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HomeMy WebLinkAboutBuilding Permit # 1/4/2016 %AORTH BUILDING PERMIT 0 1 T�V.D 06 TOWN OF NORTH ANDOVER 00 ' APPLICATION FOR PLAN EXAMINATION - Permit No#: Date Received �SSACUS Date Issued: IMPORTANT: Applicant must complete all items on this page LOCATION kCi 9- OVAM i(,L(AV-C- Print PROPERTY OWNER tf&A� q Print 100 Year Structure yes no MAP PARCEL: �D ZONING DISTRICT: Historic District ye no 0 Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building NCrn_e family ri Mclition 11 Two or more family 11 Industrial r�Ajteration No. of units: 11 Commercial nlRepair,—replacement 11 Assessory Bldg 11 Others: 11 Demolition El Other DESCRIPTION OF WORK TO BE PERFORMED: ,A ih 4 6t Identification- Please Type or Print Clearly OWNER: Name: C l Phone: Address: k _ U '6 Contractor Name: Phone: 6VN SSID' 34" Email: !: W�VVV I Y\% Uj�q Address:'e 0 9'%� SQ4 I 0`1 Supervisor's Construction License: 0�11901— Exp. Date: 5 17S Home Improvement License: 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: $ 9 0 FEE: $ Check No.: /a, Receipt No.: NOTE: PersoJis contracting with unregistere4 contractors do not have access to the guarantyfund Sion, Siq n ato re,,of,'cohtt86f 6 a FORTH Town ofAndover .� �, ® "; O ® '� AILs h V� _ Q. �.Kver, a9 S 11\1 IMl WICK qTA COCMC `V S V BOARD OF HEALTH Food/Kitchen PER I L NUmL Septic System THIS CERTIFIES THAT BUILDING INSPECTOR .................. .................................... ............ .... ...........................�................. ° Foundation has permission to erect.......................... buildings on ® � Rough to be occupied as ........ .... 4 .�J..........�.... .�...: .. !�.Irspect ®..�.... ........ ...®`►�1►.s..... ......... . chimney �• provided that the person accepting this ermit shall in every 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 PERMIT EXPIRES IN 6 ®NT ELECTRICAL INSPECTOR UNLESS TI ST Rough Service .................................. ............................................ Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® Occupy BuRough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be one FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 4 Federal 10 9 05-MS629 RISE Engineering No 8186 MAContractor egisttrrauo No 120979 RISE A division or'I'hicisch Engineering CT Contractor Registration No 020120 ENGINEERING, 60 Shawmut,Canton,MA 02021 CONTRACT 339-502-5197 FAX 339-502-6345 Page 1 1'110GltAtvf CMA-HIES ENOINNURWO MIT MieCONTPACT IS CWOM FOR WOR cn as DEscFaum emow CUSTOMER PnoNE. DATE CUENTt wOPX ORDER MichaelCrepeau (781)439-5600 10/16/2015 416191 00003 SERVICE S'MM "ILLINO STAEET 195 Olympic Lane 195 Olympic Lane SERVICE CITYATATE W �LLy 8IWN0 CITY,STATE,ZIP North Andover,MA 01845 North Andover,MA 01845 JOS DESCRIPTION AIR SEALING:Provide labor and materials to seal areas of your home against wasteful,excess air leakage, This work will be performed in concert with the use orspecial tools and diagnostic tests to assure that your home will be left with a healthful level orair exchange and indoor air quality.Materials to be used to soul your home can include caulks,luams and other products. Primary areas for scaling include air leakage to attics,basements,attached garages and other unheated areas(windows are not generally addressed,)This will require(8)working hours. A reduction in cubic feet per minute(cfm)of air infiltration will occur,but the actual number of cfm is not guarainced. At the completion orthe wcatherization work,and at no additional cost to the homcoancr,a final blower door and/or combustion safely analysis will be 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 unraced fiberglass battc to(92)square feet ror damming purposes. 