HomeMy WebLinkAboutEXTERIOR WALL INSULATION NORTH
BUILDING PERMIT 0. ��LEo
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION ®
Permit No#: 6'�I Date Received A
7q AERATED
CHuse
Date Issued: *IPO:RRTANT:
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Applicant must complete all items on this page
LOCATION ��`�CS%�� �4 v6/eT? r-
Print
PROPERTY OWNER !,l �Jo1�
Print 100 Year Structure yes Uno
MAP PARCEL: ZONING DISTRICT: Historic District yes
Machine Shop Village yes
i
TYPE OF IMPROVEMENT PROPOSED USE
Residential Non- Residential
❑ New Building ❑ One family
❑Addition ❑Two or more family ❑ Industrial
❑Alteration No. of units: ❑ Commercial
❑ Repair, replacement ❑Assessory Bldg Others:
❑ Demolition ❑ Other )��5d/LTi,o 11
,x
Sep�ry SII' a �. � ood Karn �UUet(ands W i:er ed tfiic 5 ��° SNF
ry
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DESCRIPTION OF WORK TO BE PERFORMED:
�xr-(Pfos ` w!�)// D r@A Sr Pq e�
Identification- Please Type or Print Clearly
OWNER: Name: /Cry rS!ry �4 uC! ri Phone:
Address: �'�( lA ra r® �,%
Contractor Name: �,� /� �C Phone: q7 Y,,,> G 3�
Email:
Address: C-55 — -5
Supervisor's Construction License: Exp. Date:
Home Improvement License: 017 Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDING PERMIT.$92.00 PER$9000.00 OF THE TOTAL ESTIMATED COST BASED ON$925.00 PER S.F.
Total Project Cost: $ 9eo -act FEE: $
Check No.: Receipt No.:
NOTE: Persons contracting with unregistered contractors do not have access to the guaranty fund
ti V
t%ORTy
Town ofEAnc'tover
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-rallLAK. of ver, ass,
-wy COGMIG hl WICK
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.9 AERATED
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BOARD OF HEALTH
Food/Kitchen
PERMIT T LU Septic System
THIS CERTIFIES THAT ................... ... IG1ei�.r....................... BUILDING INSPECTOR
............................................ ... r.
Foundation
has permission to erect .......................... buildings on ...... .1......... ....r .... . .........6.r................
® Rough
to be occupied as .................... ... ..........SO.'a.&A......}...... .. ... .... .. .�....................... chimney
provided that the person accepting this permit 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. PLUMBING INSPECTOR
VIOLATION of the Zoning or Building Regulations Voids this Permit. Rough
Final
mw PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
35 ® UNLESS CONSTRUCTI T04tjtoRough
Service
................................................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Building Rough
Islay in a Conspicuous Place on the Premises — Do Not Remove Final
No Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approved by the Building Inspector. Burner
Street No.
Smoke Det.
.. Federal ID 0 064605629
dration
b--
RISE Engineering MA contractor�>�atioon Bio I8MX"
RA division of Thielscd Engiaeering
ENGINEERING 60 Shawmut,Canton,MA 02021 CONTRACT
339-502- M �A�X 339 5026345
Page 1
�II����
PROGRAM THIS CONTRACT IS�tNT08ElV1rEN RtaE
II1111F CMA-HES B1GUa�0ANDTa CMTO%dERPDRWORKA8
Ln
CUSTOM p PHONE DATE CuENT0 wofflcawEa
Kiersten Gaudette Ln (978)989-0682 09/23/2015 422240 00003
nnn SERVICE STREET I BALING STREET 4
41 Harold Street S1 I- 41 Harold Street S1
U
SERVICE CTTY.STATE,ZIP 09 SMUN0 Ciri.STATE,IIP
North Andover,MA 01845 u North Andover,MA 01845
""'----3 DESCRIPTION
AIR SEALING:Provide labor and materials to install Q-Ion weatherstripping and a doorsweep to(2)door(s)to restrict air leakage.
$150.00
WALLS;Famish and install blown in Gess I Cellulose to(1440)square fed of shingle and/or clapboard exterior walls.The butt of
the upper Course of your wood siding is cut to drill holes into the wall sheathing behind.The holes are then plugged and the wood
siding is reinstalled using stainless steel finish nails.Touch-up painting,if needed,will be the customers responsibility. Invoicing will
occur upon completion of installation. Subsequent to your payment,as an added service,RISE Engineering will return when weather
permits to check for any voids with an infrared scanner. Any major voids that may be found will be filled at no additional cost
$2,664.00
RISE Engineering will apply all applicable,eligible incentives to this contract.You will only be billed the Net amount. Currently,
for eligible measures,Columbia Gas offers 75%incentive,not to exceed$2,000 per calendar year,and an incentive of 1001A for the
Air Sealing measures up to the first$680 and an additional$340 if savings are justified by the auditor.
