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HomeMy WebLinkAboutBuilding Permit # 1/7/2016 BUILDING PERMIT �kORTH TOWN OF NORTH ANDOVER APPLICATION FOR PLAN EXAMINATION Permit No#.- Date Received Date Issued: IMPORTANT: Applicant must complete all items on this page fra INA 11" W P't,um TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential El New Building El One family El Addition El Two or more family El Industrial 11 Alteration No. of units: El Commercial 0 Repair, replacement El Assessory Bldg Ar Others: El Demolition El Other Pr 147-1,00 /V it! F.b d t ft '60' t' 44?;❑"8 "M , I t W 16, y�,ng/;,,',1 g lg/g' ,rr 01 099, IBM let, DESCRIPTION OF WORK TO BE PERFORMED: "e,, —rvl 5V 1C 54 Identification- Please Type or Print Clearly OWNER: Name: Pr o vt �—t W eda e- Phone: !J-7,F-,W3 - Address: dt V%_ 19 vim.. 161 r. ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE;BULDING PERMIT:$1200 PER$1000-00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: Check No.: Receipt No.: NOTE: Persons contracting with unregistered contractors do not have access o the guaranty fund' Signature of contractor- q��.Ag �e NORTH ' ir0%wn Ot2 over ® '. .y •� No. 1 "Komu 1- 2.61 ' O LAKE h 4 ver, as cocmc KIWICM V RATED `S U BOARD OF HEALTH PE �R �M� T T L U Food/Kitchen Septic System THIS CERTIFIES THAT .!� ..... .......... BUILDING INSPECTOR ... s.... .......... ................................. has permission to erect .......................... buildings on .IL ...................s�....... ... .......... OFL Foundation Rough r to be occupied as ........ .. ....se 1 ... .. ....,...............�.... .7w�' P................................... Chimney provided that the person accepting this pe salt 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. fl Final PERMIT EXPIRES I 6 MONTHSELECTRICAL INSPECTOR LES- TIO ST S'% Rough Service ................................... ........................................... Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Reguired 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. Federal In 9 05-0405629 RISE Engineering RI Contractor Registration No 8106 MA Contractor Registration No 120979 RISE A division of ThicIsch Engineering CT Contractor Registration No 620120 ENGINEERING' 60 Shawinut,Cmuon,MA 02021 CONTRACT 339-502-5197 FAX 339-502-634-5 Page PROGRAM THIS CONTRACT IS ENTERED INTO BETWEEN RISE CMA-IIES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CUEnT# VIORKORDER Kenneth Wedge (978)683-1826 09/28/2015 422298 00003 SERVICE STREET BILLING STREET 14 Linden Avenue H Linden Avenue SERVICE CITY,STATE,ZIP BILLING CIM STATE.ZIP North Andover,MA 01845 North Andover,MA 01815 JOB DESCRIPTION AIR SEALING:provide labor and materials to sea]arm,;of your home against waslefid,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 fell with a lumfibilif level of air exchange mid indoor air quality.Materials to be used to seat your home can include caulks,foams and other products. Primary areas for scaling include air leakage to allies,basements,attached garages and other unhealed areas(windows are not generally addressed.) 'fids will require(7)working hours. A reduction in cubic feet per minute(cin)of air infiltration will occur,but the actual number of cfm is not guaranteed. At the completion of the weatherimlion 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 sollety of*the indoor air quality, $595.00 KNETWAI.I.SLOPE:Provide labor and materials to install R-19 unfaced fiberglass to(192)square feet of wall. Then Install V rigid board insulation. Scalall scants with FSK tape. $787.20 WALLS:Funush and install blown in Class I Cellulose to(864)square feet of vinyl-sided exterior walls.Invoicing will occur