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HomeMy WebLinkAboutBuilding Permit # 1/4/2016 TOWN OF NORTH ANDOVER NORTH APPLICATION FOR PLAN EXAMINATION °� "eO "o o � Permit NO: Date Received SSacHuSE Date Issued: IMPORTANT: A licant must com Tete all items on this page LOCATION VD � i u ' Pri t (" PROPERTY OWNER Sar o� ��yy MAP NO.: PARCELO tr PrintZONING DISTRICT: TYPE AND USE OF BUILDING HISTORIC DISTRICT YES ❑ TYPE OF IMPROVEMENT PROPOSED USE Resi al Non-Residential New Building One family Addition Two or more family Industrial iteration No. of units: Repair,replacement Assessory Bldg Commercial Demolition Moving relocation Other Others: Foundation only DESCRIPTION OF WORK TO BE PREFORMED Identification Please Type or Print Clearly) OWNER: Name: .,3- ,l 6 LV,(AC( Phone: I eV @ l® 0 .Ik kv Address: k CONTRACTOR Name: "t ® Phone: e Address: VJ� Supervisor's Construction License: - Exp. Date: Home Improvement License: 74 Exp. Date: I ARCHITECT/ENGINEER Name: Phone: Address: Reg. No. FEE SCHEDULE:BULDIN PERMIT:$12 00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost :$ e x12.00=FEE:$6D"' Check No.: Receipt No.: t `' Page 1 of 4 ®R�'f-! Town of Andover '' �„KE h ]� ver, SSS 2b COCNIC KEWOCK �• Q \ U BOARD OF HEALTH Food/Kitchen PERM11F �T� U L D- Septic System THIS CERTIFIES THAT .... �..... 640-tI ..... BUILDING INSPECTOR .............. . ....... ........... Foundation has permission to erect.......................... buildings on ... . .....0 . 1R!!-#. ..w* ............n..................... Aft Rough V�A to be occupied as .. .. . . !. .. . ............ ... .. .. ... ......'... . �... Chimney provided that the person accepting thi rmit shall in every respect conform to the terms o o�lapplicati'o'n'.... 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 PERMITIN 6 MONTHS ELECTRICAL INSPECTOR CONSTRUCTIONUNLESS STAR 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 all To Be Done FIRE DEPARTMENT Until Inspected and Approvedthe Building Inspector. Burner Street No. Smoke Det. 4 g" Federal 906 RISE Eng! wxWg Id cow R of 1 11 No A dtvls3oa leisep Pagtnealag CONTRACT 9LM PROGMM CMA-HFIS 1,11 111"11,.M * b hssica Gorbet �' (617)792-0376 08/188015 414480 00002 10 Olympic Lane Q 10 Olympic Lane North Andover,MA 01845 t, North Andover,MA 01845 JOB DESCRIPTION ' AIR SEALU40:Pmvtdo taborand materials toad d areas ofyour ham egaim wa9ft—air lesimgL Tho work will be pesfammd in, the use ofapodal wolsalta dWooWc tests to ass>rm drat year bomc wiU bo Iefl wbb a hmtda tevd of afrexclump and brdoor airg atity.Materials to be used w seal your dome can ineluda caulks,foam and other p odiccm i'rbuery mass tar seaft include air lesbW to attics,basements.a Ached garages and ostia—hewed areas(whalows we=penally addressed)M vAl rap*o(8)welders hours.A rodaetion in cubic feet per mfmue(cher)of air inliindoa will ooav,tut the actual maaofefin isaoi At the aompiadon ofthe s uW&had>t work and at no addWorai cost to Uro hoamowrxr,a final blower door as lfor c ombus<im safety enalyais will be wn&m cd by the moderator to arwm the safety of the Woorat quality. E68R00 AUR SEALING ADDER:(4)working twins. 