For the safety 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 wealherization work is complete.We will also conduct a full assessment of
the combustion safety of your heating system and water heater.This has a value of$90 and is at no cost to you Total allowable
weallreization incentive is$3,110.
$90.00
Total: $2,904.00
Program Incentive: $2,090.00
Customer Total: $814.00
WE AGREE HEREBY TO FURNISH SERVICES-COTAPLBTE IN ACCORDANCE WTM ABOVE SPECERCATIONS.FOR THE SURA OF
""'Eight Hundred Fourteen&001100 Dollars $814.00
UPON FINAL INSPECTION AND APPROVAL BY RISE ENOME M(L CUSTOMER AGREES TO REMIT AMGUNT WE IN RILL,MMMST OF 1%WILL BE CFIARGED ITONiHLY ON ANY
UNPAID BALANM AFTER IO DAYS.SEE eEims FOR amirrANrWMRdIATION ON GUARMnEE%RIOHTB OF RECISION.SCHEDULING.AKDCONTRACTORRFAaiTFNTWN.
DO NOT SIGN THIS CONTRACT IF THERE ARE ANY BLANK SP
�—
AUTHORIZED SIONA -RISE EOPMFIDO CUSTOMBR ACCE9TANCe
NOTE:THIS COMM"MAy BE WRHDRAWN an US IF NOT E]IECUTW WITHIN nATD OF ACCEPTANM
ACCEPTANCE OF CONTRACT-THE ABOVE PRICES;SpeMF TWM AND COXOmONS ARE
aArA FAC`AW TOUR ANDAREHERMACCEPTED.YOUARE AUTHORRED TO DO THE WORK
30 DAYS. AS SPECIFIED.PAYMEW WDLBE MADRAS OUTLINED ABOVE
s
OWNER AUTHORIZATION FORM
Nick Brings
(Owner's Name)
i
owner of the property located at
39 1Harold Street, North Andover, MA 01845
(Property Address)
a�
39 Harold Street, 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.
Ownees SignaWV
Date
The CorrbD7 anwealth of)Wassaehusws
Department gf1ndus&ia1,4eeiden1s
I Congress Stree4 Suite 100
Boston,YLI 02.174-2027
www.maas&gov1d'itt
�Vorkers'Compensation lusua-anceAfrtdavit:BuB7ders/Conicactor Elec€�icians/Plumbers-
To BE TILED wla
Anplicant IIa3fioranafiora
'lease i'r ung b
Mame (BusincsslOrpnization/ludividual):�jA t 1' (5•Cg ti— j in } j•= %; %;i �' r i
Address:
City/StatelZap: Phone 4 7
t;• L:.
Ase yon nn cmplaycr?(?cocci;lite appropriate hos: Type of project(D•eq
uiiret)=
1. I amn a employe with 19 crapioycts(full nadtor part-titac)_- 7- New construction
2,]I am a soTc proprietor or paztx�ship and bavc no mtployas working for rc in g. ll esnodeii g
any CaP3'Ci1Y-ileo workers'coma.instrtna- requirad-]
4_ DemoIition
3-01 am a homcownrr doing nil work myself(No workers'comp-insurance rcqu cd I t
30 rl Building addition
4-❑I am s homcov nee and will be hiring contractors to conduct Eiji work on my property-l will
cnsura that all conamctorscith�havc work=*compensation insuraocc or are solve 1I- ElectricaltCp31r5 or additions
proprietors with no cmployecs- I2_F1 Plumbing repairs or additions
5C I am a genual contractor and I have bircd tl=sub-coattzaots listai on the attached shit- 13 F]Roof repairs
lhcsc sub-conaactoo bavc cmpbyc s and ha'cworkas comp.•n Man=-Y
14.�iOt3ler
6_E]We arc a corporation and its officers have excused their right ofcxoaption per MGL c
. 152,§1(4),and we bavc no cmpjoy=s,(No wotkrrs'camp-insurance rzquirt&1
-Any applicant that checks box 91 mast also 611 out tbcsccdon below showing tbcir workers"C0Mpcosa"on polity information-
I"Homcawncrs wbo,submit this affidavit jodicating they are doing all work nod then hire outside cootractom must submit n new afrwavit indicating avh
tCootractocs that cheek this box must sttEicbcd zo additional sheet showing the name of tbcsulr cannactnrs$�state whabc or not ihoSG enGtics imavc
employees_ If the subcontractors have employ—,they mast provide tbcir workCfS'romp-policy numb=-
/are are employer that is prOviding r','orkess'compensation inSUrance for my employ-em Bdow is the policy anal job safe
fraformadan_ I
insurance Company Name: G ✓ G
Policy#or Self-ins_Lic_#: �JE7 vJL 7��'==, J Expiration Date: 0J ll f7
Job Site Address: I-C Gi/ City/statdzip: �/1 . o/1l
.4,Mch a copy of the workers'compensation policy declaration page(sbowing fae policy number atld e3pirution date).
