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HomeMy WebLinkAboutBuilding Permit # 1/4/2016 BUILDING PERMIT �aoRrH TOWN F NORTH ANDOd �� yw�,,' •-,,n as O ® APPLICATION FOR PLAN EXAMINATION Permit No#: Date Received 1 "� r RA�.AT PPRy�GJ �SsACHUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION �- PROPERTY OWNER Print Print 100 Year Structure yes no MAP PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Resi ntial Non- Residential ❑ New Building One family ❑Addition ❑Two or more family ❑ Industrial It ration No. of units: ❑ Commercial epair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition ❑ Other /��!�Wa���f�S,e,�ue�',%iii/%li�ri/f/��f���,l����f�����/�i,������������i/✓������� DESCRIPTION OF WORK TO BE PERFORMED: ()Ss Chi r S i QLo 'd1 0 Identification- Please Type or Print Clearly OWNER: Name: ( l I Phone:-k�+ AP Z' 14 �O Address: '° - Contractor Name: Phone: ° N` Email: Address. C Supervisor's Construction License: Exp, Date: Home Improvement License: Exp. Date: t ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BULDING PERMIT:$92.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$925,00 PER S.F. Total Project Cost: $ ?,!J-1° FEE: $ Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund l//„/r/i 14 1 I t4®RTH Town of Andover '' ® � `' tom+► ® ® T �O ! h �0` ver, as LAK � I COC LAK WICK �AO a\V RwreDPE UBOARD OF HEALTH Food/Kitchen K I L Septic System f THIS CERTIFIES THAT „!!!�'� BUILDING INSPECTOR .............. .....1.. ......... ......... .. ... ...... ....................... .... .... .... ���_1 .... ....... Foundation has permission to erect.......................... buildings on ..... ... ...... ... ..... .., g ® ` ... V �+ Rou h to be occupied as .. .. .... . .�..... . .. . lNf.!�.. ... .�.. ..... .. .. �........... ....... .. chimney provided that the person accepting this it shall in every re t 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 VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough Final EXPIRESPERMIT ONTH ELECTRICAL INSPECTOR UNLESSTIN ST Rough Service ............................... ..... ....................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Perinit Required t® Occupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathingor Dry Wall To Be Done FIRE DEPARTMENT Until Inspected and Approved by the Building Inspector. Burner Street No. Smoke Det. 1 � Fedoras to# RISE Engineering RI Contractor Registration No PAA Contractor Registration No A division ofThielseh Engineering CT Contractor Registration No �. GO Sfiawmut Unit tt2,Canton,11A 02021 CONTRACT �+ 339-502-6335 FAX 339-502-6345 S R I EPage 1 PROGRAM THIS CONTRACT IS ENTERED INTO W.VEEN RISE ENGINEERING CMA-HES oea ErMOAROTHECUSTOMFORwnRRAS eLOW CUSTOMER PHONE DATE WWI woRK ORDER Richard Lowe (214)562-5946 03106J2015 411618 00002,, SERVICE STREET 6a.LIMG STREET 45 Shannon Lane 45 Shannon Lane "y ' sERvica CITY,STATE,ZIP etumo cln,srArE,rrP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION VA $0.00 HEALTH&SAFETY:WeaOrcrirntion work cannot proceed until the insufficient draft issue is Tiled. $0.00 AIR SEALING:provide labor and materials to seat areas of your home against wasteful,excess air leakage. This work will be performed in concert with the use of special tools and diagnostic tests to assure that your home will be loll with a healthful level of air exchange and indoor air quality.Materials to be used to seal your home can include caulks,foams and outer products. Primary areas for scaling include air leakage to attics,basements,attached garoges and other unheated areas(windows are not generally addressed) (8)working hours, At the completion ofthe weatherivation 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. $680.00 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(120)square feet for damming purposes. 