upon completion of installation. Subsequent to Your payruent,as an added service,RISE Engineering will return when weather ficauits to check for any voids with an infrared scanner. Any major voids that may be found will be filled al No additional cost. $1,598.40 BASEMENT CEILING:Provide labor and materials to install(108)linear feet ol'R-19 unfaced fiberglass insulation to the perimeter ofthe basement ceiling it the house sill, S189.00 BASEMENT DOCIR:Provide labor and materials to insulate the back of the basement door leading to the bulkhead with 2"rigid board that meets the sections R-316.5.4 arid 316.6 requirements of building colic. Sea]all edges and sears will FSK tape. 57.2.22 RISE Engineering will apply all applicable,eligible incentives it)this contract. You will only be billed(lie Net amonat. Currently,lbreligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive ol'100%Ibr the Air Scaling measures tip to the first$680 and all additional$340 if savings an:justified by the auditor. For the safety and health of your home's indoor air quality,we will be conducting a blower door diagnostic ofthe available air flow in your home both betbre tile work is begun,tad after die weallicrization work is complete.We will also conduct a full asscssuient of the combustion safety ol'your heating system and water honer.This has It value of$90and is at no cost to you. Total allowable weatherization incentive is$3,110. $90.00 �j Federal to#05-0405629 RISE Engineering RI Contractor Registration No 0186 MA Contractor Registration No 120979 RISE A division of"Thicisch Engineering CT Contractor Registration No 620120 ENGINEERING. 60 Showinut,Canton,MA 02021 CONTRACT 339-502-5197 FAX 339-502-6345 Page 2 PROGRAM THIS CONTRACT 13 ENTERED INTO BETWEEN RISE CNIA-11ES ENGINEERING AND THE CUSTOMER FOR WORK AS DESCRIBED BELOW CUSTOMER PHONE DATE CUENrd woRx oRm Kenneth Wedge (978)683-1826 09/28/2015 422298 00003 SERVICE STREET BIUJ140 STREET 14 Linden Avenue 14 Linden Avenue SERVICE CITY,STATE,ZIP IMLL114G CITY,STATE,mp North Andover,IVIA 01845 North Andover, MA 01845 JOB DESCRIPTION Total: $3,331.82 Program Incentive: $2,670.11 Customer Total: $661.71 WE AGREE HEREBY TO FURNISH SERVICES-COMPLETE IN ACCORDANCE WITH ABOVE SPECIFICATIONS.FOR THE SUM OF ***Six Hundred Sixty-One&71/100 Dollars $661.71 UPON FINAL INSPECTION AND APPROVAL BY ROE ENCINEEFUNG.CUSTOMER AGREES TO REMITAMOUNT DUE 14 FULL INTEREST OF i%WILL BE CHANGED MONTHLY ON ANY UNPAID BAL;JjqE AFTER 30 DAYS.SEE REVERSE FOR IMPORTANT INFORMATION ON GUARANTEES,RIGNTS OF RECUStON,SCREDUUUG,AND CONTRACTOR PErMTRATIOU. 00 NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SPACES CUSTOMER ACCEPTANCE NOTE:THIS CONTRACT MAY BE WffNDRAViN BY US IF NOT EXECUTED WITHIN DATE OF ACCEPTANCE ACCEPTANCE OF CONTRACT-THE AIIDVE PRICES,SPECIFICATIONS AND CONDITIONS ARE 30 DAYS. SATISFACTORY TO US AND ARE HEREBY ACCEPTED.YOU ARE AUTHORIZED TO 00 THE WORK AS S SPECIFIED.PAYMENT WILL BE MADE AS OUTLINED ABOVE OWNER AUTHORIZATION FORM Kenneth Wedge (Owner's Name) owner of the property located at 14 Linden Ave, North Andover, MA 01.845 (Property Address) 14 Linden Ave, North Andover, MA 01845 (Property Address) hereby authorize , (Subcontractor) an authorized subcontractor for RISE Engineering,to act on my behalf to obtain a building permit and to perform work on my property. i I Owner's Signature Gate r r The Commonwealth ofMassachusetts Department of Industrial Accidents I Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information _J rPlease Print Legibly Name (Business/Organizatiow ndividual): //A t}� I�� 4 ! lei %/'O d Address: � _ ��) ��i! tiC ei,$�- City/State/Zip: 1A A , t t If sYl �d1, Phone#: 6' /S.Ls, Are you an employer?Cbea the appropriate box: Type of project(required): 1.a1 am a employer with / amplayocs(full and/or part-time).