5340.00 DAMNU4(k Pmvidc taborand materials w inwi a 12•ieya of R m wdkc 0 fiberglass batter w(86)sgkmm fat for dmam f% Pope= $17630 ATTIC FIAT.Provide tsborand materbis to f loll an V Isycr of R 28 Class i Cetfuloso added to(I lM rq=feat ofopen attic spaoe.KEEP EXISTING RMR i $1,641.26 KNEEWALTS:Pmvide laboraad ramials to install r FSK toad sari-rigid Rbagfnw board bwAadm w(225)square&a of imwewttll amt SM-50 ATTIC ACCESS:Provide labor cad rrtaterisls w butch(1)easily moved,fissutatbrg coves for the attic acccu toiling stair.Mw cava has imegml wcwhcr4tr4qftto restrict air leakage. $200.00 ATTIC Ate:Provide tabor and materials to mandate the back of Tim auk door who Y rigW 7lmrmu board and sml the doors edge with waWwwwing to restrict sir taloa $73.91 VEN nI.ATION:Provide labor and materials to batell vemilatlon daaw in(42)rafter bays to maim sir ftow, $84.00 BASEMENT DOOR Provide lsbcrw dmateriala to fnau}ate the back of Um basement door kaft to dw butkheed wbb r rigid board that meats ate recd=R 316SA cad 316.6 tegnhommts of building aide. Seal all cdaw and seams with FSK tape. 572.22 RISE Eogtrreerhtg will apply all aWicabto.eligible iaoertdvm to tltls oo ium You will arty be billod the Nct amount Cmm*. for elW*mastoes.Cowwb a Cas oilers 75%in eadvo.not to eaaxd 52,000 peradardar yem and an inceative of 10046 fix the Air Sedt g mmsums up w tits first 5680 and an additlmat 5340 ifs wiugs are justified by the suditor. Fa tba sd*ad heft ofyour hames bndoor ate quatby.we will be c=Wcdng a blowadootdleg is of ate avail"air(low in yaw bones both before the work is begun,mad aRa too weathutcafm work is canpleta.We will aim c=duct a ffdl assewrwd of Federal 10# RISE Engineering RiContractor ReaWbationNo MA Contractor Registration No A division ofni6wh Eagioeering CTConbectm Registration No 60Shsevaat Unit a caalon.MA 02021 CONTRACT 339,502.6335 FAX 339-502-315 Page 2 PROGRAM I=CONTRA=ISrxenEDWOBETWEEN NSE CMA-HES n ENGUMMO CUSTOMER FORwORH AS To ORKORDER Jessica Gorbet (617)792-0376 08/28/2015 414480 00002 10 Olympic Lane 10 Olympic Lane North Andover,MA 01845 North Andover,MA 01845 JOB DESCRIPTION the combustion sarety of your heating system and water heater.This has a value of$90 and is at no cost to you Tots/allowable weathetization incentive is$3,110. $90.00 Total: $4,145.19 Program Incentive: $3,110.00 Customer Total: $1,035.19 WE AGREE HHREW TO FURNISH SERVICES-COMPLETE tN ACCORDANCE V MH ABOVE SPEMCAMOM FOR THE SUM OF ***One Thousand Thirty-Five&191100 Dollars $1,035.19 ON ANY WlCE1FEN70DAY EECAND APPROV�RE EMFOit WONYAMMORMMGNCN WARANrEEB.IOOMa OFFRZCMX SCNFDOUN0.AWCONMLCMRFA97NACHARM MOMMY ML 00 NOT SIGN THIS CONTRACTIF THERE ARE ANY BLANK SPACES Signature USHnGWUoI�26,2016) Email: jusUn.gorbet@yahoo.com NOTEtTHr4 CONTRACT MAY OEYlnHDRA"OYUS IF NOT e%ECUTEDYmNW ACC@TANCEOF COrrTMCT•iHEAOOVEPRICR9.iPECFTCA710NSIVmCONDtROWARE SATISFACTORY TO US ANDARE HERWYAp�rED.YW ARE AUTFIORQFD TO DOTHEwOitK 30 DAYS, ASSPEQFiFA.PAYYEMYALLSENADEAS OUTLOOD)ASOVE OWNER AUTHORIZATION FORM C:12 v(Owner's Name owner of the property located at (Property Address) Ar' t9!