Loading...
HomeMy WebLinkAboutBuilding Permit # 3/24/2016 BUILDING PERMIT �oRYy p' 0��. L@D 16�-yO SII TOWN OF NORTHA VER � - ® APPLICATION FOR PLAN EXAMINATION I �� cotiicnewic my Permit No#�: � I Date Received PPa`�5 �SS9CH�1`'�� Date Issued: t v IMPORTANT:Applicant must complete all items on this page LOCATION Prilif PROPERTY OWNER !!i Cr ' A� "�� V Pr Print 100 Year Structure yes no MAP,0(Qf PARCEL: t ZONING DISTRICT: Historic District yes t no Machine'Shop Village yes no 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 - 1[�Ieffl��:�ge,yye DESCRIPTION OF WORK TO BE PERFORMED: C`V P" �l 10 W �AUCAIA+�-A Identification.- Please Type or Print Clearly OWNER: Name: L Q IU Al �� L'U /�li���Phone: 7 Address: I l ' �o 3u3ul,4 6 6r'� rll y' a s Contractor Name: C rA-t v'5\ o � yc Phone: - Ss Email: 101`k' K'A0J on CD V-k ( L(Vlt„0 Q, t IA Address. S 0 F I v, Q, C ® � s e.� -✓1 Supervisor's Construction Licenser Exp. Date: Home Improvement License: I Exp. Date: 1 _91:3— A ARCHITECT/ENGINEER Phone: Address: Reg. No. FEE SCHEDULE.BULDING PERMIT.$12.00 PER$1000.00 OF THE TOTAL ESTIMATED COST BASED ON$125.00 PER S.F. Total Project Cost: $ � � �C`� I r FEE: $ CO — Check No.: Receipt No.: U I NOTE: Persons contraWini-with Aregistered contractors do not have access to the guaranty fund ,m'^ r,,. y o a�'T,-' r 'rh�" �p.r, .•r— `" Hi'f r I,srYh,;`�,. �rr!'" 1 s;rA a r ln� ,�' `,`„.,:✓� "r f tkORT#1 o Town of 4\A ndover ® No. 2AI aq Zh ver, Mass y� . > > T O LAKE CoCKICN1WICN 7S U BOARD OF HEALTH Food/Kitchen PER I LD Septic System THIS CERTIFIES THAT .......... ..... • ... .. BUILDING INSPECTOR .S ......�...LLC.............. t has permission to erect .......................... buildings on .. .....%.... .......�.... .............. ... L .. Foundation .. Rough tobe occupied as ........ ........+-Mrofft ................................................................................................... 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 EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR UNLESS CONSTRUCTION STARTS Rough Service (�' y ................................ Final � BUILDING INSPECTOR GAS INSPECTOR Occupancy Permit Required to Occupy Buildinga 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 Approved by the Building Inspector. Burner Street No. Smoke Det. �'�� N+4V,1�t04�1�t�iar a J a 11$.R4>li>415 IIIh, RURttRitABRR�ttI :RQIkt CONTRACT AGREEMENT made as of the T day of c,/tbt 2016. I. CONTRACTING PARTIES Owner: RCG LLC, 17 Ivaloo St, Suite 100, Somerville, MA 02143 Trade Subcontractor: Portanova Roofing, Inc, Tax ID# 148 Minot Street, Dorchester, MA 02122 II. PROJECT Roofing Work — #47, #45 and #39 High Street, North Andover, MA 01845 III. WORK TO BE PERFORMED Supply and install all labor, material, and equipment to perform the following work: 47 High "Darby Scott lower" (First root) - We will remove and replace existing rubber roof system with 3" of rigid insulatio new rubber roof system, nand - Roof will come with 20yr manufacturers warranty - We will terminate rubber under windows with termination bar. Then we will ins tall new aluminum flashing under windows and down over rubber. All old caulking will be cut out under windows and new 40yr, bronze colored caulk will be applied. *includes only under windows* 42 windows total - Roof will conic with new large copper drip edge to cover fascia. Gutter will be reused Includes all termination bar and bronze reglet at front wall - Includes all debris removal via dumpster First roof to start upon deposit of$21,622,22 (1/3 of total cost) Second Payment of$21,622,22 at halfway point Portttnova Roofing, 111c., 148 Minot Street, Dorchester, MA 02122 T:617-331-5815 wtivw.PortanovaRooftjig,t:otn t f Final payment of$21,622.22 due upon completion (Estimated 3 weeks) Total cost of$64,867.67 45 High 'Ballast