• 7. ❑New construction 2.❑I am a sole proprietor or partnership and have no employees working for me in 8. Remodeling any capacity.[No workers'comp.insurance required-) 301 am a homeowner doing all work myselE[No workers'comp.insurance required.)t 9. ❑Demolition 10 E]Building addition 4-[]]am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all contractors other have workers'compensation insurance or are sole 11.0 Electrical repairs or additions Proprietors with no emmployexs 12.❑Plumbing repairs or additions 5-01 am a general contractor and I have bired the subcontractors listed on the attached sheet- 13_�ROOf repairs These sub-contractors have employees and have workers'comp.innaancc.t 6.0 We are a corporation and its officers have exercised their right ofacmptioo per MGL c. 14.❑Other 152,§1(4),and we have no employees.f No workers'comp.insurance required) *Any applicant that checks box#1 must also fill out the section below sbowing their workers'compensation policy h&rmatkxL t Homeowners who submit this affidavit indicating they are doing all work and then biro outside contractors must submit a new affidavit indicating such- tcoutractors that check this box must attached an additional sheet showing the name of the sub-contractors.and state whether or not those entities have enployocs. If the sub-contractors have employees,they must provide their workers'comp.policy numbs- 1 am an employer that u providing workers'compensation insurance for my employees. Below is the policy and job site information. y Lasumnce Company Name: p `�C% CA Policy#or Self-ins.Lic. Expiration Date: 621 /21 Job Site Address: City/State/Lip: y/- i9h�4d'l� Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 ind/or one-year imprisonment,as well as civil penalties in the form of a STOP WORKORDER and a fine of up to$250.00 a lay against the violator_A copy of this statement may be forwarded to the Office of Investigations of the DIA for insurance ;overage verification. t do hereby certify under the pains and penalties of perjury that the information provided above is true and correct ' e zignature: (�i �� / � E `'- - -- Date. 'hone#: 1�2 —%&d Official use only. Do not write in this area,to be completed by city or town oolciaL City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical Inspector 5:Plumbing Inspector 6.Other Contact Person_ Phone#: POLABEA-01 JONEILL CERTIFICATE LIABILITY INSURANCE DATE(MWDD/YYYY) 4111.� 1/6/2016 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(les)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). CONTACT PRODUCER NAME: Durso&Jankowski Insurance Agency PHONE 978 688-7000 VC,No):(978)688-7001 11 Saunders Street Ac,No Ext):— 11 ) _ ___ — North Andover,MA 01845 E-MAIL ADDRESS: INSURER(S)-AFFORDING_ COVERAGE _ NAIC# INSURER A:Nautilus Insurance Co. 17370 INSURED INSURER B:Safety Insurance Company Polar Bear Insulation Co.Inc. INSURER C: Peter Leblanc&Steven Leblanc P O Box 958 INSURER D Andover,MA 01810 [INSURIRE:SURER F: COVERAGES CERTIFICATE NUMBER: 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 ll POLICY EXP LIMITS LTR. TYPE OF INSURANCE INSD I D I POLICY NUMBER MM/DD MM/DD/YYY A X COMMERCIAL GENERAL LIABILITY I EACH OCCURRENCE I$ 1,000,000 DAMAGE TO RENTED CLAIMS MADE OCCUR NN538691 ! 03/24/2015 j 03/24/2016 PREMISES(Ea occurrence $ 50,000 —' — I MED EXP(Any one person) I$ 5,000 — PERSONAL&ADV INJURY !