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HomeMy WebLinkAboutBuilding Permit # 2/2/2016 OR BUILDING PERMIT TOWN OF NORTH ANDOVER ° t APPLICATION FOR PLAN EXAMINATION �ft - Permit NO: -o k Date Received Date Issued: �` �9SSA C HUS�4�y IMPORTANT: Applicant must complete all items on this page LQC'ATION �r C ., ✓ N y PROPERTY OWNED✓ P MAP NO PARCEL> zOf�ING�DISTRI,GT, Hlstorrc Disfncf ye no✓; ,;; ,, . ,, ~Machine.✓Shop village na TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building X One family ❑Addition ❑ Two or more family ❑ Industrial ❑Alteration No. of units: ❑ Commercial Repair, replacement ❑ Assessory Bldg ❑ Others: ❑ Demolition ❑ Other ❑;Septic ❑WeII ❑ Floodpla[n ��Wetlands ` = ❑ UUatershetl�Distnct ' 0w C S�gn�l� Identification Please Type or Print Clearly) OWNER: Name: 7-4n Phone: 41 Address: �CONTRi�GT�R Narrre No ✓t ✓ ✓ ✓ y t ✓✓ s P ✓ Address � � �r � ✓" ( 4 5 l✓ i l%/d ✓ 5 Super�rfsor's CQn�trucfion License+ ' Exp Date' fig/ � / 4. t�xr ✓ r t7"to a✓fit.;� ...........✓✓�'✓;✓� '' ✓�5�� ' � � a p , Exp Da#e `✓ � . ✓ x ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE:BOLDING PERMIT:$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ I Check No.: '?5101 Receipt No.: 2_L.Ct& I NOTE: Persons contracting 'th unregistered contractors do not have access to the palranty fund Signature'of Agent/Owner „ " Signature of contract: -°°' IA®RTH Town. of Andover t- '• ® W. ® ® ' p 0 LANE � � ver' ass, COC NIC hE W1CN x,95 RATE V U BOARD OF HEALTH Food/Kitchen PERMI �T� T LD Septic System swum a THIS CERTIFIES THAT ,,,,,,,,,,,,,,, ,,,,, ,,,,, , , BUILDING INSPECTOR ....... ... ... ... ............................ 75 ................ ......... has permission to-erect Foundation p .......................... buildings on ........... ...... ..... ..... ....... .•............... ................................. Rough to be occupied as .............. ..... ........ ...... .. .... .. ................................... 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 PERMITTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTIO TARTS Rough Service .................. ... . :.. ,ct .,,�.............................. Final BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required t® ccupy Building Rough Display in a Conspicuous Place on the Premises — Do Not Remove Final No Lathing r Dry Wall To Be Done 'FIRE DEPARTMENT Until Inspected and Approvedy the Building Inspector. Burner Street No. Smoke Det. NORTH ANDOVER BUILDING DEPARTMENT Tel: 978-688-9545 DEBRIS DISPOSAL FORM In accordance with the provision of MGL c 40 S 54, a condition of Building Permit at: , is that the debris resulting from this work shall be disposed of in a properly licensed solid waste disposal facility as defined by MGL c 11, S 150 A. Also, note Permits are required under Fire Prevention laws Chapter 148 Section 1 OA. The debris will be disposed of in: FCC (Location of Facility) ignature of Permit Applicant -a Aa //4. D to 2 e l 1 e ,Is i 5s d C��PiO �� 0442 reg Betterbuilt Construction Estimate E B TTM 100 Cummings Center Suite 226 G �. Beverly,MA 01915 l Phone# (978)998-4751 info@betterbuittcorp.com 71/6/2016 ( EL 821 Fax# (978)998-4861 www.BetterbuiItcorp.com - 111 i customer • Project Adress J Et M Reatly Trust 24 Waverly Road Matthew Xenakis North Andover,MA 01845 701 Salem St North Andover,Ma 01845 rz -_- �- - As agreed Roof Strip - - ------ ----------- -- 1 1 Scope of Work 78021[nspect Shingt.:. Strip existing Asphalt Shingles on the entire house and install a new roofing system according 0 0.00 0.00 to the procedure below. D... Inspect roof decking for any rotten or damaged areas. 0.00 0.00 eplace/... Replace any rotted or broken roofing boards at a cost of$4.00 per linear foot for ledger board 0.00 0.00 and$70.00 per sheet for 1/2"plywood 804-Ice 8 Water Install 6 feet of ice It water on all leading edges,valleys&transitions 0.00 0.00 806- 15 pound... Install 15 pound felt paper to cover the rest of the roof 0.00 0.00 808-Drip Edge Install an 8-inch drip edge on all eave and rake edges.Color:White 0.00 0.00 809-Vent Pip... Install new vent pipe flanges 0.00 0.00 810-Chimney... Install new lead flashing around chimney 0.00 0.00 813-HD Timb... Install new GAF HD Timberline Architectural shingles,fastened by nails(six nails per shingle- 0.00 0.00 hurricane nailing) 814-Shingle C... Home owner to choose color of shingles.Color: 0.00 0.00 820-Ridge Ve... Install a ridge vent system on the main peak of the house 0.00 0.00 815-Roof Stri... Strip existing rubber roof over the front porch and install a new roofing system according to 0.00 0.00 the procedure below. 