5188.60 A`i-L'(C FLAT-Provide labor and materials to install a 10"layer or R-35 Class I Cellulose added to(540)square feet of open attic space. $793.80 A711C ACCESS:Provide labor and materials to insulate the back of(1)attic hatch with 2"rigid Theritiax board.Weatherstrip the perimeter, $60.00 ATTIC ACCESS:Provide labor and materials to install(1) new,finished plywood,knecwall space access hatch:fhe hatch will be insulated with code wir pfunt 2"rigid"fhermax board,weather-stripped,and held closed by eye hooks. (Wood surfaces will be unfinished. Prime coat andtor paint is not included,) 5120.00 VENTILATION,Provide labor and materials to install(2)insulated exhaust hose with roof moumcd flapper vent to exhaust 16turc bathroom fan(s). $237.50 VENTILATION.Provide labor and mutcrials to install ventilation chutes in(39)rafter bays Irs maintain air flow. $78.00 COMMON WALLS:Provide tabor and materials to install 2"FSK raced semi-rigid fiberglass board insulation to(308)square feet of common wall area. 31,078.00 RISE Engineering will apply all applicable,eligible incentives to this contract. You will only be billed the Net mnoant. Currently,for eligible measures,Columbia Gas oflors 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 100%for the Air Scaling mimsures up to the first$680 and an additional$340 irsavings are justified by the auditor. For the surety 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 weathcrizztion work is complete.We will also conduct a full assessment of the combustion safety of your licating system and watcr heater'rhis has a value or$90 and is at no cost to you. Total allowable weatheriaation incentive is S3,1 IU. 590.00 } " OCT 2 Federal IO 8 05-MBS29 RISE Engineering RI Contractor Registration No 8186 PAA Contractor Registration No 120979 A division of Thicisch Engineering CT Contractor Registration No 620120 ENGINEERING 60 Shawmnt;Canton,NIA 02021 CONTRACT T 339-50'_15197 VAX 339-502.6345 ri Page 2 PROGRAM TMS CONTRACT 1S ENTERED INTO DETWEEN RUSE CMA-HES ENOINMI NO AWME CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER 1,11099: DATE CLIENT! WORK OROM Michael Crepeau {781}439-5600 10/16/2015 416191 00003 SERVICE STRPST BILUNO STREET 195 Olympic Lane 195 Olympic Lane SERVICE CRY,STATE,ZIP 0111010 CITY,$TAM ZIP North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION Total: $3,325.90 Program incentive: $2,686.83 Customer Total: $638.98 WEAGREE HEREBYTO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF *-**Six Hundred Thirty-right&981100 Dollars $638.88 UPON ECTTON AND APPROVAL BY RISE ekazuEEnWD.CUSTOMER AGREES To REMIY AMOUNT DUE 91 FULL 0ITEREST OF 1%WILL DE CNARGEO MONTHLY ON ANY UIWAW EAFTElt N DAYS.SEEREMMS MR IMPORTANT M':GWJATR0U ON GUARANTEES,RIGHTS OF REM10N.SC1tEDUUNO,SBO COHTMCTOR REGTSTMTKilL 00 NOT SIGN THIS CONTRACT tF THERE ARE ANY$LANK SPACES At"ORM SIGNATURE-RISE Engimoft CUSTOMERAC- NOTE:THIS CONTRACT MAY Be WRHORAWN BY US IF NOT EXECUTED Y(n im DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-7119 ADM PIUCES,SPECUICATIONS AND CONDITIONS ARS 30 DAYS. sAWACTO RY To US AND ARE NEREOYACCEPTED.YOU ARE AUTHOAM To DD THE WORK AS SPECIFIED.PAYW-WV LL 0E MADE AS OUTUNED ABOVE #Ir*I OWNER AUTHORIZATION FORM Michael Crepeau (Owner's Name) owner of the properly located at 19�01ympic Lane, North Andover MA 01845 (property Address) 19�01ympic Lane, North Andover MA 01845 (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, Chores Sig atu Elate t % _a The Commonwealth of Massachusetts Department of Industrial Accidents Orice of In wsti aztions I Congress Street,Suite 100 Boston,VA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit, Builders/Contractors/Electricians/Plumbers Applicant Information Please Print Le gihly tarot (Business%{rsnirti€�n'tttc§ividesl): y�t t f_i� 1 (� , Yom,- Address: `00 ' 054 34 - ---- -- Ci �SState/Zi le i1 Phone.0: -Vfa I S7 b, 4'a 3 Are you an employer?Chock the appropriate box: Type of project(required), 1,9 l am a employer with _ 4. I arra a general contractor and 1 empl«yetis(full andFbr part-titne). * have hired the sub-contractors � 13 New construction 3. t am a �Ic propnrtcsr or partner- titled on the attached sheet.. T Remodeling ship and have no employes I ha se.suis-���ttractors have a. C]Demolition workingfor nit:in an capacity, ernployce,and have workers'Y "�. ' 9. ( wilding addition [-No comp,insurance eotrips insurance.