$ 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GE� NERAL AGGREGATE I$ 2,000,000 X' POLICY , PRO r� PRODUCTS-COMP/OPAGG $ 1,000,000 -�JECT `�LOC ! �---C ---�-$ OTHER: j COMBINED SINGLE LIMIT AUTOMOBILE LIABILITY Is 1,000,000 � I {Ea accidence _ B !ANY AUTO 2100926 01/04/2016 01/04/2017 BODILY INJURY(Perperson) $ �l ALL OWNED �( SCHEDULED BODILY INJURY(AUTOS Per accident),$ AUTOS �'- �NON-0WNED I PROPERTY DAMAGE $ X I HIRED AUTOSAUTOS (Per accident $- f i UMBRELLA LIAB X OCCUR ! EACH OCCURRENCE $ 1,000,000 , A !i EXCESS LIAB CLAIMS-MAD IAN019284 03/24/2015 03/24/2016 AGGREGATE $ I _ DED I RETENTION$ _ $ I � !WORKERS COMPENSATION PER i OTH- STATUTE ER_ AND EMPLOYERS'LIABILITY I r Y/N E.L.EACH ACCIDENT $ ANY PROPRIETOR/PARTNER/EXECUTIVE OFFICERIMEMBER EXCLUDED? N/A (Mandatory In NH) E.L.DISEASE-EA EMPLOYEES$ If yes,describe under E-L-DISEASE-POLICY LIMIT $ DESCRIPTION OF OPERATIONS below I i I DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,maybe attached if more space Is required) Insulation Work-Mineral Insulation Work-Mineral;Additional insured for general liability per blanket additional insured endorsement with respects to work performed on their behalf by the above insured is Thielsch Engineering CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Thielsch Engineering Columbia Gas ACCORDANCE WITH THE POLICY PROVISIONS. 195 Francis Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE n-1000 e)n-1n A/1n0n/1nMnnMATlnr\l An-...tir.............+ 1/4/2016 Preview:Certificates of Insurance -CERTIFICATE OF LIABILITY INSURANCE !TE104i2DIYYYY) ��- 0110412016 _E 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 NAh1E: NE X Automatic Data Processing Insurance Agency,Inc. PHONE : fart.No). 1 Adp Boulevard ADDRESS : Roseland,NJ 07068 INSURER(S)AFFORDING COVERAGE NAIC C INSURERA: NorGUARD Insurance Company 31470 INSURED INSURER B: POLAR BEAR INSULATION CO INC INSURER C PO BOX 958 Andover,MA 01810 INSURER D: INSURER E: INSURER F- COVERAGES CERTIFICATE NUMBER: 429703 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 REOUIREhIENT.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. NSR TYPE OF INSURANCE POLICY POLICY P I LTR INSD YND POLICY NUMBER (h1hVDD(YYYY) (taraln XYYyy) LIMITS COIAMERCIAL GENERAL LIABILITY EACH OCCURRENCE 5 CLAir.IS MADE ❑OCCUR PREL11SES IEn u¢une —) S LIED EXP lianynne H`r 1 PERSOI AL 6 ADV 11,JUKY S GENL AGGREGATE Lit-III APPLIES PER: GENEWLAGGRE(JAIE 5 POLICY PRO LOC PRODUCTS-COI.1P�CP AGG S PRO OTHER: S AUTOMOBILE LIABILITY COMBINED SI'CL IMI '. IE­idiat) S AIA All 11) BODILY INJURY WP ALLC,;',t;LO SCHEDULED BODILY INJURY IPcr,-,_udeMl S AUTOS AUTOS NON-C NNEIJ 'iU'E Y At.AU S HIREDI\UIOS AUTOS N'es a.erderd! S UMBRELLALIAS OCCUR EACH OCCUKKENC"E EXCESS UAB CLAIUS-h1ADE AGGREGATE UED RETENTIONS S WORKERS COMPENSATION X I S"HAA ERH AND EMPLOYERS'UABILITY YIN A OFFICER MEf.BE2 EXCLUDED? ❑Y NIA N POWC772258 0110112016 01/01/2017 E.L FJ,CH ACCIUEIii S 1,688.800 (Mandatory in NH) E.L.DISEASE EA Et'-111'1- 1 1,000,000 It yes.dcscnbc uI^_rr DESCRIPTION OF CPEfU�tICT:S bio:: E.L.DISEASE-PCUCY UIJIT S 1,099,000 DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES(ACORD 101.Additional Remarks SchMute.may be att ched if more space is rtquirtd) CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Theilsch Engineering,Inc. ACCORDANCE WITH THE POLICY PROVISIONS. 195 Frances Ave Cranston,RI 02910 AUTHORIZED REPRESENTATIVE A©1988-2014 ACORD CORPORATION.All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD r� A6; of CousuM''r Ams M office()f pa rkplazaL-Suite 5170 16 BostoI MV-sachuseas stration �®m,��p�coveme Contra.r` 102726 _ Tvpw.. DBA '6 25 4 —__ Ewlmtion, 7f2l2C? [ON CO- 'T POLAR BSU Vincent Leac - - ---`� P.O.BOX 95801810 =_ k�pn for change. p,NDOVER, MA _ upaa�Address dna recnra Cal* ca=e 01 Address u Renewai :,-j DP�A1 u SUM�'�612is CSSL-106417 pETER A LUSLAK plafstow NEI 03865 �, ....�► 042812018 • v�,::�z�stan�r