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Home My WebLink AboutBuilding Permit # 3/21/2016 1 BUILDING PERMIT Sao TH D TOWN OF NORTH ANDOVER � - APPLICATION FOR PLAN EXAMINATION Permit IVo#: ��/ Date Received '�R�TEo PPP�5 �Ssgc Hus�`� Date Issued: ! ! iNfP RTANT: Applicant must complete all items on this page LOCATION AJC) I/- ,6-P {�6—e PROPERTY OWNER `C 4 TILI/ -J C0,4)-sr-v Print 100 Year structure yes o MAP i PARCEL: ZONING DISTRICT: Historic District yes no – Machine Shop Village yes, no TYPE OF IMPROVEMENT PROPOSED USE Residential Non- Residential ❑ New Building ❑ One family L1 Addition El Two or more family El Industrial ❑Alteration No. of units: ❑ Commercial J&Repair, replacement ❑Assessory Bldg ❑ Others: ❑ Demolition El Other ; 1 r I.oaa I �f'�Wet and � N s ed�Distr�c� �, f R we DESCRIPTION OF WORK TO BE PERFORMED: Identification- Please Type or Print Clearly OWNER: Name: �'�%��' OAKAl�;C/t// Phone: ' � � Address: Contractor Name: ' �c'c LG''hone: C7.7-7P e6) ® 6 Email Address: P.0, 00X 5S27 Supervisor's Construction License: / Exp. Date: Home,Improvement License: Exp. Date: ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASEDON$925.00 PER S.F. Total Project Cost: $ , FEE: $ CX7 Check No.: /,z)-�I� Receipt No.: r�/ 3-1 NOTE: Persons contracting with unregistered co tr ctors do not have access to ran c1ORTH Town of Amimidover - L z20�. h ver, Mass, 02/0 o LAIKIE COCHICHEW1cx A0RATEO S U BOARD OF HEALTH Food/Kitchen P �ERMIT T LENEW Septic System THIS CERTIFIES THATT4PA04&..f1BUILDING INSPECTOR ............... ...............%.. .......... .......................................... has permission to erect g Foundation ............ ............ buildings ... ... .... .� ..R'!I........ .. .... . !� ......... ® Rough tobe occupied as .......... . .. .. ® ........... ............ .l� ................................................................ 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 PERMIT I E IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service Final E BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required 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 Approvedthe Building Inspector. Burner Street No. Smoke Det. Ocempsey Roof ing LLC P.O.BOX 383 Billerica, MA, 01821 Radek Cell: 978-808-6678 www.dempsey-roofing.com Fax: 978-362-3102 3/16/16 Proposal Customer Name: Cathy Johnson Address: I Salem St. City: North Andover State: MA Zip: 01845 Phone: 978-857-2001 Description: • Install tarp from roof to ground to protect siding &landscape • Strip existing 1 and 2 layers down to roof deck. Inspect&re-nail where necessary. Replace three plywood's with mold. Any additional replacement will be at an additional cost of time and material: $65/sheet • Install 6' of ice and water shield underlayment along all eves • Install 151b paper on remainder • Install white Pro Flow vented drip edge along all eves • Install 8"'white aluminum drip edge on all gables • Install LTD Lifetime GAF Timberline or CertainTeed Landmark architect roofing shingles (color &manufacture chosen by homeowner) • Eliminate 3" pipe and pipe flange. Board in • Install one new 3"pipe flange • Will use current step flashing • Cut in and install cap shingles over ridge vent to ensure proper ventilation • Cover gable vents from inside • Counter flash and caulk chimney. If there appears to be inadequate lead flashing, there will be a need to grind in new lead flashing at an additional cost of$450 • Clean all gutters • Remove all roofing debris • Material, labor, permit and dump fee included Porch roof: material is included; labor will be done by others Total: $9000 $3000 down for materials, remainder due upon completion Ten year warrantee on all workmanship Proposal valid for 30 days Via. L3 A _ 3�t-7r� Signature of acceptance The Commonwealth of Massachusetts Department oflndustrialAceldents 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.govldia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information rPlease Print Lelzibl Name (Business/Organization/Individual): �' /� Z-Z—C Address: City/State/Zip:S�e! �10e��',I�',V PIc92/ Phone#: % -74,9 66 Are you an employer?Check the appropriate box: Type of project(required): 1. �I am a employer with 1� : employees(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.] 