roofs" (Second roof) - Remove existing rubber roof and insulation than install new 3" rigid insulation and new rubber roof system. This is a concrete deck roof so we will use hammer drills and masonry fasteners. There may be debris falling from ceiling. We will coordinate with Keiran. We are not responsible for concrete deck in anyway - Roof comes with 20yr manufacturers warranty - We will install new large copper drip edge where needed - All debris will be removed via dumpster - We will install new termination bar and new reglet where needed Second roof to start upon deposit of$26,222.22 (1/3 of total cost) Second Payment of$26,222.22 at halfway point .Final payment of$26,222.22 due upon completion(Estimated 5 weeks) Total cost of$78,666.67 39 High "Horse shoe shaped roof' (Third roof) - Remove existing rubber roof and insulation than install new 3" ridgi.d insulation and new rubber roof system - Roof will come with 20yr manufacturers warranty - We will terminate rubber under windows with termination bar. Then we will install new aluminum flashing under windows and down over rubber. All old caulking will be cut ut o under windows and new 40yr. bronze colored caulk will be applicd- *includes only under windows* 418' of windows total - Includes new large copper edge metal Includes all new 4" drains Portanova Rooting,lne., 148 Minot Street,Dorchester, MA 02122 T:617-331-5815 wwwTortanovaRoofing.com _ L! - All debris will be removed via dumpster - Includes all new termination bar and reglet where needed Third roof to start upon deposit of$31,722.22 (1/3 of total cost) Second Payment of$31,722.22 at halfway point Final payment of$31,722,22 due upon completion (Estimated 5 weeks) Total cost of$95,166.67 1 IV. INSURANCE PROVISIONS Portanova Roofing Inc. shall maintain in effect industry standard Workmen's Compensation Insurance for all of its employees and General Liability Insurance for the duration of the Work of this Contract. � r V. MANNER OF EXECUTION `y 1'<; All Work shall be performed and completed in compliance with all federal, state, city, and local codes and ordinances. All Work shall be performed in compliance with OSHA rules and regulations. All OSHA violations and fines related to the Work of this Contract shall be the responsibility of the Trade Subcontractor performing the Work. All Work shall be performed in a first class workmanlike fashion consistent with the highest standards in the construction industry AGREED: D to ETik-, angre oOiiu -M-angel RCG West Mill NA LLC Trade Subcontractor 04) Date Ken Portanova, Portanova Roofing, In Portanova Roofing, Inc., 1,18 Minot Street, Dorchester,MA 02122 T:617-331-5815 www.Portanovaltooiing.com The Commonwealth of Massachusetts F Department oflndustrialAccidents d 1 Congress Street,Suite 100 Boston,MA 02114-2017 www.mass.gov/dia Workers'Compensation Insurance Affidavit:Builders/Contractors/E lectricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Applicant Information `` ( -��1P-lease Print Lel4ibly Name (Business/Organization/Individual): r o rA C1 to �>c^ Y�QC9 t� I_V` e Address: (� �w� c City/State/Zip: �.- d Phone Are you an employer?Check the appropriate box: Type of project(required): 1. I am a employer with _employees(full and/or part-time). 7, ❑New construction 2.E]I am a sole proprietor or partnership and have no employees working for me in 8. ❑Remodeling any capacity.[No workers'comp.insurance required.] 9. ❑Demolition 3.❑I am a homeowner doing all work myself.[No workers'comp.insurance required.]t 4.F]I am a homeowner and will be hiring contractors to conduct all work on my property. I will 10E]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.[]Plumbing repairs or additions 5. I am a general contractor and I have hired the sub-contractors listed on the attached sheet. ❑ 13.E]Roof repairs These sub-contractors bade employees and have workers'comp.insurance.t 6.