HomeMy WebLinkAboutBuilding Permit # 3/7/2016 CD
BUILDING PERMIT %AORTH
TOWN OF NORTH ANDOVER
APPLICATION FOR PLAN EXAMINATION
Date Received
Permit Nod TED
C
Date Issued:
lssu. l ORTANT: Applicant must complete all items on this page
LOCATION E"
not
PROPERTY OWNER Cle 41, ae-
Print 100 Year Structure yes no
MAP PARCEL: ZONING DISTRICT: Historic District yes no
�517
Machine Shop Village yes no
TYPE OF IMPROVEMENT _ PROPOSED PSE
Residential Non- Residential
Li New Building [I One family
Li Addition [I Two or more family 0 Industrial
Li Alteration No. of units: 0 Commercial
L1 Repair, replacement Li Assessory Bldg 11 Others:
FJ Demolition 11 Other
a Distract
�J
�n
DESCRIPTION OF WORK TO BE PERFORMED:
Identification- Please Type or Print Clearly
OWNER: Name: Phone: 4,1,,)
VVd .
Address: PI?
Contractor Narne kphone:
7--4
Email:
Address:
Supervisor's Construction License: _Exp. Date:
Home Improvement License: LZ2 Exp. Date:
ARCHITECT/ENGINEER Phone:
Address: Reg. No.
FEE SCHEDULE.BULDINGPJRMIT.,$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F.
Total Project Cost: $ FEE: $
C,
�2 6'
Check No.: z-, Receipt No.: 6
NOTE: Persons contracting with unregistered contractors do not have access to the guaran"tyfund
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coc KIc"IWICK �•
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RATEO ^Pa`��5
U BOARD OF HEALTH
i7ERMI M "
Food/Kitchen
L now Septic System
THIS CERTIFIES THAT .................. ....... ......OrNI .a ....... ........................ BUILDING INSPECTOR
has permission to erect .......................... buildings on .....Oil. ....�V►.. . ... ....,,.. .. „S, .. .........
Foundation
Rough
tobe occupied as .... .......... .... ........ .................................................................. Chimney
provided that the person acceptin 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
PERMI T EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR
LESS CONSTRUCS Rough
Service
.IRTS
................................................ Final
BUILDING INSPECTOR
GAS INSPECTOR
Occupancy Permit Required to Occupy Buildinz Rough
Display in a Conspicuous Place on the Premises — Do Not Remove Fina'
No. Lathing or Dry Wall To Be Done FIRE DEPARTMENT
Until Inspected and Approvedy the Building Inspector. Burner
Street No.
Smoke Det.
DAVE'S CONTRACTING INC.
Residential & Commercial
Proposal CS#064680
2/20/16 HIC#171844
Prepared For: Job Dame:
Judy Letourneau JudyLetourneau
279 Sutton St. 279 Sutton St.
N. Andover, MA. 01845 N. Andover, MA
603-203-4822
Scope of Work:
Preparation: All Roofs
1. Strip existing roof down to substrate, and re-nail existing substrate.
2. Replace any damaged substrate with 1x8 spruce at$5.00 Inft. 32' incl in price.
3. All necessary Permits to be provided from Town of North Andover by us prior to start.
Installation:
1. Install 6' of Ice and Water shield, dormer low slope, with Rhino-Guard underlayment
over remainder of surface.
2. Install 8" white aluminum drip edge to entire perimeter.
3. Apply a GAF, Ltd lifetime architectural asphalt shingle to be fastened with 1%z" roofing
nails.
4. Cut ridge 3"total and install Cobra vent and hip and ridge caps.
5. Install new flashing where needed, and Replace all pipe flanges with new aluminum.
6. Service existing rubber roof and flash where needed at steep slope transition.
Disposal:
1. All debris to be removed by Dave's Contracting Inc., and disposed of in an approved
facility. '
Warranty:
1. 10 year labor warranty provided by Dave's Contracting Inc.
f
2. LTD lifetime warranty from manufacturer.
Proposal Price: NineteenThousand Five Hundred-----------.A ----------------------$19,500.00
Payment Terms. QOma0 on start $10;000-.,00-,on completion.
Owner Contractor
1.19 Drumhill Rd., #372, Chelmsford, MA. 01824 * 978-4.53-88015
�irx cote
__ _
The Commonwealth of Massachusetts
Department oflndustrialAceldents
Fa r X congress Street,Suite 100
Boston,MA.O2ZZ4"0X7
www mass,gov/die
QOM 5�f
Vvovkers'Compensation Insurance Affidavit:Builders/Contractors(Electricians/Plumbers.