3.❑I am a homeowner doing all work myself,[No workers'comp.insurance required.]t 9. El Demolition ❑4.F1 am a homeowner and will be hiring contractors to conduct all work on my property. I will 10 Building addition ensure that all contractors either have workers'compensation insurance or are sole 1 L❑Electrical repairs or additions proprietors with no employees. • 12.F]Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13. Roof repairs These sub-contractors have employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of'exemption per MGL a 14.❑Other 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 their workers'compensation policy information. i Homeowners who submif this affidavit indicating they are doing all work and then hire outside contractors must submit a new affidavit indicating such. tContractors that check this box must attached an additional sheet showing the name of the sub-contractors and state whether or not those entities have employees. If the sub-contractors have employees,they must provide their workeis'comp.policy number. I am an employer that is providing workers'compensation insurance for my employees.'Below is thepolicy and job site information. Insurance Company Name: Policy#or Self-ins.Lie.#: 47 WC-- /-OO`�70 1?0�4Expiration Date: Job Site Address: ( S 4L L s�7 City/State/Zip: Attach a copy of the workers'compensation policy declaration page(showing the policy number and expiration date). 12,1,2 Failure to secure coverage as required under MGL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 O 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 DTA for insurance coverage verification. Ido hereby certt der tlz pai a talties of pezjuty that the information provided abo ve is true and correct. Si nature: � Date: Phone#: L�1>1cnP 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.Building Department 3.City/Town Clerk 4.Electrical Inspector 5.Plumbing Inspector 6.Other Contact Person: Phone#: %m 03118/2016 15:01 Prescott & Son Insurance Agency (FAX)7813333278 P.0011002 CERTIFICATE OF LIABILITY INSURANCE DATE(MMlDDnYYY) ,./ 3/18/2016 HIS 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 13ETWEEN 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 18 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 CN NAMEA T Commercial Lines Prescott and Son Insurance Agenoy,Inc. PHONE (781,)322-2350 FAX I[AIVI No.Ext)-963 Eastern ,Avenua e.MAIL IN9URER(S)AFFORDING COVERAGE NAIL# Malden MA 02148 INSURER A:Endurance Amprioan In® Co INSURED INSURER B: Dempsey Roofing LLC INSURERC: _ 7 RICHARDSON ST INSURER D: INSURER E Billerica MA 01021 INOURFF1 E; COVERAGES CERTIFICATE NUMBER-CLI631822656 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, NOR ADDLSUSK LTR TYPE OF INSURANCE POLICY ER POL EFF POLICY WSLWUXML YY LIMITS X COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE 9 1,000,000 A CLAIM$.MADEFil OCCUR Eccu 100,000 Me oeeurrence) $ CEC20000050401 9/3/2015 9/3/2016 MED EXP(Any one arson) 5,000 PER60NAL&ADV INJURY S 1,000,000 GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE S 2,000,000 X POLICY❑JPRO•ECT F-1LOC PRODUCTS-COMP/OP AGG $ 1,000,000 OTHER: $ AUTOMOBILE LIABILITYINED SINGMMT JF e eceldent _ ANY AUTO BODILY INJURY(Por person) ALL OWNED SCHEDULED BODILY INJURY(Pereoddant) 3 AUTOS AUTOS HIRED AUTOS NON-OWNED PROPERTY DAMA E $ AUTOS ent 9 UMBRELLA LIAM OCCUR EACH OCCURRENCE S EXCESS LIAR CLAIMS-MADE AGGREGATE DED RrTENTIONS WORKERS C0h1PENBATIONTAT AND EMPLOYERS'LIABILITY Y I N ANY PROPRIETOR/PARTNER/EXECUTIVE E.L.EACH ACCIDENT S OFFICER/MEMBER EXCLUDED? NIA (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ Uea,deseribe und■r SCRIPTI OPERATIONS below G.L.DISEASE-POLICY LIMIT 9 DESCRIPTION OF OPERATIONS I LOCATIONS/VEHICLES (ACORD 101,Additional Remarks echodule,may be etteohad If more*pato Is mqulred) RE: 59 Salam Road, North Andover, Ma 01845 CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE Town of North Andover THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN 1600 Osgood Street ACCORDANCE WITH THE POLICY PROVISIONS, Building 20 Suite 2035 AUTHORIZED REPRESENTATIVE North .Andover, MA 01845 --..a J S ScholniCk/pJR ®1988.2014 ACORD CORPORATION. All rights reserved. ACORD 26(2014/01) The ACORD name and logo are registered marks of ACORD INS025(201401) 0311812016 15:02 Prescott &Son Insurance Agency (FAX)7813333278 P.0021002 AI.