✓ f� r )Vo V -erl liio- 1J L (Property Address) hereby authorize , {Subcontractor} an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform worst on my property. G Owner's Signature Date 0IF. 15rp 1 r, 2/01 The Commonwealth of Massachusetts Department of Industrial Accidents Office of In►,estigadons 1 Congress Street,Suite 100 Boston,,VA 02114-21117 www.niass.gov/dia Workers'Compensation Insurance Affidavit. Builders/Contractors/Electricians/Plumbers Applicant Information Please.Print Legibly NameY'� Address: 00 130X 114 — -- City�'StaterZip:,- �t til Phone te': -VU S" °3493 3 . Are you an employer?Check the appropriate box: i'ype of project(required)' 1. l am a em ka er with 4. [;] I am a general contractor and T p ?° - _— G, []New construction Inttl£tyccs(full and/or part-time).* have;hired the sub contractors 3, am a oh pr r}arictar car partner• Fisted tin the attached sheet. 7. . Rcm£xi4ling, ship and have no employees i lwsc sub-contractors,have S. C]Demolition wor},ing for me in any capacity. emplotveca and have workers' Building;addition [�£t lvtirkcn comp,Tttatlratiti ttlritl7,instlydncC:° 5. [) tt e are a corporation and its 10,C)Electrical repair,,or additions rrquircd-] ;l.C3 l tart a hilrtteCtvsmer doing all work officers,have exercised their 1 l.(;]Plumbing repairs or additions nayswlt', [No workers' comp. right of exemption ler hiGL 12'.[]Roof repairs insurance required.] t €. 154,§1(4),and we have no eniployees, (No workers' l i.-Other cutup. insurance required.) *Mv apptfrant that checks hnx si 1 mutalio fill out the�cc titni W,o �t.att�ifat s3<#r u�arr sr Ec*����safe�>r=�nliq iri rtn3tian- fit'Me" ncr"Who salbmit this alt-ida4'itind catvr'e the ;+re doing all w"rk m'ti h4 n hvc 3t t+�1c s}r rac6 rr�most sithmit a nsw afiu�3it fnlicatirti suc€s. Cotaracwt's drat check this t7ox trust attaAn!ar alt inomu1 beet sho%%ifig tt.r s,aane of 0%sub-Ax ji r.;cti+r3 and state uiiezl:tr or trot ti,,osc et lilies l ax°c if th,C stab-contracwFr hal't<err:E Iratic'-s,they must PnIVze".a:their 'A VII&CTa w tyt,1 oli:y taurr$Xr. '. I attt an employer that is Providing(workerscomperr`sfftion insurance for n,y emplgyees. Below is the pohcl=and job site information. Insurance Company Name:�t Policy#err Sclf-ins. Lic. : Expiration t7ate._V 0 Job Site Address.._ V,�,��1 10 t �+ citylStatc zipy 'tA h&�,V cy— hero ' Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). I�ailure to secure coverage as required kinder Section 15A of MGL c. 151 can lead to the imposition of criminal penalties of a fine ilp to S1,5t)t,00 sandior one-year impris+on=nt,as well as civil Vertaltits in tine form of a MOP WORK ORDER and,'a fine of up to$250400 a day against the violator. He advised that a copy ol'this statement may be forwarded to the Office of Investigations of the DIA for insurance coverage verification. I day hereby certify under the Palm and Penalties of perjury that the information Provided ab©re1 is true and vorreet. 