Failure to secure coverage as required under MGL c- 152,§25A.is a criminal violation punishable by a fine up to$1500-00
and/or one-year imprisonment,as well as civil penalties in the form of a STOP WORK ORDER and a fine of up to$250.00 a
Jay against the violator_A copy of this statement may he forwarded to the Office of investigations ofthe DIA for utatrance
:overage verification.
r do hereby certify uesder the paras and penalfaes ofpcisfury t3rarthe informaation provided afoye is true and carrttt
l r ` !,=
iiQnature t c i i-' ,�. Date:
r
'hone#- Gr-2o'. � .,� _�U.f�
Ofrwi'al use oniy. Do not Prate in this area,to 6e completed by city,or town oflkiaL
City or Town: Per-mit/License#
Issuing Authority(circle one):
I.Board of Health 2.Building Department 3.City/Town Clerk 4-IElectdcal IIaspettor 5.Plumbing Inspector
6-Other
Contact Peasom: Phone#:
1/4/2016 Preview:Certificates of Insurance
--li ODATE(I.W;DDO'YYY)
CERTIFICATE OF LIABILITY INSURANCE 01/0412016
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).
CONTACT
PRODUCER NAIdE:
PHOUE X
Automatic Data Processing Insurance Agency,Inc. 11 tro.Exn-
t•,I.L
1 Adp Boulevard ADDRESS:
Roseland,NJ 07068 INSURERS)AFFORDING COVERAGE NAIC7
JUSURER A: NorGUARD Insurance Company 31470
INSURED INSURER B:
POLAR BEAR INSULATION CO INC INSURER C:
PO BOX 958
u1suRER o:
Andover,MA 01810
INSURER E;
INSURER F: -
COVERAGES CERTIFICATE NUMBER: 429703 REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICES OF IIISURANCE LISTED BELMN HAVE BEEN ISSUED TO THE INSURED NAMIED ABO`dE FOR THE POLICY PERIOD
INDICATED.NOTIVI)THSTANDING ANY REOUiREt:;ENT_TERM OR CONDITION OF ANY CONTRACT OR OTHER DOCUMENT':.';TH RESPECT TO:YHiCH THIS
CERTIRCATE L;AY BE ISSUED OR is AY PERTA',N_THE iNSURA DICE AFFORDED BY THE POLICIES D`ESCR!BED HEREIN iS SUBJECT TO ALL THE TERLIS.
EXCLUSIONS AND CONDMON IS OF SUCH POLICIES LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAU,!S
INSTt AIJITC MR
POLICY F POLICY FJ(P I LW11TS
LTR TYPE OF INSURANCE IVSD YND POLICYIIULIBER (L7I.VDD,YYYY) (1.V.VDD:YYYYi
COMMERCIAL GENERAL LIABILITY I b:ct L'CCt_I:I:EhCt ',
CL.tILIS:.1:.tiE �::C:L 1. IIitf.11St_It.:�:_r:•:_r:�•�
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AUTOMDSILE LABILITY tta:t._>•ttl:
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EXCESS LIAR CLAVAS NALt 1Ll_CN_%.It
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WORKERS COMPENSATION /` St r r r r-
AND Er.IPLOYERS'LIABILnY
Y e 7r 1,000,900
r w I I� 11-11;1 1 u:tl•.t:+6c111''8 v ,Ira N POlNC772'_58 0110112016 01101,12017 t L EACF ACCILtI.I
A FI tl r nhtt t LLL L �j� I 1 1,000,000
I(rJandloyr NH) tLLn�tibEtAE1:U'Lr,`•tt5
C.EsC HILI CCF(2PENA 11 CI.s:.:.oa tL UIsE:•SE P:;uV urJl) 1.000,000
DESCRIPTIOU OF OPERATIONS i LOCATIONS f VEHICLES IACORD tot.Additional Remmky SClI dIHo.may he attached it niore p—is required)
CERTIFICATE HOLDER CANCELLATION
SHOULD ANY OF 7HE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE
THE EXPIRATION DATE THEREOF. NOTICE WILL BE DELIVERED IN
Theilsch Engineering,Inc. ACCORDANCE MATH THE POLICY PROVISIONS.