5246.00 ATTIC FLAT:Provide labor and materials to install an 8"layer of R-28 Class I Cellulose added to(1860)square feet ofopen attic space. $2,543.20 KNEEWALLS:Provide labor and materials to install 2" FSK faced semi-rigid fiberglass board insulation to(72)square feet of kneewall area $252.00 ATTIC ACCESS:Provide labor and materials to insulate the back of(I)attic hatch with 2"rigid Theraim board.Weatherstrip the perimeter. $60.00 ATTIC ACCESS:Provide labor and materials to install(1) easily moved,insulating cover for the attic access folding stair. A small flat surface of plywood will be created around the opening widrin the attic. This will nilow the cover's integral%=then-stripping to restrict air leakage. $237.65 VENTILATION:Provide tabor mid materials to install ventilation chutes in(18)rafter bays to maintain air flow. $36.00 Federal ID 9 RISE Engineering RlCotractoContractor bion o MA No A division ofThictsch Engineering CT Contractor Registration No 60 Shawmut Unit tt2,Canton,61A 02021 CONTRACT 339-502-6335 FAX 339-502.6345 I iP^1 I ,S E 13ROC)RAM Page 2 THIS CONTRACT IS ENTERED INTO EETMeN RISE ENGINEERING CriiA-I>ES DEESCRIBED01H.Orrwd14TDraERFDRvxRKAs CUSTOMER PHONE DATE CLIENT WORKORDER Richard Lowe (214)562-5946 03106/2015 411618 00002 DILUNG STREET 45 Shannon Lane 45 Shannon Lane SERVICE CITY.STATE.ZIP ... (( (t � < �'. BILLING CIW STATE.21P North Andover,M (! North Andover,MA 01845 OB DE5Cl2lPTIfliV Total: $4,399.85 Program Incentive: $3,020.00 Customer Total: $9,379.85 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***One Thousand Three Hundred Seventy-Nine&851100 Dollars $1,379.86 U=PW APPROVAL SY R13E ENMINEETlM AGREES TO REAUT AMOUNT DUE II FULL.INTEREST OF VA WAI.UE CHARGED MONTHLY ON ANY UTlFAIDII CAYS.B FOR 1NPOlitANT TONON OUARANYEES,RAaWSOFRECl5lON,SCNEDUUNO,AND CONTRACTOR REGISTM'nON. DON §IGN THIS CONTRACT IF THERE ARE ANY tBLANK SPACES r AUTIIO -Tt Eno nD CV ST ACCEPT NOTEaHtB CONTRACT MAY BE WITHDRAWN US IF fKIT EXECUTED WITHIN DATE OF ACCEPTANCE _._ .., . ._.__.—_-. ._..._.__ .._..._... .,_,_...__... L ACCEPTANCE OF CONTRACT.THE ADOVE PRICES,SPECIFICATIONS ANDCONDITIONS ARE 30 DAYS, SAMPACTORY TO US AND ARE HEREBY ACCEPTED,YOU ARE AUTHORIZED TO 00 THE WORK AS SPECIFIED.PAYMENT""nS MADE AS OUTLINED ABOVE -L OWNER AUTHORIZATION FORM (Owner's iia e) owner of the property located at (Property Address) (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. A Owner's SignatO Date The Commonwealth ofa'assachusetts Department of Industrial Accidents fere of In ttestigations I Congress,Street,Suite 100 .' Boston,,41A 02114-2017 ,—, www.masy.gov/dio Workers'Compensation Insurance Affidav=it: Builders/C ontractors lectricions/Plumbors Applicant Information Please Print legibly Name(Busincssi aiiicztion;ttadividual): ti M's Y.r nth M&7"iyl Y , Address: 00 t3ox 34' ----- C'%t}lata#e1Zi t 3 6 Phone 3 7 10.3'-4'�S 3 Are you an cmployer`Check the appropriate box.- 'rype of project(required): . I am a general oontracttr and I LK. 1 am a employerwith � G, Neu°construction employees(full and?or part-time').* have hired the sub-contractors 2.0 1 am a sale proprietor or partner- listed on the attached sheet_ 7. Remodeling ship and have rare<mployees l hc,.s sub-contractors have 8, Demolition working iitrmc era any . employees and have workers' r capacity _ [ Building addition [No1Y0i1lCr:'comp.tttSttCane: comp,inSur.3nce.= wired, 5. We are a corporation and its 10.