'sigrsature Phone U:q NIS IS-U- 34 FC ncial use only. Iyer not write in this area,tea be completed ba 6Ah or to nr of;�rcialty`or Town: Permit/I.1censc suing Authority(circle one)( Board of health 2.Building Department 3.C'ityrrown Clerk 9,Electrical Inspector 5.Plumbing Inspector 6.Other - C ootaet Person: - Phone s 0T�®® DATE 7/2 0/ A�-. 15 l\�(J� 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 Nancy Usher NAME: Y Martin J Clayton Insurance Agency, Inc. PHONE (413)536-0804 1 FAX No):(413)534-7874 _(A/C No.Ext): 1649 Northampton Street E-MAIL P _ADDRESS_ P. 0. BOX 989 INSURER(S)AFFORDING 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 INSURERD: 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 - ADDL SUER POLICY EFF POLICY EXP ! LIMITS LTR TYPE OF INSURANCE POLICY NUMBER MM DD MM OD I X COMMERCIAL GENERAL LIABILITY _EACH OCCURRENCE $ 1,000,000 r DAMAGE TO RENTED _ A _ CLAIMS-MADE u OCCUR PREMISES(Ea occurrence) $ 50,000 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 f PRO- - L _- 2,000,000 X POLICY E]JECT El LOC PRODUCTS-COMP/OP AGG I OTHER: I $ COMBINED SINGLE LIMIT i$ AUTOMOBILE LIABILITY Ea accident) _ ANY AUTO BODILY INJURY(Per person) $_. _ ALL OWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS _. AUTOS NON-OWNED PROP RTY DAMAGE $ HIRED AUTOS AUTOS ------ — ------ $ X UMBRELLA LIAB OCCUR EACH OCCURRENCE $ 1,000,000 $ _ EXCESS LIAB CLAIMS-MADE AGGREGATE__-- $ _._1,000,000 - ---- - _ DED RETENTION BE020792125-194985 10/18/2014110/18/2015 $ PER WORKERS COMPENSATION OTH- AND EMPLOYERS'LIABILITY _ STATUTE_ ER PROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ OFFICER/MEMBER EXCLUDED? � N/A - - (Mandatory in NH) E.L.DISEASE EA EMPLOYE__$ If yes,describe under j �ANY DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 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 - "-'���`�"1� . ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD MP?'d d§tbd with pdfFactory trial version www.pdffactorV.com + CERTIFICATE OF LIABILITY INSURANCE 9{1 Fd2131 THIS CERTIFICATE IS ISSUED AS A MATTER,OF INFORMATION ONUf AND CON ERS t G RIGH Su•€1N THE CERTIFICATE HOLDER,7N?S CERTIFICATE DOES NOT AFf AMATWELY CR NEGA IVELY AMEND,>XTFND OR ALTER THE COVERAGE AFFORDED BY THE POLICIES BELOW,THIS CERTIFICATE OF INSUPA ACE DCIES NOT CWw5TITCITT A CONTRACT BETWEEN THE ISSUING I-"SURFR(S),AUTHORIZED REPRESENTATIVE DR P€iOOUCER,AND THE CERTI`IC T_HOLDER. IMPORTANT-It the ctrti#sate holde,cs ar,7UVITIORAL INN'EI'L,fh+-006CY,`WE)r"Vu t tre R*65 i1 SVBRCTGATION IS WAPUED,svb)ect to tm terms and cand;tims of ttte Polcy,certain pe 4cles cn.