❑We are a corporation and its officers have exercised their right of exemption per MGL c. 14.Q Other 152,§1(4),and Ave 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. t Homeowners who submit 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-confraci6rs have employees,they must provide their workers'comp.policy number. I am an employer•that is providing workers'compensation insurance for my employees.'Below is the policy and job site information. Insurance Company Name: in c1 r n in J TO Policy#or Self-ins,Lie.#:�D T`► C.� X (�7 7 Expiration Date: l 0 Cb' fob Site Address: qCity/State/Zip: 1V A(Jo✓{/' A. Attach a copy of the wo kers' ompensation 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 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. I do hereby certify under the pains and penalties ofperjury that the information provided above is true and correct. Signature: Date: C. —/ Phone#• 61:2 Official use only. Do not write in this area,to be completed by city of-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#: Mar 2416 04:12p p'2 DATE(MAlIDDfYYYV) '.. CERTIFICATE OF LIABILITY INSURANCE 03/24/2016 R NEGATIVELY AMEND, EXTEND OR AL EN OTHEAGISSUINGOR DED THIS CERTIFICATE 15 ISSUENSURER(S),THAUTHORIZED D AS A MATTOER OF INFORMATION ONLY AND CONFERS NO COTER TRIGHTS UPON THE CERTIFICABY TE HOLDER. THIS CERTIFICATE DOES NOT AFFIRMATIVELY BELOW. THIS CERTIFICATE OF INSURANCE DOES NOT CONSTITUTE A CONTRACT HE to REPRESENTATIVE OR PRODUCER,AND THE CERTIFICATE HOLDER. he IMPORTANT: IF the certificate holder Is an certain policiesmaySequ a ane endorolicsement,nAsstatemenendorsed. on thist certiBcaOteAdoOs not on{ferDrights)t t the the terms and Conditions of the policy, certificate holder in lieu of such endorsement(s). NAn1E. FAX 61 7) 325 - 78 92 PRODUCER PHONE (61,']) 325 - 8952 _ I INCTHE INSURANCE STORE (A1C,No,Ext):. E-MAIL ADDRESS: NAIGP '. 106 SPRING STREET - INSURER(S)AFFORDING COVERAGE _jN-�-- WEST RORBURX, DIA 02132 wsuREaA:WESTERN WORLD INSURA1iCE COMPAN I —�— INSURER 0:TRAV>LERS CO2�IIdERCIAZ AUTO — ---�'— INSURED INSURER C; PORTANOVA ROOFING INC INSURER D: 50 Elm Street - INSURER E: _ _ ... ... ... .- _ CobaS5et Ma. 02025 INSURER r: REVISION NUMBER: COVERAGES CER7(FICATE NUMBER: ICY THIS VdTH RESPECT TO VIHICH —TRIS IS TO CERTIFY THA1 7: T THE POLICIES OF INSURANCE USTED BELOW ''SAVE BEEN ISSUED TO THE INSURED cRE NEOiSA SUB,:EESPECCIT H TO ALL '01 E TERMS, INDICATED. NOTWITMAY BETANDI.NG ANYOR MAYOUPERTAIN. THE`(INSURANCEOR DIAFON OF AN FORDED BY T)E CONTRACT'POLICIES DES OTHER IBEC DOCUM EXCLUSIONS AND CONDITIONS OF SUCH PCLICISSUED '.ES.LIMITS ShOVVN M,AY HAVE BEEN REDUCED BY PAID CLAIMS. POucr I uruTS POLICY NUMBER @II,VDOIYYYY) (N'rNOD7YYYY) 3 1,000'000 I SR TYPE OF INSURANCE INSR WVD 'EACHOCCURRENCE LTR _ -p, AGETd�ENTc GERERALLIASILITY 5 100 r000 I PREIAISES(Ea oec�meneel - - _ I i $ 5,000 co1AMERCIALGENERALU,ABILITY INPP8189354 11/04/15 11/04/16 !-0EDEXP(AnyonaPelson; 1,000,000 g CLAIIdS-MADE I R I OCCUR I ?ERSOhAL 8 ADV INJURY _5_ .. _ .- -r - 2,000,000 j GENERAL AGGREGATE I $ _ - - ------- `PRODUCTS-COMPfOP AGG 5 2,000,000 GENL.AGGREGATE LIMIT APPLIES PER: S 000 000 PRO- LOC AUTOMOBILE LIABILITY 1 r� POLICV JECT (Ea accident) II I •,BODILY INJURY iAer oersol) S _ ANY AUTO l BODILY INJURY accldeM) S SCHEDULED 'BA2D290560 1 PROEERTYDA—A•A—G $ 100,000 b AUTOS�D -AUTOS I (pel accident)_ NO.N-OWNED S X HIRED f.UTOS X AUTOS EACH OCCURRENCE UMBRELLALfAB -- -- OCCUR AGGREGATE -- EXCESS L[AS CLAIMS-IAADE $ �J ]EO -- RETENTION >--_-" W S AI'J• - O H' TORY LIMITS � ER WORKERS COMPENSATION AND EIAPLOYERS'LIABILM Y JN E.L.EACH ACCIDENT S ANY=RCPRIETOR,PARTNERJEXECUTIVE �T 11 rA I E.L DISEASE•EA FKIPLOYEE F OFFICERIMEMaER EXCLUDED' IL_7I '.. (Mandatory in NH) :EL DISEASE-POLCY LIMT