= required] 5. 0 We are a corporation and its 14.[)Electrical repairs or additions :1.0 1 am a homeowner doing all work officers have;exercised their I I.[]Plumbing rcpairs or additions tnyr�lt; Ltvo worker ' comp, right oft\emption ps:r MGL 12.[]Roof repairs insurance required.] t c. 154,§1(4).and we have no employees, [oto workers' 13,0 Other comp.insurance required.] 'Any appli m that checks box 41 triu4t also fallout the bet tion mow policy inforanation, r Homcros-nerx who submit this altidakit iatdscati tg tlscy are doing all w rk and tfaen hire outsidc comm tom must submit a ww oaf dz&61 indicating such. 'Contractors that check this box tnu3t attached an aaditional hit showing tAx name of the suh-€on¢rac6ots and state Whether or not ahoy:zntitic€have errtploye-Ns If the sub-contractees haat emgloir ,they must p¢atiala•ttieir w'oei tzs'temp.policy nuniaba" lover that is providing workers'compensation insurunre for my employees. ltehma is the policy and job site I am an 7emp information. Insurance Company l',iatne:_ c, �.&, is a►t I ,....__... .... Policy#or Self-ins, Lie.ff; V1._ _ _ !� _2 � v Expiration Date; Job Site Addressj o� DAM n%(, City/Stateizip: _ _:n A-c e 4 Attach a copy of the workers'compensation police declaration page(showing the policy number and expiration elate). Failure to secure cover-age as required under Iketion 35A«f MGL c. 152cats lead to the imposition of criminal penalties of a fine up to S1,500.00 andror one-year imprisonment,as well as civil petialtie's its the forth of s,rop WORD ORDER and sa fine of up to$250,00 a day against the violator. Be advi.wd that a copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I do herebf certify under the pains and penalties of perjure that the information provided above is true and correct, Thione it:I VS 3 S-U° 4 t 3, (}ffaciatl use only. Do not write in this area..to be completed by city or town oj�cial. City or Town: w ,mm Permitll.icense 9 _.._. issuing Authority(circle one). I.Board of Iieaith ?.Building Department 3.cityl'rown Clerk 4.Electrical Inspector 5.Plumbing ltr9 .tor h,Other C ootact Pemn: _,. ; T.--_._.w_ Phone b: .._,... ACID CERTIFICATE OF LIABILITY INSURANCE THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORMATION CNIL:f MD CONFERS NO FUGK-,S Lj-,ON T-HE Ctkll,-VG-ATE f4oi-DFR,THIS CERTIFICATE DOES NOT AffIRMATMILLY OR NEGATIVELY AMONtJ,CYTZN01 OR ALTER THE COVERAGE AJ`WRDEV BY THE;'CLICIES BELOW.THIS CERWICATE Of INSURANCE DO'5NOT CONSTITUTE A CONTRACT BETWEEN THC ISSUI14G INSURER(S),AUTIAORIZED —REPAESENTATTVE OR PW0114LER,Affln THE CERIIFICATt HOLO4P, IMIXORTAWT:U the ceftfirate harder'is an ADOITIOR' L INSURED,U`*P<Ak-y(WS)must be e040 S-UR6iATION IS WAWEVfe,,Jb"- to thms teolm;and canditiom of the poficy,certain pc,14cie4 may mqu".an er-d-orwr4nt,A stawntnt on Mhl'ceeifttit',f14e5 C'ut celifer rigtts to the wuncate,fidd--r in lieu Of skr 97M wd Risi(Senices y k3igt Clayton Martin J Inc Agency Inc 1640 Northampton St PO Box 989 AIC.1 Llk Ho"e MA 01041 msuRFA 4 Am6.1--w;m-co PO BOX 344 fpswich,MA 01038 CERTIFICATE WMSER: TM%IS TO EWT—Ify TF A—T TE PM vIES OFINSORANCE LISTED BELOW ti.AVE $9W TC iK80RfDKAhAEbAWNS FORTH E F .ICY PER)ICIO N04CATS0.NOW4TOSTANDING ANY REWiREMENT,TERM.ORCONVOICN, OFANY CONTRACTOR 07kER DOCiVIENTW11H RESPECT TOV"CHT)<R CERTIFICATE MAYBE WoSO OR MAY PSRTA;tc TK--INSVRANCE AFF OROEDBY114E WMACIES DESCRI8EOJiZREWfS SU9j=-CT TOACLIIiE TERMS, LXCX'dsI0NkR AW Cowffons OF S€LXIK POUVES.LWITS S4,irAVN*MAY HAVE BEEN PEC;QED BY PAID QAW-,. nW t14 -Vj�k' K4 ry MA6EP W-A VAMWY OCi, -------- rP*%�EKYkL iKNMA-'UMX�ry �0 010A�AIA5� n jr,0 okAs1-1Nu&AW wm v -kKFE-SFI "'0A414Y'w'-' jj 0 ..i MY ALTO $ 77W.7 WvM s 0 _j neo L] WlptaftcobsVllu"O" r5177 AND InAPLOVOW"AAkm A+-Y'PRO P ft-T ok"oART NE pvhz�M A la, °i jaX!