[]Electrical repairs or additions 3.0 I ] officers have exercised r I I,ised theirS or addittolas 1 arts a hOMeowner doing all work Plumbin g rc +97 p ' tnyiclt;['vo workers'comp. right of exemption per MGL 12.0 hoof repairs insurance e rt gaat`reci.]t c. 152,§I(4).arid we have no employees.[No workers' I10 tither cixnpa insurance required,] *Any appli"nt that cheeks box 41>t`wY alu fill out the t-&iioa b&i i lhuwi vb shcst cict44rs'compcnsatk_m polccy it fv',,vatic i. x Homratoncn who ruirnit this;Affidavit indicatoig they are dcxing all a t�rk and thr we outsi&c.ontr3oors,must wl-mt anew afiltiaiit irAicating such. tC<mtractucs that check this box trust affached an Alitionat sheet showintg the„erne of the sub-cvnlrm=es aral state whe her or 310t those"nntics hark employers. if the.suit-contrsczwns ,avc cmplQy=',s1ce}m�,t isnis'd their wv-A ts'cc�t-p,p>litk ttuuibrr. lam an exmpkrer that is providing;vorrkers'compensatian imuranee fear mry employre,,v. Below is the policy and job site information. InsurancecompanyNatnc: ij _ t``Iw- o_ ) _ Folic}€€or Self-ins.Lic.ft: "1._l t. _ t. _...._.�_ _ Expiration Date:,_VO3 { l' Job Site Address.4�.% AraY'1 LCl.� CityfStateiZip:W:t���yTj(rl A ��� ttuach a copy of the workers'compensation policy declaration page(showing the policy member and expiration date). Failure to secure coverage as required under ection 25A ofa'S GL c. 152:can lead to the imposition ofcriminal penalties of fine up to 51,500.00 and/or one-year imprisoriTnent,as well a,:civil penalties in the forth of STOP WORK ORDER and a fine of up to$250,00 a day against the violator. Be advised that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance:coverage veritication. I der hereby cerfify under the pains and penakies of perjury than lite information provided above is trite and correct. - 4icmature � "#�` `°. ",`b°^ i)stte: Official use only. Do not write in this area,to be completed by city or town official. 0ty or Town: _ Permit/License _ issuing Authority(circle ane); I.Board of I3ealth 2.Building Department 3.City/Town Clerk 4.Elcetrical Inspector 5,Plumbing Inspector 6.Other Contact Persotat�_� � .., Throne At. C CERTIFICATE OF LIA131LITY INSURANCE -NIS CERTTFIC,ATE 15 ISSUE AS k BATTER OF Itrft7WATION ONVf AND CONFERS NO i��iGKTS UPON THE CtRTIPPICATE HOLDER,THIS CERTIFICATE DOES NOT AFrjAP.ATA1etY CA NEGATIVELY AMEND,�XTF.ND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW.THIS CERTIFICATE 04 INSURANCE 004 5,NOT CONSTFTtITc A CONTRACT BETWEEN i HE IS$VINa KSURER(S),AUTHORIZED REPRESENTATIVE OR PAObUCER,AIRb THE CERTIFICATE HOLDER, IMPORTANT:If tt*certificate Ar It Wo AF✓EIITIONAL INSURED,tt*W (ws)must be endo;sel.If S—VB ti0;ATION IS WANED,wbjeet to tti- temsr and conditions of the IotLCY,certa n pct4ies may fe-qut an t!r4o.strrent.A staters em on ting ceetsf lte.does rat confer rights to the t ttilrrate hot6er In lieu of sum ef4arstftwt(s). Seekity ktsigned Risk ServicesClayton btertin J tns Agency tnc wo-s tB56)MI5 t 118 4$49 pton St PO Box 589 j, {I ;6344581 Holyoke MA 01041 s�o - I'aI cYSe '. txl�#;Ittysi&k Cnm '.SEc3=r.5>1MM'FS`R' (,` to € 3112 Gauthier Imine on tic WURER a PO Box 344 mslMp C: 1pa*ia,MA 01038 _q_;: t133e�+€'RE'. G Cft�TlflCAfi£�&U�IBER. REVI I0 NUM is to EMM TRAT TN>RCk.Ims OF fusuRAtaI".E LISTED BELOW a,AVE ESEN aSSUED 70 THF INSURED P",Eb MOVE FOP.THE RXICY M. 105 Rt OICATF0,NOT1'.5'TI4STANDI ANY REOin,Rclt,_gc"T.,TERM OR CONDITION OFANY CONTRACTOR 07kER C UMENT WITH RESPECT TO VVWCH THIS CERTIFICATE MAYBE ISSUED OR MAY KRUIN,THE 14#WRM; E AFFORDED BY IHE f-XJCICS DEWRiSED HERE44 IS SUBJECT TO ALL 7t E TERMS, £kt:t.tl52£'i¢t�'S Ahi#1(>( ?363tilds Sd Ci-t dN�Cid~�a�.Ltt;el'f'S�e�4!k M..AI°t{{at'E�1,�.;,=N FtEtz.�'.J.EU BY GAltl C:€.Aft�K. T4'[F_tit?o&L- iak .N`,, P:di::Y s[I.