If yes,descliba mfer DESCRIPTION OF OPERATIONS below I i DESCRIPTION OF OPERATIONS r LOCATIONS rVEHIcLES(Attach ACORD 101,Additional Remarks Schedule,Il nofe space es required: ROOFING & CARPENTRY: PROPERTY 45, 47, 39 HIGH ST NORTH ANDOVER MA 01845 CERTIFICATE HOLDER CANCELLATION TORN OE' ANDOVER BUILDING DEPARTMENT JOE BROWN SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE 1600 OSGOOD ST THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN ACCORDANCE WITH THE POLICY PROVISIONS. NORTH ANDOVER 13A 01845 AUTHORIZED REPRESENTATIVE 1988-2010 ACORD CORPORATION. All rights reserved. ACORD 25(2010105) The ACORD name and logo are registered marks of ACORD r ATE(MM/DD/YYYY) few CERTIFICATE OF LIABILITY INSURANCE 03124/2016 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(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 CONTANAME;CT Ann Gallagher THE INSURANCE STORE INC. A/C,N Ext); (617)325 8952 FM(AIC, aooRlEss: ainsur@aol.com 106 SPRING ST. INSURERS I AFFORDING COVERAGE NAIC it WEST ROXBURY MA 02132 INSURERA: TRAVELERS INDEMNITY GOOF AMERICA(THE) I 25666 INSURED INSURER B: PORTANOVA ROOFING INC INSURER C; INSURER D 50 ELM COURT INSURER E; _ COHASSET MA 02025 INSURER F: COVERAGES CERTIFICATE NUMBER; 39650 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 UBR- POLICYEFF POLICY EXP LTR TYPE OF INSURANCE INSD WVD: POLICY NUMBER MMIDDIYYYY MM/DD/YYYY LIMITS COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE S DAMAGE ICLAIMS-MADE FIOCCUR PREM SESO'Ea occurreRENTEDnce) nce) $ i MED=XP(Anyone Gerson) $ WA PERSONAL BADV INJURY S GENLAGGREGATE LINtn"APPLIES PER: GENERALAGG:REGATE s PRO- L:1 POLICY ElJECT D LOC PRODUCTS-COMP!OPAGG $ OTHER: I $ AUTOntOBILE LIABILITY COMBINED SINGLE LIMIT S Ea accidenll ANY AUTO BODILY INJURY;Per person 5 AL_OWNED SCHEDULED N/A BODILY INJURY;Peraccident) 5 AUTOS AUTOS -- NON-OWNED !Peru R7Y DAPAAGE HIRED AUTOS AUTOS I UMBRELLA/.IAB OCCUR EACH OCCURRENCE 3 EXCESS LIAR CLAIMS-NiADE. WA AGGREGATE $ DED RETENTION S Ii $ �/ PER OTW- iWORKERSCOrAPENSATION X STA—UTE ER i AND EMPLOYERS'LIABILITY ' ANYPROPRIETOR/PARTNERIEXECUTIVE Y/N E,L.EACH ACCICENT $ 500,000 A OFF ICER/MEMSEREXCLUDED? NIA NIA NIA 6HUB8D80784115 10126/2015 10/26/2016 (Mandatory In NH) E.L.DISEASE-EA EMPLOYEE $ 500,000 0 yes,describe under OESGRIP.ION OF OPERATIONS below I E.L D'SEASE-POLICY LIMI7 S 500,000 I i i I NIA DESCRIPTION OF OPERATIONS l LOCATIONS I VEHICLES (ACORD 101,Additional Remarks Schedule,maybe attached if more space is required) '.. Workers'Compensation benefits will be paid to Massachusetts employees only. Pursuant to Endorsement INC 20 03 06 B,no authorization is given to pay claims for benefits to employees in states other than Massachusetts if the insured hires,or has hired those employees outside of Massachusetts. This certificate of Insurance shows the policy in force on the date that this certificate was issuer(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.mass.govilwdhvorkers-compensation/investigations/. CERTIFICATE HOLDER CANCELLATION SHOULD ANY OF THE ABOVE DESCRIBED POLICIES BE CANCELLED BEFORE THE EXPIRATION DATE THEREOF, NOTICE WILL BE DELIVERED IN TOWN OF ANDOVER BUILDLING DEPT ACCORDANCE WITH THE POLICY PROVISIONS. 1600 OSGOOD ST AUTHORIZED REPRESENTATIVE ANDOVER MA 01845 Daniel M.Crowley,CPCU,Vice President—Residual Market—WCRIBMA ©'1988-2014 ACORD CORPORATION. All rights reser ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD dZl X091 VZ �•dJ ' W M" e5-1074 , YA 148 AT&OT ST A 1` • :' , rF i Dorchester MA '0 122 09/21/2617. ctTxe. (lnzozzarzcricafl>i oC �rrttrzc�r��c//t I office of Consumer Affairs&Business Regulation i ME IMPROVEMENT CONTRACTOR egistration:, 178521 Type: xpira " n: 4/23/2016 Private Corporatio;,, PORTANOVA ROOFING ItJC. ee KENNETH PORTANOVA 148 MINOT STREET gam_ DORCHESTER,MA 02122 Undersecretary �i