�R�® DATE(MMIDDNYYY) CERTIFICATE OF LIABILITY INSURANCE 03/18/2016 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 INJURANCE 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 polloy(ies) must be andomed. If SUBROGATION IS WAIVED, subject to the terms and conditions of the policy,certain policies may require an endorsement. A statement on this cortiflcata does not confer rights to the certificate holder In lieu of such endorsament(s). PRODUCER CONTACT NAME. Paul Rackl PRESCOTT&SON INS.AGENCY INC. PHONE1AIr-00. 781 322.2350 E-MAIL paulMproscoltandoon.com 953 EASTERN AVENUE IN9URfiR9 AFFORDING COVERAOE NAIC0 MALDEN MA 02148 INSURER A: AIM MUTUAL INS CO 33758 INSURED INSURER B: DEMPSEY ROOFING LLC INSURER INSURER D; P O BOX 383 INSURER E; BILLERICA MA 01821 INSURLRF: COVERAGES CERTIFICATE NUMBER: 38354 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. INSRPOLICY EFF POLIQYEXP LTR TYPE OF INSURANCE P UMBER fly1mlogNmi (MM/DDNYYVlLIMiYr} COMMERCIALOENERAL LIABILITY EACH OCCURRENCEDAMAGE TQ RFNTED S CLAIMS-MADE 7 OCCUR PREMISES 6 S MED EXP(Any one ereon) S N/A PERSONALgADVINJURY b GEN'L AGGREGATE LIMIT APPLIES PER: GENERAL AGGREGATE $ POLICY PRO. JECT �LOC PRODUCTS-COMPIOPAGG S OTHER: S AUTOMO13ILEL1ABILnTY M9INEDBINGLELIMIT $ dqnD ANYAUTO BODILY INJURY(Per pereon) S ALL OWNED SCHEDULED N/A BODILY INJURY(Per t,ccldenl) b AUTOS AUTOSN/A P��accld AMA E $ HIREDAUTOB AUTOS $ UMBRELLA LIAR pCGUR EACH OCCURRENCE $ EXCESS LIAR CLAIMS-MADE N/A AGGREGATE S DED I I RETENTIONS $ WORKERS COMPENSATION X I gTEAFITUTE I ERH AND EMPLOYFRS'LIABILITY YIN A OF ICERIMEMSPANYPF(OPRIPYCREXC UDED7ECUTIVE NIA NIA NIA AWC40070274872015A 07/01/2015 07/01/2018 E.L.EACH ACCIDENT S 1,000,000 (Mandatory In NH) E.L.DISEABE-EA EMPLOYEE $ 1,000000 If yyea,deetribe under DESCRIPTIONOFOPERATIONS E.L.DISEASE-POLICY LIMIT $ 1,000,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schaduia.may be attached It more epnce Ii required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 20 03 OB B,no authorization Is given to pay claims for benefits to employees in stales other than Massachusetts It the insured hires,or has hired those employees outside of Massachusetts, This Certificate of Insurance shows the policy in force on the data that this certificate was Issued(unless the expiration date on the above policy precedes the Issue date of this certificate of Insurance). The status of this coverage can be monitored daily by accessing the Proof of Coverage-Coverage Verification Search tool at www.meas.govAwd/workers-compensation/investigations/, CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE.DESCRIBED POLICIES ESE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN Town of North Andover ACCORDANCE WITH THE POLICY PROVISIONS. 1800 Osgood St BIdg20 Suite 2035 AUTHORIZED REPRESENTATIVE North Andover MA 01845 Daniel Crc�y,CPCU,Vice President—Residual Market—WCRIBMA m 1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014/01) The ACORD name and logo are registered marks of ACORD Massachusetts Department oCPublic Safety Board or Building R eplations and Standards Construction Supervisorspccialt}. � License: CSSL-099681 i ERIC IDEMPSE Y 7 RICI ARIDSON'S I'RR BILI,ERICA r ✓. �� ,i na ` Expiration Cotrn�issioner 05/23/2016 a-\ Office of Consumer Affairs&c Business Regulation OME IMPROVEMENT CONTRACTOR Registration: 178026 Type: �—� Expiration_ _._3/612018.3 LLC DEMPSEY ROOFING LLC = - � = E F ERIC DEMPSEY 7 RICHARD ST g i� BILLERICA,MA 01821 Undersecretary n