_j0j$ %%p f t E. «s A,'01-h' 000 OF 0r'Ef4kT'0t&w � EL L.sEA&f 1-4ic I t"T -1100,WO nz, Lftd N: --t;Wf1—F)CATE CANCKLATION Gt*0Ut41 1«41'(k 1Vk i'�WVt BE 1.. EULED KFORC Ctear"wt TW-EXPIPATiON DA!r Ti-EAEOC NOT;-^E leit-L FiE DELN1Er-=iti Contractor Svcs AGGORDA-WC MTF Ti4F-Pct,--Y AUI�11-4za 50 Washington Street WastboroUgh,MA 61501 iowl' sigriature: AaWD 25(2010,105) 8PAC 3139 AC"R®® DATE(MMIDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 7�7�zo15 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 NancyUsher NAME: Martin J Clayton Insurance Agency, Inc. PHcoNN Exq: (413)536-0804 ) .No):(413)534-7874 E-MAIL 1649 Northampton Street ADDRESS:P. 0. BOX 989 INSURERS)AFFORDING COVERAGE NAIC# Holyoke MA 01041-0989 INSURERA:Nationwide Mutual-Harleysville NATIO INSURED INSURER B:Alli_ed World Natl Assurance_Co Gauthier 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 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. INSRSUER -- POLICY EFF 1 POLICY EXP LIMITS LTR TYPE OF INSURANCE ! POLICY NUMBER MM DD YYY MMIDD X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ 1,000,000 t-- DAMAGE TO RENTED -- 50,000 A ��CLAIMS-MADE ,X OCCUR PREMISES Ea occurrence $ X GL43487F 7/6/2015 7/6/2016 MED EXP(Any one person)..-. $ 5,000 JPERSONAL&ADV INJURY $ _ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: ' GENERAL AGGREGATE $ 2,000,000 X POLICY E]PE� E LOCPRODUCTS2,OOO,000 -COMP/OP AGG $ OTHER: AUTOMOBILE LIABILITY (Ea accident)accidtSINGLE LIMIT $ ANY AUTO BODILY INJURY(Per person) $ '.. ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS -- ---- HIRED AUTOS _ ANO-OWNEDUTOS PROPERTY DAMAGE $ _(Per accident)__ - __ _ $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ -...__X00,000 B EXCESS LIAB _ CLAIMS-MADE, AGGREGATE..___ _ _ _ $ 1,000,000 DED RETENTION �BE020792125-194985 10/18/2014 10/1 WORKERS COMPENSATION 8/2015 �$ STATUTE_ __ _ AND EMPLOYERS'LIABILITY Y/N -- - _ ANY PROPRIETOR/PARTNER/EXECUTIVE I� N/A I E.L.EACH ACCIDENT _ $ OFFICERIMEMBER 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 I LOCATIONS I 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 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 IVP9'Z,1i`bNtbd with pdfFactory trial version www.pdffactorV.com Ma"ac hu tts- pa�tment of public Safety goasd of Building RCOUfations and Standards *;,4171 License,.,GSSL-1q pft .P.'C.SRI 344 IPwich MA 019,A Expiration a�sur g finer OSIM2017 m Office of Consumer Affairs and Business Regulation 10 Park Plaza- Suite 5170 Boston,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type. Individual Expiration: 10/112016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER _..._ P.O. BOX 344 .... ....__ �._ __ ._.._ IPSWICH, MA 01938 _.._._ _------ .. . . ._.....................__ __._ -___ Lipdate Address and return card.Mark reason for change. Address "_...' Rene»al Employment Lost Card SCA( Cb 0M-05ift `J ..... Office of Consumer Affairs&Business Regulation License or registration valid for individul use only ;30ME IMPROVEMENT CONTRACTOR before the expiration date If found return to. registration: I73410 Type: Office of Consumer Affairs and Business Regulation z expiration: IOIi/201&' Individual 24FarkFtaza-Suite5174 Boston,MA 42126 KURT GAUTHIER KURT GAUTHIER 44 ESSEX Rl7 ., I!f� IPSWICH,MA 01938 _ "� Undersecretary "ot valid wi outgnat siure