TO BE FILE WITH THE PEIIMT`I Vo"AUTHORx'Y* Please Print Le 'bl
A ''licaut Information
Name (Business/Orgabization/Yndividual):
tt
...
Address: AJ A
city/State/Zip: Phone : .. . a
Type of project(xequir'ed):
Are you an employer?Cheelithe approprlate box:
Z�� em to ees fill and/or part-time)x 7. T`7eYV constriicti0n
1, �am a employer with----C P y (
2.QI ain a sole proprietor or partnership and have no employees working for me in 8. F]Remo deliiig
any capacity.[Noworlcers,comp.insurance required.] �, Demolition
3.E]I am a homeowner doing all work myseIt[No workers'comp.insurance required]t 10 F]Building addition
4.F]I am a homeowner and will be hiring contractors to conduct all work an my property. I will 11 F]Electrical lepaixs or additions
ensure that all contractors either have workers'compensation insurance or are sole 12 :plittnbiilg repairs or additions
proprietors with no employees.
5,❑I am a general contractor and X have hired the sub-contractors listed ort the attached sheet.
11 E]X66freliairs
These sub-contractors have employees and have workers'comp.insurance 14 " Other
6.Q We are a eorporattori and its,officers have exercised their right of exemption per MGL c.
152,§1(4),and We have no employees:[No workers'comp.insurance required.]
Any applicant that checks bots of must also fill out the section below showing their workers'compensation policy ht£ormation.
ts
i Homeowners who subn4�s Ad attached an additional
ic�ating they are sheegshowu g the name of the all work and the conftacforide os and state wrs must hether of nOth°S enf tkes have such,
$Contractors that check this
loyees,they must provide their workers'comp.policy number.
employees. If the sub-contractors have emp
nce far my employees. Below is tliepolicy anrlyo�+site
X am an employer that is pr'ovidingworlcers'compensation insurw
information. y
Insurance Company Name:
'IO R/ Expiration Date: .
Policy#or Self-ins.Lie.#:
�Z City/State/Zip:
Jab Site Address: „
Attach a copy of the w0 rkers'compensation policy declaration page(showing the policybab�b e )!
a ane up to$1500 00
Failure to secure coverage as requirl as civil ed under MGL o.152,§25A is a criminal violation pun un
y
and/or ane-year imprisonment,as wetmay be forwarded to the Office of InVeesttigat ons of the DIA or insur50 a
a 0
day against the violator.A copy of this statement ay
coverage verification.
X do hereby certify under'the pains andpenalties ofpeiyuly that the information iavided alcove is te'ue and correct
Date:
Si ature:
Phone#'
official use only. Do not write in this area,to be completed by city or toren official
Permit/License#i
City or Town'
Issuing Authority(circle one):
1.Board of health 2.Building Department 3.City/`l'own Clexl �.Electrical Inspector �.Plumbing Inspector
6.Other
Phone
Contact Person:
0 DATE(MMIDD/YYYY)
ACCOR" CERTIFICATE OF LIABILITY INSURANCE 2/26/16
THIS CERTIFICATE IS ISSUED AS A MATTER OF INFORM I kTION ONLY AND CON ERS NO RIGHTS UPON THE CERTIFICATE HOLDER THIS
CERTIFICATE DOES NOT AFFIRMATIVELY OR NEGATIVE.Y 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
REPRESENTA71VE OR PRODUCER,AND THE CERTIFICATE HOLDER.
IMPORTANT: If the certificate-holder isan ADDITIONAL IURED, the policy(ies) must be endorsed. If SUBROGATION IS WAIVED,subject to
the terms and conditions of the policy,certain policies may equire an endorsement A statement on this certificate does not confer rights to the
certificate holder in lieu of such ondorsernenUs).
PRODUCER CONTACT
,NAME: Ja'k-e- Lindmark
Lindmark Insurance Agency, Inc PHONE (781)
NQ_EAU1J_Z6�1) 245-01QQ R.ILL_2 96__..5_5...5_
3
607 North Ave ,�DEWAJL
_ DRgSs: Jake@ Lindmark InsuranceAqencV.cam
Door 12 INSPRIER(S)AFFORDING.-C-OvERACE.
Wakefield, MA 01880INSURER A:NORTHLAM INSURANCE
INSURED INSURER B:PILGRIM INSURANCE
------...........
