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HomeMy WebLinkAboutBuilding Permit # 4/15/2016 t%0RTf1 8 BUILDING PERMIT C, TOWN OF NORTH AND 1 0 APPLICATION FOR PLAN EXAMINATION V Permit NO: 77 Date Receiveda. Avg. Date Issued: CHUS IMPORTANT:Applicant must coj-,�pfete all items on this page LOCATION Print PROPERTY OWNER Print MAP NO: PARCEL: ZONING DISTRICT: Historic District yes no Machine Shop Village yes no TYPE OF IMPROVEMENT PROPOSED USE Reodential Non- Residential 17 New Building I One family 1-1 Addition 1-1 Two or more family 11 Industrial [,-]AI ration No. of units: I Commercial 1- epair, replacement J Assessory Bldg Others: 1-1 Demolition [:] Other Cl Septic 11 Well 1-1 Floodplain 0 Wetlands El Watershed District Li Water/Sewer < Y, 1`7 aq U/1 Identification Please Type or Print Clearly) OWNER: Name: Phone: Address: "2 CONTRACTOR Name,"—, Phone: es, Address: 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 BASED ON$125.00 PER S.F. Total Project Cost: $ FEE: $ Check No.: Receipt No.. NOTE: Persons contracting g istered contractors do not have access-to the guar fiend Signature of Agent/Owner /Signature of contractor t%°RTH Town of Andover ® C!O �rKa vel' `Ctssy / //y �Q coc"Ic«tw�c« y1' �®AD�ATED Jkr S V BOWL BOARD OF HEALTH Food/Kitchen PERMIT I L�! Septic System �f sCea i T r iN _ BUILDING INSPECTOR THISCERTIFIES THAT ............................ ............................................................................................. .................. Foundation has permission to erect .......................... buildings on ...............���//.���."....................................... 7 •. Rough to be occupied as .........................` �^. ....12C�.............................................................................. 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 Rough VIOLATION of the Zoning or Building Regulations Voids this Permit: Final PERMIT EXPIRES IN 6 MONTHS ELECTRICAL INSPECTOR CONSTRUCTIONUNLESS STARTS Rough j Service .................... ... . ........................................ Final 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 Approvedy the Building Inspector. Burner Street No. Smoke Det. RA CARLO ROOFING .CO Home Improvement Lic. 106052 Construction Lic. 0020350 R.A.Carlo COmpamy Vinyl Siding*Roofing*Windows 65 Dunster Road Bedford, Massachusetts 01730 Phone (781) 275-7310 Fax (781) 275-9775 Proposal Submitted To://Name MR JAMES SAAIFRANK 10/10/15 JAddress 439 WINTE ST NORTH . OVER MA 01845 Whone 603-365-8559 78-557-54. .6 , L�tit0 '��5a v �� Contact We hereby submit specifications and estimates for: ti Strip existing roof Install TITANIUM UNDERLAYMENT Install new metal dripedge. Install new ventcollar flashing and new flashing in chimney. j INSTALL RIDGEVENT ALONG PEAK'OF ROOF Install ice and water shield along roof edges and in all valleys.6' Apply newCertainteed LANDMARK LIMITED LIFETIME asphalt fiberglass self- sealing shingles to all roofing areas Cover house with tarps Clean and truck all debris away. Any rotted wood to be replaced at$3.75 a ft. INSTALL 1/2" INSULATION BOARD INSTALL NEW RUBBER ROOF RA CARLO BETTER BUSINESS BUREAU ACCREDITED A+RATING LIMITED LIFE TIME Guarantee for Materials add 15 Year Guarantee for Labor We propose hereby to furnish material and labor, complete in aco� a e with above specifications, for the sum of_$ 14,500.00 .Authorized Signature Note: This proposal may be withdrawn by us if not accepted within da . Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. 1/3 at start of job balance upon completion Start Date Completion Date Customer and RA Carlo will determine start date at signing of contract. PLEASE COVER STORED THINGS IN ATTIC SOME DEBRIS MAY FALL IN RA CARLCARLO ROOFING .COM Home Improvement Lic. 106052 .Construction Lic. Cs02O350 Vinyl Siding*Roofing*Windows 65 Dunster Road Bedford, Massachusetts 01730 Phone (781) 275-7310 Fax (781) 275-9775 Proposal Submitted To://Name MR J MES SAAIFRANK 10/10/15 Address 439 WINTER ST NORTFI A OIER M%014 z Phone 603-365-8559 978-557-547 f, � on act We hereby submit specifications and estimates for: Strip existing roof Install TITANIUM UNDERLAYMENT Install new metal dripedge. Install new ventcollar flashing and new flashing in chimney. INSTALL RIDGEVENT ALONG PEAK OF ROOF Install ice and water shield along roof edges and in all valleys.6' Apply newCertainteed LANDMARK LIMITED LIFETIME.asphalt fiberglass self- sealing shingles to all roofing areas Cover house with tarps Clean and truck all debris away. Any rotted wood to be replaced at$3.75 a ft. INSTALL 1/2" INSULATION BOARD INSTALL NEW RUBBER ROOF RA CARLO BETTER BUSINESS BUREAU ACCREDITED A+RATING LIMITED LIFE TIME Guarantee for Materials add 15 Year Guarantee for Labor We propose hereby to furnish material and labor, comp et�iine c wn o e specifications, for the sum of_$ 14,500.00 .Authorized Signature Note: This proposal maybe withdrawn by us if not accepted within days. Acceptance of Proposal: The above prices, specifications and conditions are satisfactory a are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. 1/3 at start of job balance upon completion Start Dat" Completion Date \ Customer and RA Carlo wil rmine start date at signing of contract. PLEASE COVER STORED THINGS IN ATTIC SOME DEBRIS MAY FALL IN �� Art 1 RA CARLO ROOFING .COM Home Improvement Lic. 106052 Construction Lie. 0020350 R.A.Carlo CD Vinyl Siding*Roofing*Windows 65 Dunster Road Bedford, Massachusetts 01730 Phone (781) 275-7310 Fax (781) 275-9775 Proposal Submitted To://Name MR JAMES SAAlFRANK 10/10/15 Address 439WINTER STNORT H)NDOVERMA01845 )��"�hone 603-365-8559�78-557-54 LvAoi Contact We hereby submit specifications and estimates for: Strip existing roof Install TITANIUM UNDERLAYMENT Install new metal dripedge. Install new ventcollar flashing and new flashing in chimney. INSTALL RIDGEVENT ALONG PEAK OF ROOF Install ice and water shield along roof edges and in all valleys.6' Apply newCertainteed LANDMARK LIMITED LIFETIME asphalt fiberglass self- sealing shingles to all roofing areas Cover house with tarps Clean and truck all debris away. Any rotted wood to be replaced at$3.75 a ft. INSTALL 1/2" INSULATION BOARD INSTALL NEW RUBBER ROOF RA CARLO BETTER BUSINESS BUREAU ACCREDITED A+RATING LIMITED LIFE TIME Guarantee for Materials add 15 Year Guarantee for Labor We propose hereby to furnish material and labor, complete in ac�-Ja specifications, for the sum of—$ 14,500.00 Authorized Signature , . '�e with above Note: This proposal may be withdrawn by us if not accepted within da . Acceptance of Proposal: The above prices, specifications and conditions are satisfactory and are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. 