195 Frances Ave
Cranston,R102910 AUTHORLED REPRESEHTATIVE
I
Ar;1988-2014 ACORD CORPORATION_All rights reserved.
ACO RD 25(2014101) The ACORD name and logo are registered marks of ACORD
POLABEA-01 JONEI
LL
DATDYYYY)ERTIFICATE OF LIABILITY INSURANCE 1/612016
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).
PRODUCER CONTACT
NAME:
Durso&Jankowski Insurance Agency PHONE 978 600 FAX (978 688-7001
11 Saunders Street ac N, o�E�_( ._ ).-88-70 (ac,No) )
North Andover,MA 01845 E-Maa
ADDRESS.
INSURER(S)AFFORDING COVERAGE NAICB
INSURERA:NautilusInsuranceCo. 117.370
INSURED INSURER B:Safety Insurance Company— 33618
Polar Bear Insulation Co.Inc. INSURER C:
Peter Leblanc&Steven Leblanc — _
P O BOX 958 INSURER D=
Andover,MA 01810 INSURER E: J
INSURER 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 SUBR; POLICY EFF ' POLICY EXP
LTR I TYPE OF INSURANCE 1 INSD I WVD! POLICY NUMBER MM/DD MMIDD ! LIMITS
A X COMMERCIAL GENERAL LIABILITY I
I � � I EACH OCCURRENCE �'$ 1,0003000
—1 ( DAMAGE TO RENTED
T CLAIMS-MADE I OCCUR I NN538691 03/24/2015 03/24/2016 PREMISES(Ea oxunence) S _ 50,000
MED EXP(Any one person) j S 5,000
PERSONAL&ADV INJURYS 1,000,000
— —_—.— _ —
GEN'LAGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE I s 2,000,000
I�PRO- --
POLICY JECT LOC _ S 1,400,000
--
X PRODUCTS-COMP/OP AGG
- $
OTHER:
IAUTOMOBILELIABILITY j COMBINED SINGLE LIMIT 5 1,000,000
_ Ea accident _. ! _ _
B _ ANY AUTO 2100926 01/04/2016 01/04/2017� BODILY INJURY(Per person) $
AALL
UTOS OWNED
AUTOS SCHEDULED ! i BODILY INJURY(Per accident) $
X P
OWNED ROPERTY DAMAGE :S
' HIRED AUTOS AUTOS I_(Peraccidena
$
UMBRELLA LIAR ' 1,000,000OCCUR
A I EXCESS LIABI CLAIMS-v1ADE i 'AN019284 03/24/2015 03/24/2016 'AGGREGATE
DED RETENTION 5
WORKERS COMPENSATION ' !PER OTH- '
(STATUTE _ ER
�ANDEMPLOYERS'LIABILITY Y/Ni - -
ANY PROPRIETORIPARTNERIEXECUTIVE l ,E.L EACH ACCIDENT ___S _
OFFICER/MEMBEREXCLUDED? NSA
(Mandatory In NH) I i i E.L DISEASE-EA EMPLOYEE!$
If yes,describe under — — —
DESCRIPTION OF OPERATIONS below E.L DISEASE-POLICY LIMIT 5
!
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 Thietsch 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�noo onto AI+AOrt!�/'lOOl1CATIAI.1 All...�t.a..-........,...�
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10 PaTk a, Salle X2.116
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Ylome Re on- 10272
TVP DEA
_ EWIMijair 7M2010
pOLAR BEAR lt�l5U��,ON C'C-
Vincent LeBlanc =_ - ,�oa� �
for
P.0.BOX 958 =- Lost Card
ANDOVER, MA 01 Up&e Addr and return �� ioy,nent []
- ; Address
ppg.CAt sa SUM ''M8t2ie
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