=_y r slyer yeti i�.rido,"rr4nt.A Statement cr,tnts 4`104 ca:ther Fk;hts to ch>_ ckttrlicate hdder In lieu of such E4uhtsSernefttl5}. ti&y Berkley Ass tsed Risk+ervices CW ton Mw in U Ina Agency ft- (800) 314,4680 a� r�,, I856)215 Hite Holyoke MA 01044 =r�� i'ciltCyStro' E�klytY>}sltdsm P:. Sj$?Y'FCRiye ft:�'£R E Neat —31-325 =a CSauthler Insulation IMC PCI Box 38.4 �s�R Ipswieb,SAA 01938 4 to—VERAU79 ERTIFICATE NUMSEW EVISIt AI NUMBER: THIS`I-S-t 0 GERT4F(Tt At Th.Pt}I t tE 7F N SUPJ,f.C£117iE£I BELU}d yL E td 3SsCtEO T�Trc II GllR£.D P:iSMW A60Ye FOR 71sT€F'G=ICY PERIDO 6NNCAISO.I,K TWTHSTANDIM-1 ANY REOUREME T TERM f OR CadNVIII.N or AW CONTRACTOR OTkER DOCUMENT WITH R d'C<�T TO Yw"f TH's CERTIFICATE MAYBE iSSUExD 00 WAY PERTA4A:,THE 1NSVRAP .F 6FFC`RDED SY THE 17LICIES DESCRIBED t4€REM IS 11J9JCCT TO ALL THE TERMS. tx�.LLStrrrB ANO C YrT!CkNS LF StlCtt k� .SC E5.LMiITS Se- WN MAY Piki�11rE S N RE-D.J ED 9Y CAllb C AIM&UP . i.�`3+',£RCW.viN€f2.�2 r_u,aT?f," ir`�€fdrs85 rem a_ .c 3 iaEDu';.J AI:£^d>t+.E.fiiATc S G€g¢T.tGLWxiiz rt i ro�ri e.��E,rEp: Autos UAN"ty M",ALTO N+icq iP.cam: $ t au e€. I �rsc e�rime ., 's 77 ( aa;.xo+xua;:w:F Zx1ea6tl.�a+ Luh*rn':4 mz��c€va-s Y ►Ala fwucRyv"bAckAy t A•;•s4( fNE7JAg kTr<S1t r�;u ,s iY; t5:au?2tii5 4:5.r3 Z01£ £t£,�.-,ars,>: $ Sirtx`I s Cc€M:E'lExsr -��. s tcu. � AiAARFr?£ 3 'P .._... f,A--V nMWl r r�r.:Esc er.e4xe 0..-SCa'kxb'Kx«PF�°c�Le,T^�t�bera* s•s_se..F� F`�s£.t kgltT � 5tlt%G'�3 O D _:c - £.-IL �`. tt.. �Rdaea •_ ✓h"y 5%=y .r�+a g�,rft F?,�^•»:sa®zk'S 4�.vc�j ±:.7Lr.,E3tYG�n,Y-�Y �W=:Y*w'u.'pa%s r<av F:':.£€�aLR.�•4tYC3.' CERTIFICATE—140—L-09- CANCELLATION f}ii'7UtL'Ast r•L�T}IE.F.£343°.'E i"tc5CHi3E[J PC5`_n:.�$t's=Gfit3�LLEG B[F�iG CI@BPo UIt 7}§S EAR'R.Tikt,,ATE TI-EnEov.Noa1Ec 4t•a 5€t Ei k'ERsa;c Cteare ult r�YCS AGX0gLANCC%TIi THE P1CX1,V C?I.S tEs. 50 Washington Stmet Westborough,#Air 01561 „ ignature: ACCIRiD 25(2020105) 8RAC 3139 E1:k;"tryCitfjellI' Office of Consumer Affairs and Business Regulation n. 10 Park Plaza- Suite 5170 Briton,Massachusetts 02116 Home Improvement Contractor Registration Registration: 173410 Type: Individual Expiration: 10!1/2016 Tr# 257812 KURT GAUTHIER KURT GAUTHIER P.Q. BOX 344 IPSWICH, MA 01938 ............... ......... ............. _............... Update Address and return card.Mark reason for change. Address ` " Renewal .._ Employment Lost Card Sf„`.A 1 is 26M 057 I I Office of Consumer Affairs&Business Regulation License or registration valid for individul use only TOME IMPROVEMENT CONTRACTOR before the expiration date. If found return to: 1 ,0eg�stration 173410 Type: Office of Consumer Affairs and Business Regulation r w 10 Park Plaza-Suite 5170 � s ;Expiration: =1011/2016 Individual Boston,MA 02116 KURT GAUTHIER KURT GAUTHIER 44 ESSEX RD IPSWICH,MA 01938 _._... ...._ _......_....__. C)ndersecretary 'ot valid wi out si nature �R "9 hu s-Dep.,tmet of PuJ,sic Safety Board of RuOding Re utaflons and Standard 1zs 4 ou9h� License.(�t,_1025�B2 KUW R GAt R P.(X Box 344 3Pswrich MA Ofgj 1' J sl �I- t xpirafjon scam 060'+t.Zt317