1/3 at start of job balance upon completion Start Date Completion Date Customer and RA Carlo will determine start date at signing of contract. PLEASE COVER STORED THINGS IN ATTIC SOME DEBRIS MAY FALL IN ')c RA CA RLO ROOFING .COM Home Improvement Lie. 106052 Construction Lie. Cs02O350— R.A.Carlo CompAny Vinyl Siding*Roofing*Windows 65 Dunster Road Bedford, Massachusetts 01730 Phone (781) 275-7310 Fax (781) 275-9775 Proposal Submitted To://Name MR JMESSAAIFRANKIO/10/15 Address 439 WINTER ST NORTH AN OVER M 01 45 Phone 603-365-8559 978-557-547 anact We hereby submit specifications and estimates Strip existing roof Install TITANIUM UNDERLAYMENT Install new metal dripedge. Install new ventcollar flashing and new flashing in chimney. INSTALL RIDGEVENT ALONG PEAK OF ROOF Install ice and water shield along roof edges and in all valleys.6' Apply newCertainteed LANDMARK LIMITED LIFETIME asphalt fiberglass self- sealing shingles to all roofing areas Cover house with tarps Clean and truck all debris away. Any rotted wood to be replaced at$3.75 a ft. INSTALL 1/2" INSULATION BOARD INSTALL NEW RUBBER ROOF RA CARLO BETTER BUSINESS BUREAU ACCREDITED A+RATING LIMITED LIFE TIME Guarantee for Materials add 15 Year Guarantee for Labor We propose hereby to furnish material and labor, comp Vetti'n c rd c w o e s. specifications, for the sum of 14,500.00 Authorized Signature Ll Note: This proposal may be withdrawn by us if not accepted within days. Acceptance of Proposal: The above prices, specifications and connditioks are satisfactory a d are hereby accepted. You are authorized to do the work as specified. Payment will be made as outlined above. 1/3 at start of job balance upon completion Start Dat&---M)'--t,1 Completion Datcl-\->�—\"� Customer and RA Carlo will da&imine start date at signing of contract. PLEASE COVER STORED THINGS IN ATTIC SOME DEBRIS MAY FALL IN The Commonwealth of Massachusetts Department ofIndustrialAccidents I Congress Street,Suite 100 Boston,MA 02114-2017 wtviv.mass.govIdia Workers'compensation insurance Affidavit:Builders/Contractors/Electricians/Plumbers. TO BE FILED WITH THE PERMITTING AUTHORITY. Please Print Legi licant Information bl Name (Business/Organization/Individual): Address:— 6)S I 21� City/State/Zip Phone#. b Are you an employer?Check the appropriate box: Type of project(required): 1,[31-am a employer with employees(full and/or part-time).* 7. El New construction 2.[J 1 am a sole proprietor or partnership and have no employees working for me in 8. n Remodeling any capacity.[No workers'comp.insurance required.] 9. El Demolition 3.FJ I am a homeowner doing all work inysclE[No workers'comp.insurance required.]t 10❑Building addition 4.n I am a homeowner and will be hiring contractors to conduct all work on my property. I will11. Electrical repairs or additions ensure that all contractors either have workers'compensation insurance or are sole 12. Plumbing repairs or additions proprietors with no employees. 5fl I am a general contractor and I have hired the sub-contractors listed on the attached sheet. 13.E]Roof repairs These sub-contractors have employees and have workers'comp.insuranceJ 14.[:]Other 6.Q We are a corporation and its officers have exercised their right ofexemption per MGL c. 