816-Poly-Iso... Install 1/2"Fiberboard over entire roof surface,fastened by screws and aluminum plates 0.00 0.00 817- .060 roof... Install.060 fully adhered EPDM rubber roofing 0.00 0.00 808-Drip Edge Install an 3"drip edge around the perimeter of the flat roof.Color:White 0.00 0.00 819-6'Cover... Install 6'Cover tape on all aluminum L-Stock to rubber seams 0.00 0.00 951 -Cover Be... Homeowner will cover at(belongings in attic to protect from debris, BetterBuilt is not 0.00 0.00 responsible for any damage 952-Cracks We are not responsible for any of the cracks that may arise in any walls or ceilings 0.00 0.00 953-Dumpster Dumpster will be placed next to house in the driveway 0.00 0.00 955-No Interr... Job will be started and completed without any interruptions 0.00 0.00 954-Timely M... All work will be done in a professional and timely manner 0.00 0.00 956-Clean BetterBuilt wilt clean jobsite at the end of each day and dispose of all job related debris 0.00 0.00 958-Permit Our price includes the cost of the building permit obtained at the Andover Building 0.00 0.00 Department 959-Payment... Payment terms: 30%deposit, 30%work in progress and 40%due upon completion 0.00 0.00 Total Thank you for the opportunity and please call us with any questions. Acceptance Signature Page 1 T Betterbuilt Construction Estimate E E3 B�T� 100 Cummings Center Suite 226 G Beverly,MA 01915 71/6/2 016 EL 821 Phone# (978)998-4751 infoC�betterbuiltcorp.com ���� Fax# (978)998-4861 www.Betterbui[tcorp.com Customer - Info ProjectAdress J ft M Reatly Trust 24 Waverly Road Matthew Xenakis North Andover,MA 01845 701 Salem St North Andover,He 01845 - . • , -- — - -- - ----- --- -- -- - Project _- As agreed - Roof Strip Scope of Work 960-Warranty Warranty: BetterBuilt Enterprises LLC Guarantees all work performed for a period of two years. 0.00 0.00 If any problems with workmanship occur we will cover the cost of all labor and materials to correct the problem and meet the customer's satisfaction. MA License#160616 961 -Addition... Unseen and additional carpentry may be necessary to complete roof. Siding may need to be 0.00 0.00 removed to ensure proper flashing at dormers. Additional labor will be billed at an hourly rate of$65/hr plus any necessary material 50-Roofing Total Cost for all labor,Material,Permit Fees and Trash removal fees to replace roof. 1 8,200.00 8,200.00 962-Right to... You may cancel this agreement provided you notify BetterBuilt in writing at our main office by 0.00 0.00 ordinary mail posted, by telegram sent or delivered, by e-mail, not later than midnight of the third business day following the signing of this agreement. Total $8,200.00 Thank you for the opportunity and please call us with any questions. Acceptance Signature Page 2 The Commonwealth ofMassachusefis Department of IndlusWal.A(celdents M F 1 Congress Street,Suite 100 Boston,MA.02114.2017 -www mass.go-v/dia workers'compensation Insurance Affidavit:Euffders/Contractors/Electricians/Plumbexs. TO BE MED WITH THE PERMLTT NG AUTHORITY. Please Paint I,edbly App dicantinformatiOn Na1ne (Business/organization/Individual): �l)P/7h'Ld>(' Address: (Up C iIrfl 60,nas City/State/Zip: l Phone#: )9- � Are you an employer?ChecIr,t e appropriate box: Type Of project(required): 1. I am a employer with _employees(full and/or part-time)-" `/, �New construction 2. I am a sole proprietor or partnership and have no employees working forme in 8. Remodellrig any capacity.[Noworkers'comp.insurance required.] 9, []Demolition 3.,❑I am ahoineowner doing allwork myself[No workers'comp.insurance required.]t 10 0$uildng addition 4.❑I am a homeowner and will be hiring contractors to conduct all work on my property. 1 will ensure that all confracfors either have wozkers'compensation insurance or are sole 11.[(Electrical repairs or additions proprietors with no employees. 12.[]Plumbing repair or additions 5.E]I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ]3,FC]Roof repairs These sub-contractors hale employees and have workers'comp.insurance. 14 El Other 6.E]We are a corporation and ifs ofiigers have exercised their right of exemption per MGI,e, 152,§1(4),and we have no,employees.