HOLDER,THIS CERTIFICATE DOES NOT AFiTRMATVVE Y€P NEGATIVELY AMI!:10,EXTEND Or,ALTER T[iE COVERAGE APFC-Rom BY THE RG12CIES BELOW.THIS CERTIFICATE Of INSUPANCE 00{--NOT CONSTI11MT A CONTRACT BETWEEN 1HE ISSUING INSUIRER(S,,AUTHORIZED REPRESENTATIVE Ok P'ROt)LiCER,AND THE CERTIFICATE 1104-DER IMPORTANT-It the c&tlfirate holder Is an ADDITIONAL INSItRED<V {6Sity<I-s)ma$< be entlOr,ed.if SUB OGATION 15 WA1'VED,Subject to the tams and conditions of the WILY,MUM pc,,c.es may wqu rtn trldorsR ent,A statemerq on this ce?tl kite 46ee not center nOts to the conifiirate hdder In Ileu Of sum e csa semen t(s}. . 3etkiey Ass=9604 RisV Se-MCe+ Clayton Martin 3 ins Agency tm 11349 pilon St PO Bax 989 e az€, (800)634-460 � � (865)215-8118 Holyoke MA 01044 %r mss' �'rlc� ta�hf��ssk rbe+� ro ta. Acm-6- sz s 31325 . Gauthkr Insuixtion Fnc s, PO Box 344 1pswiCb,MA 0193E CQ CERTIFICATE NUMBER REWIOU NUMBER.. HIS IS O TtFY TStR 11?tE POLICIES OF NSI_IR.AhCE LISTED BELMV HAVE 8~. I UEEE S TOT-HE SA:SuRED NAMED ABOVE POR THE PR1_1CY P tNOICATSO,t0TtlftM ANOJNGAtNY RSOtAREi.ENT,TERM OR CON 1I N€r ANY CONTRACT OR OTHER DOCUMENT WITH RESPECT TO WHIG"Tt?S CERTIFIC:ATEMAY BE IRSt11 e`Y OR WAY F'eAlAgN,TKE WS4%RM,10E ASFORDED BY TFfE PLVCIES DESCRIBED f?ERE,,N IS SUWE'T TO ACL 1iE TEPAS.. RXCLW,jo kS AI,0 CONDfr"S OF SLICK ePOLICI S.LUJITS Sxti+.:WN V..Av HAVE BEEN PX-V9CED BY PAID CLAI€& LTk 'TXk r, 5tfllata..E gqJ F+,'ri,t:.v tts/€ a4G"v1 6E/aF�dti 4+A$sU.lYY �.�•'OCt.;4:4�kF-s`£ $ CL�'Y"&RC�a[Y`tati3thi cr+a�.iri i�;iu.°�€5�t-av�S $._..@—�. .. r'� $ am*4-AfWcL .sAp -sFs_A:_ AU:'i}5 scmxf-D A'a?C=:a 'U°4.Y RxS;nY t�*a ar laa4) 'r�T.E�A4TG» �lw'ii5 �fa3 at+Plus3:i tBi�NfltJ4 LiA8 Q:C11%:. � cAcx�;t.tAr2F"44Y..E � €7tf,-48 L.IAB `£ AL-C,REGATE WiFRfLR CQ�FhS+Sitta� .' N 07),AM EYl?'LRY"S•LAW" „L«f'Y ami� ER 0' excar Yxs J r raA M,AARP3mm ;:aq:,!2015 1 13tI: #SI ELEAC9A� s p' $ it 3 _. t "M W =1 .l-VME 4Atu0ir...Ec $ SEkfi.G 2� �r �r « � aL c��ssG•ac�k'.r tr.�. 3 sc>�3 El i 1 L=A 1Gh F, FG, ay rt.�.vim» GERTIRCATE lilt GOER CA 4} cr tilt THE EXNRt T-QN DATE";4{ERECiK#7i'CF M!br-DELNTIR1N COrttt ttx Svcs ACCORDM* f WITH THE ae ICY Or 4S<rwa:;. 5o Washington Str"t Westborough,MA 0104 �` t�I1�ILIr�: aCoPD 25(2010105) Ac 3139 A`CORV DATE(MMIDD/ �/ CERTIFICATE OF LIABILITY INSURANCE 7/7/zo15 15 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). PRODUCER CONTACT Nancy Usher Martin J Clayton Insurance Agency, Inc. AX w_co No Ext: (413)536-0804 �n/c No)c(413)534-7874 1649 Northampton Street ADDRIESS., P. 0. BOX 989 INSURERS)AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville_ NATIO INSURED wsuRERB:Allied World Nat_1 Assurance Co Gauthier Insulation INSURER C: 44 ESSEX ROAD INSURER D INSURER E: 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. INSR rADDLR - - POLICY EFF�POLICY EXP LIMITS LTR TYPE OF INSURANCE BURPOLICY NUMBER MM D YYY MM DD YY X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 n DAMAGE TO RENTED 50,000 A _�CLAIMS-MADE l I OCCUR PREMISES Ea occurrence $ _ X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person) $ 5,000 PERSONAL&ADV INJURY $ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ 2,000,000 POLICY']PRO ❑LOC 2,000,000 X JECT PRODUCTS-COMP/OP AGG $ OTHER: $ ACOMBINED SINGLE LIMIT AU LIABILITYaccident)- $ _(Ea accident_ -- $-- - -----_-.....____ ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS - -- NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Peraccidenl 7t UMBRELLA LIAB OCCUR EACH OCCURRENCE $_ 1,000,000 B EXCESS LIAB _ CLAIMS-MADE AGGREGATE __ 1 $ 000,.000_ DED RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY YIN STATUTE _ ERS_ _ ANY PROPRIETORWARTNER/EXECUTIVE ❑ N/A E.L.EACH ACCIDENT__ _ $ OFFICER/MEMBER EXCLUDED? (Mandatory in NH) E.L.DISEASE-EA EMPLOYE $ If yes,describe under DESCRIPTION OF OPERATIONS below I .E.L.DISEASE-POLICY LIMIT $ i i 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 INSURED(S) 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 195 FRANCIS AVENUE ACCORDANCE WITH THE POLICY PROVISIONS. CRANSTON, RI 02910 AUTHORIZED REPRESENTATIVE Daniel Sullivan/MEG ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD F F?rdi`b'5tbd with pdfFactory trial version www.r)dffactory.com Ma"ac husetts.Departrnent of public Safety B+asrd at Building Regul tions and standards t.xix#8°ud aea,�a a�errte,s.���s» �.Rtu� Liceose�CSSL-io2s s2 KUWr IR CAUrflo 'r PfL%I344 77a*wkb MA 01938 Expiratir n ocrws ssonr osmtY7 Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 101112016 Tr# 257812 KURT GAUTHIER _. KURT GAUTHIER — _-_........- P.O. BOX 344 _ __�_ _ ___.. IPSWICH, MA 01938 ......._........ ......... Update ........ _____ ____ ......_.. U ate Address and return card.Mark reason for change. Address L....' Renewal Employment I Lost Card SCA 1 G 20M-05.11 ... LJ - ft Y nnev>ea.rurnu 1 e� .,jr' ru.;w/( ofrice of Consumer Affairs&Business Regulation ]license or registration valid for individul use only y ]OME IMPROVEMENT CONTRACTOR before the expiration date, if found return to: '7tegistration: 173410 Type Office of Consumer Affairs and Business Regulation v 10 Park Plaza-Suite 5174 r ,expiration:. 10111201E Individual . ' Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RDr'� IPSWICH,MA 01538 ___ ___._....._.... __. ............ Ondersccretary `at valid wi out signature