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. t Homeowners who submit this affidavit indicating they are doing all work and then hire outside contractors must submit a now 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 workers'comp.policy number. I ant all employer that is providing 1volIfels'compensation insurance fol•my employees. Below is tilepolicy andjob site o ill rniati011. f Insurance Company Name: io il, �G-p 7 1 73(�V�2 Expiration Date: Policy#or Self-ins.Lie,It: P; 2 city/State/Zip:_ Job Site Address, ation date). Attach a copy of the workers' compensation policy declaration page(showing the policy nudpir Failure to secure coverage as required tinder MOL c. 152,§25A is a criminal violation punishable by a fine up to$1,500.00 and/or one-year iluprisollment,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. iprovided above is trove and Correct I do hereby cer el-thepains and penalties ofpellUPY that the illftil'lltatiOl Si nature: ate: ft Phone# ` Official use only. Do not write ill this area,to be completed by city ol'tolvil Official City or Town: Permit/License 7M Issuing Authority(circle one): 1.Board of Health 2.Building Department 3.City/Town Clerk 4.Electrical inspector 5.Plumbing Inspector Board 6.Other Contact Person: s Phone M Contact Person: �����® DATE(MWDD/YYYY) CERTIFICATE OF LIABILITY INSURANCE 04/14/2016 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 CONTACT NAME: annie lukas T. EDMUND GARRITY&CO., INC. A/CNN Ext: (617)354-4640 F,nc No: E-MAIL ADDRESS: annie@garrity-insurance.com InSurance.Com 545 CONCORD AVENUE INSURER(S)AFFORDING COVERAGE NAIC# CAMBRIDGE MA 02138 INSURERA: TRAVELERS INDEMNITY CO OF AMERICA(THE) 25666 INSURED INSURER B: RA CARLO INC INSURERC: INSURER D: 65 DUNSTER RD INSURER E: BEDFORD MA 01730 INSURER F: COVERAGES CERTIFICATE NUMBER: 44929 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 TYPE OF INSURANCE ADDL SUER POLICY NUMBER MWDD EFF MW LICDY EXEXP LIMITS LTRWMD COMMERCIAL GENERAL LIABILITY EACH OCCURRENCE $ DAMAGE CLAIMS-MADE D OCCUR PREMISESa occurrence) $ MED EXP(Any one person) $ N/A PERSONAL&ADV INJURY $ GEN'L AGGREGATE LIMITAPPLIES PER: GENERAL AGGREGATE $ POLICY F]JEPRCT O ❑LOC PRODUCTS-COMP/OP AGG $ '.. OTHER: $ AUTOMOBILE LIABILITY COMBINED SINGLE LIMIT $ Ea accident ANY AUTO BODILY INJURY(Per person) $ ALL OWNED SCHEDULED AUTOOr AUTOS N/A BODILY INJURY(Per accident) $ NON-OWNED PROPERTY DAMAGE $ HIRED AUTOS AUTOS Per acadenI '... UMBRELLA LIAB OCCUR EACH OCCURRENCE $ EXCESS LIAB CLAIMS-MADE N/A AGGREGATE $ DED I I RETENTION$ $ WORKERS COMPENSATION X STATUTE ER AND EMPLOYERS'LIABILITY OTH ANYPROPRIETOR/PARTNER/EXECUTIVE Y/N E.L.EACH ACCIDENT $ 100,000 A OFFICERIMEMBEREXCLUDED? N/A N/A N/A 6HUB2E92734915 10/27/2015 10/27/2016 (Mandatory in NH) E.L.DISEASE-EA EMPLOYEE $ 100,000 If yes,describe under DESCRIPTION OF OPERATIONS below E.L.DISEASE-POLICY LIMIT $ 500,000 N/A DESCRIPTION OF OPERATIONS/LOCATIONS/VEHICLES(ACORD 101,Additional Remarks Schedule,may be attached if more space is required) Workers'Compensation benefits will be paid to Massachusetts employees only.Pursuant to Endorsement WC 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 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.mass.gov/iwd/workers-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 N Andover ACCORDANCE WITH THE POLICY PROVISIONS. 384 Osgood St AUTHORIZED RE/PRESENTATIVE North Andover MA 01845 L Daniel M.CroWley,CPCU,Vice President—Residual Market—WCRIBMA ©1988-2014 ACORD CORPORATION. All rights reserved. ACORD 25(2014101) The ACORD name and logo are registered marks of ACORD Massachusetts -Department of Public Safety Board of Building Regulations and Standards Cbnatruction SupM-isor License: CS-020350 ROBERT A CARO 65 DUNSTER RD, Bedford MA 01730 Expiration Commissioner 04/12/2016 jliI office of i7ousumer a`tairs&Business�egeiiation. - _ +1FtOME 1MPROVEMEDIT CONTRACTOR Type: CjRegistration: 106052 DBA Expiration: ?x21;2016 R.A.CARLO CO Robert Carlo cz 7unster,Road ^.:d.kln 01730 Un i ��