[No workers'comp.insurance required.] "Any applicant that checks Box#1 must also fill out the section below showing theirworkerscompensation policy information I Homeowners who suliriiit tpis affidavit indicating they are doing all work andthea hire outside contractors must submit a new affidavit indicating such. ame of the sub contractors and state whether or not those entities have tContractors that check this box must-attached an additional sheet showing the nemployees,&t must provide their workers'comp.policy number. employees. If the sub-contracfozs have X am an employer that is pi vidirzg workers'compensation insurance for my employees'Below is the policy and job site information. Insurance Company Namo. ' Policy#or SeLC ins,Lic.#: ®®® Expiration Date: ll r lob Site Address: City/State/Zip: �reT{ n Attach a copy of the workers' cornpensatIon policy declaration page(showing the policy number and expir anon 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 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 day against the violator.A copy of this statement may be forwarded to the Office of Investigations of the DIA.for insurance coverage verification. p do hereby certify under thapain dpen s er;wy that the information provided above is true and correct. Data: Sim o: Phone#: )� Official use only. Do not write in this area,to be completed by city or town official. City or Town: Permit/License# Issuing Authority(circle one): 1.Board of Health 2.BuildingDepartment 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6,Other- Contact Person: Phone#: /DD/YYYY) A CERTIFICATE ®F LIABILITY INSURANCE1771/13/16 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 NAME: Carmen Cocca Cocca Insurance Associates Inc PHONE FAX No. (781) 245-0888 A/ No: (781) 246-3926 dba Water Street Insurance Age E-MAILs: carmen@getinsurancehere.com 27 Water Street INSURES AFFORDING COVERAGE NAIcn Wakefield, MA 01880 INSURERA:Arch S ecialt INSURED INSURER B:Travelers Indemnit Betterbuilt Enterprises LLC INSURER C:Evanston 100 Cummings Ctr Ste 226-G INSURER D: Beverly, MA 01915 INSURER E: 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 OFSUCH POLICIES.LIMITS SHOWN MAY HAVE BEEN REDUCED BY PAID CLAIMS. INSR AML SUBR POLICY EFF POLICY EXP LTR TYPE OF INSURANCE INSR WVD POLICY NUMBER MM/DD/Y MM/DD/YYYY LIMITS A GENERAL LIABILITY y AGL00293300 9/2/15 9/2/16 EACH OCCURRENCE $ 1,000,000 X COMMERCIALGENERAL LIABILITY DAMAGE TO RENTED PR EMI E Ea occurrence $ 50,000 CLAIMS-MADE Fx_1 OCCUR MED EXP(Anyone person) $ cj 000 PERSONAL&ADVINJURY $ 11000,000 GENERAL AGGREGATE $ 2,000,000 GEN'LAGGREGATE LIMITAPPLIES PER PRODUCTS-COMP/OPAGG $ 2,000,000 X POLICY F7 PRO- LOC $ AUTOMOBILE LIABILITY CONBM ( SINGLELIMIT $ ANYAUTO BODILY INJURY(Per person) $ ALLOWNED SCHEDULED BODILY INJURY(Per accident) $ AUTOS AUTOS NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS eraccident C UMBRELLA LIAB X OCCUR TBDF 1/11/16 1/11/17 EACH OCCURRENCE $ 1,000,000 X EXCESS LIAB CLAIMS-MADE AGGREGATE $ 1,000,000 DED RETENTION$ $ B WORKERS COMPENSATION 000768353 4/28/15 4/28/16 WCSTATU- 0TH- AND EMPLOYERS'LIABILITY ANY PROPRIETOR/PARTNER/EXECUTIVE �Y/N N/A E.L.EACH ACGDENT $ 1,000,000 OFFICER/MEMBER EXCLUDED7 Y (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 1,000,000 Ifyes,describe under DE SCRIPTIONOFOPERATIONSbelow E.L.DISEASE-POLICY LIMIT $ 1,000,000 DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES (Attach ACORD 101,Additional Rermrks Schedule,if more space is regui red) Home Depot USA,Inc. ,its parent,affiliates and subsidiaries are named as additional insureds. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Home Depot USA, Inc. ACCORDANCE WITH THE POLICY PROVISIONS. c/o First Advantage® 1100 Alderman Drive AUTHORIZED REPRESENTATIVE Alpharetta, GA 30005 Carmen Cocca ©1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010/05) The ACORD name and logo are registered marks of ACORD Phone: Fax: E-Mail: ell,w1.wb01"?wvaCC111 o�CiYGa�6ac�cc6e i Office of Consumer Affairs&,Business Regulation ! License or registration valid for individul use only 0 ME IMPROVEMENT CONTRACTOR before the expiration date. If found return 0.- Office of Consumer Affairs and Business Regulation egistration: 160616_; TYpe:, 10 Park Plaza-Suite 5170 Expiration: 8/8/2016 Supplement Lard Boston,MA 02116 BETTER BUILT ENTERPRISES:LLC DENNIS DROGGITIS 100 CUMMINGS CENTER SUITE 2 ->��-- 90ERLY,MA 01915 Undersecretary Not valid witho ignature Massachusetts -Department of Public Safety Boar:; of BBuildingRegalations and Stan��edard .�s Construction Supen>isor License: CS-094612 3 DENNIS J DROG4_ATIS 26 BRISTOL RD =_ PEABODY,MA 611966",t, }v3Y,�`' Expiration 04/28/2016 Commissioner