<r i€R s9b'SMi'Lk'vi �t33A:.?k'!t'Y'dt LUIS fRii E�£Tt R;.Sj1R�E7ti,'f } 00 3 Ah'x hi,'Ts'3 6>lfnL Y Mt3 'r�TyaLLS;'k_+*j 'AJPi}6 Q6CL4.Y Mk3ik4Y iFu 0."X_S4.Ei I Ec gUTt*e 3�'t�1'CifL`WTi53 'nom.-i'i MS,�R.E£� �. e 4 UA UCa OCC&d' `cA,,:M t'd`c,'.L•R.Q'F. ' i hS:+RcvA iF Al.R" 6 €t itac wCr- - fxzr; o Y=_ xa AtRARQ3C?4 7 `u°sG (kY5 t5.3t12t}ixs 5 3t P,IM dt.C6M oi:WORTM Oi c OAT04 w I or. z L44!u,M tit CA&T-iTM(77 MWERAII KAM" 1 6 t-5mm ti s m f, set �_r„ s;,-ey,mVv TtFICAfiE 9000LA -O S3iCXJ#.O A4Y i:}F!HE A-W)f£:?E[043ED 1'#`lLICIE.S BE LQ4C€LLE013UOR:E Cleat tit TIfiE EX.PIRATKW DATE' NOTICE Aq+ L BE OFLN`c ED N Gono,40tor$VCs ACCCIRDAJW:z WaR THE POLICY PROVIIS&V45, nU a.:z 50 Washington atre+al Westborough,MAA 01581 ignatum ACMD 25(2010105) BRAC 3139 A ®® DATE(MM/DD/YYYY) 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 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 NanC Usher NAME: y Martin J Clayton Insurance Agency, Inc. HONEExt)-(413536-0804 {A/C,_No)_(413)534-7874 ton Street E-MAIL 1649 Northampton _ADDRESS: -_ P. 0. BOX 989 INSURER(SLAFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-_Harleysville ___ NATIO INSURED INSURERB:Allied World Natl 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. ILTR TYPE OF IADD LNSURANCE INSD SUERWVn POLICY NUMBER MMLDCDIYYYYI Y EFF MM DD EXP LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 r DAMAGE TO RENTED 50,000 A __ CLAIMS-MADE l X]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 PRO- I 2,000,000 X POLICY��JECT C_�LOC PRODUCTS-COMPlOP AGG $ OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT L $ Ea accident)_ __ ANY AUTO BODILY INJURY(Per person) $ � L_ ALL OWNEDSCHEDULED BODILY INJURY(Per accident) $ _ AUTOS AUTOS --- -- -- NON-OWNED PROPERTY DAMAGE j$ HIRED AUTOS AUTOS _(Per accident) __ $ X UMBRELLA LIAB �-d OCCUR EACH OCCURRENCE_ $ 1,000,000 EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000B _..- ---- ---- DED RETENTION BE020792125-194985 10/18/2014 10/18/2015 $ WORKERS COMPENSATION PER OTH- AND EMPLOYERS'LIABILITY STATUTE ER _....-. ANY PROPRIETOR/PARTNER/EXECUTIVE Y� 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 E.L.DISEASE-POLICY LIMIT $ i DESCRIPTION OF OPERATIONS/LOCATIONS/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 SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE MASS SAVE PROGRAM THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN CONSERVATION SERVICES GROUP, INC. ACCORDANCE WITH THE POLICY PROVISIONS. 50 WASHINGTON STREET WESTBOROUGH, MA 01581 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 MP'dr6Ntbd with pdfFactory trial version www.pdffactory.com Massachusetts-i Etartrrsrfi of public Safety 802rd Of Building 8egufatiOns and Standard 1.cense:CUL„-10 P.fk Iles.344 ttaswkh MA 419 ' 752. sF �ti Expiration �a „�sit�taer ��E3'f7 �. Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston, Massachusetts 02116 Home Improvement Contractor Registration Registration_ 173410 Type: Individual Expiration: 1011/2016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER __..___ ....... ......._ P.O. BOX 344 �.._ IPSWICH, MA 01938 ____..__ .. ____....._ ............. _._._.._._.. __.. Update Address and return card Mark reason for change. Address 1 Renewal 7r Employment Last Card SCA 1 0 20M-rJ5r1 t ._ .. ��c:Yf�iwr�lzrn�trr7��cJ?"l�rtlar�rt.:.fd Office of Consumer Affairs&Business Regulation License or registration valid for individul use only u�OME IMPROVEMENT CONTRACTOR the expiration date. if found return to: - ,�a istratiow Type: Office of Consumer Affairs and Business Regulation 9 173410 YP xpiraiian: 10F112010. individual 10 Park Plaza-Suite 170 Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER �J 44 ESSEX RD - IPSWICH,MA 01938 Undersecretary ai valid wi out signature