RAVES CONTRACTING INC INSURERC:AIM MUTUAL INSURANCE
119 DRUM HILL ROAD #372 INSURER D:11ARCKEL INSUANCE -------------
CHELMSFORD, MA 01824 INSURER E: -----
INSURER F:
COVERAGES CERTIFICATE NUMBER: REVISION NUMBER:
THIS IS TO CERTIFY THAT THE POLICIES OF INSURANCE LISTED BELOW HAVE BEEN—1, UED TO THE INSURED NAMED ABOVE FOR THE POLICY PERIOD
INDICATED. NOTWITHSTANDING ANY REQUIREMENT,TERM OF:CONDITION OF ANY CONTRACTOR OTHER DOCUMENT WITH RESPECT TO WHICH THIS
CERTIFICATE MAY BE ISSUED OR MAY PERTAIN,THE INSURA 4CE AFFORDED BY THE DOLICIES DESCRIBED HEREIN IS SUBJECT TO ALL THE TERMS,
EXCLUSIONS AND CONDITIONS OF SUCH POLICIES,LIMITS SHO V IN MAY HAVE BEEN REDUCED BY PAID CLAIMS.
INSR1 ADOL1SUBR P OL CY EFF POUCY EXP
LIR TYPEOFINSURANCE INSR WVD POI I CY NUMBER (MM/flD/YYYY IMMIDDIYYYYII LIMITS
A GENERAL LIABILITY WS246325 4, 26/15 4/26/16 EACH OCCURRENCE $____1,00.0.,Op0
DAMAGE Td R�ffNTED-
X COMMERCIAL GENERAL LIABILITY PREMISES(Ea ocrAorrenre) 100,000
CLAIMS-MADE OCCUR MEDEXII(Arryonoperson) 6_,000 _.
PFRSONAL&
_,000
PFRSONAL&ADV INJURY $ 1,000,000,
GENERAL AGGREGATE $ 21,000,000 ,
N'L AGGR EGATE L IMI T APP LIE S PE R PRODUCTS-COMP/0P AGG $ 2,000,000
POLICY PRO- LOC
B AUTOMOBILE LIABILITY PGO001OL7051 3118/15 3/18/16 (;ED INEDSINGL LIMIT
a accident) I - $, 1,000"000
ANYAUTO BODILY INJURY(Per person) $ 1 1000,000
ALL OWNED X SCHEDULED BODILY INJURY(Per accident) $ _:L,000,000
AUTOS AUTOS
HIREDAUTOS AUTOS NON OWNED (Per acqde9l) 000 1 0-01-10.1--
D V1 UMBRELLA LIAB OCCUR XOBW5403514 8129/15 8/29/16 EACH OCCURRENCE
EXCESS LIAB CLAIMS-WOE AGGREGATE 1 000 000
DED RETENTION$ — $
C WORKERS COMPENSATION VWC1006)200212015A 4125/15 4,/25716 X WO RC ST A%Y,S
F i 0TH-
AND EMPLOYERS*LIABILITY YIN I _ER.
ANY
. . .
ANY PROPRIETORWARTNERIEXECUTIVE -- EL�E&(,IiACQDINT $ 100,000
OFFICER/MEMBER EXCLUDE _jN] N/A
(Mandatory In NH) EL DISEASE-FAEMPLQYEE 100,000
If W
asaffin under
D RIPI ION OF OPE RATIONS below LL DISEASE POLICYLIMIF S 506,000
DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (Au.chACORD 101,A0
certificate holder listed as additional insurance on liability per written contract
CERTIFICATE H_0LDEK qANQELLATI-ON
H UL ANY OF THE ,BOVE DESCRIBED POLICIES BE CANCELLED BEFORE
EX'(RATION U
THEREOF, NOTICE WILL BE DEVEREO-IN
SHO
0
THE
JUDY LETOURNEAU CCORDCE WITH "CHE POLICY IROVISIONS.
279 SUTTON ST 7
N. ANDOVER, MA 0184 AUADRIZEDIPRErENTA C
7
....... ------------------ c1 904 0 OACOR )CORPORATION. All rights reserved.
ACORD 25(2010/05) The ACORD nani D and logo are regist- A marks of A ORD
Phone: Fax: (978) 988-8021 E-Mail: 11,
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MENT GONTRACTt?Ft '
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�fr����Li' DAUI�) �LOUER
119 Df HILL RD X872. " `'
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a s cdau e - ref of Rubl,
Boar of Building a ons and Sfa
�onsfi action Supervisor
License:,CS-064680
M aMa,� 9
DAVID M GLO
x- 91 DaLA ST = Y
Lo IX M "0185F
viii rissioner-
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